CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 89 year old
female, Caucasian, recently admitted on [**6-1**] until [**2155-6-18**], for inferior wall myocardial infarction.  A
catheterization at that time showed a 50% mid left anterior
descending and 40% left circumflex, obtuse marginal
occlusions as well as 50% proximal right coronary artery and
40 to 50% diagonal and 80% of distal posterior PDA
occlusions.  The right coronary artery was thought to be the
culprit but at the time of catheterization, no arteries
needed intervention.  The distal PDA lesion underwent
percutaneous transluminal coronary angioplasty.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other inferior wall, initial episode of care,Cardiogenic shock,Congestive heart failure, unspecified,Acidosis,Atrial fibrillation,Pneumonia due to Klebsiella pneumoniae,Acute kidney failure with lesion of tubular necrosis
AMI inferior wall, init,Cardiogenic shock,CHF NOS,Acidosis,Atrial fibrillation,K. pneumoniae pneumonia,Ac kidny fail, tubr necr
Admission Date:  [**2155-8-14**]     Date of Death:  [**2155-9-5**]


Service:  MED-CCU

EXPIRATION DATE:  [**2155-9-5**].

HISTORY OF PRESENT ILLNESS:  The patient is an 89 year old
female, Caucasian, recently admitted on [**6-1**] until [**2155-6-18**], for inferior wall myocardial infarction.  A
catheterization at that time showed a 50% mid left anterior
descending and 40% left circumflex, obtuse marginal
occlusions as well as 50% proximal right coronary artery and
40 to 50% diagonal and 80% of distal posterior PDA
occlusions.  The right coronary artery was thought to be the
culprit but at the time of catheterization, no arteries
needed intervention.  The distal PDA lesion underwent
percutaneous transluminal coronary angioplasty.

Post-catheterization, the patient had bradycardia and
hypotension and a re-look catheterization was without any
significant changes.  Her hospital course was also
significant for intubation for lactic acidosis.  The patient
was re-admitted in early [**Month (only) 205**] for shortness of breath and
mental status changes.  She was found to have stable pleural
effusions secondary to congestive heart failure and was
medically stabilized.

At that time, she opted for comfort care, however, when she
came from rehabilitation at this time, her code status was
changed to Full Code in the interim.

On [**8-14**], she complained of substernal chest pain,
shortness of breath and diaphoresis.  The Emergency Medical
System was activated and found the patient to be hypotensive
with altered mental status.  Per report, the patient was
lying semi-recumbent, nonresponsive except when verbally
stimulated.  She was placed on two liters of nasal cannula
oxygen and was noted to have cold and clammy extremities.
She received three sublingual Nitroglycerin tablets earlier.

At [**Hospital1 **], she was hypotensive with blood pressure
68/38 and pulse 60.  She was started on Dobutamine and
heparin.  Lytics were also started at that time.  EKG was
notable for diffuse ST elevations in weeks II, III and AVF as
well as V1 through V5.  She was intubated for airway
protection on the way to [**Hospital1 69**]
for emergent catheterization.

The catheterization was notable for right coronary artery
tapering occlusion without changes in other vessels.  She was
given Nitroglycerin with resolution of occlusion, suggestive
of a spasm.  The stent was deployed to the site of the spasm.
She was given Dobutamine with resultant hypotension and
started on Levophed.

PHYSICAL EXAMINATION:  On admission, vital signs were heart
rate 70; blood pressure 80/58; intubated with arterial blood
gas 7.27, 49, 300, lactate 5.  Sodium 133, potassium 5.0.  In
general, a thin, Caucasian female, intubated and sedated.
HEENT:  Jugular venous distention not measurable.  Pupils
small and equal.  Positive S1, S2.  No other sounds could be
appreciated.  Lungs were decreased breath sounds bilaterally
at the bases.  Mild wheezing.  Abdomen quiet, nontender,
nondistended, no masses palpable.  Extremities cool and
clammy, one plus dorsalis pedis and posterior tibial pulses
bilaterally.   Right femoral sheath in place.  No signs of
bleeding.

HOSPITAL COURSE:  The patient was admitted to the Cardiac
Care Unit with the diagnosis of right ventricular infarction.
Her mental status continued to be unchanged since admission
until her death with the patient not being able to respond to
any stimuli except for pain.

During the course of the hospital stay, she developed
Klebsiella pneumonia treated with Cefepime.  She also
developed a large deep venous thrombosis of the right lower
extremity and was started on heparin.

Her renal function, which was decreased at baseline,
continued to deteriorate during the hospital stay and
required hemodialysis to the end of her stay.

The patient's respiratory function required ventilatory
support during this stay and extubation attempt was made two
weeks after admission and was unsuccessful.  By the end of
her stay, she required tracheostomy tube placement.

Her cardiac function, despite all the interventions,
continued to deteriorate and the patient was unable to
maintain blood pressures without pressor support, despite
aggressive fluid resuscitation.  At the end of her stay, she
also developed large necrotic sacral ulcer.

Despite aggressive measures [**First Name8 (NamePattern2) **] [**Known lastname **] continued to have
multiple system failure and was made comfort measures only by
her family.  On [**9-4**], she was taken off the ventilator
the same day and expired the next day from congestive heart
failure and respiratory arrest.



                    DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-222

Dictated By:[**Name8 (MD) 4562**]

MEDQUIST36

D:  [**2155-9-18**]  08:47
T:  [**2155-9-24**]  15:36
JOB#:  [**Job Number 39894**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Cardiogenic shock,Congestive heart failure, unspecified,Acidosis,Atrial fibrillation,Pneumonia due to Klebsiella pneumoniae,Acute kidney failure with lesion of tubular necrosis'}


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: The patient is an 89 year old
female, Caucasian, recently admitted on [**6-1**] until [**2155-6-18**], for inferior wall myocardial infarction.  A
catheterization at that time showed a 50% mid left anterior
descending and 40% left circumflex, obtuse marginal
occlusions as well as 50% proximal right coronary artery and
40 to 50% diagonal and 80% of distal posterior PDA
occlusions.  The right coronary artery was thought to be the
culprit but at the time of catheterization, no arteries
needed intervention.  The distal PDA lesion underwent
percutaneous transluminal coronary angioplasty.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Cardiogenic shock,Congestive heart failure, unspecified,Acidosis,Atrial fibrillation,Pneumonia due to Klebsiella pneumoniae,Acute kidney failure with lesion of tubular necrosis'}
