CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 59 yof pmh HTN, PUD and left subclavian artery stenosis?
transferred from OSH with sscp for 20-30 minutes assoc with
nausea and vomitting x2. Pain described as nonradiating constant
chest pressure [**9-4**]. Assoc +diaphoresis and dizziness but no
SOB. Found to have ST elevation in II-III and depression lateral
lead V2-4, slight elevation in V1.
.
Patient received IV NTG, ASA 324mg, Heparin IV bolus 3000U,
metoprolol, SL nitroglycerin, integrillin, atorvastatin and
plavix. Patient was transferred to [**Hospital1 18**] ED.
.
In ED, AF 124/72 74 100% NC 2L, chest pressure [**3-7**], sent
straight to cath. LCx and RCA
.
Recent stress echo [**10-30**] normal per patient. Denies having this
chest pain ever before or prior MI. Reports sleeping on 2
pillows at night and denies PND or presyncopal/syncopal events.

MEDICAL HISTORY: 1. Hypertension
2. Peptic ulcer disease
3. PVD/?Left subclavian artery stenosis

MEDICATION ON ADMISSION: 1. sucralfate [**Hospital1 **]
2. lipitor 40mg QD
3. quinipril 20mg QD
4. cimetidine 400mg [**Hospital1 **]
5. protonix 40mg [**Hospital1 **]

ALLERGIES: Naproxen Sodium / Ciprofloxacin

PHYSICAL EXAM: VS T 96.8 BP 134/70 HR 89 RR 22 O2sat 95% 2L NC
Gen: lying in bed, NAD
HEENT: PERRL, MMM, OP clear, JVP ~9cm, no thyromegaly, neck
supple
CV: nl S1 S2 RRR no m/r/g
PULM: clear to auscultation bilaterally [**Last Name (un) **]/lat
ABD: soft nt +bs guaic neg
GROIN: nontender, no hematoma
EXT: nonedematous, 1+ DPP bilaterally

FAMILY HISTORY: Father - HTN
Mother - died of MI @ 76 yo

SOCIAL HISTORY: Lives with husband, has 3 kids and works as a traffic
supervisor.
Currently smokes [**1-27**] ppd for 30 years, occas 1 wine/week and
denies illicit drugs.
Acute myocardial infarction of other inferior wall, initial episode of care,Angiodysplasia of stomach and duodenum with hemorrhage,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Other and unspecified angina pectoris,Stricture of artery,Unspecified essential hypertension
AMI inferior wall, init,Angio stm/dudn w hmrhg,Chronic kidney dis NOS,Crnry athrscl natve vssl,Mitral valve disorder,Angina pectoris NEC/NOS,Stricture of artery,Hypertension NOS
Admission Date:  [**2126-12-28**]              Discharge Date:   [**2127-1-2**]

Date of Birth:  [**2067-11-5**]             Sex:   F

Service: MEDICINE

Allergies:
Naproxen Sodium / Ciprofloxacin

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
1. percutaneous coronary intervention w/cypher stent
2. upper endoscopy w/electrocautery
3. 3 units packed red blood cells


History of Present Illness:
59 yof pmh HTN, PUD and left subclavian artery stenosis?
transferred from OSH with sscp for 20-30 minutes assoc with
nausea and vomitting x2. Pain described as nonradiating constant
chest pressure [**9-4**]. Assoc +diaphoresis and dizziness but no
SOB. Found to have ST elevation in II-III and depression lateral
lead V2-4, slight elevation in V1.
.
Patient received IV NTG, ASA 324mg, Heparin IV bolus 3000U,
metoprolol, SL nitroglycerin, integrillin, atorvastatin and
plavix. Patient was transferred to [**Hospital1 18**] ED.
.
In ED, AF 124/72 74 100% NC 2L, chest pressure [**3-7**], sent
straight to cath. LCx and RCA
.
Recent stress echo [**10-30**] normal per patient. Denies having this
chest pain ever before or prior MI. Reports sleeping on 2
pillows at night and denies PND or presyncopal/syncopal events.

Past Medical History:
1. Hypertension
2. Peptic ulcer disease
3. PVD/?Left subclavian artery stenosis


Social History:
Lives with husband, has 3 kids and works as a traffic
supervisor.
Currently smokes [**1-27**] ppd for 30 years, occas 1 wine/week and
denies illicit drugs.


Family History:
Father - HTN
Mother - died of MI @ 76 yo


Physical Exam:
VS T 96.8 BP 134/70 HR 89 RR 22 O2sat 95% 2L NC
Gen: lying in bed, NAD
HEENT: PERRL, MMM, OP clear, JVP ~9cm, no thyromegaly, neck
supple
CV: nl S1 S2 RRR no m/r/g
PULM: clear to auscultation bilaterally [**Last Name (un) **]/lat
ABD: soft nt +bs guaic neg
GROIN: nontender, no hematoma
EXT: nonedematous, 1+ DPP bilaterally


Pertinent Results:
[**2126-12-28**] 04:20PM BLOOD cTropnT-<0.01
[**2126-12-28**] 10:25PM BLOOD CK-MB-82* MB Indx-12.0*
[**2126-12-29**] 04:48AM BLOOD CK-MB-85* MB Indx-10.3* cTropnT-2.48*
[**2126-12-29**] 01:23PM BLOOD CK-MB-49* MB Indx-7.5* cTropnT-1.62*

%HbA1c: 6.6
Na 140 Cl 109 BUN 19 Gluc 114 AGap=14 Calcium-7.9* Phos-3.6
Mg-2.4
K 4.2 HCO3 21 Cr 1.0
ALT: 14 AP: 70 Tbili: 0.3 Alb: 3.5
AST: 15 Dbili: 0.1
[**Doctor First Name **]: 61
VitB12-372 Albumin-3.5 Cholest-79
WBC 18.2 HBG 7.9 PLAT 259 HCT 25.0
N:86.0 Band:0 L:10.4 M:3.2 E:0.4 Bas:0.1


Cardiac Catherization [**12-28**]
RA pressure 12 mmHg
Right dominant
LMCA: normal
LAD: mild disease
LCx: occluded
RCA: occluded->appeared to be [**Doctor First Name **]-> stented with 3.0 stent taken
to 3.25->0% residual


Echo: [**2126-12-30**]
1. EF: 40-45%
2. The mitral valve leaflets are mildly thickened. Severe (4+)
mitral regurgitation is seen
3. Overall left ventricular systolic function is mildly
depressed. Resting regional wall motion abnormalities include
basal and mid inferior and inferolateral akinesis. Intrinsic LV
function may be more depressed given the severity of the
regurgitation
4. The estimated pulmonary artery systolic pressure is normal

SPECIMEN SUBMITTED: EGD
Procedure date     Tissue received     Report Date    Diagnosed
by
[**2126-12-31**] [**2126-12-31**] [**2127-1-2**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) 18795**]/vf
DIAGNOSIS: Antrum, mucosal biopsies:
No diagnostic abnormalities recognized.  Focal and minimal
chronic inflammation.
Clinical:   GI bleeding. EGD: Gastric angioectasias; antral
erythema.


Brief Hospital Course:
59 yof pmh HTN, PUD and PVD presents with IMI with RCA and LCx
occlusions -> s/p PTCA/RCA stent as this was determined to be
major cause of IMI. Now with GI bleed. s/p EGD 2 AVM seen and
cauterized, bx H pylori also performed.
.
##CARDIAC
#ischemia: LCX and prox RCA occlusions. s/p RCA cypher stent.
Given improvement in ST elev in II-III and depression in lateral
leads this am, likely will not recath patient this admission to
tx LCx and have her follow-up in cardiology clinic. Peak CPK
825. Continued on ASA, Plavix, Integrillin (total 18 hrs).
Increased from 40mg to lipitor 80mg and normal LFTs. Started
metoprolol 25mg PO TID and lisinopril 5mg PO QD.

#pump: Echo on [**12-30**] showed EF of 40-45% with 4+ MR as well as
basal, mid inferior and inferiolateral hypokinesis. Patient
denies history of murmur. Tolerated blood transfusions as
needed.

#rhythm: Started metoprolol. Continued telemetry and serial
EKGs.

#Anemia: Per patient, stopped taking iron supplement [**2-27**] gastric
irritation. Hct 25 on admission. Patient received blood
tranfusions to keep Hct >30 in the setting of acute MI. Hct 32
on discharge.
.
#PUD/GIB: patient reported ulcers on EGD [**8-30**]. Follow-up EGD
scheduled this month. Pt had 3 episodes of maroon
colored/melena. GI consulted and perforemd upper endoscopy [**12-31**]
which showed 2 AVM's which were cauterized and bx taken for H
pylori. Continued protonix [**Hospital1 **] and sulcrafate, held cimetidine.

.
#PVD/L subclavian artery stenosis: intermittent L hand
claudication. stable.
.
#FEN: cardiac healthy low sodium diet, replete lytes.
.
#PPX: bowel regimen, PPI, SQ heparin, C. diff precautions
.
#Code: full
.
#Dispo: PT consult, nutrition consult, likely dc home.

Medications on Admission:
1. sucralfate [**Hospital1 **]
2. lipitor 40mg QD
3. quinipril 20mg QD
4. cimetidine 400mg [**Hospital1 **]
5. protonix 40mg [**Hospital1 **]

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 90 days.
Disp:*90 Tablet(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
4. Toprol XL 25 mg Tablet Sustained Release 24HR Sig: Three (3)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*0*
5. Sucralfate 1 g Tablet Sig: One (1) Tablet PO QID (4 times a
day).
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
9. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual q5 minutes as needed for chest pain: Please take 1
tablet as needed for chest pain. [**Month (only) 116**] repeat dose every 5 minutes
as needed up 3 doses in 15 minutes.
Disp:*1 bottle* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1. ST elevation myocardial infarction

Secondary Diagnosis:
2. history of gastric ulcers
3. peripheral vascular disease
4. 15 pack year smoking history


Discharge Condition:
stable


Discharge Instructions:
Please take medications as prescribed.

You will need to take aspirin and plavix for at least 3 months.
Please follow-up with Dr. [**Last Name (STitle) **] (cardiology) for duration of
these medications.

Please keep follow-up appointments.

Please follow-up your gastric biopsy for H. pylori results.

Please call your primary care physician or come to the emergency
room if you have any chest pain, shortness of breath, near
fainting or loss of consciousness, frequent bloody or black
tarry stools or any other worrying symptoms.

Followup Instructions:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD  Date/Time: [**2127-1-9**] 3:30pm Location:
[**Street Address(2) **] [**Apartment Address(1) **], [**Hospital1 **], MA Phone: [**Telephone/Fax (1) 4475**]

Provider: [**First Name8 (NamePattern2) 1955**] [**Name8 (MD) **], MD Phone: [**Telephone/Fax (1) 52520**] Fax:
[**0-0-**]
Date/Time: [**2127-1-17**] 3:00pm

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD (Cardiology) Please call [**Telephone/Fax (1) 5003**]
to schedule a follow-up appointment in 1 month.



Completed by:[**2127-1-5**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Angiodysplasia of stomach and duodenum with hemorrhage,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Other and unspecified angina pectoris,Stricture of artery,Unspecified essential hypertension'}


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: 59 yof pmh HTN, PUD and left subclavian artery stenosis?
transferred from OSH with sscp for 20-30 minutes assoc with
nausea and vomitting x2. Pain described as nonradiating constant
chest pressure [**9-4**]. Assoc +diaphoresis and dizziness but no
SOB. Found to have ST elevation in II-III and depression lateral
lead V2-4, slight elevation in V1.
.
Patient received IV NTG, ASA 324mg, Heparin IV bolus 3000U,
metoprolol, SL nitroglycerin, integrillin, atorvastatin and
plavix. Patient was transferred to [**Hospital1 18**] ED.
.
In ED, AF 124/72 74 100% NC 2L, chest pressure [**3-7**], sent
straight to cath. LCx and RCA
.
Recent stress echo [**10-30**] normal per patient. Denies having this
chest pain ever before or prior MI. Reports sleeping on 2
pillows at night and denies PND or presyncopal/syncopal events.

MEDICAL HISTORY: 1. Hypertension
2. Peptic ulcer disease
3. PVD/?Left subclavian artery stenosis

MEDICATION ON ADMISSION: 1. sucralfate [**Hospital1 **]
2. lipitor 40mg QD
3. quinipril 20mg QD
4. cimetidine 400mg [**Hospital1 **]
5. protonix 40mg [**Hospital1 **]

ALLERGIES: Naproxen Sodium / Ciprofloxacin

PHYSICAL EXAM: VS T 96.8 BP 134/70 HR 89 RR 22 O2sat 95% 2L NC
Gen: lying in bed, NAD
HEENT: PERRL, MMM, OP clear, JVP ~9cm, no thyromegaly, neck
supple
CV: nl S1 S2 RRR no m/r/g
PULM: clear to auscultation bilaterally [**Last Name (un) **]/lat
ABD: soft nt +bs guaic neg
GROIN: nontender, no hematoma
EXT: nonedematous, 1+ DPP bilaterally

FAMILY HISTORY: Father - HTN
Mother - died of MI @ 76 yo

SOCIAL HISTORY: Lives with husband, has 3 kids and works as a traffic
supervisor.
Currently smokes [**1-27**] ppd for 30 years, occas 1 wine/week and
denies illicit drugs. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Angiodysplasia of stomach and duodenum with hemorrhage,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Other and unspecified angina pectoris,Stricture of artery,Unspecified essential hypertension'}
