CHIEF COMPLAINT: Severe back pain

PRESENT ILLNESS: Ms. [**Known lastname 82798**] is an 88yo woman with h/o  diabetes,
osteoarthritis, polymyalgia rheumatica who p/w NSTEMI. Pt has
long history of low back pain due to her OA and this most recent
episode began on [**2186-7-5**]. Pain was exacerbated by movement,
radiating to hips/legs and so severe that pt could not get out
of bed in AM of [**2186-7-6**]. Pt self-medicated with ~14 percocet
tablets in ~12 hours. At baseline, pt uses a walker and has
chronic pain [**1-30**] arthritis

MEDICAL HISTORY: Dyslipidemia
Diabetes (diet-controlled)
Hyperlipidemia
Hypertension
Arthritis
Lumbar stenosis
Scoliosis
Polymyalgia rheumatica

MEDICATION ON ADMISSION: Valsartan 80 mg PO BID
Metoprolol 12.5 mg [**Hospital1 **]
Prilosec 30 mg PO qday
Ferrous Gluconate 324 mg PO BID
Simvastatin 5 mg qhs
Caltrate 600+D 1 tablet [**Hospital1 **]
[**Hospital1 **] 81 mg daily
Lasix 40 mg PO qam
Lasix 20 mg PO qpm
Centrum Silver MVI 1 tablet daily
Senna daily prn
Oxycodone 5/325 mg q4-6h prn for pain

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: ADMISSION EXAM
VS: T=97.2 BP=95/59 HR=78 RR=21 O2 sat=99% on 15L nonrebreather

FAMILY HISTORY: Father died of gastric cancer, children alive and well.  No
family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Divorced, retired secretary, three children currently in [**Location (un) 86**]
area, lives at [**Location (un) **] [**Hospital3 **] w/ VNA services
-Tobacco history: Never smoked
-ETOH: Once a week
-Illicit drugs: Never
Subendocardial infarction, initial episode of care,Acute systolic heart failure,Hyposmolality and/or hyponatremia,Cardiogenic shock,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lumbosacral spondylosis without myelopathy,Pure hyperglyceridemia,Unspecified essential hypertension,Scoliosis [and kyphoscoliosis], idiopathic,Polymyalgia rheumatica,Coronary atherosclerosis of native coronary artery,Mitral valve disorders
Subendo infarct, initial,Ac systolic hrt failure,Hyposmolality,Cardiogenic shock,Atrial fibrillation,DMII wo cmp nt st uncntr,Lumbosacral spondylosis,Pure hyperglyceridemia,Hypertension NOS,Idiopathic scoliosis,Polymyalgia rheumatica,Crnry athrscl natve vssl,Mitral valve disorder
Admission Date:  [**2186-7-6**]              Discharge Date:   [**2186-7-7**]


Service: MEDICINE

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
Severe back pain

Major Surgical or Invasive Procedure:
Cardiac catheterization

History of Present Illness:
Ms. [**Known lastname 82798**] is an 88yo woman with h/o  diabetes,
osteoarthritis, polymyalgia rheumatica who p/w NSTEMI. Pt has
long history of low back pain due to her OA and this most recent
episode began on [**2186-7-5**]. Pain was exacerbated by movement,
radiating to hips/legs and so severe that pt could not get out
of bed in AM of [**2186-7-6**]. Pt self-medicated with ~14 percocet
tablets in ~12 hours. At baseline, pt uses a walker and has
chronic pain [**1-30**] arthritis

Pt was taken to [**Hospital1 18**]-[**Location (un) 620**] where CXR was suggestive of PNA
vs. CHF, EKG w/ ST changes. Pt was given ceftriaxone and
azithromycin IV for presumed PNA and fentanyl/oxycodone for
pain. Pt also had 15 minutes of substernal chest pain that was
resolved w/ oxygen. Pt was given morphine, dopamine, Plavix
600mg [**Last Name (LF) **], [**First Name3 (LF) **] 325mg, heparin bolus 4000 units and transferred to
[**Hospital1 18**] for PCI and further evaluation. Vital signs at
[**Hospital1 18**]-[**Location (un) 620**]: T98.8 HR100 BP121/76 RR14 O2sat 100% RA

Upon arrival at [**Hospital1 18**], pt was taken to cath lab for PCI and
found to have distal left main disease (90%), moderate diffuse
LAD disease, LCX occlusion (90% origin), RCA occlusion (100%
proximal w/ left to right collaterals), LVEF 20% and severe
mitral regurg (4+). During the procedure, pt developed AFib and
BP dropped to 77/56, then 83/58. Pt was given 450 cc fluid bolus
and started on dopamine (5 mcg --> 10 mcg) and amiodarone gtts.
Pt was deemed not a candidate for cardiac surgery and high risk
for stenting, transferred to CCU for close monitoring and
medical management.

Upon arrival to the CCU, pt was continued on dopamine 10mcg -->
5 mcg and amiodarone. Femoral swan and arterial lines were
maintained; pt was comfortable and had no complaints. Per the
family, the pt had a three pound weight gain over the past week
and increasing peripheral edema. She denied PND or orthopnea.

On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, cough, hemoptysis, black stools or red stools.
All of the other review of systems were negative. Of note, pt
did not report fever/chills/productive cough.

Cardiac review of systems is notable for absence of dyspnea on
exertion, palpitations, syncope or presyncope. Pt is relatively
inactive at baseline.

Past Medical History:
Dyslipidemia
Diabetes (diet-controlled)
Hyperlipidemia
Hypertension
Arthritis
Lumbar stenosis
Scoliosis
Polymyalgia rheumatica

Social History:
Divorced, retired secretary, three children currently in [**Location (un) 86**]
area, lives at [**Location (un) **] [**Hospital3 **] w/ VNA services
-Tobacco history: Never smoked
-ETOH: Once a week
-Illicit drugs: Never

Family History:
Father died of gastric cancer, children alive and well.  No
family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
ADMISSION EXAM
VS: T=97.2 BP=95/59 HR=78 RR=21 O2 sat=99% on 15L nonrebreather

GENERAL: Pleasant, pale elderly woman in NAD. Oriented x3. Mood,
affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, mild pallor or cyanosis of the oral mucosa. No
xanthalesma.
NECK: Supple with visible JVD elevated to jawline.
CARDIAC: PMI located in 5th intercostal space, laterally
displaced from midclavicular line. RR, normal S1, S2. No S3 or
S4. No gallops or rubs. Grade [**3-2**] holosystolic murmur in left
lower sternal border. LUNGS: No chest wall deformities,
scoliosis or kyphosis. Resp were unlabored, no accessory muscle
use. Fine bibasilar crackles. No wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c; 2+ pitting edema bilaterally.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES: Right and left DP/PT +

Pertinent Results:
[**2186-7-6**] 08:50PM BLOOD CK-MB-72* MB Indx-19.1* cTropnT-0.71*
[**2186-7-7**] 06:00AM BLOOD CK-MB-193* MB Indx-16.4* cTropnT-2.92*

[**2186-7-7**] 06:00AM BLOOD ALT-207* AST-498* LD(LDH)-702*
CK(CPK)-1180* AlkPhos-355* TotBili-1.6*

[**2186-7-7**] 06:00AM BLOOD WBC-6.6# RBC-2.83* Hgb-8.7* Hct-27.1*
MCV-96 MCH-30.8 MCHC-32.2 RDW-14.2 Plt Ct-247

[**2186-7-7**] 06:16AM BLOOD Lactate-4.8*


Brief Hospital Course:
Ms. [**Known lastname 82798**] was initially seen at an outside hospital before
being transferred to [**Hospital1 18**] for cardiac catheterization following
an episode of chest pain and EKG with diffuse ST changes
concerning for left pain disease. Upon arrival to [**Hospital1 18**], she
underwent emergent PCI and was found to have severe three vessel
disease (RCA, left main, left circumflex occlusions). Cardiac
enzymes on arrival were elevated (CK 376  MB72  MBI 19.1  Tr
0.71). TTE demonstrated LVEF 25%. The hemodynamic readings (high
RA, increased PCWP, decreased CO, increased SVR) consistent with
cardiogenic shock. After much consideration it was determined
she was not a surgical candidate and her disease was not
amendable to stenting.  After arriving in the CCU, discussion
were held with the patient and her family and it was decided to
not pursue aggressive medical care.  Rather, the decision was
made to pursue comfort as the primary goal.  Given this
decision, life prolonging medications were stopped.  Ms.
[**Known lastname 82798**] died peacefully with her family at her bedside at 7pm
on [**2186-7-7**]. Autopsy was declined.

Medications on Admission:
Valsartan 80 mg PO BID
Metoprolol 12.5 mg [**Hospital1 **]
Prilosec 30 mg PO qday
Ferrous Gluconate 324 mg PO BID
Simvastatin 5 mg qhs
Caltrate 600+D 1 tablet [**Hospital1 **]
[**Hospital1 **] 81 mg daily
Lasix 40 mg PO qam
Lasix 20 mg PO qpm
Centrum Silver MVI 1 tablet daily
Senna daily prn
Oxycodone 5/325 mg q4-6h prn for pain

Discharge Medications:
Expired.

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary: Acute myocardial infarction, coronary artery disease,
cardiogenic shock
Secondary: Hypertension, hyperlipidemia, diabetes mellitus,
polymyalgia rheumatica

Discharge Condition:
Expired.

Discharge Instructions:
Expired.

Followup Instructions:
Expired.
{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Hyposmolality and/or hyponatremia,Cardiogenic shock,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lumbosacral spondylosis without myelopathy,Pure hyperglyceridemia,Unspecified essential hypertension,Scoliosis [and kyphoscoliosis], idiopathic,Polymyalgia rheumatica,Coronary atherosclerosis of native coronary artery,Mitral valve disorders'}


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: Severe back pain

PRESENT ILLNESS: Ms. [**Known lastname 82798**] is an 88yo woman with h/o  diabetes,
osteoarthritis, polymyalgia rheumatica who p/w NSTEMI. Pt has
long history of low back pain due to her OA and this most recent
episode began on [**2186-7-5**]. Pain was exacerbated by movement,
radiating to hips/legs and so severe that pt could not get out
of bed in AM of [**2186-7-6**]. Pt self-medicated with ~14 percocet
tablets in ~12 hours. At baseline, pt uses a walker and has
chronic pain [**1-30**] arthritis

MEDICAL HISTORY: Dyslipidemia
Diabetes (diet-controlled)
Hyperlipidemia
Hypertension
Arthritis
Lumbar stenosis
Scoliosis
Polymyalgia rheumatica

MEDICATION ON ADMISSION: Valsartan 80 mg PO BID
Metoprolol 12.5 mg [**Hospital1 **]
Prilosec 30 mg PO qday
Ferrous Gluconate 324 mg PO BID
Simvastatin 5 mg qhs
Caltrate 600+D 1 tablet [**Hospital1 **]
[**Hospital1 **] 81 mg daily
Lasix 40 mg PO qam
Lasix 20 mg PO qpm
Centrum Silver MVI 1 tablet daily
Senna daily prn
Oxycodone 5/325 mg q4-6h prn for pain

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: ADMISSION EXAM
VS: T=97.2 BP=95/59 HR=78 RR=21 O2 sat=99% on 15L nonrebreather

FAMILY HISTORY: Father died of gastric cancer, children alive and well.  No
family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Divorced, retired secretary, three children currently in [**Location (un) 86**]
area, lives at [**Location (un) **] [**Hospital3 **] w/ VNA services
-Tobacco history: Never smoked
-ETOH: Once a week
-Illicit drugs: Never 

### Response:
{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Hyposmolality and/or hyponatremia,Cardiogenic shock,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lumbosacral spondylosis without myelopathy,Pure hyperglyceridemia,Unspecified essential hypertension,Scoliosis [and kyphoscoliosis], idiopathic,Polymyalgia rheumatica,Coronary atherosclerosis of native coronary artery,Mitral valve disorders'}
