CHIEF COMPLAINT: Angina (Transfer from [**Hospital3 1280**] for Interventional Cath)

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 66 year old woman with COPD and PVD transfered
from [**Hospital3 1280**] for interventional cath after worsening CP X 4
days. Over the past 3-4 months, she endorses recurrent
non-exertional substernal chest pressure. These last 4 days the
chest pressure worsened, increasing in intensity and frequency.
She called 911 and was taken to [**Hospital3 **] by ambulance. In the
ED she reported same chest pain- ECG revealed no ischemic
changes. Sx were relieved with SL nitroglycerine. Patient was
admitted to [**Hospital3 1280**] where she received Nitro and heparin gtt,
ASA, plavix, metoprolol, and lipitor. She had no CP since
receving Nitro in [**Location 44023**]. Troponin T peaked at 0.2.
Diagnostic cardiac catheterization at [**Hospital3 1280**] revealed:
1.Severe single vessel CAD, with a focal 90% stenosis of the
distal RCA involving the origin of the PDA. Diffuse
calcification and mild-to-moderate disease of all three coronary
arteries 2.Normal LV systolic function. 3. Mild LV diastolic
dysfunction 4.No evidence of valvular disease. She was
transferred to [**Hospital1 18**] this AM for interventional catheterization.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: CAD
2. CARDIAC HISTORY:
- PERCUTANEOUS CORONARY INTERVENTIONS: [**2176-7-8**] DES to distal
RCA and BMS x 2 to mid RCA
3. OTHER PAST MEDICAL HISTORY: COPD, Glaucoma, Anemia

MEDICATION ON ADMISSION: Ipratropium Bromide 17- 2INH by mouth QID PRN
Fluticasone 110 mcg/Actuation- 2 INH [**Hospital1 **]
Budesonide-Formoterol (Symbicort)- 160-4.5- 2INH [**Hospital1 **]
Citalopram 10mg QAM

ALLERGIES: Penicillins / Bactrim DS

PHYSICAL EXAM: ADMISSION EXAM:
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.
Brother passed at age 58 from CAD
Brother and Sister with HTN/HLD
Brother and Sister with arrhythmias
Sister with breast and colon cancer
Father and brother with alcoholism

SOCIAL HISTORY: - Tobacco history: 80 pack-years, now [**12-24**] pack per day
- ETOH: History of EtOH abuse, quit 15 years ago
- Illicit drugs: None
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Unspecified glaucoma,Anemia, unspecified
Subendo infarct, initial,Crnry athrscl natve vssl,Chr airway obstruct NEC,Periph vascular dis NOS,Glaucoma NOS,Anemia NOS
Admission Date:  [**2176-7-8**]              Discharge Date:   [**2176-7-10**]

Date of Birth:  [**2110-2-8**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Bactrim DS

Attending:[**Known firstname 23009**]
Chief Complaint:
Angina (Transfer from [**Hospital3 1280**] for Interventional Cath)

Major Surgical or Invasive Procedure:
cardiac catheterization with drug eluting stent x1 and bare
metal stents x2 to right coronary artery


History of Present Illness:
Mrs. [**Known lastname **] is a 66 year old woman with COPD and PVD transfered
from [**Hospital3 1280**] for interventional cath after worsening CP X 4
days. Over the past 3-4 months, she endorses recurrent
non-exertional substernal chest pressure. These last 4 days the
chest pressure worsened, increasing in intensity and frequency.
She called 911 and was taken to [**Hospital3 **] by ambulance. In the
ED she reported same chest pain- ECG revealed no ischemic
changes. Sx were relieved with SL nitroglycerine. Patient was
admitted to [**Hospital3 1280**] where she received Nitro and heparin gtt,
ASA, plavix, metoprolol, and lipitor. She had no CP since
receving Nitro in [**Location 44023**]. Troponin T peaked at 0.2.
Diagnostic cardiac catheterization at [**Hospital3 1280**] revealed:
1.Severe single vessel CAD, with a focal 90% stenosis of the
distal RCA involving the origin of the PDA. Diffuse
calcification and mild-to-moderate disease of all three coronary
arteries 2.Normal LV systolic function. 3. Mild LV diastolic
dysfunction 4.No evidence of valvular disease. She was
transferred to [**Hospital1 18**] this AM for interventional catheterization.

.
At [**Hospital1 18**], she underwent cardiac catheterization with
identification of significant RCA disease. She received a DES to
the distal RCA and BMS x 2 to the mid RCA. The procedure was
complicated by closure of the PDA. The patient also experienced
significant oozing with a drop in hematocrit from 29.8 to 22.9.

.
Following the procedure, the patient was transfered from the
cath lab to the CCU for close overnight monitoring.
.
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. She denies recent fevers, chills or
rigors. She denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.


Past Medical History:
1. CARDIAC RISK FACTORS: CAD
2. CARDIAC HISTORY:
- PERCUTANEOUS CORONARY INTERVENTIONS: [**2176-7-8**] DES to distal
RCA and BMS x 2 to mid RCA
3. OTHER PAST MEDICAL HISTORY: COPD, Glaucoma, Anemia

Social History:
- Tobacco history: 80 pack-years, now [**12-24**] pack per day
- ETOH: History of EtOH abuse, quit 15 years ago
- Illicit drugs: None

Family History:
- No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.
Brother passed at age 58 from CAD
Brother and Sister with HTN/HLD
Brother and Sister with arrhythmias
Sister with breast and colon cancer
Father and brother with alcoholism

Physical Exam:
ADMISSION EXAM:
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, loud P2. left 2nd intercostal 2/6 systolic murmur. No
thrills, lifts.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Prolonged expiratory
phase.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No edema. No femoral bruits. Cath site without
bruit or oozing.
SKIN: No stasis dermatitis, ulcers, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ PT 2+
Left: Carotid 2+ Femoral 2+  PT 2+
.
DISCHARGE EXAM:
T 97.8 HR 74-78 RR 18 BP 112-145/61-68 O2 Sat 100% RA Wt 57.5kg
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, loud P2. 1/6 systolic murmur best heart at the L upper
sternal border. No thrills, lifts.
LUNGS: CTAB, no chest wall deformities, scoliosis or kyphosis.
Resp were unlabored, no accessory muscle use. Prolonged
expiratory phase.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No edema. No femoral bruits, cath site with
moderately sized hematoma, not pulsatile, not expanding. Pulses
2+ bilaterally.

Pertinent Results:
ADMISSION LABS:

[**2176-7-8**] 08:00PM BLOOD Hct-25.1*
[**2176-7-9**] 12:56AM BLOOD Glucose-110* UreaN-6 Creat-0.5 Na-137
K-3.6 Cl-106 HCO3-20* AnGap-15
[**2176-7-9**] 12:56AM BLOOD CK-MB-7 cTropnT-0.11*
[**2176-7-9**] 05:26AM BLOOD CK-MB-15*
[**2176-7-9**] 06:00PM BLOOD CK-MB-14* cTropnT-0.25*
[**2176-7-9**] 12:56AM BLOOD Calcium-8.3* Phos-4.2 Mg-1.5*
.
DISCHARGE LABS:

[**2176-7-10**] 06:35AM BLOOD WBC-7.6 RBC-3.72* Hgb-11.1* Hct-31.8*
MCV-86 MCH-30.0 MCHC-35.0 RDW-15.9* Plt Ct-267
[**2176-7-10**] 06:35AM BLOOD Plt Ct-267
[**2176-7-10**] 06:35AM BLOOD Glucose-106* UreaN-8 Creat-0.7 Na-144
K-4.1 Cl-109* HCO3-27 AnGap-12
[**2176-7-10**] 06:35AM BLOOD CK-MB-8
[**2176-7-10**] 06:35AM BLOOD Calcium-9.1 Phos-3.9 Mg-2.0
.
Cardiac Cath ([**2176-7-8**]):
1. Limited coronary angiography in this right-dominant system
demonstrated one-vessel disease. The RCA had a 30% proximal
stenosis,
diffuse stenosis in the mid-RCA to 60% with a question of
thrombus and a
distal RCA 95% stenosis and an ostial rPDA 99% stenosis.
2. Successful PTCA and stenting of the distal RCA into the PL
system
with a 2.75 x 15 mm Promus [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 7930**] to 3.5 distally and
3.0
proximally complicated by loss of the rPDA (see PTCA comments).
3. Successful PTCA and stenting of the mid-RCA with overlapping
2.75 x
12 mm (distally) and 3.0 x 26 mm Integrity (proximally) stents
postdilated to 3.0 (see PTCA comments).
.
TTE ([**2176-7-9**]):
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Mild (1+) mitral regurgitation is seen. The
tricuspid valve leaflets are mildly thickened. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion.

Brief Hospital Course:
PRIMARY REASON FOR ADMISSION: 66 year-old woman with COPD and
worsening CP/[**Hospital **] transferred from OSH for interventional cath
now status post PCI with stent x 3 to RCA.
.
ACTIVE DIAGNOSES:
.
# CAD: Cardiac cath showed significant RCA disease now s/p PCI
with stent x3. She had BMS x2 placed to the mid RCA (2.75 x 12
mm (distally) and 3.0 x 26 mm Integrity (proximally) stents
postdilated to 3.0) and DES x1 to the distal RCA (2.75 x 15 mm
Promus [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 7930**] to 3.5 distally and 3.0 proximally). PCI
was c/b jailing of the rPDA which resulted in cessation of flow
to the PDA that was confirmed by angiography. She had a slight
bump in CKMB post procedure consistent with this finding, but
CKMB was downtrending at the time of discharge. Post-cath echo
showed normal RV size and wall motion.
.
# Post Procedure Hct Drop: Cardiac cath was c/b significant
oozing at the femoral insertion site and the pt's Hct dropped to
23 immediately post cath. She was transfused 2U pRBCs with an
appropriate response, and her Hct at the time of discharge was
stable at 32. She was admitted to the CCU for monitoring
overnight and remained hemodynamically stable throughout her
course. There was no evidence of femoral bruit or expaning
hematoma at the femoral sheath site, but there was moderate
superficial ecchymoses.
.
CHRONIC DIAGNOSES:
.
# COPD: She has a ~80 year smoking history and was maintained on
her home medications while hospatilized. A nicotine patch was
provided. She was counseled on the importance of smoking
cessation. Pt was never SOB after cardiac cath and never had any
signs of symptoms of COPD exacerbation.
.
# Anxiety: Pt was continued on her home Citalopram and had no
problems with anxiety during her course.
.
TRANSITIONAL ISSUES: Pt was discahrged home with ASA 325, Plavix
75, Metoprolol, Nitro, Lipitor 80mg and nicotine patches as well
as her existing COPD meds. She was instructed on the importance
of continuing ASA/Plavix and was counseled extensively on
smoking cessation. She will follow up with Cardiology and her
PCP.


Medications on Admission:
Ipratropium Bromide 17- 2INH by mouth QID PRN
Fluticasone 110 mcg/Actuation- 2 INH [**Hospital1 **]
Budesonide-Formoterol (Symbicort)- 160-4.5- 2INH [**Hospital1 **]
Citalopram 10mg QAM

Discharge Medications:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*11*
3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*
5. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation QID (4 times a day) as needed for
shortness of breath or wheezing.
6. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
7. Symbicort 160-4.5 mcg/Actuation HFA Aerosol Inhaler Sig: Two
(2) puffs Inhalation twice a day.
8. citalopram 10 mg Tablet Sig: One (1) Tablet PO once a day.
9. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily) for 6 weeks.
Disp:*45 Patch 24 hr(s)* Refills:*0*
10. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual as directed as needed for chest pain.
Disp:*25 tablets* Refills:*0*
11. Outpatient Lab Work
Please check labs at [**Location (un) 2274**] [**University/College **] on Friday [**7-12**]


Discharge Disposition:
Home

Discharge Diagnosis:
Non ST Elevation Myocardial Infarction
Chronic Obstructive Pulmonary disease
S/P Bunion Surgery


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You had a heart attack and blockages were found in your right
coronary artery at [**Hospital **] Hospital. You were transferred to
[**Hospital1 18**] for a procedure to open the blocked artery and you had one
drug eluting stent and two bare metal stents placed in your
right coronary artery. It is crucially important that you take
aspirin and plavix every day to prevent the stents from clotting
off and causing another heart attack. Do not miss [**First Name (Titles) 691**] [**Last Name (Titles) 4319**] or
stop taking aspirin and plavix for any reason unless Dr.
[**Last Name (STitle) **] tells you it is OK. You had some bleeding from the
catheterization site and required two units of blood to replace
the blood that was lost. You are recovering well and have had no
further chest pain. During the catheterization, you received a
lot of contrast (dye) and we will check your kidney blood tests
on Friday to make sure that your kidneys are functioning well.
It is very important that you quit smoking in order to prevent
the arteries from developing blockages and causing another heart
attack. You have been given a prescription for a nicotine patch
to help with the cravings.
Please get your blood checked on Friday [**7-12**] at [**Location (un) 2274**] in
[**University/College **].
.
We made the following changes to your medicines:
1. Start taking aspirin 325 mg and Plavix 75 mg every day for at
least one year to prevent the stents from clotting off.
2. Start taking metoprolol to lower your heart rate and help
your heart recover from the heart attack.
3. Start taking a high dose of Lipitor (Atorvastatin) to lower
your cholesterol and help your heart recover.
4. Use nitroglycerin under your tongue as needed for chest pain.
Please take one pill, wait 5 minutes and you can take one more
pill if the chest pain is still there. Please call Dr.
[**Last Name (STitle) **] if you have any chest pain and take nitroglycerin.
5. Start nicotine patches daily to help you quit smoking.

Followup Instructions:
Primary care:
[**Doctor Last Name **],MAHMOODA [**Telephone/Fax (1) 17465**]. Date/Time: [**7-24**] at 1:40pm.
[**Location (un) 2274**] [**Location (un) 38**]
.
Cardiology:
You will have an appt with Dr. [**Last Name (STitle) **] in about a month, her
office will call you at home with an appt.
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Unspecified glaucoma,Anemia, 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: Angina (Transfer from [**Hospital3 1280**] for Interventional Cath)

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 66 year old woman with COPD and PVD transfered
from [**Hospital3 1280**] for interventional cath after worsening CP X 4
days. Over the past 3-4 months, she endorses recurrent
non-exertional substernal chest pressure. These last 4 days the
chest pressure worsened, increasing in intensity and frequency.
She called 911 and was taken to [**Hospital3 **] by ambulance. In the
ED she reported same chest pain- ECG revealed no ischemic
changes. Sx were relieved with SL nitroglycerine. Patient was
admitted to [**Hospital3 1280**] where she received Nitro and heparin gtt,
ASA, plavix, metoprolol, and lipitor. She had no CP since
receving Nitro in [**Location 44023**]. Troponin T peaked at 0.2.
Diagnostic cardiac catheterization at [**Hospital3 1280**] revealed:
1.Severe single vessel CAD, with a focal 90% stenosis of the
distal RCA involving the origin of the PDA. Diffuse
calcification and mild-to-moderate disease of all three coronary
arteries 2.Normal LV systolic function. 3. Mild LV diastolic
dysfunction 4.No evidence of valvular disease. She was
transferred to [**Hospital1 18**] this AM for interventional catheterization.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: CAD
2. CARDIAC HISTORY:
- PERCUTANEOUS CORONARY INTERVENTIONS: [**2176-7-8**] DES to distal
RCA and BMS x 2 to mid RCA
3. OTHER PAST MEDICAL HISTORY: COPD, Glaucoma, Anemia

MEDICATION ON ADMISSION: Ipratropium Bromide 17- 2INH by mouth QID PRN
Fluticasone 110 mcg/Actuation- 2 INH [**Hospital1 **]
Budesonide-Formoterol (Symbicort)- 160-4.5- 2INH [**Hospital1 **]
Citalopram 10mg QAM

ALLERGIES: Penicillins / Bactrim DS

PHYSICAL EXAM: ADMISSION EXAM:
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.
Brother passed at age 58 from CAD
Brother and Sister with HTN/HLD
Brother and Sister with arrhythmias
Sister with breast and colon cancer
Father and brother with alcoholism

SOCIAL HISTORY: - Tobacco history: 80 pack-years, now [**12-24**] pack per day
- ETOH: History of EtOH abuse, quit 15 years ago
- Illicit drugs: None 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Unspecified glaucoma,Anemia, unspecified'}
