CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 52-year-old
male with a history of viral pericarditis in [**2155**] who
presented to an outside hospital with left sided chest pain
radiating to his left arm and back, shortness of breath and
diaphoresis.  The patient's symptoms began the night prior to
admission while smoking cigarettes.  The patient reported
similar chest pain with exertion on a few occasions over the
last few months, however, in the past the patient's pain
would go away after a few minutes.  This time the pain was
unremitting.  Patient went to the [**Hospital3 **] Emergency
Room where he was found to have anterior ST elevations and
received Nitroglycerin and Lopressor which took his pain to a
0/10 from [**6-15**] at peak.  The patient was then transferred to
the [**Hospital1 69**] for percutaneous
intervention.  The patient was taken to the catheterization
laboratory here which revealed a 20% left main lesion.  The
LAD had a mid lesion just after the origin of the large
diagonal branch and mild disease on the left circumflex and .
RCA. The culprit LAD lesion was crossed at the wire, dilated
and stented leaving 0 residual stenosis.  The diagonal was
snow plowed and dilated with a 25 mm balloon, leaving a 20%
residual stenosis and timi III flow.  The patient was chest
pain free when admitted to the coronary critical care unit.

MEDICAL HISTORY: Pericarditis.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a smoker with a 37 pack year
history.
Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery
AMI anterior wall, init,Crnry athrscl natve vssl
Admission Date:  [**2170-8-20**]     Discharge Date:  [**2170-8-23**]

Date of Birth:   [**2118-8-16**]     Sex:  M

Service:  Coronary Critical Care Unit

HISTORY OF PRESENT ILLNESS:  The patient is a 52-year-old
male with a history of viral pericarditis in [**2155**] who
presented to an outside hospital with left sided chest pain
radiating to his left arm and back, shortness of breath and
diaphoresis.  The patient's symptoms began the night prior to
admission while smoking cigarettes.  The patient reported
similar chest pain with exertion on a few occasions over the
last few months, however, in the past the patient's pain
would go away after a few minutes.  This time the pain was
unremitting.  Patient went to the [**Hospital3 **] Emergency
Room where he was found to have anterior ST elevations and
received Nitroglycerin and Lopressor which took his pain to a
0/10 from [**6-15**] at peak.  The patient was then transferred to
the [**Hospital1 69**] for percutaneous
intervention.  The patient was taken to the catheterization
laboratory here which revealed a 20% left main lesion.  The
LAD had a mid lesion just after the origin of the large
diagonal branch and mild disease on the left circumflex and .
RCA. The culprit LAD lesion was crossed at the wire, dilated
and stented leaving 0 residual stenosis.  The diagonal was
snow plowed and dilated with a 25 mm balloon, leaving a 20%
residual stenosis and timi III flow.  The patient was chest
pain free when admitted to the coronary critical care unit.

PAST MEDICAL HISTORY:  Pericarditis.

SOCIAL HISTORY:  The patient is a smoker with a 37 pack year
history.

MEDICATIONS:  Aspirin and Rogaine.

PHYSICAL EXAMINATION:  Vitals, temperature 98.0, pulse 95,
blood pressure 122/72, respiratory rate 20, sats 93% on 2
liters nasal cannula.  Generally alert and oriented times
three, in no acute distress, mildly obese male.  HEENT:
Extraocular movements were intact.  He is normocephalic and
atraumatic.  Oropharynx was clear.  Mucus membranes were
moist.  Neck exam, MVP to angle of the mandible while laying
flat around 8 cm, no lymphadenopathy, no thyromegaly.
Cardiovascular exam, normal S1, normal S2 with no murmurs, no
rubs and distant heart sounds.  Pulmonary exam clear to
auscultation bilaterally with no wheezes.  Abdominal exam,
active bowel sounds, soft, nontender, non distended, no
hepatosplenomegaly.  Extremities, 2+ posterior tibialis
pulses bilaterally, 2+ radial pulses bilaterally, no edema
and no hematoma, bruit or bleeding at the cath site.

LABORATORY DATA:  White blood cell count was 12.9, hemoglobin
13.9, hematocrit 39.4, platelet count 228,000, sodium 139,
potassium 4.3, chloride 107, CO2 22, BUN 18, creatinine 1.0,
glucose 115, ALT 107, AST 20.  CK was initially 755 with a CK
MB of 84 and an index of 11.1, calcium 8.7, phosphate 3.6,
magnesium 1.9, triglycerides 101, HDL 55, LDL 125.

HOSPITAL COURSE:
1.  Cardiovascular:  A) Coronary artery disease - the patient
was started on Plavix for a 30 day regimen, Integrilin for 18
hours, Aspirin and Lipitor at 10 mg per day.  The patient's
lipid profile showed evidence of hypercholesterolemia that
was above the level that would be accepted with a patient
with known MI.  Patient's liver tests were normal prior to
starting Lipitor.  The patient is a smoker and is interested
in smoking cessation.  He was encouraged to do so as it will
significantly decrease his risk of another MI.  The patient
was discharged with Wellbutrin to treat smoking related
anxiety.  B) Pump - patient started on Lopressor which was
titrated up to 25 mg [**Hospital1 **].  The patient was also started on
Lisinopril 5 mg q day.  Echocardiogram done on the [**10-22**] showed a normal left atrium with a left ventricle cavity
that was severely dilated.  The left ventricular systolic
function was severely depressed with all walls being severely
hypokinetic to akinetic.  There were no masses or thrombi
seen in the left ventricle.  The right ventricular chamber
size and free wall motion were normal.  The right ventricular
systolic function was normal.  The aortic valve leaflets were
normal with good leaflet excursion, the mitral valve leaflets
were mildly thickened.  Trivial mitral regurgitation was
seen.  There was no pericardial effusion.  Patient's ejection
fraction was estimated to be 25%.  In light of the patient's
poor ejection fraction and overall hypokinesis and akinesis,
the patient was started on a three month regimen of
anticoagulation with Coumadin.  Unfortunately the patient's
INR was subtherapeutic at 1.1 on discharge.  The target INR
for this patient is between [**3-11**].  Patient's anticoagulation
should be continued for three months for prophylaxis for left
ventricular thrombosis.  The patient's left ventricular
function was out of proportion to his known ischemic insult.
Patient was thought to have an underlying cardiomyopathy of
unknown etiology.  It was thought that the most likely cause
of this cardiomyopathy was the viral process that caused his
pericarditis in [**2155**], however, there is no definitive
evidence that this is the case.  Reversible causes of
cardiomyopathy were ruled out.  Patient's TSH was normal.
Patient's HIV titers were checked and were negative.
Patient's iron studies were normal.  Patient's urine and
serum protein electrophoresis studies were normal.  The
patient was told to follow-up with his primary care doctor
and primary cardiologist to discuss the cardiomyopathy and
depressed cardiac function that has resulted from his
illness.  C) Rhythm - the patient had no issues. The patient
was on telemetry throughout his hospitalization.  Of note,
the patient had two runs of non sustained V tach that were
asymptomatic.  In light of the patient's dilated
cardiomyopathy and potential risk for arrhythmias as a result
of that, he was seen by the electrophysiology cardiologist
who determined that he was not a candidate for AICD
placement.

2.  Pulmonary:  The patient satted in the low 90's on two
liters of oxygen by nasal cannula, however, he was able to be
easily weaned off and was satting in the mid to high 90's
when he was discharged.  The patient is a chronic smoker and
he may have mild obstructive lung disease based on his low
sats at admission.  The patient agreed to quit smoking,
however, his PFTs should be checked on an outpatient basis by
his primary care doctor.

3.  Renal:  The patient's BUN and creatinine were stable post
cath despite his large dye load during his catheterization.

4.  Heme:  The patient's H&H were stable throughout his
hospitalization.  During the third hospitalization day, the
patient was noted to have two small hematomas at the groin
cath site, however, these were stable throughout the rest of
his hospitalization and were small, less than 2 cm each.
Patient was instructed to go to the Emergency Room if these
hematomas expanded, however, it was felt that these were low
risk and unlikely to expand.

5.  Prophylaxis:  The patient received Protonix for peptic
ulcer disease and Docusate for constipation throughout his
hospitalization.

DISCHARGE MEDICATIONS:  The patient was discharged with
Lopressor 50 mg [**Hospital1 **], Zestril 5 mg q day, Coumadin 5 mg q day
with target INR of [**3-11**], Lovenox 80 mg q 12 hours
subcutaneously, Plavix 75 mg q day times 26 days after
discharge, Aspirin 325 mg q day, Lipitor 10 mg q day,
Propecia 1 mg q day, Wellbutrin 150 mg q day.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  To home




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], M.D.  [**MD Number(1) 9615**]

Dictated By:[**Last Name (NamePattern1) 11117**]

MEDQUIST36

D:  [**2170-8-28**]  20:15
T:  [**2170-9-1**]  17:56
JOB#:  [**Job Number 105094**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery'}


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 52-year-old
male with a history of viral pericarditis in [**2155**] who
presented to an outside hospital with left sided chest pain
radiating to his left arm and back, shortness of breath and
diaphoresis.  The patient's symptoms began the night prior to
admission while smoking cigarettes.  The patient reported
similar chest pain with exertion on a few occasions over the
last few months, however, in the past the patient's pain
would go away after a few minutes.  This time the pain was
unremitting.  Patient went to the [**Hospital3 **] Emergency
Room where he was found to have anterior ST elevations and
received Nitroglycerin and Lopressor which took his pain to a
0/10 from [**6-15**] at peak.  The patient was then transferred to
the [**Hospital1 69**] for percutaneous
intervention.  The patient was taken to the catheterization
laboratory here which revealed a 20% left main lesion.  The
LAD had a mid lesion just after the origin of the large
diagonal branch and mild disease on the left circumflex and .
RCA. The culprit LAD lesion was crossed at the wire, dilated
and stented leaving 0 residual stenosis.  The diagonal was
snow plowed and dilated with a 25 mm balloon, leaving a 20%
residual stenosis and timi III flow.  The patient was chest
pain free when admitted to the coronary critical care unit.

MEDICAL HISTORY: Pericarditis.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a smoker with a 37 pack year
history. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery'}
