CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Ms. [**Known lastname **] is a 46 year old woman with a hx of DM who presents
from [**Hospital3 3583**] with a STEMI. She reports awaking at 6am
with 9/10 chest pain across her chest, radiating to the left arm
and jaw. She went to work today and left at 2pm due to the pain.
She presented to [**Hospital3 3583**] at 4pm and ECG showed ST
elevations and q waves in V1-V3. She was given aspirin,
metoprolol, plavix 600mg x1, heparin gtt, nitro gtt, integrilin
gtt. She was transferred to the [**Hospital1 18**] cath lab where cardiac
cath showed acute thrombus of the proximal LAD. This was treated
with thrombectomy and BMS x 1. She was revascularized at 6:30am.

MEDICAL HISTORY: Diabetes Mellitus

MEDICATION ON ADMISSION: Glimepiride 8mg PO BID
Metformin 1000mg PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tmax: 36.8 ??????C (98.2 ??????F)

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
Mother and father both had diabetes.

SOCIAL HISTORY: -Tobacco history: smokes 10 cigarettes per day x 15 years
-ETOH: none
-Illicit drugs: none
Acute myocardial infarction of other anterior wall, initial episode of care,Acute systolic heart failure,Postmyocardial infarction syndrome,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other abnormal blood chemistry
AMI anterior wall, init,Ac systolic hrt failure,Post MI syndrome,Tobacco use disorder,DMII wo cmp nt st uncntr,Abn blood chemistry NEC
Admission Date:  [**2180-12-7**]              Discharge Date:   [**2180-12-16**]

Date of Birth:  [**2134-10-2**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7333**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
Ms. [**Known lastname **] is a 46 year old woman with a hx of DM who presents
from [**Hospital3 3583**] with a STEMI. She reports awaking at 6am
with 9/10 chest pain across her chest, radiating to the left arm
and jaw. She went to work today and left at 2pm due to the pain.
She presented to [**Hospital3 3583**] at 4pm and ECG showed ST
elevations and q waves in V1-V3. She was given aspirin,
metoprolol, plavix 600mg x1, heparin gtt, nitro gtt, integrilin
gtt. She was transferred to the [**Hospital1 18**] cath lab where cardiac
cath showed acute thrombus of the proximal LAD. This was treated
with thrombectomy and BMS x 1. She was revascularized at 6:30am.

.
On arrival to the floor, she rates the pain as [**12-27**]. She denies
shortness of breath, nausea or vomiting. She states that she did
have some pain yesterday associated with vomiting but this
resolved on its own after about an hour. She has never had this
kind of pain before.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.


Past Medical History:
Diabetes Mellitus

Social History:
-Tobacco history: smokes 10 cigarettes per day x 15 years
-ETOH: none
-Illicit drugs: none


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
Mother and father both had diabetes.


Physical Exam:
Tmax: 36.8 ??????C (98.2 ??????F)

Tcurrent: 36.8 ??????C (98.2 ??????F)
HR: 104 (104 - 105) bpm
BP: 97/71(76) {94/65(72) - 108/74(79)} mmHg
RR: 19 (14 - 19) insp/min
SpO2: 99%
Heart rhythm: ST (Sinus Tachycardia)
Wgt (current): 72.2 kg (admission): 72.2 kg
Height: 65 Inch

Physical Examination
General Appearance: Well nourished, No acute distress
Eyes / Conjunctiva: PERRL, XANTHOMA on Left eyelid
Head, Ears, Nose, Throat: Normocephalic
Lymphatic: No(t) Cervical WNL, No(t) Supraclavicular WNL
Cardiovascular: (PMI Normal), (S1: Normal), (S2: Normal),
(Murmur: Systolic)
Peripheral Vascular: (Right radial pulse: Present), (Left radial
pulse: Present), (Right DP pulse: Present), (Left DP pulse:
Present)
Respiratory / Chest: (Breath Sounds: Clear : , No(t) Crackles :
)
Abdominal: Soft, Non-tender, Bowel sounds present
Extremities: Right lower extremity edema: Absent, Left lower
extremity edema: Absent
Skin:  Not assessed, No(t) Rash: , No(t) Jaundice
Neurologic: Responds to: Not assessed, Movement: Not assessed,
Tone: Not assessed


Pertinent Results:
Cardiac catheterization [**2180-12-7**]: 1. Selective coronary
angiography in this right dominant system demonstrated one
vessel disease. The LMCA had no angigoraphically apparent
disease. The LAD had a total occlusion in the proximal portion
of the vessel after the D1 which had a very hig take off point.
The LAD was filled with thrombus up to the first septal branch.
The Cx had no angiographically apparent disease. The RCA had no
angigraphically apparent disease.
2. Limited resting hemodynamics revealed elevated left sided

Echocardiogram [**2180-12-8**]: 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 severely depressed (LVEF= 20 %) secondary to
extensive apical akinesis/dyskinesis, anteroseptal akinesis, and
anterior and inferior free wall hypokinesis. A left ventricular
apical mass/thrombus cannot be excluded. Right ventricular
chamber size is normal. with focal hypokinesis of the apical
free wall. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
The mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. The estimated
pulmonary artery systolic pressure is normal. There is a
trivial/physiologic pericardial effusion. There are no
echocardiographic signs of tamponade.

CXR [**2180-12-8**]: Normal lung volumes. Mild cardiomegaly without
obvious
overhydration. Minimal atelectasis at the left lung base.
Minimal Kerley B
lines seen in the right hemithorax, likely to reflect
interstitial fluid
overload. No focal parenchymal opacity suggesting pneumonia.
Normal
appearance of the mediastinum and the hilar structures.

ABD US
IMPRESSION:
1. No biliary abnormalities. CBD measures 4 mm.
1. 2.7-cm right hepatic lesion, likely hemangioma.
2. Gallbladder sludge without acute cholecystitis.
3. Right pleural effusion.

[**2180-12-7**] 10:04PM BLOOD CK-MB-94* MB Indx-7.6* cTropnT-7.63*
[**2180-12-8**] 04:10AM BLOOD CK-MB-58* MB Indx-5.6 cTropnT-4.65*
[**2180-12-7**] 10:04PM BLOOD ALT-74* AST-181* LD(LDH)-1190*
CK(CPK)-1233* AlkPhos-96 TotBili-0.5
[**2180-12-8**] 04:10AM BLOOD ALT-67* AST-158* LD(LDH)-1170*
CK(CPK)-1031* AlkPhos-87 TotBili-0.6
[**2180-12-9**] 05:51AM BLOOD ALT-77* AST-90* LD(LDH)-846* AlkPhos-205*
TotBili-0.5
[**2180-12-10**] 06:41AM BLOOD ALT-60* AST-42* LD(LDH)-625* AlkPhos-203*
TotBili-0.4
[**2180-12-7**] 10:04PM BLOOD %HbA1c-11.2*
[**2180-12-7**] 10:04PM BLOOD Triglyc-161* HDL-36 CHOL/HD-3.7
LDLcalc-66
[**2180-12-7**] 10:04PM BLOOD Calcium-8.5 Phos-2.7 Mg-1.5* Cholest-134
[**2180-12-10**] 06:41AM BLOOD Calcium-8.3* Phos-3.9 Mg-1.6 Iron-25*

Brief Hospital Course:
SUMMARY
Ms. [**Known lastname **] is a 46 year old woman with a history of DM who
presents with chest pain and STEMI c/b post-STEMI pericarditis.
She presented 2-3 days after onset of MI, received a BMS and had
a course complicated by pericarditis and LV akinesis. She had
very poorly controlled DM and was kept for insulin teaching and
coumadin bridging.

BY PROBLEM

A. STEMI s/p BMS to LAD complicated by:
    Systolic Heart Failure (EF 25%)
    Pericarditis
    LV Akinesis
    Sinus Tachycardia
          An LAD thrombus was removed and BMS placed. likely [**12-20**]
days after the onset of her MI. ECHO shows extensive HK, AK in
anteroseptal, inferior and apex. EF 20%. She was in sinus
tachycardia as a result of the infarction. Patient had
persistent chest pain relieved best with nsaids x 1 and
colchicine thereafter, she also had diffuse STE indicating
pericarditis. This pericarditis later caused a true fever
(negative cultures, cxr). Ms. [**Known lastname **] eventually did well without
cochicine. She was discharged on ASA, Plavix, Simvastatin 80mg,
Lisinopril and Toprol. She was discharged on coumadin with INR
checks for LV akinesis. She was discharged on low dose
furosemide for fluid maintenance. She was given extensive CHF
and DM teaching via portugese interpreter.

B. Diabetes Mellitus, Type 2. Poorly Controlled with
complications

     Her HgA1c was 11.2. She had vision difficulties and
difficult to control blood sugars. Started on insulin and
received intensive teaching. [**Last Name (un) **] consult followed. She was
discharged on a regimen of 70/30 [**Hospital1 **]  crafted by [**Last Name (un) **]

C. Elevated LFT??????s:

     Ms. [**Known lastname **] had elevated AST/ALT on admission. As these fell,
her alk phos rose. Her bilirubin was consistently normal. A RUQ
ultrasound nl. All other w/u negative (hepatitis serologies,
AMA, [**Doctor First Name **]). The main posibilties are two. She either had a drug
reaction that led to a mixed insult with hepatocellular injury
up front and biliary injury thereafter or she was transiently
hypotensive causing hepatocellular injury vis-a-vis low hepatic
arterial pressure which would explain the predominant elevation
of alkaline phosphatase (biliary injury). All levels resolved by
discharge.

TO BE FOLLOWED
1) INR on coumadin
2) Glucose control on insulin


Medications on Admission:
Glimepiride 8mg PO BID
Metformin 1000mg PO BID

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. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: 0.5 Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
7. Warfarin 2 mg Tablet Sig: Five (5) Tablet PO once a day.
Disp:*150 Tablet(s)* Refills:*2*
8. Outpatient Lab Work
Please check INR on Monday [**2180-12-18**] and call results to [**Hospital 18**]
[**Hospital **] clinic at [**Telephone/Fax (1) 2173**]
9. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Thirty (30) units Subcutaneous before breakfast: Give 15
units before dinner.
Disp:*1 BOTTLE* Refills:*2*
10. Insulin Syringe-Needle U-100 1 mL 27 x [**3-24**]  Syringe Sig: One
(1) syringe Miscellaneous twice a day.
Disp:*1 box* Refills:*2*
11. Lancets     Misc Sig: One (1) lancet Miscellaneous with
fingersticks.
Disp:*1 box* Refills:*2*
12. One Touch Test     Strip Sig: One (1) strip In [**Last Name (un) 5153**] with
fingersticks.
Disp:*1 box* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
ST Elevation Myocardial Infarction
Acute Systolic congestive Heart Failure, EF 25%
Diabetes Mellitus Type 2
Pericarditis


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


Discharge Instructions:
You had a large heart attack and your heart is now weak. You
will need to be careful that you avoid salt in your diet and
monitor yourself for fluid retention. Symptoms of fluid
retention are swelling in your legs, trouble breathing, fatigue
or dry cough. Weigh yourself every morning, call Dr. [**First Name (STitle) 437**] if
weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days.
You have been started on Insulin to help keep your blood sugars
low. You will need to check your blood sugar twice daily before
your insulin doses. We have given you instructions on what to do
if your blood sugar is too high or too low. Please follow the
diabetic diet that was given to you. You are on many new
medicines to help your heart recover from the heart attack and
to help your heart pump better. You are also on Warfarin and
your INR needs to be checked on Monday [**2180-12-18**].
Medicine changes:
1. Stop taking all of your medicines at home
2. START taking Inuslin
a. Use your long acting insulin (70/30) twice daily, as
directed, at breakfast and bedtime.
3. START taking Warfarin (Coumadin) to prevent blood clots in
your heart. Call Dr. [**Last Name (STitle) **] if you notice dark bowel
movements, your vomit blood or a cut does not stop bleeding. It
is normal to have easy bruising, bleeding gums and mild
nosebleeds on this medicine.
4. START Metoprolol, a beta blocker to help your heart pump
better.
5. START Aspirin 325mg daily to prevent the stent from clotting
off.
6. START Clopidogrel (Plavix) to prevent the stent from clotting
off. Do not stop taking Plavix or aspirin for at least one month
unless Dr. [**First Name (STitle) 437**] tells you to. Stopping these medicines could
cause another heart attack.
7. START taking Lisinopril to help your heart pump better.
8. START taking Fursemide (lasix) to prevent excess fluid from
accumulating.
.
Check your blood sugar using a glucometer before breakfast and
before dinner. Record these readings and bring them to every
doctor's appt.
.
Partners [**Name (NI) 269**] will draw your coumadin level on Monday [**12-18**] and
call the results to [**Hospital1 **].
.
You will be called on monday to arrange your services.

Followup Instructions:
Cardiology:
Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 437**] Phone: [**Telephone/Fax (1) 62**] Date/time: [**2181-1-8**] 1:30PM
.
Primary care:
Dr. [**Last Name (STitle) 86814**] [**Name (STitle) **] with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1538**] Phone:
[**Telephone/Fax (1) 250**] Date/Time:  Tuesday [**12-26**] 1:45pm. [**Location (un) **], Atrium Suite, [**Hospital Ward Name 23**] clinical Center. [**Hospital Ward Name 516**],
[**Hospital1 18**]. The clinic will contact you regarding ongoing
appointments for blood sugar checks.
.
Partners [**Name (NI) 269**] will draw your Coumadin level on [**2180-12-18**].
.




Completed by:[**2180-12-16**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute systolic heart failure,Postmyocardial infarction syndrome,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other abnormal blood chemistry'}


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: Ms. [**Known lastname **] is a 46 year old woman with a hx of DM who presents
from [**Hospital3 3583**] with a STEMI. She reports awaking at 6am
with 9/10 chest pain across her chest, radiating to the left arm
and jaw. She went to work today and left at 2pm due to the pain.
She presented to [**Hospital3 3583**] at 4pm and ECG showed ST
elevations and q waves in V1-V3. She was given aspirin,
metoprolol, plavix 600mg x1, heparin gtt, nitro gtt, integrilin
gtt. She was transferred to the [**Hospital1 18**] cath lab where cardiac
cath showed acute thrombus of the proximal LAD. This was treated
with thrombectomy and BMS x 1. She was revascularized at 6:30am.

MEDICAL HISTORY: Diabetes Mellitus

MEDICATION ON ADMISSION: Glimepiride 8mg PO BID
Metformin 1000mg PO BID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tmax: 36.8 ??????C (98.2 ??????F)

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
Mother and father both had diabetes.

SOCIAL HISTORY: -Tobacco history: smokes 10 cigarettes per day x 15 years
-ETOH: none
-Illicit drugs: none 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute systolic heart failure,Postmyocardial infarction syndrome,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other abnormal blood chemistry'}
