CHIEF COMPLAINT: Chest tightness, xfer from OSH

PRESENT ILLNESS: Mr. [**Known lastname 19442**] is an 81 year old man with a history of ischemic
dialated cardiomyopathy noted on MR [**2139-7-21**] who presented to
[**Hospital **] Hospital after waking up with chest pain yesterday. He
was in his usual state of health until last Thursday when he was
playing golf and felt much more fatigued than usual. On Friday,
he also noted somewhat more unsteadiness on his feet. Around
midnight, he woke up with tightness across his chest. He denies
any diaphoresis, DOE, SOB or LE edema. He had no F/C/N/V. He
sleeps on two pillows.

MEDICAL HISTORY: 1. Severe cardiomyopathy
2. Heart failure
3. Presumed coronary artery disease
4. h/o kidney stones in the [**2122**]
5. type 2 diabetes mellitus
6. macular degeneration
7. L CEA in [**2125**] in [**Location (un) **], followed by re-do in [**2126**] at [**Hospital1 18**];
R CEA in [**2133**] at [**Hospital1 18**]

MEDICATION ON ADMISSION: 1. aspirin 81 mg/day
2. carvedilol 12.5 mg [**Hospital1 **]
3. lisinopril 2.5 mg/day
4. prevacid 20mg
5. vitamins
6. amaryl
7. heparin gtt
8. plavix 300mg x1

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: VS: T 98.6 Bp 111/68 HR 68 RR 18 Sat 95% RA
Gen: Pleasant elderly man in no apparent distress.
HEENT: OP clear (dentures), MMM, PERRL, sclerae anicteric.
Neck: JVP not elevated
CV: Normal s1, s2. II/VI HSM at LSB
Pul: CTA bilaterally no wheezes or rales
Abd: Soft, NT, ND +BS
Ext: Femoral pulses 2+, DP 2+, no bruits, no edema
Neuro: A&Ox3

FAMILY HISTORY: Mother died age 80 from CHF, father died 85 in his sleep,
brother with [**Name (NI) 34647**] at age 65.

SOCIAL HISTORY: Former postmaster, retired age 65, no history of alcohol,
tobacco or drug use.    Daughter is wound care nurse here.
Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Chronic kidney disease, unspecified,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other general symptoms,Adrenal cortical steroids causing adverse effects in therapeutic use
AMI anterior wall, init,CHF NOS,Crnry athrscl natve vssl,Chronic kidney dis NOS,Cardiac dysrhythmias NEC,DMII wo cmp nt st uncntr,Other general symptoms,Adv eff corticosteroids
Admission Date:  [**2139-8-29**]              Discharge Date:   [**2139-9-3**]

Date of Birth:  [**2058-6-29**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Iodine; Iodine Containing

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Chest tightness, xfer from OSH

Major Surgical or Invasive Procedure:
Cardiac cath with baremetal stent placement x2

History of Present Illness:
Mr. [**Known lastname 19442**] is an 81 year old man with a history of ischemic
dialated cardiomyopathy noted on MR [**2139-7-21**] who presented to
[**Hospital **] Hospital after waking up with chest pain yesterday. He
was in his usual state of health until last Thursday when he was
playing golf and felt much more fatigued than usual. On Friday,
he also noted somewhat more unsteadiness on his feet. Around
midnight, he woke up with tightness across his chest. He denies
any diaphoresis, DOE, SOB or LE edema. He had no F/C/N/V. He
sleeps on two pillows.

At the OSH serial cardiac enzymes were obtained. His TNI was
0.65. He was also given ASA, Plavix, and a heparin gtt was
started.

Past Medical History:
1. Severe cardiomyopathy
2. Heart failure
3. Presumed coronary artery disease
4. h/o kidney stones in the [**2122**]
5. type 2 diabetes mellitus
6. macular degeneration
7. L CEA in [**2125**] in [**Location (un) **], followed by re-do in [**2126**] at [**Hospital1 18**];
R CEA in [**2133**] at [**Hospital1 18**]

Social History:
Former postmaster, retired age 65, no history of alcohol,
tobacco or drug use.    Daughter is wound care nurse here.

Family History:
Mother died age 80 from CHF, father died 85 in his sleep,
brother with [**Name (NI) 34647**] at age 65.


Physical Exam:
VS: T 98.6 Bp 111/68 HR 68 RR 18 Sat 95% RA
Gen: Pleasant elderly man in no apparent distress.
HEENT: OP clear (dentures), MMM, PERRL, sclerae anicteric.
Neck: JVP not elevated
CV: Normal s1, s2. II/VI HSM at LSB
Pul: CTA bilaterally no wheezes or rales
Abd: Soft, NT, ND +BS
Ext: Femoral pulses 2+, DP 2+, no bruits, no edema
Neuro: A&Ox3

Pertinent Results:
NSR, L atrial abnormality, leftward axis, biphasic tw V2-4,  STE
V1-3, III, AVR, TWI v5-6. ST depression V5-6, I, avl.

CMR: [**2139-7-29**] Cardiac MRI:
1. Mildly increased left ventricular cavity size with abnormal
regional left ventricular systolic function. There was akinesis
of the basal, mid and apical septum and hypokinesis of the mid
and apical inferior segments. Delayed contrast-enhanced MR
images demonstrated areas of hyperenhancement as described
above. The findings are consistent with poor likelihood of
functional recovery of these segments.
2. Right ventricular cavity size and function could not be
calculated but appeared to be normal.
3. The indexed diameters of the ascending aorta and descending
thoracic aorta were mildly increased. The aortic arch and main
pulmonary artery diameter indices was normal.
4. Mild left atrial enlargement.
5. Aortic sclerosis without frank stenosis.
6. Normal coronary artery origins with no evidence of anomalous
coronary arteries. Probable multi-vessel coronary artery
disease.
7. No evidence of pericardial constriction found.
8. A note is made of the presence of an elevated left
hemidiaphragm.

DISCHARGE LABS

[**2139-9-3**] 07:45AM BLOOD WBC-12.8* RBC-4.86 Hgb-14.3 Hct-41.0
MCV-84 MCH-29.3 MCHC-34.8 RDW-15.4 Plt Ct-185
[**2139-9-1**] 10:35AM BLOOD Neuts-89.0* Bands-0 Lymphs-6.1* Monos-4.9
Eos-0 Baso-0.1
[**2139-9-3**] 07:45AM BLOOD Glucose-154* UreaN-40* Creat-1.5* Na-140
K-4.3 Cl-104 HCO3-28 AnGap-12
[**2139-8-29**] 05:35PM BLOOD Triglyc-64 HDL-60 CHOL/HD-2.3 LDLcalc-63
[**2139-8-30**] 07:00AM BLOOD %HbA1c-7.0* [Hgb]-DONE [A1c]-DONE

Brief Hospital Course:
1) Cardiac:
Pt was admitted from an OSH on heparin and nitro drips.
Patient was pain-free but was found to have ST elevations so was
brought to the cardiac cath lab.  Given a dye allergy noted in
the past (during a IV pyelogram, he had hives), prednisone and
solumedrol were given on-call.  It was noted that he had a
totally occluded LAD after D2, RCA (with good L->R collaterals)
and 70% LCx.  The LAD was stented with two bare metal stents (in
case the patient would ne to go to CABG in the near future.)
Following the procedure, he was brought the the CCU for
monitoring.

Later in the hospitalization, consideration of LCx PCI was
undertaken, but after discussing the risks/benefits with the
patient and his daughter, as well as after consulting cardiac
surgery, it was felt that medical management would be optimized
and repeat PCI or CABG would be re-considered at a later date.

Prior to discharge, the importance of compliance with his
aspirin and plavix were reinforced.  He was also started on
simvastatin.

2) Altered mental status
The patient was noted to have subtle personality changes,
psychomotor agitation all of which improved in the days
following the PCI.  It was felt that these were induced by the
high-dose perioperative steroids and improved prior to
discharge.

3) Type II diabetes
His oral amaryl was held prior to cath and he was maintained on
insulin sliding scale.

4) Renal insufficiency
Prior to and after the catheterization, the patient received
bicarbonate and mucormyst prophylaxis.  His Cr was stable
1.4-1.5 which is lower than his baseline.  His [K] and Cr will
be checked on [**9-7**] and the results will be faxed to Dr. [**Last Name (STitle) 171**].

Medications on Admission:
1. aspirin 81 mg/day
2. carvedilol 12.5 mg [**Hospital1 **]
3. lisinopril 2.5 mg/day
4. prevacid 20mg
5. vitamins
6. amaryl
7. heparin gtt
8. plavix 300mg x1

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
4. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
5. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
8. Multi-Vitamin     Tablet Sig: One (1) Tablet PO once a day.
9. Amaryl 1 mg Tablet Sig: One (1) Tablet PO once a day.
10. Outpatient Lab Work
Please check creatinine, potassium on [**9-7**]. (fax results
to [**Telephone/Fax (1) 19842**] / Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**])


Discharge Disposition:
Home

Discharge Diagnosis:
ST-elevation myocardial infarction
Chronic renal insufficiency


Discharge Condition:
stable, afebrile.


Discharge Instructions:
Please seek medical attention for fevers > 101.4, for chest
pain, or for anything else concerning to you.

Please take all of your medications as directed.

Followup Instructions:
1) Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**]
Date/Time:[**2139-9-30**] 10:40
2) Provider: [**Name10 (NameIs) **] STUDY Phone:[**Telephone/Fax (1) 327**]
Date/Time:[**2140-5-11**] 10:30
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Chronic kidney disease, unspecified,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other general symptoms,Adrenal cortical steroids causing adverse effects in therapeutic use'}


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 tightness, xfer from OSH

PRESENT ILLNESS: Mr. [**Known lastname 19442**] is an 81 year old man with a history of ischemic
dialated cardiomyopathy noted on MR [**2139-7-21**] who presented to
[**Hospital **] Hospital after waking up with chest pain yesterday. He
was in his usual state of health until last Thursday when he was
playing golf and felt much more fatigued than usual. On Friday,
he also noted somewhat more unsteadiness on his feet. Around
midnight, he woke up with tightness across his chest. He denies
any diaphoresis, DOE, SOB or LE edema. He had no F/C/N/V. He
sleeps on two pillows.

MEDICAL HISTORY: 1. Severe cardiomyopathy
2. Heart failure
3. Presumed coronary artery disease
4. h/o kidney stones in the [**2122**]
5. type 2 diabetes mellitus
6. macular degeneration
7. L CEA in [**2125**] in [**Location (un) **], followed by re-do in [**2126**] at [**Hospital1 18**];
R CEA in [**2133**] at [**Hospital1 18**]

MEDICATION ON ADMISSION: 1. aspirin 81 mg/day
2. carvedilol 12.5 mg [**Hospital1 **]
3. lisinopril 2.5 mg/day
4. prevacid 20mg
5. vitamins
6. amaryl
7. heparin gtt
8. plavix 300mg x1

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: VS: T 98.6 Bp 111/68 HR 68 RR 18 Sat 95% RA
Gen: Pleasant elderly man in no apparent distress.
HEENT: OP clear (dentures), MMM, PERRL, sclerae anicteric.
Neck: JVP not elevated
CV: Normal s1, s2. II/VI HSM at LSB
Pul: CTA bilaterally no wheezes or rales
Abd: Soft, NT, ND +BS
Ext: Femoral pulses 2+, DP 2+, no bruits, no edema
Neuro: A&Ox3

FAMILY HISTORY: Mother died age 80 from CHF, father died 85 in his sleep,
brother with [**Name (NI) 34647**] at age 65.

SOCIAL HISTORY: Former postmaster, retired age 65, no history of alcohol,
tobacco or drug use.    Daughter is wound care nurse here. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Chronic kidney disease, unspecified,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other general symptoms,Adrenal cortical steroids causing adverse effects in therapeutic use'}
