CHIEF COMPLAINT: 

PRESENT ILLNESS: This 82-year-old white male with
a history of CVAs and severe rheumatoid arthritis who
presented to the [**Hospital6 256**] as a
transfer from an outside hospital with rapid atrial
fibrillation and chest pain.  The patient initially presented
to his urologist's office the morning of the 29th complaining
of right-sided chest pain and flank pain, which had been
present for one month, but was worse on the day of admission.
The patient pain presented as sharp, nonexertional, mildly
pleuritic, not associated with shortness of breath, nausea,
vomiting or diaphoresis.  The patient was sent home from the
doctor's office after being told he was fine but called his
doctor when he found himself unable to rise from a chair at
home.  The patient was found by EMS to be tachypneic with
heart rates in the 220s, irregular, with stable blood
pressure.  He was given adenosine up to 12 mg with no effect.
He then received 20 mg intravenous diltiazem with heart rate
in the 150s.

MEDICAL HISTORY: Significant for rheumatoid
arthritis, CVA in [**2100**] with no deficiencies and a
questionable possibility of having a transurethral resection
of prostate back in [**2097**].

MEDICATION ON ADMISSION: Codeine, Celebrex, prednisone 5 mg
po q.d., Prilosec, Methotrexate, aspirin, folate, Axid and
Xanax.

ALLERGIES: He had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient quit cigarettes when he was in his
60s.  He does not drink alcohol.  Lives in [**Location (un) 5503**],
[**State 350**] with his wife.
Atrial fibrillation,Unspecified septicemia,Congestive heart failure, unspecified,Acute respiratory failure,Retention of urine, unspecified,Unspecified disorder of kidney and ureter,Rheumatoid arthritis,Personal history of other diseases of circulatory system,Personal history of tobacco use
Atrial fibrillation,Septicemia NOS,CHF NOS,Acute respiratry failure,Retention urine NOS,Renal & ureteral dis NOS,Rheumatoid arthritis,Hx-circulatory dis NEC,History of tobacco use
Admission Date:  [**2107-1-1**]     Discharge Date:  [**2107-1-2**]


Service:  MICU

HISTORY OF PRESENT ILLNESS:  This 82-year-old white male with
a history of CVAs and severe rheumatoid arthritis who
presented to the [**Hospital6 256**] as a
transfer from an outside hospital with rapid atrial
fibrillation and chest pain.  The patient initially presented
to his urologist's office the morning of the 29th complaining
of right-sided chest pain and flank pain, which had been
present for one month, but was worse on the day of admission.
The patient pain presented as sharp, nonexertional, mildly
pleuritic, not associated with shortness of breath, nausea,
vomiting or diaphoresis.  The patient was sent home from the
doctor's office after being told he was fine but called his
doctor when he found himself unable to rise from a chair at
home.  The patient was found by EMS to be tachypneic with
heart rates in the 220s, irregular, with stable blood
pressure.  He was given adenosine up to 12 mg with no effect.
He then received 20 mg intravenous diltiazem with heart rate
in the 150s.

The patient arrived at [**Hospital3 **] in the Emergency Room
with a heart rate of 136.  Systolic blood pressure of 92.  He
was given diltiazem .25 mg intravenous times one and then a
drip was started at 15 mg per hour.  On interview, patient
gave clear history of sudden onset of chest pressure at 2
p.m., mildly pleuritic with diaphoresis, mild shortness of
breath, no electrocardiogram changes.  The first enzymes were
negative.  Blood pressure support was attempted with two
liters normal saline.  The 02 saturations decreased.  Patient
was given esmolol drip, GTT, and then his heart rate down to
the 90s but systolic blood pressure continued to be in the
90s.  Dopamine drip was then added when the systolic blood
pressure went down to the 60s.  Chest x-ray was consistent
with congestive heart failure and D dimer returned positive
so heparin was started.  The decision was made to transfer
the patient to the [**Hospital6 256**] at
that point.  They added Levophed to increase the blood
pressure and Ceftriaxone was given empirically without blood
cultures being drawn.  The patient was transferred to [**Hospital6 1760**] with stable blood pressure on
Levophed, dopamine, diltiazem drip and esmolol drip.  The
Esmolol drip and the diltiazem drip were discontinued on
arrival at [**Hospital6 256**].  Also
discontinued secondary to his low blood pressure.  Vancomycin
and Flagyl were given for presumptive sepsis.

[**Hospital **] MEDICAL HISTORY:  Significant for rheumatoid
arthritis, CVA in [**2100**] with no deficiencies and a
questionable possibility of having a transurethral resection
of prostate back in [**2097**].

ALLERGIES:  He had no known drug allergies.

MEDICATIONS ON ADMISSION:  Codeine, Celebrex, prednisone 5 mg
po q.d., Prilosec, Methotrexate, aspirin, folate, Axid and
Xanax.

SOCIAL HISTORY:  Patient quit cigarettes when he was in his
60s.  He does not drink alcohol.  Lives in [**Location (un) 5503**],
[**State 350**] with his wife.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION:  Temperature 99.1.  Heart rate of
121-126.  Heart rate 16-20.  Blood pressure 112/72. 02
saturation 96% on 100% nonrebreather.  Patient was alert and
responsive.  Pupils equal, round and reactive.  Extraocular
motions intact and full.  Oropharynx was unremarkable.  Neck
was in a tag collar, no lymphadenopathy, no jugular venous
distention noticed.  Heart was irregularly irregular with no
murmurs, rubs or gallops.  Lungs showed diffuse loud crackles
bilaterally.  Abdomen was soft, nondistended, nontender with
positive bowel sounds.  Extremities showed trace pedal edema,
1+ pedal pulses bilaterally, the right groin femoral line was
in place and was a triple lumen catheter.

HOSPITAL COURSE:  On admission to the Medical Intensive Care
Unit, the patient began to decompensate both from a blood
pressure and a respiratory prospective.  He was ultimately
intubated around 3 p.m. and his blood pressure was maintained
with four different pressor agents including vasopressin,
dopamine, phenylephrine and Levophed.  He was also given
antibiotics including ceftazidime, vancomycin and Flagyl
overall for presumed sepsis.  The patient's blood pressure
did not increase and in conversation with the family, the
patient was made "Do Not Resuscitate."  His blood pressure
and heart rate continued to decline.  He was unable to be
maintained and his heart eventually stopping and the
ventilator was then discontinued.  He was pronounced dead at
12:55 a.m. on the [**1-2**] for presumed sepsis leading to
cardiovascular collapse, respiratory failure, respiratory
arrest and cardiac arrest.  The family agreed to having an
autopsy performed.




                          [**First Name11 (Name Pattern1) 4514**] [**Last Name (NamePattern4) 8867**], M.D.  [**MD Number(1) 8868**]

Dictated By:[**Last Name (NamePattern1) 3033**]

MEDQUIST36

D:  [**2107-1-7**]  13:54
T:  [**2107-1-7**]  13:54
JOB#:  [**Job Number 37581**]
{'Atrial fibrillation,Unspecified septicemia,Congestive heart failure, unspecified,Acute respiratory failure,Retention of urine, unspecified,Unspecified disorder of kidney and ureter,Rheumatoid arthritis,Personal history of other diseases of circulatory system,Personal history of tobacco use'}


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: This 82-year-old white male with
a history of CVAs and severe rheumatoid arthritis who
presented to the [**Hospital6 256**] as a
transfer from an outside hospital with rapid atrial
fibrillation and chest pain.  The patient initially presented
to his urologist's office the morning of the 29th complaining
of right-sided chest pain and flank pain, which had been
present for one month, but was worse on the day of admission.
The patient pain presented as sharp, nonexertional, mildly
pleuritic, not associated with shortness of breath, nausea,
vomiting or diaphoresis.  The patient was sent home from the
doctor's office after being told he was fine but called his
doctor when he found himself unable to rise from a chair at
home.  The patient was found by EMS to be tachypneic with
heart rates in the 220s, irregular, with stable blood
pressure.  He was given adenosine up to 12 mg with no effect.
He then received 20 mg intravenous diltiazem with heart rate
in the 150s.

MEDICAL HISTORY: Significant for rheumatoid
arthritis, CVA in [**2100**] with no deficiencies and a
questionable possibility of having a transurethral resection
of prostate back in [**2097**].

MEDICATION ON ADMISSION: Codeine, Celebrex, prednisone 5 mg
po q.d., Prilosec, Methotrexate, aspirin, folate, Axid and
Xanax.

ALLERGIES: He had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient quit cigarettes when he was in his
60s.  He does not drink alcohol.  Lives in [**Location (un) 5503**],
[**State 350**] with his wife. 

### Response:
{'Atrial fibrillation,Unspecified septicemia,Congestive heart failure, unspecified,Acute respiratory failure,Retention of urine, unspecified,Unspecified disorder of kidney and ureter,Rheumatoid arthritis,Personal history of other diseases of circulatory system,Personal history of tobacco use'}
