CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 65-year-old
gentleman with a history of hypercholesterolemia, GERD, and
prostate cancer, who presented from the outside hospital
status post anterior ST elevation MI, status post Retivase
times two boluses with no evidence for a reperfusion as
evidenced by no changes in ST elevations.  The patient was
sent to the [**Hospital6 256**] for urgent
cardiac catheterization.

MEDICAL HISTORY: 1.  GERD.
2.  Prostate cancer.
3.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient quit smoking in [**2171**].  The
patient does not have a history of alcohol use or illicit
drug use.
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Cardiac complications, not elsewhere classified,Atrial fibrillation,Primary pulmonary hypertension,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect
AMI anterior wall, init,Cardiogenic shock,Surg compl-heart,Atrial fibrillation,Prim pulm hypertension,CHF NOS,Crnry athrscl natve vssl,Secundum atrial sept def
Admission Date:  [**2197-6-13**]       Discharge Date:  [**2197-6-18**]

Date of Birth:   [**2131-11-27**]       Sex:  M

Service:  CCU

HISTORY OF THE PRESENT ILLNESS:  The patient is a 65-year-old
gentleman with a history of hypercholesterolemia, GERD, and
prostate cancer, who presented from the outside hospital
status post anterior ST elevation MI, status post Retivase
times two boluses with no evidence for a reperfusion as
evidenced by no changes in ST elevations.  The patient was
sent to the [**Hospital6 256**] for urgent
cardiac catheterization.

During the cardiac catheterization, the patient was found to
have a proximal total occlusion of LAD.  The patient's
cardiac catheterization was complicated due to the fact that
no flow resulted status post initial PTCA and stent placement
Since clot was observed to be reforming inside after the
stent placement, Integrelin was started despite prior lytic
therapy administration.  Any other measures including
intra-arterial Diltiazem were not successful to restore the
flow beyond TIMI-I flow.  The patient was put on intra-aortic
balloon pump for afterload reduction.  During the cardiac
catheterization, the patient had transient episodes of
hypertension for which the patient was also started on
dopamine.  The patient continued complaining of chest pain,
nausea, vomiting, and diaphoresis after leaving
catheterization laboratory.

Cardiac catheterization was complicated by transient hypoxia
with ABGs showing pH of 7.29, C02 45, and P02 of 69 with
pulmonary capillary wedge pressure (PCWP) of 34.  The patient
was subsequently transferred to the Cardiac Care Unit for
close monitoring.

PAST MEDICAL HISTORY:
1.  GERD.
2.  Prostate cancer.
3.  Hypercholesterolemia.

TRANSFER MEDICATIONS:
1.  Integrelin.
2.  Plavix.
3.  Aspirin.
4.  Docusate.
5.  Senna.
6.  Lipitor.
7.  Morphine.

FAMILY HISTORY:  Noncontributory.

SOCIAL HISTORY: The patient quit smoking in [**2171**].  The
patient does not have a history of alcohol use or illicit
drug use.

HOSPITAL COURSE:  1.  CORONARY ARTERY DISEASE:  The patient
is status post massive anterior wall MI with cardiac
catheterization complicated by inability to achieve adequate
flow to the proximal LAD complicated by cardiogenic shock on
intra-aortic balloon pump upon transfer to the Cardiac Care
Unit.  The patient has been stabilized on intra-aortic
balloon pump.  The patient had an urgent echocardiogram done
which showed ejection fraction of 20% and severe anterior and
apical hypokinesis.  The patient was maintained on
intra-aortic balloon pump for the first two days.  There was
no evidence of end-organ damage of hyperperfusion.  The
patient's peak CK was over 7,000 and has been trending down
since day number two of CCU admission.

We were able to wean the patient off balloon pump on
[**2197-6-15**].  Heparin was started as well as an ACE inhibitor.
The patient has also been started on a statin, aspirin, and a
low-dose beta blocker for his coronary artery disease.  The
patient has tolerated afterload reduction with an ACE
inhibitor well and has had no symptoms of chest pain since
admission.

The patient suffered a drastic decrease in the cardiac
function as evidenced by an ejection fraction of 20%.  The
patient is at risk for development of apical clot post MI as
evidenced by apical kinesis.  Therefore, the patient has been
anticoagulated with heparin.  The patient is likewise at high
risk for sudden cardiac death as evidenced by ejection
fraction of 20%.  However, in order to properly risk
stratify the patient, the patient is to undergo
signal-averaged EKG on Monday to establish his risk for
malignant ventricular arrhythmias.

In the meanwhile, we continued optimizing the patient's
cardiac function with ACE inhibitors, beta blockers.  During
the stay in the Cardiac Care Unit, the patient developed
atrial fibrillation on [**2197-6-15**], several hours after removal
of intra-aortic balloon pump.  The patient had atrial
fibrillation with rapid ventricular response at a rate of
150s to 170s.  The patient has remained hemodynamically
stable and has been asymptomatic.  Several doses of Lopressor
5 mg IV push were tried with only transient response.

Subsequently, the patient was started on an Amiodarone drip 1
mg per minute, but developed transient hypotension with
systolic blood pressures of 70, maintaining his mean arterial
pressure of above 55.  Therefore, intravenous Amiodarone was
stopped and the patient was started on Amiodarone 400 mg p.o.
b.i.d.  The patient has remained in atrial fibrillation until
the patient was started on esmolol drip and has converted to
a normal sinus rhythm in two hours after initiation of the
esmolol drip.

Throughout the day afterwards, the patient has remained in
normal sinus rhythm and was transferred to the general
nursing floor.  However a few hours thereafter, the patient
developed atrial flutter with 1:2 conduction at a rate of 120
that was found to be nonresponsive to beta blockers.  The
patient was asymptomatic and maintained good mean arterial
pressures but was transferred to the Cardiac Care Unit and
was started on an esmolol drip with no response this time.

It was decided that most likely the patient went into atrial
flutter secondary to Amiodarone treatment of atrial
fibrillation.  The patient's Amiodarone was increased to 400
mg p.o. t.i.d.  Esmolol drip was titrated off and the patient
was restarted on Coreg 6.25 mg p.o. b.i.d.  The patient's ACE
inhibitor was held in order to prevent hypotension that could
be expected with increasing Amiodarone.

The patient, as before, has remained asymptomatic and stable.
It was planned to attempt and achieve rate control with
Amiodarone and if rate control unable to achieve or if the
patient was to become hemodynamically unstable to cardiovert
electrically.  Immediate cardioversion was not done since the
patient remained hemodynamically stable and also since
awaiting signal-averaged EKG results to show whether the
patient would at the same time benefit from an ICD
implantation.

This dictation is to be followed by an addendum.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 4937**]
MEDQUIST36

D:  [**2197-6-18**]  05:56
T:  [**2197-6-18**]  18:29
JOB#:  [**Job Number 28080**]


Name:  [**Known lastname **], [**Known firstname **] I                      Unit No:  [**Numeric Identifier 18075**]

Admission Date:  [**2197-6-13**]     Discharge Date:  [**2197-6-22**]

Date of Birth:   [**2131-11-27**]     Sex:  M

Service:

ADDITIONAL EVENTS NOTED:  On [**2197-6-19**], the patient's
rhythm was notable for atrial flutter at a rate of about 110,
blood pressure dipped around 80/60 with a MAP of 60-70.  The
patient was cardioverted on the 14th, and remained in normal
sinus rhythm throughout the remainder of his hospital course.

On the [**2197-6-20**], patient had a Physical Therapy
evaluation with recommendations for followup over several
week period to go for cardiac rehabilitation, and address
balance issues with ambulation.

[**Hospital **] hospital course was also notable for an elevated
white blood cell count on the [**6-21**] from 10 to 12,000.
At that point, the patient also had a low grade temperature
of 99 degrees, and a chest x-ray was done reporting a
questionable ill defined new lingular opacity consistent with
a possible pneumonia.  The patient was started on Zithromax
for a five day course starting at 500 mg for the first day
with 250 mg on the subsequent four days.

Additionally, the [**Hospital 1325**] hospital course was notable for
transient hypotension.  Blood pressure ranging from
90-103/51-68 with heart rate between 60 and 70.  During
Physical Therapy the patient was noted to be orthostatic.  An
IV fluid treatment was initiated on the [**6-21**] and his
blood pressure improved, and patient no longer complained of
dizziness or feeling lightheaded.  There were no subsequent
Telemetry events during the remainder of his hospital course.

DISCHARGE PLANS:  The patient is to be discharged to home
with outpatient cardiac rehabilitation in [**Location (un) 4887**] and VNA
services at home to monitor Coumadin levels.

FOLLOW-UP INSTRUCTIONS:  The patient is instructed to
followup with his PCP and with his cardiologist, Dr.
[**Last Name (STitle) 86**].

DISCHARGE MEDICATIONS:
1. Lipitor 20 mg q day.
2. Plavix 75 mg q day.
3. Aspirin 325 mg q day.
4. Amiodarone 400 mg q day.
5. Zestril 5 mg q day.
6. Coumadin 2.5 mg q day.
7. Carvedilol 12.2 mg [**Hospital1 **].
8. Celexa 20 mg po q day.
9. Zithromax, Z-Pak for five days starting on the [**6-22**].

                     DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-749



Dictated By:[**Last Name (NamePattern1) 18076**]

MEDQUIST36

D:  [**2197-6-22**]  07:25
T:  [**2197-6-22**]  07:27
JOB#:  [**Job Number 18077**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Cardiac complications, not elsewhere classified,Atrial fibrillation,Primary pulmonary hypertension,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect'}


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: 

PRESENT ILLNESS: The patient is a 65-year-old
gentleman with a history of hypercholesterolemia, GERD, and
prostate cancer, who presented from the outside hospital
status post anterior ST elevation MI, status post Retivase
times two boluses with no evidence for a reperfusion as
evidenced by no changes in ST elevations.  The patient was
sent to the [**Hospital6 256**] for urgent
cardiac catheterization.

MEDICAL HISTORY: 1.  GERD.
2.  Prostate cancer.
3.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient quit smoking in [**2171**].  The
patient does not have a history of alcohol use or illicit
drug use. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Cardiac complications, not elsewhere classified,Atrial fibrillation,Primary pulmonary hypertension,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect'}
