CHIEF COMPLAINT: S/P cath for NSTEMI - 90% L Main Ostial Lesion stented.  In CCU
[**12-21**] dementia, mod AS and close monitoring.

PRESENT ILLNESS: HPI: 85 yo F h/o unstable angina with multiple past admissions
to [**Hospital3 3583**], moderate AS, hypercholesterolemia, past
smoker, COPD, CRI, H/O TIA, Dementia, Anemia, AAA, GERD (? h/o
GIB) presents on Tx from [**Hospital3 **] where she presented for
Chest Pain and SOB from NH - found to have NSTEMI.  On
presentation here, seen by CT surgery and poor [**Doctor First Name **] candidate,
so taken to cath here.  Pt now s/p cath with stenting of 90%
ostial L Main lesion with resolution of ST changes post-cath.
Doing well.

MEDICAL HISTORY: HTN
hypercholesterolemia
CRI
COPD
Dementia
H/O TIA
?SSS
Anemia
GERD with ? h/o GIB
OA
AAA found incidentally on cath today

MEDICATION ON ADMISSION: All: PCN, shellfish, PCN, sulfa, aleve, risperidol
On tx - lovenox, IV nitro, Lopressor 12.5 [**Hospital1 **]
also, zyprexa, fluoxetine, mirtazapine, lorazepam, albuterol INH

ALLERGIES: Shellfish / Sulfa (Sulfonamides) / Penicillins / Levofloxacin

PHYSICAL EXAM: V: AF, 142/57, 51, 18, 99%
G: Sleeping, NAD, arousable easily
H: Pupils reactive, NCAT, no LAD, transmitted murmur in carotids
C: RRR, III/VI SEM (cresc/decresc) at RUSB transmitted to LUSB.
No axillary murmur appreciated.  No JVD.
L: Clear laterally and anteriorly
A: Soft, NT, No masses, decr BS
E: Groin with sheath in no bleeding, no hematoma, 2+ DP, 1+ PT
bilaterally. Good cap refill - L foot cooler than R (cath on R).
N: grossly non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: 50 pk-yr h/o tobacco - quit 5 yrs ago
Lives in [**Location **].  Husband died of MI at age 59.
Unspecified disorder of kidney and ureter,Esophageal reflux,Personal history of tobacco use,Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve stenosis,Iron deficiency anemia secondary to blood loss (chronic),Chronic airway obstruction, not elsewhere classified,Other persistent mental disorders due to conditions classified elsewhere,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension
Renal & ureteral dis NOS,Esophageal reflux,History of tobacco use,Subendo infarct, initial,Crnry athrscl natve vssl,Mitral insuf/aort stenos,Chr blood loss anemia,Chr airway obstruct NEC,Mental disor NEC oth dis,Abdom aortic aneurysm,Hypertension NOS
Admission Date:  [**2141-9-15**]              Discharge Date:   [**2141-9-17**]


Service: MEDICINE

Allergies:
Shellfish / Sulfa (Sulfonamides) / Penicillins / Levofloxacin

Attending:[**First Name3 (LF) 45**]
Chief Complaint:
S/P cath for NSTEMI - 90% L Main Ostial Lesion stented.  In CCU
[**12-21**] dementia, mod AS and close monitoring.


Major Surgical or Invasive Procedure:
Cardiac catheterization with stent placement


History of Present Illness:
HPI: 85 yo F h/o unstable angina with multiple past admissions
to [**Hospital3 3583**], moderate AS, hypercholesterolemia, past
smoker, COPD, CRI, H/O TIA, Dementia, Anemia, AAA, GERD (? h/o
GIB) presents on Tx from [**Hospital3 **] where she presented for
Chest Pain and SOB from NH - found to have NSTEMI.  On
presentation here, seen by CT surgery and poor [**Doctor First Name **] candidate,
so taken to cath here.  Pt now s/p cath with stenting of 90%
ostial L Main lesion with resolution of ST changes post-cath.
Doing well.


Past Medical History:
HTN
hypercholesterolemia
CRI
COPD
Dementia
H/O TIA
?SSS
Anemia
GERD with ? h/o GIB
OA
AAA found incidentally on cath today

Social History:
50 pk-yr h/o tobacco - quit 5 yrs ago
Lives in [**Location **].  Husband died of MI at age 59.


Family History:
Non-contributory


Physical Exam:
V: AF, 142/57, 51, 18, 99%
G: Sleeping, NAD, arousable easily
H: Pupils reactive, NCAT, no LAD, transmitted murmur in carotids
C: RRR, III/VI SEM (cresc/decresc) at RUSB transmitted to LUSB.
No axillary murmur appreciated.  No JVD.
L: Clear laterally and anteriorly
A: Soft, NT, No masses, decr BS
E: Groin with sheath in no bleeding, no hematoma, 2+ DP, 1+ PT
bilaterally. Good cap refill - L foot cooler than R (cath on R).
N: grossly non-focal


Pertinent Results:
Echo [**9-15**]:
Aortic Valve Area: *1.0 cm2 /  EF 50%
The left atrium is mildly dilated. Left ventricular wall
thicknesses and cavity size are normal. There is mild regional
left ventricular systolic dysfunction with focal hypokinesis of
the distal inferior wall. The remaining segments contract well.
[Intrinsic left ventricular systolic function may be more
depressed given the severity of valvular regurgitation.] Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets are mildly thickened. There is moderate
aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. At least moderate
(2+) mitral regurgitation is seen. The pulmonary artery systolic
pressure could not be quantified. There is no pericardial
effusion.
IMPRESSION: Moderate aortic valve stenosis. Regional left
ventricular systolic dysfunction c/w CAD.
..
Cath [**9-15**]:
COMMENTS:
1. Selective coronary angiography revealed a LEFT dominant
system with severe left main CAD. The vessels all had moderate
calcification. The LMCA was short and calcified. It had an
ostial 90% stenosis.  The LAD had a 50% proximal stenosis and
appeared to have aneurysmal dilatation both before and after
this stenosis. The remainder of the LAD had mild luminal
irregularities only. The LCX had mild luminal irregularities
only.  The RCA was non-dominat with no significant disease.
2. Hemodynamics revealed severely elevated left heart filling
pressures and moderately elevated right heart filling pressures.
There was mild pulmonary hypertension. The cardiac output and
index were preserved.
3. Assessment of the aortic valve revealed a 15-18mm Hg peak
aortic
gradient with a a valve area of 1.2cm2, consistent with moderate
aortic stenosis.
4. Left ventriculography was not performed.
5. Of note, there appeared to be an aneurysm in the abdominal
aorta
which meant that it was difficult to pass the J-wire up. A magic
torque wire was used. The aneurysm could well precluded IABP
use.
6. The patient's sheaths were sewn in place and she was taken
off the
table pending consideration of possible cardiac surgery. If she
is
refused this option, attempt to stent the LMCA may be done.
FINAL DIAGNOSIS:
1. Two vessel (left main) coronary artery disease.
2. Moderate aortic stenosis.
3. Mild mitral regurgitation.
4. Severe diastolic ventricular dysfunction.
5. Abdominal aortic aneurysm.

[**2141-9-15**] 11:00PM   POTASSIUM-4.5
[**2141-9-15**] 11:00PM   CK(CPK)-76
[**2141-9-15**] 11:00PM   PLT COUNT-257
[**2141-9-15**] 06:19PM   GLUCOSE-182* UREA N-20 CREAT-1.1 SODIUM-140
POTASSIUM-4.5 CHLORIDE-106 TOTAL CO2-25 ANION GAP-14
[**2141-9-15**] 06:19PM   CK(CPK)-93
[**2141-9-15**] 06:19PM   CK-MB-7 cTropnT-0.55*
[**2141-9-15**] 06:19PM   CALCIUM-8.8 PHOSPHATE-3.5 MAGNESIUM-1.7
[**2141-9-15**] 06:19PM   WBC-5.0 RBC-3.88* HGB-10.5* HCT-31.7* MCV-82
MCH-27.2 MCHC-33.2 RDW-14.8
[**2141-9-15**] 06:19PM   PLT COUNT-261
[**2141-9-15**] 10:44AM   TYPE-ART O2 FLOW-2 PO2-69* PCO2-39 PH-7.40
TOTAL CO2-25 BASE XS-0 INTUBATED-NOT INTUBA COMMENTS-NASAL [**Last Name (un) 154**]

Brief Hospital Course:
This 85 yo female was transferred from [**Hospital3 **] for
NSTEMI following at least one week history of chest pain.  At
[**Hospital1 18**], patient underwent cardiac catheterization and had stent
placement of left main coronary artery.  Of note, an AAA was
also found at the time of catheterization.  Following stent
placement, the patient was started on aspirin and Plavix, as
well as 80mg atorvastatin, 12.5mg metoprolol, and 10mg
lisinopril.  It is recommended that her blood pressure
medications be titrated for target BP of 125/75.  The patient
also underwent a TTE, which revealed moderated aortic stenosis,
mild mitral regurgitation, regional left ventricular systolic
dysfunction consistent with CAD, 50% ejection fraction.  The
patient did not exhibit any further EKG changes or chest pain
following stent placement.  Cardiac enzymes trended down with a
peak CK of 93, 55 on day of discharge.  The patient was
monitored on telemetry, noted to have some ectopy, electrolytes
were monitored without any need for replacement.    The patient
was noted to have a history of anemia upon admission, and
required one unit of PRBCs to maintain a target hematocrit of
>30.  The patient's daughter was [**Name (NI) 653**] prior to discharge to
discuss the need for follow-up with the patient's cardiologist
within 1-2 weeks.  In addition, the patient may need to undergo
repeat catheterization in [**1-22**] months to evaluate for further
disease.  In addition, the patient will need to have her
creatinine monitored due to her history of chronic renal
insufficiency, and a noted elevation in her creatinine thought
to be secondary to insult from catheterization dye.  It is
recommended that the creatinine be rechecked no later than the
Tuesday following discharge.  The patient maintained good urine
output throughout hospitalization, and did not require any IVF
as she was able to maintain adequate po intake.
        The patient was continued on Zyprexa for her history of
dementia, and a sitter was provided when necessary to ensure
patient safety.  The patient was also continued on her albuterol
inhaler PRN for her history of COPD and was maintained on a PPI
for GI protection, as well as subcutaneous heparin for DVT
prophylaxis.  Following catheterization, the patient was
restarted on and tolerated well a low sodium, heart healthy
diet.  In addition, the patient was evaluated by physical
therapy prior to discharge, it was recommended that patient
would benefit from PT at nursing home, with no acute issues
found.  The patient's daughter was [**Name (NI) 653**] on the day of
discharge and informed of the follow-up that the patient would
require, and was agreeable to schedule the necessary
appointments.


Medications on Admission:
All: PCN, shellfish, PCN, sulfa, aleve, risperidol
On tx - lovenox, IV nitro, Lopressor 12.5 [**Hospital1 **]
also, zyprexa, fluoxetine, mirtazapine, lorazepam, albuterol INH

Discharge Medications:
1. Isosorbide Dinitrate 20 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed.
5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Mirtazapine 15 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
10. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
11. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for angina.
12. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**11-20**]
Puffs Inhalation Q6H (every 6 hours) as needed for shortness of
breath or wheezing.
14. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
15. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Increase as tolerated for goal blood pressure of
125/75.


Discharge Disposition:
Extended Care

Facility:
Evanswood Center for Older Adults - [**Location (un) 8072**]

Discharge Diagnosis:
NSTEMI with stent placement in left main coronary
Aortic Stenosis
COPD
Dementia
Anemia secondary to blood loss
Chronic renal insufficiency
Hypertension
AAA- found during cardiac cath


Discharge Condition:
Good- patient hemodynamically stable, chest pain free.


Discharge Instructions:
We have started you on a new medication called Plavix for your
heart disease, you must take this medication and an aspirin
every day.  Please continue to take all of your medications as
instructed.  Please return to the hospital if you develop chest
pain, shortness of breath, fever, or chills.  You will need to
have your creatinine checked on Tuesday, and will need to
follow-up with Dr. [**Last Name (STitle) 5310**] and Dr. [**Last Name (STitle) 41415**] within the next two
weeks.
You should have your ACE inhibitor increase over the next few
months with a target blood pressure of 125/75.

Followup Instructions:
You will need to have your creatinine checked no later than
Tuesday to evaluate your renal function.  In addition, you will
need to have follow-up with Dr. [**Last Name (STitle) 5310**] within one week.
Please call [**Telephone/Fax (1) 5315**] to schedule an appointment.  Also,
please make an appointment with Dr. [**Last Name (STitle) 41415**] within the next two
weeks, call [**Telephone/Fax (1) 61767**].
Chest CT done at other hospital revealed nodules (8mm in RLL and
14mm in LLL) in your lungs, the significance of these is
unknown, and may need to be followed up with additional imaging.
 Please discuss this with your primary care doctor.  Because you
had a stent placed in your left main coronary artery, you should
discuss with your cardiologist about a repeat angiography within
3-6 months to ensure optimal blood flow.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**Doctor First Name 63**]
{'Unspecified disorder of kidney and ureter,Esophageal reflux,Personal history of tobacco use,Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve stenosis,Iron deficiency anemia secondary to blood loss (chronic),Chronic airway obstruction, not elsewhere classified,Other persistent mental disorders due to conditions classified elsewhere,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension'}


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: S/P cath for NSTEMI - 90% L Main Ostial Lesion stented.  In CCU
[**12-21**] dementia, mod AS and close monitoring.

PRESENT ILLNESS: HPI: 85 yo F h/o unstable angina with multiple past admissions
to [**Hospital3 3583**], moderate AS, hypercholesterolemia, past
smoker, COPD, CRI, H/O TIA, Dementia, Anemia, AAA, GERD (? h/o
GIB) presents on Tx from [**Hospital3 **] where she presented for
Chest Pain and SOB from NH - found to have NSTEMI.  On
presentation here, seen by CT surgery and poor [**Doctor First Name **] candidate,
so taken to cath here.  Pt now s/p cath with stenting of 90%
ostial L Main lesion with resolution of ST changes post-cath.
Doing well.

MEDICAL HISTORY: HTN
hypercholesterolemia
CRI
COPD
Dementia
H/O TIA
?SSS
Anemia
GERD with ? h/o GIB
OA
AAA found incidentally on cath today

MEDICATION ON ADMISSION: All: PCN, shellfish, PCN, sulfa, aleve, risperidol
On tx - lovenox, IV nitro, Lopressor 12.5 [**Hospital1 **]
also, zyprexa, fluoxetine, mirtazapine, lorazepam, albuterol INH

ALLERGIES: Shellfish / Sulfa (Sulfonamides) / Penicillins / Levofloxacin

PHYSICAL EXAM: V: AF, 142/57, 51, 18, 99%
G: Sleeping, NAD, arousable easily
H: Pupils reactive, NCAT, no LAD, transmitted murmur in carotids
C: RRR, III/VI SEM (cresc/decresc) at RUSB transmitted to LUSB.
No axillary murmur appreciated.  No JVD.
L: Clear laterally and anteriorly
A: Soft, NT, No masses, decr BS
E: Groin with sheath in no bleeding, no hematoma, 2+ DP, 1+ PT
bilaterally. Good cap refill - L foot cooler than R (cath on R).
N: grossly non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: 50 pk-yr h/o tobacco - quit 5 yrs ago
Lives in [**Location **].  Husband died of MI at age 59. 

### Response:
{'Unspecified disorder of kidney and ureter,Esophageal reflux,Personal history of tobacco use,Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve stenosis,Iron deficiency anemia secondary to blood loss (chronic),Chronic airway obstruction, not elsewhere classified,Other persistent mental disorders due to conditions classified elsewhere,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension'}
