CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: This is a 79yo M with history of hypertension, hyperlipidemia,
PVD who presented with 5/10 nonradiating burning chest pain in
midchest that started at 3 AM on the morning of admision. HE
denies nausea/vomitting/ diaphoresis / dizziness/palpitation.
THe pain did not wake him up from sleep and he noticed it while
he was waking up to get to the bathroom. The pain was not
relieved by mylanta/tums. At baseline, he could only walk a few
hundred feet because of claudication. This has not changed
recently. He did not notice any leg swelling/weight change.
Patient went to [**Hospital 487**] Hospital where he had ST depression in
V4-V6 and noted to have crackles on exam. Chest pain was
relieved by 2SLNTG. patient geiven lasix. trop noted to be 9.37
at OSH(0-0.5) with MB 65.1. IV heparin was started. He was then
transferred to [**Hospital1 18**]. Patient is chest pain free on IV heparin
and integrillin

MEDICAL HISTORY: 1. CAD??silent MI in the past
2. COPD
3. paroxysmal Afib
4. hypercholesterolemia
5. bilateral CEA about 20y ago
6. PVD s/p angioplasty LLE about 10y ago
7. neck CA s/p XRT 7y ago

MEDICATION ON ADMISSION: zocor 20 qhs
terazosin 2mg oi qhs
allopurinol 100 [**Hospital1 **]
albuterol 2 puffs qid
digoxin 0.125 po qd
diltiazem 240 qd
HCTZ 12.5 qam
coumadin 5 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T97.5 BP 90-110/50-60 P68 94% on RA
Gen-very pleasant elderly  gentleman, comfortable in no
pain/distress
HEENT-anicteric, oral mucosa moist, neck supple
CVS-regular HS, no murmur, faint heart sound, no pedal edema, no
JVD, carotid bruit on right
ext-femoral pulse 2+ bilaterally, no bruit, DP 1+
bilaterally(diffuicult to find)
resp-mild bibasilar crackles
[**Last Name (un) 103**]-nl BS, NT/ND
neuro-A+Ox3, move all 4 limbs symmetrically, no facial asymmetry

FAMILY HISTORY: MI in father at 65yo

SOCIAL HISTORY: denies tobacco/ETOH
Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Atrial fibrillation,Cardiogenic shock,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Acidosis,Mitral valve disorders,Unspecified disorder of kidney and ureter,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Abnormal coagulation profile
Subendo infarct, initial,Systolic hrt failure NOS,Acute kidney failure NOS,Pleural effusion NOS,Atrial fibrillation,Cardiogenic shock,Ac posthemorrhag anemia,Crnry athrscl natve vssl,Prim cardiomyopathy NEC,Urin tract infection NOS,Chr airway obstruct NEC,Acidosis,Mitral valve disorder,Renal & ureteral dis NOS,Hypertension NOS,Long-term use anticoagul,Abnrml coagultion prfile
Admission Date:  [**2177-11-29**]              Discharge Date:   [**2177-12-16**]

Date of Birth:  [**2098-2-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2078**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
This is a 79yo M with history of hypertension, hyperlipidemia,
PVD who presented with 5/10 nonradiating burning chest pain in
midchest that started at 3 AM on the morning of admision. HE
denies nausea/vomitting/ diaphoresis / dizziness/palpitation.
THe pain did not wake him up from sleep and he noticed it while
he was waking up to get to the bathroom. The pain was not
relieved by mylanta/tums. At baseline, he could only walk a few
hundred feet because of claudication. This has not changed
recently. He did not notice any leg swelling/weight change.
Patient went to [**Hospital 487**] Hospital where he had ST depression in
V4-V6 and noted to have crackles on exam. Chest pain was
relieved by 2SLNTG. patient geiven lasix. trop noted to be 9.37
at OSH(0-0.5) with MB 65.1. IV heparin was started. He was then
transferred to [**Hospital1 18**]. Patient is chest pain free on IV heparin
and integrillin

Past Medical History:
1. CAD??silent MI in the past
2. COPD
3. paroxysmal Afib
4. hypercholesterolemia
5. bilateral CEA about 20y ago
6. PVD s/p angioplasty LLE about 10y ago
7. neck CA s/p XRT 7y ago

Social History:
denies tobacco/ETOH

Family History:
MI in father at 65yo

Physical Exam:
T97.5 BP 90-110/50-60 P68 94% on RA
Gen-very pleasant elderly  gentleman, comfortable in no
pain/distress
HEENT-anicteric, oral mucosa moist, neck supple
CVS-regular HS, no murmur, faint heart sound, no pedal edema, no
JVD, carotid bruit on right
ext-femoral pulse 2+ bilaterally, no bruit, DP 1+
bilaterally(diffuicult to find)
resp-mild bibasilar crackles
[**Last Name (un) 103**]-nl BS, NT/ND
neuro-A+Ox3, move all 4 limbs symmetrically, no facial asymmetry


Pertinent Results:
ECG-irregular rate, wandering atrial pacemaker, normal axis and
interval, ST depression in V2-V6 I, II

CXR [**2177-11-28**]-bilateral hazy opacities c/w CHF

[**2177-11-29**] 09:55AM   PTT-113.3*
[**2177-12-16**] 07:05AM BLOOD WBC-8.7 RBC-3.75* Hgb-11.1* Hct-32.1*
MCV-86 MCH-29.5 MCHC-34.5 RDW-16.3* Plt Ct-321
[**2177-12-16**] 07:05AM BLOOD Plt Ct-321
[**2177-12-16**] 07:05AM BLOOD Glucose-97 UreaN-87* Creat-3.8* Na-130*
K-3.0* Cl-87* HCO3-36* AnGap-10
[**2177-12-11**] 07:25AM BLOOD LD(LDH)-273*
[**2177-12-5**] 05:36AM BLOOD ALT-18 AST-23 LD(LDH)-322* AlkPhos-68
TotBili-0.5
[**2177-12-3**] 03:59PM BLOOD CK-MB-23* MB Indx-12.9* cTropnT-4.82*
[**2177-12-3**] 05:27AM BLOOD CK-MB-36* MB Indx-13.7* cTropnT-5.10*
[**2177-12-2**] 01:36PM BLOOD CK-MB-98* MB Indx-18.5* cTropnT-3.84*
[**2177-12-16**] 07:05AM BLOOD Calcium-8.5 Phos-4.4 Mg-2.2
[**2177-11-30**] 01:56PM BLOOD calTIBC-270 VitB12-229* Folate-19.2
Ferritn-71 TRF-208
[**2177-11-29**] 06:30AM BLOOD Triglyc-68 HDL-46 CHOL/HD-2.6 LDLcalc-59
[**2177-11-30**] 01:56PM BLOOD TSH-1.4

Brief Hospital Course:
Patient had a NSTEMI on admission. Over the weekend, the
decision had been to watch him since he was chest pain free and
his Cr was rising. However, he eventually developed chest pain,
his troponin peaked at 5.10 with very ischemic looking ECG. He
was initially put on integrillin and heparin. However, his renal
function continues to worsen and the integrillin was then
switched to reapro. He subsequently passed large liquid black
stool. The reapro and heparin was thus discontinued. The renal
function continues to worsen and he also developed flash
pulmonary edema with acute respiratory distress. He was then
transferred to the CCU and aggressively diuresed with natrecor
and achieved a net loss of 3.2L. The flash pulmoary edema was
thought to be caused by his evolving MI. His EF was known to be
35%. He was then transferred to the floor. His oxygen saturation
did not improve despite aggressive diuresis with natrecor and
lasix drip. His CXR showed moderate to large bilateral pleural
effusion. Bilateral thoracentesis was performed and he had a
therapeutic tap about 2L on  the right and 1.4 L on the left.
Pleural fluid was consistent with transudative effusion. His
respiratory status improved dramatically since then. His
diuretic regimen was gradually switched to IV and then to oral
medication. He will be discharged on oral lasix 20 [**Hospital1 **]. There is
no plan for cardiac catheterization at this moment. [**Name2 (NI) **] will be
managed medically with aspirin, metoprolol XL, simvastatin and
nitroglycerin.

Patient also has a history of paroxysmal atrial fibrillation. He
was on digoxin, diltiazem and coumadin as outpatient.
However,coumadin was discontinued because of his GI bleed.
Diltiazem and digoxin were discontinued because of the frequent
4s pauses seen on telemetry. On discharge,he was in sinus rhythm
on metoprolol and amiodarone 400 [**Hospital1 **]. Digoxin was not restarted
due to his renal failure. He will have to have a GI workup
before coumadin could be restarted. GI workup will have to be
arranged as outpatient. Meanwhile, he would continue on PPI. He
had recieved a total of 3 units of pack red cells while he was
actively bleeding and since then his hematocrit had been stable.
He was also started on iron pills.  Once his EGD/colonoscopy has
been done, he should be restarted on coumadin for stroke
prevention (Afib) with a goal INR of [**2-25**].

His creatinine peaked at 4.1, likely due to decreased perfusion
from worsening CHF in the setting of MI. Renal U/S showed no
hydronephrosis or stone. There was also no cast in urine to
suggest ATN. The creatinine gradually drifted down with
resolution of his CHF status

He will be discharged to rehabilitation with close follow up.

Medications on Admission:
zocor 20 qhs
terazosin 2mg oi qhs
allopurinol 100 [**Hospital1 **]
albuterol 2 puffs qid
digoxin 0.125 po qd
diltiazem 240 qd
HCTZ 12.5 qam
coumadin 5 qd

NKDA

Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
3. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed).
4. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**1-24**] Sprays Nasal
QID (4 times a day) as needed.
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
6. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).

8. Ipratropium Bromide 0.02 % Solution Sig: 1-2 puffs Inhalation
Q6H (every 6 hours) as needed for SOB.
9. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO twice a
day: Please give 200 mg [**Hospital1 **] for two weeks and then change to 200
mg once daily as his maintenance dose.
10. Trazodone HCl 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed.
11. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR
Sig: 0.5 Tablet Sustained Release 24HR PO DAILY (Daily).
12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
TID (3 times a day). Tablet(s)
14. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
NSTEMI
acute on chronic renal failure
GI bleed
congestive heart failure
pneumonia


Discharge Condition:
good

Discharge Instructions:
Please follow-up with your primary care doctor in [**2-25**] weeks.
Dr. [**Last Name (STitle) 50167**], [**First Name3 (LF) **] [**Telephone/Fax (1) 50168**]. Fax [**Telephone/Fax (1) 56897**]

Once you have had your colonoscopy and upper endoscopy, you
should be restarted on coumadin if it is safe to do so.  Please
check with your primary care doctor prior to restarting this
medication.  Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 437**], [**Hospital1 18**] Gastroenterology ([**Telephone/Fax (1) 19233**], will call your Rehab and your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 10542**] the follow-up endoscopy and colonoscopy.

Please follow-up with your nephrologist and cardiologist as
scheduled.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], [**Name Initial (NameIs) **].D., PH.D.[**MD Number(3) **]: [**Hospital6 29**]
MEDICAL SPECIALTIES Phone:[**Telephone/Fax (1) 435**] Date/Time:[**2178-1-26**] 2:30

Please follow-up with your primary care doctor in [**2-25**] weeks.

Provider: [**Name10 (NameIs) 475**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 474**], M.D. Where: [**Hospital6 29**] CARDIAC
SERVICES Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2178-2-13**] 1:00

Outpatient EGD/Colonoscopy to be scheduled.  Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 437**],
[**Hospital1 18**] Gastroenterology ([**Telephone/Fax (1) 8892**], will call your Rehab and
your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **] the follow-up endoscopy and
colonoscopy.
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Atrial fibrillation,Cardiogenic shock,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Acidosis,Mitral valve disorders,Unspecified disorder of kidney and ureter,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Abnormal coagulation profile'}


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: This is a 79yo M with history of hypertension, hyperlipidemia,
PVD who presented with 5/10 nonradiating burning chest pain in
midchest that started at 3 AM on the morning of admision. HE
denies nausea/vomitting/ diaphoresis / dizziness/palpitation.
THe pain did not wake him up from sleep and he noticed it while
he was waking up to get to the bathroom. The pain was not
relieved by mylanta/tums. At baseline, he could only walk a few
hundred feet because of claudication. This has not changed
recently. He did not notice any leg swelling/weight change.
Patient went to [**Hospital 487**] Hospital where he had ST depression in
V4-V6 and noted to have crackles on exam. Chest pain was
relieved by 2SLNTG. patient geiven lasix. trop noted to be 9.37
at OSH(0-0.5) with MB 65.1. IV heparin was started. He was then
transferred to [**Hospital1 18**]. Patient is chest pain free on IV heparin
and integrillin

MEDICAL HISTORY: 1. CAD??silent MI in the past
2. COPD
3. paroxysmal Afib
4. hypercholesterolemia
5. bilateral CEA about 20y ago
6. PVD s/p angioplasty LLE about 10y ago
7. neck CA s/p XRT 7y ago

MEDICATION ON ADMISSION: zocor 20 qhs
terazosin 2mg oi qhs
allopurinol 100 [**Hospital1 **]
albuterol 2 puffs qid
digoxin 0.125 po qd
diltiazem 240 qd
HCTZ 12.5 qam
coumadin 5 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T97.5 BP 90-110/50-60 P68 94% on RA
Gen-very pleasant elderly  gentleman, comfortable in no
pain/distress
HEENT-anicteric, oral mucosa moist, neck supple
CVS-regular HS, no murmur, faint heart sound, no pedal edema, no
JVD, carotid bruit on right
ext-femoral pulse 2+ bilaterally, no bruit, DP 1+
bilaterally(diffuicult to find)
resp-mild bibasilar crackles
[**Last Name (un) 103**]-nl BS, NT/ND
neuro-A+Ox3, move all 4 limbs symmetrically, no facial asymmetry

FAMILY HISTORY: MI in father at 65yo

SOCIAL HISTORY: denies tobacco/ETOH 

### Response:
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Acute kidney failure, unspecified,Unspecified pleural effusion,Atrial fibrillation,Cardiogenic shock,Acute posthemorrhagic anemia,Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Urinary tract infection, site not specified,Chronic airway obstruction, not elsewhere classified,Acidosis,Mitral valve disorders,Unspecified disorder of kidney and ureter,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Abnormal coagulation profile'}
