CHIEF COMPLAINT: Respiratory distress, cardiac arrest

PRESENT ILLNESS: Ms. [**Known lastname 79692**] is a 73yo woman with h/o DM2, CHF, and HTN who
presented to [**Hospital3 **]w/ respiratory distress with
subsequent asystolic cardiac arrest.
.
Per EMS records, she was having difficulty breathing this
morning at midnight, about 1 hour after she had gone to bed. She
woke up her daughter stating she couldn't breath. Per daughter,
she has had a dry cough and has had worsening DOE. When EMS
arrived, she was able to speak/answer questions but was in
respiratory distress. Her vitals were BP 142/100 HR 140 RR 24
02sat <60 on RA.
.
On transport, the patient became unresponsive in the ambulance 2
min prior to arrival to the OSH. At the OSH her VS were T 98.1
BP 144/48 HR 30 RR 2 02sat 50% on NRB. The decision was made for
emergent intubation. At this time, she went into asystolic
arrest. CPR was initiated and atropine/epi were administered
with return of pulse (her total arrest time was 1-2 min
according to her daughter). She was intubated and set to Fi02
100% AC 600/15 with (ABG 7.26/36/88). A femoral line was placed.
A CXR was read as bilateral fluffy infiltrates c/w volume
overload vs ARDS. She was given vanc/zosyn. She became
hypotensive to SBP of 70's and was started on a dopamine gtt.
Soon after she went into a wide complex tachycardia; dopamine
was stopped and she was started on an amio gtt (w/ 150mg bolus)
with conversion back to sinus bradycardia. Pressor was changed
to levophed. She was given ASA 300mg and transferred to [**Hospital1 18**].
.
In the [**Hospital1 18**] ED, initial VS were: T 96.5 BP 93/23 HR 93 RR 17 02
sat 100% on vent. The levophed gtt was uptitrated [**3-16**] to
hypotension. She was given atropine 0.5mg for HR "in the 50's"
and amiodarone was stopped because of bradycardia. A RIJ was
placed under sterile conditions. She was given levaquin x1.
Cardiology was consulted and a bedside echo was done. Her CVP
was 16 and SV02 was 80. Labs were significant for a WBC 31.3,
lactate 2.5, proBNP 1065, trop T 0.06, and negative UA.
.
She was initially admitted to the MICU, where she was continued
on levophed. She had an episode of hyperkalemia that was treated
with calcium and dextrose. She received 20mg of IV lasix with
300cc Uop over the next few hours. Insulin gtt was started for
improved glucose control.
.
Further review of systems not possible at this time.

MEDICAL HISTORY: Chronic systolic heart failure (LVEF of 40% from [**6-20**] echo)
DM (non-compliant w/ meds)
HTN
recent D&C 3 weeks ago for uterine polyp (not malignant)
recent hospitalization for SOB (in [**State 4260**]), intubation not
required
.
Cardiac Risk Factors: (+)Diabetes, (?)Dyslipidemia,
(+)Hypertension
.
Cardiac History: CABG: none
.
Percutaneous coronary intervention: none
.
Pacemaker/ICD: none

MEDICATION ON ADMISSION: Glucophage 500 [**Hospital1 **]
Glyburide 7.5 [**Hospital1 **]
Lantus 50 units QHS
Lasix 40mg daily
Toprol XL 25mg daily
Lisinopril 2.5mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm=Tc 99.0, BP 113/43, HR 74, RR 27, O2 99% on AC 0.40
500/18 +10
Gen: Elderly woman, intubated and sedated. Withdraws from
painful stimuli but not responsive to voice.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple; JVP not visible though patient has thick neck.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2, somewhat faint heart sounds. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis.
Breathing comfortably with vent. Crackles L>R bases. No wheeze.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP
Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives independently in [**State 4260**]. No tobacco, minimal alcohol.
Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Leukocytosis, unspecified,Iron deficiency anemia, unspecified,Acute on chronic combined systolic and diastolic heart failure,Acute kidney failure, unspecified,Blood in stool,Acute respiratory failure,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Abdominal pain, other specified site,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other iatrogenic hypotension
Abn react-procedure NEC,Accid in resident instit,Leukocytosis NOS,Iron defic anemia NOS,Ac/chr syst/dia hrt fail,Acute kidney failure NOS,Blood in stool,Acute respiratry failure,Parox ventric tachycard,Crnry athrscl natve vssl,Hypertension NOS,Abdmnal pain oth spcf st,DMII wo cmp nt st uncntr,Iatrogenc hypotnsion NEC
Admission Date:  [**2126-8-27**]              Discharge Date:   [**2126-9-2**]

Date of Birth:  [**2053-7-20**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Respiratory distress, cardiac arrest

Major Surgical or Invasive Procedure:
Cardiac catheterization with drug-eluting stent


History of Present Illness:
Ms. [**Known lastname 79692**] is a 73yo woman with h/o DM2, CHF, and HTN who
presented to [**Hospital3 **]w/ respiratory distress with
subsequent asystolic cardiac arrest.
.
Per EMS records, she was having difficulty breathing this
morning at midnight, about 1 hour after she had gone to bed. She
woke up her daughter stating she couldn't breath. Per daughter,
she has had a dry cough and has had worsening DOE. When EMS
arrived, she was able to speak/answer questions but was in
respiratory distress. Her vitals were BP 142/100 HR 140 RR 24
02sat <60 on RA.
.
On transport, the patient became unresponsive in the ambulance 2
min prior to arrival to the OSH. At the OSH her VS were T 98.1
BP 144/48 HR 30 RR 2 02sat 50% on NRB. The decision was made for
emergent intubation. At this time, she went into asystolic
arrest. CPR was initiated and atropine/epi were administered
with return of pulse (her total arrest time was 1-2 min
according to her daughter). She was intubated and set to Fi02
100% AC 600/15 with (ABG 7.26/36/88). A femoral line was placed.
A CXR was read as bilateral fluffy infiltrates c/w volume
overload vs ARDS. She was given vanc/zosyn. She became
hypotensive to SBP of 70's and was started on a dopamine gtt.
Soon after she went into a wide complex tachycardia; dopamine
was stopped and she was started on an amio gtt (w/ 150mg bolus)
with conversion back to sinus bradycardia. Pressor was changed
to levophed. She was given ASA 300mg and transferred to [**Hospital1 18**].
.
In the [**Hospital1 18**] ED, initial VS were: T 96.5 BP 93/23 HR 93 RR 17 02
sat 100% on vent. The levophed gtt was uptitrated [**3-16**] to
hypotension. She was given atropine 0.5mg for HR "in the 50's"
and amiodarone was stopped because of bradycardia. A RIJ was
placed under sterile conditions. She was given levaquin x1.
Cardiology was consulted and a bedside echo was done. Her CVP
was 16 and SV02 was 80. Labs were significant for a WBC 31.3,
lactate 2.5, proBNP 1065, trop T 0.06, and negative UA.
.
She was initially admitted to the MICU, where she was continued
on levophed. She had an episode of hyperkalemia that was treated
with calcium and dextrose. She received 20mg of IV lasix with
300cc Uop over the next few hours. Insulin gtt was started for
improved glucose control.
.
Further review of systems not possible at this time.

Past Medical History:
Chronic systolic heart failure (LVEF of 40% from [**6-20**] echo)
DM (non-compliant w/ meds)
HTN
recent D&C 3 weeks ago for uterine polyp (not malignant)
recent hospitalization for SOB (in [**State 4260**]), intubation not
required
.
Cardiac Risk Factors: (+)Diabetes, (?)Dyslipidemia,
(+)Hypertension
.
Cardiac History: CABG: none
.
Percutaneous coronary intervention: none
.
Pacemaker/ICD: none

Social History:
Lives independently in [**State 4260**]. No tobacco, minimal alcohol.

Family History:
Non-contributory

Physical Exam:
VS: Tm=Tc 99.0, BP 113/43, HR 74, RR 27, O2 99% on AC 0.40
500/18 +10
Gen: Elderly woman, intubated and sedated. Withdraws from
painful stimuli but not responsive to voice.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple; JVP not visible though patient has thick neck.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2, somewhat faint heart sounds. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis.
Breathing comfortably with vent. Crackles L>R bases. No wheeze.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP
Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP

Pertinent Results:
[**2126-8-27**] 05:20AM BLOOD WBC-31.3* RBC-4.29 Hgb-13.1 Hct-38.7
MCV-90 MCH-30.6 MCHC-33.8 RDW-13.4 Plt Ct-508*
[**2126-8-27**] 05:20AM BLOOD Neuts-92.9* Lymphs-4.2* Monos-2.6 Eos-0.2
Baso-0.1
[**2126-8-27**] 05:20AM BLOOD Glucose-399* UreaN-17 Creat-1.0 Na-136
K-5.3* Cl-105 HCO3-20* AnGap-16
[**2126-8-27**] 05:20AM BLOOD Calcium-8.2* Phos-4.1 Mg-1.6
[**2126-8-27**] 12:24PM BLOOD ALT-67* AST-38 LD(LDH)-255* AlkPhos-78
Amylase-221* TotBili-1.0

[**2126-8-27**] 05:20AM BLOOD CK(CPK)-208*
[**2126-8-27**] 12:24PM BLOOD CK(CPK)-179*
[**2126-8-27**] 09:38PM BLOOD CK(CPK)-282*
[**2126-8-28**] 05:03AM BLOOD CK(CPK)-290*
[**2126-8-28**] 09:42PM BLOOD CK(CPK)-381*
[**2126-8-29**] 04:14AM BLOOD CK(CPK)-381*
[**2126-8-29**] 01:56PM BLOOD CK(CPK)-361*

[**2126-8-27**] 05:20AM BLOOD CK-MB-10 cTropnT-0.06* MB Indx-4.8
proBNP-1065*
[**2126-8-27**] 12:24PM BLOOD CK-MB-9 cTropnT-0.08*
[**2126-8-27**] 09:38PM BLOOD CK-MB-7 cTropnT-0.05*
[**2126-8-28**] 05:03AM BLOOD CK-MB-5 cTropnT-0.06*
[**2126-8-28**] 09:42PM BLOOD CK-MB-5
[**2126-8-29**] 04:14AM BLOOD CK-MB-4 cTropnT-0.05*
[**2126-8-29**] 01:56PM BLOOD CK-MB-4 cTropnT-0.04*

[**2126-9-1**] 06:40AM BLOOD WBC-12.9* RBC-3.21* Hgb-9.9* Hct-28.6*
MCV-89 MCH-31.0 MCHC-34.8 RDW-13.7 Plt Ct-399
[**2126-9-1**] 05:25PM BLOOD Glucose-254* UreaN-16 Creat-1.0 Na-139
K-4.4 Cl-100 HCO3-27 AnGap-16
[**2126-9-1**] 05:25PM BLOOD Calcium-9.2 Phos-4.1 Mg-2.1

[**2126-8-27**] CXR
1. Ill-defined bilateral perihilar consolidations, differential
includes ARDS and multifocal pneumonia. Acute cardiogenic
pulmonary edema is possible, although the cardiac silhouette is
not particularly enlarged, and clinical history is not entirely
consistent with pulmonary edema.
2. 8-mm right lower lobe nodule is relatively [**Name2 (NI) 15410**], most
probably
representing a granuloma. When the patient is clinically able,
CT could be
performed to confirm this suspicion.

[**2126-6-27**] EKG
00:42 NSR with RBBB and TWI in inferior leads.
02:58 Regular WCT at 154 with LBBB pattern, BP 110/40
03:05 Sinus brady at 56 with TWI in inferior leads and deep TWI
in V1-V6, ? STD in V3-V6.
05:03 NSR with LAD and LBBB.
07:17 ? AFlutter (no p waves visible but regular rate at 63)
14:00 LBBB at 64, irreg irreg.

[**2126-8-27**] 2D-ECHOCARDIOGRAM
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is mild to moderate regional left ventricular
systolic dysfunction with septal and apical hypokinesis.  LVEF
40%.  Right ventricular chamber size and free wall motion are
normal. The aortic valve leaflets (3) are mildly thickened.
There is mild aortic valve stenosis (area 1.2-1.9cm2). The
mitral valve leaflets are mildly thickened. Moderate (2+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. There is mild pulmonary artery systolic hypertension.
There is a small pericardial effusion. There are no
echocardiographic signs of tamponade.

[**2126-8-28**] CARDIAC CATH
1. Selective coronary angiography of this left dominant system
revealed
single vessel coronary artery disease. The LMCA was without
angiographically apparent stenosis. The LAD revealed a mid 80%
lesion after the second marginal. The Lcx and RCA and no
angiographically apparent stenoses.
2. Resting Hemodynamics revealed elevated right and left sided
filling pressures with a RVEDP of 15 mmHg and a PCWP of 19. PASP
was mildly elevated at 40 mmHg. Systemic arterial pressures were
normal on levophed. Cardiac index was preserved at 3.2L/min/m2.
3. Left Ventriculography was deferred.
4. Successful PTCA/stent to mid LAD with a 2.5x13mm Cypher
stent. The second diagonal branch was compromised as a result
and there was rescued and dilated with a 2.0mm balloon finishing
with kissing balloon inflations in LAD and diagonal. Excellent
result with normal flow and no residual stenosis.
FINAL DIAGNOSIS:
1. Single vessel coronary artery disease.
2. Mild left ventricular diastolic dysfunction
3. Successful PTCA/stent to mid LAD with a drug eluting stent.

[**2126-8-28**] CXR
Still moderate pulmonary edema has markedly improved. ET tube,
NG tube and
right IJ catheter remain in place in standard positions. There
are small bilateral pleural effusions, greater on the left side.
Linear atelectases are in the bases bilaterally.

[**2126-8-30**] CXR
The patient was extubated in the meantime interval. The right
internal
jugular line tip terminates in mid distal SVC. The
cardiomediastinal
silhouette is stable. There is overall improvement in the left
retrocardiac
opacity consistent with partial resolution of atelectasis. The
right lower
lobe opacity is still present suggesting unresolved atelectasis
as well.
Minimal vascular engorgement is present in the perihilar area
but no evidence of frank pulmonary edema is seen.

[**2126-8-27**], [**2126-8-28**] BLOOD CULTURES: No growth

[**2126-8-28**] RESPIRATORY CULTURE (Final [**2126-8-30**]): RARE GROWTH
OROPHARYNGEAL FLORA. YEAST. RARE GROWTH.

[**2126-8-27**] Right groin CATHETER TIP-IV WOUND CULTURE (Final
[**2126-8-30**]): No significant growth.

[**2126-8-28**] R IJ CATHETER TIP-IV WOUND CULTURE (Final [**2126-9-2**]): No
significant growth.

[**2126-9-1**] CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final
[**2126-9-2**]): Feces negative for C.difficile toxin A & B by EIA.

Brief Hospital Course:
A/P 73 yo woman with h/o DM, systolic CHF with EF 40%, and HTN
who presented with respiratory distress requiring intubation
complicated by asystolic cardiac arrest and s/p cath with DES to
LAD.
.
# Acute on chronic systolic and diastolic heart failure: Recent
admission for CHF exacerbation.  At this admission, echo showed
moderate regional left ventricular systolic dysfunction with
septal and apical hypokinesis; LVEF 40%.  Lung exam and lower
extremity peripheral edema was consistent with fluid overload,
which improved with diuresis.  Pt was discharged in stable
condition on her home dose of Lasix.
.
# CAD: CPK were elevated to 381 with normal CPK; trop was mildly
elevated to 0.05.  Cardiac cath showed a small LAD with 80%
occlusion, and a drug-eluting stent was placed.  It was thought
that this lesion may have precipitated her cardiac arrest.  Pt
was medically maximized with ASA 325, plavix, high-dose statin,
beta blocker, and ACE-I.  Pt was discharged with cardiology
follow-up and may need to be considered for a pacemaker in the
future.
.
# Abdominal pain: Pt has a history of longstanding but stable
LLQ pain which had been worked up in past at OSH.  Her recent
colonoscopy was unremarkable, and she is s/p D+C with normal
findings per patient's report.  She had no acute abdomen on
exam.  Her LFTs were notable only for mild transaminitis, ALT >
AST which may be [**3-16**] to her acute cardiac event and decreased
forward flow.  She was noted to have guiac positive stools
during this admission but her HCT was stable.  She was restarted
on her home dose iron and received colace for constipation
prophylaxis, of note patient does not usually take colace.  She
subsequently developed diarrhea with an elevated WBC and
low-grade temp to 99.7 which was in the setting of recent
antibiotics but her stool was negative for C. diff.  The stool
softeners were held and the diarrhea resolved prior to
discharge. The patient was discharged with GI follow up.

# Leukocytosis:  The patient was empirically started on broad
coverage with vancomycin and zosyn as she was admitted in
respiratory failure requiring intubation and ventilation with a
WBC in the 30s.  She was worked up for an infectious pulmonary
process as she reportedly had thick yellow sputum prior to
admission and still had a lingering cough during hospital
course.  She may also have aspirated during her code.  However
sputum culture was negative.  In addition, all blood, urine, and
catheter tip (R groin, R IJ) cultures came back negative.  Her
c. diff was also negative.  The increased WBC was thought to be
secondary to demarginalization vs. iatrogenic (she is enrolled
in study in which she might be given hydrocortisone; note that
WBC was 21 at [**Location (un) **]).  The patient completed a 7-day abx
course prior to discharge.
.
# HTN: The patient was initially hypotensive at the OSH and was
started on dopamine then switched to levophed.  At [**Hospital1 18**],
levophed was increased initially but was eventually tapered off.
 Her blood pressure additionally improved after extubation.  She
was restarted on a beta blocker and an ACE I which were
uptitrated as tolerated for cardioprotection.
.
# Acute renal failure: The patient had acute renal failure with
a Cr of 1.5. The renal failure was likely secondary to decreased
forward flow in the setting of her cardiac arrest.  At discharge
her Cr was stable at 0.9 to 1. The patient was diuresed with low
doses of Lasix and also autodiuresed nicely later on during her
admission.  Lisinopril 5mg PO daily was started after resolution
of ARF.
.
# Wide Complex Tachycardia: The EKG at the OSH showed wide
complex tachycardia which was thought to be [**3-16**] to dopamine.
She was started on an amiodarone drip with conversion back to
sinus rhythm.  At [**Hospital1 18**], amiodarone was stopped due to
bradycardia.  Of note, the patient has LBBB at baseline so she
could have had sinus tachycardia with aberrance that was
misinterpreted as Vtach.
.
# DM: Glycemic control was maintained with Glargine 26 U and
Humalog SS.  Metformin was held in the setting of her ARF and
was not restarted prior to discharge. Her glyburide was held
during her hospitalization and she was discharged on her home
dose of glyburide with outpatient follow up for fingersticks.

Medications on Admission:
Glucophage 500 [**Hospital1 **]
Glyburide 7.5 [**Hospital1 **]
Lantus 50 units QHS
Lasix 40mg daily
Toprol XL 25mg daily
Lisinopril 2.5mg daily

Discharge Medications:
1. Glyburide 5 mg Tablet PO QPM
2. Glyburide 5 mg 1.5 Tablets PO QAM
3. Clopidogrel 75 mg One Tablet PO DAILY
4. Aspirin 325 mg One Tablet PO DAILY
5. Lisinopril 5 mg One Tablet PO DAILY 10AM
6. Lasix 40 mg One Tablet PO once a day.
7. Metoprolol Succinate 25 mg One Tablet PO once a day: start
5pm.
8. Ferrous Sulfate 325 mg (65 mg Iron) One Tablet PO once a day
9. Atorvastatin 80 mg One Tablet PO once a day.
10. Insulin Glargine 100 unit/mL Fifty (50) units Subcutaneous
at bedtime.
11. Omeprazole 40 mg Capsule One Capsule, Delayed Release(E.C.)
PO once a day.
12. Glucometer
Ascensia Contour test strips sig 1 bottle
Refills: one
13. Glucometer
Ascensia Glucometer
Sig: one
refills: none


Discharge Disposition:
Home With Service

Facility:
Excel [**Hospital6 407**]

Discharge Diagnosis:
Primary Diagnosis
-Acute systolic congestive heart failure
-Coronary artery disease
.
Secondary diagnosis
-Hypertension
-Diabetes type II
-Abdominal pain with guiac + stools
-Acute renal failure
-Leukocytosis


Discharge Condition:
Good


Discharge Instructions:
The following medications have been added:
-Aspirin 325 mg PO daily
-Atorvastatin 80 mg PO daily
-Ferrous sulfate 325mg PO daily
-Lisinopril 5mg PO daily
-Omeprazole 40g PO daily
.
The following medications have been discontinued:
-Diovan
-Metformin
.
The following medications have been changed:
Lasix 40mg PO daily
.
The following medications will be continued at their previous
dose:
-Metoprolol XL 25mg PO daily
-Glyburide 5mg (1.5 tabs qAM, 1 tab qPM)
.
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
.
Adhere to 2 gm sodium diet

Followup Instructions:
Please follow up with your primary care doctor when you get
home.  Please follow up with your cardiologist in [**State **] about
when to restart Diovan.
.
Please follow up your blood sugar with [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 79693**] [**Name8 (MD) 2601**], MD
Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2126-9-10**] 2:30 at Health Care
Associated North Suite at [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Building at [**Hospital1 18**]
.
Please follow up with Gastroenterologist [**Name6 (MD) **] [**Last Name (NamePattern4) 2163**], MD
Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2126-9-9**] 11:15 [**Location (un) **]
[**Hospital Ward Name **], [**Hospital Unit Name **] [**Location (un) 453**].
.
Please follow up with cardiology with Dr. [**Last Name (STitle) 73**] Phone number
[**Telephone/Fax (1) 62**] Date/Time: [**2126-9-9**] 1:00 at [**Hospital Ward Name 516**] [**Hospital Ward Name 23**]
Building



Completed by:[**2126-10-7**]
{'Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Leukocytosis, unspecified,Iron deficiency anemia, unspecified,Acute on chronic combined systolic and diastolic heart failure,Acute kidney failure, unspecified,Blood in stool,Acute respiratory failure,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Abdominal pain, other specified site,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other iatrogenic hypotension'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Respiratory distress, cardiac arrest

PRESENT ILLNESS: Ms. [**Known lastname 79692**] is a 73yo woman with h/o DM2, CHF, and HTN who
presented to [**Hospital3 **]w/ respiratory distress with
subsequent asystolic cardiac arrest.
.
Per EMS records, she was having difficulty breathing this
morning at midnight, about 1 hour after she had gone to bed. She
woke up her daughter stating she couldn't breath. Per daughter,
she has had a dry cough and has had worsening DOE. When EMS
arrived, she was able to speak/answer questions but was in
respiratory distress. Her vitals were BP 142/100 HR 140 RR 24
02sat <60 on RA.
.
On transport, the patient became unresponsive in the ambulance 2
min prior to arrival to the OSH. At the OSH her VS were T 98.1
BP 144/48 HR 30 RR 2 02sat 50% on NRB. The decision was made for
emergent intubation. At this time, she went into asystolic
arrest. CPR was initiated and atropine/epi were administered
with return of pulse (her total arrest time was 1-2 min
according to her daughter). She was intubated and set to Fi02
100% AC 600/15 with (ABG 7.26/36/88). A femoral line was placed.
A CXR was read as bilateral fluffy infiltrates c/w volume
overload vs ARDS. She was given vanc/zosyn. She became
hypotensive to SBP of 70's and was started on a dopamine gtt.
Soon after she went into a wide complex tachycardia; dopamine
was stopped and she was started on an amio gtt (w/ 150mg bolus)
with conversion back to sinus bradycardia. Pressor was changed
to levophed. She was given ASA 300mg and transferred to [**Hospital1 18**].
.
In the [**Hospital1 18**] ED, initial VS were: T 96.5 BP 93/23 HR 93 RR 17 02
sat 100% on vent. The levophed gtt was uptitrated [**3-16**] to
hypotension. She was given atropine 0.5mg for HR "in the 50's"
and amiodarone was stopped because of bradycardia. A RIJ was
placed under sterile conditions. She was given levaquin x1.
Cardiology was consulted and a bedside echo was done. Her CVP
was 16 and SV02 was 80. Labs were significant for a WBC 31.3,
lactate 2.5, proBNP 1065, trop T 0.06, and negative UA.
.
She was initially admitted to the MICU, where she was continued
on levophed. She had an episode of hyperkalemia that was treated
with calcium and dextrose. She received 20mg of IV lasix with
300cc Uop over the next few hours. Insulin gtt was started for
improved glucose control.
.
Further review of systems not possible at this time.

MEDICAL HISTORY: Chronic systolic heart failure (LVEF of 40% from [**6-20**] echo)
DM (non-compliant w/ meds)
HTN
recent D&C 3 weeks ago for uterine polyp (not malignant)
recent hospitalization for SOB (in [**State 4260**]), intubation not
required
.
Cardiac Risk Factors: (+)Diabetes, (?)Dyslipidemia,
(+)Hypertension
.
Cardiac History: CABG: none
.
Percutaneous coronary intervention: none
.
Pacemaker/ICD: none

MEDICATION ON ADMISSION: Glucophage 500 [**Hospital1 **]
Glyburide 7.5 [**Hospital1 **]
Lantus 50 units QHS
Lasix 40mg daily
Toprol XL 25mg daily
Lisinopril 2.5mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Tm=Tc 99.0, BP 113/43, HR 74, RR 27, O2 99% on AC 0.40
500/18 +10
Gen: Elderly woman, intubated and sedated. Withdraws from
painful stimuli but not responsive to voice.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple; JVP not visible though patient has thick neck.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2, somewhat faint heart sounds. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis.
Breathing comfortably with vent. Crackles L>R bases. No wheeze.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP
Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 1+ DP

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives independently in [**State 4260**]. No tobacco, minimal alcohol. 

### Response:
{'Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Leukocytosis, unspecified,Iron deficiency anemia, unspecified,Acute on chronic combined systolic and diastolic heart failure,Acute kidney failure, unspecified,Blood in stool,Acute respiratory failure,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Abdominal pain, other specified site,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other iatrogenic hypotension'}
