CHIEF COMPLAINT: chest pain, inferior/posterior MI

PRESENT ILLNESS: 52 yo female, with no significant PMH, presented to OSH with a
few hours of chest pain.  She states that the pain was [**11-12**],
associated with SOB, and feeling of bilateral arm heaviness.
Thinking it was acid reflux/indigestion, she took tums which
provided no relief.  She reports associated nausea, but denies
vomiting, diaphoresis, abdominal pain.  She denied every having
pain like this in the past.  She denies PND/orthopnea, states
that she gets intermittent swelling of her LE.  She went to OSH
where EKG showed STE in inferior leads.  She was given retevase
x 2 for thrombolysis, (7pm, 7:40 pm), loaded with [**Last Name (LF) **], [**First Name3 (LF) **],
started on heparin gtt, and transferred here for further
management.  On arrival here, she was pain free, and EKG was
without ST elevations.

MEDICAL HISTORY: Hypercholesteremia
Depression
Psoriasis

MEDICATION ON ADMISSION: Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile   115/43   64  20  97% RA
Gen: very pleasant female, NAD
HEENT: PERRL, OP clear, no bruits or JVD
Lungs: CTA bilaterally, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Extr: no c/c/e, PT 2+ bilaterally
Neuro: grossly intact

FAMILY HISTORY: Father with CABG in 70's, DM
Mother [**Name (NI) 19477**] DM, MI in her 70's

SOCIAL HISTORY: Lives alone, has grown son
Social EtOH
1 ppd x 20 yrs
Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Tobacco use disorder
AMI inferopost, initial,Crnry athrscl natve vssl,Pure hypercholesterolem,Tobacco use disorder
Admission Date:  [**2153-5-8**]              Discharge Date:   [**2153-5-11**]

Date of Birth:  [**2100-12-13**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7055**]
Chief Complaint:
chest pain, inferior/posterior MI

Major Surgical or Invasive Procedure:
Cardiac Catheterization with stenting of right coronary artery


History of Present Illness:
52 yo female, with no significant PMH, presented to OSH with a
few hours of chest pain.  She states that the pain was [**11-12**],
associated with SOB, and feeling of bilateral arm heaviness.
Thinking it was acid reflux/indigestion, she took tums which
provided no relief.  She reports associated nausea, but denies
vomiting, diaphoresis, abdominal pain.  She denied every having
pain like this in the past.  She denies PND/orthopnea, states
that she gets intermittent swelling of her LE.  She went to OSH
where EKG showed STE in inferior leads.  She was given retevase
x 2 for thrombolysis, (7pm, 7:40 pm), loaded with [**Last Name (LF) **], [**First Name3 (LF) **],
started on heparin gtt, and transferred here for further
management.  On arrival here, she was pain free, and EKG was
without ST elevations.


Past Medical History:
Hypercholesteremia
Depression
Psoriasis


Social History:
Lives alone, has grown son
Social EtOH
1 ppd x 20 yrs

Family History:
Father with CABG in 70's, DM
Mother [**Name (NI) 19477**] DM, MI in her 70's

Physical Exam:
VS: afebrile   115/43   64  20  97% RA
Gen: very pleasant female, NAD
HEENT: PERRL, OP clear, no bruits or JVD
Lungs: CTA bilaterally, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Extr: no c/c/e, PT 2+ bilaterally
Neuro: grossly intact

Pertinent Results:
[**2153-5-8**] 08:00PM   cTropnT-<0.01
[**2153-5-8**] 08:00PM   WBC-11.6* RBC-4.30 HGB-14.1 HCT-40.5 MCV-94
MCH-32.7* MCHC-34.8 RDW-12.6
[**2153-5-8**] 08:00PM   NEUTS-74.3* LYMPHS-21.0 MONOS-3.5 EOS-0.9
BASOS-0.3
[**2153-5-8**] 08:00PM   PLT COUNT-435
[**2153-5-8**] 08:00PM   PT-13.5 PTT-56.0* INR(PT)-1.1

CK peak=216, Tnt peak=0.84

EKG from OSH: STE in II, III, AVF with reciprocal ST depressions
in V2
EKG on arrival: resolution of above changes

Cardiac Catheterization:
90% ulcerated plaque of proximal RCA, Cypher Drug eluting stent
placed
LVEDP=28mm Hg

TTE post catheterization: EF=55%, mild LA enlargement, mild
focal inferior hypokinesis, no pericardial effusion, no valvular
abnormalities

Brief Hospital Course:
1.  CAD: Evidence of inferior posterior MI on EKG, s/p
thrombolysis at OSH (2 doses of retavase).  EKG on arrival here
was without any ST elevations, and she was pain free.  She
likely had a MI that was aborted by thrombolytic therapy.  On
admission, she was maintained on a heparin drip, aspirin, and
[**Year/Month/Day 4532**].  She was taken to catheterization the next morning, and
she was found to have a 90% proximal, ulcerated right coronary
artery lesion.  A cypher drug eluting stent was placed.
Post-procedure, she was started on Metoprolol and Lisinopril
(titrated up as blood pressure allowed.  She was pain free after
intervention and discharged to continue on [**Year/Month/Day **], [**Year/Month/Day **] (for 9
months), Lisinopril, Toprol, and Lipitor.  Her peak CK was 216
with a peak tnt=0.84 (were trending down at time of discharge).
Her fasting lipid profile was checked revealing a total
cholesterol of 246, TG of 152, LDL of 167, and HDL of 49.  Liver
function tests were also checked and were within normal limits.
HbA1C was checked and was pending at time of discharge (glucose
was within normal limits on daily labs).  She was also
encouraged to stop smoking upon discharged.  She was discharged
to follow up with her Cardiologist.  She will need cardiac
rehabilitation and further lifestyle modification.

2.  Pump/CHF: TTE was checked after catheterization showing
EF=55% with mild LA enlargement, mild focal inferior
hypokinesis, and no valvular abnormalities.  She had a small
amount of peripheral edema at time of discharge but was
auto-diuresing (negative by Ins/Outs recorded).

3.  Rhythm: No arrhythmias were noted on telemetry.

4.  Hypercholesterolemia: as above, fasting lipids were checked,
and she was started on 80 mg of lipitor (LFT's were within
normal limits).  She will need monitoring of her liver function,
and she was advised of the possible side effect of
myalgias/myositis with this medication.

5.  Tobacco abuse: she was directed to stop smoking at time of
discharge.  She may need tobacco replacement (nicotine patch) to
facilitate this.  This can be addressed with her PCP.

6.  Disposition: She was discharged in good condition, and she
will follow up with her cardiologist, Dr. [**Last Name (STitle) 47242**].  She will
need Cardiac Rehabilitation as well as ongoing lifestyle
modification.  She will need Liver function monitoring (given
initiation of Lipitor) and Creatinine checks (given initiation
of her lisinopril).

Medications on Admission:
Multivitamin

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*8*
3. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*2*
5. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
6. Cardiac Rehabilitation


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1.  Acute Inferior-posterior MI
Secondary Diagnoses:
1.  Hypercholesterolemia
2.  Tobacco use

Discharge Condition:
Good

Discharge Instructions:
1.  Please take all your medications exactly as described in
this discharge paperwork.  We made the following changes to your
medication regimen:
    - We added Toprol XL 50 mg daily, a medication to help with
your heart and blood pressure
    - Lisinopril 2.5 mg daily, a medication to help with your
heart and blood pressure
    - Lipitor 80 mg daily, a medication to help lower your
cholesterol. You must get your liver function tested regularly
while on this medication.  In addition, you should let your
doctor know if you are experiencing muscle aches/pains while on
this medication.
    - We added [**Last Name (STitle) **] 75 mg daily (to be taken for 9 months) and
Aspirin 325 mg (to be taken indefinitely).  These medications
help to thin your blood and prevent clots from forming in your
new cardiac stents.  You must take these every day, or you risk
death/recurrent hear attack.

2.  Please follow up with your cardiologist as described below.

3.  Please call your doctor if you are experiencing chest pain,
shortness of breath, fever, chills, dizziness, lightheadedness,
or with any other concerns.

Followup Instructions:
Please call your Cardiologist, Dr. [**Last Name (STitle) 47242**] ([**Telephone/Fax (1) 60485**]) to
schedule an appointment within 1-2 weeks of discharge.  She will
need to monitor your Liver function tests while you are on
Lipitor. In addition, she may want to increase your doses of
Toprol and Lisinopril.  Finally, your creatinine and potassium
should be checked while on this medication.

You need to stop smoking, and strategies for this can be
discussed with your primary cardiologist.

You will need to undergo cardiac rehabilitation, and this can be
arranged via your cardiologist as well.

Do not return to work until you follow up with Dr. [**Last Name (STitle) 47242**]
(likely not for at least 1 month).  Avoid heavy lifting or
strenous exertion.
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Tobacco use disorder'}


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, inferior/posterior MI

PRESENT ILLNESS: 52 yo female, with no significant PMH, presented to OSH with a
few hours of chest pain.  She states that the pain was [**11-12**],
associated with SOB, and feeling of bilateral arm heaviness.
Thinking it was acid reflux/indigestion, she took tums which
provided no relief.  She reports associated nausea, but denies
vomiting, diaphoresis, abdominal pain.  She denied every having
pain like this in the past.  She denies PND/orthopnea, states
that she gets intermittent swelling of her LE.  She went to OSH
where EKG showed STE in inferior leads.  She was given retevase
x 2 for thrombolysis, (7pm, 7:40 pm), loaded with [**Last Name (LF) **], [**First Name3 (LF) **],
started on heparin gtt, and transferred here for further
management.  On arrival here, she was pain free, and EKG was
without ST elevations.

MEDICAL HISTORY: Hypercholesteremia
Depression
Psoriasis

MEDICATION ON ADMISSION: Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afebrile   115/43   64  20  97% RA
Gen: very pleasant female, NAD
HEENT: PERRL, OP clear, no bruits or JVD
Lungs: CTA bilaterally, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs
Extr: no c/c/e, PT 2+ bilaterally
Neuro: grossly intact

FAMILY HISTORY: Father with CABG in 70's, DM
Mother [**Name (NI) 19477**] DM, MI in her 70's

SOCIAL HISTORY: Lives alone, has grown son
Social EtOH
1 ppd x 20 yrs 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Tobacco use disorder'}
