CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: The patient is a 37 year old
Haitian male with no known coronary artery disease who
presented as a transfer from an outside hospital after failed
thrombolysis for chest pain.  The patient took a reportedly
sexual performance enhancing medication that a friend from
[**Country 2045**] had given him and then experienced sharp left sided
chest pain with associated shortness of breath, nausea,
vomiting, and lightheadedness, 20 to 30 minutes after
intercourse.  The patient has taken this medication in the
past without incident and denies ever experiencing such pain
before.

MEDICAL HISTORY: 1.   Diabetes mellitus type 2, recently diagnosed.
2.   Hypertension.
3.   Hospitalized for hyperglycemia in the past.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Tobacco use 1-1/2 packs per day times 25
years; positive alcohol.   Denies drug use.  He is married.
Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tobacco use disorder
AMI anterolateral, init,Crnry athrscl natve vssl,Hypertension NOS,DMII wo cmp nt st uncntr,Tobacco use disorder
Admission Date:  [**2116-3-25**]     Discharge Date:  [**2116-3-27**]

Date of Birth:              Sex:  M

Service:  CCU

CHIEF COMPLAINT:   Chest pain.

HISTORY OF PRESENT ILLNESS:  The patient is a 37 year old
Haitian male with no known coronary artery disease who
presented as a transfer from an outside hospital after failed
thrombolysis for chest pain.  The patient took a reportedly
sexual performance enhancing medication that a friend from
[**Country 2045**] had given him and then experienced sharp left sided
chest pain with associated shortness of breath, nausea,
vomiting, and lightheadedness, 20 to 30 minutes after
intercourse.  The patient has taken this medication in the
past without incident and denies ever experiencing such pain
before.

The patient went to [**Hospital6 **] Emergency Room and
thrombolysis with Reteplase was attempted after noting ST
elevations in V2 through V6, I and AVL.  The patient
continued to have persistent chest pain and ST elevations
remained and the patient was transferred to [**Hospital1 346**] for rescue percutaneous transluminal
coronary angioplasty.

REVIEW OF SYSTEMS:  The patient has positive dyspnea on
exertion after half mile of exertion with a slightly
decreased exercise tolerance over the past six months.
Denies angina, fevers, chills, constipation, diarrhea, poor
p.o. intake, urinary tract infection symptoms, focal or
neurologic deficits.

PAST MEDICAL HISTORY:
1.   Diabetes mellitus type 2, recently diagnosed.
2.   Hypertension.
3.   Hospitalized for hyperglycemia in the past.

ALLERGIES:   No known drug allergies.

MEDICATIONS:  None.

SOCIAL HISTORY:  Tobacco use 1-1/2 packs per day times 25
years; positive alcohol.   Denies drug use.  He is married.

FAMILY HISTORY:   Noncontributory.

PHYSICAL EXAMINATION:  Vital signs on admission, temperature
of 97.1 F.; heart rate of 82; blood pressure 110/64;
respiratory rate of 18; O2 saturation of 100% on four liters.
In general, the patient is a slightly obese Haitian male
lying in bed in no apparent distress, somnolent.  HEENT
examination:  Normocephalic, atraumatic.  Pupils equally
round and reactive to light.  Extraocular muscles are intact.
Sclerae mildly injected.  Neck is soft and supple; mild
jugular venous distention.  Heart:  Regular rate and rhythm,
positive S1, S2, no murmurs, rubs or gallops.  Lungs:
Scattered wheezing bilaterally.  Abdomen soft, nontender,
nondistended, normoactive bowel sounds.  Right groin venous
sheath in place, dressed, with no hematoma.  Extremities with
no cyanosis, clubbing or edema.  Warm, faint dorsalis pedis
pulses bilaterally.  Neurologic:  Oriented times three.
Grossly nonfocal.

LABORATORY:  From the outside hospital, from [**3-25**], in
the a.m., white blood cell count of 8.0, hematocrit of 43.5,
platelets 308.  Sodium 139, potassium 4.1, chloride 102,
bicarbonate 24, BUN of 15, creatinine of 1.1 and glucose of
188.  CK of 219 with an MB of 2.6 and an MB index of 1.1.
Troponin less than 0.1.

EKG #1, normal sinus rhythm at 75 beats per minute, normal
axis and intervals.  ST elevations approximately 5 mm in V2
through V4; 3-4 mm in V5 through V6; 2 to 3 mm in I and AVL.
ST depressions in III and AVF.

EKG #2, pre-catheterization, normal sinus rhythm at 70 beats
per minute, left axis deviation, ST elevations 3 mm in leads
V2 through V4, 1 to 2 mm in V5 through V6, Q's in V2 through
V4, 1 in AVL, slightly peaked Ts in II, III and AVF. \

EKG #3 post-catheterization, essentially unchanged from
pre-catheterization EKG.

IMPRESSION:  37 year old Haitian male with no known coronary
artery disease who presents with chest pain and ST elevations
from outside hospital after failed thrombolysis for a rescue
percutaneous transluminal coronary angioplasty in the setting
of ingestion of sexual performance enhancing medication.

HOSPITAL COURSE BY SYSTEM:
1.  Cardiac:  The patient was taken to the Catheterization
Laboratory immediately upon admission to [**Hospital1 346**] with the following findings:  A
right dominant system, left main coronary artery was normal,
100% proximal left anterior descending lesion was noted; left
circumflex was normal.  Right coronary artery was normal.
The patient is status post percutaneous transluminal coronary
angioplasty and stenting of left anterior descending with
TIMI-III flow restored.

Left ventriculogram showed mitral regurgitation, an ejection
fraction of 43%, severe anterolateral apical hypokinesis,
mild increase in wedge to 18; pulmonary pressures were 31/16.

Ischemia:  The patient post-catheterization was not placed on
Integrilin secondary to use of thrombolytic [**Doctor Last Name 360**] at outside
hospital.  The patient was maintained on aspirin, Plavix,
beta blocker and ACE inhibitor was started.  The patient was
also on a Nitroglycerin drip on arrival to the Cardiac Care
Unit from the Catheterization Laboratory which was eventually
weaned to off.  The patient had no further episodes of chest
pain while an inpatient at [**Hospital1 188**].

Pump:  The patient with noted mild congestive heart failure
with a wedge of 18.  The patient was mildly diuresed with
Lasix with good urine output and O2 saturations remained
stable during the hospital stay.  In addition, echocardiogram
was obtained on hospital day number two to assess left
ventricular function.

Findings from the echocardiogram included normal left atrial
size; the left ventricular wall thickness were normal.  The
left ventricular cavity size was normal.  The overall left
ventricular systolic function was moderately depressed
secondary to severe hypokinesis of the anterior septum and
anterior free wall and there was extensive apical akinesis
with an ejection fraction of 30 to 40%.  Lastly, one plus
mitral regurgitation was noted.

Based on these findings, the patient was started on
anti-coagulation with a heparin drip for prophylaxis against
thrombus formation.  In addition, the patient was to be
started on Coumadin concurrently for eventual discharge on
oral anti-coagulation.

Rhythm:  The patient was noted to be in sinus rhythm.  The
patient had no arrhythmic events while an inpatient at [**Hospital1 1444**].

Lipid:  The patient had a lipid panel checked on hospital day
number two with a total cholesterol of 204, an LDL of 133 and
an HDL of 55.  The patient was started on low-dose statin at
10 mg p.o. q. day.

Hypertension:  The patient was noted to have elevated blood
pressure in the Catheterization laboratory and was placed on
a Nitroglycerin drip post-catheterization for blood pressure
control.  The patient was subsequently weaned from the
Nitroglycerin drip and blood pressures were well controlled
with ACE inhibitors and beta blockers.

2.  Endocrine:  The patient with recently diagnosed diabetes
mellitus type 2.  The patient was not on any oral
hypoglycemics or insulin as an outpatient.  During his
inpatient stay, the patient was maintained on a regular
insulin sliding scale with fingerstick blood sugars four
times a day.  In addition, in light of recent coronary event
and the need for tight glycemic control, the patient was
placed on a basal level of NPH 4 mg subcutaneously twice a
day.  The patient's blood sugars were well controlled during
his hospital stay and this regimen was maintained without any
adjustments.

3.  Hematology:  The patient's hematocrit remained stable
during this hospital stay post catheterization.  There was no
need for a transfusion of any blood products during his time
as an inpatient.

4.  Renal:  The patient's creatinine remained stable at 1.1
post catheterization and there were no acute renal issues
during this hospital stay.

CONDITION AT DISCHARGE:   The patient left the hospital
Against Medical Advice.  The patient was advised to stay
in-house at [**Hospital1 69**] for further
management of his acute coronary event, however, patient
declined, saying that he would like to leave and that he felt
fine.

The Primary Medical Team contact[**Name (NI) **] [**Hospital6 **] to
which the patient had initially gone to for his Emergency
Room visit and tried to coordinate a transfer for further
management over there.  However, in the midst of arranging
such a transfer, the patient left the hospital.

Lastly, the patient was advised to follow-up with his primary
care physician, [**Name10 (NameIs) **], stated that he had no such primary
care physician in the [**Name9 (PRE) **] of [**State 350**] and he would
follow-up accordingly with his doctor in [**State 531**].


                          [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.

Dictated By:[**Name8 (MD) 2054**]

MEDQUIST36

D:  [**2116-5-22**]  22:06
T:  [**2116-5-26**]  09:34
JOB#:  [**Job Number 15717**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tobacco use disorder'}


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: The patient is a 37 year old
Haitian male with no known coronary artery disease who
presented as a transfer from an outside hospital after failed
thrombolysis for chest pain.  The patient took a reportedly
sexual performance enhancing medication that a friend from
[**Country 2045**] had given him and then experienced sharp left sided
chest pain with associated shortness of breath, nausea,
vomiting, and lightheadedness, 20 to 30 minutes after
intercourse.  The patient has taken this medication in the
past without incident and denies ever experiencing such pain
before.

MEDICAL HISTORY: 1.   Diabetes mellitus type 2, recently diagnosed.
2.   Hypertension.
3.   Hospitalized for hyperglycemia in the past.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Tobacco use 1-1/2 packs per day times 25
years; positive alcohol.   Denies drug use.  He is married. 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Tobacco use disorder'}
