CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 75 yr old male with history of hypertension who
presented to [**Hospital3 1443**] ER today at 1230pm with a 3 day
history of intermittent throat and chest pain.  He began to have
symptoms of throat discomfort, which he describes as "acidic."
This throat pain was followed by chest pain.  These bouts of
chest and throat pain persisted intermittently throughout
Friday, Saturday, and Sunday.  On Sunday, it worsened while he
was doing his stretches in the morning.  He reports being
nauseated on Sunday, but denies vomiting, palpitations, and
difficulty breathing.  He reports that he has never experienced
these symptoms before.  He is an active golfer and is able to
walk the golf course without difficulty.
.
On admission to [**Hospital 487**] Hospital, his EKG showed anterior ST
elevation and small inferior q waves, with BP of 194/111, HR 70s
and sinus.  He was pain free at the time of transfer.  He
received 4 baby asa, [**Name2 (NI) 4532**] 600mg, heparin 5000U bolus followed
by gtt at 800u/hr.

MEDICAL HISTORY: HTN
Back surgery in [**2074**] for herniated disc
Skin CA

MEDICATION ON ADMISSION: Dyazide
Ibuprofen

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: VS: AF, 152/84, 71, 16, O2sat 100%
Gen: Well appearing male, in NAD, lying flat in bed.
HEENT: EOMI, MMM, anicteric.
Neck: no JVD
CV: Regular rhythm, rate at
Pulm: CTA anteriorly
Abd: Soft, NT, ND, +BS
Ext: Right groin site, clean, dry and intact.  Trace pedal edema
on right, no edema on left.  1+ DP/PT pulses
Neuro:  Alert and oriented x3.

FAMILY HISTORY: [**Name (NI) **] sister had CABG [**4-18**].  Father died of unknown causes.

SOCIAL HISTORY: Smoked from age 15-64, has not smoked in 11 years.  No alcohol
use.
Acute myocardial infarction of other anterior wall, initial episode of care,Primary pulmonary hypertension,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Personal history of tobacco use,Family history of ischemic heart disease
AMI anterior wall, init,Prim pulm hypertension,Crnry athrscl natve vssl,Hypertension NOS,Hx-skin malignancy NEC,History of tobacco use,Fam hx-ischem heart dis
Admission Date:  [**2108-10-15**]              Discharge Date:   [**2108-10-18**]

Date of Birth:  [**2033-10-13**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization


History of Present Illness:
Mr. [**Known lastname **] is a 75 yr old male with history of hypertension who
presented to [**Hospital3 1443**] ER today at 1230pm with a 3 day
history of intermittent throat and chest pain.  He began to have
symptoms of throat discomfort, which he describes as "acidic."
This throat pain was followed by chest pain.  These bouts of
chest and throat pain persisted intermittently throughout
Friday, Saturday, and Sunday.  On Sunday, it worsened while he
was doing his stretches in the morning.  He reports being
nauseated on Sunday, but denies vomiting, palpitations, and
difficulty breathing.  He reports that he has never experienced
these symptoms before.  He is an active golfer and is able to
walk the golf course without difficulty.
.
On admission to [**Hospital 487**] Hospital, his EKG showed anterior ST
elevation and small inferior q waves, with BP of 194/111, HR 70s
and sinus.  He was pain free at the time of transfer.  He
received 4 baby asa, [**Name2 (NI) 4532**] 600mg, heparin 5000U bolus followed
by gtt at 800u/hr.

Past Medical History:
HTN
Back surgery in [**2074**] for herniated disc
Skin CA

Social History:
Smoked from age 15-64, has not smoked in 11 years.  No alcohol
use.

Family History:
[**Name (NI) **] sister had CABG [**4-18**].  Father died of unknown causes.


Physical Exam:
PE: VS: AF, 152/84, 71, 16, O2sat 100%
Gen: Well appearing male, in NAD, lying flat in bed.
HEENT: EOMI, MMM, anicteric.
Neck: no JVD
CV: Regular rhythm, rate at
Pulm: CTA anteriorly
Abd: Soft, NT, ND, +BS
Ext: Right groin site, clean, dry and intact.  Trace pedal edema
on right, no edema on left.  1+ DP/PT pulses
Neuro:  Alert and oriented x3.

Pertinent Results:
Labs:
TropT 0.09, CPK 296, CKMB 15
BUN 15, Creatinine 0.9, Na 139, K 3.6, Cl 101, CO2 29, Ca 9.9.
ALT 31, AST 38
WBC 7.8, Hct 44.1, Plt 180
PT 12.6, INR 1.1
.
EKG: NSR, small inferior Q waves, STE in anterior leads
.
Cardiac Cath: R and L heart cath, coronary angiography, LAD
stenting.  Right dominant.  LMCA: mild disease, LAD 100%
proximal with thrombus, LCx 60% diffuse disease, RCA 50% PDA
disease.  CO 2.66, CI 1.36
.
CXR at OSH: negative
.
[**2108-10-16**] Echo:Conclusions:
The left atrium is normal in size. The inferior vena cava is
dilated (>2.5 cm) with lack of respiratory variation c/w
increased right atrial pressure. There is mild symmetric left
ventricular hypertrophy with normal cavity size. There is
moderate regional left ventricular systolic dysfunction with
focal hypokinesis of the distal half of the anterior septum and
anterior walls. The apex is akinetic, but not aneurysmal. No
masses or thrombi are seen in the left ventricle. Right
ventricular chamber size and free wall motion are normal. The
aortic arch is mildly dilated. The aortic valve leaflets (3) are

mildly thickened but aortic stenosis is not present. Trace
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 estimated (but is likely increased given the IVC dilation).
There is a trivial/physiologic pericardial effusion.
IMPRESSION: Symmetric left ventricular hypertrophy with regional
systolic dysfunction c/w CAD (mid-LAD lesion). Likely pulmonary
artery hypertension.
.
[**2108-10-17**] Conclusions:  The left atrium is normal in size. No
atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy with normal cavity
size. There is mild to moderate regional left ventricular
systolic dysfunction with akinesis of the distal septum,
anterior wall and apex. No masses or thrombi are seen in the
left ventricle. Right ventricular chamber size and free wall
motion are normal. The aortic root is mildly dilated. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. [Due to
acoustic shadowing, the severity of mitral regurgitation may be
significantly UNDERestimated.] The left ventricular inflow
pattern suggests impaired relaxation. The tricuspid valve
leaflets are mildly thickened. The pulmonary artery systolic
pressure could not be determined. There is no pericardial
effusion.
Compared with the prior study (images reviewed) of [**2108-10-16**],
the overall LVEF is similar.
.
[**2108-10-15**] 10:00PM   GLUCOSE-126* UREA N-14 CREAT-0.8 SODIUM-139
POTASSIUM-3.7 CHLORIDE-103 TOTAL CO2-24 ANION GAP-16
[**2108-10-15**] 10:00PM   CK(CPK)-3572*
[**2108-10-15**] 10:00PM   CK-MB-265* MB INDX-7.4* cTropnT-9.21*
[**2108-10-15**] 10:00PM   CALCIUM-8.9 PHOSPHATE-3.5 MAGNESIUM-1.6
[**2108-10-15**] 10:00PM   WBC-10.0 RBC-4.93 HGB-14.2 HCT-41.0 MCV-83
MCH-28.9 MCHC-34.7 RDW-14.4
[**2108-10-15**] 10:00PM   PLT COUNT-183
[**2108-10-15**] 10:00PM   PT-13.0 PTT-26.5 INR(PT)-1.1

Brief Hospital Course:
Mr. [**Known lastname **] is a 75 yr old male with a history of hypertension who
presented to OSH with a 3 day history of intermittent throat and
chest pain and anterior ST elevations on EKG.  He was
transferred for cardiac catheterization, now s/p stent to LAD.
.
Cardiac:
Ischemia: Patient presented with STEMI, found to have totally
occluded LAD with thrombus, now s/p cypher stent.  Other
findings on catheterization include a LCX with 60% diffuse
disease and a RCA had a 50% R-PDA disease.  His enzymes were: CK
peaked at 3572, troponin 9.21, CKMB 265 prior to trending down.
After catheterization, he was started on aspirin and [**Known lastname 4532**] for
stent patency.  He was additionally started on metoprolol which
was later switched to toprol XL for improved compliance.  He was
started on an ACE inhibitor as well as a statin.  His groin was
monitored following catheterization and remained without
hematoma or bruit.  His hematocrit and creatinine remained
stable.  In addition he was seen by physical therapy on multiple
occasions who felt he was safe for d/c to home.  Cholesterol
levels were checked, total cholesterol 134, TG 90, HDL 31, LDL
85.
.
LV function: An echocardiogram was done 1 day post MI and 2 days
post MI.  Both echocardiograms showed an EF of 40%.  Results
were significant for moderate regional left ventricular systolic
dysfunction with focal hypokinesis of the distal half of the
anterior septum and anterior walls, akinetic apex without
aneurysms.  The patient had no signs on exam of heart failure.
.
Rhythm: The patient remained in sinus rhythm throughout the
hospitalization.
.
HTN: Mr. [**Known lastname **] has a history of hypertension for which he had
been taking diazide.  He is now on a regimen of beta blocker and
ace inhibitor for hypertension as well as post MI therapy.
.
Code: Full code


Medications on Admission:
Dyazide
Ibuprofen

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. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Aspirin EC 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*10 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*10 Tablet(s)* Refills:*0*
8. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*10 Tablet(s)* Refills:*0*
9. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*10 Tablet Sustained Release 24HR(s)* Refills:*0*
10. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: STEMI

Secondary: HTN
Lower back pain


Discharge Condition:
Stable.  The patient is pain free, taking PO, and ambulating
easily around the hospital.


Discharge Instructions:
You suffered from a heart attack.  A stent was placed in the
occluded artery to restore blood flow to the heart.  Due to
this, you are on new medications.  You must take aspirin and
[**Known lastname **] EVERY day to keep the stent open.  It is very important
that you do not miss [**First Name (Titles) 691**] [**Last Name (Titles) 4319**] of these medications.  Check with
your cardiologist before stopping any of these medications.
Other new medications include Toprol, Lisinopril, and
Atorvastatin.

Please limit your activities for the next 6 weeks. This includes
no heavy lifiting or strenuous exercises.  Please remain on a
low sodium, cardiac healthy diet.

Please keep all outpatient appointments.

If you begin to experience chest pain, shortness of breath,
lightheadedness, or dizziness please call 911 or your MD
immediately. You may expect some pain from your groin site which
is expected after the cardiac catherization but if you
experience worsening of pain, oozing from site, or swelling
please contact your PCP or return to the [**Name (NI) **].

Followup Instructions:
Please make an appointment with your PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] within 2
weeks after discharge.  You also need to follow up with your
cardiologist Dr. [**Last Name (STitle) 5686**] within the next 2 weeks.
{'Acute myocardial infarction of other anterior wall, initial episode of care,Primary pulmonary hypertension,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Personal history of tobacco use,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

PRESENT ILLNESS: Mr. [**Known lastname **] is a 75 yr old male with history of hypertension who
presented to [**Hospital3 1443**] ER today at 1230pm with a 3 day
history of intermittent throat and chest pain.  He began to have
symptoms of throat discomfort, which he describes as "acidic."
This throat pain was followed by chest pain.  These bouts of
chest and throat pain persisted intermittently throughout
Friday, Saturday, and Sunday.  On Sunday, it worsened while he
was doing his stretches in the morning.  He reports being
nauseated on Sunday, but denies vomiting, palpitations, and
difficulty breathing.  He reports that he has never experienced
these symptoms before.  He is an active golfer and is able to
walk the golf course without difficulty.
.
On admission to [**Hospital 487**] Hospital, his EKG showed anterior ST
elevation and small inferior q waves, with BP of 194/111, HR 70s
and sinus.  He was pain free at the time of transfer.  He
received 4 baby asa, [**Name2 (NI) 4532**] 600mg, heparin 5000U bolus followed
by gtt at 800u/hr.

MEDICAL HISTORY: HTN
Back surgery in [**2074**] for herniated disc
Skin CA

MEDICATION ON ADMISSION: Dyazide
Ibuprofen

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: VS: AF, 152/84, 71, 16, O2sat 100%
Gen: Well appearing male, in NAD, lying flat in bed.
HEENT: EOMI, MMM, anicteric.
Neck: no JVD
CV: Regular rhythm, rate at
Pulm: CTA anteriorly
Abd: Soft, NT, ND, +BS
Ext: Right groin site, clean, dry and intact.  Trace pedal edema
on right, no edema on left.  1+ DP/PT pulses
Neuro:  Alert and oriented x3.

FAMILY HISTORY: [**Name (NI) **] sister had CABG [**4-18**].  Father died of unknown causes.

SOCIAL HISTORY: Smoked from age 15-64, has not smoked in 11 years.  No alcohol
use. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Primary pulmonary hypertension,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Personal history of tobacco use,Family history of ischemic heart disease'}
