CHIEF COMPLAINT: 

PRESENT ILLNESS: Mrs. [**Last Name (STitle) 96211**] s a 77 year old
female with a known medical history of three-vessel coronary
artery disease, insulin dependent diabetes mellitus, and
peripheral vascular disease, who presented with acute
shortness of breath on the evening of [**2126-12-23**], to
the Emergency Department.  She reported the sudden onset of
shortness of breath at approximately 6 p.m. on [**12-23**],
not associated with chest pain, nausea, vomiting or
diaphoresis.  She had been medically managed for her coronary
disease.  When EMS personnel arrived, she was noted to be in
respiratory distress and was given Lasix and Nitroglycerin
spray with slight improvement.  She was thought to be in
congestive heart failure on arrival to the Emergency
Department, and was admitted for the same.

MEDICAL HISTORY: 1.  Three vessel coronary artery disease medically managed
until the present admission; declined as a surgical
candidate; ejection fraction less than 20% with apical
akinesis.
2.  Insulin dependent diabetes mellitus times 30 years.
3.  Peripheral vascular disease.
4.  History of lower gastrointestinal bleeding.
5.  History of bilateral hip fracture.
6.  Status post total abdominal hysterectomy.
7.  Status post cholecystectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin, Azithromycin, Tetracycline,
Terbutaline, Nifedipine, eggs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is widowed and lives with her
two sisters.  During the admission, one of these sisters died
of cancer.  The patient denies tobacco, alcohol or drug
history.
Subendocardial infarction, initial episode of care,Cardiac arrest,Congestive heart failure, unspecified,Mitral valve disorders,Other specified forms of chronic ischemic heart disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Other toe(s) amputation status
Subendo infarct, initial,Cardiac arrest,CHF NOS,Mitral valve disorder,Chr ischemic hrt dis NEC,DMII wo cmp nt st uncntr,Periph vascular dis NOS,Status amput othr toe(s)
Admission Date:  [**2126-12-24**]       Discharge Date:  [**2126-12-30**]


Service:  [**Hospital Unit Name 196**]

DISCHARGE DATE IS PENDING AT THE TIME OF THIS DICTATION

HISTORY OF PRESENT ILLNESS:  Mrs. [**Last Name (STitle) 96211**] s a 77 year old
female with a known medical history of three-vessel coronary
artery disease, insulin dependent diabetes mellitus, and
peripheral vascular disease, who presented with acute
shortness of breath on the evening of [**2126-12-23**], to
the Emergency Department.  She reported the sudden onset of
shortness of breath at approximately 6 p.m. on [**12-23**],
not associated with chest pain, nausea, vomiting or
diaphoresis.  She had been medically managed for her coronary
disease.  When EMS personnel arrived, she was noted to be in
respiratory distress and was given Lasix and Nitroglycerin
spray with slight improvement.  She was thought to be in
congestive heart failure on arrival to the Emergency
Department, and was admitted for the same.

In the Emergency Department, a rule out myocardial infarction
sequence was started.  On [**12-24**], the patient ruled in
for a myocardial infarction with a CK of 798, CK MB 58, and
MB index 7.3 with troponin listed as greater than 2.0.  She
was started on intravenous heparin.  She was evaluated by the
Cardiology Consult Service who recommended evaluation by
Cardiac Surgery prior to any catheterization procedure.

On the morning of [**12-25**], the patient became nauseated
and diaphoretic.  EKG done at that time showed ST segment
elevation in leads V2, V3, V4, compared to baseline.  There
were also inferior lead ST segment depressions.  The
Cardiology Service was made aware of this development and the
patient was prepared for urgent cardiac catheterization in
the setting of a likely ST segment elevation myocardial
infarction.

While being transferred to the gurney, the patient developed
bradycardic arrest, was intubated, resuscitated and
emergently taken to the Catheterization Laboratory where she
was found to have a 95% proximal left anterior descending
occlusion.  She underwent successful percutaneous
transluminal coronary angioplasty with stenting and an
intra-aortic balloon pump was placed.  The patient was
transferred to the Coronary Care Unit.  The intra-aortic
balloon pump was weaned and discontinued on [**12-26**]; the
patient was extubated on [**12-26**] successfully.  Coronary
Care Unit course was complicated by one episode of coffee
ground emesis on [**12-25**], but cleared, and the patient's
hematocrit remained stable.

A repeat echocardiogram performed in the Coronary Care Unit
showed an ejection fraction of less than 20%, a mildly
dilated left ventricle, severe hypokinesis, some
contractility in the basal inferior segment, and a distal
half of the left ventricle which was akinetic.  The patient
was started on Lovenox for apical akinesis.  She was
evaluated by Cardiac Surgery and declined as a surgical
candidate.  The patient was transferred to the [**Hospital Unit Name 196**] Service
on [**12-27**], in stable condition.

PAST MEDICAL HISTORY:
1.  Three vessel coronary artery disease medically managed
until the present admission; declined as a surgical
candidate; ejection fraction less than 20% with apical
akinesis.
2.  Insulin dependent diabetes mellitus times 30 years.
3.  Peripheral vascular disease.
4.  History of lower gastrointestinal bleeding.
5.  History of bilateral hip fracture.
6.  Status post total abdominal hysterectomy.
7.  Status post cholecystectomy.

ALLERGIES:  Penicillin, Azithromycin, Tetracycline,
Terbutaline, Nifedipine, eggs.

MEDICATIONS:  On admission:
1.  Atenolol 75 mg p.o. q. day.
2.  Imdur 30 mg p.o. q. day.
3.  Zestril 40 mg p.o. q. day.
4.  Aspirin 325 mg p.o. q. day.
5.  Calcium carbonate.
6.  NPH insulin 19 units subcutaneously q. a.m., 12 units
subcutaneously q. p.m.
7.  Lasix 60 mg p.o. q. day.

SOCIAL HISTORY:  The patient is widowed and lives with her
two sisters.  During the admission, one of these sisters died
of cancer.  The patient denies tobacco, alcohol or drug
history.

PHYSICAL EXAMINATION:  On admission, pulse 100; blood
pressure 140/80; respirations 20; 97% oxygen saturation on
six liters.  Generally, pleasant, elderly female in mild
respiratory distress who is alert and oriented times three.
HEENT:  Pupils are equal, round and reactive to light.
Extraocular movements intact.  Sclerae anicteric.  Neck:
Supple.  Jugular venous pressure at approximately 8
centimeters.  Chest:  Bibasilar rales present.
Cardiovascular:  Regular with normal S1 and S2.  No murmurs,
rubs or gallops.  Abdomen:  Soft, nondistended, nontender.
Normoactive bowel sounds.  Extremities:  No pedal edema.
Neurologic:  Alert and oriented times three.  Cranial nerves
II through XII intact.  Strength five out of five upper and
lower extremities bilaterally.  Sensation intact to light
touch.

LABORATORY:  On admission, CBC with white blood cell count of
12.8, hematocrit 44.9, platelets 228, 69% neutrophils, 23%
lymphocytes, 3.6% monocytes, 2.8% eosinophils.  Sodium 141,
potassium 4.8, chloride 102, bicarbonate 28, BUN 22,
creatinine 1.0, glucose 301.  PT 12.2, PTT 21.7, INR 1.0.

CK 85, troponin 1.3.  Urinalysis, specific gravity of 1.025,
with trace protein, glucose 100, negative ketones.  No white
or red cells present.

EKG rate of 108, in sinus rhythm; poor R wave progression,
0.5 millimeter ST segment elevations in V2 and V3.
Pseudo-normalization of T waves V4 through V6.

Chest x-ray:  Consistent with pulmonary edema.

Echocardiogram from [**2126-3-19**]:  Ejection fraction of greater
than 55%.  Aortic valve leaflets mildly thickened.

HOSPITAL COURSE:  Please refer to the HPI for the bulk of the
hospital course.  The patient remained stable on the [**Hospital Unit Name 196**]
Service after transfer from the Coronary Care Unit.  As she
was a medical management patient, her medications continued
to be optimized prior to discharge.  She was evaluated by
Physical Therapy on [**12-28**], and found to be unsafe for
discharge to home.  It was felt that she would benefit from
acute rehabilitation.

CONDITION AT DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient is being discharged to a
rehabilitation facility when a bed becomes available (pending
at the time of this dictation).

DISCHARGE INSTRUCTIONS:
1.  Diet is cardiac and diabetic.
2.  Activity with assistance.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease status post myocardial
infarction.
2.  Cardiac arrest.
3.  Congestive heart failure.
4.  Ischemic cardiomyopathy.
5.  Type 2 diabetes mellitus.
6.  Peripheral vascular disease.

DISCHARGE MEDICATIONS (subject to change at the actual time
of discharge):
1.  Aspirin 325 mg p.o. q. day.
2.  Plavix 75 mg p.o. q. day times 30 days.
3.  Lopressor 25 mg p.o. twice a day.
4.  Lipitor 10 mg p.o. q. h.s.
5.  Protonix 40 mg p.o. q. day.
6.  Lasix 80 mg p.o. q. day.
7.  Captopril 12.5 mg p.o. three times a day.
8.  NPH insulin, 8 units at breakfast and 6 units at bedtime.
9.  Coumadin 2.5 mg p.o. q. h.s.
10. Lovenox 60 mg p.o. twice a day.
11. Colace 100 mg p.o. twice a day.
12. Senokot two tablets p.o. q. h.s. and p.r.n.

DISCHARGE INSTRUCTIONS:
1.  Follow-up to be with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] within two weeks
after discharge.


                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1849**], M.D.  [**MD Number(1) 5381**]

Dictated By:[**Last Name (NamePattern1) 737**]
MEDQUIST36

D:  [**2126-12-28**]  15:53
T:  [**2126-12-28**]  16:18
JOB#:  [**Job Number 96212**]
{'Subendocardial infarction, initial episode of care,Cardiac arrest,Congestive heart failure, unspecified,Mitral valve disorders,Other specified forms of chronic ischemic heart disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Other toe(s) amputation status'}


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: 

PRESENT ILLNESS: Mrs. [**Last Name (STitle) 96211**] s a 77 year old
female with a known medical history of three-vessel coronary
artery disease, insulin dependent diabetes mellitus, and
peripheral vascular disease, who presented with acute
shortness of breath on the evening of [**2126-12-23**], to
the Emergency Department.  She reported the sudden onset of
shortness of breath at approximately 6 p.m. on [**12-23**],
not associated with chest pain, nausea, vomiting or
diaphoresis.  She had been medically managed for her coronary
disease.  When EMS personnel arrived, she was noted to be in
respiratory distress and was given Lasix and Nitroglycerin
spray with slight improvement.  She was thought to be in
congestive heart failure on arrival to the Emergency
Department, and was admitted for the same.

MEDICAL HISTORY: 1.  Three vessel coronary artery disease medically managed
until the present admission; declined as a surgical
candidate; ejection fraction less than 20% with apical
akinesis.
2.  Insulin dependent diabetes mellitus times 30 years.
3.  Peripheral vascular disease.
4.  History of lower gastrointestinal bleeding.
5.  History of bilateral hip fracture.
6.  Status post total abdominal hysterectomy.
7.  Status post cholecystectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin, Azithromycin, Tetracycline,
Terbutaline, Nifedipine, eggs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is widowed and lives with her
two sisters.  During the admission, one of these sisters died
of cancer.  The patient denies tobacco, alcohol or drug
history. 

### Response:
{'Subendocardial infarction, initial episode of care,Cardiac arrest,Congestive heart failure, unspecified,Mitral valve disorders,Other specified forms of chronic ischemic heart disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Other toe(s) amputation status'}
