CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 66-year-old
male with a past medical history of prostate cancer who is
admitted to the [**Hospital1 69**] for a
ST-elevation myocardial infarction.

MEDICAL HISTORY: Prostate cancer; status post
prostatectomy in [**2150-10-20**].

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was unremarkable.

SOCIAL HISTORY: The patient is married.  He quit smoking
five months prior to admission.
Acute myocardial infarction of other inferior wall, initial episode of care,Atrial fibrillation,Pneumonia, organism unspecified,Postmyocardial infarction syndrome,Coronary atherosclerosis of native coronary artery
AMI inferior wall, init,Atrial fibrillation,Pneumonia, organism NOS,Post MI syndrome,Crnry athrscl natve vssl
Admission Date:  [**2151-4-2**]     Discharge Date:  [**2151-4-9**]

Date of Birth:   [**2084-9-21**]     Sex:  M

Service:  Coronary Care Unit

ADMISSION DIAGNOSIS:  ST-elevation myocardial infarction.

HISTORY OF PRESENT ILLNESS:  The patient is a 66-year-old
male with a past medical history of prostate cancer who is
admitted to the [**Hospital1 69**] for a
ST-elevation myocardial infarction.

The patient reported chest discomfort on the evening prior to
admission.  He subsequently ate dinner and went outside to
shovel snow.  At that time, he developed [**7-29**] substernal
chest pain that was nonradiating.  He denied any shortness of
breath, nausea, or vomiting.  He denied diaphoresis.

The patient was taken to an outside hospital where an
electrocardiogram showed ST elevations in the inferior leads.
At the outside hospital, the patient was given aspirin,
heparin, and morphine.  The patient underwent thrombolysis
with TNK.  He substernal chest pain persisted, and he was
transferred to [**Hospital1 69**] for
rescue cardiac catheterization.

In the Catheterization Laboratory, the patient was found to
have a totally occluded distal right coronary artery and
diffuse left anterior descending artery disease.  Stenting of
the right coronary artery led to TIMI-II flow from the
midvessel.

The patient was randomized to the Cool myocardial infarction
protocol.   A transvenous pacer was placed in the setting of
Wenckebach and bradycardia to the 30s with hypotension.  The
patient was then transferred to the Coronary Care Unit with
an intra-aortic balloon pump and on dopamine.

PAST MEDICAL HISTORY:   Prostate cancer; status post
prostatectomy in [**2150-10-20**].

MEDICATIONS ON ADMISSION:  None.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient is married.  He quit smoking
five months prior to admission.

FAMILY HISTORY:   Family history was unremarkable.

REVIEW OF SYSTEMS:  No shortness of breath, diabetes, or
strokes.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on admission revealed temperature was 97.8 degrees
Fahrenheit, heart rate was 74, blood pressure was 110/68,
respiratory rate was 16, and oxygen saturation was 99% with
an FIO2 of 40%.  The patient was on a dopamine and with an
intra-aortic balloon pump.  In general, the patient was alert
by not oriented.  His pupils were dilated.  The mucous
membranes were moist.  There was no lymphadenopathy in the
head or neck.  The sclerae were anicteric.  There were no
bruits.  The heart sounds revealed normal first heart sounds
and second heart sounds.  The rate was regular.  The chest
was clear to auscultation anteriorly.  The abdomen was
nontender and nondistended.  Bowel sounds were present.  The
extremities revealed no clubbing, cyanosis, or edema.  The
right groin had an intra-aortic balloon pump.  The left groin
had a pacer wire with a small hematoma.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Laboratories
revealed white blood cell count was 13.5, hematocrit was
39.7, and platelets were 345.  INR was 1.2 and partial
thromboplastin time was 26.  Sodium was 138, potassium was
3.8, chloride was 103, bicarbonate was 29, blood urea
nitrogen was 15, creatinine was 1.2, and blood glucose was
132.  Creatine kinase was 1244.  MB was 128.  ALT was 23, AST
was 122, amylase was 196, and alkaline phosphatase was 62.
Troponin was greater than 50.  Albumin was 3.1.

PERTINENT RADIOLOGY/IMAGING:  Arterial blood gas showed
7.21/41/82 with a lactate of 54.

Electrocardiogram revealed a sinus rhythm at a rate of 70.
There was Mobitz type I block.  There were persistent ST
elevations of 2 mm in leads II, III, and aVF.  There were ST
depressions of 1 mm in V1 through V5, I, and aVL.

HOSPITAL COURSE BY ISSUE/SYSTEM:

1.  CARDIOVASCULAR SYSTEM:  The patient was admitted to the
Coronary Care Unit after cardiac catheterization for an acute
inferior ST-elevation myocardial infarction.  He returned
from the Catheterization Laboratory on a dopamine drip with
an intra-aortic balloon pump.

The patient was initially maintained on aspirin.  Beta
blockers and ACE inhibitors were initially held as the
patient was requiring pressors on the balloon pump.  A lipid
profile was checked, and the patient was initially started
Lipitor.

On the evening of his admission to the Coronary Care Unit, it
was noted that his pacer wire was not sensing or pacing.  It
was subsequently discontinued.  The patient's dopamine was
weaned off.  The patient was then started on a low-dose ACE
inhibitor as well as Plavix.  A beta blocker was not started
as the patient was noted to have a Wenckebach heart block.

The patient's intra-aortic balloon pump was weaned from 1:1
to 1:2.  The patient underwent an echocardiogram on [**4-4**]
which revealed an ejection fraction of 25% with severe global
left ventricular hypokinesis.  There was akinesis in the
inferior, inferolateral, and inferoseptal areas with relative
sparing of the apex and anterior walls.

The patient was noted to volume overloaded on [**4-3**] and
was diuresed with a dose of Lasix.

On the evening of [**4-3**], the patient complained of left
shoulder pain which was sharp in nature and radiated to the
anterior chest wall.  The pain was worse with coughing.  The
patient denied any nausea, vomiting, or shortness of breath
at that time.  He stated that the pain was different from his
pain when he had his myocardial infarction.

A STAT echocardiogram was obtained which showed no change
from the echocardiogram the day before.  A rub was heard at
this time.  It was felt that the patient was suffering from
post myocardial infarction pericarditis.  Nonsteroidal
antiinflammatory drugs were avoided to treat this given the
risk after myocardial infarction.  The patient was started on
Tylenol.  At this time, the patient was also noted to be in
atrial fibrillation, and he was started on a heparin drip.

The patient was given morphine for his pain at this time and
subsequently developed hypotension with a systolic blood
pressure of 80.  He transiently required dopamine to maintain
his blood pressure; however, this was quickly weaned off.

The intra-aortic balloon pump was discontinued on [**4-3**].

It was felt that the patient would eventually require a
coronary artery bypass graft.  The Cardiothoracic Surgery
Service was consulted on [**4-4**].  At that time, the patient
had developed a cough and a likely pneumonia.  Therefore, the
Surgery Service felt that it would be best to delay a
coronary artery bypass graft until that had resolved.

On [**4-4**], the patient was noted to be in atrial flutter
with some episodes of Wenckebach and pauses up to four
seconds.  The patient was maintained on heparin and was
eventually transitioned to Coumadin.  He remained relatively
stable from a cardiovascular point of view and was
transferred to the Cardiology floor on [**4-6**].

The patient's pain from his pericarditis resolved on the
standing Tylenol regimen.  The patient was monitored on
telemetry and his pauses resolved.  On [**4-8**], the patient
was started on a beta blocker.  It was felt that the patient
should be risk stratified, and an Electrophysiology
consultation was obtained.  The patient was to follow up with
the Electrophysiology Service for risk stratification as an
outpatient.

The patient underwent a repeat echocardiogram on [**4-8**]
which showed an ejection fraction of 30%, with 1+ mitral
regurgitation, and inferior hypokinesis.

The patient was felt to be safe for discharge home on [**4-9**].  He was to follow up with the Cardiothoracic Surgery
Service for coronary artery bypass graft after resolution of
his pneumonia.  He was also to follow up with the
Electrophysiology Service for risk stratification.

2.  RENAL ISSUES:  Upon admission, the patient was noted to
have an anion gap acidosis with an elevated lactate which was
felt to be secondary to poor perfusion.

The patient improved with improved perfusion with the
intra-aortic balloon pump.  Repeat arterial blood gases study
were normal.

3.  INFECTIOUS DISEASE ISSUES:  On [**4-4**], the patient was
noted to have a cough.  He was initially started on
azithromycin.  A chest x-ray was checked which showed a
likely pneumonia, and the patient was then started on
levofloxacin.

The patient subsequently developed a right-sided pleural
effusion associated with his pneumonia which was noted on
[**4-7**].  The patient underwent a thoracentesis on [**4-7**].
Analysis of the pleural fluid revealed a white blood cell
count of 490, red blood cells of [**Pager number **], neutrophils of 46,
lymphocytes of 18, monocytes of 14, with a protein ratio of
less than 0.5, and an LDH ratio of less than 0.6.  The pH was
7.55.  Given the LDH in the fluid, it was sent for cytology
to rule out malignancy.  At the time of discharge, this was
still pending.

After his thoracentesis, the patient's respiratory status
improved and he was felt to be safe for discharge on [**4-9**].  He was to complete a 14-day course of Levaquin.  The
patient was to return for coronary artery bypass graft after
resolution of his pneumonia.

4.  HEMATOLOGIC ISSUES:  The patient was noted to have a drop
in his hematocrit to 28 from 34 after his cardiac
catheterization.  He was transfused 2 units of packed red
blood cells on [**4-5**].

MEDICATIONS ON DISCHARGE:
1.  Aspirin 325 mg p.o. once per day.
2.  Plavix 75 mg p.o. once per day.
3.  Pravastatin.
4.  Captopril 12.5 mg p.o. three times per day.
5.  Lopressor 12.5 mg p.o. twice per day.
6.  Levofloxacin 500 mg p.o. every day (for a 14-day course).
7.  Coumadin 5 mg p.o. once per day.

DISCHARGE DIAGNOSES:
1.  Status post acute ST-elevation myocardial infarction
(involving the inferior area).
2.  Cardiogenic shock.
3.  Ejection fraction of 30%.
4.  Post myocardial infarction pericarditis.
5.  Atrial flutter.
6.  Pneumonia; complicated by peripneumonic effusion.
7.  Lactic acidosis.
8.  Prostate cancer; status post prostatectomy in [**2150-3-20**].

DISCHARGE STATUS:  The patient was discharged to home.

DISCHARGE INSTRUCTIONS/FOLLOWUP:  The patient was to complete
his course of levofloxacin for his pneumonia and was then to
follow up with the Cardiothoracic Surgery team for coronary
artery bypass graft in approximately one month's time.






                          [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 2139**]

Dictated By:[**Last Name (NamePattern1) 222**]

MEDQUIST36

D:  [**2151-7-8**]  10:43
T:  [**2151-7-15**]  19:18
JOB#:  [**Job Number 49432**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Atrial fibrillation,Pneumonia, organism unspecified,Postmyocardial infarction syndrome,Coronary atherosclerosis of native coronary artery'}


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 66-year-old
male with a past medical history of prostate cancer who is
admitted to the [**Hospital1 69**] for a
ST-elevation myocardial infarction.

MEDICAL HISTORY: Prostate cancer; status post
prostatectomy in [**2150-10-20**].

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history was unremarkable.

SOCIAL HISTORY: The patient is married.  He quit smoking
five months prior to admission. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Atrial fibrillation,Pneumonia, organism unspecified,Postmyocardial infarction syndrome,Coronary atherosclerosis of native coronary artery'}
