CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 68-year-old
female with a past medical history significant for type 2
diabetes, hypertension, and hyperlipidemia.  One day prior to
admission, the patient developed the gradual onset of
substernal chest pressure.  She experienced severe [**8-29**] pain
with no radiation.  She did have associated symptoms of
diaphoresis and shortness of breath.  She self-medicated with
one aspirin.  Subsequently, the patient was unable to sleep
due to persistent symptoms and progressive shortness of
breath.  She then called her neighbor who called 9-1-1.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,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,Personal history of tobacco use,Anemia, unspecified
AMI anterior wall, init,CHF NOS,Crnry athrscl natve vssl,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,History of tobacco use,Anemia NOS
Admission Date:  [**2200-3-3**]       Discharge Date:  [**2200-3-8**]

Date of Birth:   [**2131-12-24**]       Sex:  F

Service:  CARDIOLOGY

HISTORY OF THE PRESENT ILLNESS:  The patient is a 68-year-old
female with a past medical history significant for type 2
diabetes, hypertension, and hyperlipidemia.  One day prior to
admission, the patient developed the gradual onset of
substernal chest pressure.  She experienced severe [**8-29**] pain
with no radiation.  She did have associated symptoms of
diaphoresis and shortness of breath.  She self-medicated with
one aspirin.  Subsequently, the patient was unable to sleep
due to persistent symptoms and progressive shortness of
breath.  She then called her neighbor who called 9-1-1.

In the ambulance, the patient was given two sublingual
nitroglycerin and put on oxygen.  She arrived at [**Hospital1 **]
Emergency Department where her EKG revealed ST elevations in
leads V1 through lead V4 and left axis deviation.  She was
treated with Fentanyl, nitroglycerin, Integrelin, and heparin
drips.  She was subsequently transferred to [**Hospital6 1760**] for further management.

On arrival to [**Hospital3 **] Hospital, her EKG showed left axis
deviation, ST elevations in leads V1 through V4 and ST
depressions in the inferior leads.  The patient was
subsequently taken to the Catheterization Laboratory where
she was found to have a 100% proximal LAD occlusion which was
stented without complication.  She also had a mid RCA lesion
of 50% and a 40% distal RCA lesion.  Her left main coronary
artery was within normal limits.  In the Catheterization
Laboratory it was also noted that she had elevated cardiac
pressures including a capillary wedge pressure of 27.  At the
conclusion of the catheterization procedure, the patient was
stable and transferred to the CCU for observation and
management.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  The patient
was afebrile, pulse 96, blood pressure 135/80, respiratory
rate 16, 97% on 2 liters oxygen.  The patient appeared very
well, in no acute distress.  She had no carotid bruits.  Her
carotid upstroke was brisk.  She had no appreciable JVD.
Cardiac:  Holosystolic murmur at the apex and also a systolic
ejection murmur at the base.  Her S1 and S2 heart sounds were
within normal limits.  She had no gallops.  Lungs:  Clear
bilaterally anteriorly.  Abdomen:  Soft, nontender.  Groin:
Her right groin had no hematoma and no bruits.  Extremities:
Notable for trace lower extremity edema and 2+ pulses
bilaterally.  Neurologic:  Nonfocal with her motor and
sensory function grossly intact.

LABORATORY DATA:  An echocardiogram was performed which
showed a 35-40% ejection fraction.  It also showed apical
akinesis.  A subsequent chest x-ray revealed mild pulmonary
edema and cardiomegaly.  Her mediastinum was within normal
limits.

Her Chem-7 was within normal limits including her renal
function, BUN 28, and creatinine 0.8.  Her hematocrit was
29.5 which remained stable.  Her peak CK level was 3,200,
troponin I peak 1.2.

HOSPITAL COURSE:  Throughout her hospital course, her
cardiovascular status remained stable.  The patient required
no hemodynamic support.  Her heart rate and blood pressure
were treated with Lopressor and Captopril during her
admission.  These medications were titrated for a goal heart
rate in the 60s and a blood pressure goal of 120 systolic.
She was also treated with aspirin and statins.

During her hospital course, she did develop intermittent
shortness of breath consistent with congestive heart failure.
She was treated with loop diuretics which improved her
respiratory status over the course of her admission up until
discharge.  At no time did the patient develop an arrhythmia
during her hospital course and she had a signal-average EKG
performed during her admission which will be interpreted at a
later date.

Her hematocrit remained stable throughout her admission.  Due
to her history of diabetes, she was initially started on an
insulin sliding scale and subsequently changed back to her
oral home medications.  Due to her improved respiratory
status with diuresis and resolution of her pulmonary crackles
on examination, the patient was deemed stable for discharge
on the date of [**2200-3-8**].

DISCHARGE MEDICATIONS:
1.  Plavix 75 mg q.d.
2.  Atorvostatin 20 mg q.d.
3.  Aspirin 325 mg q.d.
4.  Toprol XL 50 mg q.d.
5.  Zestril 5 mg q.d.
6.  Warfarin 2 mg q.d.
7.  Glyburide 5 mg b.i.d.
8.  Avandia 4 mg b.i.d.
9.  Metformin 500 mg five pills per day, two with breakfast,
two with lunch, and one with dinner.
10. Lasix 20 mg q.d.

FOLLOW-UP:  The patient has the following appointments
scheduled:  1)  Dr. [**Last Name (STitle) 7986**], PCP, [**Name10 (NameIs) **] Tuesday, [**2200-3-11**] at
2:30 p.m.  At that time, she will need her INR and PT checked
with Coumadin dosing and a referral to see a cardiologist at
a later date.  2)  Dr. [**Last Name (STitle) 911**] at [**Hospital1 18**] scheduled for [**2200-3-21**] at 10:00 a.m.  At this time, she will need her blood
pressure and heart rate medications titrated.  She will also
need her signal-average EKG interpreted.



                   [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D.  [**MD Number(1) 422**]

Dictated By:[**Name8 (MD) 6284**]
MEDQUIST36

D:  [**2200-3-7**]  04:19
T:  [**2200-3-7**]  19:18
JOB#:  [**Job Number 49786**]


Admission Date:  [**2200-3-3**]       Discharge Date:  [**2200-3-8**]

Date of Birth:   [**2131-12-24**]       Sex:  F

Service:  CARDIOLOGY

HISTORY OF PRESENT ILLNESS:  This is a 68 year old female
with a history of type 2 diabetes, hypertension,
hyperlipidemia, who was in her usual state of health until
one day prior to admission when she developed severe
substernal chest pressure while eating.  Pain did not
radiate.  She had associated diaphoresis and shortness of
breath.  She self-medicated with one aspirin.  She was unable
to sleep due to persistent symptoms.  She called her neighbor
who subsequently called 911 and she was taken to [**Hospital3 1280**]
emergency department.  While in the ambulance she was given
two doses of sublingual nitroglycerin and given oxygen.  In
the E.D. she had an EKG which showed ST elevations in leads
V1 through V4.  She had left axis deviation.  She was treated
with fentanyl and nitro drip, Integrilin drip, heparin drip
and patient was subsequently transferred to [**Hospital1 18**] for further
management.  On arrival she was taken to the cath lab where
it was revealed she had 100% proximal LAD occlusion.  This
lesion was stented without complications.  Also in the cath
lab her pressures were measured.  This was notable for a
wedge pressure of 26, right atrial pressure 19 systolic, RV
pressure 43 systolic, PA pressure 41 systolic, 22 diastolic,
mean of 32.  Cardiac index was 2.6.  In the cath lab it was
also noted that she had a mid-RCA lesion of 50% and a distal
RCA lesion of 40%.  Systolic ejection murmur at the base.
Left main artery was clean.  Patient was transferred to the
CCU in stable condition.

PHYSICAL EXAMINATION:  On exam she was afebrile.  Vital signs
were stable.  Patient appeared very well, in no acute
distress.  She had no appreciable JVD.  Heart exam revealed a
holosystolic murmur at the base.  This murmur was also heard
at the apex.  Lungs were clear to auscultation bilaterally
anteriorly.  Abdomen was soft and nontender.  Right groin was
soft with no hematoma palpated and no bruit.  Extremities had
trace edema and 2+ pulses bilaterally.  Neuro exam was
nonfocal.  Motor and sensory functions were grossly intact.

HOSPITAL COURSE:  The [**Hospital 228**] hospital course was notable
for the development of mild fluid overload.  This occurred on
hospital day two.  She was diuresed successfully with Lasix.
During this time she had intermittent shortness of breath on
exertion.  As patient was diuresed, her respiratory status
continued to improve.  In terms of her cardiovascular status,
she remained hemodynamically stable.  She had no events on
telemetry during her hospital course.  An echo performed
during her hospital stay showed an ejection fraction of 35%
to 40%.  This echo also revealed apical akinesis, prompting
the initiation of anticoagulation.

Her hematocrit on admission was 29.8.  This remained stable
throughout her hospital admission, ranging from 28.5 to 31.
Guaiac was negative.  Due to her improving respiratory status
with diuresis, it was decided that patient was stable for
discharge.

DISCHARGE DIAGNOSES:
1.  Anterior myocardial infarction.
2.  Congestive heart failure.

DISCHARGE MEDICATIONS:
1.  Plavix 75 mg q.d.
2.  Atorvastatin 20 mg q.d.
3.  Aspirin 325 q.d.
4.  Toprol XL 50 mg q.d.
5.  Zestril 5 mg q.d.
6.  Coumadin 2 mg q.d.
7.  Glyburide 5 mg b.i.d.
8.  Avandia 4 mg b.i.d.
9.  Metformin 500 mg, five pills per day.
10. Lasix 20 mg q.d.

FOLLOWUP:  The patient has a followup appointment scheduled
with Dr. [**Last Name (STitle) 7986**], her PCP, [**Name10 (NameIs) **] Tuesday, [**3-11**], at 2:30 p.m.
At that time she will need her coagulation test rechecked and
her blood and urine cultures followed up.  She has a
cardiology followup appointment with Dr. [**Last Name (STitle) 911**] at [**Hospital1 18**] on
[**3-21**] at 10:00 a.m.





                            [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D.  [**MD Number(1) 422**]

Dictated By:[**Doctor Last Name 23886**]
MEDQUIST36

D:  [**2200-3-7**]  15:09
T:  [**2200-3-7**]  16:59
JOB#:  [**Job Number 49785**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,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,Personal history of tobacco use,Anemia, unspecified'}


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 68-year-old
female with a past medical history significant for type 2
diabetes, hypertension, and hyperlipidemia.  One day prior to
admission, the patient developed the gradual onset of
substernal chest pressure.  She experienced severe [**8-29**] pain
with no radiation.  She did have associated symptoms of
diaphoresis and shortness of breath.  She self-medicated with
one aspirin.  Subsequently, the patient was unable to sleep
due to persistent symptoms and progressive shortness of
breath.  She then called her neighbor who called 9-1-1.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,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,Personal history of tobacco use,Anemia, unspecified'}
