CHIEF COMPLAINT: Inferior STEMI

PRESENT ILLNESS: 53 yo man with PMH significant for HTN and asthma presented to
[**Hospital6 3105**] on [**7-29**] c/o chest pain and was
discharged to home [**7-30**] after negative ETT.  This am patient
woke up with 8/10 bilateral arm and chest pain and called 911.
Paramedics administered morphine 8 mg and SLNTG and pain down to
3/10.  Initial EKG showed STE II, III, F, V1 with depressions in
I, L, V2 and V3.  Patient was given Lopressor 5 mg IV x 3,
Heparin and Integrillin drips, and aspiring.  Brought to cath
which revealed prox to mid RCA TO, stented, as well as mLCx 80%.
 LAD clean.  During cath patient required atropine and dopamine
for transient hypotension and bradycardia.  RA 18, RV 41/7, PA
43/20 (29), PCWP 25, CO 4.5, CI 2.7.  EKG post-intervention NSR
at 70 bpm, nl axis, nl intervals, 1 mm STE V1, resolved STE II,
III, F and resolved ST depressions in I, L, V2, V3.  Patient
brought to CCU feeling very well but still on dopamine.  Denies
CP, SOB, nausea, or lightheadedness.

MEDICAL HISTORY: HTN
Asthma
Hypercholesterolemia
h/o spinal surgery [**2128**]

MEDICATION ON ADMISSION: prior to [**2129-7-29**] - quinipril 10 mg po qd
after [**2129-7-29**] - aspirin 81 mg po qd, lipitor, atenolol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T  BP 103/63 P 82 91% on RA, 98% on 2L
GEN - NAD, A&Ox3
HEENT - PERRL, EOMI
NECK - no JVD
HEART - nl s1s2, RRR, no mrg
LUNGS - CTAB
ABD - soft, NT/ND, NABS
EXT - Venous sheath in place in R groin, no hematoma or bruit,
no edema, 2+ PT pulses

FAMILY HISTORY: No family hx of CAD

SOCIAL HISTORY: Denies alcohol, quit tobacco 6 years ago.
Acute myocardial infarction of inferolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Unspecified essential hypertension,Pure hypercholesterolemia,Asthma, unspecified type, unspecified
AMI inferolateral, init,Crnry athrscl natve vssl,Hypotension NEC,Hypertension NOS,Pure hypercholesterolem,Asthma NOS
Admission Date:  [**2129-7-31**]              Discharge Date:   [**2129-8-4**]

Date of Birth:  [**2075-8-13**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Inferior STEMI

Major Surgical or Invasive Procedure:
Cardiac catheterization with stent to RCA [**2129-7-31**]
Cardiac catheterization with stent to LCx [**2129-8-3**]

History of Present Illness:
53 yo man with PMH significant for HTN and asthma presented to
[**Hospital6 3105**] on [**7-29**] c/o chest pain and was
discharged to home [**7-30**] after negative ETT.  This am patient
woke up with 8/10 bilateral arm and chest pain and called 911.
Paramedics administered morphine 8 mg and SLNTG and pain down to
3/10.  Initial EKG showed STE II, III, F, V1 with depressions in
I, L, V2 and V3.  Patient was given Lopressor 5 mg IV x 3,
Heparin and Integrillin drips, and aspiring.  Brought to cath
which revealed prox to mid RCA TO, stented, as well as mLCx 80%.
 LAD clean.  During cath patient required atropine and dopamine
for transient hypotension and bradycardia.  RA 18, RV 41/7, PA
43/20 (29), PCWP 25, CO 4.5, CI 2.7.  EKG post-intervention NSR
at 70 bpm, nl axis, nl intervals, 1 mm STE V1, resolved STE II,
III, F and resolved ST depressions in I, L, V2, V3.  Patient
brought to CCU feeling very well but still on dopamine.  Denies
CP, SOB, nausea, or lightheadedness.

Past Medical History:
HTN
Asthma
Hypercholesterolemia
h/o spinal surgery [**2128**]

Social History:
Denies alcohol, quit tobacco 6 years ago.

Family History:
No family hx of CAD

Physical Exam:
PE: T  BP 103/63 P 82 91% on RA, 98% on 2L
GEN - NAD, A&Ox3
HEENT - PERRL, EOMI
NECK - no JVD
HEART - nl s1s2, RRR, no mrg
LUNGS - CTAB
ABD - soft, NT/ND, NABS
EXT - Venous sheath in place in R groin, no hematoma or bruit,
no edema, 2+ PT pulses

Pertinent Results:
[**2129-7-31**] 01:02PM   TRIGLYCER-96 HDL CHOL-64 CHOL/HDL-3.2
LDL(CALC)-123
[**2129-7-31**] 01:02PM   CK(CPK)-2620*
[**2129-7-31**] 01:02PM   CK-MB-420* MB INDX-16.0* cTropnT-7.65*
[**2129-7-31**] 01:02PM   GLUCOSE-120* UREA N-11 CREAT-0.8 SODIUM-140
POTASSIUM-4.3 CHLORIDE-107 TOTAL CO2-24 ANION GAP-13

C.cath [**7-31**] - prox to mid RCA TO, stented, as well as mLCx 80%.
LAD clean.  During cath patient required atropine and dopamine
for transient hypotension and bradycardia.  RA 18, RV 41/7, PA
43/20 (29), PCWP 25, CO 4.5, CI 2.7.


Brief Hospital Course:
.
1) CAD: The patient was admitted with an inferior STEMI, found
to involve the RV.  Cardiac catheterization showed total
occlusion of the RCA, which was stented with a Cypher DES.  The
LCx was found to be 80% stenosed, which stented in a planned
intervention on [**8-3**].  He received integrillin x 18 hours.  He
was also started on aspirin, Plavix, high-dose statin, and beta
blocker.  An ACE-I not started during this admission because of
hypotension.  His cardiac enzymes trended down throughout the
admission.  TTE on [**8-3**] showed regional LV and RV hypokinesis,
with EF of 40-45%.  Lipid panel showed LDL of 123.  He was
instructed to f/u with his PCP and cardiologist in [**Hospital1 487**], MA.
.
2) Hypotension:  Patient required dopamine hours after cath for
low blood pressure.  Given his levated CVP with hypotension, he
was presumed to have RV involvement.  He was maintained on IVF
post-catheterization.  Dopamine gtt was weaned overnight on
[**7-31**].  He continued to be hemodynamically stable throughout rest
of hospitalization.
.
3) Asthma: Mr. [**Known lastname 63776**] has an outpatient diagnosis of
asthma.  He was continued on his outpatient inhalers and had no
complaints throughout his admission.  He maintained good O2 sats
throughout his stay.
.
4) FEN: IVF, Mg and Phos repletion.  He was maintained on a
cardiac diet.
.


Medications on Admission:
prior to [**2129-7-29**] - quinipril 10 mg po qd
after [**2129-7-29**] - aspirin 81 mg po qd, lipitor, atenolol

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*6*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*8*
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. Montelukast Sodium 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*6*


Discharge Disposition:
Home

Discharge Diagnosis:
CAD s/p cath with stents to RCA and LCx
Asthma
Hypertension
Hypercholesterolemia


Discharge Condition:
Good

Discharge Instructions:
Take all medications as prescribed.
You must take Plavix daily for 6-9 months for your stents, until
you are told to stop by your cardiologist.
You should stop the quinapril for now and this may be added by
your cardiologist in the future. You are now on a higher dose of
Lipitor, this may be decreased by your cardiologist in the
future.
Return to the ER for chest pain, L arm pain, nausea or other
concerning symptoms

Followup Instructions:
Follow up with your primary care provider, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **]
([**Telephone/Fax (1) 63777**], within one week.
Follow up with your new cardiologist in [**Hospital1 487**] within one
month. You should bring copies of all your reports with you.



Completed by:[**2129-8-5**]
{'Acute myocardial infarction of inferolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Unspecified essential hypertension,Pure hypercholesterolemia,Asthma, unspecified type, unspecified'}


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: Inferior STEMI

PRESENT ILLNESS: 53 yo man with PMH significant for HTN and asthma presented to
[**Hospital6 3105**] on [**7-29**] c/o chest pain and was
discharged to home [**7-30**] after negative ETT.  This am patient
woke up with 8/10 bilateral arm and chest pain and called 911.
Paramedics administered morphine 8 mg and SLNTG and pain down to
3/10.  Initial EKG showed STE II, III, F, V1 with depressions in
I, L, V2 and V3.  Patient was given Lopressor 5 mg IV x 3,
Heparin and Integrillin drips, and aspiring.  Brought to cath
which revealed prox to mid RCA TO, stented, as well as mLCx 80%.
 LAD clean.  During cath patient required atropine and dopamine
for transient hypotension and bradycardia.  RA 18, RV 41/7, PA
43/20 (29), PCWP 25, CO 4.5, CI 2.7.  EKG post-intervention NSR
at 70 bpm, nl axis, nl intervals, 1 mm STE V1, resolved STE II,
III, F and resolved ST depressions in I, L, V2, V3.  Patient
brought to CCU feeling very well but still on dopamine.  Denies
CP, SOB, nausea, or lightheadedness.

MEDICAL HISTORY: HTN
Asthma
Hypercholesterolemia
h/o spinal surgery [**2128**]

MEDICATION ON ADMISSION: prior to [**2129-7-29**] - quinipril 10 mg po qd
after [**2129-7-29**] - aspirin 81 mg po qd, lipitor, atenolol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: T  BP 103/63 P 82 91% on RA, 98% on 2L
GEN - NAD, A&Ox3
HEENT - PERRL, EOMI
NECK - no JVD
HEART - nl s1s2, RRR, no mrg
LUNGS - CTAB
ABD - soft, NT/ND, NABS
EXT - Venous sheath in place in R groin, no hematoma or bruit,
no edema, 2+ PT pulses

FAMILY HISTORY: No family hx of CAD

SOCIAL HISTORY: Denies alcohol, quit tobacco 6 years ago. 

### Response:
{'Acute myocardial infarction of inferolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Unspecified essential hypertension,Pure hypercholesterolemia,Asthma, unspecified type, unspecified'}
