CHIEF COMPLAINT: recurrent chest pain, s/p anterolateral MI one week ago

PRESENT ILLNESS: 87-year-old woman with history of HTN, DM2 was transferred from
OSH after having recurrent chest pain s/p anterolateral MI 1
week ago. On [**2164-2-4**] patient presented to OSH with chest pain,
found to have STE in V1 and V2. Because she presented 36 hours
after the event, she did not undergo emergent catherization. Did
not receive any thrombolytics. Treated with heparin gtt for 48
hours, ASA, metoprolol, and simvastatin. Troponin peaked at
39.54. Echo showed EF of 30% with anterior wall akinesis,
several septal hypokinesis, apical hypokinesis, and mid-inferior
wall moderate hypokinesis; no valvular abnormality. Lisinopril
was continued. Diltiazem was switched to metoprolol. Clopidogrel
was added.
.
Of note, patient was also found to have a LLL pneumonia, treated
with ceftriaxone and azithromycin. She had an E. coli UTI
treated with ceftriaxone. Patient was discharged to rehab on
[**2164-2-10**].
.
On [**2164-2-12**] patient had recurrent dull, substernal chest pain
with mild dyspnea, presented to [**Hospital **] Hospital, was trasferred
to [**Hospital1 18**] for cath. Cath revealed 3-vessel disease; hence, no PCI
was done. Per patient's wish, no CABG is considered, and she is
being managed medically.
.
On review of systems, she reports history of "small" stroke [**6-21**]
years ago. Denies any history of 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.
.
Cardiac review of systems is notable for dull chest pain, but no
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.
.
On arrival to the CCU patient had stable vitals, alert, awake,
chest-pain free.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: Diabetes (+), Dyslipidemia (+),
Hypertension (+)
2. CARDIAC HISTORY:
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS: none
-PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:  none

MEDICATION ON ADMISSION: ASA 325 mg qday
clopidogrel 75 mg qday
glyburide 5 mg qday
metoprolol 25 mg [**Hospital1 **]
MVI
simvastatin 40 mg qday
levoflox 750 mg qday (last dose [**2164-2-14**])
lisinopril 10 mg qday
metformin 500 mg [**Hospital1 **]
calcium 1200 mg qday
vitamin D 800 units qday

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: T 97.7, BP 108/80, HR 86, RR 24, O2 sat 100%4L NC
GENERAL: Elderly woman in 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, otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: none
-ETOH: none
-Illicit drugs: none
Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Acute myocardial infarction of anterolateral wall, subsequent episode of care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
Crnry athrscl natve vssl,Pneumonia, organism NOS,AMI anterolateral,subseq,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2164-2-12**]              Discharge Date:   [**2164-2-14**]


Service: MEDICINE

Allergies:
No Drug Allergy Information on File

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
recurrent chest pain, s/p anterolateral MI one week ago

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
87-year-old woman with history of HTN, DM2 was transferred from
OSH after having recurrent chest pain s/p anterolateral MI 1
week ago. On [**2164-2-4**] patient presented to OSH with chest pain,
found to have STE in V1 and V2. Because she presented 36 hours
after the event, she did not undergo emergent catherization. Did
not receive any thrombolytics. Treated with heparin gtt for 48
hours, ASA, metoprolol, and simvastatin. Troponin peaked at
39.54. Echo showed EF of 30% with anterior wall akinesis,
several septal hypokinesis, apical hypokinesis, and mid-inferior
wall moderate hypokinesis; no valvular abnormality. Lisinopril
was continued. Diltiazem was switched to metoprolol. Clopidogrel
was added.
.
Of note, patient was also found to have a LLL pneumonia, treated
with ceftriaxone and azithromycin. She had an E. coli UTI
treated with ceftriaxone. Patient was discharged to rehab on
[**2164-2-10**].
.
On [**2164-2-12**] patient had recurrent dull, substernal chest pain
with mild dyspnea, presented to [**Hospital **] Hospital, was trasferred
to [**Hospital1 18**] for cath. Cath revealed 3-vessel disease; hence, no PCI
was done. Per patient's wish, no CABG is considered, and she is
being managed medically.
.
On review of systems, she reports history of "small" stroke [**6-21**]
years ago. Denies any history of 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.
.
Cardiac review of systems is notable for dull chest pain, but no
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.
.
On arrival to the CCU patient had stable vitals, alert, awake,
chest-pain free.

Past Medical History:
1. CARDIAC RISK FACTORS:: Diabetes (+), Dyslipidemia (+),
Hypertension (+)
2. CARDIAC HISTORY:
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS: none
-PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:  none

Social History:
-Tobacco history: none
-ETOH: none
-Illicit drugs: none


Family History:
No family history of early MI, otherwise non-contributory.

Physical Exam:
VS: T 97.7, BP 108/80, HR 86, RR 24, O2 sat 100%4L NC
GENERAL: Elderly woman in 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.

NECK: Supple with JVP of 9 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. 2/6 systolic murmur at apex. No
thrills, lifts. No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB from anterior with
no crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+


Pertinent Results:
[**2164-2-12**] 10:01AM   WBC-8.0 RBC-3.19* HGB-9.8* HCT-28.6* MCV-90
MCH-30.7 MCHC-34.1 RDW-13.7
[**2164-2-12**] 10:01AM   PLT COUNT-320
[**2164-2-12**] 10:01AM   PT-15.3* PTT-43.9* INR(PT)-1.3*
[**2164-2-12**] 10:01AM   CALCIUM-9.0 PHOSPHATE-3.6 MAGNESIUM-1.7
[**2164-2-12**] 10:01AM   CK-MB-3 cTropnT-1.05*
[**2164-2-12**] 10:01AM   GLUCOSE-174* UREA N-23* CREAT-0.8 SODIUM-141
POTASSIUM-3.9 TOTAL CO2-25
[**2164-2-12**] 05:27PM   CK-MB-NotDone cTropnT-0.90*
[**2164-2-12**] 05:27PM   CK(CPK)-44
[**2164-2-12**] 05:27PM   POTASSIUM-4.2
.
Cardiac cath [**2164-2-12**]:
right dominant
LCMA: proximal mild dissection, 40% mid, 40% distal
LAD: 99% complex mid
LCx: 80% ramus, 100% mild circumflex with late filling of major
OM
RCA: complex 100% mid, 80% distal


Brief Hospital Course:
87-year-old woman with history of HTN, DM2 was transferred from
OSH after having recurrent chest pain s/p anterolateral MI 1
week ago, with cath showing 3-vessel disease, being medically
managed per patient's wish.

# CAD: mid-LAD infarct and old interfior MI per ECG. Cardiac
catheterization revealed 3-vessel disease. Per the patient's
wish, CABG was not an option, and she was medically managed with
metoprolol, ASA, clopidogrel, lisinopril, statin. She was
discharged without any recurrent chest pain. If her symptoms
recur in the future, initiating nitrates or increasing the dose
of her beta blocker if her blood pressure and heart rate permit
should be considered.
.
# PUMP: recent echo showed EF 30% with anterior wall akinesis,
several septal hypokinesis, apical hypokinesis, and mid-inferior
wall moderate hypokinesis; no valvular abnormality. Continued on
ACEI and beta blocker.
.
# HTN: Continued on BB, ACEI.
.
# DM2: she was put on insulin sliding scale while in the
hospital, but was discharged on her metformin and glyburide.

Medications on Admission:
ASA 325 mg qday
clopidogrel 75 mg qday
glyburide 5 mg qday
metoprolol 25 mg [**Hospital1 **]
MVI
simvastatin 40 mg qday
levoflox 750 mg qday (last dose [**2164-2-14**])
lisinopril 10 mg qday
metformin 500 mg [**Hospital1 **]
calcium 1200 mg qday
vitamin D 800 units qday


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).
3. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Calcium Carbonate 500 mg (1,250 mg) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
7. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Metformin 850 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
10. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: 1.5 Tablet Sustained Release 24 hrs PO DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital 5682**] Rehab and Skilled Nursing Center

Discharge Diagnosis:
Primary diagnosis: coronary artery disease

Secondary diagnoses: diabetes mellitus type 2, hypertension,
dyslipidemia


Discharge Condition:
stable


Discharge Instructions:
You presented with chest pain. You underwent a cardiac
catheterization that showed severe coronary disease. Per your
wish, surgeric options were not considered, and you were managed
with medications. Please follow up with your doctors and take
[**Name5 (PTitle) **] your medications as instructed below.

Followup Instructions:
Please make a follow-up appointment with your primary care
physician, [**Name10 (NameIs) **] [**Last Name (STitle) **], [**Telephone/Fax (1) 10508**] in 2 weeks. Please follow
up with your regular cardiologist within 2 weeks. If you wish,
you can see a cardiologist at the [**Hospital1 18**] by calling [**Telephone/Fax (1) 62**]
to make an appointment.
{'Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Acute myocardial infarction of anterolateral wall, subsequent episode of care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}


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: recurrent chest pain, s/p anterolateral MI one week ago

PRESENT ILLNESS: 87-year-old woman with history of HTN, DM2 was transferred from
OSH after having recurrent chest pain s/p anterolateral MI 1
week ago. On [**2164-2-4**] patient presented to OSH with chest pain,
found to have STE in V1 and V2. Because she presented 36 hours
after the event, she did not undergo emergent catherization. Did
not receive any thrombolytics. Treated with heparin gtt for 48
hours, ASA, metoprolol, and simvastatin. Troponin peaked at
39.54. Echo showed EF of 30% with anterior wall akinesis,
several septal hypokinesis, apical hypokinesis, and mid-inferior
wall moderate hypokinesis; no valvular abnormality. Lisinopril
was continued. Diltiazem was switched to metoprolol. Clopidogrel
was added.
.
Of note, patient was also found to have a LLL pneumonia, treated
with ceftriaxone and azithromycin. She had an E. coli UTI
treated with ceftriaxone. Patient was discharged to rehab on
[**2164-2-10**].
.
On [**2164-2-12**] patient had recurrent dull, substernal chest pain
with mild dyspnea, presented to [**Hospital **] Hospital, was trasferred
to [**Hospital1 18**] for cath. Cath revealed 3-vessel disease; hence, no PCI
was done. Per patient's wish, no CABG is considered, and she is
being managed medically.
.
On review of systems, she reports history of "small" stroke [**6-21**]
years ago. Denies any history of 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.
.
Cardiac review of systems is notable for dull chest pain, but no
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.
.
On arrival to the CCU patient had stable vitals, alert, awake,
chest-pain free.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: Diabetes (+), Dyslipidemia (+),
Hypertension (+)
2. CARDIAC HISTORY:
-CABG: none
-PERCUTANEOUS CORONARY INTERVENTIONS: none
-PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:  none

MEDICATION ON ADMISSION: ASA 325 mg qday
clopidogrel 75 mg qday
glyburide 5 mg qday
metoprolol 25 mg [**Hospital1 **]
MVI
simvastatin 40 mg qday
levoflox 750 mg qday (last dose [**2164-2-14**])
lisinopril 10 mg qday
metformin 500 mg [**Hospital1 **]
calcium 1200 mg qday
vitamin D 800 units qday

ALLERGIES: No Drug Allergy Information on File

PHYSICAL EXAM: VS: T 97.7, BP 108/80, HR 86, RR 24, O2 sat 100%4L NC
GENERAL: Elderly woman in 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, otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history: none
-ETOH: none
-Illicit drugs: none 

### Response:
{'Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Acute myocardial infarction of anterolateral wall, subsequent episode of care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
