CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 61 year old female
with no significant past medical history.  Her coronary
artery disease risk factors included age and tobacco use.
The patient was in her usual state of health until the
morning of admission when she started to experience a left
arm pain while at rest.  The arm pain progressed to a
substernal chest pain similar to a "brick on her chest", and
was associated with shortness of breath.  She denied any
nausea, vomiting, neck pain or back pain.

MEDICAL HISTORY: Appendectomy 20 years ago.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin which gives her hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with coronary artery disease in her
70s; sister with angina symptoms in her sixties.

SOCIAL HISTORY: The patient is a current tobacco user with
approximately 40 pack years.
Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Heart disease, unspecified,Personal history of tobacco use
AMI inferopost, initial,Crnry athrscl natve vssl,Heart disease NOS,History of tobacco use
Admission Date:  [**2146-3-29**]     Discharge Date:  [**2146-4-2**]

Date of Birth:   [**2084-9-15**]     Sex:  F

Service:  CCU

HISTORY OF PRESENT ILLNESS:   This is a 61 year old female
with no significant past medical history.  Her coronary
artery disease risk factors included age and tobacco use.
The patient was in her usual state of health until the
morning of admission when she started to experience a left
arm pain while at rest.  The arm pain progressed to a
substernal chest pain similar to a "brick on her chest", and
was associated with shortness of breath.  She denied any
nausea, vomiting, neck pain or back pain.

She subsequently activated Emergency Medical Services and was
brought to the [**Location (un) 620**] Emergency Room.  While there, she was
found to have inferior ST segment elevations on an EKG.  She
was given an aspirin and started on Nitroglycerin drip,
heparin bolus, along with a drip, Integrilin bolus with drip
and Lopressor 5 mg intravenously times two.  After the
Nitroglycerin drip was started, her blood pressure dropped to
70 systolic and remained there for approximately 15 minutes.
Her pressure responded to a two liter intravenous fluid bolus
and the Nitroglycerin drip was discontinued.  She was then
transferred to the [**Hospital1 69**] for
cardiac catheterization.

In the catheterization laboratory, she was found to have a
chronically occluded right coronary artery lesion of
approximately 90% and acutely occluded 90% proximal left
circumflex, which was stented with a 3.5 millimeter by 15
millimeter Zeta stent.  Her wedge pressures were found to be
elevated at approximately 22 and she subsequently received 20
mg of intravenous Lasix to which she diuresed over 2.5 liters
with a reduction in her wedge to 16.  She was then
transferred to the Coronary Care Unit in stable condition.

PAST MEDICAL HISTORY:   Appendectomy 20 years ago.

ALLERGIES:   Penicillin which gives her hives.

MEDICATIONS UPON ADMISSION:  None.

FAMILY HISTORY:   Mother with coronary artery disease in her
70s; sister with angina symptoms in her sixties.

SOCIAL HISTORY:   The patient is a current tobacco user with
approximately 40 pack years.

PHYSICAL EXAMINATION:   Physical examination showed a
temperature of 98.9 F.; heart rate of 75; blood pressure
107/58; 02 saturations were 100% at room air.  In general,
this is an elderly female in no apparent distress.  Her
pupils were equally round and reactive to light.  Her
extraocular movements were intact.  Her oropharynx was clear.
She showed no jugular venous distention or carotid bruits.
She had a normal carotid upstroke.  Her lungs were clear to
auscultation bilaterally.  Her heart was a regular rate and
rhythm with a normal S1, S2.  There was no murmur,
regurgitation or gallop appreciated.  Her abdomen was soft,
obese, nontender, nondistended, with normoactive bowel
sounds.  Her extremities were without cyanosis, clubbing or
edema.  She had plus two dorsalis pedis pulses.  Her
neurological examination showed her alert and oriented times
three with no focal abnormalities.

LABORATORY:  Upon admission, showed a white blood cell count
of 16.8, a hematocrit of 38.0 and a platelet count of 269.
Her Chem-7 showed a sodium of 140, potassium of 3.6, a
chloride of 109, bicarbonate of 24, BUN of 12, creatinine
0.5, glucose of 118.

Her PT was 12.8, PTT 40.1, INR was 1.1.  Her liver function
tests were normal.  Her magnesium was 1.6, calcium 7.7,
phosphate 3.0.

EKG post intervention showed a normal sinus rhythm at 75
beats per minute with a normal axis and normal intervals.
She had an isolated Q wave in lead III.   She had [**12-30**]
millimeter to [**Street Address(2) 2914**] depression in leads V2 and V3.

Chest x-ray showed no acute cardiopulmonary process.

HOSPITAL COURSE:  This is a 61 year old female with a history
of tobacco use who was admitted from an outside hospital with
an acute inferior ST elevation myocardial infarction.  She
was immediately taken to the cardiac catheterization
laboratory and was found to have two vessel coronary artery
disease with the right coronary artery with a 90% lesion and
an acutely occluded 90% proximal left circumflex artery.

The left circumflex lesion was successfully stented and the
patient was transferred to the Coronary Care Unit for further
observation.

PROBLEM LIST:
1.  CARDIAC:  The patient was admitted to Coronary Care Unit.
She was placed on Telemetry and her cardiac enzymes were
cycled.  Her peak CK was 3,745 with a CK MB of 654 for an MB
index of 17.5.  She was placed on aspirin, Plavix, an ACE
inhibitor and a beta blocker.  She was also placed on a G23B
inhibitor for 18 hours following the catheterization.

Her lipid panel was checked which showed a total cholesterol
of 192 with an LDL of 123.  She had normal liver function
tests and was started up on a lipid lowering [**Doctor Last Name 360**].

An echocardiogram showed there was a mild symmetrical left
ventricular hypertrophy with a normal cavity size.  There was
a moderate regional left ventricular systolic dysfunction
with a focal near akinesis of the basal two-thirds of the
inferior and inferolateral wall.  The remaining segments
contracted well.  The right ventricular chamber size and free
wall motion were normal.  The aortic valve leaflets were
structurally normal with good leaflet excursion.  No aortic
regurgitation was seen.  The mitral valve leaflets were
mildly thickened.  Mild plus one mitral regurgitation was
seen.  The pulmonary artery systolic pressure could not be
estimated.  There was no pericardial effusion.  The ejection
fraction was estimated to be about 35%.

On the third day of her admission, the patient was taken back
to the Cardiac Catheterization Laboratory for further
intervention on the right coronary artery lesion.  This
lesion was successfully stented without any complications and
the patient was returned to the floor.

While on the floor, the patient remained hemodynamically
stable and her ACE inhibitor and beta blocker were gradually
titrated up.  Her electrolytes were repleted as needed.

DISCHARGE DIAGNOSES:
1.  Two vessel coronary artery disease status post a stent
placement in the left circumflex and the right coronary
artery.
2.  Tobacco use.

DISCHARGE STATUS:   The patient was discharged home.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg p.o. q. day.
2.  Plavix 75 mg p.o. q. day.
The patient was instructed to take the aspirin and the Plavix
unless specifically instructed by her Cardiologist.  She was
explained the importance of these medications given her
recent coronary interventions.
3.  Metoprolol XL 25 mg p.o. q. day.
4.  Captopril 12.5 mg p.o. three times a day.
5.  Atorvastatin 20 mg p.o. q. day.

DISCHARGE INSTRUCTIONS:
1.  The patient was instructed of the importance of
discontinuing smoking.
2.  She was also told to return to the Emergency Room if she
develops any further chest pain, shortness of breath, jaw
pain, back pain or any other cardiac symptoms.
3.  She was scheduled a follow-up appointment with Dr. [**First Name4 (NamePattern1) 122**]
[**Last Name (NamePattern1) **].
4.  She was also told to follow-up with her primary care
physician.


                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D.  [**MD Number(1) 1014**]

Dictated By:[**Name8 (MD) 6284**]

MEDQUIST36

D:  [**2146-6-17**]  16:24
T:  [**2146-6-25**]  19:20
JOB#:  [**Job Number 48909**]
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Heart disease, unspecified,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: 

PRESENT ILLNESS: This is a 61 year old female
with no significant past medical history.  Her coronary
artery disease risk factors included age and tobacco use.
The patient was in her usual state of health until the
morning of admission when she started to experience a left
arm pain while at rest.  The arm pain progressed to a
substernal chest pain similar to a "brick on her chest", and
was associated with shortness of breath.  She denied any
nausea, vomiting, neck pain or back pain.

MEDICAL HISTORY: Appendectomy 20 years ago.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin which gives her hives.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with coronary artery disease in her
70s; sister with angina symptoms in her sixties.

SOCIAL HISTORY: The patient is a current tobacco user with
approximately 40 pack years. 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Heart disease, unspecified,Personal history of tobacco use'}
