CHIEF COMPLAINT: s/p cardiac arrest

PRESENT ILLNESS: This is a 63 yo F w/ CAD s/p multiple stents and CABG x 1 in
[**2132**] (LIMA to LAD) not on ASA/Plavix, AVR, and GI bleed who
presents s/p cardiac arrest. Per husband pt had some trouble
breathing for last few days. Felt weak last night, poor po.
Tonight she felt poorly, nauseous, uneasy. Had BM and tried to
vomit but was unable to do so. She had elevated blood sugars
around 300 so took an extra Avandia. Tonight, had episode of
gasping for air then stopped breathing- husband started CPR
while she was still on the couch (he ? if she possibly
aspirated) then called 911. This was around 1730. EMS arrived 15
minutes later and gaive 1 shock, epi, lidocaine, atropine.
Patient at that time had wide complex tachycardia without pulse.
She was then inutbated with RSI, fent, rocuronium. Patient went
to [**Hospital1 487**] then transferred to [**Hospital1 18**]. Started on hypothermia at
[**Hospital1 487**] and then continued on admission.
.
In the ED vitals were 130/86, 94, intubated. She was given ASA
325 and Plavix 300. Patient had head CT that showed no head
bleed. She was then started on ASA, Plavix, heparin gtt, and
lidocaine gtt. Once in the CCU an echo was done that showed new
wall motion abnormality. Patient was then taken to cath lab.
.
Of note patient was on plavix for 1 year with many bleeds and
blood transfusions. Still anemic at times and gets epo shots
prn.
.
ROS not completed since patient intubated.

MEDICAL HISTORY: - Coronary Artery Disease - s/p 2 Cypher stents to LAD in [**1-28**],
then angioplasty for LAD ISR in [**7-28**]
- Congestive Heart Failure(Systolic)
- Prior Mechanical Aortic Valve Replacement in [**2113**]
- History of GI Bleed secondary to AV Malformations of Small
Bowel and Stomach
- History of Stroke/TIA in [**2123**], no residual effects
- Carotid Disease, Left Carotid Atery Occlusion
- Hypertension
- Hyperlipidemia
- Type II Diabetes Mellitus
- Anemia secondary to GI Bleed
- Depression
- Anal Fissure Repair
- Hemorrhoidectomy

MEDICATION ON ADMISSION: Atorvastatin 20mg po qday
Docusate Sodium
Ferrous Gluconate 325mg po qday
Lisinopril 2.5mg po qday
Metformin 1g [**Hospital1 **]
Metoprolol Tartrate 25mg [**Hospital1 **]
Omeprazole [Prilosec] 20mg po qday
Rosiglitazone [Avandia] 4mg po qday
Sertraline [Zoloft] 25mg po qday
Warfarin 6mg po qday

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: GENERAL: Intubated, not responsive to painful stimuli
HEENT: Intubated, PERRL.
NECK: Supple, JVD difficult to appreciate
CARDIAC: RRR, 2/6 systolic murmur loudest at upper sternal
border
LUNGS: course breath sounds bilaterally
ABDOMEN: Soft, NTND. hypoactive bowel sounds
EXTREMITIES: no edema, cool feet
PULSES:
Right: 1+ radial, DP not palpable
Left: 1_ radial, DP not palpable

FAMILY HISTORY: Mother and father both died of MI in 60s; brother (age 69) has
heart murmur

SOCIAL HISTORY: Disabled
Lives with spouse
Smoked 1/2PPD for 25 years quit [**2130-12-22**]
No h/o EtOH or drugs
Acute myocardial infarction of unspecified site, initial episode of care,Acute kidney failure, unspecified,Acute on chronic systolic heart failure,Pneumonitis due to inhalation of food or vomitus,Anoxic brain damage,Acidosis,Cardiac arrest,Anemia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Percutaneous transluminal coronary angioplasty status,Heart valve replaced by other means
AMI NOS, initial,Acute kidney failure NOS,Ac on chr syst hrt fail,Food/vomit pneumonitis,Anoxic brain damage,Acidosis,Cardiac arrest,Anemia NOS,Cor ath unsp vsl ntv/gft,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Depressive disorder NEC,Status-post ptca,Heart valve replac NEC
Admission Date:  [**2134-7-3**]              Discharge Date:   [**2134-7-9**]

Date of Birth:  [**2070-10-28**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 2901**]
Chief Complaint:
s/p cardiac arrest

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
This is a 63 yo F w/ CAD s/p multiple stents and CABG x 1 in
[**2132**] (LIMA to LAD) not on ASA/Plavix, AVR, and GI bleed who
presents s/p cardiac arrest. Per husband pt had some trouble
breathing for last few days. Felt weak last night, poor po.
Tonight she felt poorly, nauseous, uneasy. Had BM and tried to
vomit but was unable to do so. She had elevated blood sugars
around 300 so took an extra Avandia. Tonight, had episode of
gasping for air then stopped breathing- husband started CPR
while she was still on the couch (he ? if she possibly
aspirated) then called 911. This was around 1730. EMS arrived 15
minutes later and gaive 1 shock, epi, lidocaine, atropine.
Patient at that time had wide complex tachycardia without pulse.
She was then inutbated with RSI, fent, rocuronium. Patient went
to [**Hospital1 487**] then transferred to [**Hospital1 18**]. Started on hypothermia at
[**Hospital1 487**] and then continued on admission.
.
In the ED vitals were 130/86, 94, intubated. She was given ASA
325 and Plavix 300. Patient had head CT that showed no head
bleed. She was then started on ASA, Plavix, heparin gtt, and
lidocaine gtt. Once in the CCU an echo was done that showed new
wall motion abnormality. Patient was then taken to cath lab.
.
Of note patient was on plavix for 1 year with many bleeds and
blood transfusions. Still anemic at times and gets epo shots
prn.
.
ROS not completed since patient intubated.


Past Medical History:
- Coronary Artery Disease - s/p 2 Cypher stents to LAD in [**1-28**],
then angioplasty for LAD ISR in [**7-28**]
- Congestive Heart Failure(Systolic)
- Prior Mechanical Aortic Valve Replacement in [**2113**]
- History of GI Bleed secondary to AV Malformations of Small
Bowel and Stomach
- History of Stroke/TIA in [**2123**], no residual effects
- Carotid Disease, Left Carotid Atery Occlusion
- Hypertension
- Hyperlipidemia
- Type II Diabetes Mellitus
- Anemia secondary to GI Bleed
- Depression
- Anal Fissure Repair
- Hemorrhoidectomy


Social History:
Disabled
Lives with spouse
Smoked 1/2PPD for 25 years quit [**2130-12-22**]
No h/o EtOH or drugs


Family History:
Mother and father both died of MI in 60s; brother (age 69) has
heart murmur

Physical Exam:
GENERAL: Intubated, not responsive to painful stimuli
HEENT: Intubated, PERRL.
NECK: Supple, JVD difficult to appreciate
CARDIAC: RRR, 2/6 systolic murmur loudest at upper sternal
border
LUNGS: course breath sounds bilaterally
ABDOMEN: Soft, NTND. hypoactive bowel sounds
EXTREMITIES: no edema, cool feet
PULSES:
Right: 1+ radial, DP not palpable
Left: 1_ radial, DP not palpable


Pertinent Results:
Admission:
[**2134-7-3**] 11:40PM BLOOD WBC-19.4*# RBC-3.79* Hgb-11.1* Hct-35.6*
MCV-94# MCH-29.2 MCHC-31.1 RDW-18.2* Plt Ct-341
[**2134-7-3**] 11:40PM BLOOD PT-21.7* PTT-25.7 INR(PT)-2.0*
[**2134-7-3**] 11:40PM BLOOD Glucose-432* UreaN-35* Creat-1.6* Na-136
K-4.0 Cl-102 HCO3-20* AnGap-18
[**2134-7-4**] 12:32AM BLOOD Type-ART Rates-/12 PEEP-5 pO2-264*
pCO2-47* pH-7.27* calTCO2-23 Base XS--5 Intubat-INTUBATED
Comment-GREEN TOP
[**2134-7-3**] 11:45PM BLOOD Lactate-4.8*
[**2134-7-4**] 04:01PM BLOOD freeCa-1.09*
.
Cardiac Enzymes:
[**2134-7-3**] 11:40PM BLOOD CK-MB-40* MB Indx-8.9*
[**2134-7-3**] 11:40PM BLOOD cTropnT-0.41*
[**2134-7-3**] 11:40PM BLOOD CK(CPK)-447*
[**2134-7-4**] 05:00AM BLOOD CK-MB-87* MB Indx-11.4* cTropnT-0.85*
[**2134-7-4**] 05:00AM BLOOD CK(CPK)-761*
[**2134-7-4**] 04:00PM BLOOD CK-MB-96* MB Indx-14.3* cTropnT-1.1*
[**2134-7-4**] 04:00PM BLOOD CK(CPK)-673*
[**2134-7-5**] 06:21AM BLOOD CK-MB-83* MB Indx-10.2* cTropnT-1.55*
[**2134-7-5**] 06:21AM BLOOD CK(CPK)-814*
.
Discharge labs:
[**2134-7-9**] 05:51AM BLOOD WBC-10.7 RBC-2.61* Hgb-7.4* Hct-22.8*
MCV-87 MCH-28.3 MCHC-32.4 RDW-17.9* Plt Ct-322
[**2134-7-9**] 04:09AM BLOOD PT-18.4* PTT-25.6 INR(PT)-1.7*
[**2134-7-9**] 04:09AM BLOOD Glucose-121* UreaN-53* Creat-1.9* Na-135
K-3.7 Cl-101 HCO3-23 AnGap-15
[**2134-7-9**] 04:09AM BLOOD Calcium-7.7* Phos-4.3 Mg-2.7*
[**2134-7-9**] 06:27AM BLOOD Type-ART pO2-113* pCO2-33* pH-7.45
calTCO2-24 Base XS-0
.
[**2134-7-9**] CXR:
ET tube tip is 4.9 cm above the carina. NG tube tip is in the
stomach.
Moderate cardiomegaly is stable. Right IJ catheter tip is in
unchanged
position at the cavoatrial junction. Widened mediastinum with
engorgement of the vasculature is unchanged. Left lower lobe
atelectasis has markedly
improved. Perihilar and right lower lobe opacities have worsened
and
consistent with moderate pulmonary edema. There is no evident
pneumothorax.
.
[**2134-7-7**] EEG:
IMPRESSION: This video EEG telemetry captured no pushbutton
activations. No electrographic seizures or interictal
epileptiform
discharges were seen. The background was very low voltage on
this day
of recording with some visible beta frequency activity at times.
This
finding suggests the presence of a severe encephalopathy which
can occur
because of hypoxic ischemic injury, medications, metabolic
disturbances,
and other etiologies of diffuse brain dysfunction.
.
[**2134-7-5**] Echo:
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy with normal cavity size. There is mild
to moderate regional left ventricular systolic dysfunction with
hypokinesis of the distal half of the septum and anterior walls,
and apex. The remaining segments contract normally (LVEF = 45
%). [Intrinsic left ventricular systolic function is likely more
depressed given the severity of mitral regurgitation.] No masses
or thrombi are seen in the left ventricle. Right ventricular
chamber size and free wall motion are normal. A well seated
mechanical aortic valve prosthesis is present. The prosthetic
aortic valve leaflets appear mobile, but the transaortic
gradient is higher than expected for this type of prosthesis.
Trace aortic regurgitation is seen. [The amount of regurgitation
present is normal for this prosthetic aortic valve.] The mitral
valve leaflets are mildly thickened. There is no mitral
stenosis. Severe (4+) mitral regurgitation is seen. There is
mild pulmonary artery systolic hypertension. There is an
anterior space which most likely represents a prominent fat pad.

IMPRESSION: Suboptimal image quality. Mild symmetric left
ventricular hypertrophy with regional systolic dysfunction c/w
CAD. Well seated mechanical AVR with mobile leaflets but
increased gradient. Severe mitral regurgitation. Mild pulmonary
artery systolic hypertension.
.
[**2134-7-4**] CT head:
No acute intracranial hemorrhage.
.
[**2134-7-4**] Cath:
COMMENTS:
1. Coronary angiography in this right dominant system
demonstrated two
vessel disease. The LMCA had no significant disease. The LAD was

occluded proximally with filling of the mid-vessel in a
retrograde
fashion from the LIMA; the distal LAD filled via minimal
collaterals
from the LCx. The LCx had no significant disease. The RCA was
diffusely
disease and occluded in the mid segment; the distal vessel
filled
antegrade and via collaterals from the LCx.
2. Arterial conduit angiography revaeled the LIMA to be widely
patent up
until the distal anastamosis site with retrograde filling of the
mid LAD
but occlusion of the LAD distal to the graft without the
appearance of
an acute event.
3. Limited resting hemodynamics revealed mild systemic arterial
hypertension.

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Patent LIMA-LAD with occlusion of the LAD distal to the
anastamosis
site of uncertain age not suitable for PCI.
3. Mild systemic arterial hypertension.
.
[**2134-7-4**] Echo:
There is mild to moderate regional left ventricular systolic
dysfunction with distal anterior, septal and apical akinesis.
The remaining segments are incompletely visualized but appear to
contract normally (LVEF = 35-40%). Right ventricular chamber
size and free wall motion are normal. A mechanical aortic valve
prosthesis is present. The aortic valve prosthesis cannot be
adequately assessed. The mitral valve leaflets are mildly
thickened. Moderate (2+) mitral regurgitation is seen. There is
no pericardial effusion.

IMPRESSION: Mild to moderate regional left ventricular systolic
dysfunction c/w mid LAD-territory infarction. Moderate mitral
regurgitation. Mechanical aortic prosthesis - cannot assess
function.


Brief Hospital Course:
This is a 63 yo F w/ CAD s/p multiple stents and CABG x 1 in
[**2132**] (LIMA to LAD) not on ASA/Plavix, AVR, and GI bleed who
presents s/p cardiac arrest.
.
# S/P cardiac arrest: Patient was intubated and cooled per
Arctic Sun protocol. Echo was done that showed new wall motion
abnormality so patient was taken to cardiac catherization.
However, at catherization, no vessel was deemed necessary of
stenting. Patient had EEG that showed very limited neurological
activity. [**Name (NI) **] husband and family made patient [**Name (NI) 3225**] after
extensive discussion with CCU team and neurology. Patient passed
away on [**2134-7-9**].
.
# CAD s/p multiple PCI and CABG: Patient was on aspirin and
plavix. Patient had cardiac catherization per above.
.
# DM 2: Manged with insulin
.
# h/o GI bleed: Patient has a h/o GI bleed [**2-23**] AVMs. Patient's
HCT slowly trended down this hospitalization. However, patient
did not receive transfusion during hospial stay.
.

Medications on Admission:
Atorvastatin 20mg po qday
Docusate Sodium
Ferrous Gluconate 325mg po qday
Lisinopril 2.5mg po qday
Metformin 1g [**Hospital1 **]
Metoprolol Tartrate 25mg [**Hospital1 **]
Omeprazole [Prilosec] 20mg po qday
Rosiglitazone [Avandia] 4mg po qday
Sertraline [Zoloft] 25mg po qday
Warfarin 6mg po qday


Discharge Medications:
patient deceased [**2134-7-9**]

Discharge Disposition:
Expired

Discharge Diagnosis:
Patient deceased [**2134-7-9**]

Discharge Condition:
Patient deceased [**2134-7-9**]

Discharge Instructions:
Patient deceased [**2134-7-9**]

Followup Instructions:
Patient deceased [**2134-7-9**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]

Completed by:[**2134-7-9**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Acute kidney failure, unspecified,Acute on chronic systolic heart failure,Pneumonitis due to inhalation of food or vomitus,Anoxic brain damage,Acidosis,Cardiac arrest,Anemia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Percutaneous transluminal coronary angioplasty status,Heart valve replaced by other means'}


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: s/p cardiac arrest

PRESENT ILLNESS: This is a 63 yo F w/ CAD s/p multiple stents and CABG x 1 in
[**2132**] (LIMA to LAD) not on ASA/Plavix, AVR, and GI bleed who
presents s/p cardiac arrest. Per husband pt had some trouble
breathing for last few days. Felt weak last night, poor po.
Tonight she felt poorly, nauseous, uneasy. Had BM and tried to
vomit but was unable to do so. She had elevated blood sugars
around 300 so took an extra Avandia. Tonight, had episode of
gasping for air then stopped breathing- husband started CPR
while she was still on the couch (he ? if she possibly
aspirated) then called 911. This was around 1730. EMS arrived 15
minutes later and gaive 1 shock, epi, lidocaine, atropine.
Patient at that time had wide complex tachycardia without pulse.
She was then inutbated with RSI, fent, rocuronium. Patient went
to [**Hospital1 487**] then transferred to [**Hospital1 18**]. Started on hypothermia at
[**Hospital1 487**] and then continued on admission.
.
In the ED vitals were 130/86, 94, intubated. She was given ASA
325 and Plavix 300. Patient had head CT that showed no head
bleed. She was then started on ASA, Plavix, heparin gtt, and
lidocaine gtt. Once in the CCU an echo was done that showed new
wall motion abnormality. Patient was then taken to cath lab.
.
Of note patient was on plavix for 1 year with many bleeds and
blood transfusions. Still anemic at times and gets epo shots
prn.
.
ROS not completed since patient intubated.

MEDICAL HISTORY: - Coronary Artery Disease - s/p 2 Cypher stents to LAD in [**1-28**],
then angioplasty for LAD ISR in [**7-28**]
- Congestive Heart Failure(Systolic)
- Prior Mechanical Aortic Valve Replacement in [**2113**]
- History of GI Bleed secondary to AV Malformations of Small
Bowel and Stomach
- History of Stroke/TIA in [**2123**], no residual effects
- Carotid Disease, Left Carotid Atery Occlusion
- Hypertension
- Hyperlipidemia
- Type II Diabetes Mellitus
- Anemia secondary to GI Bleed
- Depression
- Anal Fissure Repair
- Hemorrhoidectomy

MEDICATION ON ADMISSION: Atorvastatin 20mg po qday
Docusate Sodium
Ferrous Gluconate 325mg po qday
Lisinopril 2.5mg po qday
Metformin 1g [**Hospital1 **]
Metoprolol Tartrate 25mg [**Hospital1 **]
Omeprazole [Prilosec] 20mg po qday
Rosiglitazone [Avandia] 4mg po qday
Sertraline [Zoloft] 25mg po qday
Warfarin 6mg po qday

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: GENERAL: Intubated, not responsive to painful stimuli
HEENT: Intubated, PERRL.
NECK: Supple, JVD difficult to appreciate
CARDIAC: RRR, 2/6 systolic murmur loudest at upper sternal
border
LUNGS: course breath sounds bilaterally
ABDOMEN: Soft, NTND. hypoactive bowel sounds
EXTREMITIES: no edema, cool feet
PULSES:
Right: 1+ radial, DP not palpable
Left: 1_ radial, DP not palpable

FAMILY HISTORY: Mother and father both died of MI in 60s; brother (age 69) has
heart murmur

SOCIAL HISTORY: Disabled
Lives with spouse
Smoked 1/2PPD for 25 years quit [**2130-12-22**]
No h/o EtOH or drugs 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Acute kidney failure, unspecified,Acute on chronic systolic heart failure,Pneumonitis due to inhalation of food or vomitus,Anoxic brain damage,Acidosis,Cardiac arrest,Anemia, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Depressive disorder, not elsewhere classified,Percutaneous transluminal coronary angioplasty status,Heart valve replaced by other means'}
