CHIEF COMPLAINT: chest pain.

PRESENT ILLNESS: 48 y/o Portugese speaking male pmhx significant for htn, DMII,
hypercholesterolemia, CAD with MI three years prior presenting
from [**Location (un) 47**] [**Hospital3 1280**] after L circumflex stent placement
for STEMI.
Pt presented to [**Hospital3 1280**] with left arm pain, sob, and chest
pain. 12 lead EKG demonstrated St elevations lat. leads. Upon
cath, Lcirc 100% occluded, 80% PDA, 91% RCA. Unable to balloon
RCA, PDA. tight diagnol also found, in addition to RCA and PDA
lesions. IABP placed. After cath records report pt to be
complaining of chest pain. Pt sent to [**Hospital1 18**] for repeat cath,
receiving ASA, plavix, integrillin.

MEDICAL HISTORY: MI [**2103**] - no interventions per patient.
Htn
Hypercholesterolemia
DMII

MEDICATION ON ADMISSION: Medications on transfer:
Aspirin 325
Atorvastatin 80
Clopidogrel Bisulfate 75
Eptifibatide 2 mcg/kg/min IV drip
Heparin SC
Insulin sliding scale
Oxycodone-Acetaminophen 1-2 tabs prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals- 97.2, 71, 145/88, 13, 100% 2L NC
General-male in no acute distress laying flat on bed with son at
bedside
[**Name (NI) 67943**], no injection, mucous membranes moist
CV-diminished heart sounds, Regular rhythm, no murmurs noted
Abdomen-soft, non tender, non distended
Lungs-Clear anteriorly
extr-warm well perfused, 1+ DP pulses. no C/C/E

FAMILY HISTORY: Father with MI in 60's
hx of htn, diabetes in family

SOCIAL HISTORY: 38 pack/ yr smoking hx. Denies alcohol or illicit drug use
Acute myocardial infarction of unspecified site, initial episode of care,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Old myocardial infarction,Family history of ischemic heart disease,Tobacco use disorder
AMI NOS, initial,Status-post ptca,Crnry athrscl natve vssl,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Old myocardial infarct,Fam hx-ischem heart dis,Tobacco use disorder
Admission Date:  [**2106-7-12**]              Discharge Date:   [**2106-7-16**]

Date of Birth:  [**2057-11-23**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1436**]
Chief Complaint:
chest pain.

Major Surgical or Invasive Procedure:
cardiac cath with stent placement at Framinham [**Hospital3 1280**].


History of Present Illness:
48 y/o Portugese speaking male pmhx significant for htn, DMII,
hypercholesterolemia, CAD with MI three years prior presenting
from [**Location (un) 47**] [**Hospital3 1280**] after L circumflex stent placement
for STEMI.
Pt presented to [**Hospital3 1280**] with left arm pain, sob, and chest
pain. 12 lead EKG demonstrated St elevations lat. leads. Upon
cath, Lcirc 100% occluded, 80% PDA, 91% RCA. Unable to balloon
RCA, PDA. tight diagnol also found, in addition to RCA and PDA
lesions. IABP placed. After cath records report pt to be
complaining of chest pain. Pt sent to [**Hospital1 18**] for repeat cath,
receiving ASA, plavix, integrillin.


Past Medical History:
MI [**2103**] - no interventions per patient.
Htn
Hypercholesterolemia
DMII


Social History:
38 pack/ yr smoking hx. Denies alcohol or illicit drug use


Family History:
Father with MI in 60's
hx of htn, diabetes in family


Physical Exam:
vitals- 97.2, 71, 145/88, 13, 100% 2L NC
General-male in no acute distress laying flat on bed with son at
bedside
[**Name (NI) 67943**], no injection, mucous membranes moist
CV-diminished heart sounds, Regular rhythm, no murmurs noted
Abdomen-soft, non tender, non distended
Lungs-Clear anteriorly
extr-warm well perfused, 1+ DP pulses. no C/C/E


Pertinent Results:
[**2106-7-12**] 07:47PM   WBC-14.4* RBC-5.82 HGB-15.1 HCT-43.2 MCV-74*
MCH-25.9* MCHC-34.9 RDW-14.1
[**2106-7-12**] 07:47PM   CK-MB-329* MB INDX-6.4* cTropnT-15.30*
[**2106-7-12**] 07:47PM   CK(CPK)-5163*

EKG [**2106-7-13**] Normal sinus rhythm. RSR' pattern in lead V1,
probable normal variant.

Cath- [**2106-7-10**]- Lcirc 100% occluded, 80% PDA, 91% RCA. Unable to
balloon RCA, PDA. tight diagnol also found, in addition to RCA
and PDA lesions.
.
TTE [**2106-7-13**]:
LA: normal in size. No atrial septal defect is seen by 2D or
color Doppler. LV: wall thicknesses and cavity size are normal.
Overall left ventricular systolic function is mildly depressed
with lateral wall hypokinesis (on some views basal inferior
appears hypokinetic as well). EF 40-45%. No masses or thrombi
are seen in the left ventricle. RV: chamber size and free wall
motion are normal.
Aortic valve: leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. No aortic valve
stenosis. There is a small pericardial effusion. There are no
echocardiographic signs of tamponade.


Brief Hospital Course:
48 y/o male with STEMI, s/p cath and stent placement in L circ,
with residual stenosis apparently in the Ramus intermedius after
PTCA, chest pain free off aortic balloon pump, with stable BP in
100's/70's in CCU.
.
 Cath at outside hospital performed on [**2106-7-10**] with L circ 100%
occluded, 80% PDA, 91% RCA. Unable to balloon RCA, PDA. tight
diagnol also found, in addition to RCA and PDA lesions. The pt
was referred to [**Hospital1 18**] as he had continued to have chest pain
despite the interventions, however at [**Hospital1 18**] pt denied any chest
pain/pressure. Films were reviewed with interventionalists and
pt appeared to have sufficient TIMI flow past tight Diag s/p
POBA. Therefore no acute indication for further intervention was
found. Pt was continued on ASA, BB, plavix, statin, ACE-I
started to decrease afterload. Integrillin x 18 hours and hep
gtt. Metoprolol was increase to 50 mg qd for better bp control.
Pump- TTE demonstrated EF of 40 to 45% with lat wall HK but
otherwise normal. Intra-aortic balloon pump d/c'd on [**2106-7-13**] as
pt had appropriate hemodynamics. No valvular disease by echo.
Maintained on telemetry. Stable throughout admission until
discharge with no intervention needed.


Medications on Admission:
Medications on transfer:
Aspirin 325
Atorvastatin 80
Clopidogrel Bisulfate 75
Eptifibatide 2 mcg/kg/min IV drip
Heparin SC
Insulin sliding scale
Oxycodone-Acetaminophen 1-2 tabs prn

Medications prior to admission:
Brazilian medications


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*90 Tablet(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*1*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*3*
4. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
hold if SBP<100.
Disp:*60 Tablet(s)* Refills:*2*
6. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
7. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1)
Sublingual q 5 minutes as needed for chest pain: up to three
tablets if no relief call 911.
Disp:*30 tab* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
ST elevation MI, with L circumflex stent placement and possible
residual stenosis in the ramus intermedius.


Discharge Condition:
stable


Discharge Instructions:
Please continue to take all medications and attend all follow-up
appointments as directed. You MUST take aspirin and plavix every
day without missing a dose since you have had a stent. If you
miss a dose, you are at risk of having a severe heart attack.

If you have any chest pain, shortness of breath or any other
concerning symptoms, please call your doctor immediately or go
to the emergency room.

Followup Instructions:
Cardiology follow- up with Dr. [**Last Name (STitle) 6254**], Heart Center [**Hospital 3856**].
[**7-29**], 9:00 AM. If questions or to confirm, call [**Telephone/Fax (1) 6256**]

Primary Care follow up with Dr. [**Last Name (STitle) 67944**], [**Hospital1 67945**].
Wellness Center [**Location (un) **]. Tuesday [**8-10**]. Will call pt with
earlier date if possible. Questions or to confirm. Please call
[**Telephone/Fax (1) 12295**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Old myocardial infarction,Family history of ischemic heart disease,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: 48 y/o Portugese speaking male pmhx significant for htn, DMII,
hypercholesterolemia, CAD with MI three years prior presenting
from [**Location (un) 47**] [**Hospital3 1280**] after L circumflex stent placement
for STEMI.
Pt presented to [**Hospital3 1280**] with left arm pain, sob, and chest
pain. 12 lead EKG demonstrated St elevations lat. leads. Upon
cath, Lcirc 100% occluded, 80% PDA, 91% RCA. Unable to balloon
RCA, PDA. tight diagnol also found, in addition to RCA and PDA
lesions. IABP placed. After cath records report pt to be
complaining of chest pain. Pt sent to [**Hospital1 18**] for repeat cath,
receiving ASA, plavix, integrillin.

MEDICAL HISTORY: MI [**2103**] - no interventions per patient.
Htn
Hypercholesterolemia
DMII

MEDICATION ON ADMISSION: Medications on transfer:
Aspirin 325
Atorvastatin 80
Clopidogrel Bisulfate 75
Eptifibatide 2 mcg/kg/min IV drip
Heparin SC
Insulin sliding scale
Oxycodone-Acetaminophen 1-2 tabs prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals- 97.2, 71, 145/88, 13, 100% 2L NC
General-male in no acute distress laying flat on bed with son at
bedside
[**Name (NI) 67943**], no injection, mucous membranes moist
CV-diminished heart sounds, Regular rhythm, no murmurs noted
Abdomen-soft, non tender, non distended
Lungs-Clear anteriorly
extr-warm well perfused, 1+ DP pulses. no C/C/E

FAMILY HISTORY: Father with MI in 60's
hx of htn, diabetes in family

SOCIAL HISTORY: 38 pack/ yr smoking hx. Denies alcohol or illicit drug use 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Percutaneous transluminal coronary angioplasty status,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Old myocardial infarction,Family history of ischemic heart disease,Tobacco use disorder'}
