CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 59yo male with history of HIV and CAD s/p NSTEMI and CABG in
[**2136**] presenting with 40 minutes of pressure beginning at 8pm
this evening while at rest. Pt reports he had just taken his
evening meds when he felt aching and tingling in his left thump
that then progressed up his arm to his shoulder and transitioned
into chest pressure. No SOB/Diaphoesis/N/V. This was different
then his previous episodes of chest pain.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.
In the ED, initial vitals were T 98.5, HR 73, BP 155/84, RR 16,
Sat 100%.  EKG suggested an inferior MI, so a code-STEMI was
called and he was taken to the cath lab. Got integrillin heparin
aspirin plavix. BMS was placed in the SVG to PDA. Some
bradycardia during case, got atropine once. Recovered.

MEDICAL HISTORY: MI
HIV
Hyperlipidemia
Lung nodules
Emphysema
peptic Ulcer Disease
HPV
Depression
peripheral neuropathy

MEDICATION ON ADMISSION: Tylenol PRN
Albuterol 90mcg 2 puffs Q6hrs PRN wheezing
Atorvastatin 80mg daily
Citalopram 40mg daily
Diazepam 5mg Q6hrs PRN spasm
Truvada (emtricitabine-tenofovir) 200-300mg daily
Lexiva (fosamprenavir) 1400mg Q12 hrs
Gabapentin 800mg TID
Metoprolol 50mg [**Hospital1 **]
Omeprazole 40mg daily
Oxycodone 5-10mg Q3hrs PRN
Tamsulosin SR 0.4mg QHS
Zolpidem 5mg QHS

ALLERGIES: Bactrim / Hayfever / Pollen Extracts

PHYSICAL EXAM: Admission Exam:
VS: T= 97.9 BP=107/52 HR=65 RR= 18 O2 sat= 98
GENERAL: WDWN [**Male First Name (un) 4746**] in NAD. Oriented x3. Mood, affect appropriate.

FAMILY HISTORY: His family history includes father with emphysema, and his
mother
had lung cancer.  He has a brother with skin cancer.

SOCIAL HISTORY: On social history, he is not currently working.  He lives with a
close friend and former partner.  [**Name (NI) **] is actively smoking [**12-5**]
pack
per day which is cut down from 1-2 packs in the past.  He also
smokes occasional marijuana.  He denies any travel to the
Midwest
but did live in [**State 2690**] for 10 years and otherwise has been in the
Northeast.
Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Asymptomatic human immunodeficiency virus [HIV] infection status,Other emphysema,Other and unspecified hyperlipidemia,Other diseases of lung, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Nonspecific abnormal findings in stool contents,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Depressive disorder, not elsewhere classified,Tobacco use disorder
AMI inferopost, initial,Crn ath atlg vn bps grft,Asymp hiv infectn status,Emphysema NEC,Hyperlipidemia NEC/NOS,Other lung disease NEC,Idio periph neurpthy NOS,Abn find-stool contents,Peptic ulcer NOS,Depressive disorder NEC,Tobacco use disorder
Admission Date:  [**2140-10-5**]              Discharge Date:   [**2140-10-8**]

Date of Birth:  [**2081-5-29**]             Sex:   M

Service: MEDICINE

Allergies:
Bactrim / Hayfever / Pollen Extracts

Attending:[**Known firstname 1711**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization

History of Present Illness:
59yo male with history of HIV and CAD s/p NSTEMI and CABG in
[**2136**] presenting with 40 minutes of pressure beginning at 8pm
this evening while at rest. Pt reports he had just taken his
evening meds when he felt aching and tingling in his left thump
that then progressed up his arm to his shoulder and transitioned
into chest pressure. No SOB/Diaphoesis/N/V. This was different
then his previous episodes of chest pain.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.
In the ED, initial vitals were T 98.5, HR 73, BP 155/84, RR 16,
Sat 100%.  EKG suggested an inferior MI, so a code-STEMI was
called and he was taken to the cath lab. Got integrillin heparin
aspirin plavix. BMS was placed in the SVG to PDA. Some
bradycardia during case, got atropine once. Recovered.

Past Medical History:
MI
HIV
Hyperlipidemia
Lung nodules
Emphysema
peptic Ulcer Disease
HPV
Depression
peripheral neuropathy

Social History:
On social history, he is not currently working.  He lives with a
close friend and former partner.  [**Name (NI) **] is actively smoking [**12-5**]
pack
per day which is cut down from 1-2 packs in the past.  He also
smokes occasional marijuana.  He denies any travel to the
Midwest
but did live in [**State 2690**] for 10 years and otherwise has been in the
Northeast.


Family History:
His family history includes father with emphysema, and his
mother
had lung cancer.  He has a brother with skin cancer.


Physical Exam:
Admission Exam:
VS: T= 97.9 BP=107/52 HR=65 RR= 18 O2 sat= 98
GENERAL: WDWN [**Male First Name (un) 4746**] in NAD. Oriented x3. Mood, affect appropriate.

HEENT: NCAT. Sclera anicteric. Dry MM
NECK: Supple with JVP of 10 cm while laying flat
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No S3 or S4.
LUNGS: Decreased air movement bilaterally. No wheezing, crackles
or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: Right femoral sheath in place.
Right: Radial 2+ DP 2+ PT 2+
Left: Radial 2+ DP 2+ PT 2+

Pertinent Results:
[**2140-10-5**] 09:30PM BLOOD cTropnT-0.26*
[**2140-10-5**] 09:30PM BLOOD WBC-8.3 RBC-4.20*# Hgb-12.8*# Hct-37.6*#
MCV-90 MCH-30.5 MCHC-34.1 RDW-13.7 Plt Ct-247
[**2140-10-6**] 01:45AM BLOOD WBC-8.4 RBC-3.48* Hgb-10.6* Hct-31.9*
MCV-92 MCH-30.5 MCHC-33.3 RDW-13.9 Plt Ct-222

Cardiac CATH [**10-5**]:
1. Selective coronary angiography demonstrated three vessel
disease. The
LAD had sequential 70-80& stenoses in the mid-distal portion of
the
vessel. The circumflex artery had a long proximal 80% stenosis.
The
right coronary arteyr was proximally occluded proximal to the
vein graft
touchdown.
2. Selective conduit angiography demonstrated that the LIMA-LAD
was
patent. The SVG to the ramus was patent. The SVG to the PDA was
occluded
with what appears to be fresh clot. The SVG to OM1 was patent
with an
80% stenosis near the touchdwon.
3. Resting hemodynamics demonstrate systemic normotension.

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Normal ventricular function.
3. STEMI s/p thrombectomy

[**2140-10-6**] Echo:
The left atrium is normal in size. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is mildly
depressed (LVEF= 45 %) secondary to moderate hypokinesis of the
inferior wall and mild hypokinesis of the posterior wall. There
is no ventricular septal defect. The aortic root is mildly
dilated at the sinus level. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. Mild (1+)
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Mild (1+)
mitral regurgitation is seen. The pulmonary artery systolic
pressure could not be determined. There is no pericardial
effusion.

Compared to prior study (pre-CABG) of [**2137-1-9**], the left
ventricular ejection fraction is increased. Apical
hypokinesis/akinesis is no longer present.

Brief Hospital Course:
ASSESSMENT AND PLAN 59 YO HIV positive gentleman with history of
CABG in [**2136**] presenting to ED with acute onset left arm pain and
chest pressure found to have STEMI secondary to occulsion of SVG
to PDA. Had cardiac cath, s/p PTCI with placement of BMS. Pt
transfered to the CCU for close monitoring.
.
# CORONARIES: Patient underwent cardiac cathterization with
placement of BMS in SVG to PDA. CP free on the floor with
resolution of EKG fidnings and stable in the CCU. He was started
on aspirin and his plavix was transitioned to plasugrel.
Integrillin was continued for 18h post cath. There was initial
concern about interactions between his HAART and atorvastain.
Pharmacy was consulted they did not feel interaction was an
issue. His home statin was continued. He was switched from
plavix to prasugrel on day 2 and after receiving a loading dose
of 60mg was maintained on 10mg daily. His BB and ACE-I were
initially held secondary to hypotension during the procedure.
His was eventually restarted on metoprolol and lisinopril. At
discharge he was taking 25mg metoprolol XL, 5 mg lisinopril,
81mg Aspirin, 10mg Prasugrel and 80 mg atorvastatin.
.
# PUMP: Evidence of hypokinesis in [**2136**]. An echo the morning
following his procedure showed demonstrated similar findings of
LVH hypokinesis and an EF of 40% which was unchanged from [**2136**].


# HIV: He was continued on his HAART for the duration of his
stay. After consultation with pharmacy his statin dose was
continued.

# PUD: Continued omeprazole
.
# Guiac positive stool: On morning of discharge patient reported
dark stool. This was found to be guiac positive. Pt has been
taking Iron supplements and has had a stable hematocrit
throughout his hospital course. An acute bleeding event was
thought to be unlikely. However given his history of PUD this
should be investigated further as an outpatient. Pt encouraged
to discuss this with his PCP.
.
# Depression: Continued citalopram
.
# Peripheral neuropathy: Continued neurontin


Medications on Admission:
Tylenol PRN
Albuterol 90mcg 2 puffs Q6hrs PRN wheezing
Atorvastatin 80mg daily
Citalopram 40mg daily
Diazepam 5mg Q6hrs PRN spasm
Truvada (emtricitabine-tenofovir) 200-300mg daily
Lexiva (fosamprenavir) 1400mg Q12 hrs
Gabapentin 800mg TID
Metoprolol 50mg [**Hospital1 **]
Omeprazole 40mg daily
Oxycodone 5-10mg Q3hrs PRN
Tamsulosin SR 0.4mg QHS
Zolpidem 5mg QHS

Discharge Medications:
1. citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
2. ferrous gluconate 325 mg (37.5 mg Iron) Tablet Sig: One (1)
Tablet PO BID (2 times a day).
3. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
4. gabapentin 800 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours.
5. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
7. emtricitabine-tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
8. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
9. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q6H (every 6 hours) as needed for
wheezing/SOB.
10. acetaminophen  Oral
11. fosamprenavir 700 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
12. metoprolol succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
13. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
14. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
15. prasugrel 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
16. diazepam 5 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for spasm.


Discharge Disposition:
Home

Discharge Diagnosis:
ST elevation MI


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


Discharge Instructions:
You were admitted to [**Hospital1 18**] because you had a heart attack. You
were taken to the cath lab and a stent was placed in a vessel in
your heart to relieve the blockage of blood flow. While you were
here we made the following changes to your medications:

1) START metoprolol 25mg once a day

2) START Prasugrel 10mg once a day

3) START aspirin 81mg

You should continue to take your other medications as directed.

You should also follow up with your PCP within the week.

Followup Instructions:
Pleace call your PCP this week to schedule follow up:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD. [**Telephone/Fax (1) 798**]
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Asymptomatic human immunodeficiency virus [HIV] infection status,Other emphysema,Other and unspecified hyperlipidemia,Other diseases of lung, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Nonspecific abnormal findings in stool contents,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Depressive disorder, not elsewhere classified,Tobacco use disorder'}


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

PRESENT ILLNESS: 59yo male with history of HIV and CAD s/p NSTEMI and CABG in
[**2136**] presenting with 40 minutes of pressure beginning at 8pm
this evening while at rest. Pt reports he had just taken his
evening meds when he felt aching and tingling in his left thump
that then progressed up his arm to his shoulder and transitioned
into chest pressure. No SOB/Diaphoesis/N/V. This was different
then his previous episodes of chest pain.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.
In the ED, initial vitals were T 98.5, HR 73, BP 155/84, RR 16,
Sat 100%.  EKG suggested an inferior MI, so a code-STEMI was
called and he was taken to the cath lab. Got integrillin heparin
aspirin plavix. BMS was placed in the SVG to PDA. Some
bradycardia during case, got atropine once. Recovered.

MEDICAL HISTORY: MI
HIV
Hyperlipidemia
Lung nodules
Emphysema
peptic Ulcer Disease
HPV
Depression
peripheral neuropathy

MEDICATION ON ADMISSION: Tylenol PRN
Albuterol 90mcg 2 puffs Q6hrs PRN wheezing
Atorvastatin 80mg daily
Citalopram 40mg daily
Diazepam 5mg Q6hrs PRN spasm
Truvada (emtricitabine-tenofovir) 200-300mg daily
Lexiva (fosamprenavir) 1400mg Q12 hrs
Gabapentin 800mg TID
Metoprolol 50mg [**Hospital1 **]
Omeprazole 40mg daily
Oxycodone 5-10mg Q3hrs PRN
Tamsulosin SR 0.4mg QHS
Zolpidem 5mg QHS

ALLERGIES: Bactrim / Hayfever / Pollen Extracts

PHYSICAL EXAM: Admission Exam:
VS: T= 97.9 BP=107/52 HR=65 RR= 18 O2 sat= 98
GENERAL: WDWN [**Male First Name (un) 4746**] in NAD. Oriented x3. Mood, affect appropriate.

FAMILY HISTORY: His family history includes father with emphysema, and his
mother
had lung cancer.  He has a brother with skin cancer.

SOCIAL HISTORY: On social history, he is not currently working.  He lives with a
close friend and former partner.  [**Name (NI) **] is actively smoking [**12-5**]
pack
per day which is cut down from 1-2 packs in the past.  He also
smokes occasional marijuana.  He denies any travel to the
Midwest
but did live in [**State 2690**] for 10 years and otherwise has been in the
Northeast. 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Asymptomatic human immunodeficiency virus [HIV] infection status,Other emphysema,Other and unspecified hyperlipidemia,Other diseases of lung, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Nonspecific abnormal findings in stool contents,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Depressive disorder, not elsewhere classified,Tobacco use disorder'}
