CHIEF COMPLAINT: weakness, lower retrosternal squeezing chest pain

PRESENT ILLNESS: 87 yo female c 1.5 days of persistent lower retrosternal chest
pain, max [**4-6**], described as "squeezing" type discomfort
accompanied c generalized weakness, nausea and lightheadedness.
This pain was preceeded by a gastric reflux event, pt tried
taking Mylanta which did not relieve this sensation.  States
that these episodes have been occurring for the past 1.5 years c
syncope and light headedness.  This had been worked up at [**Hospital 1263**]
Hospital and was told she has atypical chest pain likely related
to her GERD.  At [**Doctor Last Name 1263**], she recently had her atenolol increased
from 50'->75' [**Last Name (LF) **], [**First Name3 (LF) **] EGD c dilatation for a stricture and a nml
stress test.

MEDICAL HISTORY: HTN
Angina in the [**2170**]
GERD
Esophageal stricture s/p dilatation [**2195-6-15**]
Hiatal hernia
Hypothyroidism
Lumbar stenosis

MEDICATION ON ADMISSION: ASA 325' qd
Atenolol 75' qd
Estrogen 0.625' qd
Levoxyl 100' qd
Niacin 250' tid
Norvasc 5' qd
Zestril 40' qd
Protonix 40' qd
MVI qd
Xalatan 5% 1 drop b/l qd

ALLERGIES: Demerol / Percocet

PHYSICAL EXAM: Upon admission: 98.0  150/50->124/60  48  18  99% RA
Gen: slightly anxious, A&Ox3, elderly
HEENT: PERRL, EOMI, mmm, no nuchal rigidity
Cardio - very bradycardic but regular rhythm, distant heart
sounds
Pulm - CTA b/l, no wheezes/rales/rhonchi
Abd - S/NT/ND, BS present
Ext - no cyanosis/clubbing/edema, diminished pedal pulses
Neuro - CN II-XII intact, [**3-2**] muscle strength equal and b/l of
UE and LE
DTRs 1+ and equal b/l, negative babsinki/clonus

FAMILY HISTORY: Father deceased at 85 yo: old age
Mother deceased at 64 yo: cardiac complications
3 siblings c atherosclerosis

SOCIAL HISTORY: Retired legal secretary
Lives alone in [**Location (un) 538**], states she is doing well
Denies any etoh, smoking or IVDA
Atrioventricular block, complete,Other and unspecified angina pectoris,Esophageal reflux,Unspecified acquired hypothyroidism,Unspecified essential hypertension
Atriovent block complete,Angina pectoris NEC/NOS,Esophageal reflux,Hypothyroidism NOS,Hypertension NOS
Admission Date:  [**2195-6-29**]              Discharge Date:   [**2195-7-3**]


Service: MED

Allergies:
Demerol / Percocet

Attending:[**First Name3 (LF) 1055**]
Chief Complaint:
weakness, lower retrosternal squeezing chest pain

Major Surgical or Invasive Procedure:
[**2195-6-30**] pacemaker placement


History of Present Illness:
87 yo female c 1.5 days of persistent lower retrosternal chest
pain, max [**4-6**], described as "squeezing" type discomfort
accompanied c generalized weakness, nausea and lightheadedness.
This pain was preceeded by a gastric reflux event, pt tried
taking Mylanta which did not relieve this sensation.  States
that these episodes have been occurring for the past 1.5 years c
syncope and light headedness.  This had been worked up at [**Hospital 1263**]
Hospital and was told she has atypical chest pain likely related
to her GERD.  At [**Doctor Last Name 1263**], she recently had her atenolol increased
from 50'->75' [**Last Name (LF) **], [**First Name3 (LF) **] EGD c dilatation for a stricture and a nml
stress test.

Past Medical History:
HTN
Angina in the [**2170**]
GERD
Esophageal stricture s/p dilatation [**2195-6-15**]
Hiatal hernia
Hypothyroidism
Lumbar stenosis

Social History:
Retired legal secretary
Lives alone in [**Location (un) 538**], states she is doing well
Denies any etoh, smoking or IVDA

Family History:
Father deceased at 85 yo: old age
Mother deceased at 64 yo: cardiac complications
3 siblings c atherosclerosis

Physical Exam:
Upon admission: 98.0  150/50->124/60  48  18  99% RA
Gen: slightly anxious, A&Ox3, elderly
HEENT: PERRL, EOMI, mmm, no nuchal rigidity
Cardio - very bradycardic but regular rhythm, distant heart
sounds
Pulm - CTA b/l, no wheezes/rales/rhonchi
Abd - S/NT/ND, BS present
Ext - no cyanosis/clubbing/edema, diminished pedal pulses
Neuro - CN II-XII intact, [**3-2**] muscle strength equal and b/l of
UE and LE
DTRs 1+ and equal b/l, negative babsinki/clonus

Pertinent Results:
[**2195-6-29**] 02:00PM   GLUCOSE-125* UREA N-15 CREAT-1.0 SODIUM-130*
POTASSIUM-5.0 CHLORIDE-94* TOTAL CO2-25 ANION GAP-16
[**2195-6-29**] 02:00PM   CK(CPK)-87
[**2195-6-29**] 02:00PM   cTropnT-<0.01
[**2195-6-29**] 02:00PM   CK-MB-NotDone
[**2195-6-29**] 02:00PM   WBC-8.4 RBC-4.28 HGB-13.5 HCT-38.8 MCV-91
MCH-31.4 MCHC-34.7 RDW-12.2
[**2195-6-29**] 02:00PM   NEUTS-63.7 LYMPHS-27.4 MONOS-6.0 EOS-1.9
BASOS-1.0
[**2195-6-29**] 02:00PM   PLT COUNT-220
[**2195-6-29**] 02:00PM   PT-12.7 PTT-27.0 INR(PT)-1.1

Brief Hospital Course:
1. Cardiac: 3rd degree heart block s/p pacemaker placement; HTN
Patient initially very bradycardic with mild HTN upon admission.
Her EKG showed a RBBB with a ventricular rate of 36. Her
atenolol was decreased from 75 mg to 25 mg qd. Her cardiac
enzymes were negative. The patient was placed on telemetry and
transferred to the floor.  Shortly after transfer, it was noted
on telemetry that the patient had progressed into 3rd degree
heart block.  She was mentating normally and was hemodynamically
stable, but her heart rate continued in the 30s. Cardiology was
consulted and it was decided at this time that the patient
should be transferred from the medicine service to the CCU. In
the CCU, the patient had a temporary pacer initially placed.
Then on [**2195-6-30**] a pacemaker was placed.  Patient did experience a
lead misplacement complication and a mild pericardial effusion.
She did recover from this and was completely asymptomatic at the
time of discharge to the rehab facility. An echo was repeated on
[**2195-7-2**] which showed that the overall left ventrical systolic
function was preserved, right ventrical size and motion was
normal, small pericardial effusion which was slightly larger
than the prior study, no tamponade. Her EF was 45-50% c mild
aortic and moderate mitral regurgitation.  A chest x-ray
following her pacer placement showed that her cardiac leads were
in the correct position and there was no active lung disease.
The patient also became hypotensive following pacer placement
and therefore all hypertensive medications were held.  Her blood
pressure then increased to 148/73 and atenolol 25 mg qd was
re-started with good control.  The patient became mildly
hypertensive and therefore her out-patient regimen was restarted
except that Norvasc 5 mg qd was held.  Therefore the patient was
d/c'ed c atenolol 50' qd, Zestril 40' qd and ASA 325' qd. The
patient will follow-up with her PCP for further evaluation and
monitoring in one week and will follow-up with the device clinic
on [**2195-7-7**] c Dr. [**First Name4 (NamePattern1) 3692**] [**Last Name (NamePattern1) 284**].

2. Hematology
The patient's hematocrit was noted to have decreased following
her pacer placement from the high 30s to the low 30s.  She was
asymptomatic, no BRBPR, guiac negative, no hematuria.  A CT of
the abdomen showed that there was no retroperitoneal hemorrhage.
 She was closely monitored and her hematocrit stabilized and she
remained asymptomatic.  It was felt that this likely had been
due to her procedure and the pericardial effusion. Her rehab
facility will re-check her hematocrit in [**1-29**] days to ensure
stabilization. The patient was also started on Vitamin B12,
Folate 1' qd and Iron 325' qd.

3. GERD/Esophageal stricture s/p EGD [**5-31**]
The patient remained asymptomatic throughout her hospital stay
and was maintained on her out-patient protonix 40 mg qd.  She
will follow-up with PCP for further care.

4. Hypothyroidism
The patient remained stable and her outpatient Levoxyl was
continued as previously prescribed.

5. r/o DVT
The patient experienced new onset left foot swelling following
her pacer placement. Patient had also been taking estrogen upon
admission. There were no palpable cords, no calf tenderness, no
SOB/CP. No tenderness in foot or lower extremity.  An US of the
extremity was performed to verify there were no DVTs. She had
pneumoboots for the majority of her hospital stay as well.

Medications on Admission:
ASA 325' qd
Atenolol 75' qd
Estrogen 0.625' qd
Levoxyl 100' qd
Niacin 250' tid
Norvasc 5' qd
Zestril 40' qd
Protonix 40' qd
MVI qd
Xalatan 5% 1 drop b/l qd

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO QD (once a day).
Disp:*30 Tablet(s)* Refills:*2*
2. Levothyroxine Sodium 100 mcg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Niacin 250 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*90 Tablet(s)* Refills:*2*
4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Multivitamin     Capsule Sig: One (1) Cap PO QD (once a day).
Disp:*30 Cap(s)* Refills:*2*
6. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic  HS
(at bedtime).
Disp:*1 drops* Refills:*2*
7. Zolpidem Tartrate 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed.
Disp:*30 Tablet(s)* Refills:*0*
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
Disp:*1 ML(s)* Refills:*0*
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
Disp:*30 Tablet(s)* Refills:*0*
11. Vitamin B-12 1,000 mcg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*2*
12. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
14. Iron 325 (65) mg Tablet Sig: One (1) Tablet PO once a day
for 3 months.
Disp:*90 Tablet(s)* Refills:*0*
15. Estrogens Conj Synthetic A 0.625 mg Tablet Sig: One (1)
Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
16. Zestril 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
3rd degree heart block s/p pacemaker placement


Discharge Condition:
Stable

Discharge Instructions:
Make and keep all follow-up appointments.
Take all medications as directed.
Go to the ED if you experience chest pain, shortness of breath,
fevers, chills, nausea, vomiting.

Followup Instructions:
1. Primary care follow-up in 1 week: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5762**], [**Hospital 7200**] Center in [**Location (un) 538**], [**Telephone/Fax (1) 608**]
2. Device Clinic with Dr. [**First Name4 (NamePattern1) 3692**] [**Last Name (NamePattern1) 284**] [**2195-7-7**] 2:00 pm.
[**Hospital Ward Name 23**] Center Cardiac SE, [**Telephone/Fax (1) 59**]
3. Please re-check labs: CBC and chem 7 in [**1-29**] days.



Completed by:[**2195-7-3**]
{'Atrioventricular block, complete,Other and unspecified angina pectoris,Esophageal reflux,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}


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: weakness, lower retrosternal squeezing chest pain

PRESENT ILLNESS: 87 yo female c 1.5 days of persistent lower retrosternal chest
pain, max [**4-6**], described as "squeezing" type discomfort
accompanied c generalized weakness, nausea and lightheadedness.
This pain was preceeded by a gastric reflux event, pt tried
taking Mylanta which did not relieve this sensation.  States
that these episodes have been occurring for the past 1.5 years c
syncope and light headedness.  This had been worked up at [**Hospital 1263**]
Hospital and was told she has atypical chest pain likely related
to her GERD.  At [**Doctor Last Name 1263**], she recently had her atenolol increased
from 50'->75' [**Last Name (LF) **], [**First Name3 (LF) **] EGD c dilatation for a stricture and a nml
stress test.

MEDICAL HISTORY: HTN
Angina in the [**2170**]
GERD
Esophageal stricture s/p dilatation [**2195-6-15**]
Hiatal hernia
Hypothyroidism
Lumbar stenosis

MEDICATION ON ADMISSION: ASA 325' qd
Atenolol 75' qd
Estrogen 0.625' qd
Levoxyl 100' qd
Niacin 250' tid
Norvasc 5' qd
Zestril 40' qd
Protonix 40' qd
MVI qd
Xalatan 5% 1 drop b/l qd

ALLERGIES: Demerol / Percocet

PHYSICAL EXAM: Upon admission: 98.0  150/50->124/60  48  18  99% RA
Gen: slightly anxious, A&Ox3, elderly
HEENT: PERRL, EOMI, mmm, no nuchal rigidity
Cardio - very bradycardic but regular rhythm, distant heart
sounds
Pulm - CTA b/l, no wheezes/rales/rhonchi
Abd - S/NT/ND, BS present
Ext - no cyanosis/clubbing/edema, diminished pedal pulses
Neuro - CN II-XII intact, [**3-2**] muscle strength equal and b/l of
UE and LE
DTRs 1+ and equal b/l, negative babsinki/clonus

FAMILY HISTORY: Father deceased at 85 yo: old age
Mother deceased at 64 yo: cardiac complications
3 siblings c atherosclerosis

SOCIAL HISTORY: Retired legal secretary
Lives alone in [**Location (un) 538**], states she is doing well
Denies any etoh, smoking or IVDA 

### Response:
{'Atrioventricular block, complete,Other and unspecified angina pectoris,Esophageal reflux,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}
