CHIEF COMPLAINT: STEMI

PRESENT ILLNESS: Mr. [**Known lastname 70972**] is a 53 yo with PMH significant for hyperlipidemia
who was in his USOH until 2 evenings ago when he began feeling
"washed out" and short of breath; decided to go to bed early and
sleep in. He was feeling well the next day until yesterday
evening around 7:15 when he was standing in his garage and began
feeling SOB and "woozy." This resolved by sitting; then at 8:40
he was sitting in the living room watching TV with friends and
began feeling woozy, SOB, with [**2167-3-11**] substernal chest pressure
that was not resolved by laying down on the floor. He also
endorsed nausea, vomiting, and cold sweats. His wife called EMS
and he was brought to [**Hospital6 33**] where his CP
continued; urelieved by NTG, morphine, or dilaudid. He was also
given lovenox. Initial EKG showed NSR with 1-1.5 mm II, III, aVF
with loss of ST segment. This was not initially interpreted as
an STEMI until this morning at 6am when CE's turned positive and
Q waves appeared in the inferior leads; at this point he was
started on integrellin; loaded with plavix and transferred to
[**Hospital1 18**] for urgent cath. He was taken to the cath lab at 10am and
was found to have total occlusion of proximal LCX; thrombectomy
was performed and a BMS was placed with resultant TIMI 3 flow.
He was started on a nitro drip in the cath lab for HTN. On
transfer to the CCU he is chest-pain free and [**Hospital1 **] dyspnea but
is complaining of fatigue/nausea.
.
Upon further questioning Mr [**Known lastname 70972**] [**Last Name (Titles) **] any h/o CP or dyspnea.
He routinely walks 1 mi at lunch w/o difficulty. He does smoke
[**12-6**] ppd for 40yrs and has an extensive FH of early MI. He sleeps
on 2 pillows but [**Month/Day (2) **] orthopnea/PND, LE edema, or any other
problems.

MEDICAL HISTORY: Hypercholesterolemia

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99 HR 60 BP 168/81, RR 15, 98% 5L n/c; wt 225lbs
Gen: A&O, NAD
skin: pink
CV: RRR no m/r/g; no carotid bruits; JVD unasssessable
Pulm: CTA anteriorly/laterally
Abd: S/ND/NT
Groin: R groin w/ sheath in place
Ext: no edema; 2+ DP pulses

FAMILY HISTORY: father died of MI at age 57; grandfather with [**Name2 (NI) **] in 50's.

SOCIAL HISTORY: smokes [**12-6**] PPD since age 15. drinks 6 beers 1 night/week. no
drugs. works as chief probation officer
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia
Subendo infarct, initial,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS
Admission Date:  [**2163-12-31**]              Discharge Date:   [**2164-1-3**]

Date of Birth:  [**2110-8-27**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
STEMI

Major Surgical or Invasive Procedure:
Right and left cardiac catheterization with thrombectomy of left
circumflex and placement of bare metal stent to left circumflex
artery.


History of Present Illness:
Mr. [**Known lastname 70972**] is a 53 yo with PMH significant for hyperlipidemia
who was in his USOH until 2 evenings ago when he began feeling
"washed out" and short of breath; decided to go to bed early and
sleep in. He was feeling well the next day until yesterday
evening around 7:15 when he was standing in his garage and began
feeling SOB and "woozy." This resolved by sitting; then at 8:40
he was sitting in the living room watching TV with friends and
began feeling woozy, SOB, with [**2167-3-11**] substernal chest pressure
that was not resolved by laying down on the floor. He also
endorsed nausea, vomiting, and cold sweats. His wife called EMS
and he was brought to [**Hospital6 33**] where his CP
continued; urelieved by NTG, morphine, or dilaudid. He was also
given lovenox. Initial EKG showed NSR with 1-1.5 mm II, III, aVF
with loss of ST segment. This was not initially interpreted as
an STEMI until this morning at 6am when CE's turned positive and
Q waves appeared in the inferior leads; at this point he was
started on integrellin; loaded with plavix and transferred to
[**Hospital1 18**] for urgent cath. He was taken to the cath lab at 10am and
was found to have total occlusion of proximal LCX; thrombectomy
was performed and a BMS was placed with resultant TIMI 3 flow.
He was started on a nitro drip in the cath lab for HTN. On
transfer to the CCU he is chest-pain free and [**Hospital1 **] dyspnea but
is complaining of fatigue/nausea.
.
Upon further questioning Mr [**Known lastname 70972**] [**Last Name (Titles) **] any h/o CP or dyspnea.
He routinely walks 1 mi at lunch w/o difficulty. He does smoke
[**12-6**] ppd for 40yrs and has an extensive FH of early MI. He sleeps
on 2 pillows but [**Month/Day (2) **] orthopnea/PND, LE edema, or any other
problems.

Past Medical History:
Hypercholesterolemia

Social History:
smokes [**12-6**] PPD since age 15. drinks 6 beers 1 night/week. no
drugs. works as chief probation officer

Family History:
father died of MI at age 57; grandfather with [**Name2 (NI) **] in 50's.

Physical Exam:
T 99 HR 60 BP 168/81, RR 15, 98% 5L n/c; wt 225lbs
Gen: A&O, NAD
skin: pink
CV: RRR no m/r/g; no carotid bruits; JVD unasssessable
Pulm: CTA anteriorly/laterally
Abd: S/ND/NT
Groin: R groin w/ sheath in place
Ext: no edema; 2+ DP pulses

Pertinent Results:
WBC 16.9, Hct 44, plt 281
CK 3357, trop 10.72
Cr 0.7
.
Cath findings
CI 2.61
RAP 16 mean
PCWP 20
PA 49/19, mean 30
RV 49/7,
.
LMCA: clean
LAD 40% lesion at origin, diffuse dz after D1 with up to 70%
stenosis; D1 focal 80%
LCX TO prox; BMS placed
RCA diffuse dz with 70% mid lesion
.
Echo: EF 55-60%; no WMA noted; mild LVH

Brief Hospital Course:
Mr [**Known lastname 70972**] is a 53 yo who was transferred from [**Hospital3 **] with an inferior STEMI.  He was taken acutely to the
cath lab where he was found to have an acute occlusion of LCX
which was intervened with thrombectomy and BMS; also with
diffuse CAD involving RCA, LAD, D1.  Of note the The LMCA was
patent. He was started on a nitro drip in the cath lab for htn
and transferred to the CCU.  In the CCU he was weaned of the
nitro drip and started on captopril and metoprolol which was
switched to atenolol 50mg daily for discharge.  He was also
begun on lipitor 80.  Echo showed no wall motion abnormality and
a preserved EF of 55-60% with mild LVH.  He had no clinical
signs of heart failure.  He stayed in normal sinus rhythm.  He
was transferred out to the floor the following day where he met
with physical therapy and did well.  He was counseled about
smoking cessation and he states he plans to quit smoking.
Because of his 3 vessel disease he will likely need CABG within
the next few months as an outpatient and he will be followed by
Dr. [**Last Name (STitle) **] here for cardiology.

Medications on Admission:
none

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.
Disp:*30 Tablet, Sublingual(s)* Refills:*2*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
ST segment elevation myocardial infarction with acute occlusion
of left circumflex artery and diffuse coronary artery disease
but no left main coronary artery disease.
.
hyperlipidemia.


Discharge Condition:
Good.


Discharge Instructions:
Please take all medications as prescribed, please keep all
follow-up appointments. Please call your primary care doctor,
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 36589**], your cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], or return
to the Emergency room if you experience chest pain, shortness of
breath, nausea, vomiting, light-headedness, sweating, abdominal
pain, fevers, chills, or any symptoms that concern you.

Followup Instructions:
Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**2164-1-9**] at
2:00pm. Please call ([**Telephone/Fax (1) 7236**] if questions regarding this
appointment.
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}


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: STEMI

PRESENT ILLNESS: Mr. [**Known lastname 70972**] is a 53 yo with PMH significant for hyperlipidemia
who was in his USOH until 2 evenings ago when he began feeling
"washed out" and short of breath; decided to go to bed early and
sleep in. He was feeling well the next day until yesterday
evening around 7:15 when he was standing in his garage and began
feeling SOB and "woozy." This resolved by sitting; then at 8:40
he was sitting in the living room watching TV with friends and
began feeling woozy, SOB, with [**2167-3-11**] substernal chest pressure
that was not resolved by laying down on the floor. He also
endorsed nausea, vomiting, and cold sweats. His wife called EMS
and he was brought to [**Hospital6 33**] where his CP
continued; urelieved by NTG, morphine, or dilaudid. He was also
given lovenox. Initial EKG showed NSR with 1-1.5 mm II, III, aVF
with loss of ST segment. This was not initially interpreted as
an STEMI until this morning at 6am when CE's turned positive and
Q waves appeared in the inferior leads; at this point he was
started on integrellin; loaded with plavix and transferred to
[**Hospital1 18**] for urgent cath. He was taken to the cath lab at 10am and
was found to have total occlusion of proximal LCX; thrombectomy
was performed and a BMS was placed with resultant TIMI 3 flow.
He was started on a nitro drip in the cath lab for HTN. On
transfer to the CCU he is chest-pain free and [**Hospital1 **] dyspnea but
is complaining of fatigue/nausea.
.
Upon further questioning Mr [**Known lastname 70972**] [**Last Name (Titles) **] any h/o CP or dyspnea.
He routinely walks 1 mi at lunch w/o difficulty. He does smoke
[**12-6**] ppd for 40yrs and has an extensive FH of early MI. He sleeps
on 2 pillows but [**Month/Day (2) **] orthopnea/PND, LE edema, or any other
problems.

MEDICAL HISTORY: Hypercholesterolemia

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99 HR 60 BP 168/81, RR 15, 98% 5L n/c; wt 225lbs
Gen: A&O, NAD
skin: pink
CV: RRR no m/r/g; no carotid bruits; JVD unasssessable
Pulm: CTA anteriorly/laterally
Abd: S/ND/NT
Groin: R groin w/ sheath in place
Ext: no edema; 2+ DP pulses

FAMILY HISTORY: father died of MI at age 57; grandfather with [**Name2 (NI) **] in 50's.

SOCIAL HISTORY: smokes [**12-6**] PPD since age 15. drinks 6 beers 1 night/week. no
drugs. works as chief probation officer 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}
