CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 69-year-old
female with no prior known coronary artery disease who
presents with substernal chest pain, diaphoresis, dyspnea and
left arm numbness for two hours.  She initially presented to
[**Hospital 1562**] Hospital where an EKG was performed and showed an
inferior posterior myocardial infarction.  She was given IV
Lopressor, Aspirin, Nitroglycerin, started on Heparin and
thrombolysis with TNK.  ?????? hour after receiving TNK the
patient continued to have persistent chest pain as well as [**Known lastname **]
elevations in the inferior leads with [**Known lastname **] depressions in the
anterior leads.  She then developed nausea, a sudden increase
in her chest pain and junctional bradycardia with her heart
rate only 30 beats per minute and an episode of hypotension.
She received 0.5 mg of Atropine in intravenous fluids with
good response.  She was transferred to [**Hospital1 190**] via Med Flight for cardiac catheterization.
The cardiac catheterization showed mild luminal
irregularities in the LAD and left circumflex arteries and
there were severe focal 96% mid right coronary artery
narrowing in a segment of 60% narrowing.  This was stented
with a 3.5 by 18 mm stent with timi III flow resulting.  The
right heart cath showed elevated filling pressures.
Specifically, the RVADP was 21, the pulmonary capillary wedge
pressure was 21, mean right atrial pressure was 18, pulmonary
artery pressure was 42/25.  20 mg of Lasix was given
intravenously.  An LV gram showed an EF of 55-60% with rather
severe inferior hypokinesis or akinesis.

MEDICAL HISTORY: Asthma, COPD, back pain and
hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No early coronary artery disease although
her father had a CABG at age 77.

SOCIAL HISTORY: She quit tobacco 10 years ago.   No alcohol.
Her PCP is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1193**], [**Telephone/Fax (1) 43120**].  She is followed
by a pulmonologist.
Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Other and unspecified hyperlipidemia,Constipation, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
AMI inferopost, initial,Crnry athrscl natve vssl,CHF NOS,Obs chr bronc w(ac) exac,Hyperlipidemia NEC/NOS,Constipation NOS,Abn react-cardiac cath
Admission Date:  [**2157-5-29**]     Discharge Date:  [**2157-6-4**]

Date of Birth:   [**2088-4-8**]     Sex:  F

Service:  Cardiac Intensive Care Unit

HISTORY OF PRESENT ILLNESS:  The patient is a 69-year-old
female with no prior known coronary artery disease who
presents with substernal chest pain, diaphoresis, dyspnea and
left arm numbness for two hours.  She initially presented to
[**Hospital 1562**] Hospital where an EKG was performed and showed an
inferior posterior myocardial infarction.  She was given IV
Lopressor, Aspirin, Nitroglycerin, started on Heparin and
thrombolysis with TNK.  ?????? hour after receiving TNK the
patient continued to have persistent chest pain as well as [**Known lastname **]
elevations in the inferior leads with [**Known lastname **] depressions in the
anterior leads.  She then developed nausea, a sudden increase
in her chest pain and junctional bradycardia with her heart
rate only 30 beats per minute and an episode of hypotension.
She received 0.5 mg of Atropine in intravenous fluids with
good response.  She was transferred to [**Hospital1 190**] via Med Flight for cardiac catheterization.
The cardiac catheterization showed mild luminal
irregularities in the LAD and left circumflex arteries and
there were severe focal 96% mid right coronary artery
narrowing in a segment of 60% narrowing.  This was stented
with a 3.5 by 18 mm stent with timi III flow resulting.  The
right heart cath showed elevated filling pressures.
Specifically, the RVADP was 21, the pulmonary capillary wedge
pressure was 21, mean right atrial pressure was 18, pulmonary
artery pressure was 42/25.  20 mg of Lasix was given
intravenously.  An LV gram showed an EF of 55-60% with rather
severe inferior hypokinesis or akinesis.

PAST MEDICAL HISTORY:  Asthma, COPD, back pain and
hypercholesterolemia.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Theophylline, Fosamax, Advair which is Serevent
plus Fluticasone and Atrovent.

FAMILY HISTORY:  No early coronary artery disease although
her father had a CABG at age 77.

SOCIAL HISTORY:  She quit tobacco 10 years ago.   No alcohol.
Her PCP is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1193**], [**Telephone/Fax (1) 43120**].  She is followed
by a pulmonologist.

PHYSICAL EXAMINATION:  Vital signs on admission, temperature
95.9, pulse 81, blood pressure 98/37, respirations 15, oxygen
saturation 93% on four liters and her exam in general, she is
an alert, pale female in no acute distress.  HEENT:  Pupils
are equal, round, and reactive to light, extraocular
movements intact, anicteric sclera, mucus membranes moist.
Neck, JVP was not seen.  There is no lymphadenopathy.  Chest,
prolonged expiratory phase with end expiratory wheeze.
Cardiovascular, normal S1 and S2, regular rate and rhythm, no
murmurs, no S3 or S4.  Abdomen soft, nontender, non
distended, positive bowel sounds.  Extremities, no clubbing,
cyanosis or edema, 2+ dorsalis pedis pulses bilaterally.
Neuro, alert and oriented times three, cranial nerves II
through XII intact.  Upper extremity strength was full, lower
extremities, not tested secondary to recent cardiac
catheterization.  Groin, no hematoma, there is a pressure
dressing in place.

LABORATORY DATA:  On admission, sodium 140, potassium 3.8,
chloride 101, CO2 28, BUN 17, creatinine 0.6 and glucose 126,
calcium 9.9, CK 59, troponin I was less than 0.1,
Theophylline was 7.0 with normal range being [**10-2**].  CBC,
white cells 3.5 with a differential of 74% neutrophils, 17%
lymphs, 6% monos, 2% eosinophils.  Hematocrit was 45,
platelet count 262,000, INR 1.0, PTT 21.9, PT 12.0.  EKG at
11:40 a.m. at [**Hospital 1562**] Hospital showed normal sinus rhythm at
64 with 1-[**Known lastname 1766**] elevations in leads 2, 3 and AVF, there are
[**Known lastname **] depressions in leads V1 through V3, there is T wave
inversion in lead AVL after lytic was given.  There was no
prelytic EKG.  After cardiac catheterization at [**Hospital1 346**], additional EKG showed normal sinus
rhythm at 83 with 1 mm Q wave in leads 2, 3 and AVF, complete
resolution of the [**Known lastname 43121**] changes in the lateral and
anteroseptal leads.

IMPRESSION:  This is a 69-year-old female with
hypercholesterolemia, history of tobacco abuse, COPD but no
known prior CAD who presents with an inferior posterior
myocardial infarction involving both the LV and the RV.  She
was lysed at the outside hospital with TNK, developed
junctional bradycardia and hypotension that responded to
Atropine and had persistent EKG changes and chest pain
despite [**Last Name (LF) 43122**], [**First Name3 (LF) **] she was transferred to our hospital for
emergent cardiac catheterization where she received a stent
to her right coronary artery.

HOSPITAL COURSE:
1.  Cardiac:  Following the stent placement she had complete
resolution of her chest pain.  We gave her Aspirin, Plavix
and Lipitor and initiated Lopressor at 25 mg po bid.  Because
of the elevated filling pressure suggesting right ventricular
involvement, we obtained an echocardiogram which showed an
ejection fraction of 40-50% which was mildly depressed.  This
is secondary to hypokinesis of the posterior wall.
Additionally, the right ventricular systolic function was
also depressed.  There was mild mitral regurgitation.  If her
blood pressure tolerates, she will be started on an ACE
inhibitor as an outpatient.

2.  Pulmonary:  The patient was noted to have worsening
pulmonary function and oxygenation during her stay in the
CCU.  Initially she had evidence of pulmonary edema which was
treated effectively with diuresis.  However, her pulmonary
status did not significantly improve.  She had diffusely
decreased breath sounds.  Chest x-ray only showed bibasilar
atelectasis.  The clinical picture was most consistent with
mild COPD exacerbation.  She improved with Prednisone,
nebulizers and Flovent.  Theophylline was restarted, as she
had been on this at home.

3.  GI:  The patient had a lot of nausea post procedure,
lasting almost three days.  This was treated successfully
with Ondansetron.  Constipation was managed with a typical
bowel regimen.

4.  Prophylaxis:  Heparin was given subcutaneously for DVT
prophylaxis.  Pantoprazole was given for GI prophylaxis.

DISCHARGE MEDICATIONS:  Aspirin 325 mg po q d, Plavix 75 mg
po q d for one month, Lipitor 10 mg po q d, Lopressor 25 mg
po q d, Theophylline 300 mg po bid, Albuterol nebulizer/MDI,
Atrovent nebulizer/MDI, Flovent 110 mcg two puffs inhaled
[**Hospital1 **], Prednisone taper 40 mg po q d, then 20 mg po q d, then
10 mg po q d, then 5 mg po q d for two days, then
discontinue.

DISCHARGE STATUS:  To rehabilitation for physical therapy.

DISCHARGE CONDITION:  Good.

DISCHARGE DIAGNOSIS:
1.  Posterior/inferior myocardial infarction with RV and LV
involvement.
2.  Status post stent to the RCA.
3.  Mild COPD exacerbation.




                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 4786**]

Dictated By:[**Name8 (MD) 2734**]

MEDQUIST36

D:  [**2157-6-29**]  11:26
T:  [**2157-7-3**]  20:15
JOB#:  [**Job Number **]
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Other and unspecified hyperlipidemia,Constipation, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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 69-year-old
female with no prior known coronary artery disease who
presents with substernal chest pain, diaphoresis, dyspnea and
left arm numbness for two hours.  She initially presented to
[**Hospital 1562**] Hospital where an EKG was performed and showed an
inferior posterior myocardial infarction.  She was given IV
Lopressor, Aspirin, Nitroglycerin, started on Heparin and
thrombolysis with TNK.  ?????? hour after receiving TNK the
patient continued to have persistent chest pain as well as [**Known lastname **]
elevations in the inferior leads with [**Known lastname **] depressions in the
anterior leads.  She then developed nausea, a sudden increase
in her chest pain and junctional bradycardia with her heart
rate only 30 beats per minute and an episode of hypotension.
She received 0.5 mg of Atropine in intravenous fluids with
good response.  She was transferred to [**Hospital1 190**] via Med Flight for cardiac catheterization.
The cardiac catheterization showed mild luminal
irregularities in the LAD and left circumflex arteries and
there were severe focal 96% mid right coronary artery
narrowing in a segment of 60% narrowing.  This was stented
with a 3.5 by 18 mm stent with timi III flow resulting.  The
right heart cath showed elevated filling pressures.
Specifically, the RVADP was 21, the pulmonary capillary wedge
pressure was 21, mean right atrial pressure was 18, pulmonary
artery pressure was 42/25.  20 mg of Lasix was given
intravenously.  An LV gram showed an EF of 55-60% with rather
severe inferior hypokinesis or akinesis.

MEDICAL HISTORY: Asthma, COPD, back pain and
hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No early coronary artery disease although
her father had a CABG at age 77.

SOCIAL HISTORY: She quit tobacco 10 years ago.   No alcohol.
Her PCP is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1193**], [**Telephone/Fax (1) 43120**].  She is followed
by a pulmonologist. 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Other and unspecified hyperlipidemia,Constipation, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
