CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 67 year old male with
a past medical history significant for hypertension, diabetes
mellitus Type 2 who went to [**Hospital 16039**] Hospital with three days
of chest pain.  At the outside hospital, the patient was
noted to have new left bundle branch block.  He was given
Lovenox times one and transferred to [**Hospital6 649**] for further management.  Upon arrival to [**Hospital6 1760**] the patient reported
shortness of breath without nausea and vomiting.  The patient
was on nitroglycerin drip as well as Morphine drip and
appeared to be in cardiogenic shock with systolic blood
pressures in the 70s to 80s and heartrate approximately 110.
In the Catheterization Laboratory the patient was intubated.
At catheterization they noted a right dominant system.  There
was an right coronary artery 90% ostial, 70% mid left
circumflex, totally occluded 70% of mid left circumflex,
totally occluded ostial 2.  Left anterior descending 90%
ostial, 90% mid, 90% diagonal #1. Left main without
significant disease.  An intra-aortic balloon pump was placed
in the left femoral.  Echocardiogram at the time demonstrated
no tamponade and an ejection fraction of 15 to 20%.  There
was no mitral regurgitation and there was anterior akinesis.
The left anterior descending was stented successfully at the
ostium and mid ostial diagonal #1 was dilated.  The patient
was transferred to the CCU on a Dopamine drip at 20 and
Levophed 20.  At the time his orogastric tube drainage
demonstrated coffee ground emesis.

MEDICAL HISTORY: Cerebrovascular accident times two,
hypertension, diabetes mellitus Type 2.

MEDICATION ON ADMISSION: Pravachol, Norvasc, Lisinopril,
Aggrenox, Hydrochlorothiazide, and insulin.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Not obtained at admission.

SOCIAL HISTORY: Not obtained.
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Infection and inflammatory reaction due to other vascular device, implant, and graft,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery
AMI anterior wall, init,Cardiogenic shock,React-oth vasc dev/graft,Urin tract infection NOS,CHF NOS,Acute respiratry failure,Food/vomit pneumonitis,Hematoma complic proc,Crnry athrscl natve vssl
Admission Date:  [**2152-4-4**]       Discharge Date:  [**2152-4-16**]

Date of Birth:   [**2084-7-14**]       Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  This is a 67 year old male with
a past medical history significant for hypertension, diabetes
mellitus Type 2 who went to [**Hospital 16039**] Hospital with three days
of chest pain.  At the outside hospital, the patient was
noted to have new left bundle branch block.  He was given
Lovenox times one and transferred to [**Hospital6 649**] for further management.  Upon arrival to [**Hospital6 1760**] the patient reported
shortness of breath without nausea and vomiting.  The patient
was on nitroglycerin drip as well as Morphine drip and
appeared to be in cardiogenic shock with systolic blood
pressures in the 70s to 80s and heartrate approximately 110.
In the Catheterization Laboratory the patient was intubated.
At catheterization they noted a right dominant system.  There
was an right coronary artery 90% ostial, 70% mid left
circumflex, totally occluded 70% of mid left circumflex,
totally occluded ostial 2.  Left anterior descending 90%
ostial, 90% mid, 90% diagonal #1. Left main without
significant disease.  An intra-aortic balloon pump was placed
in the left femoral.  Echocardiogram at the time demonstrated
no tamponade and an ejection fraction of 15 to 20%.  There
was no mitral regurgitation and there was anterior akinesis.
The left anterior descending was stented successfully at the
ostium and mid ostial diagonal #1 was dilated.  The patient
was transferred to the CCU on a Dopamine drip at 20 and
Levophed 20.  At the time his orogastric tube drainage
demonstrated coffee ground emesis.

PAST MEDICAL HISTORY:  Cerebrovascular accident times two,
hypertension, diabetes mellitus Type 2.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Pravachol, Norvasc, Lisinopril,
Aggrenox, Hydrochlorothiazide, and insulin.

SOCIAL HISTORY:  Not obtained.

FAMILY HISTORY:  Not obtained at admission.

PHYSICAL EXAMINATION:  134 regular, blood pressure 107/69,
100% assisted control ventilation 700 by 12, positive
end-expiratory pressure 5, FIO2 of 100%.  Intra-aortic
balloon pump placed.  Generally, he moved all four
extremities.  Head, eyes, ears, nose and throat, sclera
anicteric, right pupil more briskly reactive than left, no
APD.  Neck jugulovenous distension to ear supine.  Lungs
equal, coarse breathsounds bilaterally without crackles or
wheeze.  Heart, tachycardiac, no murmurs appreciated.
Abdomen obese, no pulsatile mass.  Extremities, pulses
present.  Left groin intra-aortic balloon pump, right groin
arterial sheath.  Neurological, he was sedated, did move all
four and was grimacing.  Electrocardiogram, sinus
tachycardiac with left bundle branch block, no evidence of
acute ischemia.

LABORATORY DATA:  2 AM laboratory data, white count 9.6,
hematocrit 34.6, platelets 195, INR 1.2, lactaid 1.5, sodium
142, chloride 108, bicarbonate 22, BUN 37, creatinine 1.7,
glucose 154, creatinine kinase 555, CKMB 51, troponin greater
than 50.  Arterial blood gases at that time, 7.24, 39, 183,
ionized calcium of 1.10.  At 7 AM, white count 12.9,
hematocrit 29.1, platelets 227, INR 1.3, sodium 140,
potassium 4.7, chloride 111, bicarbonate 16, BUN 36,
creatinine 1.6, glucose 300, creatinine kinase 752, AST 83,
ALT 27, alkaline phosphatase 100, bilirubin 0.5, calcium 7.2,
magnesium 1.8, phosphorus 4.3.  Arterial blood gases of 7.28,
33 and 66.

HOSPITAL COURSE:  1.  The patient was admitted to the CCU,
cardiac surgery was deferred at the time, the patient was on
pressors and an intra-aortic balloon pump as well as on
Dopamine and Levophed.  A Swan was placed which demonstrated
a cardiac index of 4.54, cardiac output 10.8, SVR 393.  Thus,
he was doing excellent on pressors and concern SVR may have
been later due to sepsis.  Since his ejection fraction was 15
to 20% and there was apical aneurysm the patient was started
on anticoagulation with a heparin drip and later converted to
Coumadin.  The following day, pressors continued to be weaned
and temporary pacing wire which had been placed in the
Catheterization Laboratory was removed.  The patient was
aggressive diuresed approximately 1 to 3 liters per day to
maximize cardiac performance.  The Levophed was eventually
weaned off by [**4-8**] and the Dobutamine was weaned off on
[**4-13**].  Following that, the patient's ACE inhibitor was
titrated up to 50 mg t.i.d. at which he was maintained.  Once
the patient was extubated and off of pressors and the ACE
inhibitor was maximally dosed, the patient was started on low
dose Carvedilol of approximately 3.125 mg b.i.d. without any
decompensation noted.  He was maintained on Aspirin, Plavix,
beta blocker and Lipitor was initiated on [**4-15**].  The
patient was also started on Lasix 80 mg p.o. q.d.  When the
patient was aggressively being diuresed he responded briskly,
with great response to 40 to 60 mg of Lasix intravenously.

2.  Infectious disease - The patient was on a two week course
of Vancomycin due to Staphylococcus epidermidis which grew
from a femoral line draw.  A femoral line was placed on
admission, and was removed within the first day.  There was
no subsequent positive blood cultures.  The patient also had
a urinary tract infection with pansensitive Klebsiella for
which he was treated with a ten day course, initially with
Levofloxacin and then later Ceftazidime.  He was also covered
for an aspiration pneumonia, that was potentially witnessed
though the sputum was without growth during the course of his
stay.  He was originally on Levofloxacin and Flagyl.  Since
he was afebrile he was discontinued on the Flagyl but he
later spiked and thus was initiated on Ceftazidime which then
covered the pneumonia as well as the Klebsiella urinary tract
infection.  Thus, he was on a two week course of Vancomycin
and a ten day course of Levofloxacin and overlapped by
Ceftazidime for urinary tract infection as well as aspiration
pneumonia.

3.  Pulmonary - The patient was intubated in the
Catheterization Laboratory for hypoxic respiratory failure
secondary to cardiogenic shock.  He was weaned quickly after
resolution of his cardiogenic shock with aggressive diuresis
as previously mentioned.  He was maintained on Albuterol and
Ipratropium nebulizer treatments for wheezing which also
improved with further diuresis.  The patient was discharged
home on metered dose inhalers.

4.  Gastrointestinal - The patient arrived fro the
Catheterization Laboratory and had a slightly positive
orogastric tube lavage which appeared to be coffee ground,
which may have been due to periprocedural bleeding, the
orogastric output was never grossly bloody.  There was never
any evidence of active bleeding, thus the proton pump
inhibitors was started.  Over the course of the [**Hospital 228**]
hospital stay he was transfused 5 units of packed red blood
cells.  Transfusion was likely required due to repeated
phlebotomy, as well as bilateral groin hematoma that had
developed post procedures.

5.  Renal - On admission creatinine was elevated at 1.6, but
never had decreased urinary output except during early trials
of pressure weaning, but urine output never decreased to 0.
Creatinine trended down steadily during hospital course.

6.  Diabetes mellitus, Type 2 - The patient was placed on an
insulin drip, and eventually weaned down to regular insulin
sliding scale as he stabilized.

7.  The patient had a history of stroke, with baseline
right-sided weakness, appeared more pronounced due to
deconditioning but improved over the course of the stay and
no new weaknesses, deficits were noticed.  The patient had
originally been on Aggrenox as an outpatient, but since on
aspirin and Plavix as well as Coumadin, the Aggrenox was not
reinitiated.

PROCEDURES PERFORMED:  The patient had a right internal
jugular catheter, Swan, and then had a left internal jugular
catheter, Swan.  The patient had a cardiac catheterization on
admission with intra-aortic balloon pump placement as well as
a temporary pacing wire placement.  Pacing wire was removed
on [**4-4**] and the intra-aortic balloon pump was removed
by [**4-6**].

DISCHARGE DIAGNOSIS:
1.  Myocardial infarction
2.  Congestive heart failure
3.  Ejection fraction of approximately 20% with an apical
aneurysm
4.  Type 2 diabetes mellitus
5.  History of cerebrovascular accident with right-sided
weakness

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o. q.d.
2.  Plavix 75 mg p.o. q.d.
3.  Carvedilol 3.125 mg p.o. b.i.d.
4.  Captopril 50 mg p.o. t.i.d.
5.  Furosemide 80 mg p.o. q. AM
6.  Lipitor 10 mg p.o. q.d.
7.  Warfarin 5 mg p.o. q. PM, goal INR of 2 to 3 for apical
aneurysm
8.  Protonix 40 mg p.o. q.d.
9.  Regular insulin sliding scale with q. a.c. q. h.s. blood
sugar checks
10. Albuterol and alternate metered dose inhaler q. 6 hours

Diet - Sodium restriction, less than 2 gm per day.  Fluid
restriction 1500 cc per day.

FOLLOW UP: Within seven to ten days with cardiologist, [**First Name11 (Name Pattern1) **]
[**Last Name (NamePattern4) 30311**], MD, phone [**Telephone/Fax (1) 25135**].  The patient's contact
person is his brother-in-law, [**Name (NI) 3788**] [**Name (NI) 49362**], phone [**Telephone/Fax (1) 49363**]
with cell [**Telephone/Fax (1) 49364**].  Mr. [**Name13 (STitle) 49362**] is very involved with Mr.
[**Known lastname 36243**]' care.

DISPOSITION:  The patient is to be discharged to go to the
rehabilitation hospital at Capony Islands in [**Location (un) **]
[**State 350**], phone [**Telephone/Fax (1) 44529**].



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 17134**]
MEDQUIST36

D:  [**2152-4-15**]  19:48
T:  [**2152-4-15**]  19:53
JOB#:  [**Job Number 49365**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Infection and inflammatory reaction due to other vascular device, implant, and graft,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery'}


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 is a 67 year old male with
a past medical history significant for hypertension, diabetes
mellitus Type 2 who went to [**Hospital 16039**] Hospital with three days
of chest pain.  At the outside hospital, the patient was
noted to have new left bundle branch block.  He was given
Lovenox times one and transferred to [**Hospital6 649**] for further management.  Upon arrival to [**Hospital6 1760**] the patient reported
shortness of breath without nausea and vomiting.  The patient
was on nitroglycerin drip as well as Morphine drip and
appeared to be in cardiogenic shock with systolic blood
pressures in the 70s to 80s and heartrate approximately 110.
In the Catheterization Laboratory the patient was intubated.
At catheterization they noted a right dominant system.  There
was an right coronary artery 90% ostial, 70% mid left
circumflex, totally occluded 70% of mid left circumflex,
totally occluded ostial 2.  Left anterior descending 90%
ostial, 90% mid, 90% diagonal #1. Left main without
significant disease.  An intra-aortic balloon pump was placed
in the left femoral.  Echocardiogram at the time demonstrated
no tamponade and an ejection fraction of 15 to 20%.  There
was no mitral regurgitation and there was anterior akinesis.
The left anterior descending was stented successfully at the
ostium and mid ostial diagonal #1 was dilated.  The patient
was transferred to the CCU on a Dopamine drip at 20 and
Levophed 20.  At the time his orogastric tube drainage
demonstrated coffee ground emesis.

MEDICAL HISTORY: Cerebrovascular accident times two,
hypertension, diabetes mellitus Type 2.

MEDICATION ON ADMISSION: Pravachol, Norvasc, Lisinopril,
Aggrenox, Hydrochlorothiazide, and insulin.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Not obtained at admission.

SOCIAL HISTORY: Not obtained. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Infection and inflammatory reaction due to other vascular device, implant, and graft,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery'}
