CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 80-year-old
female with no prior heart disease who presents with one week
of intermittent chest discomfort radiating to the neck and
down both arms.  The patient was initially evaluated at [**Hospital3 6454**] the night prior to admission to [**Hospital3 **] with
increasing symptoms, responsive to nitrates.  The patient
ruled in for myocardial infarction with a troponin I of 3.39,
and an ECG significant for new left bundle-branch block
compared to that prior in [**2165**].  On the morning of transfer
to [**Hospital3 **], the patient had recurrent pain with inferior
ST-segment changes and was transferred for urgent cardiac
catheterization on nitroglycerin, heparin, Integrilin, and
Plavix.

MEDICAL HISTORY: Hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for 5 to 6 cigarettes per day
times 58 years.
Hemorrhage complicating a procedure,Acute myocardial infarction of other inferior wall, initial episode of care,Thrombocytopenia, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Hemorrhage complic proc,AMI inferior wall, init,Thrombocytopenia NOS,Abn react-cardiac cath,Crnry athrscl natve vssl,Hypotension NEC,Hypertension NOS,Hypothyroidism NOS
Admission Date: [**2171-4-13**]        Discharge Date: [**2171-4-16**]


Service:  [**Hospital Unit Name 196**]


HISTORY OF PRESENT ILLNESS:  The patient is an 80-year-old
female with no prior heart disease who presents with one week
of intermittent chest discomfort radiating to the neck and
down both arms.  The patient was initially evaluated at [**Hospital3 6454**] the night prior to admission to [**Hospital3 **] with
increasing symptoms, responsive to nitrates.  The patient
ruled in for myocardial infarction with a troponin I of 3.39,
and an ECG significant for new left bundle-branch block
compared to that prior in [**2165**].  On the morning of transfer
to [**Hospital3 **], the patient had recurrent pain with inferior
ST-segment changes and was transferred for urgent cardiac
catheterization on nitroglycerin, heparin, Integrilin, and
Plavix.

PAST MEDICAL HISTORY:  Hypothyroidism.

Hypertension.

Chronic renal insufficiency.

ALLERGIES:  PENICILLIN.

MEDICATIONS:
1. Accupril.
2. Hydrochlorothiazide.
3. Synthroid.
4. Ativan.


SOCIAL HISTORY:  Significant for 5 to 6 cigarettes per day
times 58 years.

PHYSICAL EXAMINATION:  The patient was afebrile, heart rate
of 55, blood pressure 120/60, breathing 16, saturating 100
percent on 2 liters nasal cannula.  The patient was in no
acute distress.  HEENT:  Normocephalic, atraumatic.
Extraocular movements intact.  Pupils equal, round and
reactive to light.  Neck:  No jugular venous distention.
Cardiovascular:  Regular rate and rhythm without murmurs.
Lungs:  Clear to auscultation bilaterally.  Abdomen:  Soft,
nontender, and nondistended with normoactive bowel sounds.
Extremities:  Without edema.

DIAGNOSTIC STUDIES:  EKG number 1:  Normal sinus rhythm, left
bundle-branch block, left atrial enlargement, and inferior T-
wave inversions.  Subsequent EKGs with pseudonormalization of
inferior T waves and new-onset ST elevation.  CBC, chem-7,
and coags were within normal limits.  Cardiac enzymes
significant for troponin I of 3.39 at the outside hospital,
declined to 1.97 prior to transfer with CK of 152 and MB
fraction of 9.4.

HOSPITAL COURSE:  The patient was taken urgently to cardiac
catheterization.  Please see catheterization note for full
details.  Briefly, a 95 percent distal RCA lesion was stented
upon transfer from the cath lab to the floor.  The patient
became mildly hypotensive with blood pressures to 60s and
bradycardic with heart rates in the 40s, was subsequently
given 1 amp of atropine and intravenous fluids with
resolution of her bradycardia and hypotension.  On further
examination, the patient was noted to have right groin
hematoma and right flank tenderness, at which time the
patient's Integrilin drip was discontinued.  A CT of the
abdomen was obtained once the patient was hemodynamically
stable and vascular surgery was asked to consult.  CT of the
abdomen was significant for large extraperitoneal hematoma
surrounding the bladder along the right retroperitoneum.
Vascular surgery recommended transfusion to keep hematocrit
above 30 with q.4h. hematocrits and discontinuation of any
anticoagulation.  Thereafter, the patient remained
hemodynamically stable and a right femoral ultrasound was
obtained, which showed no evidence of pseudoaneurysm or
hematoma.  On hospital day 3, the patient received a
transthoracic echocardiogram, which revealed preserved
systolic function without other significant abnormalities.
The patient's hematocrits remained stable throughout the
remainder of her hospital course and was cleared by physical
therapy prior to discharge.  Of note, a urinalysis was
significant for findings consistent with a urinary tract
infection, at which time the patient was placed on the course
of Bactrim.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  To home with services.

DISCHARGE DIAGNOSES:  ST elevation myocardial infarction.

Retroperitoneal bleed.

Urinary tract infection.

DISCHARGE MEDICATIONS:
1. Aspirin 325 mg p.o. q.d.
2. Plavix 75 mg p.o. q.d. times 6 months.
3. Levothyroxine 50 mcg 1 tablet p.o. q.d.
4. Metoprolol sustained release 25 mg 1 tablet p.o. q.d.
5. Lisinopril 5 mg 1 tablet p.o. q.d.
6. Atorvastatin 40 mg 2 tablets p.o. q.d.
7. Trimethoprim and sulfamethoxazole 160-800 mg 1 tablet p.o.
   q.d. for 3 days.


FOLLOW-UP PLANS:  Dr. [**First Name (STitle) **] at [**Hospital 1411**] Medical Center on
[**2171-4-25**], Thursday at 9:15 a.m.  Additionally, the patient
was instructed to call Dr. [**Last Name (STitle) **] for an appointment within 2 to
3 weeks.



                        [**First Name8 (NamePattern2) **] [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], MD
[**MD Number(2) 15194**]

Dictated By:[**Doctor Last Name 21141**]
MEDQUIST36
D:  [**2171-7-3**] 14:02:01
T:  [**2171-7-3**] 18:35:49
Job#:  [**Job Number 55999**]
{'Hemorrhage complicating a procedure,Acute myocardial infarction of other inferior wall, initial episode of care,Thrombocytopenia, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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 an 80-year-old
female with no prior heart disease who presents with one week
of intermittent chest discomfort radiating to the neck and
down both arms.  The patient was initially evaluated at [**Hospital3 6454**] the night prior to admission to [**Hospital3 **] with
increasing symptoms, responsive to nitrates.  The patient
ruled in for myocardial infarction with a troponin I of 3.39,
and an ECG significant for new left bundle-branch block
compared to that prior in [**2165**].  On the morning of transfer
to [**Hospital3 **], the patient had recurrent pain with inferior
ST-segment changes and was transferred for urgent cardiac
catheterization on nitroglycerin, heparin, Integrilin, and
Plavix.

MEDICAL HISTORY: Hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for 5 to 6 cigarettes per day
times 58 years. 

### Response:
{'Hemorrhage complicating a procedure,Acute myocardial infarction of other inferior wall, initial episode of care,Thrombocytopenia, unspecified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery,Other specified hypotension,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
