CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 79 yo male w/ past medical history significant for myasthenia
[**Last Name (un) 2902**] complains of [**9-22**] pressure like substernal chest pain
starting yesterday while lying in bed, lasting 2 hours,
unrelieved by tylenol or aspirin.  Associated with diaphoresis.
No shortness of breath.  Resolved on its own. Pt had recurrence
of pain this morning upon awakening, went to PMD's office and
was noted to have 1-[**Street Address(2) 1766**] elevations in V2-V3, was given
aspirin and sent to the ED.  On arrival at ED, he had [**8-22**] chest
pain with 0.[**Street Address(2) 1755**] elevation in V2, 1 mm elevation in V3, 0.5
mmm elevation in V4 with TWI in V1-V4.  He was taken to the cath
lab and found to have a 90% LAD occlusion that was stented, and
a non intervenable diffusely diseased RCA.  He was also noted to
have normal right sided heart pressures with an oxygen step up
in the right atrium.

MEDICAL HISTORY: myasthenia [**Last Name (un) 2902**] dx [**2138**]
post herpetic neuralgia left leg
prostate cancer s/p xrt [**2136**] and resection (TURP) [**2133**]
h/o thrombocytopenia, resolved
no history of cad, diabetes, hypercholesterolemia, or
hypertension

MEDICATION ON ADMISSION: aspirin 81mg, multivitamin, cellcept 1 [**Hospital1 **], mestinon
60tid->30tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp afebrile BP 163/82 Pulse 54 Resp 12 O2 sat 99%RA
Gen - Alert, no acute distress
HEENT - NCAT, PERRL, extraocular motions intact, anicteric,
mucous membranes moist, hard of hearing L ear.
Neck - 2+ carotid pulses b/l. No JVD, no cervical
lymphadenopathy, no bruits
Chest - Clear to auscultation bilaterally anteriorly and
laterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - 8French fremoral sheath on right, 2+ Left femoral pulse.
No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally, 1+ PT
pulses bilaterall.  No bruits.
Neuro - Alert and oriented x 3, cranial nerves [**3-26**] intact,
upper and lower extremity strength 5/5 bilaterally, sensation
grossly intact
Skin - No rash

FAMILY HISTORY: mother: DM

SOCIAL HISTORY: former chemical engineer, married with four children, no
smoking, occ alcohol.
Subendocardial infarction, initial episode of care,Atrial fibrillation,Myasthenia gravis without (acute) exacerbation,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Other and unspecified hyperlipidemia
Subendo infarct, initial,Atrial fibrillation,Mysthna grvs w/o ac exac,Crnry athrscl natve vssl,Hx-prostatic malignancy,Hyperlipidemia NEC/NOS
Admission Date:  [**2144-9-4**]              Discharge Date:   [**2144-9-7**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2901**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Cardiac Catherization


History of Present Illness:
79 yo male w/ past medical history significant for myasthenia
[**Last Name (un) 2902**] complains of [**9-22**] pressure like substernal chest pain
starting yesterday while lying in bed, lasting 2 hours,
unrelieved by tylenol or aspirin.  Associated with diaphoresis.
No shortness of breath.  Resolved on its own. Pt had recurrence
of pain this morning upon awakening, went to PMD's office and
was noted to have 1-[**Street Address(2) 1766**] elevations in V2-V3, was given
aspirin and sent to the ED.  On arrival at ED, he had [**8-22**] chest
pain with 0.[**Street Address(2) 1755**] elevation in V2, 1 mm elevation in V3, 0.5
mmm elevation in V4 with TWI in V1-V4.  He was taken to the cath
lab and found to have a 90% LAD occlusion that was stented, and
a non intervenable diffusely diseased RCA.  He was also noted to
have normal right sided heart pressures with an oxygen step up
in the right atrium.

He denied doe, pnd, orthopnea, dyspnea, edema, palpitations,
syncope, or presyncope.

Past Medical History:
myasthenia [**Last Name (un) 2902**] dx [**2138**]
post herpetic neuralgia left leg
prostate cancer s/p xrt [**2136**] and resection (TURP) [**2133**]
h/o thrombocytopenia, resolved
no history of cad, diabetes, hypercholesterolemia, or
hypertension

Social History:
former chemical engineer, married with four children, no
smoking, occ alcohol.

Family History:
mother: DM

Physical Exam:
Temp afebrile BP 163/82 Pulse 54 Resp 12 O2 sat 99%RA
Gen - Alert, no acute distress
HEENT - NCAT, PERRL, extraocular motions intact, anicteric,
mucous membranes moist, hard of hearing L ear.
Neck - 2+ carotid pulses b/l. No JVD, no cervical
lymphadenopathy, no bruits
Chest - Clear to auscultation bilaterally anteriorly and
laterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - 8French fremoral sheath on right, 2+ Left femoral pulse.
No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally, 1+ PT
pulses bilaterall.  No bruits.
Neuro - Alert and oriented x 3, cranial nerves [**3-26**] intact,
upper and lower extremity strength 5/5 bilaterally, sensation
grossly intact
Skin - No rash

Pertinent Results:
cariac enzymes:
[**2144-9-4**] 02:00PM   CK(CPK)-50
[**2144-9-4**] 02:00PM   CK-MB-NotDone
[**2144-9-4**] 02:00PM   cTropnT-0.03*
[**2144-9-4**] 07:44PM   CK-MB-NotDone cTropnT-0.21*
[**2144-9-4**] 07:44PM   CK(CPK)-71
.
[**2144-9-4**] 02:00PM   WBC-5.9 RBC-4.18* HGB-12.5* HCT-36.5* MCV-87
MCH-29.9 MCHC-34.3 RDW-14.2
[**2144-9-4**] 02:00PM   PLT COUNT-216
[**2144-9-4**] 02:00PM   NEUTS-73.0* LYMPHS-20.5 MONOS-4.9 EOS-1.2
BASOS-0.4
[**2144-9-4**] 02:00PM   GLUCOSE-91 UREA N-11 CREAT-0.8 SODIUM-141
POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-26 ANION GAP-14
.
cardiac cath [**2144-9-4**]:
**PRESSURES
RIGHT ATRIUM {a/v/m} 6/5/5
RIGHT VENTRICLE {s/ed} 24/6
PULMONARY ARTERY {s/d/m} 24/10/15
PULMONARY WEDGE {a/v/m} 13/12/9
AORTA {s/d/m} 104/55/73
**CARDIAC OUTPUT
HEART RATE {beats/min} 50
RHYTHM SINUS
O2 CONS. IND {ml/min/m2} 125
A-V O2 DIFFERENCE {ml/ltr} 54
CARD. OP/IND FICK {l/mn/m2} 4.3/2.3
**RESISTANCES
SYSTEMIC VASC. RESISTANCE 1265
PULMONARY VASC. RESISTANCE 112
  FICK
**% SATURATION DATA (FL)
SVC LOW 56
RA HIGH 57
RA MID 66
RA LOW 76
IVC HIGH 78
RV INFLOW 67
RV MID 65
RV APEX 67
PA MAIN 66
PA LEFT 67
AO 100
**ARTERIAL BLOOD GAS
pO2 124
pCO2 39
pH 7.42

**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**RIGHT CORONARY
1) PROXIMAL RCA   DIFFUSELY DISEASED
2) MID RCA   NORMAL
2A) ACUTE MARGINAL   NORMAL
3) DISTAL RCA   DISCRETE 80
4) R-PDA   DIFFUSELY DISEASED
4A) R-POST-LAT   DIFFUSELY DISEASED

**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**LEFT CORONARY
5) LEFT MAIN   NORMAL
6) PROXIMAL LAD   DISCRETE 90
6A) SEPTAL-1   NORMAL
7) MID-LAD   NORMAL
8) DISTAL LAD   NORMAL
9) DIAGONAL-1   DIFFUSELY DISEASED
10) DIAGONAL-2   NORMAL
12) PROXIMAL CX   NORMAL
13) MID CX   NORMAL
13A) DISTAL CX   NORMAL
14) OBTUSE MARGINAL-1   NORMAL
15) OBTUSE MARGINAL-2   NORMAL
16) OBTUSE MARGINAL-3   NORMAL

PTCA COMMENTS:     Initial angiography revealed a 90% proximal
LAD
stenosis with TIMI II flow distally. We decided to treat this
lesion
with direct stenting. Integrillin was given prophylactically. A
8 French
XBLAD 3.5 guide provided excellent support. The lesion was
crossed with
a BMW wire without difficulty. A 2.75x23 mm Cypher DES was
deployed at
14 atms. The stent was postdilated with a 3.0x18 mm NC ranger
baloon
inflated at 14 atms twice. Subsequent angiography revealed
compromise of
the ostium of a moderate size diagonal and we decided to rescue
it with
baloon PTCA. An ACE 2.0 baloon was advanced into the diagonal
and was
inflated to 10 atms and then to 14 atms. Final angiography
revealed no
residual stenosis in the stented LAD, no dissection and TIMI III
flow.
The origin of the diagonal had a 30% resdiual stenosis. The
patient left
the lab pain free and in stable condition

ECHO [**2144-9-7**]:
No atrial septal defect or patent foramen ovale is seen by 2D,
color Doppler
or saline contrast with maneuvers. Left ventricular wall
thicknesses are
normal. The left ventricular cavity size is normal. Overall left
ventricular
systolic function is mildly depressed (ejection fraction 40-50
percent). Right
ventricular chamber size and free wall motion are normal. The
aortic valve
leaflets (3) are mildly thickened but not stenotic. Mild (1+)
aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There
is no mitral valve prolapse. Mild (1+) mitral regurgitation is
seen. There is
no pericardial effusion.


Brief Hospital Course:
Hospital course by problem:
CAD:
This patient's cardiac catheterization was complicated by a
jailed diagonal artery.  He was chest pain free throughout his
postcath course, however.  His medical regimen for secondary
prevention of acute coronary syndrome was maximized.

AF:
He did have an episode of tachycardia that was felt to be likely
atrial fibrillation, and he was started on anticoagulation with
coumadin.

Oxygen step up:  He had a follow up echo which showed no ASD.

Hematuria and Urinary retention:
He had an episode of hematuria associated with foley placement
which cleared with irrigation.  He also had an episode of
urinary retention for which he was seen by urology.  He was sent
home with a leg bag for foley drainage and was scheduled for a
voiding trial as an outpatient.

Myasthenia [**Last Name (un) **]:
He was maintained on his home myasthenia regimen.

Medications on Admission:
aspirin 81mg, multivitamin, cellcept 1 [**Hospital1 **], mestinon
60tid->30tid

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day). Tablet,
Delayed Release (E.C.)(s)
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day): Do NOT stop this medication unless instructed by a
cardiologist.
Disp:*30 Tablet(s)* Refills:*6*
3. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
4. Pyridostigmine Bromide 60 mg Tablet Sig: 0.5 Tablet PO Q8H
(every 8 hours).
5. Multivitamin     Capsule Sig: One (1) Cap PO QD (once a day).

6. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
7. Coumadin 2 mg Tablet Sig: 1-2 Tablets PO at bedtime: take 2
tablets (4mg) on [**2144-9-7**] and [**2144-9-8**].  Then call Dr. [**Last Name (STitle) 2903**] for
further instructions.
Disp:*60 Tablet(s)* Refills:*2*
8. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO QD (once a day).
Disp:*15 Tablet(s)* Refills:*2*
9. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
10. Trazodone HCl 50 mg Tablet Sig: 0.5 Tablet PO at bedtime as
needed for insomnia.
Disp:*30 Tablet(s)* Refills:*0*
11. Outpatient Lab Work
Please check INR on [**2144-9-8**] and call Dr. [**Last Name (STitle) 2903**] at ([**Telephone/Fax (1) 2904**]
with the results.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1. Anterior Wall STEMI
2. Oxygenation "set-up" from left atrium to Pulmonary Artery on
catherization. No ASD on echo.
3. New onset Atrial Fibrillation
4. Hematuria
5. Urinary retention, resolved
6. history of prostate Cancer
7. [**First Name9 (NamePattern2) 2905**] [**Last Name (un) **]

Discharge Condition:
stable and improved

Discharge Instructions:
1. Take all medications as outlined below.  Do NOT stop taking
plavix unless instructed to by a cardiologist.
2. Follow up with Urology as instructed below.
3. Do Not take any medication containing Diphenhydramine
(Benadryl) as it may make your urinary retention worse. You can
try to use Trazadone for insomnia.
4. Call your Doctor or return to ED should you develop chest
pain, difficulty breathing, palpitations, or other concerning
symptoms.
5. You have been started on a blood thinner called coumadin.
You will need to have frequent blood draws to monitor the level.
Dr. [**Last Name (STitle) 2903**] will instruct you on changing the dose of coumadin with
each blood draw.

Followup Instructions:
1. You have an appointment scheduled with Dr. [**First Name8 (NamePattern2) 1158**] [**Last Name (NamePattern1) 770**] in
urology for Wednesday, [**2144-9-30**] at 3:00 pm.  Please call
[**Telephone/Fax (1) 2906**] if you need to reschedule.
2. Provider: [**First Name11 (Name Pattern1) 1037**] [**Last Name (NamePattern4) 1038**], M.D. Where: [**Hospital6 29**]
NEUROLOGY Phone:[**Telephone/Fax (1) 558**] Date/Time:[**2144-12-17**] 12:00
3. Please call Dr. [**Last Name (STitle) 911**] in cardiology at ([**Telephone/Fax (1) 2907**] by the
end of this week to schedule a follow up appointment.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2908**] MD, [**MD Number(3) 2909**]
{'Subendocardial infarction, initial episode of care,Atrial fibrillation,Myasthenia gravis without (acute) exacerbation,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,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: chest pain

PRESENT ILLNESS: 79 yo male w/ past medical history significant for myasthenia
[**Last Name (un) 2902**] complains of [**9-22**] pressure like substernal chest pain
starting yesterday while lying in bed, lasting 2 hours,
unrelieved by tylenol or aspirin.  Associated with diaphoresis.
No shortness of breath.  Resolved on its own. Pt had recurrence
of pain this morning upon awakening, went to PMD's office and
was noted to have 1-[**Street Address(2) 1766**] elevations in V2-V3, was given
aspirin and sent to the ED.  On arrival at ED, he had [**8-22**] chest
pain with 0.[**Street Address(2) 1755**] elevation in V2, 1 mm elevation in V3, 0.5
mmm elevation in V4 with TWI in V1-V4.  He was taken to the cath
lab and found to have a 90% LAD occlusion that was stented, and
a non intervenable diffusely diseased RCA.  He was also noted to
have normal right sided heart pressures with an oxygen step up
in the right atrium.

MEDICAL HISTORY: myasthenia [**Last Name (un) 2902**] dx [**2138**]
post herpetic neuralgia left leg
prostate cancer s/p xrt [**2136**] and resection (TURP) [**2133**]
h/o thrombocytopenia, resolved
no history of cad, diabetes, hypercholesterolemia, or
hypertension

MEDICATION ON ADMISSION: aspirin 81mg, multivitamin, cellcept 1 [**Hospital1 **], mestinon
60tid->30tid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp afebrile BP 163/82 Pulse 54 Resp 12 O2 sat 99%RA
Gen - Alert, no acute distress
HEENT - NCAT, PERRL, extraocular motions intact, anicteric,
mucous membranes moist, hard of hearing L ear.
Neck - 2+ carotid pulses b/l. No JVD, no cervical
lymphadenopathy, no bruits
Chest - Clear to auscultation bilaterally anteriorly and
laterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - 8French fremoral sheath on right, 2+ Left femoral pulse.
No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally, 1+ PT
pulses bilaterall.  No bruits.
Neuro - Alert and oriented x 3, cranial nerves [**3-26**] intact,
upper and lower extremity strength 5/5 bilaterally, sensation
grossly intact
Skin - No rash

FAMILY HISTORY: mother: DM

SOCIAL HISTORY: former chemical engineer, married with four children, no
smoking, occ alcohol. 

### Response:
{'Subendocardial infarction, initial episode of care,Atrial fibrillation,Myasthenia gravis without (acute) exacerbation,Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Other and unspecified hyperlipidemia'}
