CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: This is a 51-year-old female
with hyperlipidemia and a family history of coronary artery
disease who was awoken at 3 a.m. on the day of admission with
chest tightness radiating down her left arm and with
tingling, nausea, and diaphoresis worsened by exertion.  She
described it as [**8-17**] in intensity.

MEDICAL HISTORY: 1.  Hyperlipidemia.
2.  Heart murmur.
3.  Cesarean section.
4.  Hiatal hernia.
5.  She had left knee repaired arthroscopically.
6.  History of bursitis and arthritis.
7.  Gastroesophageal reflux disease (with a Schatzki's ring).

MEDICATION ON ADMISSION: She is on Centrum once per day.
Protonix which she discontinued about one week ago.  She
denies any over-the-counter or herbal medications.  Her
physician had suggested starting Lipitor for her high
cholesterol, but she had refused earlier.

ALLERGIES: She is allergic to CORTISPORIN EAR DROPS (she
reports swelling of the ear to this medication).

PHYSICAL EXAM: 

FAMILY HISTORY: She has a family history of coronary artery
disease.  Her father had a heart attack around the age of 50.
Her mother had diabetes and had a myocardial infarction at
the age of 78.

SOCIAL HISTORY: She had a 10-pack-year history of tobacco,
but she quit 30 years ago.  She denies any alcohol use.  She
has two children who live nearby, but she lives alone in
[**Location (un) 3320**].  She has two grandchildren.
Acute myocardial infarction of other inferior wall, initial episode of care,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux
AMI inferior wall, init,Hematoma complic proc,Crnry athrscl natve vssl,Pure hypercholesterolem,Esophageal reflux
Admission Date:  [**2110-5-12**]     Discharge Date:  [**2110-5-16**]

Date of Birth:   [**2048-8-7**]     Sex:  F

Service:  CCU

CHIEF COMPLAINT:  Chest pain.

HISTORY OF PRESENT ILLNESS:  This is a 51-year-old female
with hyperlipidemia and a family history of coronary artery
disease who was awoken at 3 a.m. on the day of admission with
chest tightness radiating down her left arm and with
tingling, nausea, and diaphoresis worsened by exertion.  She
described it as [**8-17**] in intensity.

At 9:30 a.m., she was seen by her primary care physician who
saw absent R waves in V1 through V4 on electrocardiogram and
ST elevations in V2 through V6 and sent the patient to [**Hospital3 6265**] Emergency Department.

While at [**Hospital3 3583**] Emergency Room, she was given
sublingual nitroglycerin, Retavase times one dose, a heparin
drip, Lopressor intravenously, a nitroglycerin drip and
med-flighted to [**Hospital1 69**] for
catheterization.  At [**Hospital3 3583**], her vital signs were
stable.

On arrival at [**Hospital1 69**], Ms.
[**Known lastname 15674**] was taken to the Catheterization Laboratory and found
to 3-vessel disease with total occlusion of the left anterior
descending artery after the second diagonal which was
successfully angioplastied.  There was total occlusion of the
right coronary artery with prominent left-to-right collateral
from the left circumflex.  There was mild left circumflex
disease with a 50% stenosis of the mid vessel.  She was also
noted to have increased right and left heart filling
pressures, with mean pulmonary capillary wedge pressure of
22, with a left ventricular ejection fraction of 30%, and
anterolateral, and apical, as well as anterolateral akinesis.

REVIEW OF SYSTEMS:   No fevers, chills, cough, shortness of
breath, chest pain, or lightheadedness.  No abdominal pain.
No melena.  No bright red blood per rectum.  No dysuria.

PAST MEDICAL HISTORY:
1.  Hyperlipidemia.
2.  Heart murmur.
3.  Cesarean section.
4.  Hiatal hernia.
5.  She had left knee repaired arthroscopically.
6.  History of bursitis and arthritis.
7.  Gastroesophageal reflux disease (with a Schatzki's ring).

ALLERGIES:  She is allergic to CORTISPORIN EAR DROPS (she
reports swelling of the ear to this medication).

MEDICATIONS ON ADMISSION:  She is on Centrum once per day.
Protonix which she discontinued about one week ago.  She
denies any over-the-counter or herbal medications.  Her
physician had suggested starting Lipitor for her high
cholesterol, but she had refused earlier.

FAMILY HISTORY:   She has a family history of coronary artery
disease.  Her father had a heart attack around the age of 50.
Her mother had diabetes and had a myocardial infarction at
the age of 78.

SOCIAL HISTORY:  She had a 10-pack-year history of tobacco,
but she quit 30 years ago.  She denies any alcohol use.  She
has two children who live nearby, but she lives alone in
[**Location (un) 3320**].  She has two grandchildren.

PHYSICAL EXAMINATION ON PRESENTATION:  On physical
examination, her temperature was 97, blood pressure was
130/56, heart rate was 64, pulmonary artery pressures were 29
and 14 (with 21 as a mean), respiratory rate was 18, and she
was saturating 100% on 2 liters nasal cannula.  She was in no
acute distress, pleasant.  Mucous membranes were moist.
Jugular venous pressure was about 7 cm.  Her lungs were clear
to auscultation bilaterally.  She had some breath sounds
in the left lower chest.  Heart was regular in rate and
rhythm.  A [**3-13**] crescendo-decrescendo systolic murmur at the
base radiating to her neck.  No gallops, and no rubs.  The
abdomen was soft and nontender.  Normal active bowel sounds.
She had 2+ dorsalis pedis and posterior tibialis pulses.
There was no clubbing, cyanosis, or edema.  There was active
bleeding and oozing from the left catheter site.  She was
alert and oriented times three.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Her laboratory
data revealed white blood cell count was 10.2, hematocrit was
35, and platelets were 295.  Differential with 85%
neutrophils and 11% lymphocytes.  INR was 1.4 and partial
thromboplastin time was 95.7.  Sodium was 140, potassium was
3.9, chloride was 106, bicarbonate was 24, blood urea
nitrogen was 9, creatinine was 0.6, and blood glucose was
118.  LDH was 275.  Total cholesterol was 233, triglycerides
were 45, high-density lipoprotein was 67, and low-density
lipoprotein was 157.  Her creatine kinase peaked at 2795 and
decreased throughout the rest of the hospital stay.  Troponin
was greater than 50.  Her CK/MB peaked at 449 and decreased
to 5.  The MB index peaked at 16.1 and decreased to 4.3.  Her
hemoglobin A1c was 5.5.

PERTINENT RADIOLOGY/IMAGING:  Electrocardiogram showed a
normal sinus rhythm at 60, with 1-mm ST elevations in leads
V2 through V5, with Q waves in V1 through V3 and V5.

An echocardiogram showed a left ventricular ejection fraction
of 40% with a mildly dilated left atrium.  Distal anterior,
septal, apical, and distal lateral hypokinesis to akinesis
was present.  There was trace mitral regurgitation, but no
aortic stenosis.

HOSPITAL COURSE:  The patient finished her 18-hour course of
Integrilin status post catheterization.  She was treated with
aspirin, Lipitor, Plavix, metoprolol, and an ACE inhibitor.
The patient did well and remained stable throughout the
hospital stay.

Due to her anteroapical hypokinesis and akinesis with a 30%
to 40% ejection fraction, she was started on anticoagulation.
She was started on a heparin drip while waiting for her
Coumadin become therapeutic.

The patient did well and was evaluated by Physical Therapy
who felt that the patient was safe to go home.  Her
medications were reviewed.  The patient was kept in house
while waiting for her INR to be therapeutic.  Her Plavix was
essentially discontinued since the patient did not receive a
stent.  She had initially been started on Plavix for a more
aggressive regimen for her diffuse coronary artery disease,
but given that the patient was also on Coumadin it was felt
that the aspirin and Coumadin would be sufficient.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  Discharge status was to home.

DISCHARGE DIAGNOSES:
1.  Anterior myocardial infarction.
2.  Native coronary artery disease, status post intervention.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to see her primary care physician on
Tuesday, [**5-18**].  Her primary care physician was [**Name (NI) 653**]
and updated as to her hospital course.
2.  The patient was to follow up with her cardiologist within
two weeks.

MEDICATIONS ON DISCHARGE:
1.  Aspirin 325 mg p.o. once per day.
2.  Protonix 40 mg p.o. once per day.
3.  Lipitor 10 mg p.o. q.h.s.
4.  Lisinopril 10 mg p.o. once per day.
5.  Metoprolol-XL 25 mg p.o. once per day.
6.  Coumadin 3 mg p.o. once per day (this dose to be adjusted
as per her primary care physician based on her INR for a goal
INR of 2 to 3).





                          [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 5219**]

Dictated By:[**Name8 (MD) 6371**]

MEDQUIST36

D:  [**2110-5-18**]  14:57
T:  [**2110-5-21**]  07:52
JOB#:  [**Job Number 47789**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux'}


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: This is a 51-year-old female
with hyperlipidemia and a family history of coronary artery
disease who was awoken at 3 a.m. on the day of admission with
chest tightness radiating down her left arm and with
tingling, nausea, and diaphoresis worsened by exertion.  She
described it as [**8-17**] in intensity.

MEDICAL HISTORY: 1.  Hyperlipidemia.
2.  Heart murmur.
3.  Cesarean section.
4.  Hiatal hernia.
5.  She had left knee repaired arthroscopically.
6.  History of bursitis and arthritis.
7.  Gastroesophageal reflux disease (with a Schatzki's ring).

MEDICATION ON ADMISSION: She is on Centrum once per day.
Protonix which she discontinued about one week ago.  She
denies any over-the-counter or herbal medications.  Her
physician had suggested starting Lipitor for her high
cholesterol, but she had refused earlier.

ALLERGIES: She is allergic to CORTISPORIN EAR DROPS (she
reports swelling of the ear to this medication).

PHYSICAL EXAM: 

FAMILY HISTORY: She has a family history of coronary artery
disease.  Her father had a heart attack around the age of 50.
Her mother had diabetes and had a myocardial infarction at
the age of 78.

SOCIAL HISTORY: She had a 10-pack-year history of tobacco,
but she quit 30 years ago.  She denies any alcohol use.  She
has two children who live nearby, but she lives alone in
[**Location (un) 3320**].  She has two grandchildren. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux'}
