CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 42 year old
male with a history of coronary artery disease and cirrhosis.
Two days prior to admission, the patient began experiencing
pleuritic chest pain localizing to the left thoracic back and
left flank which was associated with shortness of breath,
dyspnea on exertion with only one flight of stairs.  He
denied any anginal chest pain.  He did report cough with
yellow sputum production.  He called Emergency Medical
Services and was en route to the VA when he became more
hypotensive and was diverted to [**Hospital1 188**].

MEDICAL HISTORY: 1.  ETOH.
2.  Cirrhosis.
3.  Coronary artery disease with history of myocardial
infarction.
4.  Cerebrovascular accident without sequelae.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smokes half to one pack per
day.  The patient lives with his wife and 22 month old twins.
Acute respiratory failure,Primary pulmonary hypertension,Pneumonia, organism unspecified,Septic shock,Unspecified pleural effusion,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified
Acute respiratry failure,Prim pulm hypertension,Pneumonia, organism NOS,Septic shock,Pleural effusion NOS,Acute kidney failure NOS,Parox ventric tachycard,CHF NOS
Admission Date:  [**2165-12-10**]     Discharge Date:  [**2165-12-12**]

Date of Birth:   [**2123-5-16**]     Sex:  M

Service:  MICU ORANG

HISTORY OF PRESENT ILLNESS:   The patient is a 42 year old
male with a history of coronary artery disease and cirrhosis.
Two days prior to admission, the patient began experiencing
pleuritic chest pain localizing to the left thoracic back and
left flank which was associated with shortness of breath,
dyspnea on exertion with only one flight of stairs.  He
denied any anginal chest pain.  He did report cough with
yellow sputum production.  He called Emergency Medical
Services and was en route to the VA when he became more
hypotensive and was diverted to [**Hospital1 188**].

In the Emergency Room, he was complaining of back pain, left
chest pain, cough, dyspnea and he was diaphoretic.  He denied
fever, chills, nausea, vomiting or abdominal pain.

In the Emergency Room, the blood pressure was originally
75/68; pulse 126.  He was 90% on six liters nasal cannula.
He received five liters of normal saline with a response in
his blood pressure, however, the tachycardia persisted.  The
patient required increasing amounts of supplemental oxygen,
eventually requiring a non-rebreather, and the decision was
made to intubate the patient for respiratory failure.

In addition to this, he received ceftriaxone and Azithromycin
as well as Flagyl for presumed pneumonia.  After intubation,
the patient's blood pressure again dropped and he was started
on pressors to maintain his blood pressure.  The patient was
managed aggressively per a sepsis protocol.

PAST MEDICAL HISTORY:
1.  ETOH.
2.  Cirrhosis.
3.  Coronary artery disease with history of myocardial
infarction.
4.  Cerebrovascular accident without sequelae.

MEDICATIONS:
1.  Propranolol.
2.  Folate.
3.  Multivitamin.

ALLERGIES:   No known drug allergies.

SOCIAL HISTORY:   The patient smokes half to one pack per
day.  The patient lives with his wife and 22 month old twins.

PHYSICAL EXAMINATION:   Examination on admission is
significant for a temperature of 98.6 F.; pulse 109; blood
pressure 129/80; the patient was intubated and sedated.
There was mild scleral icterus.  The patient had coarse
breath sounds bilaterally and decreased breath sounds at the
left base.  The patient was tachycardic but normal S1 and S2.
Abdomen was soft, nontender, nondistended.

The patient was found to have a white blood cell count of 15.

SUMMARY OF HOSPITAL COURSE:  The patient had a CT scan to
assess for aortic aneurysm, however, none was found.  The
patient also had a CT scan to assess for possible pulmonary
embolism of which there was no evidence for this.  The
patient was noted to have only interval large increase in a
left pleural effusion.  There was also a question of a
pericardial effusion, however, this was not demonstrated to
be significant on an echocardiogram which was performed at
that time.

The patient was admitted to the Medical Intensive Care Unit
floor for further care.  A left chest tube was placed for the
large effusion which showed an exudative effusion.  The
patient was continued on empiric antibiotics for pneumonia,
sepsis and shock.  As well, the patient had an increasing
pressor requirement.  [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 104**] stimulation test revealed an
inappropriate response and the patient was managed with
fludrocortisone and hydrocortisone.

During the hospital course, the patient had an increasing
pressor requirement.  He had evidence of shunt physiology
with decreased oxygen saturations and increased PEEP.  He was
also noted to have elevated pulmonary artery pressures by
Swan measurement.  The pulmonary pressures were just over 80
systolic.

The patient developed disseminated intervascular
coagulopathy.  He also experienced acute renal failure.

In the evening prior to the patient's passing, he experienced
an episode of ventricular tachycardia for which he was
shocked out of this rhythm with success.  The patient
required an epinephrine drip after this to maintain blood
pressures and frequent boluses of the epinephrine.

Through conversations with the family, the decision was made
to not pursue further attempts at defibrillation should the
patient again develop ventricular tachycardia.

In the morning of [**12-12**], the patient again went into a
ventricular tachycardic rhythm and became asystolic shortly
afterwards.  At the time, the patient had been receiving
multiple pressors for blood pressure support in addition to
this to maintain his oxygenation; attempts at nitrous oxide
as well as Flovent aerosolized had been attempted without
further success.

There was evidence for septic shock as well as cardiogenic
shock and ultimately passed away after an episode of
ventricular tachycardia.

The patient's wife as well as his mother and father were
notified and they agreed to a post mortem examination.



                          [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7585**]

Dictated By:[**Name8 (MD) 12502**]

MEDQUIST36

D:  [**2165-12-12**]  17:16
T:  [**2165-12-13**]  20:49
JOB#:  [**Job Number 54231**]
{'Acute respiratory failure,Primary pulmonary hypertension,Pneumonia, organism unspecified,Septic shock,Unspecified pleural effusion,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Congestive heart failure, 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: 

PRESENT ILLNESS: The patient is a 42 year old
male with a history of coronary artery disease and cirrhosis.
Two days prior to admission, the patient began experiencing
pleuritic chest pain localizing to the left thoracic back and
left flank which was associated with shortness of breath,
dyspnea on exertion with only one flight of stairs.  He
denied any anginal chest pain.  He did report cough with
yellow sputum production.  He called Emergency Medical
Services and was en route to the VA when he became more
hypotensive and was diverted to [**Hospital1 188**].

MEDICAL HISTORY: 1.  ETOH.
2.  Cirrhosis.
3.  Coronary artery disease with history of myocardial
infarction.
4.  Cerebrovascular accident without sequelae.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smokes half to one pack per
day.  The patient lives with his wife and 22 month old twins. 

### Response:
{'Acute respiratory failure,Primary pulmonary hypertension,Pneumonia, organism unspecified,Septic shock,Unspecified pleural effusion,Acute kidney failure, unspecified,Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified'}
