CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 72 y/o woman with no known CAD, hx of htn,diabetes,
hypercholesterolemia with c/o non radiating chest pain with N/V
that started overnight the night prior to admission and
prevented her from sleeping. Had intermittant chest pain through
the night that continued upon waking up. Accompanied by nausea
and and non-bloody vomiting. Also acommpanied by shortness of
breath. Denies having chest pain ever in the past. Went to PCP
on morning of admission and was transferred to [**Location (un) 620**] ED when
ST elevations noted in leads I, aVL, ST depressions in II, III
and aVF on EKG.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (doesn't check FS), HTN,
Hypercholesterolemia
2. CARDIAC HISTORY:  None

MEDICATION ON ADMISSION: Januvia (Sitagliptin+Metformin)
Simvastatin 40 mg qd
Amaryl (Glimepiride)
Ecotrin (ASA)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Anxious appearing elderly woman with Italian accent.
Oriented x3.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI.
CARDIAC: RR, normal S1, S2. No m/r/g. No S3 or S4. Chest pain
reproducible with palpation.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB
anteriorly (not assessed posteriorly given need to lie flat post
cath.)
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No LE edema. 2+ DP pulses. R-sided cath side
non-erythematous, no bleeding.

FAMILY HISTORY: MI in parents, can't remember specifics

SOCIAL HISTORY: -Tobacco history:  No
-ETOH:  [**12-8**] glasses wine/month
-Illicit drugs:  No
Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy
AMI lateral NEC, initial,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII oth nt st uncntrld,Diabetic retinopathy NOS
Admission Date:  [**2143-9-5**]              Discharge Date:   [**2143-9-8**]

Date of Birth:  [**2071-8-13**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
CARDIAC CATH [**9-5**]:
LMCA: No CAD
LAD: Mid vessel 50% diffuse. 70% proximal diagonal
LCx: Total occlusion mid vessel
RCA: Proximal 60% diffuse and distal RCA into PDA 60%
Intervention: Promus DESx2 placed into the LCx


History of Present Illness:
72 y/o woman with no known CAD, hx of htn,diabetes,
hypercholesterolemia with c/o non radiating chest pain with N/V
that started overnight the night prior to admission and
prevented her from sleeping. Had intermittant chest pain through
the night that continued upon waking up. Accompanied by nausea
and and non-bloody vomiting. Also acommpanied by shortness of
breath. Denies having chest pain ever in the past. Went to PCP
on morning of admission and was transferred to [**Location (un) 620**] ED when
ST elevations noted in leads I, aVL, ST depressions in II, III
and aVF on EKG.

In the [**Location (un) 620**] ED, she was A&OX3, BP 191/81, HR 96, O2 at 100%
on NRB. She was given ASA, 5000units heparin, 600mg plavix, 2mg
morphine and NTG given in ED. Her pain resolved.

She then was transferred to cardiac cath at the [**Hospital1 18**], which
showed total occlusion of the LCx; two DES were placed.

Upon arrival to the floor, vitals were HR 85, Sat 100% on 2L NC,
RR 16, BP 176/81. She continued to have mild chest pain,
improved from prior.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes (doesn't check FS), HTN,
Hypercholesterolemia
2. CARDIAC HISTORY:  None

Social History:
-Tobacco history:  No
-ETOH:  [**12-8**] glasses wine/month
-Illicit drugs:  No

Family History:
MI in parents, can't remember specifics

Physical Exam:
GENERAL: Anxious appearing elderly woman with Italian accent.
Oriented x3.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI.
CARDIAC: RR, normal S1, S2. No m/r/g. No S3 or S4. Chest pain
reproducible with palpation.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB
anteriorly (not assessed posteriorly given need to lie flat post
cath.)
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No LE edema. 2+ DP pulses. R-sided cath side
non-erythematous, no bleeding.

Pertinent Results:
Admission Labs:
Chem7: 138/3.7/104/21/10/0.5/237
CK-MD 58, Trop 0.66
CBC: 12.9/38.1/213, INR 1.2
[**2143-9-5**] 04:25PM   GLUCOSE-237* UREA N-10 CREAT-0.5 SODIUM-138
POTASSIUM-3.7 CHLORIDE-104 TOTAL CO2-21* ANION GAP-17
[**2143-9-5**] 04:25PM   ALT(SGPT)-45* AST(SGOT)-84* CK(CPK)-941* ALK
PHOS-78 AMYLASE-43 TOT BILI-0.7
[**2143-9-5**] 04:25PM   CK-MB-58* MB INDX-6.2 cTropnT-0.66*
[**2143-9-5**] 04:25PM   %HbA1c-8.3* eAG-192*
[**2143-9-5**] 04:25PM   WBC-12.9* RBC-4.67 HGB-13.6 HCT-38.1 MCV-82
MCH-29.2 MCHC-35.8* RDW-13.7
[**2143-9-5**] 04:25PM   GLUCOSE-237* UREA N-10 CREAT-0.5 SODIUM-138
POTASSIUM-3.7 CHLORIDE-104 TOTAL CO2-21* ANION GAP-17
[**2143-9-5**] 04:25PM   GLUCOSE-237* UREA N-10 CREAT-0.5 SODIUM-138
POTASSIUM-3.7 CHLORIDE-104 TOTAL CO2-21* ANION GAP-17

EKG:
[**2143-6-21**]: NSR at [**Street Address(2) 99903**] changes, small Q waves in lead I

[**2143-9-5**] at 3PM: NSR at [**Street Address(2) 95877**] elevations in I, avL, V5, V6
and ST depressions in II, III, avF

[**2143-9-5**] at 5:30 PM: NSR at [**Street Address(2) 99904**] changes, Q waves in I,
aVL, V5, V6
.
CARDIAC CATH:
LMCA: No CAD
LAD: Mid vessel 50% diffuse. 70% proximal diagonal
LCx: Total occlusion mid vessel
RCA: Proximal 60% diffuse and distal RCA into PDA 60%
Intervention: Promus DESx2 placed into the LCx

ECHO [**9-6**]:The left atrium is elongated. No atrial septal defect
is seen by 2D or color Doppler. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. LV systolic function appears depressed (ejection
fraction 40 percent) secondary to severe hypokinesis of the
posterior and lateral walls, and mild hypokinesis of the
inferior free wall. There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
ascending aorta is mildly dilated. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Mild to
moderate ([**12-8**]+) mitral regurgitation is seen. Moderate [2+]
tricuspid regurgitation is seen. The tricuspid regurgitation jet
is eccentric and may be underestimated. There is borderline
pulmonary artery systolic hypertension. There is no pericardial
effusion.

Discharge Labs:

[**2143-9-8**] 06:55AM BLOOD WBC-8.2 RBC-3.83* Hgb-11.3* Hct-32.4*
MCV-85 MCH-29.6 MCHC-34.9 RDW-13.9 Plt Ct-199
[**2143-9-8**] 06:55AM BLOOD Plt Ct-199
[**2143-9-8**] 06:55AM BLOOD PT-13.8* PTT-24.6 INR(PT)-1.2*
[**2143-9-8**] 06:55AM BLOOD Glucose-217* UreaN-23* Creat-0.6 Na-141
K-4.3 Cl-105 HCO3-26 AnGap-14
[**2143-9-8**] 06:55AM BLOOD ALT-42* AST-46* AlkPhos-62 TotBili-0.6
[**2143-9-8**] 06:55AM BLOOD Calcium-8.9 Phos-3.8 Mg-2.0
[**2143-9-5**] 04:25PM BLOOD %HbA1c-8.3* eAG-192*

Brief Hospital Course:
72 yo woman with PMH DMII with retinopathy, HTN,
hypercholesterolemia who presents with one day of chest pain,
shortness of breath and N/V who was found to have Lateral MI on
EKG. Cath showed complete LCx occlusion which was stented with 2
DES.
.
# STEMI of LCx: Presented with typical chest pain, STE in the
lateral leads with reciprocal changes in the inferior leads, as
well as subsequent development of Q waves in the lateral leads
in the setting of elevated cardiac enzymes, with troponins and
CKMB of 0.66 and 58, respectively, on admission, peaking at 3.76
and 99, respectively, within 24 hours. The patient underwent
emergent catheterization and 2 Promus drug eluting stents were
placed in the LCx, which was found to be 100% occluded.

The patient remained in sinus rhythm and hemodynamically stable
post-catheterization and throughout the course of the admission;
her cardiac exam remained stable; she also remained clinically
euvolemic. Her percutaneous access site remained without
clinical evidence of bruits, hematoma, or pseudoaneurysm.

Post-catheterization, the patient was started on ASA 325 mg
daily for an indefinite course, and Plavix 75 mg daily x12
months; Metoprolol 25 mg [**Hospital1 **] and Captopril 6.25 mg TID were
started to optimize rate control and afterload reduction, with
the Captopril transitioned to Lisinopril 5 mg daily prior to
discharge and Metoprolol transition to Toprol XL 50 mg qd;
Atorvastatin 80 mg daily was also started to optimize her lipid
profile and for potential pleotrophic survival benefits.

Echo [**9-6**] showed: LV systolic function appears depressed
(ejection fraction 40 percent) secondary to severe hypokinesis
of the posterior and lateral walls, and mild hypokinesis of the
inferior free wall.
.
# DM2: Glucose was controlled with an insulin sliding scale; the
patient resumed oral diabetes medications upon discharge.
.
# Transaminitis: Presented with a mild trans aminitis that
peaked 24h after admission, with ALT 80 and AST 226 and showed a
normalizing trend prior to discharge.

Medications on Admission:
Januvia (Sitagliptin+Metformin)
Simvastatin 40 mg qd
Amaryl (Glimepiride)
Ecotrin (ASA)

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
5. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: [**12-8**] Tablet,
Sublinguals Sublingual PRN (as needed) as needed for chest pain:
Place under tongue for chest pain, can use three times for an
episode of chest pain, call 911 immediately.
Disp:*30 Tablet, Sublingual(s)* Refills:*0*
6. Januvia  Oral
7. Glimepiride  Oral
8. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
9. Outpatient Lab Work
Please draw the following labs on Friday [**2143-9-13**]: Na, K, BUN,
Cr, WBC, Hgb/HCT, platelets.


Discharge Disposition:
Home

Discharge Diagnosis:
Myocardial infarction


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted because you had a heart attack. We performed a
procedure called cardiac catheterization that identified a
blockage in your artery and we opened this blockage. We know
that there was some damage to your heart and you will have to
followup with a cardiologist. You will also have to start taking
various different medications.
.
Please start taking the following NEW medications:
START Plavix 75 mg daily (for one year)
START Toprol XL 50 mg daily
START Lisinopril 5 mg daily
START Nitroglycerin below your tongue as needed for chest pain

STOP TAKING Simvastatin 40 mg daily
START Atorvastatin 80 mg daily instead

STOP TAKING Ecotrin
START taking Aspirin 325 mg daily instead

Please have blood taken on Friday [**2143-9-13**] so that labs can be
checked; you can do this at [**Hospital1 18**].

Please attend the follow-up appointments detailed below.


Followup Instructions:
You have an appointment with Dr. [**Last Name (STitle) 171**] at 10/13 at 10AM.
Please call [**Telephone/Fax (1) 62**] for directions and if you need to make
a change.

Please follow-up with your PCP in the next week.

Please return to the ED if you have any chest pain, shortness of
breath, nausea/vomiting or any other symptoms that are
concerning to you.
{'Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy'}


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: 72 y/o woman with no known CAD, hx of htn,diabetes,
hypercholesterolemia with c/o non radiating chest pain with N/V
that started overnight the night prior to admission and
prevented her from sleeping. Had intermittant chest pain through
the night that continued upon waking up. Accompanied by nausea
and and non-bloody vomiting. Also acommpanied by shortness of
breath. Denies having chest pain ever in the past. Went to PCP
on morning of admission and was transferred to [**Location (un) 620**] ED when
ST elevations noted in leads I, aVL, ST depressions in II, III
and aVF on EKG.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes (doesn't check FS), HTN,
Hypercholesterolemia
2. CARDIAC HISTORY:  None

MEDICATION ON ADMISSION: Januvia (Sitagliptin+Metformin)
Simvastatin 40 mg qd
Amaryl (Glimepiride)
Ecotrin (ASA)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: Anxious appearing elderly woman with Italian accent.
Oriented x3.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI.
CARDIAC: RR, normal S1, S2. No m/r/g. No S3 or S4. Chest pain
reproducible with palpation.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB
anteriorly (not assessed posteriorly given need to lie flat post
cath.)
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No LE edema. 2+ DP pulses. R-sided cath side
non-erythematous, no bleeding.

FAMILY HISTORY: MI in parents, can't remember specifics

SOCIAL HISTORY: -Tobacco history:  No
-ETOH:  [**12-8**] glasses wine/month
-Illicit drugs:  No 

### Response:
{'Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy'}
