CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 59 year old
woman with a history of hypertension and coronary artery
disease, status post myocardial infarction in 08/97, with a
stent to the right coronary artery four years ago, who
presented to [**Hospital3 27946**] Emergency Department with
chest pain.  The patient reported that her pain lasted 45
minutes and was pressure radiating into both arms.  She
denied nausea, vomiting, diaphoresis or shortness of breath.
On electrocardiogram, the patient had inferior ST elevation.
She was treated with thrombolytics (PNK), Heparin, Morphine,
Nitroglycerin and Plavix.  The patient was then med-flighted
to [**Hospital1 69**] for emergent cardiac
catheterization due to persistent chest pain and ST
elevation.  In the catheterization laboratory, the patient
went into ventricular fibrillation arrest.  She was shocked
five times while awake.  A temporary pacer was placed.  An
intra-aortic balloon pump was placed as well.  On
catheterization, the patient was found to have an elevated
right ventricular end diastolic pressure of 16 consistent
with right ventricular infarction.  In addition, total
occlusion of the proximal right coronary artery was seen with
a visible stent distal to the occlusion.  A second stent was
then placed in the new occlusion in the proximal right
coronary artery.  The patient also had a 50% midvessel left
anterior descending stenosis and a mild lesion in one of the
diagonal branches.

MEDICAL HISTORY: 1.  Hypertension.
2.  Coronary artery disease, status post myocardial
infarction in [**2139-9-4**], status post angioplasty in [**2140**].

MEDICATION ON ADMISSION: 1.  Zantac.
2.  Cozaar.
3.  Nitroglycerin Spray.

ALLERGIES: Aspirin causes anaphylaxis.  The patient is also
allergic to Dilaudid and Keflex.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has a history of smoking one
pack per day of tobacco and has moderate ethanol use reported
to be one glass of wine per night.  She lives with herself
and her granddaughter who she is raising.
Acute myocardial infarction of inferoposterior wall, initial episode of care,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Old myocardial infarction
AMI inferopost, initial,Surg compl-heart,Parox ventric tachycard,Crnry athrscl natve vssl,Hypertension NOS,Tobacco use disorder,Old myocardial infarct
Admission Date:  [**2144-11-18**]       Discharge Date:

Date of Birth:                    Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 59 year old
woman with a history of hypertension and coronary artery
disease, status post myocardial infarction in 08/97, with a
stent to the right coronary artery four years ago, who
presented to [**Hospital3 27946**] Emergency Department with
chest pain.  The patient reported that her pain lasted 45
minutes and was pressure radiating into both arms.  She
denied nausea, vomiting, diaphoresis or shortness of breath.
On electrocardiogram, the patient had inferior ST elevation.
She was treated with thrombolytics (PNK), Heparin, Morphine,
Nitroglycerin and Plavix.  The patient was then med-flighted
to [**Hospital1 69**] for emergent cardiac
catheterization due to persistent chest pain and ST
elevation.  In the catheterization laboratory, the patient
went into ventricular fibrillation arrest.  She was shocked
five times while awake.  A temporary pacer was placed.  An
intra-aortic balloon pump was placed as well.  On
catheterization, the patient was found to have an elevated
right ventricular end diastolic pressure of 16 consistent
with right ventricular infarction.  In addition, total
occlusion of the proximal right coronary artery was seen with
a visible stent distal to the occlusion.  A second stent was
then placed in the new occlusion in the proximal right
coronary artery.  The patient also had a 50% midvessel left
anterior descending stenosis and a mild lesion in one of the
diagonal branches.

MEDICATIONS ON ADMISSION:
1.  Zantac.
2.  Cozaar.
3.  Nitroglycerin Spray.

ALLERGIES:  Aspirin causes anaphylaxis.  The patient is also
allergic to Dilaudid and Keflex.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Coronary artery disease, status post myocardial
infarction in [**2139-9-4**], status post angioplasty in [**2140**].

SOCIAL HISTORY:  The patient has a history of smoking one
pack per day of tobacco and has moderate ethanol use reported
to be one glass of wine per night.  She lives with herself
and her granddaughter who she is raising.

PHYSICAL EXAMINATION:  On admission, heart rate 127, blood
pressure 135/89.  On examination, head, eyes, ears, nose and
throat revealed no jugular venous distention.  Cardiovascular
- regular rhythm, 2+ systolic murmur.  The lungs are clear to
auscultation.

LABORATORY DATA:  Significant laboratories include a CK of
377 up to 800 with a troponin of 12.7.

Electrocardiogram on admission revealed normal sinus rhythm
at 100 beats per minute, ST elevation greater than 4.0
millimeters in lead II, greater than 8.0 millimeters in lead
III and greater than 6.0 millimeters in aVF.  There is
reciprocal changes in lateral leads and ST depressions in V2.

HOSPITAL COURSE:  The patient was maintained on 18 hours of
Integrilin postcatheterization. She was treated with Plavix
but no Aspirin due to her allergic reaction.   She was
quickly weaned off pressors after returning to the CCU from
the catheterization laboratory.  Intra-aortic balloon pump
was pulled without difficulty.  The patient had occasional
evidence of nonsustained ventricular tachycardia, decreasing
with each hospital day.  An echocardiogram was done which
showed an ejection fraction of 40 to 45% with focal basal
right ventricular free wall hypokinesis, trivial mitral
regurgitation and focal hypokinesis of the basal half of the
inferior and inferolateral walls of the left ventricle.  The
patient spiked a fever of 102 although her white blood cell
count did not go up. She was pancultured and started on
Vancomycin and Levofloxacin for presumed pneumonia consistent
with a borderline chest x-ray.  Gram stain showed 4+ gram
positive cocci and 2+ gram negative rods.  Cultures are not
available at the time of this dictation.  The patient was
weaned off the ventilator with ease.  She, however, remained
agitated and somewhat sedated postextubation.  She was
treated with Haldol and Ativan and improved with each
hospital day.  On hospital day two, her CK peaked at 1900.
The patient was found to have liver function tests within
normal limits except for borderline elevated AST 78, ALT 52.
Lipid panel is as follows:  total cholesterol 246, LDL 145,
HDL 59, triglycerides 211.  Therefore, she was started on a
statin.  Once the patient was tolerating p.o, she was
restarted on her Metoprolol and ace inhibitor.

The remainder of the hospital course will be dictated under
separate cover.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D.  [**MD Number(1) 1014**]

Dictated By:[**Last Name (NamePattern1) 42053**]
MEDQUIST36

D:  [**2144-11-21**]  12:55
T:  [**2144-11-21**]  13:37
JOB#:  [**Job Number 42054**]


Admission Date:  [**2144-11-17**]     Discharge Date:  [**2144-11-23**]

Date of Birth:   [**2084-12-7**]     Sex:  F

Service:  CCU

HISTORY OF PRESENT ILLNESS:  This 59-year-old female with
history of coronary artery disease, status post myocardial
infarction with stent to right coronary artery four years ago
presenting with chest pain to [**Hospital3 3834**] [**Hospital3 **].
Patient reports that her pain lasted about 45 minutes and was
a pressure radiating to both arms.  No nausea or vomiting. No
diaphoresis.  No shortness of breath.  Patient had ST
elevations inferiorly.  Patient was treated with TNK,
heparin, morphine, nitroglycerin and Plavix.  Patient was
then medflighted to [**Hospital6 256**] for
emergent catheterization due to persistent chest pain and ST
elevation.

In catheterization laboratory patient went into ventricular
fibrillation arrest.  She was shocked five times and awakened
thrashing.  A temporary placer wire was placed.  An aortic
balloon pump was placed.  Cardiac catheterization findings
were 50% mid left anterior descending stenosis, proximal
right coronary artery occlusion, increased right ventricular
end-diastolic pressure.  Electrocardiogram showed normal
sinus rhythm at 100 beats per minute, ST elevation in II,
greater than 4 mm, III greater than 8 mm and aVF greater than
6 mm with reciprocal changes in the lateral leads and ST
depression in V2.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Coronary artery disease, status post myocardial
infarction in [**2139-9-4**] times one, status post
angioplasty.

ALLERGIES:  Aspirin leads to anaphylaxis.  Dilaudid and
Keflex lead to unknown reactions.

MEDICATIONS:  Zantac, Cozaar and nitroglycerin spray.

SOCIAL HISTORY:  One pack per day tobacco user.  Moderate
alcohol use.  Lives with spouse and children.

PHYSICAL EXAMINATION:  Vital signs:  Heart rate 127.  Blood
pressure 135/89.  Saturation 100% on ventilator.  Physical
examination:  General:  Patient intubated and sedated.  Head,
eyes, ears, nose and throat:  No jugular venous distention.
Of note, patient was lying flat however.  Cardiovascular:
Regular rate and rhythm, 2+ systolic murmur.  Pulmonary:
Clear to sides and anteriorly.  Abdomen:  Positive bowel
sounds, soft. Extremities:  Palpable dorsalis pedis pulses,
cool.  Neurological:  Patient is sedated.

INITIAL LABORATORIES:  Arterial blood gases:  pH of 7.27, 43,
288 at 12 a.m. on the day of admission.  Sodium 129,
potassium 3.5, chloride 97, glucose 201, hemoglobin 13.1,
hematocrit 39, lactate was 2.0.

INITIAL ASSESSMENT:  This is a 59-year-old female with
history of myocardial infarction and right coronary artery
stent now with acute inferior posterior myocardial
infarction.

HOSPITAL COURSE:

1.  Cardiovascular:  Patient with history of right coronary
artery occlusion with stent, now 50% mid left anterior
descending lesion with proximal right coronary artery
occlusion.  Cardiac catheterization at this hospital showed
focal basal right ventricular wall hypokinesis and an
ejection fraction of 40-45%.  Patient had rescue PCI of the
right coronary artery.  Plavix was initially given for
management since patient had a history of anaphylactic
reaction to aspirin.  Intraaortic balloon pump was given for
increasing coronary perfusion and was weaned after dopamine
therapy.  Patient was placed initially on a heparin drip and
was later discontinued from that.  Patient also had
beta-blocker and ACE inhibitor started.

The patient initially had a run of non-sustained ventricular
tachycardia on telemetry and was started on lidocaine
infusion.  This was soon discontinued as ventricular ectopy
in the context of reperfusion was not concerning.  Patient
was put on regimen of increased fluids to maintain cardiac
perfusion.  Patient had a repeat echocardiogram which showed
ejection fraction of 40% with focal hypokinesis of the right
ventricular free wall inferior lateral left ventricular, as
well as trivial myocardial infarction.  Patient had
intraaortic balloon pump pulled with no complications and
gradually had beta-blocker titrated up and had no further
telemetry events throughout the rest of her hospital course.

2.  Pulmonary:  Patient was initially kept on a ventilator.
Patient spiked fevers.  Sputum was sent off for Gram stain,
which was positive for gram positive cocci in clusters and
gram negative rods.  Patient was initially started on
vancomycin and levofloxacin and never developed a significant
white blood cell count elevation.  Patient was extubated and
had no complications.

3.  Infectious Disease:  Patient spiked several fevers while
on the ventilator.  She was started on vancomycin and
levofloxacin.  Vancomycin was discontinued after day two, but
levofloxacin was continued.  Patient to have a full ten day
course of levofloxacin for presumed pneumonia.

Overall, after initial intraaortic balloon pump placement and
a ventilator management, patient was able to be weaned
without complications and aside from a course complicated by
a fever spike and initiation of antibiotic therapy.  Patient,
overall, did well and was able to saturate well on room air
and had no further telemetry events towards the end of the
hospital course.

DISCHARGE DIAGNOSES:
1.  Inferior posterior myocardial infarction.
2.  Coronary artery disease.
3.  Status post stent placement in right coronary artery.

DISCHARGE MEDICATIONS:
1.  Lisinopril 20 mg po q.d.
2.  Levofloxacin 500 mg po q.d. times five days.
3.  Metoprolol 75 mg po b.i.d.
4.  Simvastatin 40 mg po q.d.
5.  Protonix 40 mg po q.d.
6.  Plavix 75 mg po q.d. This medication should be continued
for life as patient is allergic to aspirin.

DISCHARGE CONDITION:  Good.

DISCHARGE STATUS:  To home.

FOLLOW-UP:  Patient to call Dr. [**Last Name (STitle) **], her primary
cardiologist for follow-up appointment, as well as to have
rehabilitation arranged through Dr.[**Name (NI) 31668**] office.









                          [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 2057**]

Dictated By:[**First Name3 (LF) 22495**]

MEDQUIST36

D:  [**2144-11-23**]  13:09
T:  [**2144-11-26**]  10:15
JOB#:  [**Job Number 42055**]
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Old myocardial infarction'}


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: 

PRESENT ILLNESS: The patient is a 59 year old
woman with a history of hypertension and coronary artery
disease, status post myocardial infarction in 08/97, with a
stent to the right coronary artery four years ago, who
presented to [**Hospital3 27946**] Emergency Department with
chest pain.  The patient reported that her pain lasted 45
minutes and was pressure radiating into both arms.  She
denied nausea, vomiting, diaphoresis or shortness of breath.
On electrocardiogram, the patient had inferior ST elevation.
She was treated with thrombolytics (PNK), Heparin, Morphine,
Nitroglycerin and Plavix.  The patient was then med-flighted
to [**Hospital1 69**] for emergent cardiac
catheterization due to persistent chest pain and ST
elevation.  In the catheterization laboratory, the patient
went into ventricular fibrillation arrest.  She was shocked
five times while awake.  A temporary pacer was placed.  An
intra-aortic balloon pump was placed as well.  On
catheterization, the patient was found to have an elevated
right ventricular end diastolic pressure of 16 consistent
with right ventricular infarction.  In addition, total
occlusion of the proximal right coronary artery was seen with
a visible stent distal to the occlusion.  A second stent was
then placed in the new occlusion in the proximal right
coronary artery.  The patient also had a 50% midvessel left
anterior descending stenosis and a mild lesion in one of the
diagonal branches.

MEDICAL HISTORY: 1.  Hypertension.
2.  Coronary artery disease, status post myocardial
infarction in [**2139-9-4**], status post angioplasty in [**2140**].

MEDICATION ON ADMISSION: 1.  Zantac.
2.  Cozaar.
3.  Nitroglycerin Spray.

ALLERGIES: Aspirin causes anaphylaxis.  The patient is also
allergic to Dilaudid and Keflex.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has a history of smoking one
pack per day of tobacco and has moderate ethanol use reported
to be one glass of wine per night.  She lives with herself
and her granddaughter who she is raising. 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Cardiac complications, not elsewhere classified,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Old myocardial infarction'}
