CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: The patient is a 65 y.o.f. with diverticulitis and IBS who p/w
inferior STEMI. Last night at approximately 10 p.m. she
developed right sided chest discomfort that radiated to the
underside of her right arm. This occurred on and off throughout
the night and was accompanied by diaphoresis. "Breathes fast" at
baseline (improved now with weight loss), but no increasing SOB,
orthopnea, PND, palpitations, or prior episodes of chest pain.
She was able to sleep, but when she awoke this a.m. she
continued to have the chest discomfort and when getting up felt
faint, lightheaded, and nauseated, so she caller her daughter
who is a nurse [**First Name (Titles) **] [**Name (NI) 336**]. EMS was called and BP on the scene was
96/60, HR 52, 99% RA. She was brought to [**Hospital3 **] where
EKG showed ST elevations in II, III, aVF, V6, ST depressions in
I, avL, V2-V5. STEMI protocol was initiated, she was given ASA
324mg, heparin started, atorvastatin 80mg x 1, plavix 600 mg x
1, 500cc NS, 0.5 mg ativan, and she was sent to [**Hospital1 18**] for
cardiac catheterization.
.
Cardiac catheterization showed right dominant system with 95%
lesions in RCA with slow flow, no obstructive disease in LMCA,
LAD, Lcx. She underwent BMS if RCA with temporary pacer
placement. During stent deployment became hypotensive to SBP
60's, given atropine 1 mg IV x 2, and BP responded. Pacer d/c'd
at end of case.
.
Of note her recent history is remarkable for a cough/flu in mid
[**Month (only) 956**]. She then had a precancerous lesion removed and tooth
pulled on [**1-26**]. Subsequent to that she developed loose stools
for the next 2 weeks. Yesterday she was seen at her GI doctor's
office and placed on a brat diet and was prescribed lomotil,
which she took at 3pm and 9pm.
.
On review of symptoms, she 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. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. She has
chronic upper back discomfort x 2 months, felt by her to be d/t
water aerobics, which comes and goes, not worsening. +urinates
frequently. All of the other review of systems were negative.
+recent intentional weight loss of 36 pounds in one year.
.
Cardiac review of systems is notable for absence of chest pain
currently (see above), dyspnea on exertion, paroxysmal nocturnal
dyspnea, orthopnea, palpitations, syncope.

MEDICAL HISTORY: Diverticulitis - no surgeries
IBS
Radical hysterectomy
UTI's (uretheral narrowing)
PNA
Sciatica
HTN
? CHF - per patient, was in [**Location (un) 5354**] in [**2132**] and developed SOB
and found to have mild CHF, 'd/t stress' - prompted stress test
which was not optimal per patient, but never but on cardiac meds
and never told that she had an MI
.
Cardiac Risk Factors: Hypertension, remote minimal tobacco
.
Cardiac History: Stress test in [**2132**] - could not reach capacity
d/t obesity

MEDICATION ON ADMISSION: Atenolol 50mg daily
Prevacid 30mg daily

ALLERGIES: Penicillins / Tetracycline / Detrol / Nitrofurantoin

PHYSICAL EXAM: VS: T 96.4 , BP 143/80 , HR 72 , RR 18, O2 100% on 2L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant. Obese.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without JVD.
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 bilaterally. Fresh blood around
groin lines, no hematoma.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: Social history is significant for the absence of current tobacco
use (very occasional 30 yrs ago, 'didn't inhale', 1 pack would
last 2 weeks). There is no history of alcohol abuse. There is no
immediate family history of premature coronary artery disease or
sudden death. Maternal uncle died of MI at 47, brother with CAD
recently in 60s. Mother with [**Name (NI) 5895**], father deceased at 92.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use (very occasional 30 yrs ago, 'didn't inhale', 1 pack would
last 2 weeks). There is no history of alcohol abuse. There is no
immediate family history of premature coronary artery disease or
sudden death. Maternal uncle died of MI at 47, brother with CAD
recently in 60s. Mother with [**Name (NI) 5895**], father deceased at 92.
Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Mitral valve disorders,Personal history of other diseases of digestive system,Family history of ischemic heart disease
AMI inferopost, initial,Crnry athrscl natve vssl,Hypertension NOS,Cardiac dysrhythmias NEC,Mitral valve disorder,Prsnl hst ot spf dgst ds,Fam hx-ischem heart dis
Admission Date:  [**2149-2-11**]              Discharge Date:   [**2149-2-14**]

Date of Birth:  [**2083-2-19**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Tetracycline / Detrol / Nitrofurantoin

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Coronary catheterization


History of Present Illness:
The patient is a 65 y.o.f. with diverticulitis and IBS who p/w
inferior STEMI. Last night at approximately 10 p.m. she
developed right sided chest discomfort that radiated to the
underside of her right arm. This occurred on and off throughout
the night and was accompanied by diaphoresis. "Breathes fast" at
baseline (improved now with weight loss), but no increasing SOB,
orthopnea, PND, palpitations, or prior episodes of chest pain.
She was able to sleep, but when she awoke this a.m. she
continued to have the chest discomfort and when getting up felt
faint, lightheaded, and nauseated, so she caller her daughter
who is a nurse [**First Name (Titles) **] [**Name (NI) 336**]. EMS was called and BP on the scene was
96/60, HR 52, 99% RA. She was brought to [**Hospital3 **] where
EKG showed ST elevations in II, III, aVF, V6, ST depressions in
I, avL, V2-V5. STEMI protocol was initiated, she was given ASA
324mg, heparin started, atorvastatin 80mg x 1, plavix 600 mg x
1, 500cc NS, 0.5 mg ativan, and she was sent to [**Hospital1 18**] for
cardiac catheterization.
.
Cardiac catheterization showed right dominant system with 95%
lesions in RCA with slow flow, no obstructive disease in LMCA,
LAD, Lcx. She underwent BMS if RCA with temporary pacer
placement. During stent deployment became hypotensive to SBP
60's, given atropine 1 mg IV x 2, and BP responded. Pacer d/c'd
at end of case.
.
Of note her recent history is remarkable for a cough/flu in mid
[**Month (only) 956**]. She then had a precancerous lesion removed and tooth
pulled on [**1-26**]. Subsequent to that she developed loose stools
for the next 2 weeks. Yesterday she was seen at her GI doctor's
office and placed on a brat diet and was prescribed lomotil,
which she took at 3pm and 9pm.
.
On review of symptoms, she 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. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. She has
chronic upper back discomfort x 2 months, felt by her to be d/t
water aerobics, which comes and goes, not worsening. +urinates
frequently. All of the other review of systems were negative.
+recent intentional weight loss of 36 pounds in one year.
.
Cardiac review of systems is notable for absence of chest pain
currently (see above), dyspnea on exertion, paroxysmal nocturnal
dyspnea, orthopnea, palpitations, syncope.


Past Medical History:
Diverticulitis - no surgeries
IBS
Radical hysterectomy
UTI's (uretheral narrowing)
PNA
Sciatica
HTN
? CHF - per patient, was in [**Location (un) 5354**] in [**2132**] and developed SOB
and found to have mild CHF, 'd/t stress' - prompted stress test
which was not optimal per patient, but never but on cardiac meds
and never told that she had an MI
.
Cardiac Risk Factors: Hypertension, remote minimal tobacco
.
Cardiac History: Stress test in [**2132**] - could not reach capacity
d/t obesity


Social History:
Social history is significant for the absence of current tobacco
use (very occasional 30 yrs ago, 'didn't inhale', 1 pack would
last 2 weeks). There is no history of alcohol abuse. There is no
immediate family history of premature coronary artery disease or
sudden death. Maternal uncle died of MI at 47, brother with CAD
recently in 60s. Mother with [**Name (NI) 5895**], father deceased at 92.

.


Family History:
Social history is significant for the absence of current tobacco
use (very occasional 30 yrs ago, 'didn't inhale', 1 pack would
last 2 weeks). There is no history of alcohol abuse. There is no
immediate family history of premature coronary artery disease or
sudden death. Maternal uncle died of MI at 47, brother with CAD
recently in 60s. Mother with [**Name (NI) 5895**], father deceased at 92.

.


Physical Exam:
VS: T 96.4 , BP 143/80 , HR 72 , RR 18, O2 100% on 2L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant. Obese.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without JVD.
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 bilaterally. Fresh blood around
groin lines, no hematoma.
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:
COMMENTS:
1.  Selective coronary angiography in this right dominant system

revealed single vessel coronary artery disease.  The LMCA had no

obstructive disease.  The LAD had no obstructive disease.  The
LCx had
no obstructive disease.  The RCA had a 95% focal lesion in the
mid
vessel.
2.  Left ventriculography was not performed.
3.  Central aortic pressure was normal at 120/66
(systolic/diastolic in
mmHg).
4.  Successful direct stenting of the mid RCA with a 3.0x18mm
vision stent which was postdilated to 3.5mm. Successful
temporary venous
pacing wire insertion which was subsequently removed. Final
angiography
revealed 0% residual stenosis, no angiographically apparent
dissection
and timi 3 flow. The patient left the lab with persistent st
elevation
but pain free and hemodynamically stable and was transfered to
the CCU
service for further care. (see ptca comments)

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Normal ventricular function.
3. Acute inferior myocardial infarction, managed by acute ptca.
 PTCA of  vessel


Brief Hospital Course:
65 y/o F with hypertension and no previous cardiac history
presenting with IMI.
.
# CAD/Ischemia: EKGs showed inferior STEMI with reciprocal
lateral depressions. Cardiac cath consistent with this, showing
a 95% mid-RCA lesion s/p BMS without complications. Transient
hypotension during deployment of stent that resolved with
atropine. ST changes persist s/p catheterization, but improved,
and patient currently without chest discomfort.
- Aspirin 325mg daily
- Plavix 75mg daily for 12 months
- Atorvastatin 80mg daily
- Added lopressor 12.5 [**Hospital1 **] yesterday, tolerated well
- lipid panel shows LDL 91 on statin now
.
# Pump: Questionable history of episode of CHF, not on cardiac
meds for this as an outpatient. Currently no signs or symptoms
of HF.
- TTE shows EF 40-45, with inferior, inferolateral and basal
inferoseptal hypokinesis
- ischemic dysfunction of the posteromedial papillary muscle
with posterior leaflet tethering and a jet of moderate (2+)
mitral regurgitation
- give trial metoprolol 12.5mg [**Hospital1 **] today, add ACE once patient;s
BP tolerates as an outpatient.
- I/O show patient autodiuresing, euvolemic, no dyspnea or
orthopnea, no furosemide indicated
.
# Rhythm: NSR, bradycardia in setting of IMI. No history of
arrhythmia.
- Telemetry shows PVC's, SR
- replete K and Mg
.
# HTN: On atenolol as outpatient, so presumed HTN.
- trial metoprolol yest tol. well, add ACE as outpatient given
low blood pressure.
.
# Chronic back pain
- Tylenol and codeine PRN
.
# FEN:
- ADAT, follow lytes and replete
.
# Prophylaxis: PPI, SQ heparin
.
# Dispo
- home today, f/u dr/ [**Doctor Last Name **] ([**Telephone/Fax (1) 68572**]
.
# Code: Full, confirmed with patient
.
# Communication: Patient. HCP is daughter, [**Name (NI) **] [**Telephone/Fax (3) 109883**]


Medications on Admission:
Atenolol 50mg daily
Prevacid 30mg daily


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 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
ST Elevation Myocardial Infarction
HTN
CAD


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to [**Hospital1 18**] with an ST elevation myocardial
infarction.
Please take your previous medications as prescribed. The
following changes has been made to your medications:
- Please start taking aspirin 325 mg daily for secondary
cardiovascular prevention (to prevent another heart attack)
- Please start taking atorvastatin 80mg daily for your heart and

for your cholesterol
- Please continue taking Atenolol but change the dosing to 25mg
daily (split the 50mg tablet in half) for your heart and blood
pressure (prevents remodelling of the heart)
- Please start taking clopidogrel (Plavix) 75 mg daily to keep
stents open
- Do NOT take the estrogen patch, this may increase risk of
heart attack
- You have follow scheduled with Dr. [**Last Name (STitle) 1637**] on [**3-3**] at 130PM
If you develop chest pain, jaw pain, or chest pressure with pain

radiating into arm, or if you for any reason become concerned
about your medical condition please call 911 or present to
nearest ED.
- We also gave you Nitroglycerin tablets to take if you
experience chest pain, please call 911 or your doctor if chest
pain recurs even if it dissapears with nitroglycerine.
**DO NOT STOP TAKING THE ASPIRIN OR PLAVIX UNLESS INSTRUCTED TO
DO SO BY YOUR CARDIOLOGIST EVEN IF ANOTHER DOCTOR TELLS YOU TO**
We strongly recommend you stop smoking as discussed.

Followup Instructions:
[**Last Name (LF) **],[**First Name3 (LF) 1575**] J. [**Telephone/Fax (1) 14655**] on [**3-3**] at 130PM of Cardiology
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Mitral valve disorders,Personal history of other diseases of digestive system,Family history of ischemic heart disease'}


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: The patient is a 65 y.o.f. with diverticulitis and IBS who p/w
inferior STEMI. Last night at approximately 10 p.m. she
developed right sided chest discomfort that radiated to the
underside of her right arm. This occurred on and off throughout
the night and was accompanied by diaphoresis. "Breathes fast" at
baseline (improved now with weight loss), but no increasing SOB,
orthopnea, PND, palpitations, or prior episodes of chest pain.
She was able to sleep, but when she awoke this a.m. she
continued to have the chest discomfort and when getting up felt
faint, lightheaded, and nauseated, so she caller her daughter
who is a nurse [**First Name (Titles) **] [**Name (NI) 336**]. EMS was called and BP on the scene was
96/60, HR 52, 99% RA. She was brought to [**Hospital3 **] where
EKG showed ST elevations in II, III, aVF, V6, ST depressions in
I, avL, V2-V5. STEMI protocol was initiated, she was given ASA
324mg, heparin started, atorvastatin 80mg x 1, plavix 600 mg x
1, 500cc NS, 0.5 mg ativan, and she was sent to [**Hospital1 18**] for
cardiac catheterization.
.
Cardiac catheterization showed right dominant system with 95%
lesions in RCA with slow flow, no obstructive disease in LMCA,
LAD, Lcx. She underwent BMS if RCA with temporary pacer
placement. During stent deployment became hypotensive to SBP
60's, given atropine 1 mg IV x 2, and BP responded. Pacer d/c'd
at end of case.
.
Of note her recent history is remarkable for a cough/flu in mid
[**Month (only) 956**]. She then had a precancerous lesion removed and tooth
pulled on [**1-26**]. Subsequent to that she developed loose stools
for the next 2 weeks. Yesterday she was seen at her GI doctor's
office and placed on a brat diet and was prescribed lomotil,
which she took at 3pm and 9pm.
.
On review of symptoms, she 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. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. She has
chronic upper back discomfort x 2 months, felt by her to be d/t
water aerobics, which comes and goes, not worsening. +urinates
frequently. All of the other review of systems were negative.
+recent intentional weight loss of 36 pounds in one year.
.
Cardiac review of systems is notable for absence of chest pain
currently (see above), dyspnea on exertion, paroxysmal nocturnal
dyspnea, orthopnea, palpitations, syncope.

MEDICAL HISTORY: Diverticulitis - no surgeries
IBS
Radical hysterectomy
UTI's (uretheral narrowing)
PNA
Sciatica
HTN
? CHF - per patient, was in [**Location (un) 5354**] in [**2132**] and developed SOB
and found to have mild CHF, 'd/t stress' - prompted stress test
which was not optimal per patient, but never but on cardiac meds
and never told that she had an MI
.
Cardiac Risk Factors: Hypertension, remote minimal tobacco
.
Cardiac History: Stress test in [**2132**] - could not reach capacity
d/t obesity

MEDICATION ON ADMISSION: Atenolol 50mg daily
Prevacid 30mg daily

ALLERGIES: Penicillins / Tetracycline / Detrol / Nitrofurantoin

PHYSICAL EXAM: VS: T 96.4 , BP 143/80 , HR 72 , RR 18, O2 100% on 2L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant. Obese.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without JVD.
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 bilaterally. Fresh blood around
groin lines, no hematoma.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: Social history is significant for the absence of current tobacco
use (very occasional 30 yrs ago, 'didn't inhale', 1 pack would
last 2 weeks). There is no history of alcohol abuse. There is no
immediate family history of premature coronary artery disease or
sudden death. Maternal uncle died of MI at 47, brother with CAD
recently in 60s. Mother with [**Name (NI) 5895**], father deceased at 92.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use (very occasional 30 yrs ago, 'didn't inhale', 1 pack would
last 2 weeks). There is no history of alcohol abuse. There is no
immediate family history of premature coronary artery disease or
sudden death. Maternal uncle died of MI at 47, brother with CAD
recently in 60s. Mother with [**Name (NI) 5895**], father deceased at 92. 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Mitral valve disorders,Personal history of other diseases of digestive system,Family history of ischemic heart disease'}
