CHIEF COMPLAINT: Transfer from [**Hospital3 4107**] emergency department with an
inferior STEMI

PRESENT ILLNESS: Ms. [**Known lastname 76166**] is a [**Age over 90 **]F with a PMH s/f HTN, DM, chronic heart
failure who was brought to the [**Hospital3 **] ED this morning
by her daughter after "not looking right". She reports her mothe
was having difficulty feeding herself, groaning, experiencing
neck pain, mild nausea, and diaphoresis. In the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], the
patient was hypotensive with a systolic BP in the 60s, tachypnic
to 40s, and an EKG showed inferior ST elevations. She was
managed with IV fluids, with improvement of her blood pressure,
heparin, integrillin, 600mg clopidogrel load, 365mg aspirin,
80mg atorvastatin, and transferred to the [**Hospital1 18**] cath lab.
.
In the cath lab, her code status was reversed from DNR/DNI to
full coede for the procedure. Cardiac cath showed a completely
occluded proximal RCA. Thrombectomy [**Last Name (un) 69330**] an export catheter was
performed without success. After multiple inflations with the
balloon, two bare metal stents were placed,, one 2.5x23mm
minivision BMS was deployed into the distal vessel, and one
3x23mm BMS was deployed proximally. The Sino-atrial branch
became jailed, and the patient went into sinus arrest with an AV
junctional rhythm. EP was called, and a coronary sinus pacing
wire was placed. She was also in cardiogenic shock, for which a
dobutamine drip was started.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. OTHER PAST MEDICAL HISTORY:
-Type 2 Diabetes Mellitus
-Dyslipidemia
-HTN
-Hypothyroidism
-S/p cholecystectomy

MEDICATION ON ADMISSION: Glimepiride 4mg [**Hospital1 **]
Metformin 500mg [**Hospital1 **]
Avandia 4mg [**Hospital1 **]
Levothyroxine 88mcg daily
Theragram-M 1 tab daily
Flexamin 1 tab daily
Omeprazole 20mg daily
Bumetanide 1mg daily
Methocarbamol 500mg QID prn
Propoxyphene 100mg q6H prn

ALLERGIES: Influenza Virus Vaccine / Prednisone

PHYSICAL EXAM: VS: T=94...BP=113/77...HR=83...RR=18...O2 sat=100% 4L NC
GENERAL: Overweight elderly female, breathing through pursed
lips.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Very dry mucous membranes.
NECK: +JVD
CARDIAC: Regular rhythm, normal rate. No audible murmurs, rubs
or gallops.
LUNGS: Patient lying flat with a sheath in, unable to listen
posteriorly. Anteriorly, has clear breath sounds.
ABDOMEN: Obese, soft, nontender to deep palpation in all four
quadrants. NABS.
EXTREMITIES: Cool LLE with 1+ dorsalis pedis pulse, warm RLE
with 2+ dorsalis pedis pulse.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
.

FAMILY HISTORY: Unable to review, pt sedated

SOCIAL HISTORY: Unable to review, pt sedated
Acute myocardial infarction of other inferior wall, initial episode of care,Acute respiratory failure,Chronic diastolic heart failure,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Cardiogenic shock,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Functional disturbances following cardiac surgery,Cardiac arrest,Unspecified acquired hypothyroidism,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension
AMI inferior wall, init,Acute respiratry failure,Chr diastolic hrt fail,Acute kidney failure NOS,Septicemia NOS,Severe sepsis,Cardiogenic shock,Abn react-cardiac cath,Hrt dis postcardiac surg,Cardiac arrest,Hypothyroidism NOS,Esophageal reflux,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2177-9-5**]              Discharge Date:   [**2177-9-8**]


Service: MEDICINE

Allergies:
Influenza Virus Vaccine / Prednisone

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
Transfer from [**Hospital3 4107**] emergency department with an
inferior STEMI

Major Surgical or Invasive Procedure:
Cardiac cath

History of Present Illness:
Ms. [**Known lastname 76166**] is a [**Age over 90 **]F with a PMH s/f HTN, DM, chronic heart
failure who was brought to the [**Hospital3 **] ED this morning
by her daughter after "not looking right". She reports her mothe
was having difficulty feeding herself, groaning, experiencing
neck pain, mild nausea, and diaphoresis. In the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], the
patient was hypotensive with a systolic BP in the 60s, tachypnic
to 40s, and an EKG showed inferior ST elevations. She was
managed with IV fluids, with improvement of her blood pressure,
heparin, integrillin, 600mg clopidogrel load, 365mg aspirin,
80mg atorvastatin, and transferred to the [**Hospital1 18**] cath lab.
.
In the cath lab, her code status was reversed from DNR/DNI to
full coede for the procedure. Cardiac cath showed a completely
occluded proximal RCA. Thrombectomy [**Last Name (un) 69330**] an export catheter was
performed without success. After multiple inflations with the
balloon, two bare metal stents were placed,, one 2.5x23mm
minivision BMS was deployed into the distal vessel, and one
3x23mm BMS was deployed proximally. The Sino-atrial branch
became jailed, and the patient went into sinus arrest with an AV
junctional rhythm. EP was called, and a coronary sinus pacing
wire was placed. She was also in cardiogenic shock, for which a
dobutamine drip was started.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. OTHER PAST MEDICAL HISTORY:
-Type 2 Diabetes Mellitus
-Dyslipidemia
-HTN
-Hypothyroidism
-S/p cholecystectomy


Social History:
Unable to review, pt sedated

Family History:
Unable to review, pt sedated

Physical Exam:
VS: T=94...BP=113/77...HR=83...RR=18...O2 sat=100% 4L NC
GENERAL: Overweight elderly female, breathing through pursed
lips.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Very dry mucous membranes.
NECK: +JVD
CARDIAC: Regular rhythm, normal rate. No audible murmurs, rubs
or gallops.
LUNGS: Patient lying flat with a sheath in, unable to listen
posteriorly. Anteriorly, has clear breath sounds.
ABDOMEN: Obese, soft, nontender to deep palpation in all four
quadrants. NABS.
EXTREMITIES: Cool LLE with 1+ dorsalis pedis pulse, warm RLE
with 2+ dorsalis pedis pulse.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
.


Pertinent Results:
Cardiac Cath [**2177-9-11**]:
1.  Acute inferior myocardial infarction of the proximal RCA.
2.  Hemodynamics consistent with RV infarction and cardiogenic
shock.
3.  Successful placement of a temporary pacemaker in the
coronary sinus
for sinus node arrest.
4. Successful stenting of the proximal and distal RCA.
.
ECHO [**2177-9-6**]: The left atrial volume is markedly increased
(>32ml/m2). The right atrium is moderately dilated. There is
mild symmetric left ventricular hypertrophy with normal cavity
size. There is mild to moderate regional left ventricular
systolic dysfunction with focal akinesis of the basal to mid
inferolateral wall, and hypokinesis of the inferior wall and
inferior septum. The remaining left ventricular segments
contract normally. The right ventricular cavity is markedly
dilated with severe global free wall hypokinesis. The number of
aortic valve leaflets cannot be determined. The aortic valve
leaflets are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Trivial mitral regurgitation is
seen. The tricuspid valve leaflets are mildly thickened.
Moderate [2+] tricuspid regurgitation is seen. The estimated
pulmonary artery systolic pressure is normal. There is an
anterior space which most likely represents a fat pad.
.
IMPRESSION: Suboptimal image quality. Regional left and right
ventricular dysfunction consistent with inferior/inferolateral
MI with right ventricular infarction. Moderate tricuspid
regurgitation.
.
CXR [**2177-9-7**]: There is no overt CHF. ET tube is in the standard
position. The cuff is slightly overinflated. Swan-Ganz catheter
tip is in the main pulmonary artery. Cardiomegaly and widened
mediastinum are stable. There is no pneumothorax or enlarging
pleural effusions. There is left lower lobe atelectasis and
right upper lobe medial atelectasis.



Brief Hospital Course:
Ms. [**Known firstname 108381**] is a [**Age over 90 **] F with a PMH s/f DM, HTN, dyslipidemia, and
CHF who presented to the [**Hospital1 18**] with an inferior STEMI, s/p BMS
to the RCA, complicated by a jailed sino-atrial artery with
sinus arrest s/p insertion of a coronary sinus pacing wire and
cardiogenic shock.
.
# SHOCK: Cardiogenic shock secondary to RV dysfunction. Family
was not interested in ballon pump or dialysis. Patient's
hemodynamics began to demonstrate septic picture with increased
CO and decreased SVR. Borderline temp with leukocytosis, green
sputum with gram +ve cocci, gram -ve rods, gram +ve rods.
Started Vancomycin and Zosyn. Patient anuric. Patient's BP
required increasing pressors and fluids for support. Hypotension
worsened in setting of A flutter with rapid rate. MAP 40s.
Patient passed away with family at bedside.
.
# CORONARIES: RV infarction, s/p two bare metal stents to the
proximal and mid RCA for a totally occluded proximal RCA.
Developed cardiogenic shock.
.
# RHYTHM: Cardiac catheterization was complicated by a jailed
sinus artery, requiring a coronary sinus pacer. Patient atrial
paced. Patient entered A Flutter with rapid rate.
.
#. Respiratory failure: Patient intubated. Increasing O2
requirement.


Medications on Admission:
Glimepiride 4mg [**Hospital1 **]
Metformin 500mg [**Hospital1 **]
Avandia 4mg [**Hospital1 **]
Levothyroxine 88mcg daily
Theragram-M 1 tab daily
Flexamin 1 tab daily
Omeprazole 20mg daily
Bumetanide 1mg daily
Methocarbamol 500mg QID prn
Propoxyphene 100mg q6H prn


Discharge Medications:
Expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Cardiogenic shock
STEMI

Discharge Condition:
Expired


Completed by:[**2177-9-17**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute respiratory failure,Chronic diastolic heart failure,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Cardiogenic shock,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Functional disturbances following cardiac surgery,Cardiac arrest,Unspecified acquired hypothyroidism,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}


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: Transfer from [**Hospital3 4107**] emergency department with an
inferior STEMI

PRESENT ILLNESS: Ms. [**Known lastname 76166**] is a [**Age over 90 **]F with a PMH s/f HTN, DM, chronic heart
failure who was brought to the [**Hospital3 **] ED this morning
by her daughter after "not looking right". She reports her mothe
was having difficulty feeding herself, groaning, experiencing
neck pain, mild nausea, and diaphoresis. In the [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], the
patient was hypotensive with a systolic BP in the 60s, tachypnic
to 40s, and an EKG showed inferior ST elevations. She was
managed with IV fluids, with improvement of her blood pressure,
heparin, integrillin, 600mg clopidogrel load, 365mg aspirin,
80mg atorvastatin, and transferred to the [**Hospital1 18**] cath lab.
.
In the cath lab, her code status was reversed from DNR/DNI to
full coede for the procedure. Cardiac cath showed a completely
occluded proximal RCA. Thrombectomy [**Last Name (un) 69330**] an export catheter was
performed without success. After multiple inflations with the
balloon, two bare metal stents were placed,, one 2.5x23mm
minivision BMS was deployed into the distal vessel, and one
3x23mm BMS was deployed proximally. The Sino-atrial branch
became jailed, and the patient went into sinus arrest with an AV
junctional rhythm. EP was called, and a coronary sinus pacing
wire was placed. She was also in cardiogenic shock, for which a
dobutamine drip was started.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. OTHER PAST MEDICAL HISTORY:
-Type 2 Diabetes Mellitus
-Dyslipidemia
-HTN
-Hypothyroidism
-S/p cholecystectomy

MEDICATION ON ADMISSION: Glimepiride 4mg [**Hospital1 **]
Metformin 500mg [**Hospital1 **]
Avandia 4mg [**Hospital1 **]
Levothyroxine 88mcg daily
Theragram-M 1 tab daily
Flexamin 1 tab daily
Omeprazole 20mg daily
Bumetanide 1mg daily
Methocarbamol 500mg QID prn
Propoxyphene 100mg q6H prn

ALLERGIES: Influenza Virus Vaccine / Prednisone

PHYSICAL EXAM: VS: T=94...BP=113/77...HR=83...RR=18...O2 sat=100% 4L NC
GENERAL: Overweight elderly female, breathing through pursed
lips.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Very dry mucous membranes.
NECK: +JVD
CARDIAC: Regular rhythm, normal rate. No audible murmurs, rubs
or gallops.
LUNGS: Patient lying flat with a sheath in, unable to listen
posteriorly. Anteriorly, has clear breath sounds.
ABDOMEN: Obese, soft, nontender to deep palpation in all four
quadrants. NABS.
EXTREMITIES: Cool LLE with 1+ dorsalis pedis pulse, warm RLE
with 2+ dorsalis pedis pulse.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
.

FAMILY HISTORY: Unable to review, pt sedated

SOCIAL HISTORY: Unable to review, pt sedated 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute respiratory failure,Chronic diastolic heart failure,Acute kidney failure, unspecified,Unspecified septicemia,Severe sepsis,Cardiogenic shock,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Functional disturbances following cardiac surgery,Cardiac arrest,Unspecified acquired hypothyroidism,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
