CHIEF COMPLAINT: Substernal chest pain

PRESENT ILLNESS: The patient is a 73 year old male with a history of CAD s/p 2
prior MIs but no CABG or stents, history of 35-40 years of
tobacco with COPD, HTN and HL who presented to [**Hospital3 **]
via ambulance on [**2122-1-24**] after experiencing [**10-31**] substernal
chest pain. The patient had been getting ready for bed when he
experienced nausea and vomiting x  diaphoresis and shortness of
breath. He then experienced [**10-31**] substernal chest pain that was
similar to his prior angina but much more severe. The pain
radiated down his left arm. He took 2 SL nitros at home without
relief and his wife called 911 and thus taken by ambulance to
[**Hospital3 **]. In the ambulance, he was in atrial fibrillation
and then suffered a vfib arrest and was shocked three times and
went into torsades. The patient was then loaded with 150 mg IV
amio and started on an amio gtt. At [**Hospital1 46**], he was found to have
2-[**Street Address(2) 2051**] elevations V2-V6. He was placed on Aggrastat, Plavix,
Lopressor, Amio gtt at 1 mg, nitro gtt and morphine and Mg 2 mg.
^The nitro was increased to 70 mcg/hr and the patient states he
became pain free. He was transferred to [**Hospital1 18**] for cath.

MEDICAL HISTORY: CAD s/p 2 prior MIs with medical management
HTN
COPD with h/o blebs and spontaneous pneumothoraceses
Anorectal carcinoma with guaiac positive stool

MEDICATION ON ADMISSION: Oxycontin 80 mg [**Hospital1 **]
Norvasc 5 mg PO QD
Plavix 75 mg
Celebrex 200 mg [**Hospital1 **]
Pepcid 40 mg [**Hospital1 **]
Resotril 30 mg QHS
Flonase
Serevent
Flovent
ventalin
Imdur 30 mg QD

ALLERGIES: Shellfish

PHYSICAL EXAM: Tc=97 P=70  BP=120/70 RR=16 97% on 2 liters O2

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient lives with his wife. [**Name (NI) **] walks with a cane at
baseline. He admits to a history of tobacco use ( quit 25 years
ago) and used to smoke 1 ppd x 35-40 years. He denies any EtOH,
IV or illicit drug use. However, he does use chronic oxycontin
and suffers "withdrawal" symptoms when he doesn't get his fixed
doses.
Acute myocardial infarction of other anterior wall, initial episode of care,Ventricular fibrillation,Congestive heart failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus
AMI anterior wall, init,Ventricular fibrillation,CHF NOS,Gastrointest hemorr NOS,Chr airway obstruct NEC,Crnry athrscl natve vssl,Old myocardial infarct,Hypertension NOS,Hx-rectal & anal malign
Admission Date:  [**2122-1-25**]              Discharge Date:   [**2122-1-28**]

Date of Birth:  [**2048-11-15**]             Sex:   M

Service: MEDICINE

Allergies:
Shellfish

Attending:[**Known firstname 134**]
Chief Complaint:
Substernal chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization on [**2122-1-24**]:
EF 45%
Cypher stent to mid LAD

History of Present Illness:
The patient is a 73 year old male with a history of CAD s/p 2
prior MIs but no CABG or stents, history of 35-40 years of
tobacco with COPD, HTN and HL who presented to [**Hospital3 **]
via ambulance on [**2122-1-24**] after experiencing [**10-31**] substernal
chest pain. The patient had been getting ready for bed when he
experienced nausea and vomiting x  diaphoresis and shortness of
breath. He then experienced [**10-31**] substernal chest pain that was
similar to his prior angina but much more severe. The pain
radiated down his left arm. He took 2 SL nitros at home without
relief and his wife called 911 and thus taken by ambulance to
[**Hospital3 **]. In the ambulance, he was in atrial fibrillation
and then suffered a vfib arrest and was shocked three times and
went into torsades. The patient was then loaded with 150 mg IV
amio and started on an amio gtt. At [**Hospital1 46**], he was found to have
2-[**Street Address(2) 2051**] elevations V2-V6. He was placed on Aggrastat, Plavix,
Lopressor, Amio gtt at 1 mg, nitro gtt and morphine and Mg 2 mg.
^The nitro was increased to 70 mcg/hr and the patient states he
became pain free. He was transferred to [**Hospital1 18**] for cath.

Cardiac Cath [**2122-1-24**]:
EF 45%, no MR, anterolateral, apical and inferoapical akinesis
CO 4.6, CI 2.89
LVEDP 33, RA 13, PCW 22, PA 42/21

Left-dominant system
Normal LMCA, 95% distal LAD, 70% OM2, small and non-dominant RCA

ROS: occasional BRBPR with guaiac positive stool, no
hematuria/hemetemesis

Past Medical History:
CAD s/p 2 prior MIs with medical management
HTN
COPD with h/o blebs and spontaneous pneumothoraceses
Anorectal carcinoma with guaiac positive stool

Social History:
The patient lives with his wife. [**Name (NI) **] walks with a cane at
baseline. He admits to a history of tobacco use ( quit 25 years
ago) and used to smoke 1 ppd x 35-40 years. He denies any EtOH,
IV or illicit drug use. However, he does use chronic oxycontin
and suffers "withdrawal" symptoms when he doesn't get his fixed
doses.

Family History:
Noncontributory.

Physical Exam:
Tc=97 P=70  BP=120/70 RR=16 97% on 2 liters O2

Gen - Anxious, AOX3
HEENT - PERLA, wears glasses, EOMI, no JVD
Heart - Irregular, no M/R/G
Lungs - CTAB
Abdomen - Soft, NT, no masses or hepatosplenomegaly, active BS
Ext - No C/C/E, right groin no hematoma or bruits, +2 d. pedis
bilaterally


Pertinent Results:
[**2122-1-25**] 10:16PM   CK(CPK)-3932*
[**2122-1-25**] 10:16PM   CK-MB-56* MB INDX-1.4
[**2122-1-25**] 10:16PM   HCT-32.4*
[**2122-1-25**] 03:41PM   GLUCOSE-115* UREA N-20 CREAT-0.9 SODIUM-140
POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-25 ANION GAP-14
[**2122-1-25**] 03:41PM   CK(CPK)-3158*
[**2122-1-25**] 03:41PM   CK-MB-81* MB INDX-2.6
[**2122-1-25**] 03:41PM   CALCIUM-8.4 PHOSPHATE-3.1 MAGNESIUM-2.2
[**2122-1-25**] 03:41PM   WBC-8.5 RBC-3.88* HGB-11.6* HCT-33.5* MCV-86
MCH-29.8 MCHC-34.5 RDW-15.7*
[**2122-1-25**] 03:41PM   PLT COUNT-126*
[**2122-1-25**] 04:44AM   HCT-32.6*
[**2122-1-25**] 01:28AM   GLUCOSE-137* UREA N-17 CREAT-1.0 SODIUM-137
POTASSIUM-3.8 CHLORIDE-106 TOTAL CO2-25 ANION GAP-10
[**2122-1-25**] 01:28AM   CK(CPK)-2127*
[**2122-1-25**] 01:28AM   CK-MB-83* MB INDX-3.9
[**2122-1-25**] 01:28AM   CALCIUM-8.4 PHOSPHATE-2.4* MAGNESIUM-2.3
[**2122-1-25**] 01:28AM   WBC-6.5 RBC-3.92* HGB-11.1* HCT-33.5* MCV-85
MCH-28.4 MCHC-33.3 RDW-16.1*
[**2122-1-25**] 01:28AM   PLT COUNT-137*
[**2122-1-25**] 12:00AM   TYPE-ART PO2-74* PCO2-45 PH-7.36 TOTAL CO2-26
BASE XS-0
[**2122-1-25**] 01:28AM   PT-13.6 PTT-39.3* INR(PT)-1.2
[**2122-1-25**] 12:00AM   HGB-10.8* calcHCT-32 O2 SAT-96

Cardiology Report ECG Study Date of [**2122-1-28**]  7:22:58 AM


Sinus rhythm with PACs
Extensive T wave changes suggest myocardial infarct
Since previous tracing of [**2122-1-27**], QT interval decreased

ECHO Study Date of [**2122-1-27**]

Left Ventricle - Ejection Fraction: 30% (nl >=55%)
 Conclusions:
The left atrium is normal in size. Left ventricular wall
thicknesses are
normal. The left ventricular cavity size is normal. Overall left
ventricular
systolic function is moderately depressed with akinesis of the
distal septum
and apex and severe hypokinesis of the inferior and
infero-lateral walls. The
basal anterior, antero-septal and lateral walls move best. Right
ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3)
are mildly thickened but aortic stenosis is not present. Trace
aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There
is no mitral valve prolapse. Mild (1+) mitral regurgitation is
seen. There is
borderline pulmonary artery systolic hypertension. There is no
pericardial
effusion.

IMPRESSION: Moderate regional LV systolic dysfunction c/w
multivessel CAD.

C.CATH Study Date of [**2122-1-24**]

COMMENTS:
1. Selective coronary angiography revealed a left dominant
system with
two vessel CAD. The LMCA had no angiographic evidence of
coronary artery
disease. The LAD had a discrete distal 95% stenosis, which was
stented
(see below).  The LCX was large and dominant.  It gave off a
large OM1
branch and a large OM 2 branch. The OM2 branch had a 70%
stenosis
proximally. The RCA was small and non-dominant. It did not have
any
angiographically apparent CAD.
2. Hemodynamics performed after the intervention revealed
elevated left
and right heart pressures and a preserved cardiac index.
3. Left ventriculography revealed anterolateral, apical and
inferoapical
akinesis.  There was no mitral regurgitation. Calculated EF was
44%.
4. Successful direct stenting of the mid-LAD with a 3.0 x 18 mm
Cypher
DES. Final angiography revealed no residual stenosis, no
apparent
dissection, and TIMI 3 flow (see PTCA comments).
5. Successful closure of the right common femoral arteriotomy
with a 6
French Angioseal device.

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Mild systolic and diastolic ventricular dysfunction.
3. Acute myocardial infarction treated by primary PCI with
placement of
a drug-eluting stent in the mid-LAD.
4. Successful Angioseal.


Brief Hospital Course:
The patient is a 73 year old male with a history of CAD s/p 2
prior MIs with HTN and COPD who presented with an anterior STEMI
c/b vfib arrest

1. CAD
- The patient had suffered a large anterior STEMI complicated by
V. fib arrest in the ambulance ride to the hospital. He had a
Cypher stent placed to his mid-LAD and suffered no more chest
pain.
-The patient was originally started on ASA, aggrastat, Plavix
and a statin. He was also placed on heparin due to akinesis of
the apex. However, the patient developed a subsequent voluminous
GI bleed and required 2 units of blood. He had reported bright
red blood per rectum as an outpatient given his history of
rectal carcinoma. As a result, the aggrastat and heparin were
discontinued. Although the patient would benefit from coumadin
due to his akinetic apex, it was decided not to initiate
long-term anticoagulation as he did not tolerate this well. He
should have a repeat echo in 4 weeks to reassess his wall motion
and EF.
- He was placed on metoprolol 25 mg [**Hospital1 **] and Lisinopril 5 mg.

2. CHF EF 45%
- The patient remained euvolemic during his stay.
- He had a repeat echo on [**2122-1-27**] which showed persistent
akinesis of the distal septum and apex with an EF of 30%.
- He was started on an ACE for cardiac remodeling.

3. HTN
- The patient takes Norvasc 5 mg and Imdur 30 mg at home. We
started Metoprolol 25 mg [**Hospital1 **] and Lisinopril 5 mg. His systolic
blood pressure on presentation was in the 120s but remained in
the 100s during the rest of his stay. He denied feeling dizzy or
lightheaded and did well with PT.

4. COPD
- The patient has a history of spontaneous pneumothoraces
secondary to bullous lung disease. We continued the patient's
outpatient inhaler regimen. He remained stable.

5. Gastrointestinal bleed
- The morning after presentation on aggrastat and heparin as
well as plavix, the patient developed a large acute GIB with
bright red blood per rectum. He denied any abdominal pain. The
heparin and aggrastat were discontinued and he was transfused
with 2 units of blood. The patient has a history of anorectal
carcinoma s/p chemo and radiation in [**2113**]. GI and surgery were
consulted and both recommended conservative management. The
patient states that he had a reportedly normal colonoscopy 2
months ago at an outside hospital ([**Doctor First Name 8125**]). However, we felt that
his GI bleed was either from recurrent anorectal carcinoma or
radiation proctitis. The patient will need another colonoscopy
soon to confirm this. He also reports a recent 12 pound weight
loss.
- The patient thereafter, reported no GI bleeds and remained
hemodynamically stable.

6. Non-sustained ventricular tachycardia
- The patient had runs of NSVT on telemetry during his stay. He
also exhibited atrial ectopic activity on EKG giving an
irregular heart beat. Given his low EF, EP was asked to evaluate
the patient for a question of an ICD. However, EP felt that he
required a full GI workup to determine if he had recurrent
rectal carcinoma and if so, determine his prognosis before they
implanted an ICD with mortality benefits in the year following
an MI. This would require an inpatient repeat colonoscopy. The
patient decided against staying in the hospital to have a
complete GI workup as he recently had a colonoscopy at [**Doctor First Name 8125**].
Instead, the patient decided to meet with Dr. [**Last Name (STitle) 174**], his
outpatient cardiologist early the following week to discuss
whether an ICD should be placed.

7. Dispo - The patient was seen by PT who recommended home PT.
The patient qualifies for [**Hospital3 **] free care and case management
believed he would benefit from outpatient rehabilitation.


Medications on Admission:
Oxycontin 80 mg [**Hospital1 **]
Norvasc 5 mg PO QD
Plavix 75 mg
Celebrex 200 mg [**Hospital1 **]
Pepcid 40 mg [**Hospital1 **]
Resotril 30 mg QHS
Flonase
Serevent
Flovent
ventalin
Imdur 30 mg QD

Discharge Medications:
1. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 30 days.
Disp:*30 Tablet(s)* Refills:*9*
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Oxycodone HCl 40 mg Tablet Sustained Release 12HR Sig: Two
(2) Tablet Sustained Release 12HR PO Q12H (every 12 hours).
4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain.
Disp:*30 Tablet, Sublingual(s)* Refills:*0*
6. Temazepam 15 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
Disp:*60 Capsule(s)* Refills:*2*
7. Salmeterol Xinafoate 50 mcg/Dose Disk with Device Sig: [**11-23**]
Disk with Devices Inhalation Q12H (every 12 hours).
Disp:*1 Disk with Device(s)* Refills:*2*
8. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 inhaler* Refills:*2*
9. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Albuterol Sulfate 0.083 % Solution Sig: 1-2 puffs Inhalation
Q6H (every 6 hours) as needed.
Disp:*1 inhaler* Refills:*2*
11. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
12. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. outpatient  rehabilitation


Discharge Disposition:
Home

Discharge Diagnosis:
myocardial infarction
v.fib arrest
testicular mass
lower Gi bleed


Discharge Condition:
good

Discharge Instructions:
Continue your medications as listed on the next page. Do not
stop your plavix or aspirin unless you have spoken to your
cardiologist

Please return to the hospital or call your doctor if you have
chest pain or shortness of breath or blood in your stool or if
there are any concerns at all

Followup Instructions:
Please follow up with your PCP within the next two weeks. PCP:
[**Name10 (NameIs) 60341**],[**Name11 (NameIs) **] [**Name Initial (NameIs) **] [**Telephone/Fax (1) 60342**].

Please follow up with your gastroenterologists within a month of
your discharge

Please follow up with your cardiologsit, Dr. [**Last Name (STitle) 174**] by next week.
He will discuss with you regarding the rhythm of your heart and
the possibility of a defibrillation
{'Acute myocardial infarction of other anterior wall, initial episode of care,Ventricular fibrillation,Congestive heart failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}


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: Substernal chest pain

PRESENT ILLNESS: The patient is a 73 year old male with a history of CAD s/p 2
prior MIs but no CABG or stents, history of 35-40 years of
tobacco with COPD, HTN and HL who presented to [**Hospital3 **]
via ambulance on [**2122-1-24**] after experiencing [**10-31**] substernal
chest pain. The patient had been getting ready for bed when he
experienced nausea and vomiting x  diaphoresis and shortness of
breath. He then experienced [**10-31**] substernal chest pain that was
similar to his prior angina but much more severe. The pain
radiated down his left arm. He took 2 SL nitros at home without
relief and his wife called 911 and thus taken by ambulance to
[**Hospital3 **]. In the ambulance, he was in atrial fibrillation
and then suffered a vfib arrest and was shocked three times and
went into torsades. The patient was then loaded with 150 mg IV
amio and started on an amio gtt. At [**Hospital1 46**], he was found to have
2-[**Street Address(2) 2051**] elevations V2-V6. He was placed on Aggrastat, Plavix,
Lopressor, Amio gtt at 1 mg, nitro gtt and morphine and Mg 2 mg.
^The nitro was increased to 70 mcg/hr and the patient states he
became pain free. He was transferred to [**Hospital1 18**] for cath.

MEDICAL HISTORY: CAD s/p 2 prior MIs with medical management
HTN
COPD with h/o blebs and spontaneous pneumothoraceses
Anorectal carcinoma with guaiac positive stool

MEDICATION ON ADMISSION: Oxycontin 80 mg [**Hospital1 **]
Norvasc 5 mg PO QD
Plavix 75 mg
Celebrex 200 mg [**Hospital1 **]
Pepcid 40 mg [**Hospital1 **]
Resotril 30 mg QHS
Flonase
Serevent
Flovent
ventalin
Imdur 30 mg QD

ALLERGIES: Shellfish

PHYSICAL EXAM: Tc=97 P=70  BP=120/70 RR=16 97% on 2 liters O2

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient lives with his wife. [**Name (NI) **] walks with a cane at
baseline. He admits to a history of tobacco use ( quit 25 years
ago) and used to smoke 1 ppd x 35-40 years. He denies any EtOH,
IV or illicit drug use. However, he does use chronic oxycontin
and suffers "withdrawal" symptoms when he doesn't get his fixed
doses. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Ventricular fibrillation,Congestive heart failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus'}
