CHIEF COMPLAINT: STEMI, V fib arrest

PRESENT ILLNESS: 77 yo [**Hospital1 100**]-speaking man with PMH significant for
hypercholesterolemia, ? CAD (no MI).  Per daughter, patient
awoke "not right," had syncopal episdoe while lying in bed.  Dtr
called EMS.  When EMS arrived, patient was cool, clammy, and
diaphoretic.  Initial BP 80/40.  Upon arrival to ED, he
complained of hand pain.  EKG showed huge STE inferiorly.
Patient given 4 baby aspirin, heparin gtt, plavix bolus.
Patient noted to suddenly be in VF.  AED applied.  Patient
shocked x2 with return of normal sinus rhythm.  He was intubated
for airway protection and brought to cath lab.  Cath showed
severe 3VD and his RCA was stented.  He was transferred to the
CCU.

MEDICAL HISTORY: - Hypercholesterolemia
- Posterior decompression for cervical stenosis [**2119**]
- L retrobulbar bony growth
- episode of chest pain 7 years ago -- likely negative stress
test

MEDICATION ON ADMISSION: Aspirin

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: T 96.6, BP 127/38, HR 72, RR 18, SaO2 100% on PS 5/5 40% FIO2,
then 95% on shovel mask
GEN - NAD, A&Ox3 (post-extubation)
HEENT - L eye proptosis, R eye EOMI, pupil round, reactive
NECK - no JVD
HEART - nl s1s2, RRR, no mrg
LUNGS - CTAB anterolaterally
ABD - soft, NT, ND, NABS
EXT - no edema, 2+ DP pulses

FAMILY HISTORY: Unknown

SOCIAL HISTORY: lives in [**Country **] with wife. Here visiting daughter and
son-in-law. Does not smoke, drink alcohol, or use illicit drugs.
Does not exercise [**1-9**] chronic back pain.
Acute myocardial infarction of other inferior wall, initial episode of care,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Anemia, unspecified,Constipation, unspecified
AMI inferior wall, init,Ventricular fibrillation,Crnry athrscl natve vssl,Pure hypercholesterolem,Anemia NOS,Constipation NOS
Admission Date:  [**2126-5-20**]              Discharge Date:   [**2126-5-23**]

Date of Birth:  [**2049-3-11**]             Sex:   M

Service: MEDICINE

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 2698**]
Chief Complaint:
STEMI, V fib arrest


Major Surgical or Invasive Procedure:
Cardiac catheterization [**2126-5-20**] s/p stent to RCA


History of Present Illness:
77 yo [**Hospital1 100**]-speaking man with PMH significant for
hypercholesterolemia, ? CAD (no MI).  Per daughter, patient
awoke "not right," had syncopal episdoe while lying in bed.  Dtr
called EMS.  When EMS arrived, patient was cool, clammy, and
diaphoretic.  Initial BP 80/40.  Upon arrival to ED, he
complained of hand pain.  EKG showed huge STE inferiorly.
Patient given 4 baby aspirin, heparin gtt, plavix bolus.
Patient noted to suddenly be in VF.  AED applied.  Patient
shocked x2 with return of normal sinus rhythm.  He was intubated
for airway protection and brought to cath lab.  Cath showed
severe 3VD and his RCA was stented.  He was transferred to the
CCU.


Past Medical History:
- Hypercholesterolemia
- Posterior decompression for cervical stenosis [**2119**]
- L retrobulbar bony growth
- episode of chest pain 7 years ago -- likely negative stress
test


Social History:
lives in [**Country **] with wife. Here visiting daughter and
son-in-law. Does not smoke, drink alcohol, or use illicit drugs.
Does not exercise [**1-9**] chronic back pain.


Family History:
Unknown

Physical Exam:
T 96.6, BP 127/38, HR 72, RR 18, SaO2 100% on PS 5/5 40% FIO2,
then 95% on shovel mask
GEN - NAD, A&Ox3 (post-extubation)
HEENT - L eye proptosis, R eye EOMI, pupil round, reactive
NECK - no JVD
HEART - nl s1s2, RRR, no mrg
LUNGS - CTAB anterolaterally
ABD - soft, NT, ND, NABS
EXT - no edema, 2+ DP pulses


Pertinent Results:
[**2126-5-23**] 06:56AM BLOOD WBC-8.1 RBC-3.33* Hgb-11.0* Hct-30.3*
MCV-91 MCH-33.0* MCHC-36.3* RDW-12.8 Plt Ct-186
[**2126-5-22**] 01:07AM BLOOD WBC-8.2 RBC-3.63* Hgb-11.5* Hct-33.4*
MCV-92 MCH-31.7 MCHC-34.4 RDW-13.4 Plt Ct-174
[**2126-5-20**] 09:15AM BLOOD Neuts-34.3* Bands-0 Lymphs-58.4*
Monos-5.6 Eos-1.1 Baso-0.6
[**2126-5-23**] 06:56AM BLOOD Plt Ct-186
[**2126-5-23**] 06:56AM BLOOD PT-13.2 PTT-41.5* INR(PT)-1.2
[**2126-5-20**] 09:15AM BLOOD PT-11.5 PTT-23.0 INR(PT)-0.9
[**2126-5-20**] 09:15AM BLOOD Plt Smr-NORMAL Plt Ct-232
[**2126-5-22**] 04:40PM BLOOD Fibrino-586*
[**2126-5-23**] 06:56AM BLOOD Glucose-86 UreaN-8 Creat-0.9 Na-141 K-3.8
Cl-107 HCO3-27 AnGap-11
[**2126-5-20**] 09:15AM BLOOD Glucose-105 UreaN-20 Creat-1.0 Na-140
K-4.1 Cl-105 HCO3-29 AnGap-10
[**2126-5-22**] 01:07AM BLOOD ALT-28 AST-61* CK(CPK)-645* AlkPhos-39
TotBili-0.5
[**2126-5-21**] 04:03AM BLOOD ALT-32 AST-94* LD(LDH)-346* CK(CPK)-1079*
AlkPhos-38* Amylase-49 TotBili-0.7
[**2126-5-20**] 05:08PM BLOOD CK(CPK)-694*
[**2126-5-20**] 09:15AM BLOOD CK(CPK)-66
[**2126-5-21**] 04:03AM BLOOD Lipase-22
[**2126-5-21**] 04:03AM BLOOD CK-MB-30* MB Indx-2.8
[**2126-5-20**] 05:08PM BLOOD CK-MB-78* MB Indx-11.2* cTropnT-1.88*
[**2126-5-20**] 09:15AM BLOOD cTropnT-0.02*
[**2126-5-23**] 06:56AM BLOOD Calcium-8.5 Phos-2.5* Mg-1.9 Iron-PND
[**2126-5-20**] 09:15AM BLOOD Cholest-227*
[**2126-5-22**] 01:07AM BLOOD Hapto-145
[**2126-5-20**] 09:15AM BLOOD Triglyc-82 HDL-56 CHOL/HD-4.1
LDLcalc-155*

pre-cath EKG: NSR at 57 bpm, nl intervals, nl axis, 4 mm STE II,
III, F, 1-[**Street Address(2) 5366**] depression in aVL, I, V2, V3, V5, V6.
.
post-cath EKG: NSR at 63 bpm, nl axis, nl intervals, STE
resolved, TWI in III and TW flattening in F.

Cardiac Cath [**2126-5-20**]: LMCA 20% ostial, LAD total occlusion after
D1, D1 with diffuse 80%, LCX diffuse with serial 60-70% mid LCX
into large OM2, RCA 99% mid with thrombus, ulceration; R>L
collaterals to the LAD
  - RCA lesion was stented
  - RA 8, RV 24/7, PA 24/14, PCWP 16, CO 3.30 (Fick), CI 2.23

Echo: [**2126-5-20**]
 The left atrium is normal in size. Left ventricular wall
thicknesses are
 normal. The left ventricular cavity size is normal. Resting
regional wall
 motion abnormalities include inferior, septal and apical
hypokinesis (views suboptimal). Left ventricular ejection
fraction ?45%. Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets are mildly
thickened. There is no aortic valve stenosis. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is mild pulmonary artery systolic hypertension.
There is a trivial/physiologic pericardial effusion.

Brief Hospital Course:
77 yo man with hypercholeterolemia s/p inferior STEMI and s/p
ventricular fibrillation arrest in ED converted to NSR.

1) CAD - Cardiac catheterization revealed severe 3 Vessel
Disease with thrombus in the RCA that was stented. He was on
integrillen for 18 hours post cath. He was started on aspirin,
plavix, lopressor, lipitor. He should remain on plavix for at
least 6 months. He would benefit from an ACE inhibitor to be
started as an outpatient. We did not start it here because his
blood pressure was somewhat low. We recommend further
revascularization either by CABG or PCI in the future. If his
anterior wall function is preserved he may have increased
benefit from CABG. It may be advisable to wait a few months to
allow the RCA stent to heal and ensure there is no acute
stenosis before taking him for CABG. We recommend repeat echo to
determine his anterior wall function.

2) Hypercholesterolemia: He was started on lipitor 80 mg QD. He
should have CK and liver function tests in 6 weeks.

3) Rhythm: Ventricular fibrillation arrest in setting of acute
inferior MI. He was shocked in the ER with return to NSR. He had
a few episodes of NSVT on telemtry which is to be expected post
MI. He does not need to have an ICD placed given the MI likely
caused his ventricular fibrillation.

4) Cardiac function: Echo on [**5-21**] after catheterization with EF
of ~45%. He also had hypokinesis of apex, septum, and inferior
wall. He does not need anticoagulation given his preserved EF.

5) Anemia - His hematocrit dropped during his hospital course.
He stabilized at 30.  CT scan was obtained without evidence of
retroperitoneal bleed. We think he was dehydrated on admission
and now equilibrating.

Medications on Admission:
Aspirin

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:*6*
2. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*6*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*1*
4. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*7 Tablet(s)* Refills:*1*
5. Atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*6*
6. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*6*
7. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO once
a day for 7 days.
Disp:*7 Tablet(s)* Refills:*1*
8. Aspirin EC 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day for 7 days.
Disp:*7 Tablet, Delayed Release (E.C.)(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Acute inferior myocardial infarction
Secondary diagnosis:
1. Hypercholesterolemia
2. Posterior decompression for cervical stenosis [**2119**]
3. L retrobulbar bony growth
4. episode of chest pain 7 years ago -- likely negative stress
test


Discharge Condition:
stable

Discharge Instructions:
Please call your primary care doctor or return to the emergency
department if you develop chest pain, shortness of breath, or
other worrisome symptom.

During your hospitalization, you underwent cardiac
catheterization and had a stent placed in the RCA. However, you
have diffuse disease in other arteries to your heart which will
likely need treatment in the future.  We have given you all of
the records from this hospitalization so that you can receive
the rest of your care at home is [**Country **].

You also have prescritions for a one week supply (with one
refill) of aspirin, Plavix, Atenolol and Lipitor. It is very
important for you to take these medications daily for your heart
and the stent that was placed. Dr. [**Last Name (STitle) **] should send you these
medicines from [**Country **].

Followup Instructions:
Please follow up with your cardiologist on return to your home
country of [**Country **]. We have given you a copy of all records from
this hospitalization to take with you.

If you have any concerns, you can call [**Hospital6 733**],
[**Telephone/Fax (1) 250**]. You can ask for an appointment with Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 1923**]. If she is not available, you can see a covering
doctor. Also, the number for the Cardiology Department (Dr.
[**Last Name (STitle) **] is [**Telephone/Fax (1) 2386**], if you have other concerns.
{'Acute myocardial infarction of other inferior wall, initial episode of care,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Anemia, unspecified,Constipation, unspecified'}


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, V fib arrest

PRESENT ILLNESS: 77 yo [**Hospital1 100**]-speaking man with PMH significant for
hypercholesterolemia, ? CAD (no MI).  Per daughter, patient
awoke "not right," had syncopal episdoe while lying in bed.  Dtr
called EMS.  When EMS arrived, patient was cool, clammy, and
diaphoretic.  Initial BP 80/40.  Upon arrival to ED, he
complained of hand pain.  EKG showed huge STE inferiorly.
Patient given 4 baby aspirin, heparin gtt, plavix bolus.
Patient noted to suddenly be in VF.  AED applied.  Patient
shocked x2 with return of normal sinus rhythm.  He was intubated
for airway protection and brought to cath lab.  Cath showed
severe 3VD and his RCA was stented.  He was transferred to the
CCU.

MEDICAL HISTORY: - Hypercholesterolemia
- Posterior decompression for cervical stenosis [**2119**]
- L retrobulbar bony growth
- episode of chest pain 7 years ago -- likely negative stress
test

MEDICATION ON ADMISSION: Aspirin

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: T 96.6, BP 127/38, HR 72, RR 18, SaO2 100% on PS 5/5 40% FIO2,
then 95% on shovel mask
GEN - NAD, A&Ox3 (post-extubation)
HEENT - L eye proptosis, R eye EOMI, pupil round, reactive
NECK - no JVD
HEART - nl s1s2, RRR, no mrg
LUNGS - CTAB anterolaterally
ABD - soft, NT, ND, NABS
EXT - no edema, 2+ DP pulses

FAMILY HISTORY: Unknown

SOCIAL HISTORY: lives in [**Country **] with wife. Here visiting daughter and
son-in-law. Does not smoke, drink alcohol, or use illicit drugs.
Does not exercise [**1-9**] chronic back pain. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Ventricular fibrillation,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Anemia, unspecified,Constipation, unspecified'}
