CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 47-year-old
male with a past medical history of coronary artery disease,
status post 2-vessel percutaneous transluminal coronary
angioplasty in [**2186**], 3-vessel percutaneous transluminal
coronary angioplasty in [**2190**], hypertension, new onset type 2
diabetes, and hypercholesterolemia who presents with the
sudden onset of substernal chest pain status post exercise.

MEDICAL HISTORY: 1.  Coronary artery disease; the patient is status post
percutaneous transluminal coronary angioplasty times three in
[**2190**] at [**Hospital1 69**]; the patient is
status post percutaneous transluminal coronary angioplasty
times two in [**2186**] at [**Hospital 4415**].
2.  Type 2 diabetes.
3.  Hypercholesterolemia.
4.  Hypertension.

MEDICATION ON ADMISSION: Diltiazem 180 mg p.o. q.d.,
Lipitor 10 mg p.o. q.d., Glyset 25 mg p.o. q.d.,
Prevacid 30 mg p.o. q.d., metoprolol 50 mg p.o. b.i.d.,
Glucophage 500 mg p.o. q.d.

ALLERGIES: Allergies included PENICILLIN and IODINE.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father died of a myocardial
infarction at age 40, and a brother who died of a myocardial
infarction at age 40.

SOCIAL HISTORY: No ethanol use.  No tobacco at this time; he
quit 20 years ago.  The patient is married.
Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia
AMI anterior wall, init,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Pure hypercholesterolem
Admission Date:  [**2193-9-10**]     Discharge Date:  [**2193-9-15**]

Date of Birth:   [**2146-7-27**]     Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  The patient is a 47-year-old
male with a past medical history of coronary artery disease,
status post 2-vessel percutaneous transluminal coronary
angioplasty in [**2186**], 3-vessel percutaneous transluminal
coronary angioplasty in [**2190**], hypertension, new onset type 2
diabetes, and hypercholesterolemia who presents with the
sudden onset of substernal chest pain status post exercise.

The patient presented to [**Hospital3 15174**] on the
morning of admission with a chief complaint of substernal
burning without radiation which developed while doing
exercise.  Of note, this is the second time the patient has
exercised in many months.  The pain became worse over the
next few minutes to [**5-16**] and increased to [**8-16**] while he was
in the ambulance.  His nitroglycerin patch did not help, and
he only had slight relief with sublingual nitroglycerin times
three.  In addition, he had slight shortness of breath but
denies headache, change in vision, dizziness, nausea,
vomiting, abdominal pain, change in bowel or urinary habits,
or fevers, chills, and sweats.  Of note, he had a negative
stress test in [**2193-5-7**].

He was sent to [**Hospital3 15174**] via ambulance.  In
the Emergency Department he received aspirin, nitroglycerin
drip, heparin drip, Dilaudid, and TNK with decreased in his
pain but without resolution of symptoms.  Electrocardiogram
at that time showed ST elevations and J point elevations in
V2 through V4.

The patient was transferred to [**Hospital1 188**] where he underwent catheterization.  Catheterization
results showed 100% occlusion of the proximal left anterior
descending artery and 50% stenosis of first diagonal.
Angio-Jet percutaneous transluminal coronary angioplasty and
stenting was performed on proximal left anterior descending
artery and the percutaneous transluminal coronary angioplasty
was performed on first diagonal with good results.  An
intra-aortic balloon pump was placed at this time as well.

PAST MEDICAL HISTORY:
1.  Coronary artery disease; the patient is status post
percutaneous transluminal coronary angioplasty times three in
[**2190**] at [**Hospital1 69**]; the patient is
status post percutaneous transluminal coronary angioplasty
times two in [**2186**] at [**Hospital 4415**].
2.  Type 2 diabetes.
3.  Hypercholesterolemia.
4.  Hypertension.

FAMILY HISTORY:  The patient's father died of a myocardial
infarction at age 40, and a brother who died of a myocardial
infarction at age 40.

SOCIAL HISTORY:  No ethanol use.  No tobacco at this time; he
quit 20 years ago.  The patient is married.

MEDICATIONS ON ADMISSION:  Diltiazem 180 mg p.o. q.d.,
Lipitor 10 mg p.o. q.d., Glyset 25 mg p.o. q.d.,
Prevacid 30 mg p.o. q.d., metoprolol 50 mg p.o. b.i.d.,
Glucophage 500 mg p.o. q.d.

ALLERGIES:  Allergies included PENICILLIN and IODINE.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature maximum 98.7,
temperature current 98.3, pulse ranged from 82 to 92, blood
pressure 104 to 124/67 to 74 with a mean of 86 to 99,
respiratory rate of 11 to 16, oxygen saturation 94% to 98% on
2 liters.  Pulmonary artery pressure was 29/15 with a mean
of 22.  Cardiac output was 7 (that was on 6 of dopamine).
Intra-aortic balloon pump augmented systole was 109,
augmented diastole was 111.  The patient was lying flat in no
apparent distress.  HEENT revealed extraocular movements were
intact.  Pupils were equal, round, and reactive to light and
accommodation.  The oropharynx was clear with moist mucosa.
Neck was supple.  No lymphadenopathy.  Lungs were clear to
auscultation bilaterally, anteriorly and laterally.
Cardiovascular revealed jugular venous distention not
appreciated.  Carotids had normal upstroke and normal volume
with bilateral bruits.  A regular rate.  Normal S1 and S2.
No S3 or S4.  No murmurs, rubs or gallops.  Abdomen had
decreased bowel sounds, soft, nontender, and nondistended. No
hepatosplenomegaly.  Liver was about 5 cm.  Extremities had
no edema.  The right groin revealed intra-aortic balloon pump
site and pulmonary artery catheterization site were clean,
dry and intact without tenderness.  Dorsalis pedis pulses
were 2+ bilaterally.  Neurologic examination revealed alert
and oriented times three.  Cranial nerves II through XII were
intact.

LABORATORY DATA ON ADMISSION:  Laboratories on admission
revealed white count 7.8, hematocrit was 41.7, platelets
of 252, MCV 89, RDW 12.7.  Chem-7 revealed sodium of 136,
potassium 4.7, chloride 103, bicarbonate 22, BUN 16,
creatinine 0.8, glucose 284.  PT 14.2, PTT 108.5, INR 1.3.
Creatine kinase at 11 a.m. was 83, at 5 p.m. was 3021.
Arterial blood gas at 11 a.m. was 7.33/46/115.  Creatine
kinases trended from 11:15 on the day of admission from 83
to 3021 at 5 p.m. to 3450 at 11 p.m., to 1734 at 5:30 a.m. on
[**9-11**], to 1277 at 11:30 a.m. on [**9-11**], to 83
at 9:30 a.m. on [**9-15**].

RADIOLOGY/IMAGING:   Electrocardiogram post catheterization
showed continued ST elevations and J point elevations in V2
through V3.

Post catheterization echocardiogram showed an ejection
fraction of 30%, moderate systolic dysfunction, basal
anterior hypokinesis, mid anterior akinesis, basal
anteroseptal hypokinesis, mid anteroseptal akinesis.
Anterior apex akinesis, inferior apex akinesis, and apex
akinesis.  The was trace mitral regurgitation and trace
tricuspid regurgitation.

IMPRESSION:  This is a 47-year-old male with a past medical
history of type 2 diabetes, high cholesterol, hypertension,
and coronary artery disease, status post percutaneous
transluminal coronary angioplasty times two, who presented
with acute coronary syndrome refractory to medical treatment
and TNK, now status post Angio-Jet percutaneous transluminal
coronary angioplasty and stent of proximal left anterior
descending artery and percutaneous transluminal coronary
angioplasty of first diagonal with intra-aortic balloon pump
placement.

HOSPITAL COURSE:  The [**Hospital 228**] hospital course was
unremarkable.  Dopamine was discontinued on day one.  The
intra-aortic balloon pump was discontinued on day two.  The
patient was continued on heparin throughout his hospital
course and transitioned to Coumadin on hospital day four.
The patient was continued on Lipitor and aspirin, and Plavix
was added and will be continued for 30 days post
catheterization.  The patient was continued on Lopressor and
captopril throughout his hospital course, and changed to
Zestril 10 mg q.d. and atenolol 25 mg q.d. at discharge.  The
patient was discharged to the medical floor on hospital day
three and discharged from the hospital once his INR was
within the 2 to 2.5 range.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was stable.

DISCHARGE STATUS:   He was discharged home.

DISCHARGE FOLLOWUP:  Instructions to follow up with his
primary care physician on the [**Name9 (PRE) 766**] after discharge.
Primary care physician was to check INR and titrate Zestril
up and atenolol as tolerated.

MEDICATIONS ON DISCHARGE:
1.  Lipitor 10 mg p.o. q.d.
2.  Aspirin 325 mg p.o. q.d.
3.  Plavix 75 mg p.o. q.d. times 30
days.
4.  Prevacid 30 mg p.o. q.d.
5.  Atenolol 25 mg p.o. q.d.
6.  Zestril 10 mg p.o. q.d.
7.  Glyset 25 mg p.o. q.d.
8.  Glucophage 500 mg p.o. q.d.
9.  Coumadin 5 mg p.o. q.d.



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

Dictated By:[**Last Name (NamePattern1) 24478**]

MEDQUIST36

D:  [**2193-9-16**]  21:57
T:  [**2193-9-19**]  14:05
JOB#:  [**Job Number 24479**]

cc:[**Hospital3 24480**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}


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 47-year-old
male with a past medical history of coronary artery disease,
status post 2-vessel percutaneous transluminal coronary
angioplasty in [**2186**], 3-vessel percutaneous transluminal
coronary angioplasty in [**2190**], hypertension, new onset type 2
diabetes, and hypercholesterolemia who presents with the
sudden onset of substernal chest pain status post exercise.

MEDICAL HISTORY: 1.  Coronary artery disease; the patient is status post
percutaneous transluminal coronary angioplasty times three in
[**2190**] at [**Hospital1 69**]; the patient is
status post percutaneous transluminal coronary angioplasty
times two in [**2186**] at [**Hospital 4415**].
2.  Type 2 diabetes.
3.  Hypercholesterolemia.
4.  Hypertension.

MEDICATION ON ADMISSION: Diltiazem 180 mg p.o. q.d.,
Lipitor 10 mg p.o. q.d., Glyset 25 mg p.o. q.d.,
Prevacid 30 mg p.o. q.d., metoprolol 50 mg p.o. b.i.d.,
Glucophage 500 mg p.o. q.d.

ALLERGIES: Allergies included PENICILLIN and IODINE.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father died of a myocardial
infarction at age 40, and a brother who died of a myocardial
infarction at age 40.

SOCIAL HISTORY: No ethanol use.  No tobacco at this time; he
quit 20 years ago.  The patient is married. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}
