CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 70-year-old
woman with hypertension and hyperlipidemia but without prior
coronary events who presented to her Emergency Room with
chest pain and marked anterior ST segment elevations.  This
was preceded by a three day history of nausea and vomiting
with uncertainty as to whether there was some chest
discomfort with this as well.  Initial CPK was only 270.  She
was transferred to [**Hospital1 69**] for
urgent intervention.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Pure hypercholesterolemia,Unspecified essential hypertension
AMI anterior wall, init,CHF NOS,Atrial fibrillation,Crnry athrscl natve vssl,Esophageal reflux,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2117-9-28**]     Discharge Date:  [**2117-10-4**]

Date of Birth:   [**2047-7-28**]     Sex:  F

Service:  CCU TEAM

HISTORY OF PRESENT ILLNESS:  The patient is a 70-year-old
woman with hypertension and hyperlipidemia but without prior
coronary events who presented to her Emergency Room with
chest pain and marked anterior ST segment elevations.  This
was preceded by a three day history of nausea and vomiting
with uncertainty as to whether there was some chest
discomfort with this as well.  Initial CPK was only 270.  She
was transferred to [**Hospital1 69**] for
urgent intervention.

Coronary angiography demonstrated the left anterior
descending to be patent but with a 90% proximal stenosis.
There was an 80% distal LAD lesion with no other significant
coronary artery disease.  The proximal LAD lesion was stented
with a good result with no residual and the distal LAD lesion
was treated with balloon dilatation.  Left ventricular
angiography at the time demonstrated severe anterolateral and
apical hypokinesis with an ejection fraction of 315.
Pulmonary capillary wedge pressure was markedly elevated to
28 mm and cardiac index reduced to 1.7 mm.  In view of this,
an intra-aortic balloon pump was placed.

In the CCU she responded well to diuresis, maintaining a
stable blood pressure and the balloon pump was removed the
following day.  Echocardiography confirmed anteroseptal and
atypical akinesis with an ejection fraction of 30%.  There is
no evidence of left ventricular apical thrombus although this
cannot be excluded.  CPK did not peak beyond the initial
value, suggesting her infarction may have occurred a few days
prior to admission.  Because of the severe apical left
ventricular involvement predisposing to apical thrombus, we
felt it best to anticoagulate with Coumadin in addition to
the Aspirin and Plavix required for stenting.  We did have
some reservation concerning this because of a history of past
GI bleeding and therefore observed her carefully with no
evidence of bleeding in the hospital.  Her hematocrit
remained stable at 33.7%.  INR at the time of discharge was
2.0.

She will require Aspirin and Plavix for the month following
stenting after which the Plavix can be discontinued and
Aspirin could be reduced to a lower dose.  The Coumadin could
be discontinued after 3-6 months at which time the incidents
of thromboembolism is much reduced.  The INR should be
maintained at no more than the 2 to 2.5 range with her
additional antiplatelet therapy.  The patient is to follow-up
with outpatient cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20426**], in
[**Hospital1 1474**], Mass.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease.

DISCHARGE STATUS:  Good.  Discharged to home.




                          [**First Name8 (NamePattern2) 2053**] [**Last Name (NamePattern1) 2052**], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern1) 41557**]

MEDQUIST36

D:  [**2117-11-2**]  19:48
T:  [**2117-11-8**]  13:37
JOB#:  [**Job Number 44050**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Pure hypercholesterolemia,Unspecified essential hypertension'}


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 a 70-year-old
woman with hypertension and hyperlipidemia but without prior
coronary events who presented to her Emergency Room with
chest pain and marked anterior ST segment elevations.  This
was preceded by a three day history of nausea and vomiting
with uncertainty as to whether there was some chest
discomfort with this as well.  Initial CPK was only 270.  She
was transferred to [**Hospital1 69**] for
urgent intervention.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Pure hypercholesterolemia,Unspecified essential hypertension'}
