CHIEF COMPLAINT: Chest pain/pressure

PRESENT ILLNESS: On the afternoon on the day of his admission, the patient had
returned to his desk at work, following coming up some stairs,
when he noticed that he had a sensation of reflux substernally.
After five minutes, the sensation intensified, so the patient
took a Tylenol. The pressure in his chest then increased, and
the patient began to also feel radiation of pain in his left
arm. When the patient became diaphoretic, he began to take his
symptoms more seriously. Following an episode of nausea, the
patient asked his co-workers to call an ambulance.
.
On review of systems, the patient denies any prior history of
stroke, TIA, deep venous thrombosis, pulmonary embolism, regular
cough, hemoptysis, black stools or red stools. He denies recent
fevers, chills or rigors. He denies exertional buttock or calf
pain. The patient does have hip pain.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, -
Hypertension
2. CARDIAC HISTORY:
-CABG:  None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD:  None
3. OTHER PAST MEDICAL HISTORY: Patient had a spontaneous
pneumothorax in [**2086**].

MEDICATION ON ADMISSION: None that he takes regularly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: WDWN male in NAD. Mood, affect appropriate.
HEENT: NCAT. PERRL, EOMI.
NECK: Supple. No LAD.
CARDIAC: S1, S2. No murmurs, rubs, gallops, extra heart sounds
heard.
LUNGS: CTAB anteriorly
ABDOMEN: Soft, non-tender, BS +.
EXTREMITIES: No edema
GROIN: Catheter site dressed, clean, dry, intact. No bruits
heard.
PULSES:  radial pulses 2+; DP and PT pulses found via Doppler

FAMILY HISTORY: The patient's father had an MI at age 48, then a quadruple
bypass. He died of a ruptured AAA at age 75. The patient's
brother, age 65, had a stent earlier this year.

SOCIAL HISTORY: -Tobacco history:  44-pack year history of smoking
Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Examination of participant in clinical trial,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Family history of ischemic heart disease
AMI inferior wall, init,Crnry athrscl natve vssl,Tobacco use disorder,Exam-clincal trial,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Fam hx-ischem heart dis
Admission Date:  [**2128-12-14**]              Discharge Date:   [**2128-12-16**]

Date of Birth:  [**2068-9-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7333**]
Chief Complaint:
Chest pain/pressure

Major Surgical or Invasive Procedure:
Cardiac catheterization


History of Present Illness:
On the afternoon on the day of his admission, the patient had
returned to his desk at work, following coming up some stairs,
when he noticed that he had a sensation of reflux substernally.
After five minutes, the sensation intensified, so the patient
took a Tylenol. The pressure in his chest then increased, and
the patient began to also feel radiation of pain in his left
arm. When the patient became diaphoretic, he began to take his
symptoms more seriously. Following an episode of nausea, the
patient asked his co-workers to call an ambulance.
.
On review of systems, the patient denies any prior history of
stroke, TIA, deep venous thrombosis, pulmonary embolism, regular
cough, hemoptysis, black stools or red stools. He denies recent
fevers, chills or rigors. He denies exertional buttock or calf
pain. The patient does have hip pain.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

Past Medical History:
1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, -
Hypertension
2. CARDIAC HISTORY:
-CABG:  None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD:  None
3. OTHER PAST MEDICAL HISTORY: Patient had a spontaneous
pneumothorax in [**2086**].


Social History:
-Tobacco history:  44-pack year history of smoking

Family History:
The patient's father had an MI at age 48, then a quadruple
bypass. He died of a ruptured AAA at age 75. The patient's
brother, age 65, had a stent earlier this year.

Physical Exam:
GENERAL: WDWN male in NAD. Mood, affect appropriate.
HEENT: NCAT. PERRL, EOMI.
NECK: Supple. No LAD.
CARDIAC: S1, S2. No murmurs, rubs, gallops, extra heart sounds
heard.
LUNGS: CTAB anteriorly
ABDOMEN: Soft, non-tender, BS +.
EXTREMITIES: No edema
GROIN: Catheter site dressed, clean, dry, intact. No bruits
heard.
PULSES:  radial pulses 2+; DP and PT pulses found via Doppler


Pertinent Results:
CBC:
[**2128-12-14**] 10:32PM BLOOD WBC-11.8* RBC-4.26* Hgb-14.5 Hct-40.4
MCV-95 MCH-34.0* MCHC-35.8* RDW-13.3 Plt Ct-226
[**2128-12-15**] 04:35AM BLOOD WBC-10.7 RBC-4.11* Hgb-14.1 Hct-40.0
MCV-97 MCH-34.4* MCHC-35.4* RDW-13.1 Plt Ct-213
.
CEs:
[**2128-12-14**] 10:32PM BLOOD CK-MB-96* MB Indx-7.2* cTropnT-5.37*
[**2128-12-15**] 04:35AM BLOOD CK-MB-59* MB Indx-6.0 cTropnT-4.48*
[**2128-12-15**] 10:22AM BLOOD CK-MB-38* MB Indx-5.1 cTropnT-2.84*
.
Lipids:
[**2128-12-15**] 04:35AM BLOOD Triglyc-181* HDL-37 CHOL/HD-5.6
LDLcalc-135* Cholest-208*
.
[**2128-12-14**], Cardiac Cath, FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Mild systemic hypertension.
3. Successful deployment of PROMUS drug eluting stent in mid LCX
for
treatement of STEMI.
.
[**2128-12-15**], ECHO, Conclusions:
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thicknesses and cavity size are normal. There
is mild regional left ventricular systolic dysfunction with
focal hypokinesis of the basal half of the inferolateral wall.
The remaining segments contract normally (LVEF = 50 %). Tissue
Doppler imaging suggests a normal left ventricular filling
pressure (PCWP<12mmHg). Right ventricular chamber size and free
wall motion are normal. The ascending aorta is mildly dilated.
The aortic arch is mildly dilated. The aortic valve leaflets
(?#) appear structurally normal with good leaflet excursion.
There is no aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve appears structurally normal with trivial
mitral regurgitation. There is no mitral valve prolapse. The
pulmonary artery systolic pressure could not be determined.
There is an anterior space which most likely represents a
prominent fat pad. IMPRESSION: Suboptimal image quality. Mild
regional left ventricular systolic dysfunction c/w CAD. Dilated
thoracic aorta.

Discharge labs:
[**2128-12-16**] 07:15AM BLOOD WBC-9.6 RBC-4.30* Hgb-14.7 Hct-41.6
MCV-97 MCH-34.3* MCHC-35.4* RDW-13.4 Plt Ct-182
[**2128-12-16**] 07:15AM BLOOD Glucose-99 UreaN-12 Creat-1.0 Na-136
K-4.4 Cl-102 HCO3-25 AnGap-13
[**2128-12-16**] 07:15AM BLOOD Calcium-9.5 Phos-3.1 Mg-1.9


Brief Hospital Course:
# CORONARIES: The patient had a STEMI in his left circumflex.
Cardiac catheterization showed single vessel coronary artery
disease.  The LMCA had no obstructive disease. The LAD had a
long 50% lesion in the mid-portion.  The LCX was
subtotally occluded in the mid-portion.  The RCA had a long 50%
stenosis
in the mid-portion. The patient received successful
PTCA/stenting of mid LCX with 2.5 X 18 mm PROMUS drug-eluting
stent deployed at 20 atms. Patient was randomized to the ICE Tea
research study and received the study drug, intracoronary
thrombolytic, per study protocol. Final angiogram showed normal
flow, no dissection and 0% residual stenosis in the stent. The
patient's subsequent ECGs showed flattening of ST elevations and
no Q waves. The patient was then medically managed with aspirin,
Plavix, and atorvastatin. He received integrillin therapy for 18
hours. The patient was started on 12.5 mg metoprolol twice a
day, converted to 25mg metoprolol XL upon discharge.
.
# PUMP: The patient displayed no signs or symptoms of heart
failure. His echocardiogram showed mild regional left
ventricular systolic dysfunction with focal hypokinesis of the
basal half of the inferolateral wall. The remaining segments
contract normally (LVEF=50%). Tissue Doppler imaging suggests a
normal left ventricular filling pressure (PCWP<12mmHg).
.
# RHYTHM: The patient was followed on telemetry and remained in
normal sinus rhythm during his hospitalization.
.
# HYPERTENSION: The patient regularly had systolic blood
pressure readings in the 150s during his hospitalization. He was
started on captopril 6.25 mg three times a day, which was
converted to 2.5 mg lisinopril once daily upon discharge.
.
# DYSLIPIDEMIA: The patient was started on atorvastatin 80 mg
once daily.

Medications on Admission:
None that he takes regularly

Discharge Medications:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. metoprolol succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
ST elevation myocardial infarction
Dyslipidemia
Hypertension

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


Discharge Instructions:
Mr. [**Known lastname 88516**],

It was a pleasure treating you at [**Hospital1 1170**].

You had a heart attack in which the left circumflex artery of
your heart was blocked. A drug-eluting stent was placed in that
artery to keep the artery open. You will need to take
medications to keep the stent open and to help your heart heal
to the best extent possible. You will also need to follow up
with your PCP and [**Name Initial (PRE) **] cardiologist.

START aspirin 325 mg once daily.
START Plavix 75 mg once daily. (Do not stop the Plavix for any
reason unless your cardiologist says you may. The aspirin and
Plavix will keep your stent open.)
START atorvastatin 80 mg once daily to lower your cholesterol
and help keep your arteries open.
START lisinopril 2.5 mg once daily to protect your heart.
START metoprolol XL 25 mg once daily to protect your heart.

It is also important that you stop smoking, which will help
prevent any more heart disease. You should not return to work
for 10 days to two weeks.


Followup Instructions:
Name:[**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 88517**],MD
Specialty: Primary Care
When: Tuesday, [**12-28**] at 2:30pm
Location: [**Hospital **] MEDICAL GROUP
Address: [**Hospital1 **] [**Location (un) **], [**Location (un) **],[**Numeric Identifier 66490**]
Phone: [**Telephone/Fax (1) 12295**]

Name: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], MD
Specialty: Cardiology
When: Wednesday, [**1-12**] at 3pm
Location: HEART CENTER OF [**Hospital1 **]
Address: [**Location (un) **],2ND FL, [**Location (un) **],[**Numeric Identifier 7398**]
Phone: [**Telephone/Fax (1) 6256**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Examination of participant in clinical trial,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Family history of ischemic heart disease'}


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/pressure

PRESENT ILLNESS: On the afternoon on the day of his admission, the patient had
returned to his desk at work, following coming up some stairs,
when he noticed that he had a sensation of reflux substernally.
After five minutes, the sensation intensified, so the patient
took a Tylenol. The pressure in his chest then increased, and
the patient began to also feel radiation of pain in his left
arm. When the patient became diaphoretic, he began to take his
symptoms more seriously. Following an episode of nausea, the
patient asked his co-workers to call an ambulance.
.
On review of systems, the patient denies any prior history of
stroke, TIA, deep venous thrombosis, pulmonary embolism, regular
cough, hemoptysis, black stools or red stools. He denies recent
fevers, chills or rigors. He denies exertional buttock or calf
pain. The patient does have hip pain.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: - Diabetes, - Dyslipidemia, -
Hypertension
2. CARDIAC HISTORY:
-CABG:  None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD:  None
3. OTHER PAST MEDICAL HISTORY: Patient had a spontaneous
pneumothorax in [**2086**].

MEDICATION ON ADMISSION: None that he takes regularly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GENERAL: WDWN male in NAD. Mood, affect appropriate.
HEENT: NCAT. PERRL, EOMI.
NECK: Supple. No LAD.
CARDIAC: S1, S2. No murmurs, rubs, gallops, extra heart sounds
heard.
LUNGS: CTAB anteriorly
ABDOMEN: Soft, non-tender, BS +.
EXTREMITIES: No edema
GROIN: Catheter site dressed, clean, dry, intact. No bruits
heard.
PULSES:  radial pulses 2+; DP and PT pulses found via Doppler

FAMILY HISTORY: The patient's father had an MI at age 48, then a quadruple
bypass. He died of a ruptured AAA at age 75. The patient's
brother, age 65, had a stent earlier this year.

SOCIAL HISTORY: -Tobacco history:  44-pack year history of smoking 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Examination of participant in clinical trial,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Family history of ischemic heart disease'}
