CHIEF COMPLAINT: chest pain and SOB

PRESENT ILLNESS: 62 year-old woman with PMH of IMI s/p DES x1 to RCA & [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 1 to
LAD ([**12-11**]) and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 1 to LAD ([**12-12**]) presents for repeat cardiac
catheterization due to persistent chest pain.  After the initial
IMI & stent placement in [**12-11**], pt had been asymptomatic until
[**7-11**] when she began to develop recurrent CP. On [**2188-12-11**], the
patient underwent a successful proximal LAD stenting. Two weeks
later, CP returned, several times at rest, with radiation to her
shoulder blades. The patient also reports sob a/w the chest
discomfort. She denies PND, orthopnea, lightheadedness over the
past month. Pt does report increased BLE edema since having her
HCTZ dose cut in half around [**Holiday **] time.

MEDICAL HISTORY: HTN
High cholesterol
Left breast cancer with mastectomy [**2176**]
Ovarian cyst
Hysterectomy [**2168**]
IMI [**12-11**]
Diverticulitis
GERD
Anxiety

MEDICATION ON ADMISSION: Toprol XL 100mg daily.
Lisinopril 20mg daily.
HCTZ 12.5mg daily.
Xanax 0.25mg [**Hospital1 **].
Prilosec 20mg daily.
Lipitor 40mg daily.
Zetia 10mg daily.
Plavix 75mg daily.
ASA 325mg daily.
Temazepam 30mg qHS.
NTG 0.4mg SL p.r.n.
Imdur 30mg daily.
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: (on admission to CCU s/p cath procedure)
Gen: afebrile, 140/86, 72, 12, 100% on 2L
HEENT: NC/AT, MM Dry.
Neck: No JVD
COR: S1 S2 RRR no mrg
Pulm: CTA anteriorly
Abd: soft, mild TTP suprapubic, mild distension. neg rebound,
neg cullen sign, neg grey-[**Doctor Last Name 4862**] sign. no voluntary or
involuntary guarding.
Ext: WWP L: 2+ DP, 2+ PT; R: 1+ DP, 2+PT. R cath site w systolic
bruit. no thrill. no hematoma.
Neuro: A/O x 3.

FAMILY HISTORY: (-) FHx CAD

SOCIAL HISTORY: She is married and does clerical work. 30 ppd cigs, quit 1 yr
ago. No EtOH, no illicit drugs.
Coronary atherosclerosis of native coronary artery,Peripheral vascular complications, not elsewhere classified,Intermediate coronary syndrome,Aneurysm of artery of lower extremity,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction,Personal history of malignant neoplasm of breast,Shigella flexneri
Crnry athrscl natve vssl,Surg comp-peri vasc syst,Intermed coronary synd,Lower extremity aneurysm,Hypertension NOS,Pure hypercholesterolem,Old myocardial infarct,Hx of breast malignancy,Shigella flexneri
Admission Date:  [**2189-1-28**]              Discharge Date:   [**2189-1-31**]

Date of Birth:  [**2126-3-31**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
chest pain and SOB

Major Surgical or Invasive Procedure:
(1) cardiac catheterization with drug-eluting stent placement x
1
(2) L femoral catheterization with fluoro-assisted balloon
tamponade of R CFA bleed
(3) Ultrasound-guided thrombin injection to R CFA false aneurysm

History of Present Illness:
62 year-old woman with PMH of IMI s/p DES x1 to RCA & [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 1 to
LAD ([**12-11**]) and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 1 to LAD ([**12-12**]) presents for repeat cardiac
catheterization due to persistent chest pain.  After the initial
IMI & stent placement in [**12-11**], pt had been asymptomatic until
[**7-11**] when she began to develop recurrent CP. On [**2188-12-11**], the
patient underwent a successful proximal LAD stenting. Two weeks
later, CP returned, several times at rest, with radiation to her
shoulder blades. The patient also reports sob a/w the chest
discomfort. She denies PND, orthopnea, lightheadedness over the
past month. Pt does report increased BLE edema since having her
HCTZ dose cut in half around [**Holiday **] time.

Past Medical History:
HTN
High cholesterol
Left breast cancer with mastectomy [**2176**]
Ovarian cyst
Hysterectomy [**2168**]
IMI [**12-11**]
Diverticulitis
GERD
Anxiety

Social History:
She is married and does clerical work. 30 ppd cigs, quit 1 yr
ago. No EtOH, no illicit drugs.

Family History:
(-) FHx CAD

Physical Exam:
(on admission to CCU s/p cath procedure)
Gen: afebrile, 140/86, 72, 12, 100% on 2L
HEENT: NC/AT, MM Dry.
Neck: No JVD
COR: S1 S2 RRR no mrg
Pulm: CTA anteriorly
Abd: soft, mild TTP suprapubic, mild distension. neg rebound,
neg cullen sign, neg grey-[**Doctor Last Name 4862**] sign. no voluntary or
involuntary guarding.
Ext: WWP L: 2+ DP, 2+ PT; R: 1+ DP, 2+PT. R cath site w systolic
bruit. no thrill. no hematoma.
Neuro: A/O x 3.


Pertinent Results:
[**2189-1-28**] 01:30PM   HCT-34.8*
[**2189-1-28**] 04:09PM   PT-13.6* PTT-34.8 INR(PT)-1.2*
[**2189-1-28**] 04:09PM   PLT COUNT-257
[**2189-1-28**] 04:09PM   NEUTS-84.7* BANDS-0 LYMPHS-11.7* MONOS-2.7
EOS-0.8 BASOS-0.1
[**2189-1-28**] 04:09PM   WBC-10.8 RBC-3.79* HGB-11.9* HCT-34.6* MCV-91
MCH-31.3 MCHC-34.3 RDW-13.4
[**2189-1-28**] 04:09PM   HAPTOGLOB-174
[**2189-1-28**] 04:09PM   LD(LDH)-143 TOT BILI-0.3 DIR BILI-0.1 INDIR
BIL-0.2
[**2189-1-28**] 04:09PM   GLUCOSE-106* UREA N-14 CREAT-0.7 SODIUM-140
POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-23 ANION GAP-16
[**2189-1-28**] 08:50PM   PT-12.8 PTT-22.3 INR(PT)-1.1
[**2189-1-28**] 08:50PM   PLT COUNT-184
[**2189-1-28**] 08:50PM   WBC-14.4* RBC-4.67 HGB-14.1 HCT-40.8 MCV-88
MCH-30.2 MCHC-34.6 RDW-14.4
[**2189-1-28**] 08:50PM   CALCIUM-8.9 PHOSPHATE-3.1 MAGNESIUM-1.7
[**2189-1-28**] 08:50PM   CK-MB-NotDone
[**2189-1-28**] 08:50PM   CK(CPK)-95
[**2189-1-28**] 08:50PM   GLUCOSE-120* UREA N-11 CREAT-0.8 SODIUM-138
POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-22 ANION GAP-15
[**2189-1-29**] 12:00AM   HCT-42.8
.
[**2187-12-22**] Cardiac Catheterization at [**Hospital3 5097**] d/t acute MI:
Successful stenting of the RCA using a 3.0 x 16 mm Taxus stent.
Successful mid LAD stenting using a 2.5 x 24 mm Taxus.
.
[**2188-10-3**] ETT: The patient exercised for 6 minutes of [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
protocol to an APHR of 77%. No ischemic EKG changes with
exercise. Cardiolite images revealed a matched apical perfusion
likely c/w apical thinning vs. a small apical infarction.
Otherwise, no significant perfusion abnormality. Gated images
revealed no regional or global WMA. EF 64%.
.
[**2188-12-11**] Cath: LAD had an 80% lesion prior to the stent, which was
widely patent. Successful PCI of the proximal LAD using a 3.0 x
13 mm Cypher DES. RCA stent was widely patent.
.
[**2189-1-28**]: Cardiac Cath:
LVgram: no MR, LVEF 65%. Mild inf HK
LMCA: mild distal tapering
LAD: patent stents w TIMI 2 flow
LCx: mid 70% before sm OM2 and large OM3.
RCA: mild luminal irregularities prox p stent, large RPL system

.
[**2189-1-28**]: post-PCI EKG: NSR at 74. nl axis/intervals. downsloping
STD 2mm V2 (new), 1mm STD V3-4 (new), TWI v1 (old)
.
[**2189-1-28**]: CT ABD w/o contrast: Beginning in the right inguinal
region, there is a focal area of soft tissue attenuation
extending upward into the retroperitoneum just to the base of
the kidney that is moderate in size, likely representing a
retroperitoneal hematoma. IMPRESSION: Moderate sized right
retroperitoneal hematoma extending from the inguinal region up
to the base of the right kidney.
.
[**2189-1-29**]: R Femoral U/S: At the right groin puncture site there
is a 4.1 x 2.1-cm pseudoaneurysm. More than half of the
pseudoaneurysm is thrombosed; however, there is active flow
observed through the neck. The neck is well seen and measures
approximately 2-3 mm in diameter. There is no evidence of an
arteriovenous fistula.
.
[**2189-1-29**]: CT Ab/Pel: 1. Interval expansion of right
retroperitoneal hematoma, now extending up from the inguinal
region and dissecting into the right flank. 2. Rounded
high-attenuation collection seen in the inguinal region
consistent with hematoma. Ultrasound would be necessary to
exclude pseudoaneurysm.

Brief Hospital Course:
#Cardiovascular
(1) Ischemia:  The patient was admitted to the hospital for
repeat elective catherization for persistent chest pain.
Cardiac catheterization was performed on [**1-28**] and revealed 70% L
circumflex occlusion.  This lesion was corrected with a 3.0 x 23
mm Cypher drug eluting stent.  The procedure was complicated by
a retroperitoneal bleed secondary to R CFA tear and
pseudoaneurysm as documented below but was otherwise well
tolerated.  When the patient arrived on the floor, she was free
of chest pain and shortness of breath.  She was continued on her
aspirin, plavix, and statin at her home doses.  Her BB and ACE
inhibitor were held after the procedure given her hypotension.
Her cardiac enzymes were followed after the procedure and the CK
was 95 and the CK-MB was below detection threshold.  EKG showed
downsloping STD 2mm in V2 and 1mm STD V3-4 which were both new
and TWI in V1 that was present on previous EKG.  Daily EKGs
revealed no further findings that were concerning for ischemia.
The patient remained without chest pain and SOB while in house.
.
(2) Retroperitoneal Bleed: Right femoral angiography conducted
during the procedure demonstrated entry of the access sheath
slightly above the location of the inguinal ligament, which
elicited concern for RP bleed.  At the time of cath, manual
compression of the site was conducted once bivalirudin wore off.
 After the cath, pt became hypotensive to 70/50 upon sheath
removal.  The hypotension did not respond to 1mg atropine x 2.
CT scan of the abdomen and pelvis revealed RP hemorrhage. She
was given fluid resuscitation, with acute resolution of BP to
90s systolic. Hematocrit was stable at 34.6, but given potential
acutiy of blood loss, there was still great concern for
significant RP bleed.  The patient was transferred to the CCU
for intensive monitoring of BP.  Upon arrival at CCU, BP was
140/60 and stable.  At that time, the patient denied CP, SOB,
lightheadedness, back pain, or abdominal pain at rest. She did
c/o dry mouth.
.
Shortly after admission to the CCU, the patient again developed
persistent hypotension to 70s systolic.  She was given 1mg
atropine x 2 with no improvement in her BP.  Intervention
cardiology was called emergently, and the patient was taken to
the cath lab for angiography with balloon tamponade of suspected
R CFA tear.  Angiography revealed  a tear at the junction of
CFA.  Balloon tamponade x 3 was able to stop the bleeding as
evidenced by angiography.  She received 3 units of pRBCs during
the procedure.  She was sent back to the CCU for intensive
monitoring of hemodynamics and HCT.
.
On the following day ([**1-29**]), the patient remained
hemodynamically stable but showed steadily decreasing HCT.  HCT
decreased from 42.8 directly after the procedure to 32.8 at 7pm
on [**1-29**].  She was given another unit of pRBCs with acute
improvement of HCT to 35.  She was sent for repeat CT scan of
the abdomen and pelvis, which showed expansion of the RP bleed
and also a high-attenuation collection in the R inguinal region
that was suspicious for R CFA pseudoaneurysm.  R femoral U/S
verified this finding, showing 4 x 2 cm pseudoaneurysm with
active flow and no AV fistula.  Vascular surgery suggested
ultrasound-guided thrombin injection of the pseudoaneursym.
.
On [**1-30**] the patient received the thrombin injection, and HCT
thereafter remained stable.
.
#Hypertension: The patient has known hypertension that is
controlled with outpatient regimen of toprol xl, lisinopril,
HCTZ, and imdur.  Her BP meds were held during the first two
days of the hospital course due to her hypotension and the
concern for an ongoing RP bleed.  After thrombin injection,
metoprolol was slowly reintroduced to her medication regimen.
She was discharged with instructions to follow up as an
outpatient for addition of an ACE-I and nitrate.
.
#Hyperlipidemia:  The patient was continued on her outpatient
doses of atorvastatin and ezetimibe during her hospital course.
.
#Anxiety:  The patient has chronic anxiety which is treated with
xanax.  During the first hospital day, xanax was held given its
potential to lower BP.  On the second hospital day, xanax was
re-added with good effect.  She was pre-treated with ativan
before her thrombin injection given her significant anxiety. She
tolerated this well.
.
#Prophylaxis: The patient was kept on a prophylactic regimen of
a proton pump inhibitor, bowel regimen, and pneumo boots during
her hospital course.

Medications on Admission:
Toprol XL 100mg daily.
Lisinopril 20mg daily.
HCTZ 12.5mg daily.
Xanax 0.25mg [**Hospital1 **].
Prilosec 20mg daily.
Lipitor 40mg daily.
Zetia 10mg daily.
Plavix 75mg daily.
ASA 325mg daily.
Temazepam 30mg qHS.
NTG 0.4mg SL p.r.n.
Imdur 30mg daily.
.

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 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
(1) Coronary Artery Disease s/p stent placement to LCx, RCA, and
LAD
(2) Right Common Femoral Artery tear and pseudoaneurysm s/p
thrombin injection repair


Discharge Condition:
Stable


Discharge Instructions:
(1) Please take your medications as directed.
 - You must take aspirin and plavix every day for at least [**5-15**]
months.
 - Your blood pressure medications were changed: Continue Toprol
XL at 100mg daily. Stop Hydrochlorothiazide and Lisinopril until
you follow up.
.
(2) Please follow up with your outpatient cardiologist, Dr.
[**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 7047**], at your scheduled follow up appointment at the end of
[**Month (only) 958**].

(3) Please follow up with your PCP's office (Dr. [**Last Name (STitle) 105054**] [**Name (STitle) 43880**]) on
Thurs, [**2-5**] at 1pm.  You will see her nurse practitioner.  You
should bring a copy of your discharge summary with you.
Relevant issues at that time will be inspection of your groin
catheter sites and checking a hematocrit.

(3) Please return to the hospital if you have recurrent chest
pain, shortness of breath, swelling in your legs, fainting
episodes, dizziness upon standing, increased belly pain,
confusion, lightheadedness, or fever > 101.5.  Also return if
you have redness or swelling around your groin catheter sites.

Followup Instructions:
(1) Please follow up with your outpatient cardiologist, Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7047**], at your regularly scheduled appointment at the
end of [**Month (only) 958**].

(2) Please follow up with your PCP's office (Dr. [**Last Name (STitle) 105054**] [**Name (STitle) 43880**]) on
Thurs, [**2-5**] at 1pm.  You will see her nurse practitioner.  You
should bring a copy of your discharge summary with you.
Relevant issues at that time will be inspection of your groin
catheter sites and checking a hematocrit.  Please call their
office at [**Telephone/Fax (1) 27929**] if you need to reschedule the
appointment.



Completed by:[**2189-1-31**]
{'Coronary atherosclerosis of native coronary artery,Peripheral vascular complications, not elsewhere classified,Intermediate coronary syndrome,Aneurysm of artery of lower extremity,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction,Personal history of malignant neoplasm of breast,Shigella flexneri'}


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 and SOB

PRESENT ILLNESS: 62 year-old woman with PMH of IMI s/p DES x1 to RCA & [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 1 to
LAD ([**12-11**]) and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 1 to LAD ([**12-12**]) presents for repeat cardiac
catheterization due to persistent chest pain.  After the initial
IMI & stent placement in [**12-11**], pt had been asymptomatic until
[**7-11**] when she began to develop recurrent CP. On [**2188-12-11**], the
patient underwent a successful proximal LAD stenting. Two weeks
later, CP returned, several times at rest, with radiation to her
shoulder blades. The patient also reports sob a/w the chest
discomfort. She denies PND, orthopnea, lightheadedness over the
past month. Pt does report increased BLE edema since having her
HCTZ dose cut in half around [**Holiday **] time.

MEDICAL HISTORY: HTN
High cholesterol
Left breast cancer with mastectomy [**2176**]
Ovarian cyst
Hysterectomy [**2168**]
IMI [**12-11**]
Diverticulitis
GERD
Anxiety

MEDICATION ON ADMISSION: Toprol XL 100mg daily.
Lisinopril 20mg daily.
HCTZ 12.5mg daily.
Xanax 0.25mg [**Hospital1 **].
Prilosec 20mg daily.
Lipitor 40mg daily.
Zetia 10mg daily.
Plavix 75mg daily.
ASA 325mg daily.
Temazepam 30mg qHS.
NTG 0.4mg SL p.r.n.
Imdur 30mg daily.
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: (on admission to CCU s/p cath procedure)
Gen: afebrile, 140/86, 72, 12, 100% on 2L
HEENT: NC/AT, MM Dry.
Neck: No JVD
COR: S1 S2 RRR no mrg
Pulm: CTA anteriorly
Abd: soft, mild TTP suprapubic, mild distension. neg rebound,
neg cullen sign, neg grey-[**Doctor Last Name 4862**] sign. no voluntary or
involuntary guarding.
Ext: WWP L: 2+ DP, 2+ PT; R: 1+ DP, 2+PT. R cath site w systolic
bruit. no thrill. no hematoma.
Neuro: A/O x 3.

FAMILY HISTORY: (-) FHx CAD

SOCIAL HISTORY: She is married and does clerical work. 30 ppd cigs, quit 1 yr
ago. No EtOH, no illicit drugs. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Peripheral vascular complications, not elsewhere classified,Intermediate coronary syndrome,Aneurysm of artery of lower extremity,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction,Personal history of malignant neoplasm of breast,Shigella flexneri'}
