CHIEF COMPLAINT: acute mi, respiratory failure

PRESENT ILLNESS: 67M with PMH of DM2, HTN, and obesity who presented to OSH
w/SSCP x 1 hour on [**2127-3-28**]. +N, V, and diaphoresis. EKG
demonstrated STE V2-V3 so started on heparin and aggrestat and
transferred to [**Hospital1 18**] for cath. Angiography here revealed 100%
new occlusion of LAD, moderate LMCA stenosis, and mildly diffuse
disease of RCA. PCI stenting of LAD with 3.5 x 16 DES. Pt had
been feeling well PTA, including playing golf 2d PTA.

MEDICAL HISTORY: 1. Type II diabetes mellitus
2. Colon CA
3. Gout

MEDICATION ON ADMISSION: Aspirin
Lopressor
Aggrastat
Heparin

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: HR 97 BP 89/63 on IABP
Gen: intubated, sedated.
HEENT: PERRL, MMM, no icterus
CV: normal S1/S2, no murmurs, rubs, gallps.
Pul: CTA b/l
Abd: obese, nt, nd +bs
Ext: distal pulses intact

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home with wife.
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Pneumonitis due to inhalation of food or vomitus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified septicemia,Severe sepsis,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Gout, unspecified,Personal history of malignant neoplasm of gastrointestinal tract, unspecified
AMI anterior wall, init,Cardiogenic shock,CHF NOS,Atrial fibrillation,Ac kidny fail, tubr necr,Food/vomit pneumonitis,Hyp kid NOS w cr kid V,Meth sus pneum d/t Staph,Septicemia NOS,Severe sepsis,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Obesity NOS,Gout NOS,Hx of GI malignancy NOS
Admission Date:  [**2127-3-29**]              Discharge Date:   [**2127-4-10**]

Date of Birth:  [**2060-4-10**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
acute mi, respiratory failure

Major Surgical or Invasive Procedure:
percutaneous coronary intervention

History of Present Illness:
67M with PMH of DM2, HTN, and obesity who presented to OSH
w/SSCP x 1 hour on [**2127-3-28**]. +N, V, and diaphoresis. EKG
demonstrated STE V2-V3 so started on heparin and aggrestat and
transferred to [**Hospital1 18**] for cath. Angiography here revealed 100%
new occlusion of LAD, moderate LMCA stenosis, and mildly diffuse
disease of RCA. PCI stenting of LAD with 3.5 x 16 DES. Pt had
been feeling well PTA, including playing golf 2d PTA.

Past Medical History:
1. Type II diabetes mellitus
2. Colon CA
3. Gout

Social History:
Lives at home with wife.

Family History:
NC

Physical Exam:
VS: HR 97 BP 89/63 on IABP
Gen: intubated, sedated.
HEENT: PERRL, MMM, no icterus
CV: normal S1/S2, no murmurs, rubs, gallps.
Pul: CTA b/l
Abd: obese, nt, nd +bs
Ext: distal pulses intact

Pertinent Results:
[**2127-3-29**] 04:51AM BLOOD WBC-25.9* RBC-4.44* Hgb-14.0 Hct-41.2
MCV-93 MCH-31.5 MCHC-33.9 RDW-13.2 Plt Ct-360
[**2127-3-29**] 04:51AM BLOOD PT-14.8* PTT-63.8* INR(PT)-1.4
[**2127-3-29**] 04:51AM BLOOD Glucose-411* UreaN-24* Creat-1.3* Na-135
K-4.2 Cl-100 HCO3-16* AnGap-23
[**2127-3-30**] 04:29AM BLOOD ALT-130* AST-434* LD(LDH)-[**2076**]*
CK(CPK)-1532* AlkPhos-65 Amylase-146* TotBili-0.5 DirBili-0.1
IndBili-0.4
[**2127-3-29**] 04:51AM BLOOD CK(CPK)-3381*
[**2127-3-30**] 04:29AM BLOOD CK-MB-395* MB Indx-25.8* cTropnT->25

Echo [**3-30**]: mild symmetric LVH. LV cavity size is normal. Overall
LV sys fxn severely depressed, EF 15%. Ant and septal severe HK
and lateral and apical akinesis are present with some some
preservation of inferior wall motion.


Brief Hospital Course:
1) Cardiovascular:

a) Pump: Mr. [**Known lastname **] was admitted after a large anterior wall MI.
An echocardiogram performed on [**2127-3-30**] showed anterolateral
wall akinesis with an approximate EF of 15%. He was initially
supported on levophed, dopamine and dobutamine, i addition to an
intraaortic balloon pump.  Dopamine was weaned off on [**3-30**],
levophed was weaned off on [**4-2**].  Dobutamine was off [**4-3**] but
restarted [**4-4**].  Beta blockers and ace-inhibitors were held
while he was maintained on pressors and ionotropic support.

For diuresis, he was placed on a lasix drip at 5-15mg/hr.
Because he was on so many drips, despite double-concentrating
them, he required lasix plus nesiritide for adequate diuresis.
Pt passed away on [**2127-4-10**]

b) Rhythm: during cardiac catheterization, he had a brief
episode of ventricular tachycardia.  An amiodarone drip was
started and then discontinued on [**3-30**]. On [**3-31**] however, he went
into rapid atrial fibrillation which was attributed to volume
overload.  Cardioversion was attempted twice, followed by
re-loading amiodarone, and another attempt.  After diuresis and
several hours on amiodarone, he reverted to normal sinus rhythm
spontaneously.  He was loaded with 400 PO TID x1 week followed
by 400mg [**Hospital1 **] [**Last Name (un) 2557**] [**4-7**].

c) Ischemia: his initial ischemic event was likely an acute
occlusive thrombus of LAD.  He is status post placement of drug
eluting stents to his LAD.
Aspirin and atorvastatin were continued.  Heparin drip was
continued for his IABP and also for his atrial fibrillation and
low ejection fraction.

Coumadin will be started prior to discharge.

# ID/Respiratory: Post-cath, the patient was found to have
leukocytosis and fevers.
He was initially treated with six days of levofloxacin
([**Date range (1) 12721**]) for empiric treatment of a positive UTI and this was
changed to vanco + flagyl for empiric treatment MRSA pneumonia.
He was briefly on aztreonam, flagyl and cipro for broad coverage
given  some gram negative rods seen on a sputum culture.  On
[**4-5**] the patient developed an erythematous maculopapular rash on
his flanks and chest.  On the suspicion that this was a
drug-rash, and given that the predominant organism on his
cultures were gram positive cocci, only the vanco-flagyl were
continued.

# Renal: ARF likley due to poor forward flow, dye load. Urine
sed w/hyaline casts. ?ATN. Baseline Cr is 1.3.  Creatinine
improved with dobutamine despite agressive diuresis with I>>>O.
We continued to monitor creat closely while diuresing.

# Anemia: having little drops every few days - ?phlebotomy
- transfuse 1 unit pRBC's [**4-5**]
.
# Nutrition ?????? NGT insertion for medications. Maintain NPO.
Nutrition consult.
.
# Endo: We maintained tight glucose control with an insulin
dripg.

# PPx- lansoprazole

# Access-RIJ, left A-line, L arterial sheath with balloon pump
now d/ced, PIV. Successfully placed L-IJ x2 on [**4-6**] but 1 port
didn't flow both times so concerned about clot. Plan to switch
central lines given continued ID concerns.

# Code: FULL CODE

Medications on Admission:
Aspirin
Lopressor
Aggrastat
Heparin

Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Coronary artery disease

Discharge Condition:
Deceased
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Pneumonitis due to inhalation of food or vomitus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified septicemia,Severe sepsis,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Gout, unspecified,Personal history of malignant neoplasm of gastrointestinal tract, unspecified'}


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: acute mi, respiratory failure

PRESENT ILLNESS: 67M with PMH of DM2, HTN, and obesity who presented to OSH
w/SSCP x 1 hour on [**2127-3-28**]. +N, V, and diaphoresis. EKG
demonstrated STE V2-V3 so started on heparin and aggrestat and
transferred to [**Hospital1 18**] for cath. Angiography here revealed 100%
new occlusion of LAD, moderate LMCA stenosis, and mildly diffuse
disease of RCA. PCI stenting of LAD with 3.5 x 16 DES. Pt had
been feeling well PTA, including playing golf 2d PTA.

MEDICAL HISTORY: 1. Type II diabetes mellitus
2. Colon CA
3. Gout

MEDICATION ON ADMISSION: Aspirin
Lopressor
Aggrastat
Heparin

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: HR 97 BP 89/63 on IABP
Gen: intubated, sedated.
HEENT: PERRL, MMM, no icterus
CV: normal S1/S2, no murmurs, rubs, gallps.
Pul: CTA b/l
Abd: obese, nt, nd +bs
Ext: distal pulses intact

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives at home with wife. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Congestive heart failure, unspecified,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Pneumonitis due to inhalation of food or vomitus,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Methicillin susceptible pneumonia due to Staphylococcus aureus,Unspecified septicemia,Severe sepsis,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Gout, unspecified,Personal history of malignant neoplasm of gastrointestinal tract, unspecified'}
