CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: EVENTS / HISTORY OF PRESENTING ILLNESS: 51 yo M with cardiac
risk factors including IDDMx18 years, smoker who recently quit 1
week ago, father with MI at age 49, who presents with 5/10
nonradiating SSCP associated with diaphoresis, lightheadeness,
dizziness, nausea & emesis . The pain started suddenly while he
was at rest about 2 hrs prior to ED visit. No prior MI. In route
with EMS, he vomited x1 and was given SLNG x2 and ASA.
.
In the ED, he was 128/107, 76, 11, 100% on NRB. EKG showed
inferior lateral STE. Code STEMI was called. He was given
metoprolol, nitro gtt, plavix load 600mg, heparin gtt and
brought to the cath lab.
.
In the cath lab, he had a BMS placed to the RCA.
.
On review of symptoms, 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 current absence of
chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: IDDM
HTN
Anxiety
Depression
? Sleep apnea

MEDICATION ON ADMISSION: Lantus 50 Units SQ Q PM
Novolin 15 Units SC before meals
Prozac 40mg daily
Chantix
Medication for anxiety - unclear of name
ativan
viagra
flexpan?

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death

SOCIAL HISTORY: Social history is significant for tobacco use. Patient reports
that he quit smoking 1 week prior to presentation.  Does report
drinking 2 glasses of vodka per night.
Acute myocardial infarction of other inferior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension
AMI inferior wall, init,Parox ventric tachycard,Crnry athrscl natve vssl,Tobacco use disorder,DMII wo cmp nt st uncntr,Long-term use of insulin,Hypertension NOS
Admission Date:  [**2158-2-7**]              Discharge Date:   [**2158-2-10**]

Date of Birth:  [**2106-11-25**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 134**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization and bare metal stent placement in right
coronary artery


History of Present Illness:
EVENTS / HISTORY OF PRESENTING ILLNESS: 51 yo M with cardiac
risk factors including IDDMx18 years, smoker who recently quit 1
week ago, father with MI at age 49, who presents with 5/10
nonradiating SSCP associated with diaphoresis, lightheadeness,
dizziness, nausea & emesis . The pain started suddenly while he
was at rest about 2 hrs prior to ED visit. No prior MI. In route
with EMS, he vomited x1 and was given SLNG x2 and ASA.
.
In the ED, he was 128/107, 76, 11, 100% on NRB. EKG showed
inferior lateral STE. Code STEMI was called. He was given
metoprolol, nitro gtt, plavix load 600mg, heparin gtt and
brought to the cath lab.
.
In the cath lab, he had a BMS placed to the RCA.
.
On review of symptoms, 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 current absence of
chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.


Past Medical History:
IDDM
HTN
Anxiety
Depression
? Sleep apnea


Social History:
Social history is significant for tobacco use. Patient reports
that he quit smoking 1 week prior to presentation.  Does report
drinking 2 glasses of vodka per night.

Family History:
There is no family history of premature coronary artery disease
or sudden death

Physical Exam:
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP


Pertinent Results:
[**2158-2-7**] 09:45AM   PT-11.0 PTT-22.7 INR(PT)-0.9
[**2158-2-7**] 09:45AM   PLT COUNT-408
[**2158-2-7**] 09:45AM   NEUTS-87.0* LYMPHS-8.7* MONOS-3.5 EOS-0.2
BASOS-0.6
[**2158-2-7**] 09:45AM   WBC-13.6* RBC-4.98 HGB-16.4 HCT-47.4 MCV-95
MCH-33.0* MCHC-34.7 RDW-13.0
[**2158-2-7**] 09:45AM   CALCIUM-10.0 PHOSPHATE-1.8* MAGNESIUM-1.8
[**2158-2-7**] 09:45AM   estGFR-Using this
[**2158-2-7**] 09:45AM   GLUCOSE-144* UREA N-11 CREAT-0.8 SODIUM-137
POTASSIUM-3.8 CHLORIDE-99 TOTAL CO2-22 ANION GAP-20
[**2158-2-7**] 09:50AM   cTropnT-0.02*
[**2158-2-7**] 10:43AM   HGB-13.1* calcHCT-39 O2 SAT-98
[**2158-2-7**] 10:43AM   TYPE-ART O2 FLOW-15 PO2-180* PCO2-15*
PH-7.67* TOTAL CO2-18* BASE XS-0 INTUBATED-NOT INTUBA
[**2158-2-7**] 12:02PM   PLT COUNT-347
[**2158-2-7**] 06:33PM   PLT COUNT-290
[**2158-2-7**] 06:33PM   CK-MB-342* MB INDX-11.0*
.
ECHO [**2158-2-8**]: The left atrium is normal in size. The estimated
right atrial pressure is 0-5 mmHg. Left ventricular wall
thicknesses and cavity size are normal. There is mild regional
left ventricular systolic dysfunction with hypokinesis of the
basal half of the inferior and inferolateral walls. The
remaining segments contract normally (LVEF = 45 %). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic stenosis. Trace aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. There is no mitral valve prolapse. Mild
(1+) mitral regurgitation is seen. The pulmonary artery systolic
pressure could not be determined. There is an anterior fat pad.

IMPRESSION: Normal chamber sizes with mild regional left
ventricular systolic dysfunction c/w CAD. Mild mitral
regurgitation.
.
Cardiac catheterization:

COMMENTS:     1. Coronary angiography in this right dominant
system
revealed one vessel coronary artery disease. The LMCA, LAD, LCx
had no
flow-limiting coronary artery disease. The RCA was totally
occluded
proximally.
2. Resting hemodynamics revealed elevated left and right sided
filling
pressures with mean PCW of 23 mmHg and RVEDP of 20 mmHg. There
was
mild-moderate pulmonary arterial hypertension with PASP of 35
mmHg. The
cardiac index was 2.2 L/min/m2. There was normal systemic
arterial
pressure of 133/83 mmHg on Dopamine drip.
3. Left ventriculography was deferred.
4. Successful PTCA and stenting of the proximal RCA with a 4.0 x
24 mm
DRIVER BMS. FInal angiography revealed no residual stenosis, no
angiographically apparent dissection and TIMI II flow in the
distal RCA.
(See PTCA comments)

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Left ventricular diastolic dysfunction.
3. Elevated right sided filling pressure.
4. Acute Inferiot myocardial infarction.
5. Successful PCI of the proximal RCA.


Brief Hospital Course:
.
ASSESSMENT AND PLAN, TO BE REVIEWED AND DISCUSSED IN
MULTIDISCIPLINARY ROUNDS:
51M smoker, IDDM, HTN, and +family history who presents with
IMI-STEMI. Now s/p cath with BMS to RCA.
.
# CAD/Ischemia: No further chest pain
- asa, plavix (for 1 year per cath report), statin, as tolerated

- Started low dose bblocker and ace inhibitor and titrated as
blood pressure tolerated.
- Fasting lipids normal with LDL of 72 and HDL of 92.
- HbA1c 13.1
- Patient to take home Chantix
.
# Pump: EF 45% with some hypokinesis of inferior walls noted on
ECHO. Not in acute or chronic heart failure. On ACE inhibitor
for comorbid coronary artery disease.

.
# Rhythm: Initially noted to have runs of NSVT, up to 11 beats
post procedure, thought to be due to reperfusion injury.
Monitored on telemetry for duration of admission and noted to
have occasional PVCs with no further NSVT 24 hours after
catheterization.
.
# Valves: 1+ MR noted on ECHO otherwise no valvular disease.
.
# HTN: Normotensive; on betablocker and ace inhibitor for
coronary artery disease.
.
# DM: On lantus and novalog at home. Started on half home dose
regimen for hypoglycemia post myocardial infarction. FS then
elevated to 400s. Restarted on home regimen with improvement.
HgA1C significantly elevated to 13.1. Given new glucometer. Will
need close follow up of his diabetes mellitus.
.
# Depression
- Continued Prozac
.


Medications on Admission:
Lantus 50 Units SQ Q PM
Novolin 15 Units SC before meals
Prozac 40mg daily
Chantix
Medication for anxiety - unclear of name
ativan
viagra
flexpan?


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. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. 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*
6. Lantus 100 unit/mL Solution Sig: Fifty (50) units
Subcutaneous qPM.
7. Novolin N 100 unit/mL Suspension Sig: Fifteen (15) units
Subcutaneous before meals.
8. Medical supplies
Glucometer
9. One Touch Ultra Test     Strip Sig: One (1) strip In [**Last Name (un) 5153**]
four times a day.
Disp:*120 strips* Refills:*2*
10. One Touch UltraSoft Lancets     Misc Sig: One (1) lancet
Miscellaneous four times a day.
Disp:*120 lancets* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary: Inferior Myocardial infarction
Secondary: Insulin dependent diabetes


Discharge Condition:
Good, chest pain free, vital signs stable


Discharge Instructions:
You were admitted to the hospital with a heart attack. You had a
stent placed in your coronary artery to open up the blockage.
.
You were started on new medication which include:
Aspirin
Plavix
Lisinopril
Toprol XL
.
Please call [**Hospital6 **] to update your registration
information at ([**Telephone/Fax (1) 1921**]. You have been set up with a follow
up appointment with a new primary care physician. [**Name10 (NameIs) **] below. For
registration purposes, [**First Name4 (NamePattern1) 1356**] [**Last Name (NamePattern1) **] will be listed as your primary
care physician.
.
Please call Cardiology clinic to set up an appointment with a
cardiologist ([**Telephone/Fax (1) 2037**]
.
Please call your doctor or return to the emergency room if you
develop any worrisome symptoms such as shortness of breath,
chest pain, palpitations, lightheadedness, bleeding, etc.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 2671**] [**Last Name (NamePattern4) 11064**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2158-3-16**] 3:30 located at [**Hospital6 733**],
[**Hospital Ward Name 23**] Building [**Location (un) **], [**Location (un) 830**] [**Location (un) 86**], MA
{'Acute myocardial infarction of other inferior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension'}


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: EVENTS / HISTORY OF PRESENTING ILLNESS: 51 yo M with cardiac
risk factors including IDDMx18 years, smoker who recently quit 1
week ago, father with MI at age 49, who presents with 5/10
nonradiating SSCP associated with diaphoresis, lightheadeness,
dizziness, nausea & emesis . The pain started suddenly while he
was at rest about 2 hrs prior to ED visit. No prior MI. In route
with EMS, he vomited x1 and was given SLNG x2 and ASA.
.
In the ED, he was 128/107, 76, 11, 100% on NRB. EKG showed
inferior lateral STE. Code STEMI was called. He was given
metoprolol, nitro gtt, plavix load 600mg, heparin gtt and
brought to the cath lab.
.
In the cath lab, he had a BMS placed to the RCA.
.
On review of symptoms, 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 current absence of
chest pain, dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: IDDM
HTN
Anxiety
Depression
? Sleep apnea

MEDICATION ON ADMISSION: Lantus 50 Units SQ Q PM
Novolin 15 Units SC before meals
Prozac 40mg daily
Chantix
Medication for anxiety - unclear of name
ativan
viagra
flexpan?

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death

SOCIAL HISTORY: Social history is significant for tobacco use. Patient reports
that he quit smoking 1 week prior to presentation.  Does report
drinking 2 glasses of vodka per night. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Unspecified essential hypertension'}
