CHIEF COMPLAINT: STEMI

PRESENT ILLNESS: [**Age over 90 **] yo with PMH of atrial fibrillation, ?SVT, Sjogren's disease,
systemic HTN, GERD, who presented to [**Hospital6 3105**]
on [**2153-6-18**] with left sided chest discomfort in the setting of
rapid heartbeat. Episode lasted approximately one hour. She has
had these episodes in the past, but they have usually lasted
only a few minutes. Patient was found to have ST elevations in
lateral leads (I and aVL) with ST depressions in aVR. CPK peaked
at 1261 and troponin of 54.56. Underwent cath at [**Hospital1 487**] which
demonstrated 80% stenosis of mid LAD, 100% occlusion of first
diag, 50% left main stenosis, 50% left circumflex, 70% stenosis
of PDA, LVEF of 35% with anterior and apical akinesis. Underwent
angioplasty and BMS to her first diagonal artery. Transferred to
[**Hospital1 18**] for CT [**Doctor First Name **] evaluation for possible CABG.
.
Pt is currently comfortable, she has no chest pain, shortness of
breath, or dizziness.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, [**Doctor First Name **] at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.

MEDICAL HISTORY: atrial fibrillation
?SVT
Sjogren's disease
systemic HTN
GERD
.
.
PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
- History of supraventricular tachycardia, atrial fibrillation
3. OTHER PAST MEDICAL HISTORY:
- sjogren's syndrome
- GERD

MEDICATION ON ADMISSION: HOME MEDICATIONS:
- aspirin 81mg PO daily
- sotalol 40mg PO BID
- amlodipine 10mg PO daily
- colace 100mg PO daily
- SL NTG PRN
- omeprazole 20mg PO daily

ALLERGIES: Penicillins / Ciprofloxacin / Sulfa (Sulfonamide Antibiotics) /
Macrodantin

PHYSICAL EXAM: Gen: alert, oriented, NAD
HEENT: supple, no JVD
CV: RRR, no M/R/G, distant HS. Left pacer site with drsg [**Name5 (PTitle) 767**]
[**Name5 (PTitle) **] [**Name5 (PTitle) 2729**] in lab, no evidence of ecchymosis or swelling
under dressing.
RESP: [**Month (only) **] BS right base only, left now clear
ABD: soft, NT/ND
EXTR: no peripheral edema.
NEURO: A/O
Extremeties: no edema
Pulses:

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: SOCIAL HISTORY: lives alone, has help with chores. has a nephew
who is involved but [**Name (NI) **] sometimes is reluctant to involve him.
-Tobacco history: None.
-ETOH: None.
-Illicit drugs: None.
Acute myocardial infarction of other lateral wall, initial episode of care,Hemorrhage of gastrointestinal tract, unspecified,Sinoatrial node dysfunction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Sicca syndrome,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
AMI lateral NEC, initial,Gastrointest hemorr NOS,Sinoatrial node dysfunct,Hyperlipidemia NEC/NOS,Hypertension NOS,Sicca syndrome,Esophageal reflux,Crnry athrscl natve vssl,Status-post ptca
Admission Date:  [**2153-6-20**]              Discharge Date:   [**2153-6-28**]


Service: MEDICINE

Allergies:
Penicillins / Ciprofloxacin / Sulfa (Sulfonamide Antibiotics) /
Macrodantin

Attending:[**First Name3 (LF) 1515**]
Chief Complaint:
STEMI

Major Surgical or Invasive Procedure:
Pacemaker implantation
Cardiac catheterization with bare metal stent to the diagonal
coronary artery


History of Present Illness:
[**Age over 90 **] yo with PMH of atrial fibrillation, ?SVT, Sjogren's disease,
systemic HTN, GERD, who presented to [**Hospital6 3105**]
on [**2153-6-18**] with left sided chest discomfort in the setting of
rapid heartbeat. Episode lasted approximately one hour. She has
had these episodes in the past, but they have usually lasted
only a few minutes. Patient was found to have ST elevations in
lateral leads (I and aVL) with ST depressions in aVR. CPK peaked
at 1261 and troponin of 54.56. Underwent cath at [**Hospital1 487**] which
demonstrated 80% stenosis of mid LAD, 100% occlusion of first
diag, 50% left main stenosis, 50% left circumflex, 70% stenosis
of PDA, LVEF of 35% with anterior and apical akinesis. Underwent
angioplasty and BMS to her first diagonal artery. Transferred to
[**Hospital1 18**] for CT [**Doctor First Name **] evaluation for possible CABG.
.
Pt is currently comfortable, she has no chest pain, shortness of
breath, or dizziness.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, [**Doctor First Name **] at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.


Past Medical History:
atrial fibrillation
?SVT
Sjogren's disease
systemic HTN
GERD
.
.
PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
- History of supraventricular tachycardia, atrial fibrillation
3. OTHER PAST MEDICAL HISTORY:
- sjogren's syndrome
- GERD


Social History:
SOCIAL HISTORY: lives alone, has help with chores. has a nephew
who is involved but [**Name (NI) **] sometimes is reluctant to involve him.
-Tobacco history: None.
-ETOH: None.
-Illicit drugs: None.


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
Gen: alert, oriented, NAD
HEENT: supple, no JVD
CV: RRR, no M/R/G, distant HS. Left pacer site with drsg [**Name5 (PTitle) 767**]
[**Name5 (PTitle) **] [**Name5 (PTitle) 2729**] in lab, no evidence of ecchymosis or swelling
under dressing.
RESP: [**Month (only) **] BS right base only, left now clear
ABD: soft, NT/ND
EXTR: no peripheral edema.
NEURO: A/O
Extremeties: no edema
Pulses:

Right: DP 1+ PT 1+
Left: DP 1+ PT 1+


Pertinent Results:
[**2153-6-28**] 07:15AM BLOOD WBC-8.4 RBC-3.55* Hgb-10.0* Hct-30.3*
MCV-85 MCH-28.1 MCHC-32.9 RDW-14.3 Plt Ct-244
[**2153-6-20**] 11:51PM BLOOD WBC-7.8 RBC-3.84* Hgb-11.3* Hct-33.4*
MCV-87 MCH-29.5 MCHC-33.9 RDW-13.8 Plt Ct-174
[**2153-6-27**] 07:05AM BLOOD PT-12.3 PTT-26.3 INR(PT)-1.0
[**2153-6-28**] 07:15AM BLOOD Glucose-117* UreaN-17 Creat-1.0 Na-141
K-3.7 Cl-105 HCO3-28 AnGap-12
[**2153-6-20**] 11:51PM BLOOD Glucose-124* UreaN-24* Creat-1.1 Na-141
K-3.7 Cl-105 HCO3-25 AnGap-15
[**2153-6-22**] 07:30AM BLOOD CK(CPK)-123
[**2153-6-21**] 07:02AM BLOOD CK(CPK)-138
[**2153-6-20**] 11:51PM BLOOD CK(CPK)-182
[**2153-6-21**] 07:02AM BLOOD CK-MB-8 cTropnT-3.18*
[**2153-6-20**] 11:51PM BLOOD CK-MB-10 MB Indx-5.5 cTropnT-3.55*
[**2153-6-27**] 07:05AM BLOOD Calcium-8.9 Phos-2.9 Mg-2.0
.
[**6-27**]/CXR:
The lead of the single-chamber pacemaker is terminating in the
right ventricle. Unchanged position of the left pectoral
generator.
Otherwise no change. Mild elevation of the left hemidiaphragm.
No pulmonary edema. No pleural effusions.
.


Brief Hospital Course:
[**Age over 90 **] yo with PMH of atrial fibrillation, ?SVT, Sjogren's disease,
systemic HTN, GERD, who presented to OSH with chest discomfort
in the setting of rapid heartbeat, found to have ST elevations
in lateral leads (I and aVL) with ST depressions in aVR. CPK
peaked at 1261 and troponin at 54.56. Found to have 3VD, s/p BMS
to her first diagonal artery. Transferred to [**Hospital1 18**] for EP
evealuation re: pacemaker for tachy-brady syndrome.
.
# STEMI/CAD: Underwent cath at [**Hospital1 487**] which demonstrated 80%
stenosis of mid LAD, 100% occlusion of first diag, 50% left main
stenosis, 50% left circumflex, 70% stenosis of PDA, LVEF of 35%
with anterior and apical akinesis. S/p BMS to first diagonal
artery. Pt was started on Plavix, lisinopril 15mg daily, and
Lipitor 80mg daily. Aspirin was increased to 325 mg daily.
Metoprolol 12.5mg [**Hospital1 **] was started once patient was no longer
having episodes of bradycardia; this can be converted to
metoprolol succinate 25mg daily on d/c. Lisinopril 15mg daily
was started prior to d/c. She did not have further episodes of
chest pain.
.
# Atrial fib: History of paroxysmal atrial fibrillation and ?
SVT.
- found to be bradycardic at OSH in response to lopressor. Also
noticed to be tachy-brady upon arrival to CCU, with rates
varying from the 40s to the 120s. Also with pauses > 5 seconds
at OSH. Patient went in to AF with RVR after transfer that was
terminated with 2.5mg metoprolol IV. EP was consulted and
recommended a pacemaker for tachy-brady syndrome. Pacer was
sucessfuly placed [**2153-6-27**]. Patient was not on coumadin at the
time of admission. It is unclear why her PMD felt coumadin was
contraindicated, but it was felt during hospital stay that pt
was a fall risk and the risk of coumadin would outweight the
benefit in her case, particularly given that she would need
Plavix and ASA after her stent. CHADS score 2. ASA was increased
to full dose. Amiodorone was started for rhythm control as
recommended by EP, and she is on metoprolol for rate control.
She will require a 5 gram load of amiodarone and should change
to 100 mg daily after her load of 400 mg daily for 13 days.
TFT's and LFT's should be checked and PFT's should be arranged
by her PCP.
.
# PUMP: Per OSH report, TTE [**12-31**] demonstrated LVEF 55%, 1+MR,
1+TR. Appears euvolemic on exam throughout hospital course. Pt
is on ACEi and long acting Bblocker.
.
# Dyslipidemia: continue lipitor as above.
.
# Hypertension: BP currently controlled on lisinopril and
metoprolol at time of d/c.
.
# Sjogren's syndrome: Stable.
.
# GERD: Famotidine continued given possible interaction between
PPIs and Plavix.
.
# BRBPR: Noted by nursing staff. Hct follwed serially and was
stable throughout hospital course. C diff was negative. There
was no more evidence of [**Month/Year (2) **] in stools per nursing at the
time of discharge. Consider colonoscopy as an outpatient.
.
# Leukocytosis: WBC 12. Pancultures sent, no source of infection
found. CXR showed no infiltrate. C diff toxin negative.
Leukocytosis resolved and patient afebrile at time of d/c.
.


Medications on Admission:
HOME MEDICATIONS:
- aspirin 81mg PO daily
- sotalol 40mg PO BID
- amlodipine 10mg PO daily
- colace 100mg PO daily
- SL NTG PRN
- omeprazole 20mg PO daily


Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Do not stop taking or miss [**First Name (Titles) 691**] [**Last Name (Titles) 4319**] unless Dr.
[**Last Name (STitle) **] tells you to. .
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever, pain.
3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO twice a day.
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain:
every 5 minutes X 3 [**Last Name (STitle) 4319**] PRN
.
6. Lisinopril 5 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
7. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 13 days: Then decrease to 100 mg daily indefinitely.

9. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day: Hold
SBP < 100.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Nursing and Rehab

Discharge Diagnosis:
Tachy/Brady syndrome
ST Elevation Myocardial Infarction
Atrial fibrillation with Rapid ventricular response


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


Discharge Instructions:
You had a heart attack because of a rapid heart rate and needed
a bare metal stent to fix a blocked coronary artery. You were
transferred here for further treatment. We noticed that you had
pauses on telemetry and a pacemaker was placed. You will need to
come back in 1 week to check the pacer. You can take the
dressing off on Monday [**7-2**] and take a shower. No soaps or
creams to the pacer site. No lifting your left arm over your
head of lifting more than 5 pounds for 6 weeks.
Medication changes:
1. Stop taking Amlodipine, Colace and Omeprazole
2. Take famotidine to protect your stomach
3. Increase your aspirin to 325 mg to prevent strokes with your
atrial fibrillation.
4. Continue with the nitroglycerin as needed
5. Start taking amiodarone to control your heart rate and
rhythm.
6. Start taking Metoprolol to control your heart rate and rhythm
7. Start Atorvastatin to lower your cholesterol
8. Start taking Tylenol as needed for the pacer pain
9. Start taking Plavix daily to keep the stent from clotting off
and causing another heart attack. Do not stop taking Plavix
unless Dr. [**Last Name (STitle) **] tells you to.

Followup Instructions:
Department: Internal Medicine
Name: Dr. [**First Name (STitle) 487**] KIDD
When: Monday [**2153-7-2**] at 3 PM
Address: [**Street Address(2) **], [**Apartment Address(1) 85042**] [**Hospital1 **],[**Numeric Identifier 66038**]
Phone: [**Telephone/Fax (1) 69547**]

Department: Cardiology
Name: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5423**]
When: Thursday [**2153-8-2**] at 3 PM
Location: [**Location (un) **] CARDIO
Address: [**Street Address(2) **], [**Apartment Address(1) **], [**Location (un) **],[**Numeric Identifier 39854**]
Phone: [**Telephone/Fax (1) 5424**]

Department: CARDIAC SERVICES
When: THURSDAY [**2153-7-5**] at 10:00 AM
With:  DEVICE CLINIC [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: MONDAY [**2153-8-13**] at 3:00 PM
With: [**First Name4 (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



Completed by:[**2153-6-29**]
{'Acute myocardial infarction of other lateral wall, initial episode of care,Hemorrhage of gastrointestinal tract, unspecified,Sinoatrial node dysfunction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Sicca syndrome,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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: STEMI

PRESENT ILLNESS: [**Age over 90 **] yo with PMH of atrial fibrillation, ?SVT, Sjogren's disease,
systemic HTN, GERD, who presented to [**Hospital6 3105**]
on [**2153-6-18**] with left sided chest discomfort in the setting of
rapid heartbeat. Episode lasted approximately one hour. She has
had these episodes in the past, but they have usually lasted
only a few minutes. Patient was found to have ST elevations in
lateral leads (I and aVL) with ST depressions in aVR. CPK peaked
at 1261 and troponin of 54.56. Underwent cath at [**Hospital1 487**] which
demonstrated 80% stenosis of mid LAD, 100% occlusion of first
diag, 50% left main stenosis, 50% left circumflex, 70% stenosis
of PDA, LVEF of 35% with anterior and apical akinesis. Underwent
angioplasty and BMS to her first diagonal artery. Transferred to
[**Hospital1 18**] for CT [**Doctor First Name **] evaluation for possible CABG.
.
Pt is currently comfortable, she has no chest pain, shortness of
breath, or dizziness.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, [**Doctor First Name **] at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.

MEDICAL HISTORY: atrial fibrillation
?SVT
Sjogren's disease
systemic HTN
GERD
.
.
PAST MEDICAL HISTORY:
1. CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
- History of supraventricular tachycardia, atrial fibrillation
3. OTHER PAST MEDICAL HISTORY:
- sjogren's syndrome
- GERD

MEDICATION ON ADMISSION: HOME MEDICATIONS:
- aspirin 81mg PO daily
- sotalol 40mg PO BID
- amlodipine 10mg PO daily
- colace 100mg PO daily
- SL NTG PRN
- omeprazole 20mg PO daily

ALLERGIES: Penicillins / Ciprofloxacin / Sulfa (Sulfonamide Antibiotics) /
Macrodantin

PHYSICAL EXAM: Gen: alert, oriented, NAD
HEENT: supple, no JVD
CV: RRR, no M/R/G, distant HS. Left pacer site with drsg [**Name5 (PTitle) 767**]
[**Name5 (PTitle) **] [**Name5 (PTitle) 2729**] in lab, no evidence of ecchymosis or swelling
under dressing.
RESP: [**Month (only) **] BS right base only, left now clear
ABD: soft, NT/ND
EXTR: no peripheral edema.
NEURO: A/O
Extremeties: no edema
Pulses:

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: SOCIAL HISTORY: lives alone, has help with chores. has a nephew
who is involved but [**Name (NI) **] sometimes is reluctant to involve him.
-Tobacco history: None.
-ETOH: None.
-Illicit drugs: None. 

### Response:
{'Acute myocardial infarction of other lateral wall, initial episode of care,Hemorrhage of gastrointestinal tract, unspecified,Sinoatrial node dysfunction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Sicca syndrome,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
