CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 52 yo male with PMH hypercholesterolemia, hypertension, smoking
history presents with acute chest pain. Pain began at 6:35pm
while he was refereeing a baseball game. Pt states that he was
running around when he developed acute non-radiating [**8-22**]
substernal chest tightness associated with SOB, diaphoresis,
nausea, and left hand numbness.
.
Presented to [**Hospital3 **]. Vital signs were p80, 214/131,
100% 3lnc. Labs there include Hct 36.8, Plt 195. Guiac negative.
Pt was given IV nitro, ASA, morphine, heparin bolus and
aggrastat. Pt was transferred via Life Flight to [**Hospital1 18**] for cath.

MEDICAL HISTORY: hypertension
hypercholesterolemia
smoking
basal cell skin cancer (s/p excision)

MEDICATION ON ADMISSION: Zestril 10mg qd
Lipitor 20mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile, p67, 132/82, rr15, 94%RA
Gen: NAD, lying flat on back
HEENT: PERRL, EOMI, clear OP, MMM
Neck: unable to assess JVP
CVS: RRR, nl s1 s2, no m/g/r
Lungs: CTAB, no c/w/r
Abd: soft, NT, ND, +BS
Groin: no hematoma or bruit
Ext: no edema bilaterally, 2+DP bilaterally

FAMILY HISTORY: Father had MI and quadruple bypass surgery at age of 63

SOCIAL HISTORY: smokes 1 ppd x 30 years
drinks 18 beers/wk over the weekend
Denies drug use
works as probation officer
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Personal history of other malignant neoplasm of skin
Subendo infarct, initial,CHF NOS,Ventricular fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Tobacco use disorder,Hx-skin malignancy NEC
Admission Date:  [**2147-11-29**]              Discharge Date:   [**2147-12-2**]

Date of Birth:  [**2095-3-5**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
s/p cardiac catheterization with 4 stents placed.


History of Present Illness:
52 yo male with PMH hypercholesterolemia, hypertension, smoking
history presents with acute chest pain. Pain began at 6:35pm
while he was refereeing a baseball game. Pt states that he was
running around when he developed acute non-radiating [**8-22**]
substernal chest tightness associated with SOB, diaphoresis,
nausea, and left hand numbness.
.
Presented to [**Hospital3 **]. Vital signs were p80, 214/131,
100% 3lnc. Labs there include Hct 36.8, Plt 195. Guiac negative.
Pt was given IV nitro, ASA, morphine, heparin bolus and
aggrastat. Pt was transferred via Life Flight to [**Hospital1 18**] for cath.


Past Medical History:
hypertension
hypercholesterolemia
smoking
basal cell skin cancer (s/p excision)

Social History:
smokes 1 ppd x 30 years
drinks 18 beers/wk over the weekend
Denies drug use
works as probation officer

Family History:
Father had MI and quadruple bypass surgery at age of 63

Physical Exam:
VS: afebrile, p67, 132/82, rr15, 94%RA
Gen: NAD, lying flat on back
HEENT: PERRL, EOMI, clear OP, MMM
Neck: unable to assess JVP
CVS: RRR, nl s1 s2, no m/g/r
Lungs: CTAB, no c/w/r
Abd: soft, NT, ND, +BS
Groin: no hematoma or bruit
Ext: no edema bilaterally, 2+DP bilaterally

Pertinent Results:
[**2147-11-29**] 09:00PM   GLUCOSE-127* UREA N-25* CREAT-1.0
POTASSIUM-3.7 CHLORIDE-98
[**2147-11-29**] 09:03PM   K+-4.3
[**2147-11-29**] 09:03PM   TYPE-ART PO2-114* PCO2-49* PH-7.32* TOTAL
CO2-26 BASE XS--1 INTUBATED-NOT INTUBA
.
EKG: [**2147-11-29**] 19:11: sinus rhythm @78, nl axis, nl intervals,
3mm ST elevations in 2,3,f with reciprocal depressions in 1,L,
v2, v5, v6.
.
EKG: [**2147-11-29**] 22:32: sinus rhythm @71, nl axis and intervals,
resolution of ST elevation in inferior leads, q wave in 3, T
wave flattening 1, V1, V2, V6, T wave inversions in avL
.
[**2147-11-29**] Cardiac catheterization:
1. Selective coronary angiography revealed a right dominant
system with
a totally occluded proximal RCA. The LMCA was angiographically
normal.
The LAD had mild disease. The LCx was a nondominant vessel
without
critical lesions.
2. Hemodynamics after PCI revealed elevated systemic pressures,
mildly
elevated right and left sided filling pressures (RVEDP 15, PCWP
mean 20
mm Hg).
3. After passage of the wire across the lesion, the patient had
several
runs of NSVT, which developed into VF requiring defibrillation.
The
patient converted into an idioventricular rhythm after
defribrillation
with 200 J. He was also treated with 300 mg IV amiodarone. Later
in the
case, he spontaneously went into sinus rhythm.
4. Successful PTCA and stenting of the RCA with four 3.5 mm
Cypher
drug-eluting stents which were post-dilated to 4.0 mm and a 3.0
mm Zeta
stent. Final angiography showed no residual stenosis, no
dissection and
normal flow (see PTCA comments).
.
FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Successful stenting of the RCA.
.
[**2147-11-30**] TTE
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or
color Doppler. There is mild symmetric left ventricular
hypertrophy. The left
ventricular cavity size is normal. Overall left ventricular
systolic function
is low normal (LVEF 50%) due to hypokinesis of the basal and
midventricular
segments of the inferior free wall and posterior wall. The right
ventricular
cavity is mildly dilated. Right ventricular systolic function is
borderline
normal. The aortic root is moderately dilated. The ascending
aorta is
moderately dilated. The aortic valve leaflets (3) are mildly
thickened but
aortic stenosis is not present. Trace aortic regurgitation is
seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse.
Trivial mitral regurgitation is seen. There is no pericardial
effusion.
.


Brief Hospital Course:
1. CAD: Pt was taken straight to the cath lab. Hemodynamics were
as follows: RA 16, RV 33/17, PCW 20, PA 33/20 (27), CO/CI
6.34/2.65. Coronary angiography showed total occlusion of the
proximal RCA. Left main, LAD, and LCx were without significant
disease. Balloon inflation occurred at 9:20pm followed by
placement of 3 cypher stents and one zeta (bare metal) stent
with resulting normal flow. Pt remained hemodynamically stable.
Pt was found to have an inferior MI with RV infarction. Pt was
continued on aspirin, plavix. Aggrastat was continued to 18
hours post-cath. Pt was re-started on statin. Beta-blocker and
ACEI were titrated up. Nitro was not given. Peak CK was 2400
with peak Tn of 6.62. Cardiac enzymes trended down.
Echocardiogram found low normal (LVEF 50%) due to hypokinesis of
the basal and midventricular segments of the inferior free wall
and posterior wall and borderline normal RV systolic function.
Pt remained hemodynamically stable and chest pain free
throughout the hospitalization. Pt was discharged with aspirin,
plavix, statin, atenolol, and lisinopril.
.
2. Pump: Echocardiogram found low normal (LVEF 50%) due to
hypokinesis of the basal and midventricular segments of the
inferior free wall and posterior wall and borderline normal RV
systolic function. Hypertension was managed with metoprolol and
captopril with BP ranging from 120-150 systolic.
.
3. Rhythm: Pt had a VT/VF arrest in cath lab in setting of wire
being passed through the artery. He was shocked with 200J and
returned to a perfusing rhythm, AVIR then NSR. He was given a
300mg IV bolus of amio. Antiarrythmics were not continued, since
the source of the arrythmia was the wire. On the floor, pt had
frequent episodes of NSVT. Electrolytes were repleted as needed.
.
4. Hypercholesterolemia: Pt was continued on Lipitor.
.
5. ETOH use: Given history of drinking 18 beers per week, pt was
put on CIWA scale with ativan q2h prn. Pt was also put on a
small standing dose of Ativan for mild aggitation. Pt did not
display any significant signs of alcohol withdrawal.
.
6. FEN: Pt was given cardiac/low sodium diet
.
7. Code status: FULL CODE


Medications on Admission:
Zestril 10mg qd
Lipitor 20mg qd

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Inferior myocardial infarction with RV infarction.


Discharge Condition:
Stable

Discharge Instructions:
If you develop chest pain or difficulty breathing, call your
doctor or return to the emergency room.

Followup Instructions:
Follow-up with your primary care [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (Titles) 59917**] on [**12-5**], 10:30am.

Ask Dr. [**Last Name (STitle) 59917**] to refer you to a cardiologist. Please see the
cardiologist within 1-2 weeks.
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Personal history of other malignant neoplasm of skin'}


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: 52 yo male with PMH hypercholesterolemia, hypertension, smoking
history presents with acute chest pain. Pain began at 6:35pm
while he was refereeing a baseball game. Pt states that he was
running around when he developed acute non-radiating [**8-22**]
substernal chest tightness associated with SOB, diaphoresis,
nausea, and left hand numbness.
.
Presented to [**Hospital3 **]. Vital signs were p80, 214/131,
100% 3lnc. Labs there include Hct 36.8, Plt 195. Guiac negative.
Pt was given IV nitro, ASA, morphine, heparin bolus and
aggrastat. Pt was transferred via Life Flight to [**Hospital1 18**] for cath.

MEDICAL HISTORY: hypertension
hypercholesterolemia
smoking
basal cell skin cancer (s/p excision)

MEDICATION ON ADMISSION: Zestril 10mg qd
Lipitor 20mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile, p67, 132/82, rr15, 94%RA
Gen: NAD, lying flat on back
HEENT: PERRL, EOMI, clear OP, MMM
Neck: unable to assess JVP
CVS: RRR, nl s1 s2, no m/g/r
Lungs: CTAB, no c/w/r
Abd: soft, NT, ND, +BS
Groin: no hematoma or bruit
Ext: no edema bilaterally, 2+DP bilaterally

FAMILY HISTORY: Father had MI and quadruple bypass surgery at age of 63

SOCIAL HISTORY: smokes 1 ppd x 30 years
drinks 18 beers/wk over the weekend
Denies drug use
works as probation officer 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Personal history of other malignant neoplasm of skin'}
