CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 87 y.o woman with past medical history significant for
hypertension, hyperlipidemia and ischemic colitis who presents
with a [**First Name3 (LF) **].  The patient woke up this morning and felt unwell,
with a sensation of fullness in her chest.  She then felt
nauseous and then started developing frank pain that was in the
centre of her chest and radiating to her back.
.
She was brought to the [**Hospital1 **] [**Location (un) 620**] ED where her EKG was
significant for ST elevations in II, II, V2-V6 and reciprocal
depression in aVR.  The patient was transferred then from [**Hospital1 **]
[**Location (un) 620**] to [**Hospital1 18**] for emergent cardiac catherization.  The
catherization was complicated initially with dissection of the
right femoral artery.  Angiography demonstrated a thrombus in
the LAD.  However with wiring, the procedure was then
complicated by dissection of the LAD as well.  Balloon
angioplasty was performed up and down the LAD with no stent
placed.
.
On review of systems, she denies any past history of chest pain
or MI.  Her functional status is excellent and is able to walk
up several flights of stairs without difficulty.  No history of
asthma, COPD or stroke.

MEDICAL HISTORY: Hypertension
Hypothyroid
GERD
Ischemic colitis
Diverticulosis
Anemia

MEDICATION ON ADMISSION: levothyroxine 50mg daily
omeprazole 20mg daily
Iron (unknown dose)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:

FAMILY HISTORY: Positive for all 4 of her brothers having [**Name2 (NI) **].  Her father
passed away from an MI at the age of 61.

SOCIAL HISTORY: Lives with her husband in a condominium.  She is independent in
all of her ADLs and IADLs.  Has 4 children.
-Tobacco history:  Denies
-ETOH:  Denies
-Illicit drugs:  Denies
Acute myocardial infarction of other anterior wall, initial episode of care,Dissection of coronary artery,Hematoma complicating a procedure,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Other constipation,Diverticulosis of colon (without mention of hemorrhage),Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified misadventures during medical care
AMI anterior wall, init,Dissection cor artery,Hematoma complic proc,Surg compl-heart,Hypertension NOS,Hypothyroidism NOS,Esophageal reflux,Constipation NEC,Dvrtclo colon w/o hmrhg,Abn react-cardiac cath,Medical misadventure NEC
Admission Date:  [**2105-5-28**]              Discharge Date:   [**2105-6-2**]


Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1515**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization with balloon angioplasty


History of Present Illness:
87 y.o woman with past medical history significant for
hypertension, hyperlipidemia and ischemic colitis who presents
with a [**First Name3 (LF) **].  The patient woke up this morning and felt unwell,
with a sensation of fullness in her chest.  She then felt
nauseous and then started developing frank pain that was in the
centre of her chest and radiating to her back.
.
She was brought to the [**Hospital1 **] [**Location (un) 620**] ED where her EKG was
significant for ST elevations in II, II, V2-V6 and reciprocal
depression in aVR.  The patient was transferred then from [**Hospital1 **]
[**Location (un) 620**] to [**Hospital1 18**] for emergent cardiac catherization.  The
catherization was complicated initially with dissection of the
right femoral artery.  Angiography demonstrated a thrombus in
the LAD.  However with wiring, the procedure was then
complicated by dissection of the LAD as well.  Balloon
angioplasty was performed up and down the LAD with no stent
placed.
.
On review of systems, she denies any past history of chest pain
or MI.  Her functional status is excellent and is able to walk
up several flights of stairs without difficulty.  No history of
asthma, COPD or stroke.


Past Medical History:
Hypertension
Hypothyroid
GERD
Ischemic colitis
Diverticulosis
Anemia

Social History:
Lives with her husband in a condominium.  She is independent in
all of her ADLs and IADLs.  Has 4 children.
-Tobacco history:  Denies
-ETOH:  Denies
-Illicit drugs:  Denies

Family History:
Positive for all 4 of her brothers having [**Name2 (NI) **].  Her father
passed away from an MI at the age of 61.


Physical Exam:
Admission Exam:

General: Well appearing woman in NAD, AAOx3
Heent: Sclerae anicteric.  EOMI.  JVP not elevated.  No carotid
bruits.
CV: Regular rate and rhythm, [**2-1**] blowing systolic murmur
radiating to apex. Obscured S1, normal S2.  No rubs or gallops.
Pulmonary: Clear to auscultation bilaterally.
Abdomen: Soft, non-tender, non distended.  Bowel sounds present.
Groin: Introducer sheath in right inguinal region with 1cm of
sheath extending out.  Small hematoma.
Extremities: No edema.  2+ radial and dorsalis pedis pulses
throughout.

Discharge Exam :


Pertinent Results:
ECHO ([**5-29**]): The left atrium is normal in size. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. LV ejection fraction (50 percent) is
borderline/mildly depressed secondary to akinesis of the apex
and hypokinesis of the apical half of the anterior free wall and
anterior septum. The basal half of the inferior, posterior, and
lateral walls are hyperdynamic. Right ventricular chamber size
and free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets are moderately thickened.
There is mild aortic valve stenosis (valve area 1.2-1.9cm2; not
quantitated due to difficulty obtaining a clear left ventricular
outflow tract flow velocity spectrum). Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. There is no
pericardial effusion.


Brief Hospital Course:
ACTIVE ISSUES:
#[**Name (NI) **] -
Pt was transfered from [**Hospital1 **] [**Location (un) 620**] with EKG showing evidence of
ST elevations in I, II, V2-V5 with reciprocal change in AVR.
Cardiac enzymes were CK: 227, CKMB: 12.5, Trop-T: 0.172. At
[**Hospital1 18**], pt had cardiac catheterization which was complicated by
dissected LAD. Balloon angioplasty was performed, no stent
placed. Procedure also complicationed by R. femoral artery
dissection and R. groin hematoma. Cardiac enzymes trended down.
Patient was medically managed and started on aspirin, plavix,
metoprolol, nitro drip, and heparin. Echo showed LVEF of 50%
with hypokinesesis of apical half of anterior free wall and
anterior septum. At time of discharge she had been chest pain
free for 3 days and was stable on a medication regimen including
ASA, plavix, metoprolol, Imdur, and lisinopril. She will follow
up with DR. [**Last Name (STitle) **] in cardiology.
.
#rhythm - stable in sinus rhythm
.
#femoral artery dissection - Patient developed R. groin
hematoma. When sheath was pulled had difficulty achieving
hemostasis. C-clamp was required for 15-30 minutes. HCTs
remained stable. No transfusions were required. Distal pulses
intact. At time of discharge ecchymosis of R. groin resolving
and hematoma decreasing in size.
.
CHRONIC ISSUES:
#hypothyroid: stable. continued on home dose of levothyroxine
.
#GERD: stable. continued on home dose of omeprazole.
.
TRANSITIONAL ISSUES:
#R. groin hematoma - Follow up with PCP to examine hematoma for
resolution


Medications on Admission:
levothyroxine 50mg daily
omeprazole 20mg daily
Iron (unknown dose)

Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
primary diagnosis
- ST elevation myocardial infarction
- hematoma (right groin)

secondary diagnosis
- hypothyroidism


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.



Completed by:[**2105-6-4**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Dissection of coronary artery,Hematoma complicating a procedure,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Other constipation,Diverticulosis of colon (without mention of hemorrhage),Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified misadventures during medical care'}


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: 87 y.o woman with past medical history significant for
hypertension, hyperlipidemia and ischemic colitis who presents
with a [**First Name3 (LF) **].  The patient woke up this morning and felt unwell,
with a sensation of fullness in her chest.  She then felt
nauseous and then started developing frank pain that was in the
centre of her chest and radiating to her back.
.
She was brought to the [**Hospital1 **] [**Location (un) 620**] ED where her EKG was
significant for ST elevations in II, II, V2-V6 and reciprocal
depression in aVR.  The patient was transferred then from [**Hospital1 **]
[**Location (un) 620**] to [**Hospital1 18**] for emergent cardiac catherization.  The
catherization was complicated initially with dissection of the
right femoral artery.  Angiography demonstrated a thrombus in
the LAD.  However with wiring, the procedure was then
complicated by dissection of the LAD as well.  Balloon
angioplasty was performed up and down the LAD with no stent
placed.
.
On review of systems, she denies any past history of chest pain
or MI.  Her functional status is excellent and is able to walk
up several flights of stairs without difficulty.  No history of
asthma, COPD or stroke.

MEDICAL HISTORY: Hypertension
Hypothyroid
GERD
Ischemic colitis
Diverticulosis
Anemia

MEDICATION ON ADMISSION: levothyroxine 50mg daily
omeprazole 20mg daily
Iron (unknown dose)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam:

FAMILY HISTORY: Positive for all 4 of her brothers having [**Name2 (NI) **].  Her father
passed away from an MI at the age of 61.

SOCIAL HISTORY: Lives with her husband in a condominium.  She is independent in
all of her ADLs and IADLs.  Has 4 children.
-Tobacco history:  Denies
-ETOH:  Denies
-Illicit drugs:  Denies 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Dissection of coronary artery,Hematoma complicating a procedure,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Other constipation,Diverticulosis of colon (without mention of hemorrhage),Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified misadventures during medical care'}
