CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 70-year-old female
with a history of coronary artery disease suffered an acute
myocardial infarction in [**2128-4-14**], and she was taken to
catheterization laboratory and found three vessel disease
with successfully stented left anterior descending artery,
found to have left ventricular diastolic dysfunction with a
preserved ejection fraction of 57% with anterior apical
dyskinesis and anterolateral hypokinesis.

MEDICAL HISTORY: 1. Coronary artery disease in [**2129-11-14**], received
brachytherapy through a restented left anterior descending
artery, instent restenosis in [**2128-4-14**], stented left
anterior descending artery.
2. Lower back pain.
3. Congestive obstructive pulmonary disease/asthma, O2
dependent at night.
4. Gastrointestinal bleed status post
esophagogastroduodenoscopy with cauterization.
5. Hyperlipidemia.
6. Peripheral vascular disease status post aorto-bifemoral
bypass.
7. Congestive heart failure.
8. Hypothyroidism.
9. Hypertension.

MEDICATION ON ADMISSION: 1. Aspirin 325 mg po q day.
2. Prednisone 10 mg po q day.
3. Atenolol 25 mg po q day.
4. Lisinopril 5 mg po q day.
5. [**Year (4 digits) **] prn.
6. Flovent two puffs q hs.
7. Serevent two puffs [**Hospital1 **].
8. Diltiazem.
9. Lipitor 10 mg q day.
10. Compazine.
11. Plavix 75 mg q day.
12. Lasix 25 mg q day.
13. Vicodin.
14. Buthalital.
15. Isosorbide 30 mg q day.
16. Trazodone 100 mg q hs.
17. Prevacid 40 mg [**Hospital1 **].

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother has diabetes.  Father has coronary
artery disease.  Died at age 56 of a myocardial infarction.

SOCIAL HISTORY: A half pack per day smoker.  No alcohol,
seven children, divorced, former telephone operator.
Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Urinary tract infection, site not specified,Chronic diastolic heart failure,Paroxysmal ventricular tachycardia,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified
AMI anterior wall, init,Comp-oth cardiac device,Urin tract infection NOS,Chr diastolic hrt fail,Parox ventric tachycard,Chr airway obstruct NEC,Crnry athrscl natve vssl,Periph vascular dis NOS
Admission Date:  [**2129-4-8**]     Discharge Date:  [**2129-4-15**]

Date of Birth:   [**2059-3-27**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  Patient is a 70-year-old female
with a history of coronary artery disease suffered an acute
myocardial infarction in [**2128-4-14**], and she was taken to
catheterization laboratory and found three vessel disease
with successfully stented left anterior descending artery,
found to have left ventricular diastolic dysfunction with a
preserved ejection fraction of 57% with anterior apical
dyskinesis and anterolateral hypokinesis.

In [**2128-11-14**], the patient returned to [**Hospital3 **] for
chest pain.  Catheterization revealed totally occluded left
anterior descending artery with brachytherapy.
Echocardiogram in [**2128-11-14**] showed an ejection
fraction of 50%, mild symmetric left ventricular hypertrophy
with hypokinetic anterior wall and kinetic anteroseptal wall,
hypokinetic anterior apex, akinetic septal apex, and lateral
apex and akinetic apex, 1+ mitral regurgitation.

The patient was admitted to an outside hospital for a GI
bleed, where aspirin and Plavix were discontinued upon the
outside hospital.  The patient is found to have "several
ulcers".  EGD performed with cauterization of lesions.  The
patient is discharged home 48 hours.

On the morning of admission, she awoke, had a bowel movement,
and shortly after that, she developed severe substernal chest
pain [**6-23**] radiating to the back, positive diaphoresis, no
nausea or vomiting.  The patient took nitroglycerin x3 with
no relief and called EMS.  Electrocardiogram was 3-[**Street Address(2) 1755**]
elevations in leads V2 through V4.  Morphine, Heparin drip,
and nitroglycerin drip were started.

REVIEW OF SYSTEMS:  The patient with one pillow orthopnea.
No change in weight.  She has dyspnea on exertion with
walking one block, no stairs.

FAMILY HISTORY:  Mother has diabetes.  Father has coronary
artery disease.  Died at age 56 of a myocardial infarction.

SOCIAL HISTORY:  A half pack per day smoker.  No alcohol,
seven children, divorced, former telephone operator.

PAST MEDICAL HISTORY:
1. Coronary artery disease in [**2129-11-14**], received
brachytherapy through a restented left anterior descending
artery, instent restenosis in [**2128-4-14**], stented left
anterior descending artery.
2. Lower back pain.
3. Congestive obstructive pulmonary disease/asthma, O2
dependent at night.
4. Gastrointestinal bleed status post
esophagogastroduodenoscopy with cauterization.
5. Hyperlipidemia.
6. Peripheral vascular disease status post aorto-bifemoral
bypass.
7. Congestive heart failure.
8. Hypothyroidism.
9. Hypertension.

ALLERGIES:  She has no known drug allergies.

MEDICATIONS ON ADMISSION:
1. Aspirin 325 mg po q day.
2. Prednisone 10 mg po q day.
3. Atenolol 25 mg po q day.
4. Lisinopril 5 mg po q day.
5. [**Year (4 digits) **] prn.
6. Flovent two puffs q hs.
7. Serevent two puffs [**Hospital1 **].
8. Diltiazem.
9. Lipitor 10 mg q day.
10. Compazine.
11. Plavix 75 mg q day.
12. Lasix 25 mg q day.
13. Vicodin.
14. Buthalital.
15. Isosorbide 30 mg q day.
16. Trazodone 100 mg q hs.
17. Prevacid 40 mg [**Hospital1 **].

LABORATORY VALUES ON ADMISSION:  White blood cell count 16.5,
hematocrit 29.7, platelets 250.  Sodium 140, potassium 3.8,
chloride 107, CO2 23, BUN 11, creatinine 0.6, glucose 97,
calcium 8, phosphate 4, magnesium 1.6.

On coronary artery catheterization, she had a 60% right
coronary artery proximal lesion, 60% right coronary artery
distal lesion, right posterolateral 100% stenosis, left
anterior descending artery 100% occlusion proximal to
previous stent, LCX without significant lesion.

A postcatheterization electrocardiogram showed atrial
flutter/fibrillation, left axis deviation, [**Street Address(2) 4793**] elevations
in V2 through V4, T-wave inversions in V2 through VI, poor
R-wave progression.

VITALS ON ADMISSION:  Temperature 99.0, heart rate is 82,
blood pressure 98/48, respiratory rate 16, and oxygen 94% on
4 liters nasal cannula.  In general, this is a frail
appearing woman in no apparent distress, alert and oriented
times three.  HEENT:  No lymphadenopathy, no jugular venous
distention.  Pupils are equal, round, and reactive to light.
Cardiovascular:  Faint heart sounds.  Pulmonary:  Bivalve
sounds secondary to emphysematous changes.  Abdomen is soft,
nontender, nondistended no hepatosplenomegaly.  Extremities:
No edema, no pulses, dopplerable, no cyanosis or clubbing.

HOSPITAL COURSE BY SYSTEMS:
1. Coronary artery disease/ischemia:  The patient was found
to have a large acute myocardial infarction.  She received
successful cardiac catheterization with stenting of the left
anterior descending artery.  In the post myocardial
infarction period, she did have a period of tachycardia to
160s, which was found to be VT.  For this she was bolused
with lidocaine and put on a lidocaine drip.  EP was consulted
to assess the need for further EP studies and also
defibrillator placement.

The patient was talked to extensively and declined EP study,
and pacemaker, and AICD placement at this time.  To lower the
risk of recurrent VT, she was placed on amiodarone 400 mg po
q day, and additionally, she was sent home with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of
Hearts monitor for which strips will be examined over the
next two weeks by EP.  She has an outpatient with this EP in
approximately four weeks from discharge for followup and
further discussion of risk of morbidity and mortality from
cardiac arrhythmias.

Nevertheless, after the first 24 hours, she did not have any
recurrence of ventricular arrhythmias.  She was kept on the
lidocaine for the first 48 hours.  The lidocaine drip was
weaned off for 72+ hours prior to discharge, she was off
lidocaine and had no further arrhythmic events.

Pump:  The patient had repeat echocardiogram in-house, which
showed an ejection fraction of 25-35% reduced from the 50%
before.  This should be followed up.  It is unclear how much
of this is from damage versus myocardial stunning.  It is
possible the patient will recover from significant amount of
ejection fraction in the future.

Other systems:  GI:  She has a history of gastrointestinal
bleed.  We followed her hematocrit.  There was no drop in
hematocrit.  No recurrent gastrointestinal bleed.  She was
kept on proton-pump inhibitor, and stool softeners.

Heme:  The patient did receive 1 unit of packed red blood
cells for a decreased hematocrit, which was most likely
secondary to the prior gastrointestinal bleed.  She had no
need for blood and her hematocrit was stable.

Renal:  The patient's renal function was stable.  No acute
issues.

DISCHARGE MEDICATIONS:
1. Aspirin 325 mg po q day.
2. Plavix 75 mg po q day.
3. Prednisone 10 mg po q day.
4. Atenolol 25 mg po q day.
5. Lisinopril 5 mg po q day.
6. Fluticasone two puffs [**Hospital1 **].
7. Salmeterol 1-2 puffs [**Hospital1 **].
8. Lipitor 10 mg po q day.
9. Lasix 20 mg po q day.
10. Lansoprazole 30 mg po q day.
11. Levothyroxine 75 mcg po q day.
12. Spironolactone 12.5 mg po q day.
13. Amiodarone 400 mg po q day.
14. Levofloxacin 250 mg po q day for three days.
15. Prochlorperazine 25 mg prn.
16. Vicodin prn.
17. Bubatol prn.
18. Ativan prn.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Acute anterior myocardial infarction.
3. Congestive heart failure.
4. Ventricular arrhythmia.
5. Congestive obstructive pulmonary disease.
6. Hypertension.
7. Hyperlipidemia.




                          [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D.  [**MD Number(1) 422**]

Dictated By:[**Last Name (NamePattern1) 1737**]

MEDQUIST36

D:  [**2129-4-14**]  15:24
T:  [**2129-4-20**]  08:53
JOB#:  [**Job Number 34496**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Urinary tract infection, site not specified,Chronic diastolic heart failure,Paroxysmal ventricular tachycardia,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified'}


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: Patient is a 70-year-old female
with a history of coronary artery disease suffered an acute
myocardial infarction in [**2128-4-14**], and she was taken to
catheterization laboratory and found three vessel disease
with successfully stented left anterior descending artery,
found to have left ventricular diastolic dysfunction with a
preserved ejection fraction of 57% with anterior apical
dyskinesis and anterolateral hypokinesis.

MEDICAL HISTORY: 1. Coronary artery disease in [**2129-11-14**], received
brachytherapy through a restented left anterior descending
artery, instent restenosis in [**2128-4-14**], stented left
anterior descending artery.
2. Lower back pain.
3. Congestive obstructive pulmonary disease/asthma, O2
dependent at night.
4. Gastrointestinal bleed status post
esophagogastroduodenoscopy with cauterization.
5. Hyperlipidemia.
6. Peripheral vascular disease status post aorto-bifemoral
bypass.
7. Congestive heart failure.
8. Hypothyroidism.
9. Hypertension.

MEDICATION ON ADMISSION: 1. Aspirin 325 mg po q day.
2. Prednisone 10 mg po q day.
3. Atenolol 25 mg po q day.
4. Lisinopril 5 mg po q day.
5. [**Year (4 digits) **] prn.
6. Flovent two puffs q hs.
7. Serevent two puffs [**Hospital1 **].
8. Diltiazem.
9. Lipitor 10 mg q day.
10. Compazine.
11. Plavix 75 mg q day.
12. Lasix 25 mg q day.
13. Vicodin.
14. Buthalital.
15. Isosorbide 30 mg q day.
16. Trazodone 100 mg q hs.
17. Prevacid 40 mg [**Hospital1 **].

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother has diabetes.  Father has coronary
artery disease.  Died at age 56 of a myocardial infarction.

SOCIAL HISTORY: A half pack per day smoker.  No alcohol,
seven children, divorced, former telephone operator. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Urinary tract infection, site not specified,Chronic diastolic heart failure,Paroxysmal ventricular tachycardia,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Peripheral vascular disease, unspecified'}
