CHIEF COMPLAINT: Chest pain and shortness of breath status
post left anterior descending stenting

PRESENT ILLNESS: This is a [**Age over 90 **]-year-old woman, a
nursing home resident, with known coronary artery disease
status post percutaneous transluminal coronary angioplasty of
the left anterior descending x 2 in [**2137**], non-Q myocardial
infarction in [**2145**], who complained of chest pain associated
with shortness of breath starting the night prior to
admission.  She was given sublingual nitroglycerin at the
nursing home.  She was then brought to the Emergency Room at
2 P.M. on the day of admission.  In the Emergency Room, her
temperature was 97.6, blood pressure 91/43, pulse 75,
respirations 21, and oxygen saturation 98% on 2 liters. Her
examinations were notable for bilateral pedal edema,
bilateral crackles, and guaiac positive stools.  Her
electrocardiogram revealed atrial fibrillation with slow
ventricular rate, incomplete left bundle branch block, ST
elevations in V1 to V2, ST depression in I, II, AVL, V5 to
V6, with T wave inversions in I, II, AVL and V3 through V6.
She remained stable in the Emergency Room, and her initial CK
was 91, troponin was less than .3, hematocrit was 33.4, and
INR was 2.9.

MEDICAL HISTORY: Coronary artery disease status post
acute anterior myocardial infarction in [**2137**], status post
percutaneous transluminal coronary angioplasty of left
anterior descending x 2, status post non-Q myocardial
infarction in [**2145**], congestive heart failure, last
echocardiogram in [**2147-1-19**] with an ejection fraction
of 20 to 25%, new onset atrial fibrillation, started on
Coumadin [**2148-8-20**], diabetes Type 2 diagnosed in
[**2146**], chronic renal insufficiency, status post acute renal
failure in [**2146**], baseline creatinine 1.7 to 2.0,
hypertension, ascending aortic aneurysm size 4 x 4 cm, right
upper lobe mass with mediastinal lymphadenopathy, dementia,
osteoarthritis, glaucoma, status post right hip fracture in
[**2136**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: [**Hospital3 **] resident, no alcohol,
no tobacco.
Coronary atherosclerosis of native coronary artery,Other acute and subacute forms of ischemic heart disease, other,Congestive heart failure, unspecified,Hematoma complicating a procedure,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Other chronic pulmonary heart diseases,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Crnry athrscl natve vssl,Ac ischemic hrt dis NEC,CHF NOS,Hematoma complic proc,Atrial fibrillation,DMII wo cmp nt st uncntr,Anemia NOS,Chr pulmon heart dis NEC,Abn react-cardiac cath
Admission Date:  [**2148-10-3**]       Discharge Date:  [**2148-10-5**]


Service:  CCU

CHIEF COMPLAINT:  Chest pain and shortness of breath status
post left anterior descending stenting

HISTORY OF PRESENT ILLNESS:  This is a [**Age over 90 **]-year-old woman, a
nursing home resident, with known coronary artery disease
status post percutaneous transluminal coronary angioplasty of
the left anterior descending x 2 in [**2137**], non-Q myocardial
infarction in [**2145**], who complained of chest pain associated
with shortness of breath starting the night prior to
admission.  She was given sublingual nitroglycerin at the
nursing home.  She was then brought to the Emergency Room at
2 P.M. on the day of admission.  In the Emergency Room, her
temperature was 97.6, blood pressure 91/43, pulse 75,
respirations 21, and oxygen saturation 98% on 2 liters. Her
examinations were notable for bilateral pedal edema,
bilateral crackles, and guaiac positive stools.  Her
electrocardiogram revealed atrial fibrillation with slow
ventricular rate, incomplete left bundle branch block, ST
elevations in V1 to V2, ST depression in I, II, AVL, V5 to
V6, with T wave inversions in I, II, AVL and V3 through V6.
She remained stable in the Emergency Room, and her initial CK
was 91, troponin was less than .3, hematocrit was 33.4, and
INR was 2.9.

Because of the concern for acute myocardial infarction, she
was started on a nitro drip and was brought to the
catheterization laboratory directly.  Catheterization
revealed three vessel disease with left anterior descending
proximal 80%, left circumflex proximal 70%, obtuse marginal I
80%, obtuse marginal II 80%, and right coronary artery
proximal 60%, and mid 70% stenosis.  The proximal left
anterior descending was successfully stented.  The right
heart catheterization showed PA 63% with a calculated cardiac
index of 2.34, RA pressure mean of 14, RV pressure 49/11,
with an end diastolic pressure of 16, PA pressure 56/26, with
a mean of 39, wedge of 25.

Because of her initial INR of 2.9, she had excessive bleeding
at the right femoral site, with Angioseal
post-catheterization.  The bleeding was controlled with
pressure for two hours.  Due to excessive bleeding, no
Integrilin was given post-catheterization, and two units of
fresh frozen plasma were ordered.  She was transferred to the
Coronary Care Unit for overnight observation.

PAST MEDICAL HISTORY:  Coronary artery disease status post
acute anterior myocardial infarction in [**2137**], status post
percutaneous transluminal coronary angioplasty of left
anterior descending x 2, status post non-Q myocardial
infarction in [**2145**], congestive heart failure, last
echocardiogram in [**2147-1-19**] with an ejection fraction
of 20 to 25%, new onset atrial fibrillation, started on
Coumadin [**2148-8-20**], diabetes Type 2 diagnosed in
[**2146**], chronic renal insufficiency, status post acute renal
failure in [**2146**], baseline creatinine 1.7 to 2.0,
hypertension, ascending aortic aneurysm size 4 x 4 cm, right
upper lobe mass with mediastinal lymphadenopathy, dementia,
osteoarthritis, glaucoma, status post right hip fracture in
[**2136**].

MEDICATIONS AT NURSING HOME:  Aspirin 81 mg once daily, Coreg
12.5 mg twice a day, Digoxin .125 mg every other day,
enalapril 10 mg twice a day, lasix 20 mg once daily,
Glipizide 10 mg twice a day, insulin 70/30 32 units in the
morning, Imdur 20 mg once daily, sublingual nitroglycerin as
needed, Axid 150 mg twice a day, Warfarin 3 and 3.5 mg every
other day, Zocor 40 mg once daily, vitamin B12 1 mg once
daily, folic acid 1 mg once daily, Prozac 40 mg once daily.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  [**Hospital3 **] resident, no alcohol,
no tobacco.

REVIEW OF SYSTEMS:  Worsening of dyspnea on exertion for
several months, persistent chest pain associated with
shortness of breath for about 12 hours prior to admission.

PHYSICAL EXAMINATION:  Afebrile, blood pressure 100 to
110/30s to 40s, heart rate 60s to 70s, oxygen saturation 100%
on 4 liters nasal cannula.  General:  Awake, alert and
oriented times three, lying flat in bed, in no acute
distress.  Cardiovascular:  Irregular rate and rhythm, normal
S1 and S2.  Lungs:  Clear to auscultation bilaterally
anteriorly.  Abdomen:  Soft, nontender, nondistended.
Extremities:  Right groin site with pressure dressing, large
ecchymosis around the site, small hematoma, not extending
beyond the marks, slight tenderness, bilateral distal pulses.

LABORATORY DATA:  White count 8.8, hematocrit 33.4 down to
22.9 post-catheterization, platelets 177 down to 161.  PT
20.4, PTT 26.8, INR 2.9.  After two units of transfusion, PT
16.4, PTT 42.8, INR 1.2.  Chem 7:  Sodium 139, potassium 4.9,
chloride 107, bicarbonate 19, BUN 67, creatinine 1.9, glucose
215.  First CK 91, troponin less than .3.

HOSPITAL COURSE:  She was ruled out for myocardial infarction
with serial negative cardiac enzymes.  Follow-up
electrocardiograms were unremarkable.  She received two units
of fresh frozen plasma and one unit of packed red blood
cells.  Her hematocrit remained stable in the 30s after the
transfusion.  She was gently diuresed with low doses of
intravenous lasix (20 mg), with good responses.  Her oxygen
saturations remained in the high 90s after being weaned off
oxygen.

While in-house, she had no more complaints of chest pain or
shortness of breath.  She reported feeling at her baseline.
Given the multiple comorbidities, the decision was made to
maximize her medical management.  She was restarted on her
regular outpatient regimen on hospital day two except with
increased dose of lasix and a post-stenting Plavix.  She was
observed in-house for one more day, and discharged home on
hospital day three in stable condition.

Her most recent laboratories prior to discharge show a
hematocrit of 30.2, platelets 150.  Potassium 4.4, BUN 61,
creatinine 1.8, glucose 124.  CK 91 on admission, down to 83,
down to 76.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  [**Hospital3 **].

DISCHARGE DIAGNOSIS:
1.  Congestive heart failure exacerbation
2.  Coronary artery disease status post proximal left
anterior descending stent

DISCHARGE MEDICATIONS:
1.  Aspirin 81 mg once daily
2.  Coreg 12.5 mg twice a day
3.  Digoxin .125 mg every other day
4.  Enalapril 10 mg twice a day
5.  Lasix 40 mg once daily
6.  Zocor 40 mg once daily
7.  Warfarin 3 mg daily at bedtime
8.  Sublingual nitroglycerin as needed
9.  Glipizide 10 mg twice a day
10. Insulin 70/30 32 units every morning
11. Imdur 20 mg once daily
12. Folic acid 1 mg once daily
13. Vitamin B12 1 mg once daily
14. Prozac 40 mg once daily
15. Axid 150 mg twice a day
16. Plavix 75 mg once daily for 30 days




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 44831**]
MEDQUIST36

D:  [**2148-10-4**]  22:39
T:  [**2148-10-5**]  02:20
JOB#:  [**Job Number **]
{'Coronary atherosclerosis of native coronary artery,Other acute and subacute forms of ischemic heart disease, other,Congestive heart failure, unspecified,Hematoma complicating a procedure,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Other chronic pulmonary heart diseases,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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 and shortness of breath status
post left anterior descending stenting

PRESENT ILLNESS: This is a [**Age over 90 **]-year-old woman, a
nursing home resident, with known coronary artery disease
status post percutaneous transluminal coronary angioplasty of
the left anterior descending x 2 in [**2137**], non-Q myocardial
infarction in [**2145**], who complained of chest pain associated
with shortness of breath starting the night prior to
admission.  She was given sublingual nitroglycerin at the
nursing home.  She was then brought to the Emergency Room at
2 P.M. on the day of admission.  In the Emergency Room, her
temperature was 97.6, blood pressure 91/43, pulse 75,
respirations 21, and oxygen saturation 98% on 2 liters. Her
examinations were notable for bilateral pedal edema,
bilateral crackles, and guaiac positive stools.  Her
electrocardiogram revealed atrial fibrillation with slow
ventricular rate, incomplete left bundle branch block, ST
elevations in V1 to V2, ST depression in I, II, AVL, V5 to
V6, with T wave inversions in I, II, AVL and V3 through V6.
She remained stable in the Emergency Room, and her initial CK
was 91, troponin was less than .3, hematocrit was 33.4, and
INR was 2.9.

MEDICAL HISTORY: Coronary artery disease status post
acute anterior myocardial infarction in [**2137**], status post
percutaneous transluminal coronary angioplasty of left
anterior descending x 2, status post non-Q myocardial
infarction in [**2145**], congestive heart failure, last
echocardiogram in [**2147-1-19**] with an ejection fraction
of 20 to 25%, new onset atrial fibrillation, started on
Coumadin [**2148-8-20**], diabetes Type 2 diagnosed in
[**2146**], chronic renal insufficiency, status post acute renal
failure in [**2146**], baseline creatinine 1.7 to 2.0,
hypertension, ascending aortic aneurysm size 4 x 4 cm, right
upper lobe mass with mediastinal lymphadenopathy, dementia,
osteoarthritis, glaucoma, status post right hip fracture in
[**2136**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: [**Hospital3 **] resident, no alcohol,
no tobacco. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other acute and subacute forms of ischemic heart disease, other,Congestive heart failure, unspecified,Hematoma complicating a procedure,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Other chronic pulmonary heart diseases,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
