CHIEF COMPLAINT: AMI in cath lab folowing abnormal outpt ETT

PRESENT ILLNESS: 57 yo M hx HTN, hyperlipidemia and obesity. Pt presented with
worsening of palpitation x6 months, less frequently for several
years prior to that. Describes these as sensation of fluttering,
lasting seconds, associated with some nausea and weakness.
Denies any associated chest pain or associated with exertion.
He evaluated with outpt event monitor revealing NSVT, started on
toprol with some symptomatic improvement.
In addition he had an outpt ETT with a small reversible
anterolateral defect.
He presented today for elective cardiac cath.
While performing diagnostic cath, pt developed heavy chest pain,
nausea, palpitations. Cath revealed an evolving anterior STEMI,
initially with 80% mid LAD progressing to complete LAD occusion,
this was stented with 2 bare metal stent. A clot was noted in
1st diag., attempted IC eptifibatide, tPA, balloon dilation and
aspiration catheter, however clot persisted. Procedure performed
via R radial approach, no groin sticks were attempted.
After pt arrived in CCU, he developed an episode of nausea,
diaphoresis, blurry vision following cleaning of his groin, felt
to be a vagal reaction. BP reduced to 80's, HR remained in 80's.
BP improved to 105/69 with 500 cc NS. Pt's symptoms resolved.
EKG repeated, unchanged.
Pt currently feeling well, denies CP, SOB, nausea, diaphoresis.

MEDICAL HISTORY: HTN
Hypercholesterolemia
Obesity
Sleep apnea (could not tolerate CPAP)
NSVT
Bronchospastic airway disease
Prior history of hematuria in the late [**2126**]??????s (patient reports
being told that his hematuria might be due to "varicose veins of

MEDICATION ON ADMISSION: MEDS: [**Hospital6 33836**] Pharmacy in [**Location (un) 16843**]
Fosinopril 10mg daily every morning
Omeprazole 20mg daily every morning
Lipitor 10mg daily every morning
Toprol XL 50mg daily every morning

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: per Dr. [**Last Name (STitle) 6812**]
VS: T 97.6 BP 105/69 HR 70 RR 14 O2 96% on RA
Gen: WDWN obese middle aged male 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 premature CAD

SOCIAL HISTORY: Patient smoked 4ppd for approximately 12-13 years, quitting
about 30 years ago. Patient is married with three children. He
lives with his wife, [**Name (NI) 553**] ([**Telephone/Fax (1) 73004**]). Works as a general
contractor
Cardiac complications, not elsewhere classified,Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Surg compl-heart,AMI anterior wall, init,Parox ventric tachycard,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Hypertension NOS,Abn react-cardiac cath
Admission Date:  [**2153-6-27**]              Discharge Date:   [**2153-6-29**]

Date of Birth:  [**2096-6-8**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
AMI in cath lab folowing abnormal outpt ETT

Major Surgical or Invasive Procedure:
cardiac catheterization
echocardiogram


History of Present Illness:
57 yo M hx HTN, hyperlipidemia and obesity. Pt presented with
worsening of palpitation x6 months, less frequently for several
years prior to that. Describes these as sensation of fluttering,
lasting seconds, associated with some nausea and weakness.
Denies any associated chest pain or associated with exertion.
He evaluated with outpt event monitor revealing NSVT, started on
toprol with some symptomatic improvement.
In addition he had an outpt ETT with a small reversible
anterolateral defect.
He presented today for elective cardiac cath.
While performing diagnostic cath, pt developed heavy chest pain,
nausea, palpitations. Cath revealed an evolving anterior STEMI,
initially with 80% mid LAD progressing to complete LAD occusion,
this was stented with 2 bare metal stent. A clot was noted in
1st diag., attempted IC eptifibatide, tPA, balloon dilation and
aspiration catheter, however clot persisted. Procedure performed
via R radial approach, no groin sticks were attempted.
After pt arrived in CCU, he developed an episode of nausea,
diaphoresis, blurry vision following cleaning of his groin, felt
to be a vagal reaction. BP reduced to 80's, HR remained in 80's.
BP improved to 105/69 with 500 cc NS. Pt's symptoms resolved.
EKG repeated, unchanged.
Pt currently feeling well, denies CP, SOB, nausea, diaphoresis.



Past Medical History:
HTN
Hypercholesterolemia
Obesity
Sleep apnea (could not tolerate CPAP)
NSVT
Bronchospastic airway disease
Prior history of hematuria in the late [**2126**]??????s (patient reports
being told that his hematuria might be due to "varicose veins of

the kidneys")
GERD
Lower back pain, s/p steroid injections


Social History:
Patient smoked 4ppd for approximately 12-13 years, quitting
about 30 years ago. Patient is married with three children. He
lives with his wife, [**Name (NI) 553**] ([**Telephone/Fax (1) 73004**]). Works as a general
contractor

Family History:
no family history of premature CAD

Physical Exam:
per Dr. [**Last Name (STitle) 6812**]
VS: T 97.6 BP 105/69 HR 70 RR 14 O2 96% on RA
Gen: WDWN obese middle aged male 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 without JVD.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.


Pertinent Results:
EKG demonstrated NSR, nl axis, nl intervals + RBBB, TWi in V1,
old, no ST changes, no significant change compared with prior
dated [**2153-6-15**]
.
Admit labs:
134  97  12
------------< 248
4.4  22  0.8
Ca: 8.9 Mg: 2.1 P: 3.5
.
      15
11.9 >---< 249
      43
.
CK [**Telephone/Fax (3) 73005**]
MB [**2070-10-9**]
Cholesterol 209, Trig 124, HDL 51, LDL 133
.
Cardiac cath
1. Selective coronary angiography in this left dominant
circulation
demonstrated single vessel coronary artery disease.  The LMCA
had no
flow limiting disease.  The LAD had a mid 80% stenosis after
takeoff of
a large diagonal branch.  The D1 had no flow limiting disease.
The LCx
was a large vessel with no flow limiting disease.  The major OM
and
L-PDA had no flow limiting disease.  The RCA was a relatively
small
vessel with no flow limiting disease.
2. Opening aortic pressure was moderately elevated.
3. During the procedure, the patient developed chest pain and
had runs
of NSVT and then sinus tachycardia.  The sinus tachycardia
responded to
IV metoprolol.  Upon re-engagement of the LMCA with the guide
catheter,
the proximal to mid LAD was found to be totally occluded along
with the
D1.
4. Successful direct stenting of the LAD lesion with two 3.0
bare metal
stents. Final angiography showed no residual stenosis in the
stented
segment of the LAD with residual thrombus in the diagonal branch

unchanged with administration of IC IIb/IIIA inhibitor and
thrombolytic.
There was normal flow in the distal vessel. (See PTCA comments)

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Moderate systemic arterial hypertension.
3. Successful PCI of the LAD.
4. Residual angiographic evidence of thrombus in the diagonal
branch of
the LAD.
.
Echocardiogram:
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF 60%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. The mitral valve
leaflets are structurally normal. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. The estimated
pulmonary artery systolic pressure is normal. There is no
pericardial effusion.


Brief Hospital Course:
Pt is a 57 year old man with an abnormal ETT referred for
cardiac catheterization. Pt developed anterior STEMI during
diagnostic part of the cardiac cath.  Hospital course by
problem:
.
#) Anterior STEMI - Patient was pretreated for his dye allegy.
Evolving anterior STEMI found on cath, treated with two bare
stents to the mid LAD. Pt had persistent clot in 1st diag.  We
treated with ASA, plavix, statin, lisinopril, and beta blocker.
Integrillin peri-cath.  He was monitored in the CCU postcath
given the acute onset of the thrombus.  He did well and was
transitioned to the floor.  We recommended plavix for at least 1
month then up to 1 year or as per his outpatient cardiologist.
.
# Cards pump: Echo showed above findings.  Function preserved.
Diastolic dysfunction noted.  Meds as above.
.
# Cards Rhythm: BB, Tele.  no events
.
# Vagal: Postcath and in the CCU, patient had a vagal episode.
When his groin was examined, he developed nausea, diaphoresis,
hypotension, bradycardia.  It improved with 250cc IVF and in
short time.  There was no chest pain.  The patient was otherwise
assymptomatic.
.
#) Hyperlipidemia: high dose statin
.
#) HTN: continue BB, ACEi
.
#) Nutrition: we discussed heart healthy diet options with
patient.

Medications on Admission:
MEDS: [**Hospital6 33836**] Pharmacy in [**Location (un) 16843**]
Fosinopril 10mg daily every morning
Omeprazole 20mg daily every morning
Lipitor 10mg daily every morning
Toprol XL 50mg daily every morning


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
6. Fosinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
- STEMI: acute occlusion noted duing cadiac cath of the LAD
- HTN
- hypercholesterolemia
- obesity
Secondary:
- GERD
- hx LBP


Discharge Condition:
well


Discharge Instructions:
You came to the hospital for a cardiac catheterization.  You had
some blockages in your heart ateries and stents were placed.  We
added the following medications:
1.  Plavix: you MUST take this medication every day for the next
month.  We recommend that you take it for a year or per the
recommendation of your cardiologist.
2.  ASA 325 daily
3.  Atorvastatin increased to 80mg daily
.
Please followup with your PCP and cardiologist.  Please contact
your physicians or the [**Name (NI) **] if you experience chest pain,
abdominal pain, shortness of breath, nausea, sweating.
.
Please adhere to a low salt, low carb diet.

Followup Instructions:
Please followup with Dr. [**Last Name (STitle) 11493**] within the next 1-2 weeks.
Please followup with your PCP within the next 1-2 weeks.
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: AMI in cath lab folowing abnormal outpt ETT

PRESENT ILLNESS: 57 yo M hx HTN, hyperlipidemia and obesity. Pt presented with
worsening of palpitation x6 months, less frequently for several
years prior to that. Describes these as sensation of fluttering,
lasting seconds, associated with some nausea and weakness.
Denies any associated chest pain or associated with exertion.
He evaluated with outpt event monitor revealing NSVT, started on
toprol with some symptomatic improvement.
In addition he had an outpt ETT with a small reversible
anterolateral defect.
He presented today for elective cardiac cath.
While performing diagnostic cath, pt developed heavy chest pain,
nausea, palpitations. Cath revealed an evolving anterior STEMI,
initially with 80% mid LAD progressing to complete LAD occusion,
this was stented with 2 bare metal stent. A clot was noted in
1st diag., attempted IC eptifibatide, tPA, balloon dilation and
aspiration catheter, however clot persisted. Procedure performed
via R radial approach, no groin sticks were attempted.
After pt arrived in CCU, he developed an episode of nausea,
diaphoresis, blurry vision following cleaning of his groin, felt
to be a vagal reaction. BP reduced to 80's, HR remained in 80's.
BP improved to 105/69 with 500 cc NS. Pt's symptoms resolved.
EKG repeated, unchanged.
Pt currently feeling well, denies CP, SOB, nausea, diaphoresis.

MEDICAL HISTORY: HTN
Hypercholesterolemia
Obesity
Sleep apnea (could not tolerate CPAP)
NSVT
Bronchospastic airway disease
Prior history of hematuria in the late [**2126**]??????s (patient reports
being told that his hematuria might be due to "varicose veins of

MEDICATION ON ADMISSION: MEDS: [**Hospital6 33836**] Pharmacy in [**Location (un) 16843**]
Fosinopril 10mg daily every morning
Omeprazole 20mg daily every morning
Lipitor 10mg daily every morning
Toprol XL 50mg daily every morning

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: per Dr. [**Last Name (STitle) 6812**]
VS: T 97.6 BP 105/69 HR 70 RR 14 O2 96% on RA
Gen: WDWN obese middle aged male 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 premature CAD

SOCIAL HISTORY: Patient smoked 4ppd for approximately 12-13 years, quitting
about 30 years ago. Patient is married with three children. He
lives with his wife, [**Name (NI) 553**] ([**Telephone/Fax (1) 73004**]). Works as a general
contractor 

### Response:
{'Cardiac complications, not elsewhere classified,Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
