CHIEF COMPLAINT: Chest pain and jaw tightness

PRESENT ILLNESS: 56 yo M w/ no significant PMH, who woke up this AM with chest
pain and jaw tightness that brought him to the Emergency
Department. He has not had a long history of chest pain,
relating his first episode to Sunday morning. On Sunday, he went
on a 10.5 mile race. He reports that 7 minutes into the race as
he started going uphill, he started having non-radiating,
left-sided chest pressure that lasted for about 8 minutes. He
has never had this chest pressure before. He was asymptomatic on
Monday, and then when he woke up Tuesday morning, he felt the
same non-radiating left-sided chest pressure  that felt a little
more intense than before and lasted for one minute. He denies
any associated nausea or diaphoresis. He got ready and went into
work over on the [**Hospital Ward Name 516**] of [**Hospital1 18**] and he started to have
left-sided chest pressure again at 11:30am that radiated to the
right side of his chest and felt associated parasthesias in
bilateral upper extremities and felt jaw tightness, along with
diaphoresis. ECG showed ST elevation in leads I, aVL, V2-[**Street Address(2) 109357**] depressions. At this point, he went to the [**Hospital1 18**]
ED and was taken to the cath lab.
.
In the cath lab, shown to have complete occlusion of proximal
LAD, and is now s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) 5175**]. IVUS post-PCI showed good
apposition and the pt was hemodynamically stable.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: Nephrolithiasis

MEDICATION ON ADMISSION: Multivitamins, omega 3 fatty acids, saw [**Location (un) 6485**], glucosamine,
vitamin E and D.

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Macrodantin

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS: T= 97.8 BP= 119/71 HR=78 RR=19 O2 sat= 98% RA
GENERAL: NAD. Very pleasant. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.
- Mother:  HTN
- Father:  died of thyroid cancer 30 years ago
- Brothers: HL

SOCIAL HISTORY: Works in Research Administration on the [**Hospital Ward Name 516**] of [**Hospital1 18**].
- Tobacco history:  None
- ETOH:  Occasional
- Illicit drugs:  None
Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias
AMI anterior wall, init,Crnry athrscl natve vssl,Cardiac dysrhythmias NEC
Admission Date:  [**2138-11-18**]              Discharge Date:   [**2138-11-21**]

Date of Birth:  [**2081-11-20**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamide Antibiotics) / Macrodantin

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
Chest pain and jaw tightness

Major Surgical or Invasive Procedure:
[**2138-11-18**]: Cardiac catheterization with drug-eluting stent
placement in the proximal LAD


History of Present Illness:
56 yo M w/ no significant PMH, who woke up this AM with chest
pain and jaw tightness that brought him to the Emergency
Department. He has not had a long history of chest pain,
relating his first episode to Sunday morning. On Sunday, he went
on a 10.5 mile race. He reports that 7 minutes into the race as
he started going uphill, he started having non-radiating,
left-sided chest pressure that lasted for about 8 minutes. He
has never had this chest pressure before. He was asymptomatic on
Monday, and then when he woke up Tuesday morning, he felt the
same non-radiating left-sided chest pressure  that felt a little
more intense than before and lasted for one minute. He denies
any associated nausea or diaphoresis. He got ready and went into
work over on the [**Hospital Ward Name 516**] of [**Hospital1 18**] and he started to have
left-sided chest pressure again at 11:30am that radiated to the
right side of his chest and felt associated parasthesias in
bilateral upper extremities and felt jaw tightness, along with
diaphoresis. ECG showed ST elevation in leads I, aVL, V2-[**Street Address(2) 109357**] depressions. At this point, he went to the [**Hospital1 18**]
ED and was taken to the cath lab.
.
In the cath lab, shown to have complete occlusion of proximal
LAD, and is now s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) 5175**]. IVUS post-PCI showed good
apposition and the pt was hemodynamically stable.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
Nephrolithiasis

Social History:
Works in Research Administration on the [**Hospital Ward Name 516**] of [**Hospital1 18**].
- Tobacco history:  None
- ETOH:  Occasional
- Illicit drugs:  None

Family History:
- No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.
- Mother:  HTN
- Father:  died of thyroid cancer 30 years ago
- Brothers: HL

Physical Exam:
ADMISSION PHYSICAL EXAM
VS: T= 97.8 BP= 119/71 HR=78 RR=19 O2 sat= 98% RA
GENERAL: NAD. Very pleasant. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: No JVD appreciated.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
palpable. No abdominial bruits.
EXTREMITIES: No c/c/e. Right radial sight with TR band.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ Radial 2+ DP 2+ PT 2+
.
DISCHARGE PHYSICAL EXAM
Vitals - Tm=Tc:98.2 (range 97.0-98.2 o/n) HR:64-86
BP:97-110/57-73 RR: 16-20 02 sat: 100%RA
Weight: 88.0kg (90.6kg on admission)
Tele: SR o/n
GENERAL: middle-aged white male, well-groomed, AAOx3, found
resting comfortably in supine position
NECK: No JVD appreciated. JVP difficult to visualize at 0, 15,
30 and 45 degrees HOB
CARDIAC: unchanged from prior; PMI located in 5th intercostal
space, midclavicular line. No heaves/lifts noted. Regular Rate
and Rhythm @ 70s bpm on exam, normal S1, S2. No m/r/g. No S3 or
S4.
LUNGS: Resp unlabored @ 10bpm, no accessory muscle use. CTAB,
anterior+posteriorly, no crackles, wheezes or rhonchi
appreciated.
ABDOMEN: Soft, NTND. No HSM or tenderness. HJR negative
EXTREMITIES: No c/c/e. Two peripheral IV lines in place (distal
LUE, R antecubital), sites clean, dry and intact w/o erythema or
hematoma.
PULSES: Right: Carotid 2+ DP 2+ PT 2+; Left: Carotid 2+ Radial
2+ DP 2+ PT 2+

Pertinent Results:
ADMISSION LABS
[**2138-11-18**] 12:20PM BLOOD WBC-5.1 RBC-4.95 Hgb-14.7 Hct-42.0 MCV-85
MCH-29.8 MCHC-35.1* RDW-12.9 Plt Ct-177
[**2138-11-18**] 12:20PM BLOOD Neuts-59.6 Lymphs-32.3 Monos-5.2 Eos-2.0
Baso-0.8
[**2138-11-18**] 12:20PM BLOOD PT-12.9 PTT-25.5 INR(PT)-1.1
[**2138-11-18**] 12:20PM BLOOD Glucose-113* UreaN-22* Creat-1.2 Na-138
K-3.9 Cl-102 HCO3-27 AnGap-13
[**2138-11-18**] 12:20PM BLOOD cTropnT-0.17*
[**2138-11-18**] 07:55PM BLOOD CK-MB-50* MB Indx-6.6* cTropnT-1.74*
[**2138-11-19**] 04:11AM BLOOD CK-MB-41* MB Indx-5.3 cTropnT-2.23*
.
DISCHARGE LABS
[**2138-11-21**] 06:55AM BLOOD WBC-4.9 RBC-4.42* Hgb-13.0* Hct-38.0*
MCV-86 MCH-29.4 MCHC-34.2 RDW-13.1 Plt Ct-168
[**2138-11-21**] 06:55AM BLOOD Glucose-106* UreaN-17 Creat-1.1 Na-139
K-4.1 Cl-103 HCO3-29 AnGap-11
[**2138-11-21**] 06:55AM BLOOD Calcium-8.8 Phos-2.8 Mg-2.0
[**2138-11-19**] 04:11AM BLOOD ALT-32 AST-137* CK(CPK)-769* AlkPhos-51
TotBili-0.6
[**2138-11-19**] 04:11AM BLOOD Triglyc-75 HDL-68 CHOL/HD-2.7 LDLcalc-101
LDLmeas-112
[**2138-11-19**] 04:11AM BLOOD %HbA1c-5.6 eAG-114
[**2138-11-20**] 06:00AM BLOOD TSH-5.2*
.
IMAGING
[**2138-11-18**], Cardiac Catheterization:
COMMENTS:
1. Selective coronary angiography of this right dominant system
revealed
1 vessel coronary artery disease. The LM, LCx and RCA were free
of
angiographically apparent disease. The LAD had 100% proximal
occlusion
with 30% stenosis of mid-LAD and 30% stenosis at origin
diameter.
2. Limited resting hemodynamics revealed mildy reduced systemic
arterial
pressure of 98/72mmHg.
3. Successful Export thrombectomy, PTCA and stenting of proximal
LAD
with 3.0x12mm Promus drug eluting stent postdilated to 3.5mm.
4. Successful IVUS of LAD demonstrating adequate stent strut
apposition.
5. Successful hemostasis of right radial arteriotomy with TR
band.
DIAGNOSIS:
1. Anterior wall STEMI.
2. Succesful [**Month/Day/Year **] in proximal LAD.
.
[**2138-11-19**], Trans-Thoracic Echocardiogram:
LEFT ATRIUM:
- elongated
LEFT VENTRICLE:
- normal wall thickness
- normal cavity size
- moderate-to-severe regional left ventricular systolic
dysfunction
- akinesis of mid-to-distal anterior septum anterior wall and
apex
- hypokinesis of basal septum and anterior wall
- indeterminate left ventricular diastolic function
- EF=30-35%
RIGHT VENTRICLE:
- normal chamber size
- normal free wall motion
AORTA:
- normal diameter at sinus, ascending portion and arch
- 3 leaflets, structurally normal; good excursion
- no aortic stenosis
- trace aortic regurgitation
MITRAL VALVE:
- trivial mitral regurgitation
- structurally normal
- no mitral valve prolapse
OTHER:
- no pericardial effusion
- borderline pulmonary artery systolic hypertension

Brief Hospital Course:
As per HPI, Mr. [**Known lastname **] is a 57 yo caucasian gentleman, with no
significant PMH or cardiac risk factors, admitted on [**2138-11-18**]
to CCU for post-STEMI care via Cath Lab, s/p [**Year (4 digits) **] to proximal
LAD, for 100% occlusion, with hospital course complicated by
atrial bigeminy in the initial post-cath period.
.
ACTIVE ISSUES:
# STEMI: On admission via ED, cath lab was activated secondary
to ST-elevation changes to leads I and aVL, V2-[**Street Address(2) 109358**]-depressions on leads II, III and aVF, based on multiple ECGs.
Pt was bolused with Heparin and ASA prior to intervention.
Emergent catheterization revealed complete occlusion of proximal
LAD, which resolved with drug-eluting stent placement. He was
anticoagulated with Integrillin for 6 hours, and started on
Prasugrel 60mg once, with plans to continue ASA 325mg qdaily x 1
month and Prasugrel 10mg x 15 months, with de-escalation of ASA
to 81mg after 1 month time. Post-intervention care and
observation was unremarkable for events, dysrhythmias or
hemodynamic compromise. Lisinopril 2.5mg daily, Metoprolol
Succinate 25mg Daily and Atorvastatin 80mg daily were initiated,
for afterload reduction, lipid control and mortality benefit.
Cardiac enzymes trended appropriately, and pt remained
asymptomatic throughout.
.
Trans-thoracic echocardiogram to assess left ventricular
function was notable for moderate-to-severe focal LV systolic
dysfunction (EF=30-35%, and wall-motion abnormalities as
described), trace aortic regurgitation and borderline elevation
of pulmonary artery systolic pressures. This was attributed to
myocardial stunning, and repeat TTE in 3 months is recommended
on discharge, to reassess recovery of LV function. In the
meantime, anticoagulation therapy, to include Warfarin 5mg
qdaily with LMWH bridge x 5 days, was initiated, given elevated
risk of thrombus formation, given the severity and location of
LV wall-abnormalities. At the time of discharge, the plan was to
check an INR 3-5 days later, at a coumadin clinic regionally
close to pt home.
.
On discharge, pt demonstrated no ECG changes concerning for
complications or arrhythmia, or signs of acute cardiac
dysfunction (chest pain, exertional shortness of breath, etc).
Discharge instructions indicated suggested medication changes
for PCP.
.
# CAD:
As noted, pt had no significant prior medical history, and
exhibited no cardiac/coronary risk factors on admission.
Baseline lipid panel was noteworthy for Chol/HD 2.7 and LDL
measured of 112, and HbA1c was 5.6%.
.
Atorvastatin 80mg qdaily was started as described, with LDL goal
of <70. Baseline hepatic function panel was noteworthy for mild
transaminitis of ALT 137, which was attributed to myocardial
injury.
.
On discharge, pt had tolerated statin well, denying muscle
discomforts or new signs or symptoms. It was recommended to
check Lipid and Hepatic panels in 2 months, to assess LFT
changes with Statin and LDL and to guide dose changes as deemed
appropriate. Pt was in addition provided a prescription for
sublingual nitroglycerin, and educated as to angina and relevant
alarming signs
.
# Arrhythmia:
As documented, pt exhibited atrial bigeminy on presentation,
prior to PCI. This, though accompanied with slight hypotension
and bradycardia, resolved after intervention, with no ectopy or
hemodynamic compromise thereafter. He was monitored on telemetry
and via serial ECGs during his stay.
.
Metoprolol Tartrate 12.5mg [**Hospital1 **] was started cautiously after
intervention. Pt tolerated this well, and was discharged on
long-acting Metoprolol Succinate 25mg qdaily, with plans to
modify as outpatient as necessary.
.
.
TRANSITIONAL ISSUES
# INR should be checked 3-5 days status-post discharge. At that
time, LMWH bridge should be discontinued and Warfarin dose
adjusted to INR goal of [**3-13**].  Anticoagulation should be
continued for at least 3 months, with consideration of extending
therapy to 6 months.
# Recommend increasing lisinopril dose to 5mg qdaily or 10mg
qdaily, as tolerated by blood pressure, with appropriate BMP
checks at regular intervals to assess electrolyte abnormalities
and renal function.
# Recommend increasing metropolol succinate as tolerated by
heart rate and blood pressure.
# Recommend follow-up Trans-Thoracic Echocardiogram in 1 month,
to evaluate recovery of LV function and residual wall-motion
abnormalities.
# Recommend rechecking that lipid and hepatic panels in 2
months, to assess LFT changes with the statin and his LDL level
in order to guide dose changes as deemed appropriate.

Medications on Admission:
Multivitamins, omega 3 fatty acids, saw [**Location (un) 6485**], glucosamine,
vitamin E and D.

Discharge Medications:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. prasugrel 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*11*
4. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*
5. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Vitamin D  Oral
7. Glucosamine Chondroitin MaxStr  Oral
8. multivitamin  Oral
9. warfarin 2 mg Tablet Sig: 2.5 Tablets PO Once Daily at 4 PM.
Disp:*90 Tablet(s)* Refills:*2*
10. enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) syringe
Subcutaneous [**Hospital1 **] (2 times a day).
Disp:*8 syringe* Refills:*2*
11. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablets
Sublingual as directed as needed for chest pain: Take 1 tab,
then wait 5 min, can take 1 more tab if still have chest pain
but call 911 or Dr. [**Last Name (STitle) 911**] .
Disp:*25 tablets* Refills:*0*
12. Outpatient Lab Work
Please check INR, chem-7 and CBC on Monday [**11-24**] wtih
results to Dr. [**Last Name (STitle) 10755**] at Phone: [**Telephone/Fax (1) 46461**]
Fax: [**Telephone/Fax (1) 46473**]. You can go to his office to have this drawn
on Monday.


Discharge Disposition:
Home

Discharge Diagnosis:
ST Elevation myocardial infarction
Acute Systolic Dysfunction with EF 35%


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname **],

It was a pleasure to be involved in your care here at [**Hospital1 1535**].  You were admitted with chest
pain on [**2138-11-18**], and found to have a heart attack, an
ST-elevation myocardial infarction or "STEMI."  This heart
attack occurred due to blockage of one of the blood vessels
supplying your heart, the left anterior descending artery, which
was opened with a drug-eluting stent during a catheterization
procedure.  After this opening, your chest pain improved;
however, on echocardiogram (an ultrasound study of your heart),
you were noted to have a moderate decrease in pumping function
of the heart, with the ejection fraction ("EF") being 35%,
compared with a normal value of 55%.

Please note, the following changes have been made to your
medications:
1.) START aspirin 325 mg by mouth daily **IT IS IMPORTANT THAT
YOU TAKE THIS MEDICATION EVERY DAY FOR THE REST OF YOUR LIFE.**
2.) START prasugrel 10 mg by mouth daily **IT IS IMPORTANT THAT
YOU TAKE THIS MEDICATION EVERY DAY FOR AT LEAST 15 MONTHS. DO
NOT STOP UNTIL YOU ARE INSTRUCTED BY YOUR CARDIOLOGIST.  IF YOU
STOP THIS
MEDICATION, YOU ARE AT RISK FOR HAVING ANOTHER HEART ATTACK.**
3.) START atorvastatin 80 mg by mouth daily
4.) START lisinopril 2.5 mg by mouth daily
5.) START metropolol succinate 25 mg by mouth daily
6.) START nitroglycerin as needed for chest pain at home. Take
one tablet, wait 5 minutes then take another tablet. Call 911 if
you still have chest pain after taking two nitroglycerins.
7.) STOP taking vitamin E and omega 3 fish oil and check with
the pharmacist for interactions between your new medicines and
your supplements.
8.) START taking warfarin (coumadin) to thin your blood and
prevent blood clots for the next few months as your heart heals
from the heart attack. Dr. [**Last Name (STitle) 10755**] will follow your warfarin level
(INR) and tell you how much to take every day.
9.) START taking enoxaparin to thin your blood immediately until
the warfarin starts to work.

It is recommended that you have another heart Echocardiogram in
one month to monitor improvement in your heart function. Dr.
[**Last Name (STitle) 911**] will arrange this.

Please weigh yourself every day and call Dr. [**Last Name (STitle) 911**] if your
weight increases more than 3 pounds in 1 day or 5 pounds in 3
days. Please notify Dr. [**Last Name (STitle) 911**] if you see swelling in your legs,
have trouble breathing or lying flat.

It is important for you to follow up with your primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 10755**], and your new cardiologist, Dr. [**Last Name (STitle) 911**],
after discharge.  Please keep the appointments that have been
made for you, as listed below.

Wishing you all the best!

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name3 (LF) 46462**] M.
Specialty: INTERNAL MEDICINE
Address: [**Location (un) 46471**], [**Location (un) **],[**Numeric Identifier 46472**]
Phone: [**Telephone/Fax (1) 46461**]
Appointment: THURSDAY [**11-27**] AT 1:45PM

Department: CARDIAC SERVICES
When: FRIDAY [**2138-12-31**] at 3:00 PM
With: [**First Name4 (NamePattern1) 919**] [**Last Name (NamePattern1) 911**], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias'}


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: Chest pain and jaw tightness

PRESENT ILLNESS: 56 yo M w/ no significant PMH, who woke up this AM with chest
pain and jaw tightness that brought him to the Emergency
Department. He has not had a long history of chest pain,
relating his first episode to Sunday morning. On Sunday, he went
on a 10.5 mile race. He reports that 7 minutes into the race as
he started going uphill, he started having non-radiating,
left-sided chest pressure that lasted for about 8 minutes. He
has never had this chest pressure before. He was asymptomatic on
Monday, and then when he woke up Tuesday morning, he felt the
same non-radiating left-sided chest pressure  that felt a little
more intense than before and lasted for one minute. He denies
any associated nausea or diaphoresis. He got ready and went into
work over on the [**Hospital Ward Name 516**] of [**Hospital1 18**] and he started to have
left-sided chest pressure again at 11:30am that radiated to the
right side of his chest and felt associated parasthesias in
bilateral upper extremities and felt jaw tightness, along with
diaphoresis. ECG showed ST elevation in leads I, aVL, V2-[**Street Address(2) 109357**] depressions. At this point, he went to the [**Hospital1 18**]
ED and was taken to the cath lab.
.
In the cath lab, shown to have complete occlusion of proximal
LAD, and is now s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) 5175**]. IVUS post-PCI showed good
apposition and the pt was hemodynamically stable.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: Nephrolithiasis

MEDICATION ON ADMISSION: Multivitamins, omega 3 fatty acids, saw [**Location (un) 6485**], glucosamine,
vitamin E and D.

ALLERGIES: Sulfa (Sulfonamide Antibiotics) / Macrodantin

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
VS: T= 97.8 BP= 119/71 HR=78 RR=19 O2 sat= 98% RA
GENERAL: NAD. Very pleasant. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.
- Mother:  HTN
- Father:  died of thyroid cancer 30 years ago
- Brothers: HL

SOCIAL HISTORY: Works in Research Administration on the [**Hospital Ward Name 516**] of [**Hospital1 18**].
- Tobacco history:  None
- ETOH:  Occasional
- Illicit drugs:  None 

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