CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 66-year-old
gentleman with 2-vessel coronary artery disease, status post
massive anterior myocardial infarction in [**2197-6-6**] with
failed thrombolysis at an outside hospital and incomplete
revascularization after left anterior descending artery stent
at [**Hospital1 69**] with course
complicated by cardiogenic shock and intra-aortic balloon
pump placement.

MEDICAL HISTORY: 1.  Ischemic cardiomyopathy (with an ejection fraction of 25%
to 30%).
2.  Coronary artery disease (with an ST-elevation myocardial
infarction of the anterior in [**2197-6-6**]); see History of
Present Illness.
3.  Hyperlipidemia.
4.  Atrial flutter; status post ablation.
5.  Gastroesophageal reflux disease.
6.  Prostate cancer; status post prostatectomy.
7.  Implantable cardioverter-defibrillator placement in
[**2197-8-7**].
8.  A laminectomy in [**2178**].

MEDICATION ON ADMISSION: 1.  Digoxin 0.125 mg by mouth once per day.
 2.  Plavix 75 mg by mouth once per day.
 3.  Lisinopril 5 mg by mouth once per day.
 4.  Multivitamin.
 5.  Lasix 40 mg by mouth once per day.
 6.  Coumadin.
 7.  Protonix 40 mg by mouth once per day.
 8.  Lipitor 20 mg by mouth once per day.
 9.  Clonazepam 5 mg by mouth once per day.
10.  Aspirin 81 mg by mouth once per day.

ALLERGIES: ATIVAN (reportedly resulting in agitation).

PHYSICAL EXAM: 

FAMILY HISTORY: Maternal sisters and brothers with coronary
artery disease.

SOCIAL HISTORY: The patient is married.  He works as a
lawyer.  [**Name (NI) **] quit tobacco in [**2171**].  He denies alcohol or drug
use.
Congestive heart failure, unspecified,Other primary cardiomyopathies,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate,Percutaneous transluminal coronary angioplasty status
CHF NOS,Prim cardiomyopathy NEC,Old myocardial infarct,Crnry athrscl natve vssl,Pure hypercholesterolem,Hx-prostatic malignancy,Status-post ptca
Admission Date:  [**2198-1-23**]     Discharge Date:  [**2198-1-29**]

Date of Birth:   [**2131-12-7**]     Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  The patient is a 66-year-old
gentleman with 2-vessel coronary artery disease, status post
massive anterior myocardial infarction in [**2197-6-6**] with
failed thrombolysis at an outside hospital and incomplete
revascularization after left anterior descending artery stent
at [**Hospital1 69**] with course
complicated by cardiogenic shock and intra-aortic balloon
pump placement.

This event resulted in cardiomyopathy with an ejection
fraction of 25% to 30%.  Also of note, the patient developed
atrial flutter in [**2197-8-7**] which was ablated with
implantable cardioverter-defibrillator pacemaker placement.

In the past couple months, the patient has complained of
increasing fatigue, nausea, and dyspnea on exertion occurring
with one flight of stairs.  The patient otherwise denied any
chest pain or other symptoms.  Outpatient therapy by his
cardiologist was limited by hypotension with a systolic blood
pressure in the 80s to 90s.

The patient is admitted now for pulmonary artery
catheterization for tailored hemodynamic therapy with
milrinone.

Primary results from the cardiac catheterization on the day
of admission revealed a right atrial pressure of 5, right
ventricular pressure was 41/7, pulmonary artery pressure was
42/17, mean was 28, and a wedge pressure of 22, with a
capillary wedge pressure of 2.9, and a cardiac index of 1.6.


PAST MEDICAL HISTORY:
1.  Ischemic cardiomyopathy (with an ejection fraction of 25%
to 30%).
2.  Coronary artery disease (with an ST-elevation myocardial
infarction of the anterior in [**2197-6-6**]); see History of
Present Illness.
3.  Hyperlipidemia.
4.  Atrial flutter; status post ablation.
5.  Gastroesophageal reflux disease.
6.  Prostate cancer; status post prostatectomy.
7.  Implantable cardioverter-defibrillator placement in
[**2197-8-7**].
8.  A laminectomy in [**2178**].

MEDICATIONS ON ADMISSION:
 1.  Digoxin 0.125 mg by mouth once per day.
 2.  Plavix 75 mg by mouth once per day.
 3.  Lisinopril 5 mg by mouth once per day.
 4.  Multivitamin.
 5.  Lasix 40 mg by mouth once per day.
 6.  Coumadin.
 7.  Protonix 40 mg by mouth once per day.
 8.  Lipitor 20 mg by mouth once per day.
 9.  Clonazepam 5 mg by mouth once per day.
10.  Aspirin 81 mg by mouth once per day.

ALLERGIES:  ATIVAN (reportedly resulting in agitation).

FAMILY HISTORY:  Maternal sisters and brothers with coronary
artery disease.

SOCIAL HISTORY:  The patient is married.  He works as a
lawyer.  [**Name (NI) **] quit tobacco in [**2171**].  He denies alcohol or drug
use.

PHYSICAL EXAMINATION ON PRESENTATION:  His heart rate was 77,
his blood pressure was 113/73, his respiratory rate was 12,
he was afebrile.  Physical examination notable for a jugular
venous distention to the angle of the mandible.  Normal first
heart sounds and second heart sounds as well as a present
third heart sound.  No fourth heart sound appreciated.
Pulses were 2+ throughout.  Otherwise, physical examination
was within normal limits.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Blood urea
nitrogen and creatinine from [**1-17**] were 31 and 1.4.
Otherwise, laboratories were within normal limits.

PERTINENT RADIOLOGY/IMAGING:  Last echocardiogram in [**2197-7-7**] revealed an ejection fraction of 25% to 30%.

CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM:   The
patient is a 66-year-old gentleman with coronary artery
disease and resultant ischemic congestive heart failure who
presented with an increasing signs of heart failure with
outpatient therapy limited by hypotension.  The patient was
admitted for pulmonary artery catheterization for tailored
hemodynamic therapy.

1.  PUMP ISSUES:  The patient with decompensated congestive
heart failure with elevated filling pressures with a
pulmonary capillary wedge pressure of 22 at catheterization
on the day of admission.  The patient also with a decreased
cardiac index.

Therefore, the patient was started on milrinone upon arrival
to the Coronary Care Unit for anatropic support with a goal
mean arterial pressure of greater than 60, a pulmonary
capillary wedge pressure of 15 to 20, and a cardiac index of
greater than 2.

The patient tolerated this well, and the milrinone was
eventually discontinued on [**1-26**].  The patient's
pulmonary capillary wedge pressure and cardiac index were at
goal.  The patient was started on captopril at initially 6.25
mg three times per day which was titrated up.  The patient
tolerated this well.  The patient was also continued on
digoxin.  The patient was also restarted on his Coumadin on
[**1-25**].

At the time of discharge, the patient's congestive heart
failure seemed to be stabilized after aggressive therapy with
milrinone.  The patient was to follow up with his outpatient
cardiologist for further titration of his medications.

A repeat transthoracic echocardiogram on [**Month (only) 956**] revealed an
ejection fraction of 20% and 2+ mitral regurgitation.

2.  CORONARY ARTERY DISEASE ISSUES:  The patient 2-vessel
coronary artery disease, status post anterior myocardial
infarction in [**2197-6-6**].  The patient was continued on his
aspirin as well as statin.  The patient without signs or
symptoms of acute cardiac ischemia throughout his hospital
stay.

3.  RHYTHM ISSUES:  The patient was in a normal sinus rhythm
throughout his hospital stay, and status post ablation for
atrial fibrillation and atrial flutter in [**2197-7-7**].

4.  PULMONARY ISSUES:  Dyspnea on exertion was likely due to
lower output congestive heart failure.  The patient without
other pulmonary issues throughout his hospital stay.

5.  RENAL ISSUES:  The patient with a baseline creatinine of
1 to 1.2; which was slightly elevated on admission but was at
baseline at the time of discharge.

6.  HEMATOLOGIC ISSUES:  The patient with macrocytic anemia;
per laboratory tests.  The patient was started on iron three
times per day.

7.  GASTROINTESTINAL ISSUES:  The patient with chronic nausea
that reportedly was likely from bowel edema/congestive heart
failure.  The patient is followed by Gastroenterology as an
outpatient.

8.  FLUIDS/ELECTROLYTES/NUTRITION ISSUES:  The patient was
maintained on a cardiac diet which he tolerated well.

9.  PROPHYLAXIS ISSUES:  The patient was maintained on
pneumatic boots and a proton pump inhibitor throughout his
hospital stay.

CONDITION AT DISCHARGE:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:
1.  Congestive heart failure.
2.  Coronary artery disease.
3.  Hyperlipidemia.

MEDICATIONS ON DISCHARGE:
1.  Lipitor 20 mg by mouth once per day.
2.  Aspirin 325 mg by mouth once per day.
3.  Pantoprazole 40 mg by mouth once per day.
4.  Digoxin 125 mcg by mouth every day.
5.  Ferrous sulfate 325 mg by mouth once per day.
6.  Coumadin 5 mg by mouth at hour of sleep.
7.  Captopril 37.5 mg by mouth three times per day.
8.  Ambien 5 mg by mouth at hour of sleep as needed.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with Dr. [**Last Name (STitle) 17234**].
2.  The patient was instructed to follow up with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] as well as Dr. [**First Name (STitle) 2031**] of Cardiology as well.






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

Dictated By:[**Name8 (MD) 6906**]

MEDQUIST36

D:  [**2198-3-30**]  12:45
T:  [**2198-3-30**]  18:06
JOB#:  [**Job Number 110306**]
{'Congestive heart failure, unspecified,Other primary cardiomyopathies,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate,Percutaneous transluminal coronary angioplasty status'}


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: The patient is a 66-year-old
gentleman with 2-vessel coronary artery disease, status post
massive anterior myocardial infarction in [**2197-6-6**] with
failed thrombolysis at an outside hospital and incomplete
revascularization after left anterior descending artery stent
at [**Hospital1 69**] with course
complicated by cardiogenic shock and intra-aortic balloon
pump placement.

MEDICAL HISTORY: 1.  Ischemic cardiomyopathy (with an ejection fraction of 25%
to 30%).
2.  Coronary artery disease (with an ST-elevation myocardial
infarction of the anterior in [**2197-6-6**]); see History of
Present Illness.
3.  Hyperlipidemia.
4.  Atrial flutter; status post ablation.
5.  Gastroesophageal reflux disease.
6.  Prostate cancer; status post prostatectomy.
7.  Implantable cardioverter-defibrillator placement in
[**2197-8-7**].
8.  A laminectomy in [**2178**].

MEDICATION ON ADMISSION: 1.  Digoxin 0.125 mg by mouth once per day.
 2.  Plavix 75 mg by mouth once per day.
 3.  Lisinopril 5 mg by mouth once per day.
 4.  Multivitamin.
 5.  Lasix 40 mg by mouth once per day.
 6.  Coumadin.
 7.  Protonix 40 mg by mouth once per day.
 8.  Lipitor 20 mg by mouth once per day.
 9.  Clonazepam 5 mg by mouth once per day.
10.  Aspirin 81 mg by mouth once per day.

ALLERGIES: ATIVAN (reportedly resulting in agitation).

PHYSICAL EXAM: 

FAMILY HISTORY: Maternal sisters and brothers with coronary
artery disease.

SOCIAL HISTORY: The patient is married.  He works as a
lawyer.  [**Name (NI) **] quit tobacco in [**2171**].  He denies alcohol or drug
use. 

### Response:
{'Congestive heart failure, unspecified,Other primary cardiomyopathies,Old myocardial infarction,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate,Percutaneous transluminal coronary angioplasty status'}
