CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 65yoM with NO h/o CAD but with active smoking, +FHx, and ? HL
who presented to [**Hospital6 10353**] after awakening with
substernal CP at 3am, radiating to both shoulders. He was unable
to get back to sleep, so eventually went to [**Hospital1 392**] at 9am. He
also reported some lightheadedness and SOB on the prior day, but
no CP.
.
There, EKG showed elevation in III with inferior Q waves, STD in
V2, and sub millimeter depressions in lateral/high lateral
leads. Cardiac enzymes and all other labs were pending there by
transfer here. There, he was given 325 ASA, Plavix 600 mg PO, 1
SL NTG, 1L NS, and 1mg Ativan. He was transferred to [**Hospital1 18**] for
further management.
.
Here, he was taken to cath lab and found to have 100% proximal
RCA culprit lesion and had aspiration thrombectomy followed by
DES (2.5 x 15 Promus) to prox RCA with post-dilation, no
residual stenosis, and TIMI 3 flow to distal vessel. Also noted
to have normal LMCA, 60% eccentric mid-distal LAD, 70-80% mid
long LCx lesion. He had R radial approach.
.
On arrival to CCU, pt is currently resting comfortably with
stable hemodynamics and Integrilling running. ROS reviewed, as
above o/w negative, pt was in good health, working, etc. Denied
any CP, decrease in exercise tolerance, orthopnea, SOB, syncope,
leg swelling.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia (states "cholesterol was
350" was previously on meds but none currently, +FHx as below
2. CARDIAC HISTORY:
- Inferior STEMI [**2155-7-30**]: 100% occlusion of RCA s/p aspiration
thrombectomy and Promus DES to prox RCA; also with normal LMCA,
60% eccentric mid-distal LAD, 70-80% mid long LCx lesion
3. OTHER PAST MEDICAL HISTORY:
- Bladder cancer: per pt this is not active
- Active smoker ~1 ppd

MEDICATION ON ADMISSION: OTC allergy meds

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAMINATION:
95.6   135/60   p55   12   99%RA
Well, healthy appearing M in no distress, is not obese, sleeping
comfortably but awoken easily, pleasant
EOMI, no scleral icterus, mouth slightly dry but no OP lesions,
no JVD or HJR
CTAB with good air movement, no adventitious lung sounds at all
RRR with soft S1/S2, best heard LUSB, no murmurs. Strong L
radial pulse, R radial band on.
Abd normal, not obese, soft NT ND, benign
BLE's are without edema, all extrems are warm well perfused, no
cyanosis
CN 2-12 grossly intact, moving extremities, no gross focal neuro
deficits noted

FAMILY HISTORY: Mother: deceased at 70 yo, [**Name (NI) 64763**]
Father: deceased at 50 yo of MI
[**Name (NI) **] brother: CABG
[**Name (NI) **] 5 brothers, 2 with prostate ca; has 3 sisters, 2 with
Parkinsons

SOCIAL HISTORY: SOCIAL HISTORY: Lives at home with wife and has 2 children.
Lives in [**Hospital1 392**]. Was a bartender for a long time, now currently
working as a courier and able to do ADL's, can ambulate well.
Smoker for 25 yrs, then quit for 10, restarted 15 yrs ago and
smokes a little less than 1 pdd. States he drinks 3-4 drinks per
day but no eye openers, denies withdrawal sxs, seizures,
hallucinations, DT's. No illicit drugs
Acute myocardial infarction of inferolateral wall, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Tobacco use disorder
AMI inferolateral, init,Ac systolic hrt failure,Crnry athrscl natve vssl,Tobacco use disorder
Admission Date:  [**2155-7-30**]              Discharge Date:   [**2155-8-1**]

Date of Birth:  [**2090-1-17**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
100% occlusion of RCA s/p aspiration thrombectomy and Promus DES
to prox RCA; also with normal LMCA, 60% eccentric mid-distal
LAD, 70-80% mid long LCx lesion


History of Present Illness:
65yoM with NO h/o CAD but with active smoking, +FHx, and ? HL
who presented to [**Hospital6 10353**] after awakening with
substernal CP at 3am, radiating to both shoulders. He was unable
to get back to sleep, so eventually went to [**Hospital1 392**] at 9am. He
also reported some lightheadedness and SOB on the prior day, but
no CP.
.
There, EKG showed elevation in III with inferior Q waves, STD in
V2, and sub millimeter depressions in lateral/high lateral
leads. Cardiac enzymes and all other labs were pending there by
transfer here. There, he was given 325 ASA, Plavix 600 mg PO, 1
SL NTG, 1L NS, and 1mg Ativan. He was transferred to [**Hospital1 18**] for
further management.
.
Here, he was taken to cath lab and found to have 100% proximal
RCA culprit lesion and had aspiration thrombectomy followed by
DES (2.5 x 15 Promus) to prox RCA with post-dilation, no
residual stenosis, and TIMI 3 flow to distal vessel. Also noted
to have normal LMCA, 60% eccentric mid-distal LAD, 70-80% mid
long LCx lesion. He had R radial approach.
.
On arrival to CCU, pt is currently resting comfortably with
stable hemodynamics and Integrilling running. ROS reviewed, as
above o/w negative, pt was in good health, working, etc. Denied
any CP, decrease in exercise tolerance, orthopnea, SOB, syncope,
leg swelling.


Past Medical History:
1. CARDIAC RISK FACTORS: Dyslipidemia (states "cholesterol was
350" was previously on meds but none currently, +FHx as below
2. CARDIAC HISTORY:
- Inferior STEMI [**2155-7-30**]: 100% occlusion of RCA s/p aspiration
thrombectomy and Promus DES to prox RCA; also with normal LMCA,
60% eccentric mid-distal LAD, 70-80% mid long LCx lesion
3. OTHER PAST MEDICAL HISTORY:
- Bladder cancer: per pt this is not active
- Active smoker ~1 ppd

Social History:
SOCIAL HISTORY: Lives at home with wife and has 2 children.
Lives in [**Hospital1 392**]. Was a bartender for a long time, now currently
working as a courier and able to do ADL's, can ambulate well.
Smoker for 25 yrs, then quit for 10, restarted 15 yrs ago and
smokes a little less than 1 pdd. States he drinks 3-4 drinks per
day but no eye openers, denies withdrawal sxs, seizures,
hallucinations, DT's. No illicit drugs

Family History:
Mother: deceased at 70 yo, [**Name (NI) 64763**]
Father: deceased at 50 yo of MI
[**Name (NI) **] brother: CABG
[**Name (NI) **] 5 brothers, 2 with prostate ca; has 3 sisters, 2 with
Parkinsons

Physical Exam:
PHYSICAL EXAMINATION:
95.6   135/60   p55   12   99%RA
Well, healthy appearing M in no distress, is not obese, sleeping
comfortably but awoken easily, pleasant
EOMI, no scleral icterus, mouth slightly dry but no OP lesions,
no JVD or HJR
CTAB with good air movement, no adventitious lung sounds at all
RRR with soft S1/S2, best heard LUSB, no murmurs. Strong L
radial pulse, R radial band on.
Abd normal, not obese, soft NT ND, benign
BLE's are without edema, all extrems are warm well perfused, no
cyanosis
CN 2-12 grossly intact, moving extremities, no gross focal neuro
deficits noted


Pertinent Results:
[**2155-7-30**] 10:46PM   CK(CPK)-2520*
[**2155-7-30**] 10:46PM   CK-MB-269* MB INDX-10.7* cTropnT-2.49*
[**2155-7-30**] 10:46PM   HCT-40.2
[**2155-7-30**] 05:05PM   HCT-39.7*
[**2155-7-30**] 01:13PM   PLT COUNT-245
[**2155-7-30**] 11:00AM   GLUCOSE-118* UREA N-13 CREAT-0.6 SODIUM-141
POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-20* ANION GAP-20
[**2155-7-30**] 11:00AM   estGFR-Using this
[**2155-7-30**] 11:00AM   CALCIUM-8.7 PHOSPHATE-3.8 MAGNESIUM-1.9
CHOLEST-280*
[**2155-7-30**] 11:00AM   CALCIUM-8.7 PHOSPHATE-3.8 MAGNESIUM-1.9
CHOLEST-280*
[**2155-7-30**] 11:00AM   %HbA1c-5.3 eAG-105
[**2155-7-30**] 11:00AM   TRIGLYCER-217* HDL CHOL-69 CHOL/HDL-4.1
LDL(CALC)-168*
[**2155-7-30**] 11:00AM   WBC-9.1 RBC-4.01* HGB-14.9 HCT-39.9* MCV-100*
MCH-37.0* MCHC-37.2* RDW-14.0
[**2155-7-30**] 11:00AM   NEUTS-78.6* LYMPHS-17.5* MONOS-3.1 EOS-0.7
BASOS-0.2
[**2155-7-30**] 11:00AM   PLT COUNT-231
[**2155-7-30**] 11:00AM   PT-12.1 PTT-23.8 INR(PT)-1.0
.
[**2155-7-30**]
Cardiac Cath:
COMMENTS:
1. Selective coronary angiography of this right-dominant system
demonstrated severe 2 vessel CAD. The LMCA was normal. The mid
LAD had a
60% eccentric lesion. The mid LCX had a long 70-80% lesion. The
dominant
RCA was 100% occluded proximally.
2. Left ventriculography was deferred.
3. Successful thrombectomy and PCI of the proximal RCA with
Promus DES.
4. Terumo band to the right radial artery.
5. No complications of the procedure .

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease (RCA, LCX).
2. Acute inferior STEMI, managed by acute PTCA of the culprit
lesion.
3. Successful thrombectomy and PCI of the proximal RCA with a
2.5x15mm
Promus DES.
4. Aspirin 325mg/day for one month, followed by 81mg/day
indefinitely.
5. Plavix (clopidogrel) 75mg/day for 12 months.
6. Consideration of PCI of the LCX with residual ischemia.

.
Echo: [**2155-7-31**]
The left atrium is elongated. Left ventricular wall thicknesses
are normal. The left ventricular cavity size is normal. There is
mild regional left ventricular systolic dysfunction with
inferior/inferolateral akinesis/hypokinesis (see diagram).
Tissue Doppler imaging suggests a normal left ventricular
filling pressure (PCWP<12mmHg). The right ventricular cavity is
mildly dilated with focal basal free wall hypokinesis. The
aortic valve leaflets (3) are mildly thickened. There is no
aortic valve stenosis. The mitral valve leaflets are mildly
thickened. Mild (1+) mitral regurgitation is seen. The tricuspid
valve leaflets are mildly thickened. The estimated pulmonary
artery systolic pressure is normal. There is a
trivial/physiologic pericardial effusion.
.
 discharge:

[**2155-8-1**] 07:50AM BLOOD WBC-8.6 RBC-3.77* Hgb-13.6* Hct-38.6*
MCV-102* MCH-36.0* MCHC-35.2* RDW-13.4 Plt Ct-195
[**2155-8-1**] 07:50AM BLOOD Plt Ct-195
[**2155-8-1**] 07:50AM BLOOD PT-11.9 PTT-22.0 INR(PT)-1.0
[**2155-8-1**] 07:50AM BLOOD Glucose-94 UreaN-22* Creat-0.8 Na-140
K-3.8 Cl-102 HCO3-29 AnGap-13
[**2155-7-30**] 11:00AM BLOOD Calcium-8.7 Phos-3.8 Mg-1.9 Cholest-280*
[**2155-7-30**] 11:00AM BLOOD %HbA1c-5.3 eAG-105
[**2155-7-30**] 11:00AM BLOOD Triglyc-217* HDL-69 CHOL/HD-4.1
LDLcalc-168*

Brief Hospital Course:
65yoM with no prior cardiac history but with long smoking
history, family history, and possible hyperlipidemia but no
known HTN, DM who is admitted to CCU after inferior STEMI now
s/p aspiration thrombectomy and DES applied to proximal RCA with
good flow afterwards.
.
1. Inferior STEMI: Pt presented with trop 2.49, ekg showed
elevation in III with inferior Q waves, STD in V2, and sub
millimeter depressions in lateral/high lateral leads.  Pt went
for emergent cath, and had DES put in prox RCA with improved
flow afterwards.  He was given integrillin for 18hrs post cath
and started on ASA 325 for one month and then will transition to
81mg daily, plavix daily for one year, lisinopril 5mg daily,
atorvastatin 80 mg daily and metoprolol XR 25mg daily.  He
remained hemodynamically stable and was transferred to the
floor. Post-cath echo showed: mild regional left ventricular
systolic dysfunction with inferior/inferolateral
akinesis/hypokinesis with EF of 45%.  He was monitored on
telemetry with no events.  PT evaluated pt and determined that
he was safe to go home with no needs for acute rehab.  He was
counseled on lifestyle changes and demonstrated good
understanding.  Pt will need repeat echo in one month and close
PCP/cards follow up.
.
.
Transitional
.
PCP needs to know about LDL goal of 70, f/u A1C
repeat echo in one month

Medications on Admission:
OTC allergy meds

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. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. 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*


Discharge Disposition:
Home

Discharge Diagnosis:
Acute Inferior ST Elevation Myocardial Infarction
Acute systolic heart failure with ejection fraction of 45%


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


Discharge Instructions:
Mr. [**Known lastname 33856**],

It was a pleasure taking care of you.  You were admitted to the
hospital after having sustained a heart attack.  You underwent a
cardiac catheterization and had a stent placed.  You also had an
echocardiogram which showed your heart function was good.  You
were started on a number of medications which you will need to
continue to take daily as prescribed.  We also HIGHLY recommend
that you quit smoking, this is the single most important thing
you can do at the moment to prevent another heart attack.
Please talk with your PCP about strategies to help you quit.
You will need to follow up with you PCP in [**Name Initial (PRE) **] weeks time as well
as your cardiologist in [**1-2**] weeks.  Call your PCP if you notice
that your weight increases more than 3 pounds in 3 days.

MEDS:
Start atorvastating 80 mg by mouth daily
Start clopidogrel 75 mg by mouth daily
Start asprin EC 325 mg by mouth daily
Start Lisinopril 5 mg by mouth daily
Start metoprolol succinate 25 mg by mouth daily

Followup Instructions:
Department: [**Hospital3 249**]
When: FRIDAY [**2155-8-8**] at 3:15 PM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73069**], MD [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
*Dr [**Last Name (STitle) **] is your new physician at [**Name9 (PRE) 191**]. He works
closely with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**First Name3 (LF) **] both will be involved in your
care.

Department: CARDIAC SERVICES
When: FRIDAY [**2155-9-5**] at 9:00 AM
With: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], 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 inferolateral wall, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,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: 65yoM with NO h/o CAD but with active smoking, +FHx, and ? HL
who presented to [**Hospital6 10353**] after awakening with
substernal CP at 3am, radiating to both shoulders. He was unable
to get back to sleep, so eventually went to [**Hospital1 392**] at 9am. He
also reported some lightheadedness and SOB on the prior day, but
no CP.
.
There, EKG showed elevation in III with inferior Q waves, STD in
V2, and sub millimeter depressions in lateral/high lateral
leads. Cardiac enzymes and all other labs were pending there by
transfer here. There, he was given 325 ASA, Plavix 600 mg PO, 1
SL NTG, 1L NS, and 1mg Ativan. He was transferred to [**Hospital1 18**] for
further management.
.
Here, he was taken to cath lab and found to have 100% proximal
RCA culprit lesion and had aspiration thrombectomy followed by
DES (2.5 x 15 Promus) to prox RCA with post-dilation, no
residual stenosis, and TIMI 3 flow to distal vessel. Also noted
to have normal LMCA, 60% eccentric mid-distal LAD, 70-80% mid
long LCx lesion. He had R radial approach.
.
On arrival to CCU, pt is currently resting comfortably with
stable hemodynamics and Integrilling running. ROS reviewed, as
above o/w negative, pt was in good health, working, etc. Denied
any CP, decrease in exercise tolerance, orthopnea, SOB, syncope,
leg swelling.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Dyslipidemia (states "cholesterol was
350" was previously on meds but none currently, +FHx as below
2. CARDIAC HISTORY:
- Inferior STEMI [**2155-7-30**]: 100% occlusion of RCA s/p aspiration
thrombectomy and Promus DES to prox RCA; also with normal LMCA,
60% eccentric mid-distal LAD, 70-80% mid long LCx lesion
3. OTHER PAST MEDICAL HISTORY:
- Bladder cancer: per pt this is not active
- Active smoker ~1 ppd

MEDICATION ON ADMISSION: OTC allergy meds

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAMINATION:
95.6   135/60   p55   12   99%RA
Well, healthy appearing M in no distress, is not obese, sleeping
comfortably but awoken easily, pleasant
EOMI, no scleral icterus, mouth slightly dry but no OP lesions,
no JVD or HJR
CTAB with good air movement, no adventitious lung sounds at all
RRR with soft S1/S2, best heard LUSB, no murmurs. Strong L
radial pulse, R radial band on.
Abd normal, not obese, soft NT ND, benign
BLE's are without edema, all extrems are warm well perfused, no
cyanosis
CN 2-12 grossly intact, moving extremities, no gross focal neuro
deficits noted

FAMILY HISTORY: Mother: deceased at 70 yo, [**Name (NI) 64763**]
Father: deceased at 50 yo of MI
[**Name (NI) **] brother: CABG
[**Name (NI) **] 5 brothers, 2 with prostate ca; has 3 sisters, 2 with
Parkinsons

SOCIAL HISTORY: SOCIAL HISTORY: Lives at home with wife and has 2 children.
Lives in [**Hospital1 392**]. Was a bartender for a long time, now currently
working as a courier and able to do ADL's, can ambulate well.
Smoker for 25 yrs, then quit for 10, restarted 15 yrs ago and
smokes a little less than 1 pdd. States he drinks 3-4 drinks per
day but no eye openers, denies withdrawal sxs, seizures,
hallucinations, DT's. No illicit drugs 

### Response:
{'Acute myocardial infarction of inferolateral wall, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Tobacco use disorder'}
