CHIEF COMPLAINT: Acute myocardial infarction.

PRESENT ILLNESS: The patient is a 36-year-old man
who has had on and off left arm discomfort for the past month
which he has treated with NSAIDs.  Today, while the patient
was driving, he noted the onset of chest pain.  Initially it
was [**3-23**] and then escalated to [**8-23**].  At that point, the
patient pulled over to the side of the road and called EMS on
his cell phone.  When EMS arrived, they transported him to
[**Hospital3 417**] Hospital where he had a V-fib arrest in the
Emergency Department.  He was given atropine, amiodarone and
defibrillated, and shocked back into normal sinus rhythm.  An
EKG done after the arrest demonstrated sinus tach with
anterior ST elevations.  At that point, he was started on
heparin, given morphine, and intubated and transferred to
[**Hospital1 **] Hospital for emergent cardiac
catheterization.

MEDICAL HISTORY: 1. High cholesterol.
2. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of early CAD.

SOCIAL HISTORY: He lives with his wife.  [**Name (NI) **] is a
truck driver.  He has three children.
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Ventricular fibrillation,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension
AMI anterior wall, init,Cardiogenic shock,Ventricular fibrillation,Food/vomit pneumonitis,Crnry athrscl natve vssl,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2154-11-4**]       Discharge Date:  [**2154-11-8**]

Date of Birth:   [**2117-12-14**]       Sex:  M

Service:  CCU

CHIEF COMPLAINT:  Acute myocardial infarction.

HISTORY OF PRESENT ILLNESS:  The patient is a 36-year-old man
who has had on and off left arm discomfort for the past month
which he has treated with NSAIDs.  Today, while the patient
was driving, he noted the onset of chest pain.  Initially it
was [**3-23**] and then escalated to [**8-23**].  At that point, the
patient pulled over to the side of the road and called EMS on
his cell phone.  When EMS arrived, they transported him to
[**Hospital3 417**] Hospital where he had a V-fib arrest in the
Emergency Department.  He was given atropine, amiodarone and
defibrillated, and shocked back into normal sinus rhythm.  An
EKG done after the arrest demonstrated sinus tach with
anterior ST elevations.  At that point, he was started on
heparin, given morphine, and intubated and transferred to
[**Hospital1 **] Hospital for emergent cardiac
catheterization.

Cardiac catheterization revealed pulmonary artery pressures
of 49/29, with a mean of 37, a wedge of 41, a cardiac output
4.3, and a Fick calculated cardiac output of 2.3.
Angiography revealed a 90% proximal LAD lesion and discrete
90% OM1 lesion.  The LAD lesion had evidence of clot.  While
undergoing the cardiac catheterization, the patient again
went into ventricular fibrillation and was defibrillated.
The patient was given another bolus of amiodarone, and a
balloon pump was placed.  The patient was transferred to the
CCU.

PAST MEDICAL HISTORY:
1. High cholesterol.
2. Hypertension.

MEDICATIONS:  The patient denies taking any.  He has been
advised to take some by his primary care doctor, but he takes
none.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  No history of early CAD.

SOCIAL HISTORY:  He lives with his wife.  [**Name (NI) **] is a
truck driver.  He has three children.

PHYSICAL EXAM ON ADMISSION - VITAL SIGNS:  Temperature 100.0,
heart rate 99, blood pressure 98/65, respiratory rate 23.
Vent settings - AC 750 x 18, FIO2 100%, satting 100%.
GENERAL:  He was an obese, intubated man, sedated, not
responding to stimuli.
HEENT:  Pupils equal, round and reactive to light.
NECK:  Obese, unable to identify JVD.
HEART:  Regular rate and rhythm.
LUNGS:  Clear anteriorly.
ABDOMEN:  Obese, soft and nontender, positive bowel sounds.
Bruit consistent with balloon pump placement.
EXTREMITIES:  No edema.  Dorsalis pedis pulses are [**11-15**]+
bilaterally.

LABORATORY DATA:  White count 21.5, hematocrit 36.9,
platelets 273.  Chemistries - sodium 139, potassium 3.2,
chloride 106, bicarb 22, BUN 8, creatinine 0.8, glucose 262,
PT 14.4, PTT 97.2, INR 1.4.  AST, ALT, alk phos, T-bili,
amylase and lipase were all within normal limits.  CK on
admission was 1,927.

Cardiac catheterization was notable for serial 90% LAD
lesions with thrombus.  The left main and RCA were normal
without stenoses.  The circumflex was a nondominant vessel
with 90% lesion.  The mid and proximal LAD was stented with 3
stents.

ASSESSMENT:  A 36-year-old man, with an acute anterior
myocardial infarction, status post V-fib arrest x 2 with
defibrillation restoring normal sinus rhythm, who was
intubated, sedated, and has a balloon pump in place, admitted
to the CCU for post MI and post cardiac catheterization care.

HOSPITAL COURSE:  The patient was given infusion of
Integrilin.  Plavix, Lipitor, aspirin, and heparin were all
given as well.  On the first full hospital day, the patient
spiked a temperature and was started on vancomycin,
Levofloxacin and metronidazole for presumed aspiration
pneumonia in the setting of V-fib arrest and intubations.
Serial CKs were drawn.  The CK peak was approximately 14
hours after catheterization and was 6,210 with an MB fraction
peaking at 303.  The balloon pump was discontinued on
[**11-5**].  By the morning of [**11-6**], the patient's
ventilatory status had improved, and the patient was
extubated.

During this time, a sputum culture revealed sparse to
moderate growth of Staph aureus and Strep pneumoniae.  The
patient was continued on Levofloxacin for these infections.

On [**11-5**], amiodarone was discontinued, and an
echocardiogram was obtained.  The echocardiogram demonstrated
an ejection fraction of 30-40%.  Valves were within normal
limits.  The anterior septum of the LV was severely
hypokinetic, along with the anterior free wall and apex.
There were no thrombi seen.  Also on [**11-5**], the patient
was started on an ACE inhibitor which was gently titrated up.
On [**11-6**], the patient was started on a beta blocker
which was also gently titrated up over the remainder of the
[**Hospital 228**] hospital stay.

The patient was transferred to the floor on [**11-7**].  A
physical therapy consult on [**11-8**] confirmed that the
patient was able to ambulate without difficulties.  The
patient also had a signal-averaged EKG on the 26, and the
patient was discharged to home in good condition.

DISCHARGE MEDICATIONS:
1. Plavix 75 mg po qd for 9 months.
2. Atorvastatin 20 mg po qd in an ongoing way, titrated by
patient's primary care doctor.
3. Aspirin 325 mg po qd.
4. Levofloxacin 500 mg po qd for 3 more days to finish a
7-day course for aspiration pneumonia.
5. Atenolol 50 mg po qd.
6. Lisinopril 20 mg po qd.

DISCHARGE DIAGNOSES:  Acute myocardial infarction with
cardiogenic shock and ventricular fibrillation arrests x 2.

DISPOSITION:  The patient is being discharged to home with
his wife.  The patient has follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
on [**2154-12-11**].




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Last Name (NamePattern1) 8228**]
MEDQUIST36

D:  [**2154-11-8**]  14:40
T:  [**2154-11-8**]  14:43
JOB#:  [**Job Number 53892**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Ventricular fibrillation,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,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: Acute myocardial infarction.

PRESENT ILLNESS: The patient is a 36-year-old man
who has had on and off left arm discomfort for the past month
which he has treated with NSAIDs.  Today, while the patient
was driving, he noted the onset of chest pain.  Initially it
was [**3-23**] and then escalated to [**8-23**].  At that point, the
patient pulled over to the side of the road and called EMS on
his cell phone.  When EMS arrived, they transported him to
[**Hospital3 417**] Hospital where he had a V-fib arrest in the
Emergency Department.  He was given atropine, amiodarone and
defibrillated, and shocked back into normal sinus rhythm.  An
EKG done after the arrest demonstrated sinus tach with
anterior ST elevations.  At that point, he was started on
heparin, given morphine, and intubated and transferred to
[**Hospital1 **] Hospital for emergent cardiac
catheterization.

MEDICAL HISTORY: 1. High cholesterol.
2. Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of early CAD.

SOCIAL HISTORY: He lives with his wife.  [**Name (NI) **] is a
truck driver.  He has three children. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Ventricular fibrillation,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Unspecified essential hypertension'}
