CHIEF COMPLAINT: Transferred for management of STEMI

PRESENT ILLNESS: 80 year old woman (DNR) with two recent MI's, known severe CAD
with a 95% LM stenosis (felt not to be a candidate for CABG),
cardiomyopathy with an LVEF of 15-20%, moderate aortic stenosis,
HTN, AF, hepatitis C with thrombocytopenia, s/p recent
cath/admission at [**Hospital1 **] where PCI was not an option and CABG is
too high risk. Patient has continued to have ischemic events
since then with recent presentation with new onset AF, echo
revealing wall motion abnormality involving the anterior wall
and apex with possible thrombus in the LV apex. Medical
management continued with eventual discharge to home earlier
this week. She did okay initially and then represented to [**Hospital1 **] on [**2181-7-26**] evening with chest pain [**11-24**] radiating to
the left arm and back, associated with diaphoresis,
lightheadedness, shortness of breath and ST elevation. Family
refused TPA due to hx of thrombocytopenia. IV nitro inititated,
heparin, aspirin initiated and now painfree. Troponin last drawn
was 13 (still rising) although there's no lab sent with her.
Currently with minimal chest discomfort. EKG demonstrated ST
elevation inferiorly at tuft's. Plans are for evaluation here
for further treatment. Dr. [**Last Name (STitle) **] to consult. On arrival here
pt's pain free and without complaint.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: htn, hl
2. CARDIAC HISTORY:
-CABG: n/a
-PERCUTANEOUS CORONARY INTERVENTIONS: n/a
-PACING/ICD: n/a
3. Others:
hepatitis C
multiple hepatic nodules with multiple biopsies with no evidence
of malignancy.
severe diffuse coronary artery disease
severe cardiomyopathy with ef of 15-20%
severe tricuspid regurgitation with estimated pa pressure of
53mmHg
moderate aortic stenosis
hypertension
hyperlipidemia
atrial fibrillation
thrombocytopenia

MEDICATION ON ADMISSION: Outpatient Meds:
lipitor 80mg daily
plavix 75mg daily
toprol xl 50mg daily
zestril 5mg daily
alsix 80mg daily
aspirin 81mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: temp 97.6, hr 62/min, bp 110/62, sats 97% on ra
GENERAL: In NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with no JVD.
CARDIAC: rrr, nl s1, faint s2, [**4-20**] ESM as well as [**4-20**] PSM.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES: 1+ dp and pt pulses.

FAMILY HISTORY: Non-contibutory

SOCIAL HISTORY: Patient lives with daughters. she denies tobacco, alcohol or iv
drug use
Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Other primary cardiomyopathies,Acute respiratory failure,Acidosis,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Coronary vasodilators causing adverse effects in therapeutic use,Aortic valve disorders,Chronic hepatitis C without mention of hepatic coma,Unspecified essential hypertension,Thrombocytopenia, unspecified,Other specified disorders of liver
AMI inferior wall, init,Ac kidny fail, tubr necr,Prim cardiomyopathy NEC,Acute respiratry failure,Acidosis,Urin tract infection NOS,Crnry athrscl natve vssl,Atrial fibrillation,Iatrogenc hypotnsion NEC,Adv eff coronary vasodil,Aortic valve disorder,Chrnc hpt C wo hpat coma,Hypertension NOS,Thrombocytopenia NOS,Liver disorders NEC
Admission Date:  [**2181-7-27**]              Discharge Date:   [**2181-8-5**]

Date of Birth:  [**2100-11-15**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Transferred for management of STEMI

Major Surgical or Invasive Procedure:
temporary dialysis line placement
cordis placement
arterial line placement


History of Present Illness:
80 year old woman (DNR) with two recent MI's, known severe CAD
with a 95% LM stenosis (felt not to be a candidate for CABG),
cardiomyopathy with an LVEF of 15-20%, moderate aortic stenosis,
HTN, AF, hepatitis C with thrombocytopenia, s/p recent
cath/admission at [**Hospital1 **] where PCI was not an option and CABG is
too high risk. Patient has continued to have ischemic events
since then with recent presentation with new onset AF, echo
revealing wall motion abnormality involving the anterior wall
and apex with possible thrombus in the LV apex. Medical
management continued with eventual discharge to home earlier
this week. She did okay initially and then represented to [**Hospital1 **] on [**2181-7-26**] evening with chest pain [**11-24**] radiating to
the left arm and back, associated with diaphoresis,
lightheadedness, shortness of breath and ST elevation. Family
refused TPA due to hx of thrombocytopenia. IV nitro inititated,
heparin, aspirin initiated and now painfree. Troponin last drawn
was 13 (still rising) although there's no lab sent with her.
Currently with minimal chest discomfort. EKG demonstrated ST
elevation inferiorly at tuft's. Plans are for evaluation here
for further treatment. Dr. [**Last Name (STitle) **] to consult. On arrival here
pt's pain free and without complaint.

Past Medical History:
1. CARDIAC RISK FACTORS: htn, hl
2. CARDIAC HISTORY:
-CABG: n/a
-PERCUTANEOUS CORONARY INTERVENTIONS: n/a
-PACING/ICD: n/a
3. Others:
hepatitis C
multiple hepatic nodules with multiple biopsies with no evidence
of malignancy.
severe diffuse coronary artery disease
severe cardiomyopathy with ef of 15-20%
severe tricuspid regurgitation with estimated pa pressure of
53mmHg
moderate aortic stenosis
hypertension
hyperlipidemia
atrial fibrillation
thrombocytopenia

Social History:
Patient lives with daughters. she denies tobacco, alcohol or iv
drug use

Family History:
Non-contibutory

Physical Exam:
temp 97.6, hr 62/min, bp 110/62, sats 97% on ra
GENERAL: In NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with no JVD.
CARDIAC: rrr, nl s1, faint s2, [**4-20**] ESM as well as [**4-20**] PSM.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES: 1+ dp and pt pulses.

Pertinent Results:
ADMISSION LABS:

[**2181-7-27**] 11:48PM BLOOD WBC-7.7 RBC-3.83* Hgb-12.9 Hct-37.4
MCV-98 MCH-33.6* MCHC-34.4 RDW-15.0 Plt Ct-112*
[**2181-7-27**] 11:48PM BLOOD Glucose-147* UreaN-34* Creat-1.4* Na-138
K-3.8 Cl-98 HCO3-28 AnGap-16
[**2181-7-27**] 11:48PM BLOOD ALT-115* AST-303* CK(CPK)-1379*
AlkPhos-99 TotBili-0.6
[**2181-7-27**] 11:48PM BLOOD CK-MB-250* MB Indx-18.1* cTropnT-3.03*
[**2181-7-28**] 06:18AM BLOOD CK-MB-217* MB Indx-16.2*
[**2181-7-28**] 03:44PM BLOOD CK-MB-122* MB Indx-12.6* cTropnT-4.02*
[**2181-7-30**] 05:22AM BLOOD CK-MB-22* cTropnT-4.05*

MICROBIOLOGY
Urine Cx: [**7-31**], [**8-3**] negative

IMAGING:

ECHO [**2181-7-28**]:
Symmetric left ventricular hypertrophy. Mild regional
dysfunction consistent with CAD. Moderately dilated right
ventricle with borderline normal function. Tricuspid leaflets do
not coapt and there is corresponding moderate to severe
tricuspid regurgitation. Pulmonary pressures cannot be
accurately determined. Mild mitral regurgitation. Moderate
aortic stenosis.

ECG [**2181-7-28**]:
Sinus rhythm with PACs
Prolonged QT interval
Inferior infarct - age undetermined
Anteroseptal infarct - age undetermined
ST-T changes may be due to myocardial ischemia
No previous tracing available for comparison


Brief Hospital Course:
Mrs. [**Known lastname 55334**] is an 80 year old female with a history of LMain
and 3VD, moderate aortic stenosis and with status post cardiac
cath for STEMI back on [**2181-7-17**] at OSH that was not intervened
upon by PCI or CABG who then presented to another OSH with an
inferior STEMI on [**2181-7-26**] and was transferred to [**Hospital1 18**] for
further management and a second opinion regarding options for
revascularization. CABG versus high risk PCI were considered and
CT surgery was consulted. Patient remained chest pain free on
medical management of her CAD, however, the acute renal failure
she presented with evolved rapidly from the beginning of her
course, making either surgical or PCI less of an option. Renal
was consulted and felt her renal failure was likely attributable
to evolving ATN in the setting of poor forward flow related to
her recent MI and possibly due to contrast nephropathy given a
recent catheterization. The patient became oliguric and
subsequently volume overloaded and hypoxic. Aggressive diuresis
with IV lasix and diuril were unsuccessful so CVVH was
initiated. At this point she had become hemodynamically unstable
requiring pressor support with dopamine. Hemodynamic instability
was likely also affected by patient's development of slow atrial
fibrillation which requried placement of a trancutaneous pacer.
Her dopamine requirement increased significantly with CVVH which
likely contributed to the development of metabolic acidosis. On
[**8-4**] the patient was found to have a lactate of 11 and had
developed agonal respirations. She underwent intubation which
did not help to improve her worsening acidemia. The patient's
family decided to change her code status to DNR/DNI and soon
after to CMO when it was clear that her prognosis had become
very poor. She was pronounced dead on [**2181-8-5**] at 0313. Her three
daughters were at her bedside and agreed in declining an
autopsy.

Medications on Admission:
Outpatient Meds:
lipitor 80mg daily
plavix 75mg daily
toprol xl 50mg daily
zestril 5mg daily
alsix 80mg daily
aspirin 81mg daily

Meds On Transfer:
IV heparin at 600u/hour
IV nitro at 30mcg / min
asa 325mg, lipitor 20mg daily
lasix 80mg po
plavix 75mg
zestril 5mg

Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary: Status post ST elevation myocardial infarction, acute
heart failure, renal failure, metabolic acidosis, respiratory
failure
Secondary: Aortic stenosis, hepatitis C


Discharge Condition:
expired


Discharge Instructions:
Patient admitted for further management of STEMI. Her course was
complicated by acute renal failure, acute heart failure which
ultimately led to pressor support. Patient developed metabolic
acidosis and subsequent respiratory failure requiring
intubation. Her family ultimately decidied to make her DNR/DNI
and soon after CMO given her critical condition and poor
prognosis. She died on [**2181-8-5**] at 0313 with her family at her
bedside. An autopsy was declined.

Followup Instructions:
NA



Completed by:[**2181-8-5**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Other primary cardiomyopathies,Acute respiratory failure,Acidosis,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Coronary vasodilators causing adverse effects in therapeutic use,Aortic valve disorders,Chronic hepatitis C without mention of hepatic coma,Unspecified essential hypertension,Thrombocytopenia, unspecified,Other specified disorders of liver'}


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: Transferred for management of STEMI

PRESENT ILLNESS: 80 year old woman (DNR) with two recent MI's, known severe CAD
with a 95% LM stenosis (felt not to be a candidate for CABG),
cardiomyopathy with an LVEF of 15-20%, moderate aortic stenosis,
HTN, AF, hepatitis C with thrombocytopenia, s/p recent
cath/admission at [**Hospital1 **] where PCI was not an option and CABG is
too high risk. Patient has continued to have ischemic events
since then with recent presentation with new onset AF, echo
revealing wall motion abnormality involving the anterior wall
and apex with possible thrombus in the LV apex. Medical
management continued with eventual discharge to home earlier
this week. She did okay initially and then represented to [**Hospital1 **] on [**2181-7-26**] evening with chest pain [**11-24**] radiating to
the left arm and back, associated with diaphoresis,
lightheadedness, shortness of breath and ST elevation. Family
refused TPA due to hx of thrombocytopenia. IV nitro inititated,
heparin, aspirin initiated and now painfree. Troponin last drawn
was 13 (still rising) although there's no lab sent with her.
Currently with minimal chest discomfort. EKG demonstrated ST
elevation inferiorly at tuft's. Plans are for evaluation here
for further treatment. Dr. [**Last Name (STitle) **] to consult. On arrival here
pt's pain free and without complaint.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: htn, hl
2. CARDIAC HISTORY:
-CABG: n/a
-PERCUTANEOUS CORONARY INTERVENTIONS: n/a
-PACING/ICD: n/a
3. Others:
hepatitis C
multiple hepatic nodules with multiple biopsies with no evidence
of malignancy.
severe diffuse coronary artery disease
severe cardiomyopathy with ef of 15-20%
severe tricuspid regurgitation with estimated pa pressure of
53mmHg
moderate aortic stenosis
hypertension
hyperlipidemia
atrial fibrillation
thrombocytopenia

MEDICATION ON ADMISSION: Outpatient Meds:
lipitor 80mg daily
plavix 75mg daily
toprol xl 50mg daily
zestril 5mg daily
alsix 80mg daily
aspirin 81mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: temp 97.6, hr 62/min, bp 110/62, sats 97% on ra
GENERAL: In NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with no JVD.
CARDIAC: rrr, nl s1, faint s2, [**4-20**] ESM as well as [**4-20**] PSM.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES: 1+ dp and pt pulses.

FAMILY HISTORY: Non-contibutory

SOCIAL HISTORY: Patient lives with daughters. she denies tobacco, alcohol or iv
drug use 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Other primary cardiomyopathies,Acute respiratory failure,Acidosis,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other iatrogenic hypotension,Coronary vasodilators causing adverse effects in therapeutic use,Aortic valve disorders,Chronic hepatitis C without mention of hepatic coma,Unspecified essential hypertension,Thrombocytopenia, unspecified,Other specified disorders of liver'}
