CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 56 yo caucasian male w/ PMHx HTN, obesity presented to the ER
with chest pain.  Pt stated that he had felt fatigued over the
last few days PTA.  On [**12-2**] am, pt states that he woke up with
a sudden onset [**7-30**] severe substernal chest pain.  Pain was
associated w/ some shortness of breath but did not radiate to
jaw, back, arms, or legs.  Pt did not experience any nausea,
vomiting, diaphoresis.  Pt reports that he did use Viagra ~
10-12 hours PTA.  He took 325 mg tablet of aspirin and called
EMS.  EMS gave patient additional 180 mg of aspirin and 4 SL
nitroglycerin tablets and pain decreased to [**2-27**].

MEDICAL HISTORY: HTN
Obesity

MEDICATION ON ADMISSION: Atenolol
Viagra

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:  Temp 98.0  BP 116/68  HR 86  RR 18  O2 97% RA

FAMILY HISTORY: Paternal grandfather - MI
Father - MI
Mother - cancer

SOCIAL HISTORY: Married, 15 pack year history, no ETOH.
Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension
AMI anterior wall, init,Crnry athrscl natve vssl,Hypertension NOS
Admission Date:  [**2199-12-2**]              Discharge Date:   [**2199-12-5**]

Date of Birth:  [**2143-5-6**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2074**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization w/ stent x 3

History of Present Illness:
56 yo caucasian male w/ PMHx HTN, obesity presented to the ER
with chest pain.  Pt stated that he had felt fatigued over the
last few days PTA.  On [**12-2**] am, pt states that he woke up with
a sudden onset [**7-30**] severe substernal chest pain.  Pain was
associated w/ some shortness of breath but did not radiate to
jaw, back, arms, or legs.  Pt did not experience any nausea,
vomiting, diaphoresis.  Pt reports that he did use Viagra ~
10-12 hours PTA.  He took 325 mg tablet of aspirin and called
EMS.  EMS gave patient additional 180 mg of aspirin and 4 SL
nitroglycerin tablets and pain decreased to [**2-27**].

In [**Name (NI) **], pt found to have ST elevations in leads I, aVL, V1-V4.
Pt was taken to cath lab and found to have LAD 100% mid lesion
s/p 2 stents and 80% proximal lesion s/p 1 stent.

Past Medical History:
HTN
Obesity

Social History:
Married, 15 pack year history, no ETOH.

Family History:
Paternal grandfather - MI
Father - MI
Mother - cancer

Physical Exam:
Vitals:  Temp 98.0  BP 116/68  HR 86  RR 18  O2 97% RA

Gen: lying in bed comfortable NAD
HEENT: anisicoria, R>L 4mm > 3 mm, EOMI, no JVP
CV: RRR nl S1 S2 no m/r/g
Resp: CTA b/l
Abd: soft NT ND + BS
Ext: no c/c/e
Groin: c/d/i
Skin: no rash
Neuro: CN II-XII intact.


Pertinent Results:
EKG - NSR, ST elevational I, AVL V1-V4, ST depression in III,
aVF.
.
CXR - no acute cardiopulmonary abnormality
.
Catheterization - 100% mid LAD lesion s/p 2 stents, 80%
ulcerated LAD lesion, proximal LAD s/p stent, R dominant
circulation, LCx 60-70% diffuse stenosis of mid vessel, RCA 80%
proximal stenosis. PCWP - 18 mm Hg.  CO 5.4.  CI 2.6.
.
Echo - EF 30%, regional left ventricular diastolic dysfunction
c/w CAD.
[**2199-12-2**] 09:05PM   CK(CPK)-1668*
[**2199-12-2**] 09:05PM   CK-MB-143* MB INDX-8.6*
[**2199-12-2**] 03:00PM   POTASSIUM-4.0
[**2199-12-2**] 03:00PM   ALT(SGPT)-58* AST(SGOT)-219* CK(CPK)-2500*
ALK PHOS-66 TOT BILI-0.6
[**2199-12-2**] 03:00PM   CK-MB-259* MB INDX-10.4*
[**2199-12-2**] 03:00PM   CHOLEST-242*
[**2199-12-2**] 03:00PM   %HbA1c-5.7
[**2199-12-2**] 03:00PM   TRIGLYCER-215* HDL CHOL-36 CHOL/HDL-6.7
LDL(CALC)-163*
[**2199-12-2**] 03:00PM   HCT-42.2
[**2199-12-2**] 03:00PM   PLT COUNT-206
[**2199-12-2**] 11:00AM   PLT COUNT-192
[**2199-12-2**] 06:20AM   GLUCOSE-129* UREA N-17 CREAT-1.0 SODIUM-141
POTASSIUM-4.1 CHLORIDE-108 TOTAL CO2-24 ANION GAP-13
[**2199-12-2**] 06:20AM   CK(CPK)-85
[**2199-12-2**] 06:20AM   CK-MB-4 cTropnT-<0.01
[**2199-12-2**] 06:20AM   WBC-9.4 RBC-4.76 HGB-15.8 HCT-43.8 MCV-92
MCH-33.3* MCHC-36.2* RDW-12.5
[**2199-12-2**] 06:20AM   NEUTS-57.3 LYMPHS-34.3 MONOS-5.6 EOS-1.8
BASOS-0.9
[**2199-12-2**] 06:20AM   PLT COUNT-215
[**2199-12-2**] 06:20AM   PT-11.9 PTT-26.2 INR(PT)-0.9

Brief Hospital Course:
56 yo male presented to ER with anterior STEMI taken to cath lab
found to have 3VD w/ two lesions in LAD both successfully
stented; LCX w/ 60% lesion and RCA w/ 80% lesion not intervened
upon.  Transferred to CCU for further observation.
.
CAD - Pt was transferred to the CCU and placed on telemetry.
His integrilin was continued for 18 hours post catheterization.
He was maintained on aspirin, lipitor, metoprolol, and plavix.
After one day lisinopril was added.  His CKs peaked at 2500 w/
MB of 259.  The patient was arranged for re-catheterization in
[**3-26**] weeks for his diseased LCX and RCA lesion that were not
intervened upon.
.
[**Name (NI) **] - pt echo showed EF 25% with multiple akinetic areas.  As a
result it was deemed that the patient would require
anticoagulation.  He was started on coumadin and was d/c to home
on lovenox until his coumadin dose was therapeutic.  The need
for further anticoagulation would be re-assessed at the time of
his next catheterization.
.
Rhythm - no issues
.
[**Name (NI) **] - the patient was instructed to follow up with his PCP
regarding his PT/INR levels.  He was also given an appointment
to see Dr. [**Last Name (STitle) **] in 3 weeks.

Medications on Admission:
Atenolol
Viagra

Discharge Medications:
1. Outpatient Lab Work
Check PT/PTT/INR on [**2199-12-6**] and if necessary on [**2199-12-9**].
Please give the patient the results and call results in to Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5936**] - [**Telephone/Fax (1) 59520**].
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
[**Telephone/Fax (1) **]:*30 Tablet(s)* Refills:*2*
3. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
[**Telephone/Fax (1) **]:*40 Tablet(s)* Refills:*2*
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
[**Telephone/Fax (1) **]:*30 Tablet(s)* Refills:*2*
5. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Please have your PCP check the INR level and adjust the
dose accordingly.
[**Telephone/Fax (1) **]:*30 Tablet(s)* Refills:*2*
6. Enoxaparin Sodium 100 mg/mL Syringe Sig: One (1)
Subcutaneous Q12H (every 12 hours): Please take Lovenox until
INR level is therapeutic and approved by your PCP.
[**Name Initial (NameIs) **]:*14 * Refills:*0*
7. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
[**Name Initial (NameIs) **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Metoprolol Tartrate 100 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily): Hold for SBP<100 or HR <60.
[**Name Initial (NameIs) **]:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Acute anterior myocardial infarction


Discharge Condition:
hemodynamically stable, able to walk without difficulty.

Discharge Instructions:
Patient was instructed to take all of the medications as
instructed.  Pt was instructed to seek medical attention if he
were to develop CP, SOB, diaphoresis, palpitation, dizziness,
nausea/vomting, or any other concerning symptoms.  Pt needs to
follow up with his PCP [**Last Name (NamePattern4) **] [**6-29**] days.  Pt needs to be scheduled
for the 2nd cath in 6 weeks.  Pt needs to take Lovenox daily
until the INR/Coumadin level is therapeutic.  Pt needs to get
his INR level checked on [**2199-12-6**] & [**2199-12-9**] if necessary and
have his PCP review the level and have the Coumadin dose
adjusted.

Followup Instructions:
Provider: [**Name10 (NameIs) 357**] follow up with your PCP [**Name9 (PRE) **],[**Name9 (PRE) **] [**Name Initial (PRE) **].
[**Telephone/Fax (1) 42923**]  [**2199-12-11**] @ 3:15 PM.

Please follow up with your cardiologist in [**2-21**] weeks.Provider:
[**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Where: [**Hospital6 29**] CARDIAC SERVICES
Phone:[**Telephone/Fax (1) 10548**] Date/Time:[**2199-12-30**] 9:30.
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,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: 56 yo caucasian male w/ PMHx HTN, obesity presented to the ER
with chest pain.  Pt stated that he had felt fatigued over the
last few days PTA.  On [**12-2**] am, pt states that he woke up with
a sudden onset [**7-30**] severe substernal chest pain.  Pain was
associated w/ some shortness of breath but did not radiate to
jaw, back, arms, or legs.  Pt did not experience any nausea,
vomiting, diaphoresis.  Pt reports that he did use Viagra ~
10-12 hours PTA.  He took 325 mg tablet of aspirin and called
EMS.  EMS gave patient additional 180 mg of aspirin and 4 SL
nitroglycerin tablets and pain decreased to [**2-27**].

MEDICAL HISTORY: HTN
Obesity

MEDICATION ON ADMISSION: Atenolol
Viagra

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:  Temp 98.0  BP 116/68  HR 86  RR 18  O2 97% RA

FAMILY HISTORY: Paternal grandfather - MI
Father - MI
Mother - cancer

SOCIAL HISTORY: Married, 15 pack year history, no ETOH. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}
