CHIEF COMPLAINT: STEMI

PRESENT ILLNESS: 60M with GERD, HTN, dyslipidemia, strong family history of
coronary disease presenting with chest pain.  Has been well
recently but noticed increased "reflux" sensation (not
correlated with activity) but occassionally with sour taste in
mouth.  This morning he was shoveling snow at 5:30am when he
noticed a burning sensation throughout his chest which initially
felt like reflux but then became worse and spread across his
chest ([**4-3**] at worst).  he went inside and rested but developed
nausea and left arm pain.  he called EMS who brought him to
[**Hospital3 **].  Nitro spray x3 in ambulance brought pain from
[**4-3**] to [**2-1**], morphine also helped slightly.  in the [**Hospital **] HR in 120s, SBP 140s and ECG showed inferior ST
elevations (no changes in precordial leads initially).  He was
given 324mg ASA, started on heparin and tirofiban drips, and
sent to [**Hospital1 18**].  Lopressor seems to have been held per their
records, reason unclear.  Troponin pending at time of transfer.
  Patient continued to have chest pain during transfer and was
taken to the cardiac cath lab wear he was found to have total
RCA occlusion and serial moderate LCx lesions.  Two BMS were
deployed to RCA successfully.  Patient was pain free
post-procedure.  EKG post-procedure notable for st depressions
in anterior leads and development of inferior Qwaves.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, hemoptysis, black stools or red
stools. He denies recent fevers, chills or rigors, but does not
slight URI symptoms over the past few days. He denies exertional
buttock or calf pain. All of the other review of systems were
negative.
.
*** Cardiac review of systems:  able to walk [**12-27**] miles with wife
without limitation but does feel he is slightly "winded" this
year when shovelling snow.  no paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, or palpitations.  Previously had
lightheadedness not clearly related to positional change,
thought to be due to dehydration (of note, wore a cardiac
monitor with no events).

MEDICAL HISTORY: Cardiac Risk Factors: (-)Diabetes, (+)Dyslipidemia - cholesterol
high 3 weeks ago despite simvastatin 80mg, (+) Hypertension
.
Cardiac History: as above, no cardiac history, normal cardiac
event monitor (unclear if holter or [**Doctor Last Name **] of hearts)
.
Percutaneous coronary intervention: none
.
Pacemaker/ICD: none
.
Tendonitis for which he takes motrin

MEDICATION ON ADMISSION: ASA 81mg
HCTZ 12.5mg daily
Simvastatin 80mg daily
Zantac as needed
Motrin 1 tablet (dose unknown) three times daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Afebrile 163/91 101 12 99%2L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without jugular venous distention (JVP visible just
above clavicle at 30 degrees.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. femoral artery not auscultated given sheath still
present.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.  Does
have significant dry skin.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is significant family history of premature coronary artery
disease in mother and especially father's family: father died of
MI at 50, two older brothers developed coronary disease in
40s-50s, one brother has DM.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use (quit in [**2108**]). There is a history of alcohol abuse, but
patient has been abstinent for 17years.
Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia
AMI inferior wall, init,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2144-11-23**]              Discharge Date:   [**2144-11-26**]

Date of Birth:  [**2084-1-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
STEMI

Major Surgical or Invasive Procedure:
cardiac catheterization with two bare metal stents to the right
coronary artery

History of Present Illness:
60M with GERD, HTN, dyslipidemia, strong family history of
coronary disease presenting with chest pain.  Has been well
recently but noticed increased "reflux" sensation (not
correlated with activity) but occassionally with sour taste in
mouth.  This morning he was shoveling snow at 5:30am when he
noticed a burning sensation throughout his chest which initially
felt like reflux but then became worse and spread across his
chest ([**4-3**] at worst).  he went inside and rested but developed
nausea and left arm pain.  he called EMS who brought him to
[**Hospital3 **].  Nitro spray x3 in ambulance brought pain from
[**4-3**] to [**2-1**], morphine also helped slightly.  in the [**Hospital **] HR in 120s, SBP 140s and ECG showed inferior ST
elevations (no changes in precordial leads initially).  He was
given 324mg ASA, started on heparin and tirofiban drips, and
sent to [**Hospital1 18**].  Lopressor seems to have been held per their
records, reason unclear.  Troponin pending at time of transfer.
  Patient continued to have chest pain during transfer and was
taken to the cardiac cath lab wear he was found to have total
RCA occlusion and serial moderate LCx lesions.  Two BMS were
deployed to RCA successfully.  Patient was pain free
post-procedure.  EKG post-procedure notable for st depressions
in anterior leads and development of inferior Qwaves.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, hemoptysis, black stools or red
stools. He denies recent fevers, chills or rigors, but does not
slight URI symptoms over the past few days. He denies exertional
buttock or calf pain. All of the other review of systems were
negative.
.
*** Cardiac review of systems:  able to walk [**12-27**] miles with wife
without limitation but does feel he is slightly "winded" this
year when shovelling snow.  no paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, or palpitations.  Previously had
lightheadedness not clearly related to positional change,
thought to be due to dehydration (of note, wore a cardiac
monitor with no events).

Past Medical History:
Cardiac Risk Factors: (-)Diabetes, (+)Dyslipidemia - cholesterol
high 3 weeks ago despite simvastatin 80mg, (+) Hypertension
.
Cardiac History: as above, no cardiac history, normal cardiac
event monitor (unclear if holter or [**Doctor Last Name **] of hearts)
.
Percutaneous coronary intervention: none
.
Pacemaker/ICD: none
.
Tendonitis for which he takes motrin


Social History:
Social history is significant for the absence of current tobacco
use (quit in [**2108**]). There is a history of alcohol abuse, but
patient has been abstinent for 17years.

Family History:
There is significant family history of premature coronary artery
disease in mother and especially father's family: father died of
MI at 50, two older brothers developed coronary disease in
40s-50s, one brother has DM.


Physical Exam:
VS: Afebrile 163/91 101 12 99%2L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without jugular venous distention (JVP visible just
above clavicle at 30 degrees.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. femoral artery not auscultated given sheath still
present.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.  Does
have significant dry skin.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP
unable to palpate popliteal pulses bilaterally

Pertinent Results:
EKG (2hrs post-cath) demonstrated NSR at 89BPM with resolving
ST-elevations in II,III,aVF and taller Qwaves in II,III,aVF.
Also notable for R greater than S in V1, V2 and resolution of
ST-depressions in V1 and V2 seen in immediately post-cath EKG
.
TELEMETRY demonstrated:labile heart rate, mostly in 110s but
with transient decreases to 70s, SBP initially 150s-160s, then
reducing to 130s-140s
.
2D-ECHOCARDIOGRAM: none
.
nuclear ETT performed ~1.5 years ago reportedly demonstrated:
"normal" nuclear stress test with adequate exercise level
achieved.
.
CARDIAC CATH performed on [**11-24**] demonstrated:
LMCA: no obstructive disease
LAD: no obstructive disease
LCx: serial moderate stenoses
RCA: total proximal occlusion, two bare metal stents placed
sucessfully.

Of note, patient had Wenkebach heart block during procedure.


Brief Hospital Course:
60F with HTN, dyslipidemia, and family history of CAD with
possible recent unstable angina vs. GERD now with acute
ST-elevation MI s/p successful RCA intervention.
.
# CAD/Ischemia: Underwent cardiac catheterization for STEMI and
noted to have total occlusion of proximal RCA with placement of
2 bare metal stents. Per follow up ECHO RV function borderline
normal. Discharged on aspirin, plavix, high dose statin, beta
blocker and lisinopril. Lipid panel and HbA1C normal.
For LCx moderate stenoses: will need outpatient stress test in
~6weeks (likely submaximal).
.
# Pump: ECHO on this admission demonstrated EF 35-40% with
severe inferior hypokinesis. Discharged on ACE-I and beta
blocker for comorbidity of CAD.
.
# Rhythm: Monitored on telemetry with no evidence of AV nodal
blockade.
.
# Valves: ECHO negative for valvular abnormality.
.
# HTN: Betablocker and ACE-inhibitor
.
# dyslipidemia: Normal lipid panel; On high dose statin for
anti-inflammatory effects
.
# DM: Normal hemoglobin A1C.
.
# Code: Full, discussed with patient who would not want to be
resuscitated or intubated if there were no hope for meaningful
recovery.  His wife is HCP and they have discussed this at
length.  We discussed that at this time, arrhythmias that may
develop post-MI would likely be reversible so patient is full
code at this time.


Medications on Admission:
ASA 81mg
HCTZ 12.5mg daily
Simvastatin 80mg daily
Zantac as needed
Motrin 1 tablet (dose unknown) three times 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. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*2*
6. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: ST elevation myocardial infarction
Secondary: hypertension, dyslipidemia, GERD


Discharge Condition:
Good, vital signs stable, chest pain free, ambulating without
difficulty


Discharge Instructions:
You were admitted to the hospital and found to have a heart
attack. You had a stent placed in your coronary artery to
reverse the blockage.
.
You were started on new medications including lisinopril, Toprol
XL, aspirin and plavix. You should continue to take these
medications as prescribed.
.
You should follow up with Dr. [**First Name (STitle) **] [**Name (STitle) 1911**] in
cardiology (as below) and also set up an appointment with a new
primary care doctor in your area.
.
Please contact your doctor or return to the emergency room if
you develop worrisome symptoms such as chest pain, shortness of
breath, palpitations, lightheadedness, etc.

Followup Instructions:
Provider: [**Name10 (NameIs) 1918**] [**Name11 (NameIs) **] Phone:[**Telephone/Fax (1) 16827**]
Date/Time:[**2144-12-1**] 3:40

- CT scan to evaluate mediastinal lymphadenopathy seen on CXR
[**2144-11-25**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: STEMI

PRESENT ILLNESS: 60M with GERD, HTN, dyslipidemia, strong family history of
coronary disease presenting with chest pain.  Has been well
recently but noticed increased "reflux" sensation (not
correlated with activity) but occassionally with sour taste in
mouth.  This morning he was shoveling snow at 5:30am when he
noticed a burning sensation throughout his chest which initially
felt like reflux but then became worse and spread across his
chest ([**4-3**] at worst).  he went inside and rested but developed
nausea and left arm pain.  he called EMS who brought him to
[**Hospital3 **].  Nitro spray x3 in ambulance brought pain from
[**4-3**] to [**2-1**], morphine also helped slightly.  in the [**Hospital **] HR in 120s, SBP 140s and ECG showed inferior ST
elevations (no changes in precordial leads initially).  He was
given 324mg ASA, started on heparin and tirofiban drips, and
sent to [**Hospital1 18**].  Lopressor seems to have been held per their
records, reason unclear.  Troponin pending at time of transfer.
  Patient continued to have chest pain during transfer and was
taken to the cardiac cath lab wear he was found to have total
RCA occlusion and serial moderate LCx lesions.  Two BMS were
deployed to RCA successfully.  Patient was pain free
post-procedure.  EKG post-procedure notable for st depressions
in anterior leads and development of inferior Qwaves.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, hemoptysis, black stools or red
stools. He denies recent fevers, chills or rigors, but does not
slight URI symptoms over the past few days. He denies exertional
buttock or calf pain. All of the other review of systems were
negative.
.
*** Cardiac review of systems:  able to walk [**12-27**] miles with wife
without limitation but does feel he is slightly "winded" this
year when shovelling snow.  no paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, or palpitations.  Previously had
lightheadedness not clearly related to positional change,
thought to be due to dehydration (of note, wore a cardiac
monitor with no events).

MEDICAL HISTORY: Cardiac Risk Factors: (-)Diabetes, (+)Dyslipidemia - cholesterol
high 3 weeks ago despite simvastatin 80mg, (+) Hypertension
.
Cardiac History: as above, no cardiac history, normal cardiac
event monitor (unclear if holter or [**Doctor Last Name **] of hearts)
.
Percutaneous coronary intervention: none
.
Pacemaker/ICD: none
.
Tendonitis for which he takes motrin

MEDICATION ON ADMISSION: ASA 81mg
HCTZ 12.5mg daily
Simvastatin 80mg daily
Zantac as needed
Motrin 1 tablet (dose unknown) three times daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: Afebrile 163/91 101 12 99%2L
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple without jugular venous distention (JVP visible just
above clavicle at 30 degrees.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. femoral artery not auscultated given sheath still
present.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.  Does
have significant dry skin.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is significant family history of premature coronary artery
disease in mother and especially father's family: father died of
MI at 50, two older brothers developed coronary disease in
40s-50s, one brother has DM.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use (quit in [**2108**]). There is a history of alcohol abuse, but
patient has been abstinent for 17years. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
