CHIEF COMPLAINT: .
CHIEF COMPLAINT: Weakness
.

PRESENT ILLNESS: HISTORY OF PRESENTING ILLNESS:
56 M with no previous medical history, Jehovah's Witness,
presents with 6 days of left-sided chest pain. Pain began
evening on [**12-23**] and improved with motrin. The pain subsided on
[**12-24**] and returned [**12-25**]. On [**12-26**] he couldn't walk, had no
appetite, and felt dizzy and weak. He had drenching nightsweats.
His wife advised going to the hospital, but he deferred. On
[**12-27**] his chest pain returned, then [**7-24**], radiating down the
left arm and to his jaw. He awoke today, [**12-28**], feeling
profoundly weak with no strength in his legs and decided to seek
medical attention.
.
In ED, VS were HR 34, BP 113/65, RR 15.EKG showed diffuse STE.
Patient got O2, ASA, plavix, heparin bolus, and 4 mg morphine.
Integrallin was held. He was transferred directly to cath lab.
.
In the cath lab, he arrived in complete heart block with a HR of
35. A temp wire was placed. He was found to have TO of
posterolateral RCA. No disease in other vessels. Patient was
right dominant and had new MR. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 79818**] was placed near stump of
RCA and 4 mg of IC TNK was given via ballon. A lesion was dialed
and stenteed with a BMS. After [**Last Name (NamePattern4) 79818**] inflation, 4 mg of TNK was
administered. Patient was in sinus bradycardia at end of case.
(Of note, patient on study protocol and TNK may have been
placebo.)
.
Currently, he is chest pain free and without complaints. He
denies dyspnea, lightheadedness or irregular heart rate. ROS
otherwise negative. Denies recent histroy of polyurea,
polydypsia, numbness in the feet.
.

MEDICAL HISTORY: Denies history of Diabetes, Dyslipidemia, Hypertension, or
previous heart or medical problems

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=97.6 BP= 169/76 HR=46 O2 sat= 100%
GENERAL: WDWN male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI. Mom with hypertension.

SOCIAL HISTORY: Tobacco history: Never
-ETOH: Never
-Illicit drugs: Never
Patient is Jehovah's witness and refuses blood products. He
lives in [**Location **] with his wife and two children. He works doing
laundry in a hotel.
Acute myocardial infarction of other lateral wall, initial episode of care,Acute kidney failure, unspecified,Atrioventricular block, complete,Hyposmolality and/or hyponatremia,Intestinal infection due to Clostridium difficile,Bacteremia,Urinary tract infection, site not specified,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Examination of participant in clinical trial
AMI lateral NEC, initial,Acute kidney failure NOS,Atriovent block complete,Hyposmolality,Int inf clstrdium dfcile,Bacteremia,Urin tract infection NOS,Angina pectoris NEC/NOS,DMII wo cmp nt st uncntr,Other staphylococcus,Exam-clincal trial
Admission Date:  [**2187-12-28**]              Discharge Date:   [**2188-1-2**]

Date of Birth:  [**2131-4-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
.
CHIEF COMPLAINT: Weakness
.


Major Surgical or Invasive Procedure:
Cardiac catheterization with pacer wires placed for bradycardia:
One Bare Metal Stent to RCA.
Relook Catheterization [**12-29**]: stent patent


History of Present Illness:
HISTORY OF PRESENTING ILLNESS:
56 M with no previous medical history, Jehovah's Witness,
presents with 6 days of left-sided chest pain. Pain began
evening on [**12-23**] and improved with motrin. The pain subsided on
[**12-24**] and returned [**12-25**]. On [**12-26**] he couldn't walk, had no
appetite, and felt dizzy and weak. He had drenching nightsweats.
His wife advised going to the hospital, but he deferred. On
[**12-27**] his chest pain returned, then [**7-24**], radiating down the
left arm and to his jaw. He awoke today, [**12-28**], feeling
profoundly weak with no strength in his legs and decided to seek
medical attention.
.
In ED, VS were HR 34, BP 113/65, RR 15.EKG showed diffuse STE.
Patient got O2, ASA, plavix, heparin bolus, and 4 mg morphine.
Integrallin was held. He was transferred directly to cath lab.
.
In the cath lab, he arrived in complete heart block with a HR of
35. A temp wire was placed. He was found to have TO of
posterolateral RCA. No disease in other vessels. Patient was
right dominant and had new MR. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 79818**] was placed near stump of
RCA and 4 mg of IC TNK was given via ballon. A lesion was dialed
and stenteed with a BMS. After [**Last Name (NamePattern4) 79818**] inflation, 4 mg of TNK was
administered. Patient was in sinus bradycardia at end of case.
(Of note, patient on study protocol and TNK may have been
placebo.)
.
Currently, he is chest pain free and without complaints. He
denies dyspnea, lightheadedness or irregular heart rate. ROS
otherwise negative. Denies recent histroy of polyurea,
polydypsia, numbness in the feet.
.


Past Medical History:
Denies history of Diabetes, Dyslipidemia, Hypertension, or
previous heart or medical problems

Social History:
Tobacco history: Never
-ETOH: Never
-Illicit drugs: Never
Patient is Jehovah's witness and refuses blood products. He
lives in [**Location **] with his wife and two children. He works doing
laundry in a hotel.


Family History:
No family history of early MI. Mom with hypertension.

Physical Exam:
VS: T=97.6 BP= 169/76 HR=46 O2 sat= 100%
GENERAL: WDWN male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

CARDIAC: PMI located in 5th intercostal space, midclavicular
line. Bradycardic, normal S1, S2. No m/r/g. No thrills, lifts.
No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Mild crackles at bases.

ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e. No femoral bruits. Pacer line in right
femoral fossa. Feet are cool.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
.


Pertinent Results:
[**2187-12-28**] 11:02PM   CK(CPK)-456*
[**2187-12-28**] 11:02PM   CK-MB-8 cTropnT-2.32*
[**2187-12-28**] 08:31PM   ALBUMIN-3.4
[**2187-12-28**] 08:31PM   %HbA1c-11.9*
[**2187-12-28**] 08:31PM   WBC-11.8* RBC-3.81* HGB-12.4* HCT-35.1*
MCV-92 MCH-32.6* MCHC-35.3* RDW-12.3
[**2187-12-28**] 08:31PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.047*
[**2187-12-28**] 08:31PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-1000 KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2187-12-28**] 05:03PM   GLUCOSE-216* UREA N-40* CREAT-1.6* SODIUM-133
POTASSIUM-3.4 CHLORIDE-97 TOTAL CO2-26 ANION GAP-13
.
 Blood Culture, Routine (Final [**2188-1-8**]):
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    ISOLATED FROM ONE
SET ONLY.
         SENSITIVITIES PERFORMED ON REQUEST..
         SENSITIVITIES REQUESTED BY DR.[**First Name (STitle) **] [**Numeric Identifier 79819**].  FINAL
SENSITIVITIES.
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.  Sensitivity testing performed by
Sensititre.
         CLINDAMYCIN = SENSITIVE AT 0.12MCG/ML.
         OXACILLIN = SENSITIVE AT 0.25MCG/ML.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPHYLOCOCCUS, COAGULASE NEGATIVE
                             |
CLINDAMYCIN-----------       S
ERYTHROMYCIN----------  0.25 S
GENTAMICIN------------     2 S
LEVOFLOXACIN----------   0.5 S
OXACILLIN-------------       S
PENICILLIN G----------  0.06 S
TRIMETHOPRIM/SULFA----   0.5 S

   Anaerobic Bottle Gram Stain (Final [**2187-12-31**]):
      GRAM POSITIVE COCCI IN CLUSTERS.


Brief Hospital Course:
56 M with no PMH, Jehovah's witness p/w weakness, bradycardia,
hyperglycemia, STEMI s/p stenting of posterorlateral RCA.
Infarction likely involved AV node causing bradycardia that
resolved during admission.
.
ST-ELEVATION MYOCARDIAL INFARCTION - Patient with significant
right-sided infarction. Elevated troponin/CK-MB and history
suggest significant duration of ischemia and low chance of
myocardial recovery. CKs have peaked. Patient is s/p RCA
stenting with bare metal stent. Cardiac rehabilitation has been
recommended after outpatient cardiology clearance.
- Medical management with ASA, statin, plavix.
- No beta-blocker as bradycardic.
.
BRADYCARDIA - Likely seconday to ichemia of conduction system.
Patient appears to have isorhythmic dissociation. Pacer wires
placed in cath lab. Rhythm progressed from CHB to 2nd-degree to
1st -degree (conduction delay). No need for permanant pacing.
Transient VT with pacer wire pull requiring Lidocaine drip.
Resolved spontaneously.
- No beta-blocker for now.
.
PUMP - Pt had EF 40% with mild regional LV systolic dysfunction.
Also 1+ MR [**First Name (Titles) **] [**Last Name (Titles) **].  Pt tolerated ACE initiation with Lisinopril
but beta blocker was held secondary to bradycardia. CHF teaching
was done prior to discharge.
.
HYPERGLYCEMIA - Hyperglycemia likely represents longstanding
undiagnosed diabetes. HbA1c 11.9 indicative of chronic disease.
Transiently on insulin drip while in CCU. Pt was seen by [**Last Name (un) **]
consult here and recommended metformin and glyburide at d/c.
Patient has an appt to see [**Last Name (un) **] nurse for teaching of blood
sugar monitoring on the day after discharge. He will get all of
his diabetes supplies at this appointment.
.
RENAL FAILURE - Suspect acute renal failure in setting of poor
perfusion and hyperglycemic hypovolemia. [**Month (only) 116**] represent diabetic
nephropathy if more chronic. Improved on day of discharge with
creatinine 1.1.
.
CLINICAL TRIAL - Patient is on ICE-T-TIMI-49 trial, a RCT of low
dose IC tenecteplace during PCI for STEMIs. He received
tenecteplase or placebo. He will be contact[**Name (NI) **] at 30-35 days by
phone to assess for adverse advents
.
C-Diff Colitis: Pt developed diarrhea with positive c-diff
cultures, Was discharged on PO Flagyl for a total 14 day course.
On the day of discharge, pt was eating and drinking in adequate
amounts, he had no abdominal pain and the diarrhea was
resolving.
.
Bacteremia:
Coag negative staph was isolated out of 1 set of blood cultures
only, subsequent blood culteures were negative. Pt was followed
by the infectious disease team during his hospital stay who rec
8 day course of PO Bactrim. Pt was afebrile at discharge. An
ECHO was done which showed a possible filament on the arotic
valve with 1+ AR. Upon review by cardiology team, it was not
thought that this represented a vegetation or that patient
required a long course of antibiotics. Pt was instructed to call
his PCP on discharge if he developed fevers, sweating or any
other unusual symptoms.

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): Take every day for at least one month.
Disp:*30 Tablet(s)* Refills:*2*
3. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metformin 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
7. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 8 days.
Disp:*16 Tablet(s)* Refills:*0*
8. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 2 weeks.
Disp:*42 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Inferior ST Elevation Myocardial Infarction
Acute Systolic Dysfunction: EF 40%
Diabetes Mellitus Type 2: new diagnosis
Acute Renal Failure
Bradycardia: Beta Blocker held


Discharge Condition:
Stable
BUN= 14
Creat=1.1
Hct=29.5
K=4.0
Plt=375


Discharge Instructions:
You had an inferior heart attack at home. You were admitted and
a cardiac catheterization was done which showed a blockage in 1
of your arteries. The artery was opened and a stent to keep it
open was used. You had a pacing wire placed because your heart
rate was low. That is now removed and your heart rate has been
stable. You will need to take Clopodigrel (Plavix) every day for
at least one month. Do not miss [**First Name (Titles) 691**] [**Last Name (Titles) 4319**] or stop taking
Clopidrel unless Dr. [**First Name (STitle) **] tells you to.
Other new medicines include:
1. Atorvastatin:
2. Lisinopril
3. Metformin: to decrease blood sugar
4. Glyburide: to decrease blood sugar
5. Aspirin: to prevent bloot clots
.
Because of the heart attack, your heart is weak. You may retain
some fluid because of this and you should eat a low sodium diet
to help to prevent this. Weigh yourself every morning before you
eat breakfast, call Dr. [**Last Name (STitle) 8430**] if weight > 3 lbs in 1 day or 6
pounds in 3 days.
Adhere to 2 gm sodium diet, information regarding this was given
to you to take home.
.
You also were found to have a high blood sugar and have been
diagnosed as a diabetic. We have made you an appointment at the
[**Hospital **] clinic to learn more about diabetes and checking your
blood sugar at home.
.
You have a bowel infection called c.difficile. This is causing
diarrhea and may cause abdominal pain and fevers. You are on an
antibiotic, flagyl, to treat this for 2 weeks.
A blood culture was also positive, you are on another
antibiotic, bactrim, to treat this for 8 days.
.
Please call Dr. [**Last Name (STitle) 8430**] if you have any fevers, worsening
abdominal pain or diarrhea, if you are unable to eat or drink.
Also call him for any chest pain, nausea, sweating, trouble
breathing or any other concerning symptom.
.
Please call [**Hospital1 3278**] insurance tomorrow and tell them that you have
a new primary care doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 8430**] and a new
cardiologist, Dr. [**First Name8 (NamePattern2) 5987**] [**Last Name (NamePattern1) **].


Followup Instructions:
.
Primary Care:
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 8430**] ,MD
[**State **] [**Apartment Address(1) **] [**Location (un) **], [**Numeric Identifier 23881**]
Office phone: ([**Telephone/Fax (1) 79820**]
Date/Time: Thursday [**1-17**] at 12:45pm.
.
Cardiology:
Dr. [**First Name8 (NamePattern2) 5987**] [**Last Name (NamePattern1) **] Phone: [**Telephone/Fax (1) 79821**] Date Time: Office will
call you with an appt
.
[**Last Name (un) **] Diabetes Center, [**Last Name (un) 3911**], [**Location (un) 86**]:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Phone: [**Telephone/Fax (1) 2384**] Date/Time: [**2187-3-21**]
at 10am. You are on the waiting list for an earlier appt.
.
[**2188-1-3**] at 2pm. [**Last Name (un) **] Diabetes Center, [**Location (un) 1773**], desk near
waiting area. You will meet with [**First Name4 (NamePattern1) 16883**] [**Last Name (NamePattern1) 30988**], RN.



Completed by:[**2188-1-14**]
{'Acute myocardial infarction of other lateral wall, initial episode of care,Acute kidney failure, unspecified,Atrioventricular block, complete,Hyposmolality and/or hyponatremia,Intestinal infection due to Clostridium difficile,Bacteremia,Urinary tract infection, site not specified,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Examination of participant in clinical trial'}


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: .
CHIEF COMPLAINT: Weakness
.

PRESENT ILLNESS: HISTORY OF PRESENTING ILLNESS:
56 M with no previous medical history, Jehovah's Witness,
presents with 6 days of left-sided chest pain. Pain began
evening on [**12-23**] and improved with motrin. The pain subsided on
[**12-24**] and returned [**12-25**]. On [**12-26**] he couldn't walk, had no
appetite, and felt dizzy and weak. He had drenching nightsweats.
His wife advised going to the hospital, but he deferred. On
[**12-27**] his chest pain returned, then [**7-24**], radiating down the
left arm and to his jaw. He awoke today, [**12-28**], feeling
profoundly weak with no strength in his legs and decided to seek
medical attention.
.
In ED, VS were HR 34, BP 113/65, RR 15.EKG showed diffuse STE.
Patient got O2, ASA, plavix, heparin bolus, and 4 mg morphine.
Integrallin was held. He was transferred directly to cath lab.
.
In the cath lab, he arrived in complete heart block with a HR of
35. A temp wire was placed. He was found to have TO of
posterolateral RCA. No disease in other vessels. Patient was
right dominant and had new MR. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 79818**] was placed near stump of
RCA and 4 mg of IC TNK was given via ballon. A lesion was dialed
and stenteed with a BMS. After [**Last Name (NamePattern4) 79818**] inflation, 4 mg of TNK was
administered. Patient was in sinus bradycardia at end of case.
(Of note, patient on study protocol and TNK may have been
placebo.)
.
Currently, he is chest pain free and without complaints. He
denies dyspnea, lightheadedness or irregular heart rate. ROS
otherwise negative. Denies recent histroy of polyurea,
polydypsia, numbness in the feet.
.

MEDICAL HISTORY: Denies history of Diabetes, Dyslipidemia, Hypertension, or
previous heart or medical problems

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=97.6 BP= 169/76 HR=46 O2 sat= 100%
GENERAL: WDWN male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI. Mom with hypertension.

SOCIAL HISTORY: Tobacco history: Never
-ETOH: Never
-Illicit drugs: Never
Patient is Jehovah's witness and refuses blood products. He
lives in [**Location **] with his wife and two children. He works doing
laundry in a hotel. 

### Response:
{'Acute myocardial infarction of other lateral wall, initial episode of care,Acute kidney failure, unspecified,Atrioventricular block, complete,Hyposmolality and/or hyponatremia,Intestinal infection due to Clostridium difficile,Bacteremia,Urinary tract infection, site not specified,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Examination of participant in clinical trial'}
