CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: [**Age over 90 **] year old male with CAD, PVD presented to [**Location (un) 511**] [**Hospital 45759**]
Hospital on [**12-24**] with chest pain that awoke him from sleep.  He
described pain as going from shoulder to shoulder.  No
associated shortness of breath, nausea or diaphoresis.  He
called his daughter who brought him to OSH.  He has 4 to 5 month
history of similar pains which typically start while lying in
bed and resolves in [**9-26**] minutes after sitting up and
occasionally requiring sl nitroglycerin.  He states the pain has
been more frequent in the past several weeks.  It used to occur
once/month and has been occuring once/week for the past month.
     At OSH ruled in with maximum Troponin 1.67, EKG showed ST
depression with TW inversions in V3-V6, TW inversions in I, aVL,
II, III, aVF.  Diagnostic cath at OSH showed 90% distal left
main, no signifcant LAD disease, 90% mid Left circumflex, 100
proximal RCA, total occlusion of right superficial femoral
artery.  He was transferred to [**Hospital1 18**] for interventional
catheterization.

MEDICAL HISTORY: CAD s/p PCI x 2
severe PVD
hypercholesterolemia
hypothyroidism
chronic low back pain
AFib s/p ablation
s/p cholecystectomy
s/p bilateral carotid endartectomies
s/p left popliteal graft
s/p left knee arthroscopy
s/p lumbar decompression '[**34**]
s/p left leg thrombectomy

MEDICATION ON ADMISSION: Accupril 10 qd
Eccotrin 325 qd
Indur 60 qd
Lasix 40 qd
Lipitor 40 qd
MOM 30 qd prn
Plavix 75 qd
Synthroid 75 mcg
Toprol XL 75 [**Hospital1 **]
Morphine prn
Nitropaste 1" q8h

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 96.9  HR 65  BP 130/40  RR 18  98%/2L n.c.
Gen: Comfortable, no acute distress
HEENT: PERRL, EOMI, OP clear, MMM
Neck: no JVD
CV: S1, S2, RRR, 2/6 systolic murmur at base
Pulm: CTAB
Abd: (+) bowel sounds, soft, obese, nontender
Ext: bilateral venous stasis changes, no edema, warm,
well-perfused, 1+DP.
groin sites without hematoma or bruit.  Left groin ecchymosis.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: previous 30 pack-year tobacco, quit 40 yrs ago.  Occasional
EtOH.  Lives with daughter.
Subendocardial infarction, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Unspecified acquired hypothyroidism
Subendo infarct, initial,Atrial fibrillation,Crnry athrscl natve vssl,Periph vascular dis NOS,Pure hypercholesterolem,Hypothyroidism NOS
Admission Date:  [**2144-12-29**]              Discharge Date:   [**2145-1-1**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2387**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Cardiac Catheterization- Left Main Drug-Eluting Stent
Intra-arterial Balloon pump


History of Present Illness:
[**Age over 90 **] year old male with CAD, PVD presented to [**Location (un) 511**] [**Hospital 45759**]
Hospital on [**12-24**] with chest pain that awoke him from sleep.  He
described pain as going from shoulder to shoulder.  No
associated shortness of breath, nausea or diaphoresis.  He
called his daughter who brought him to OSH.  He has 4 to 5 month
history of similar pains which typically start while lying in
bed and resolves in [**9-26**] minutes after sitting up and
occasionally requiring sl nitroglycerin.  He states the pain has
been more frequent in the past several weeks.  It used to occur
once/month and has been occuring once/week for the past month.
     At OSH ruled in with maximum Troponin 1.67, EKG showed ST
depression with TW inversions in V3-V6, TW inversions in I, aVL,
II, III, aVF.  Diagnostic cath at OSH showed 90% distal left
main, no signifcant LAD disease, 90% mid Left circumflex, 100
proximal RCA, total occlusion of right superficial femoral
artery.  He was transferred to [**Hospital1 18**] for interventional
catheterization.

Past Medical History:
CAD s/p PCI x 2
severe PVD
hypercholesterolemia
hypothyroidism
chronic low back pain
AFib s/p ablation
s/p cholecystectomy
s/p bilateral carotid endartectomies
s/p left popliteal graft
s/p left knee arthroscopy
s/p lumbar decompression '[**34**]
s/p left leg thrombectomy

Social History:
previous 30 pack-year tobacco, quit 40 yrs ago.  Occasional
EtOH.  Lives with daughter.

Family History:
Non-contributory

Physical Exam:
T 96.9  HR 65  BP 130/40  RR 18  98%/2L n.c.
Gen: Comfortable, no acute distress
HEENT: PERRL, EOMI, OP clear, MMM
Neck: no JVD
CV: S1, S2, RRR, 2/6 systolic murmur at base
Pulm: CTAB
Abd: (+) bowel sounds, soft, obese, nontender
Ext: bilateral venous stasis changes, no edema, warm,
well-perfused, 1+DP.
groin sites without hematoma or bruit.  Left groin ecchymosis.

Pertinent Results:
Admission Labs:
[**2144-12-29**] 08:15PM BLOOD WBC-8.3 RBC-3.53* Hgb-11.8* Hct-32.1*
MCV-91 MCH-33.4* MCHC-36.7* RDW-13.8 Plt Ct-202
[**2144-12-29**] 08:15PM BLOOD PT-13.8* PTT-89.5* INR(PT)-1.3
[**2144-12-29**] 08:15PM BLOOD Glucose-160* UreaN-29* Creat-1.4* Na-136
K-4.5 Cl-99 HCO3-29 AnGap-13
[**2144-12-30**] 07:09PM BLOOD CK(CPK)-114
[**2144-12-30**] 07:09PM BLOOD CK-MB-4
[**2144-12-29**] 08:15PM BLOOD Calcium-8.9 Phos-2.8 Mg-2.2
.
Cardiac catheterization:
PROCEDURE DATE: [**2144-12-30**]
INDICATIONS FOR CATHETERIZATION:
NSTEMI.
Chest pain.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Successful stenting of the LMCA/LAD.
COMMENTS:
1. Limited angiography of the left coronary artery showed a 90%
distal
LMCA stenosis involving the ostial LAD and an 80% mid LCX
stenosis with
a distal LCX occlusion. The RCA was known to be occluded and not
imaged.
2. Resting hemodynamics showed central aortic hypertension.
3. Successful PTCA and stenting of the distal LMCA into the LAD
with a
3.5 mm Cypher drug-eluting stent.
.
Day of discharge labs
[**2145-1-1**] 06:45AM BLOOD WBC-9.7 RBC-3.32* Hgb-10.9* Hct-29.5*
MCV-89 MCH-32.8* MCHC-37.0* RDW-13.9 Plt Ct-179
[**2145-1-1**] 06:45AM BLOOD PT-12.4 PTT-24.8 INR(PT)-1.0
[**2145-1-1**] 06:45AM BLOOD Glucose-104 UreaN-22* Creat-1.3* Na-137
K-4.1 Cl-102 HCO3-26 AnGap-13

Brief Hospital Course:
Initial impression: [**Age over 90 **] year old female with CAD, peripheral
[**Age over 90 1106**] disease with rest chest pain. High-risk by positive
enzymes (troponin max 1.67 on [**12-24**], reference 0-0.4). ECG with
ST depressions with TWI in V3-V6, TWI in I, aVL, II, III, aVF.
Diagnostic catheterization showed 90% distal left main disease,
with no significant LAD, 90% mid left circumflex, 100% distal
left circumflex, 100% proximal right coronary artery, with left
ventriculogram EF 40%, LV mildly dilated. Inferobasal and
inferior wall akinesis, with total occlusion of RSFA. Based on
this initial catherization report, patient was transferred to
[**Hospital1 18**] for intervention. HOSPITAL COURSE BY SYSTEM:

1) Cardiovascular: Coronary angiography at [**Hospital1 18**] on [**2144-12-30**]
demonstrated LMCA 95%, distal LAD ostial 90%, left circumflex
moderate prox, 80% mid, 100% ostial RCA. Patient received a
left-main coronary artery Cypher [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 1 and was transferred to
the CCU post-catheterization for intra-aortic balloon pump to
optimize coronary hemodynamics. Patient was monitored in CCU for
1 day (where he was transfused 1 unit of packed RBCs) and
transferred back to floor, chest pain free and hemodynamically
and electrically stable, which he remained through the remainder
of his hospitalization. He was continued on his accupril,
ecotrin, imdur, lasix, lipitor, plavix, toprol XL. Plan was to
continue plavix and ASA x 9 months then ASA indefinitely.
Although patient had a history of atrial fibrillation, he was in
normal sinus rhythm for the entire admission, and coumadin was
restarted after his CCU stay for goal INR [**1-15**]. Patient will be
followed in outpatient cardiology and will have re-look cardiac
catheterization for left main disease in [**2-15**] weeks.

2) Heme: It was felt by the CCU inpatient team that the
patient's coumadin could be restarted without heparin bridge
upon discharge from CCU. He will be anticoaguled for goal INR
[**1-15**].

3) Endocrine: Continued synthroid for hypothyroidism.

5) Prophy: Anticoagulated with ASA, plavix and coumadin on
discharge. On PPI throughout.

FULL CODE

Medications on Admission:
Accupril 10 qd
Eccotrin 325 qd
Indur 60 qd
Lasix 40 qd
Lipitor 40 qd
MOM 30 qd prn
Plavix 75 qd
Synthroid 75 mcg
Toprol XL 75 [**Hospital1 **]
Morphine prn
Nitropaste 1" q8h

Discharge Medications:
1. Quinapril 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
Three (3) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*90 Tablet Sustained Release 24HR(s)* Refills:*2*
9. Warfarin 5 mg Tablet Sig: One (1) Tablet PO every other
night: alternate with 2.5mg tab.
10. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO every other
night: alternate with 5mg tab .
11. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1)
Sublingual once a day as needed for chest pain: take 1 tab every
5 mintues as needed for chest pain, up to 3 times, if no relief
call 911. .
Disp:*30 tabs* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1.non-ST elevation MI


Discharge Condition:
good. chest pain free


Discharge Instructions:
Please report chest pain, shortness of breath, palpitations, or
other medical issues to your primary physician.

You have been discharged on a new medicine called plavix. This
is to help prevent clot formation in your new stent. Please take
as prescribed below. You are also prescribed nitroglycerin to
take as needed for chest pain. Take one tab every 5 minutes, up
to 3 times, for relief of pain. If pain not relieved call 911
for emergent evaluation.


Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) **] in [**12-14**] weeks. Call [**Telephone/Fax (1) 2394**] to
schedule an appointment.

Provider: [**Name10 (NameIs) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] SURGERY (NHB)
Date/Time:[**2145-2-23**] 10:00



Completed by:[**2145-1-4**]
{'Subendocardial infarction, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Unspecified acquired hypothyroidism'}


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: chest pain

PRESENT ILLNESS: [**Age over 90 **] year old male with CAD, PVD presented to [**Location (un) 511**] [**Hospital 45759**]
Hospital on [**12-24**] with chest pain that awoke him from sleep.  He
described pain as going from shoulder to shoulder.  No
associated shortness of breath, nausea or diaphoresis.  He
called his daughter who brought him to OSH.  He has 4 to 5 month
history of similar pains which typically start while lying in
bed and resolves in [**9-26**] minutes after sitting up and
occasionally requiring sl nitroglycerin.  He states the pain has
been more frequent in the past several weeks.  It used to occur
once/month and has been occuring once/week for the past month.
     At OSH ruled in with maximum Troponin 1.67, EKG showed ST
depression with TW inversions in V3-V6, TW inversions in I, aVL,
II, III, aVF.  Diagnostic cath at OSH showed 90% distal left
main, no signifcant LAD disease, 90% mid Left circumflex, 100
proximal RCA, total occlusion of right superficial femoral
artery.  He was transferred to [**Hospital1 18**] for interventional
catheterization.

MEDICAL HISTORY: CAD s/p PCI x 2
severe PVD
hypercholesterolemia
hypothyroidism
chronic low back pain
AFib s/p ablation
s/p cholecystectomy
s/p bilateral carotid endartectomies
s/p left popliteal graft
s/p left knee arthroscopy
s/p lumbar decompression '[**34**]
s/p left leg thrombectomy

MEDICATION ON ADMISSION: Accupril 10 qd
Eccotrin 325 qd
Indur 60 qd
Lasix 40 qd
Lipitor 40 qd
MOM 30 qd prn
Plavix 75 qd
Synthroid 75 mcg
Toprol XL 75 [**Hospital1 **]
Morphine prn
Nitropaste 1" q8h

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 96.9  HR 65  BP 130/40  RR 18  98%/2L n.c.
Gen: Comfortable, no acute distress
HEENT: PERRL, EOMI, OP clear, MMM
Neck: no JVD
CV: S1, S2, RRR, 2/6 systolic murmur at base
Pulm: CTAB
Abd: (+) bowel sounds, soft, obese, nontender
Ext: bilateral venous stasis changes, no edema, warm,
well-perfused, 1+DP.
groin sites without hematoma or bruit.  Left groin ecchymosis.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: previous 30 pack-year tobacco, quit 40 yrs ago.  Occasional
EtOH.  Lives with daughter. 

### Response:
{'Subendocardial infarction, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Unspecified acquired hypothyroidism'}
