CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 43 y/o Caucasian man s/p stent [**2105**] presented to [**Hospital1 5979**] ED c/o jaw pain beginning 40 minutes prior to presenting
to OSH.  Pt reports having 2 alcoholic beverages  and later had
burning in his chest which felt like "heart burn".  Pt reports
burning in jaw bilaterally and mild diaphoresis.  He denied CP,
arm pain, or shortness of breath.  Pt denies anginal episodes or
CP since intervention in [**2105**].

MEDICAL HISTORY: CAD s/p PCI [**2105**]

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam (on admission)

FAMILY HISTORY: Mother w/ CAD

SOCIAL HISTORY: Tobacco: 0.5 pack X 15 years
EtOH: 1qwk
Limited exercise
Publisher of a magazine, lives in [**Location 5028**] with wife
Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use
Subendo infarct, initial,Parox ventric tachycard,Crnry athrscl natve vssl,Status-post ptca,History of tobacco use
Admission Date:  [**2113-8-7**]              Discharge Date:   [**2113-8-10**]

Date of Birth:  [**2069-12-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2113-8-7**]
Catherization for Anterior STEMI (3VD, LAD 99%):
Cypher drug eluting stent in proximal LAD

History of Present Illness:
43 y/o Caucasian man s/p stent [**2105**] presented to [**Hospital1 5979**] ED c/o jaw pain beginning 40 minutes prior to presenting
to OSH.  Pt reports having 2 alcoholic beverages  and later had
burning in his chest which felt like "heart burn".  Pt reports
burning in jaw bilaterally and mild diaphoresis.  He denied CP,
arm pain, or shortness of breath.  Pt denies anginal episodes or
CP since intervention in [**2105**].

In [**Hospital3 **] ED an EKG show ST elevation in the anterior
leads, V1-V5 and ST depression in II, III, and aVF.  Pt went
into Vfib arrest, shocked (200J, 300J, 360J) and started on
amiodarone gtt, integrillin gtt and transferred to [**Hospital1 18**] cath
[**Hospital1 **].

Past Medical History:
CAD s/p PCI [**2105**]

Social History:
Tobacco: 0.5 pack X 15 years
EtOH: 1qwk
Limited exercise
Publisher of a magazine, lives in [**Location 5028**] with wife

Family History:
Mother w/ CAD

Physical Exam:
Physical Exam (on admission)

VS T97.1 P76 BP124/69 RR20 O2Sat88%4LNC->93% on face tent
GENERAL: NAD, lying flat in bed w/ face tent, speaking in
complete sentences.
HEENT: PERRL, EOMI, MMM
NECK: Supple, JVP 7cm,
CARDIOVASCULAR: S1, S2, Reg, no murmurs
LUNGS: CTAB by anterior exam only due to sheath in place
ABDOMEN: Active bowel sounds, obese, soft, NT, ND, no HSM.
EXTREMITIES: DP/PT 2+ bilat.  Cool feet bilat.  Otherwise, UE
warm, well-perfused.
NEURO: A/OX3, strength and sensation grossly intact


Pertinent Results:
[**2113-8-7**] 11:02PM BLOOD WBC-19.3* RBC-4.48* Hgb-14.5 Hct-41.4
MCV-92 MCH-32.4* MCHC-35.1* RDW-13.2 Plt Ct-352
[**2113-8-7**] 11:02PM BLOOD Glucose-151* UreaN-15 Creat-1.0 Na-142
K-4.0 Cl-111* HCO3-20* AnGap-15
[**2113-8-7**] 11:02PM BLOOD ALT-97* AST-194* LD(LDH)-439*
CK(CPK)-2665* AlkPhos-72 TotBili-0.7
.
[**2113-8-8**] 06:20AM BLOOD CK(CPK)-3863*
[**2113-8-8**] 01:00PM BLOOD CK(CPK)-3442*
[**2113-8-9**] 06:31AM BLOOD CK(CPK)-1792*
.
[**2113-8-7**] 11:02PM BLOOD CK-MB-319* MB Indx-12.0* cTropnT-3.44*
[**2113-8-8**] 06:20AM BLOOD CK-MB-461* MB Indx-11.9* cTropnT-7.30*
[**2113-8-8**] 01:00PM BLOOD CK-MB-308* MB Indx-8.9* cTropnT-7.23*
[**2113-8-9**] 06:31AM BLOOD CK-MB-47* MB Indx-2.6 cTropnT-4.38*
.
[**2113-8-7**] 11:02PM BLOOD Calcium-8.4 Phos-2.4* Mg-1.8
[**2113-8-8**] 06:20AM BLOOD Calcium-8.3* Phos-2.8 Mg-2.2
[**2113-8-9**] 06:31AM BLOOD Calcium-8.3* Phos-2.3* Mg-1.7
.
[**2113-8-7**] 09:35PM BLOOD Type-ART O2 Flow-10 pO2-57* pCO2-37
pH-7.33* calHCO3-20* Base XS--5 Intubat-NOT INTUBA
Comment-NON-REBREA
[**2113-8-9**] 06:31AM BLOOD WBC-13.6* RBC-3.98* Hgb-12.6* Hct-36.7*
MCV-92 MCH-31.8 MCHC-34.4 RDW-13.5 Plt Ct-243

.
[**2113-8-7**] ECG
Sinus rhythm. There are Q waves in leads VI-V2 with ST segment
elevations of one to two millimeters in leads I, aVL and VI-V5
consistent with acute
extensive anterolateral myocardial infarction. Generalized low
QRS voltage. ST segment depression in leads III and aVF with
inverted T waves consistent with reciprocal changes. No previous
tracing available for comparison. Clinical correlation is
suggested.
.
[**2113-8-7**] Cath Report
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Elevated right and left sided filling pressures.
3. Successful treatment of proximal LAD with drug-eluting stent.

4. Successful treatment of ostial D1 with balloon angioplasty.
.
[**2113-8-8**] ECHO
Conclusions:
The left atrium is mildly elongated. Left ventricular wall
thicknesses and cavity size are normal. There is moderate
regional left ventricular systolic dysfunction with hypokinesis
of the disal half of the anterior septum and anterior walls and
of the distal anterior and inferior walls. The apex is near
akinetic. The remaining segments contract well. No
intraventricular thrombus is seen and the apex is not focally
aneurysmal. Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets appear structurally normal
with good leaflet excursion. No aortic regurgitation is seen.
The mitral valve leaflets are structurally normal. Mild (1+)
mitral regurgitation is seen. The pulmonary artery systolic
pressure could not be determined. There
is no pericardial effusion.
 .
IMPRESSION: Regional left ventricular systolic dysfunction c/w
CAD (mid-LAD lesion). Mild mitral regurgitation.  EF 35%-40%


Brief Hospital Course:
43M 3V CAD here w/ anterior STEMI, s/p successful LAD cypher
stent.


* Ischemia: The patient underwent cardiac catheterization which
showed 3 vessel disease.  A drug eluting stent was placed in the
proximal LAD. The patient had 2 vessel unrevascularized disease,
and which may require a re-look once he stabilizes.  His enzymes
were cycled until they trended downward.  His trop peaked at
7.30.  At discharge it was 4.38.

The [**Hospital 228**] medical management consistent of the following:
integrillin X 18 hrs, ASA 325, Plavix 75, Lipitor 80, Metop 12.5
TID advanced to Toprol 100 at discharge and lisinopril 10mg
daily..


* Pump: The patient's cardiac index in the cath [**Hospital **] was 1.8,
this was of unclear etiology. He received lasix for diuresis in
cath [**Hospital **] due to PCWP and PAD elevation and increasing O2
requirement.  He received Lasix overnight with good response.
An ECHO was later done to evaluate pump function and showed an
EF on 35-40%, with an akinetic apex.  The patient was
anticoagulated with Heparin and Coumadin.  At the time of
discharge he was started on Lovenox.

Other medical management included lisinopril 10 mg daily and
Toprol 100 daily.

* Rhythm: The patient maintained NSR throughout his course, but
s/p VF at OSH(suspect ischemic). He was maintained on Amiodarone
gtt initially and this was later discontinued. The patient was
monitored on telemetry with no ectopy noted.
K was kept >4 and Mg was kept >2.

* Smoking cessation: The patient was counseled on the importance
of smoking cessation as it pertained to his heart disease.


* EtOH Use: The patient was kept on a CIWA scale.


* High WBC: UA and CXR were negative.  Cyst drainage on back
prior to admission may have contributed to elevated wbc. The
patient remained HD stable throughout his course.


* FEN: Cardiac heart healthy diet. K was kept > 4 and Mg was
kept > 2.


* PROPHYLAXIS: SCDs while in bed. PPI.


*DISPOSITION: The patient was discharged home with VNA teaching
for his Lovenox.  He was scheduled to have his INR monitored at
his PCPs office.  The patient was chest pain free and
hemodynamically stable at the time of discharge.




Medications on Admission:
none

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 Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
6. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
7. Lovenox 100 mg/mL Syringe Sig: One (1)  Subcutaneous once a
day: 100mg daily

.
Disp:*14 syringes* Refills:*0*
8. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1)
Sublingual PRN as needed for chest pain.
Disp:*30 * Refills:*2*
9. Outpatient [**Name (NI) **] Work
Pt is on Coumadin.  INR is 1.2 on discharge [**2113-8-10**]. Pt must have
blood drawn on [**2113-8-14**].  INR therapeutic range is 1.5-2.0.  Pt
must have labs drawn every 2 days until therapeutic. Thereafter
pt must have weekly blood draws. [**Date Range **] results must be reported to
PCP's office Dr. [**First Name (STitle) 6164**] 1-[**Telephone/Fax (1) 64400**] or 1-[**Telephone/Fax (1) 64401**].


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Myocardial infarction: Anterior ST elevation myocardial
infarction

Discharge Condition:
Good


Discharge Instructions:
Pt has been instructed that he can drive and go back to work.
He has been advised not to resume any type of strenuos activity.
 Pt has been instructed to call 911 immediately if he should
have any chest discomfort, is diaphoretic, nauseous or becomes
short of breath.
Pt has been instructed to adhere strictly to medications and to
a cardiac heart healthy diet.
.
VNA services has been set up to provide the patient with
instruction on Lovenox.
.
Pt has been instructed to have blood draws initially every 2
days from date of discharge on [**2113-8-14**] until INR is therapeutic
(1.5-2.0).  Thereafter, pt has been instructed to have weekly
blood draws.  Therapeutic goal is 1.5-2.0

Followup Instructions:
1)Pt must follow up with Dr. [**First Name (STitle) 6164**] at [**Hospital **] Medical
Associates on [**2113-8-14**] at 9:15am.(1-[**Telephone/Fax (1) 32949**]).  Pt also has
an appointment at 8:30am with the [**Telephone/Fax (1) **] to have his INR checked.
The [**Telephone/Fax (1) **] is located in the same building as Dr. [**Last Name (STitle) 15321**] office.
2)Pt must follow up with Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] (cardiologist) in 3
months at [**Hospital1 69**]. Appt has been
made for [**11-21**] @ 2:45pm. Location: [**Hospital Ward Name 23**] Building [**Location (un) **], [**Hospital Ward Name 516**]  Tel: (1-[**Telephone/Fax (1) 920**]).



Completed by:[**2114-9-1**]
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use'}


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: 43 y/o Caucasian man s/p stent [**2105**] presented to [**Hospital1 5979**] ED c/o jaw pain beginning 40 minutes prior to presenting
to OSH.  Pt reports having 2 alcoholic beverages  and later had
burning in his chest which felt like "heart burn".  Pt reports
burning in jaw bilaterally and mild diaphoresis.  He denied CP,
arm pain, or shortness of breath.  Pt denies anginal episodes or
CP since intervention in [**2105**].

MEDICAL HISTORY: CAD s/p PCI [**2105**]

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam (on admission)

FAMILY HISTORY: Mother w/ CAD

SOCIAL HISTORY: Tobacco: 0.5 pack X 15 years
EtOH: 1qwk
Limited exercise
Publisher of a magazine, lives in [**Location 5028**] with wife 

### Response:
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use'}
