CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 62 year old male with
a history of hyperlipidemia who was well until the date of
admission when he noted the acute onset of chest pain at
11:30 AM while shoveling snow.  The pain was described as a
tightness, radiation to the left arm and axilla.  Nausea and
vomiting, diaphoresis, shortness of breath and dizziness were
all noted by the patient.  He called emergency medical
services and emergency medical services gave nitroglycerin,
aspirin, morphine sulfate with resolution of the pain from 10
out of 10 to 1 out of 10.  Taken to [**Hospital1 **] where
electrocardiogram was notable for 1 to [**Street Address(2) 1766**] elevations in
1, L, V1 and V3, T wave inversions in 3 and F.  The patient
was started on heparin drip, enteral feed and still with 1
out of 10 pain.  Transferred to [**Hospital6 2018**] Catheterization Laboratory.  Found to have 100% left
anterior descending with faint collaterals, 60% right
coronary artery lesion.  Cardiac index 2.1.  The patient had
stent to left anterior descending with kissing balloon
following stent to open up the diagonals.  Sent to CCU for
monitoring.  Course was complicated by supraventricular
tachycardia, self-terminated.  Chest painfree and no other
symptoms.

MEDICAL HISTORY: 1.  Hypercholesterolemia; 2.  Gastric ulcer in [**2181**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Uncle died from a heart attack at the age of
48, sister with breast cancer died three months ago.  No
history of any one on dialysis.

SOCIAL HISTORY: Married, lives with wife, history of
tobacco, quit 3 years ago.  No smoking since and no alcohol.
years.  The patient works as an emergency medical
services/fire fighter.  Walks but not regularly active.
Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia
AMI anterior wall, init,Crnry athrscl natve vssl,Pure hypercholesterolem
Admission Date:  [**2192-11-11**]       Discharge Date:  [**2192-11-14**]

Date of Birth:   [**2130-5-14**]       Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  This is a 62 year old male with
a history of hyperlipidemia who was well until the date of
admission when he noted the acute onset of chest pain at
11:30 AM while shoveling snow.  The pain was described as a
tightness, radiation to the left arm and axilla.  Nausea and
vomiting, diaphoresis, shortness of breath and dizziness were
all noted by the patient.  He called emergency medical
services and emergency medical services gave nitroglycerin,
aspirin, morphine sulfate with resolution of the pain from 10
out of 10 to 1 out of 10.  Taken to [**Hospital1 **] where
electrocardiogram was notable for 1 to [**Street Address(2) 1766**] elevations in
1, L, V1 and V3, T wave inversions in 3 and F.  The patient
was started on heparin drip, enteral feed and still with 1
out of 10 pain.  Transferred to [**Hospital6 2018**] Catheterization Laboratory.  Found to have 100% left
anterior descending with faint collaterals, 60% right
coronary artery lesion.  Cardiac index 2.1.  The patient had
stent to left anterior descending with kissing balloon
following stent to open up the diagonals.  Sent to CCU for
monitoring.  Course was complicated by supraventricular
tachycardia, self-terminated.  Chest painfree and no other
symptoms.

PAST MEDICAL HISTORY:
1.  Hypercholesterolemia; 2.  Gastric ulcer in [**2181**].

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Lipitor 10 q. day, on transfer from the outside
hospital medications were enteral feeds, heparin, aspirin and
nitroglycerin drip.

FAMILY HISTORY:  Uncle died from a heart attack at the age of
48, sister with breast cancer died three months ago.  No
history of any one on dialysis.

SOCIAL HISTORY:  Married, lives with wife, history of
tobacco, quit 3 years ago.  No smoking since and no alcohol.
years.  The patient works as an emergency medical
services/fire fighter.  Walks but not regularly active.

PHYSICAL EXAMINATION:  Vital signs:  Heart rate 75, blood
pressure 135/60, respirations 14, 95% on room air.  General:
Lying in bed in no acute distress.  Head, eyes, ears, nose
and throat:  Jugulovenous pressure flat.  Pupils equal, round
and reactive to light.  Extraocular movements intact. No
carotid bruits.   Cardiovascular:  Regular rate and rhythm,
no murmurs, rubs or gallops.  Lungs:  Clear to auscultation
bilaterally.  Abdomen:  Soft, nontender, nondistended and
bowel sounds present.  Extremities:  No cyanosis, clubbing or
edema.  Cool extremities.  2+ dorsalis pedis and posterior
tibial.  Right red cheek.  Neurological:  Alert and oriented
times three.  Cranial nerves II through XII grossly intact.

LABORATORY DATA:  Outside hospital laboratory data:  Sodium
137, potassium 2.9, chloride 100, bicarbonate 22, BUN 33,
creatinine 1.3, glucose 137, white blood cell count 10.7,
hematocrit 44.7, platelets 407, INR 0.9.  Arterial blood
gases at [**Hospital6 256**], pH 7.5, pACO2
22, pAO2 92, sating 98% on 2 liters of nasal cannula.
Laboratory data at [**Hospital6 256**] 2:30
PM:  White blood cell count 15.7, hematocrit 39.1, platelets
343, INR 1.5, PT 15, PTT 107.  Sodium 143, potassium 3.9,
chloride 110, bicarbonate 19, BUN 23, creatinine 0.2, glucose
138.  Electrocardiogram at outside hospital:  Normal sinus
rhythm at 60, normal axis, interval.  ST elevation in 1, V1
through V4.  No Qs, T wave inversions in 3 and F.  Cardiac
catheterization showed right atrial pressures of 13/11/9,
right ventricular pressures of 44/13.  PA 44/17/29, pulmonary
capillary wedge 26/29/22, aortic 121/65/72, cardiac output
4.8, cardiac index 2.1.  SVR 1050, PVR 117, proximal RCA 70%,
mid RCA 60%, mid LAD 100% within collaterals.  EM jailed
apparent procedure requiring kissing balloon:  Good outcome.
Cardiac catheterization complicated by supraventricular
tachycardia, self-terminated after procedure.  Conclusion:
1.  Left ventricular cavity small dilated, left ventricular
systolic function is moderately depressed, anterior
subsequent hypokinesis, akinesis present.  2.  Aortic valve
leaflets were mildly thickened.  3.  Mitral valve leaflets
were mildly thickened.

HOSPITAL COURSE:
1.  Cardiovascular - Ischemia, the patient was directly taken
to the Cardiac Catheterization Laboratory from the Emergency
Department.  In the Cardiac Catheterization Laboratory the
patient had Hepacoat stent to the left anterior descending
with post dilatation to 3.5 with kissing balloon placed in
the diagonal, 2.5 mm balloon.  The patient also had an
episode of AIVR which was self-limiting after the procedure
was done.  The patient was transferred t the CCU for further
monitoring on ................... for 18 hours and then
Plavix.  Procedure done in the Cardiac Catheterization was
complicated by intermittent supraventricular tachycardia and
intermittent left bundle.  Their recommendation was to
consider stent his right coronary artery in the near future.
The patient did well in the CCU and had an echocardiogram
done the following morning to evaluate cardiac ejection
fraction.  Echocardiogram results were as stated above.  The
patient was transferred to the floor the day after admission
to the CCU.  The patient was started on beta blocker, ACE
inhibitors and statin.  Beta blocker and ACE inhibitor were
titrated up as tolerated by blood pressure and heart rate.
The patient was subsequently discharged on the following
cardiac medication regimen:  Aspirin 325 mg q. day, Plavix 75
mg q. day, Atorvastatin 20 mg p.o. q. day, Atenolol 50 mg
p.o. q. day, and Lisinopril 20 mg p.o. q. day.

Pump, the patient's subsequent injection fraction was noted
to be approximately 35%.  Our goals while in the CCU were to
keep the patient even slightly negative.  Prn Lasix was used
to obtain this goal with good results.

Rhythm, no further Telemetry events were noted in the CCU or
on the floors.  He was in normal sinus rhythm throughout the
remainder of his stay.

It was the recommendation of the team that the patient follow
up with electrophysiology in the future for possible
consideration of implantable cardioverter defibrillator given
the patient's low ejection fraction.  No anticoagulation was
administered on this admission.  The patient is to have a
repeat echocardiogram in approximately four to six weeks for
reassessment of cardiac function.  The patient is also to
have an outpatient stress in six weeks for further evaluation
of this 70% right coronary artery lesion.

2.  Hyperlipidemia - The patient was placed on Atorvastatin.

3.  Fluids, electrolytes and nutrition - The patient was
placed on a cardiac healthy diet low fiber/cholesterol.
Nutrition consult was obtained for further teaching.

4.  Prophylaxis - Ambulation was recommended to patient.
Physical therapy was also consulted and the recommendation
was that the patient be discontinued home with outpatient
cardiac rehabilitation.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSIS:
1.  Anterior myocardial infarction, status post left anterior
descending stent.
2.  Hyperlipidemia.
3.  Ischemic cardiomyopathy.

MEDICATIONS ON DISCHARGE:
1.  Aspirin 325 mg q. day.
2.  Plavix 75 mg q. day.
3.  Atorvastatin 20 mg q. day.
4.  Atenolol 50 mg q. day.
5.  Lisinopril 20 mg q. day.

FOLLOW UP PLANS:
1.  The patient is to follow up with primary care physician,
[**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 53718**] to arrange follow up in one to two weeks,
he is to call [**Telephone/Fax (1) 2394**] to schedule an appointment.
2.  The patient is to have an appointment with cardiologist,
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**2192-11-16**], Friday.
3.  The patient discussed with cardiologist regarding having
a repeat echocardiogram and stress test in four to six weeks.



                            [**Doctor First Name 900**] [**Name8 (MD) 901**], M.D.  [**MD Number(1) 2144**]

Dictated By:[**Last Name (NamePattern1) 9622**]
MEDQUIST36

D:  [**2193-2-5**]  22:13
T:  [**2193-2-6**]  06:42
JOB#:  [**Job Number 53719**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia'}


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: This is a 62 year old male with
a history of hyperlipidemia who was well until the date of
admission when he noted the acute onset of chest pain at
11:30 AM while shoveling snow.  The pain was described as a
tightness, radiation to the left arm and axilla.  Nausea and
vomiting, diaphoresis, shortness of breath and dizziness were
all noted by the patient.  He called emergency medical
services and emergency medical services gave nitroglycerin,
aspirin, morphine sulfate with resolution of the pain from 10
out of 10 to 1 out of 10.  Taken to [**Hospital1 **] where
electrocardiogram was notable for 1 to [**Street Address(2) 1766**] elevations in
1, L, V1 and V3, T wave inversions in 3 and F.  The patient
was started on heparin drip, enteral feed and still with 1
out of 10 pain.  Transferred to [**Hospital6 2018**] Catheterization Laboratory.  Found to have 100% left
anterior descending with faint collaterals, 60% right
coronary artery lesion.  Cardiac index 2.1.  The patient had
stent to left anterior descending with kissing balloon
following stent to open up the diagonals.  Sent to CCU for
monitoring.  Course was complicated by supraventricular
tachycardia, self-terminated.  Chest painfree and no other
symptoms.

MEDICAL HISTORY: 1.  Hypercholesterolemia; 2.  Gastric ulcer in [**2181**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Uncle died from a heart attack at the age of
48, sister with breast cancer died three months ago.  No
history of any one on dialysis.

SOCIAL HISTORY: Married, lives with wife, history of
tobacco, quit 3 years ago.  No smoking since and no alcohol.
years.  The patient works as an emergency medical
services/fire fighter.  Walks but not regularly active. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia'}
