CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: This is a 80yo gentleman with history of colorectal cancer, s/p
colostomy chemo/XRT with porta cath and on coumadin who
presented to the OSH with progressive chest pain since 8PM last
night. EKG at OSH had inferior ST elevtions with suggestion of
posterior changes. He was made pain free with nitro gtt and
lopressor and ASA and was transferred for cardiac
catheterization. At OSH, his INR was 2.2. He underwent cardiac
cath with stent(DES) to the LCX and TO of RCA. He had oozing
from the sheath requiring sheath change complicated by hematoma
requiring admission to CCU. Post cath, EKG showed unresolved ST
elevation, He was given nipride IC/NTG IC without changes. He
received 4u  FFP in the cath lab.Currently, he denies chest
pain/shortness of breath.

MEDICAL HISTORY: 1. colon CA s/p abdominoperineal resection with
colostomy/XRT/chemo
2. portacath on coumadin
3, hypercholesterolemia
4. hypertension
5. gout

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN-NAD, A+O x3
HEENT-anicteric, MMM, neck supple
CV-RRR, no r/m/g, noS3/S4
resp-CTAB(anterior exam)
[**Last Name (un) 103**]-soft, NT/ND
extremities- right groin in pressure dressing, no pitting edema,
DP 1+b/l

FAMILY HISTORY: 

SOCIAL HISTORY: smoke, quit ETOH in [**2140**]
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Anemia, unspecified,Unspecified essential hypertension,Gout, unspecified,Personal history of malignant neoplasm of large intestine
Subendo infarct, initial,Crnry athrscl natve vssl,Hematoma complic proc,Anemia NOS,Hypertension NOS,Gout NOS,Hx of colonic malignancy
Admission Date:  [**2156-2-13**]              Discharge Date:   [**2156-2-16**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9554**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac cath

History of Present Illness:
This is a 80yo gentleman with history of colorectal cancer, s/p
colostomy chemo/XRT with porta cath and on coumadin who
presented to the OSH with progressive chest pain since 8PM last
night. EKG at OSH had inferior ST elevtions with suggestion of
posterior changes. He was made pain free with nitro gtt and
lopressor and ASA and was transferred for cardiac
catheterization. At OSH, his INR was 2.2. He underwent cardiac
cath with stent(DES) to the LCX and TO of RCA. He had oozing
from the sheath requiring sheath change complicated by hematoma
requiring admission to CCU. Post cath, EKG showed unresolved ST
elevation, He was given nipride IC/NTG IC without changes. He
received 4u  FFP in the cath lab.Currently, he denies chest
pain/shortness of breath.


Past Medical History:
1. colon CA s/p abdominoperineal resection with
colostomy/XRT/chemo
2. portacath on coumadin
3, hypercholesterolemia
4. hypertension
5. gout


Social History:
smoke, quit ETOH in [**2140**]


Physical Exam:
GEN-NAD, A+O x3
HEENT-anicteric, MMM, neck supple
CV-RRR, no r/m/g, noS3/S4
resp-CTAB(anterior exam)
[**Last Name (un) 103**]-soft, NT/ND
extremities- right groin in pressure dressing, no pitting edema,
DP 1+b/l


Pertinent Results:
perverbal report
TO RCA s/p DES
90% pLCx s/p DES
PCWP14

ECG post cath NSR at 50bpm, normal axis, 1st degree AVB, ST
elevation, Q and TWI in II, III, aVF

1. Two vessel coronary artery disease.
2. Acute inferoposterior MI, terminated by primary PCI.
3. Stenting of the RCA and LCX.
4. Normal filling pressures.
COMMENTS:
1. Selective coronary angiography revealed a right dominant
system with
an angiographically normal LMCA. The LAD had a 70% lesion after
D1. THe
LCX had a 90% proximal stenosis. The RCA had a mid subtotal
occlusion
followed by a long segment of moderate disease with TIMI 2 flow;
there
was a 30% lesion before the PDA.
2. Hemodynamics after PCI showed a severely depressed CI at 1.5.
3. Successful stenting of the RCA was performed with overlapping
3.5 x
33 mm, 3.0 x 8 mm and 3.0 x 8 mm Cypher DES.
4. Stenting of the LCX was performed with a 3.0 x 13 mm Cypher
DES.


Brief Hospital Course:
80yo M with h/o HTN, hypercholesterolemia, colon cancer now with
IMI post RCA and LCx stent c/b groin hematoma. He was admitted
to the CCU for monitoring of the groin hematoma. Overnight, the
hematoma is stable. His hematocrit remained stable and he has
good pulses in his lower extremities. He will continue on
aspirin, plavix x 9 months, beta blocker and lipitor.


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 300 days.
Disp:*300 Tablet(s)* Refills:*0*
3. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
MI s/p stenting


Discharge Condition:
good

Discharge Instructions:
Please take all of your medications as directed. IT IS VERY
IMPORTANT THAT YOU TAKE YOUR PLAVIX (CLOPIDOGREL). If you do not
take this medication, you may have a second heart attack. Call
your doctor or return to the emergency department if you
experience chest pain, shortness of breath or other symptoms
that are concerning to you.

Followup Instructions:
Please follow up with your primary doctor within one week. You
will also need to follow up with a cardiologist in 2 to 4 weeks.
Call ([**Telephone/Fax (1) 2037**] in order to make an appointment with a
cardiologist here at [**Hospital3 **], or you may make an appointment
with a cardiologist nearer to your home. Please bring this
imformation with you when you go to your appointment.


                             [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2139**]

Completed by:[**2156-2-27**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Anemia, unspecified,Unspecified essential hypertension,Gout, unspecified,Personal history of malignant neoplasm of large intestine'}


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: This is a 80yo gentleman with history of colorectal cancer, s/p
colostomy chemo/XRT with porta cath and on coumadin who
presented to the OSH with progressive chest pain since 8PM last
night. EKG at OSH had inferior ST elevtions with suggestion of
posterior changes. He was made pain free with nitro gtt and
lopressor and ASA and was transferred for cardiac
catheterization. At OSH, his INR was 2.2. He underwent cardiac
cath with stent(DES) to the LCX and TO of RCA. He had oozing
from the sheath requiring sheath change complicated by hematoma
requiring admission to CCU. Post cath, EKG showed unresolved ST
elevation, He was given nipride IC/NTG IC without changes. He
received 4u  FFP in the cath lab.Currently, he denies chest
pain/shortness of breath.

MEDICAL HISTORY: 1. colon CA s/p abdominoperineal resection with
colostomy/XRT/chemo
2. portacath on coumadin
3, hypercholesterolemia
4. hypertension
5. gout

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN-NAD, A+O x3
HEENT-anicteric, MMM, neck supple
CV-RRR, no r/m/g, noS3/S4
resp-CTAB(anterior exam)
[**Last Name (un) 103**]-soft, NT/ND
extremities- right groin in pressure dressing, no pitting edema,
DP 1+b/l

FAMILY HISTORY: 

SOCIAL HISTORY: smoke, quit ETOH in [**2140**] 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Anemia, unspecified,Unspecified essential hypertension,Gout, unspecified,Personal history of malignant neoplasm of large intestine'}
