CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: This 56 year old man with no known history of coronary artery
disease and positive risk factors for htn, past smoking history
and positive family history note a brief episode of chest
discomfort earlier today around 11 while driving daughter. This
lasted for a minute or so and resolved spontaneously. This
afternoon around 4 while packing trash to take to the dumpster
he again noted [**5-7**] chest discomfort which he described as
constriction around throat. no radiation was noted. there was
associated sob, cold sweat, nausea but no vomiting. His wife
drove him to [**Location (un) **] ER today and he arrived at 4:30 pm

MEDICAL HISTORY: untreated HTN

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.6 , BP 150/87, HR 70/min, RR 16/min, O2 98% on RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3. ESM in right 2nd intercostal
space without radiation.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses: Right femoral groin site clean, no hematoma. no bruit.
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. However his maternal grandmother and uncle had
[**Name (NI) **] in their 70s.

SOCIAL HISTORY: Social history is significant for 20 pack years history of
smoking quit 10years ago. There is no history of alcohol abuse.
Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia
AMI lateral NEC, initial,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2163-6-10**]              Discharge Date:   [**2163-6-14**]

Date of Birth:  [**2106-7-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 458**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
Cardiac catherization with placement of bare metal and drug
eluting stents.


History of Present Illness:
This 56 year old man with no known history of coronary artery
disease and positive risk factors for htn, past smoking history
and positive family history note a brief episode of chest
discomfort earlier today around 11 while driving daughter. This
lasted for a minute or so and resolved spontaneously. This
afternoon around 4 while packing trash to take to the dumpster
he again noted [**5-7**] chest discomfort which he described as
constriction around throat. no radiation was noted. there was
associated sob, cold sweat, nausea but no vomiting. His wife
drove him to [**Location (un) **] ER today and he arrived at 4:30 pm

Past Medical History:
untreated HTN

Social History:
Social history is significant for 20 pack years history of
smoking quit 10years ago. There is no history of alcohol abuse.

Family History:
There is no family history of premature coronary artery disease
or sudden death. However his maternal grandmother and uncle had
[**Name (NI) **] in their 70s.

Physical Exam:
VS: T 97.6 , BP 150/87, HR 70/min, RR 16/min, O2 98% on RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3. ESM in right 2nd intercostal
space without radiation.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses: Right femoral groin site clean, no hematoma. no bruit.
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP



Pertinent Results:
[**2163-6-10**] 08:33PM   POTASSIUM-4.2
[**2163-6-10**] 08:33PM   CK(CPK)-702*
[**2163-6-10**] 08:33PM   CK-MB-70* MB INDX-10.0*
[**2163-6-10**] 08:33PM   PLT COUNT-235

C.CATH
COMMENTS:
1. Selective coronary angiography of this left dominant system
demonstrated two vessel coronary artery disease. The LMCA had no

angiographically apparent CAD. The LAD had diffuse
atherosclerosis with
serial 20-30% stenoses and mid vessel 90% stenosis with a 2.0mm
D1
vessel with TIMI 2 flow and a 95% stenosis. The LCx has a 80%
stenosis
at the origin of OM1 and a 60% mid vessel stenosis at the take
off of
OM1. The RCA was small, non-dominant with mid vessel 70%
stenosis and
serial lesions of 40-50%.
2. Limited resting hemodynamic measurement demonstrated an
elevated
systemic arterial pressure at 171/101 mmHg.
3. Successful PTCA/stent to mid LAD with a 3.5x15mm and 3.5x12mm

Driver stent and postdilated with a 4.0mm balloon.
4. Successful PTCA/stent to proximal D1 with a 2.25x18mm
MicroDriver
stent. Excellent result with normal flow down vessel and no
residual
stenosis.

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Successful placement of BMS in the LAD and D1.

ECHO
The left atrium is mildly dilated. There is moderate symmetric
left ventricular hypertrophy. The left ventricular cavity size
is normal. Due to suboptimal technical quality, a focal wall
motion abnormality cannot be fully excluded. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic root is moderately dilated at the sinus level. The aortic
arch is mildly dilated. The number of aortic valve leaflets
cannot be determined. The aortic valve leaflets are mildly
thickened. There is a minimally increased gradient consistent
with minimal aortic valve stenosis. Trace aortic regurgitation
is seen. The mitral valve leaflets are mildly thickened. No
mitral regurgitation is seen. The pulmonary artery systolic
pressure could not be determined. There is no pericardial
effusion.

IMPRESSION: Suboptimal image quality. Moderate ventricular
hypertrophy with preserved global biventricular systolic
function. Minimal aortic stenosis. Trivial aortic regurgitation.
Thoracic aortic dilation.

Brief Hospital Course:
Hospital Course:
.
#CAD- In the ER patient was noted to have ST elevation in AVL
and ST depression in II, III and AVR. Labs revealed na 139, k
4.0, cl 104, co2 29, bun 15, creat 1.2. ca 9.1, ptt 13.6, inr
1.2, wbc 9.1, hb 16.4, hct 46.9, plt 222. His CK peaked at 280,
MB 15.  He was started on aspirin, plavix, heparin, aggrestat
and lopressor prior to transfering to [**Hospital1 18**] cath lab. Patient
was taken to the cath lab which revealed LAD had diffuse
atherosclerosis with serial 20-30% stenoses and mid vessel 90%
stenosis with a 2.0mm D1 vessel with TIMI 2 flow and a 95%
stenosis. The LCx has a 80% stenosis at the origin of OM1 and a
60% mid vessel stenosis at the take off of
OM1. The RCA was small, non-dominant with mid vessel 70%
stenosis and serial lesions of 40-50%. He underwent staged PCI
with BMS to LAD and Diagnol.  He was continued on aspirin,
plavix and Lipitor post procedure.  In addition, he was started
on Lisinopril and Toprol XL to be continued as an outpatient. Pt
shoul dundergo outpatient exercise testing to assess the need
for OM intervention.
.
# Pump: An ECHO was done which demonstrated moderate ventricular
hypertrophy with preserved global biventricular systolic
function, EF>55%. Pt was felt to be euvolemic and no
intervention needed.
.

.


Medications on Admission:
None

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Do NOT stop or miss doses unless directed by your
cardiologist.
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
- ST Eleveation Myocardial Infarction
Secondary diagnoses:
- Coronary artery disease
- Hypertension
- Hyperlipidemia.


Discharge Condition:
Stable, ambulating without difficulties. Cleared by physical
therapy as safe for discharge.


Discharge Instructions:
You were admitted after having chest pain and found to have a
heart attack.  You underwent cardiac catherization and had
stents placed into occluded arteries in your heart. You were
monitored in the cardiac intensive care unit afterwards. You
will need to follow up with Dr. [**First Name (STitle) **] [**Name (STitle) 1911**] in the
department of cardiology; you will need to discuss testing such
a stress test or another catherization at that time.
.
Please contact your cardiologist, primary care physician, [**Name10 (NameIs) **] go
to the emergency room if you experience any chest pain,
shortness of breath, palpitations, bleeding, dizziness, or other
concerning symptoms.
.
It has been a pleasure caring for you.
.
A number of new medications have been prescribed. It is very
important that you continue to take these as directed. This is
especially true, regarding your Plavix and Aspirin. Stopping
these medications will put you at risk for blockage in your
stents which could cause heart attack or even death.
.
Your blood pressure medications may need to be increased by your
primary care physician or cardiologist.

Followup Instructions:
1. Please call Dr. [**First Name (STitle) **] [**Name (STitle) 1911**], your outpatient
cardiologist, to schedule an outpatient stress test in [**4-3**] weeks
after hospital discharge and a hospital followup visit. His
office is located at [**Apartment Address(1) 78627**] in [**Location (un) **], [**Numeric Identifier 28704**].
The number for his office is ([**Telephone/Fax (1) 76272**].
An appointment has been made for you on Wednesday, [**7-6**], at
3:00 PM. The fax number for his office is ([**Telephone/Fax (1) 77773**]
.
2. Please call today or tomorrow to make a follow up appointment
with your primary care physician within the next 1-2 weeks. You
may need adjustments made in your blood pressure medications.
{'Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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

PRESENT ILLNESS: This 56 year old man with no known history of coronary artery
disease and positive risk factors for htn, past smoking history
and positive family history note a brief episode of chest
discomfort earlier today around 11 while driving daughter. This
lasted for a minute or so and resolved spontaneously. This
afternoon around 4 while packing trash to take to the dumpster
he again noted [**5-7**] chest discomfort which he described as
constriction around throat. no radiation was noted. there was
associated sob, cold sweat, nausea but no vomiting. His wife
drove him to [**Location (un) **] ER today and he arrived at 4:30 pm

MEDICAL HISTORY: untreated HTN

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.6 , BP 150/87, HR 70/min, RR 16/min, O2 98% on RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3. ESM in right 2nd intercostal
space without radiation.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses: Right femoral groin site clean, no hematoma. no bruit.
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. However his maternal grandmother and uncle had
[**Name (NI) **] in their 70s.

SOCIAL HISTORY: Social history is significant for 20 pack years history of
smoking quit 10years ago. There is no history of alcohol abuse. 

### Response:
{'Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
