CHIEF COMPLAINT: Chest pain.  Patient was initially
evaluated at [**Hospital 1474**] Hospital and transferred here for
further evaluation and treatment.  Initial enzymes showed a
total CPK of 4,120, CK MB 20 and troponin of 17.4.

PRESENT ILLNESS: 

MEDICAL HISTORY: Coronary artery disease, status post
cath in [**2131**] showing ejection fraction of 56% with
anterolateral apical akinesis.  The RCA is 80% obstructed.
The marginal branch of the RCA was 40% obstructed with
diffuse disease.  The mid LAD was 95%, diagonal I was 60%.
The patient underwent angioplasty of the LAD.  Patient was
noted to have mild mitral regurg.  A stress test done at that
time showed dilated left ventricle with fixed defects and
anterolateral septal wall with high grade EAE and equivocal
changes.  Previous MI was 5 years prior to 92.  History of
peptic ulcer disease.  No previous surgeries, no known drug
allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is married, lives in [**Location 1475**], is 66
years old, is a former smoker of 40 pack years, no alcohol,
semi retired and helps in a welding shop.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other complications due to other cardiac device, implant, and graft,Arterial embolism and thrombosis of lower extremity,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia
Subendo infarct, initial,Crnry athrscl natve vssl,Accidental op laceration,Comp-oth cardiac device,Lower extremity embolism,Gastrointest hemorr NOS,Ac posthemorrhag anemia
Name:  [**Known lastname 139**], [**Known firstname 140**]                     Unit No:  [**Numeric Identifier 141**]

Admission Date:  [**2141-11-9**]     Discharge Date:  [**2141-11-20**]

Date of Birth:   [**2062-11-29**]     Sex:  M

Service:

This is an addendum to the initial discharge summary
dictated.

ADDENDUM:  Discharge medications also included Lipitor 20 mg
q HS, Tums 500 mg [**Hospital1 **], multivitamin tablet q day, and
Captopril 12.5 mg tid.  The patient should follow up with Dr.
[**Last Name (STitle) 142**] in one to two weeks for postoperative evaluation.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 143**], M.D.  [**MD Number(1) 144**]

Dictated By:[**Last Name (NamePattern1) 145**]

MEDQUIST36

D:  [**2141-11-19**]  16:43
T:  [**2141-11-20**]  11:53
JOB#:  [**Job Number 146**]


Admission Date:  [**2141-11-9**]       Discharge Date:  [**2141-11-20**]


Service:  Vascular

CHIEF COMPLAINT:  Chest pain.  Patient was initially
evaluated at [**Hospital 1474**] Hospital and transferred here for
further evaluation and treatment.  Initial enzymes showed a
total CPK of 4,120, CK MB 20 and troponin of 17.4.

PAST MEDICAL HISTORY:  Coronary artery disease, status post
cath in [**2131**] showing ejection fraction of 56% with
anterolateral apical akinesis.  The RCA is 80% obstructed.
The marginal branch of the RCA was 40% obstructed with
diffuse disease.  The mid LAD was 95%, diagonal I was 60%.
The patient underwent angioplasty of the LAD.  Patient was
noted to have mild mitral regurg.  A stress test done at that
time showed dilated left ventricle with fixed defects and
anterolateral septal wall with high grade EAE and equivocal
changes.  Previous MI was 5 years prior to 92.  History of
peptic ulcer disease.  No previous surgeries, no known drug
allergies.

MEDICATIONS:  On transfer to our institution, Lopressor 12.5
mg q 6 hours, Atenolol 25 mg q d, Nitro paste 1 inch q 4
hours, Captopril 17.5 mg.

SOCIAL HISTORY:  He is married, lives in [**Location 1475**], is 66
years old, is a former smoker of 40 pack years, no alcohol,
semi retired and helps in a welding shop.

PHYSICAL EXAMINATION:  On admission, vital signs 97.5,
122/91, 70, 18, O2 saturation 98% on room air.  The patient
is alert, oriented and in no acute distress.  HEENT:  Showed
constricted pupils secondary to narcotics, EOM's intact.
Soft palate elevates.  No teeth in the lower mandible, no
icterus.  Cardiovascular exam was a regular rate and rhythm
with no murmurs, rubs or gallops.  Neck without bruits.
Lungs are clear to auscultation bilaterally.  Abdomen is
unremarkable.  Extremities with intact pulses.

LABORATORY DATA:  On transfer included a CBC with white count
6.7, hematocrit 39.1, platelet count 196,000.  Electrolytes,
sodium 135, potassium 4.6, chloride 100, CO2 77, BUN 11,
creatinine 0.1, glucose 114, PT and INR were normal, PTT were
normal.  CK totals were 0, 90 and peak to 412, MB were 82 and
6, MBI index was 20, troponin was 17.4.  Urinalysis was
negative.  EKG showed a normal sinus rhythm with a normal
axis deviation with inverted T's in V4 and V5 which were new.

HOSPITAL COURSE:  The patient was admitted to the cardiology
service and was placed in Intensive Care Unit.  IV Heparin
and Nitroglycerin were begun.  Serial CKs were obtained along
with serial EKG's.  Serial total CK's peaked at 533.  MB
fraction peaked at 9.2.  Initial troponin level was greater
than 50 and after the next 72 hours its level was 1.5.
Normal is less than .03.  Within the next 24 hours the
patient underwent cardiac catheterization.  The patient's
right sided pressures, PA was 50/17, right atrial mean was
16, pulmonary wedge pressure was 16, left ventricular end
diastolic pressure was 17.  Cardiac output was 6.0, index was
3.3, EF was 30% with akinetic anterolateral and apex walls
and hypokinetic antero basal wall and normal posterior and
basal wall.  The native vessels showed left main trunk
disease of 30%, left anterior was proximal 30% and mid 90%
left circumflex was mid 50%.  Ramus intermedius was 90% which
was angioplastied and stented and the right coronary showed
an osteal lesion of 30%.  There was concern of right external
iliac artery dissection.  The patient underwent a right
femoral ultrasound which demonstrated triphasic flow in the
right common femoral artery with plaque or flap proximal to
the right SFA with stenosis and did have episodes of SVG and
was begun on beta blockers. Aspirin and Plavix were continued
post stenting.  The groin was without bleeding and he had
distal pulses.  Dr. [**Last Name (STitle) **], the cardiologist, requested that
vascular be consulted regarding the findings on the right
iliac SFA ultrasound.  The patient, although study was
abnormal but with intact distal pulses, the patient did note
72 hours after catheterization, onset of right calf and ankle
foot pain with ambulation.  The patient underwent a repeat
peripheral arterial catheterization which demonstrated
abdominal aorta with no significant disease, renal arteries
bilaterally were normal, the right lower extremity iliac is
without critical lesions, the previous noted dissection is
not occlusive but the site is still delineated.  The common
femoral is normal, the SFA and profunda artery are normal,
the popliteals occlude mid vessel and the anterior and tibial
were not well visualized but appear thrombolytically
occluded.  There was three vessel runoff to the foot.  The
collaterals provide much of the distal flow.  The patient was
TPA'd, begun on Heparin and placed in the VICU.  The patient
had consequences of a right groin hematoma after the second
right groin intervention and angiography which required
pressure occlusion.  The patient underwent on [**11-14**], a
thrombectomy of the right tibial peroneal trunk and AT artery
with patch angioplasty of the right popliteal artery.  He
tolerated the procedure well and was transferred to the VICU
for continued monitoring and care.  The patient required a
unit of packed cells for hematocrit of 25, post transfusion
hematocrit was 35.  Total CK was 74.  The patient was placed
on peri-operative Kefzol and remained in the VICU in stable
condition.  On [**11-15**] the patient had an episode of
hematemesis.  An NG was placed with 300 cc of blood
aspirated.  The patient remained hemodynamically stable.
Serial hematocrits were obtained and Plavix and Aspirin were
held.  GI was consulted.  The patient underwent upper
endoscopy which demonstrated a few non bleeding localized
erosions in the esophagus at the GE junction consistent with
NG trauma.  There was bilious fluid in the stomach body and
antrum.  There is no active bleeding or coffee ground or
bright red blood noted.  There were few superficial non
bleeding 2 mm ulcers ranging in size from 2 mm to 5 mm in the
stomach.  The duodenum was normal.  Recommendations were to
continue the Protonix at 40 mg q d, discontinue the NG tube,
follow serial hematocrits.  Please consider the risk/benefits
of Aspirin and Plavix.  If Aspirin and Plavix need to be
continued, then we will put the patient on a higher dose of
Protonix.  The patient experienced episode of hypertension
overnight on postoperative day #1 requiring adjustments in
hypertensive medications and transfusion of packed red blood
cells.  On postoperative day #3 there were no overnight
events.  The patient continued on Protonix IV and Captopril
and beta blockers.  His hematocrit remained stable at 29.
CKs were flat and serial hematocrits remained stable.  The
patient was then begun on Aspirin.  Physical therapy saw the
patient and felt that he would be able to be discharged to
home after evaluating ambulation with stairs.  The patient's
hematocrits remained stable, groin remained stable.  The
patient was discharged in stable condition on [**2141-11-20**].  She
is to follow-up with Dr. [**Last Name (STitle) **] as instructed and see Dr.
[**Last Name (STitle) 1476**] in two weeks time.

DISCHARGE MEDICATIONS:  Include Keflex 500 mg qid times 7
days, Aspirin 81 mg q d, Lopressor 25 mg [**Hospital1 **], hold for
systolic blood pressure less than 120, heart rate less than
60, Protonix 40 mg q d, Colace 100 mg [**Hospital1 **], Percocet tablets
[**12-27**] q 4 hours prn pain, Plavix 75 mg q d.

DISCHARGE DIAGNOSIS:
1.  Non Q wave MI status post angioplasty of the ramus
intermedius with stenting.
2.  Right groin hematoma, stabilized.
3.  Right iliac external artery dissection, stabilized.
4.  Thrombolic ischemia of the right leg, status post
thrombectomy of the anterior tibial and peroneal trunk.
5.  Hypertension controlled.
6.  GI bleeding, stabilized.
7.  Blood loss anemia, transfused, corrected.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1477**], M.D.  [**MD Number(1) 1478**]

Dictated By:[**Last Name (NamePattern1) 1479**]
MEDQUIST36

D:  [**2141-11-19**]  16:01
T:  [**2141-11-19**]  16:50
JOB#:  [**Job Number 1480**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other complications due to other cardiac device, implant, and graft,Arterial embolism and thrombosis of lower extremity,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia'}


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.  Patient was initially
evaluated at [**Hospital 1474**] Hospital and transferred here for
further evaluation and treatment.  Initial enzymes showed a
total CPK of 4,120, CK MB 20 and troponin of 17.4.

PRESENT ILLNESS: 

MEDICAL HISTORY: Coronary artery disease, status post
cath in [**2131**] showing ejection fraction of 56% with
anterolateral apical akinesis.  The RCA is 80% obstructed.
The marginal branch of the RCA was 40% obstructed with
diffuse disease.  The mid LAD was 95%, diagonal I was 60%.
The patient underwent angioplasty of the LAD.  Patient was
noted to have mild mitral regurg.  A stress test done at that
time showed dilated left ventricle with fixed defects and
anterolateral septal wall with high grade EAE and equivocal
changes.  Previous MI was 5 years prior to 92.  History of
peptic ulcer disease.  No previous surgeries, no known drug
allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is married, lives in [**Location 1475**], is 66
years old, is a former smoker of 40 pack years, no alcohol,
semi retired and helps in a welding shop. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other complications due to other cardiac device, implant, and graft,Arterial embolism and thrombosis of lower extremity,Hemorrhage of gastrointestinal tract, unspecified,Acute posthemorrhagic anemia'}
