CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: The patient is a 41 yo man with h/o GERD and 3-week history of
stable angina who presented s/p cardiac catheterization with
possible RV perforation.  The patient states that his symptoms
began 3 weeks ago, when he began to experience chest pain with
exertion.  The chest pain was a pressure, [**4-3**], exacerbated with
exertion, which radiated to his left shoulder.  The pain
resolved with rest.  Given the patient's extensive cardiac
history, he presented to his brother's cardiologist, who
recommended an exercise stress test.  The patient underwent the
ETT last Tuesday, where he exercised 4-5 minutes before
repoducing the same chest pain.  The pain continued for
approximately 4 minutes of rest after the test was stopped.  He
was started on Toprol XL a nd presented to [**Hospital3 19345**] today for elective cardiac catheterization.  During the
catheterization, a 90% stenosis was found in the LAD, so the
patient was transferred to [**Hospital1 18**] for PCI.
.
During the cardiac catheterization at [**Hospital1 18**], the patient was
found to have a 99% stenosis in the LAD and an apical occlusion.
 A wire was advance through the apical occlusion in [**Doctor First Name **] to
restore flow, and there was a contrast stain worrisome for
microperforation.  The patient had a TTE at this time which did
not show any evidence of effusion.  He was thus admitted to the
CCU for further observation and evaluation.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (-) Diabetes, (+) Dyslipidemia,
(+)Hypertension
2. OTHER PAST MEDICAL HISTORY:
GERD
Hypertension
Hyperlipidemia

MEDICATION ON ADMISSION: Nexium
Toprol XL 25 mg daily
Aspirin 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.2, BP 132/74, R 16, P 88, O2 99% RA
GENERAL: Middle aged man, pleasant, in NAD.  Oriented x3. Mood,
affect appropriate.
HEENT: PERRL, EOMI, Sclera anicteric. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with JVP of 8 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, 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. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.  Right femoral
incision site c/d/i.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: DP 2+ PT 2+
Left: DP 2+ PT 2+

FAMILY HISTORY: The patient's mother had angioplasty in her 60s.  His father had
bypass surgery in his 60s.  No other known history of CAD or
sudden death.

SOCIAL HISTORY: The patient is married and lives in [**Hospital1 3597**], NH with his wife and
three children.  He works with his family as the owner of a
jewelry store.
-Tobacco history:  Never smoked
-ETOH: Rare EtOH use
-Illicit drugs:  None
Subendocardial infarction, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified angina pectoris,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Subendo infarct, initial,Accidental op laceration,Crnry athrscl natve vssl,Esophageal reflux,Hypertension NOS,Hyperlipidemia NEC/NOS,Angina pectoris NEC/NOS,Abn react-cardiac cath
Admission Date:  [**2133-6-29**]              Discharge Date:   [**2133-7-1**]

Date of Birth:  [**2092-4-24**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization w/ [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 5175**] X1


History of Present Illness:
The patient is a 41 yo man with h/o GERD and 3-week history of
stable angina who presented s/p cardiac catheterization with
possible RV perforation.  The patient states that his symptoms
began 3 weeks ago, when he began to experience chest pain with
exertion.  The chest pain was a pressure, [**4-3**], exacerbated with
exertion, which radiated to his left shoulder.  The pain
resolved with rest.  Given the patient's extensive cardiac
history, he presented to his brother's cardiologist, who
recommended an exercise stress test.  The patient underwent the
ETT last Tuesday, where he exercised 4-5 minutes before
repoducing the same chest pain.  The pain continued for
approximately 4 minutes of rest after the test was stopped.  He
was started on Toprol XL a nd presented to [**Hospital3 19345**] today for elective cardiac catheterization.  During the
catheterization, a 90% stenosis was found in the LAD, so the
patient was transferred to [**Hospital1 18**] for PCI.
.
During the cardiac catheterization at [**Hospital1 18**], the patient was
found to have a 99% stenosis in the LAD and an apical occlusion.
 A wire was advance through the apical occlusion in [**Doctor First Name **] to
restore flow, and there was a contrast stain worrisome for
microperforation.  The patient had a TTE at this time which did
not show any evidence of effusion.  He was thus admitted to the
CCU for further observation and evaluation.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.


Past Medical History:
1. CARDIAC RISK FACTORS: (-) Diabetes, (+) Dyslipidemia,
(+)Hypertension
2. OTHER PAST MEDICAL HISTORY:
GERD
Hypertension
Hyperlipidemia

Social History:
The patient is married and lives in [**Hospital1 3597**], NH with his wife and
three children.  He works with his family as the owner of a
jewelry store.
-Tobacco history:  Never smoked
-ETOH: Rare EtOH use
-Illicit drugs:  None

Family History:
The patient's mother had angioplasty in her 60s.  His father had
bypass surgery in his 60s.  No other known history of CAD or
sudden death.

Physical Exam:
VS: T 98.2, BP 132/74, R 16, P 88, O2 99% RA
GENERAL: Middle aged man, pleasant, in NAD.  Oriented x3. Mood,
affect appropriate.
HEENT: PERRL, EOMI, Sclera anicteric. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with JVP of 8 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, 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. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.  Right femoral
incision site c/d/i.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: DP 2+ PT 2+
Left: DP 2+ PT 2+


Pertinent Results:
ETT: [**2133-6-29**] at [**Hospital3 **]: Reproduced chest pressure after
4-5 minutes into the test and remained 4 minutes into recovery.
Radiographic images are currently pending.
.
CARDIAC CATH:  [**2133-6-29**] (at [**Hospital3 **]): 90% lesion in the
mid-LAD.
.
EKG:  NSR with rate of 93 BPM.  No ST or T wave abnormalities.
.
CARDIAC CATH: [**2133-6-29**] (at [**Hospital1 18**]):  LAD with 99% mid stenosis with
? thrombus, muscle bridge distal (50% stenosis) and apical
occlusion (wrap around LAD) -> PTCA -> stenting -> slow flow
suggesting acute worsening of stenosis, active plaque -> 0%
residual in mid vessel -> advanced wire through the apical
occlusion to restore some flow -> slight contrast stain
worrisome for microperforation -> echo showed no effusion ->
slow flow restored across the apical LAD.
.
CXR ([**6-29**]): PA and lateral views of the chest reveal clear lungs
with normal cardiac and mediastinal outlines and pulmonary
vascular distribution.
.
ADMISSION LABS:
U/A: Negative
Na: 140, K: 4.6, Cl: 103, CO2: 27, BUN: 9, Cr: 0.8, Glucose:
104,
Ca: 9.6
Total Chol: 214
HDL: 31
LDL: 155
Triglycerides: 148
WBC: 7.9
Hct: 46.8
Plt: 268
PT: 10.4 / INR: 1.0 / PTT: 31.3
.
Cardiac Enzymes:
[**2133-6-29**] 7pm:   CK55               Trop<0.01
[**2133-6-30**] 4am:   CK346 MB40         Trop0.29
[**2133-6-30**] 10am:  CK428 MB46 MBI10.7 Trop0.40
[**2133-6-30**] 4pm:   CK387 MB36 MBI10.7 Trop0.39
[**2133-6-30**] 10pm:  CK306 MB23 MBI7.5  Trop0.37
[**2133-7-1**] 5:45am:CK188 MB12 MBI6.4  Trop0.36


Brief Hospital Course:
The patient is a 41 yo man with h/o GERD and recently diagnosed
stable angina who presents s/p elective cardiac catheterization
with concern for LAD microperforation.
.
# Coronary Artery Microperforation:  The patient presented for
elective cardiac catheterization today at [**Hospital1 18**].  During the
procedure, the wire was attempted to be advanced through an
apical thrombus and possibly resulted in LAD microperforation.
The patient remained hemodynamically stable throughout his
course in the CCU. Pulsus checked overnight after cardiac cath,
negative throughout. The patient had serial TTE echocardiograms
to assess for pericardial effusion. Both TTE at 7:30pm on [**2133-6-29**]
and in the AM of [**2133-6-30**] showed no pericardial effusion.
.
# CAD:  The patient has a three week history of stable angina,
for which he underwent cardiac catheterization today.  The
patient had a 99% stenosis of his LAD, now s/p DES.  He is
currently chest pain free, and the heparin and integrelin gtts
were d/c'd in the setting of possible LAD perforation. He was
continued on metoprolol and titrated up to 12.5mg TID. Patient
to resume Toprol XL 25mg daily when discharged home. He was
started on Atorvastatin 80 mg daily given low HDL and high LDL
and also started on full dose ASA and Plavix 75mg daily. Patient
did develop mild substernal chest pressure [**2133-6-29**] PM w/ no EKG
changes but bump in cardiac enzymes. Cardiac enzymes peaked on
[**2133-6-30**] at 10am (CK306 MB23 MBI7.5    Trop0.37) but trended down
([**2133-7-1**] AM CK188 MB12 I6.4 Trop0.36).
.
# RHYTHM:  The patient was in NSR rhythm throughout his hospital
course. Was monitored on telemetry.
.
# GERD: Currently stable. Was started on Ranitidine in setting
of possible interaction w/ Plavix. Pt is to continue on
Ranitidine after discharge.


Medications on Admission:
Nexium
Toprol XL 25 mg daily
Aspirin 81 mg daily

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
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. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1)
Sublingual every 5 minutes as needed for chest pain: Please go
to the emergency room if chest pain persists and you are taking
many tablets.
Disp:*30 * Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Stable chest pain (angina)
s/p elective cardiac catheterization w/ drug-eluting stent
placement X1


Discharge Condition:
Improved. Vital signs stable, pt ambulating w/o issues


Discharge Instructions:
-You were admitted with chest pain for an elective cardiac
catheterization. A blockage was found in one of your heart
vessels and a stent placed to open up the vessel and maintain
blood flow.
.
-It is important that you continue to take your medications as
directed. We made the following changes to your medications
during this admission:
--> START Ranitidine 150mg twice a day for your GERD (reflux)
--> START ASA (enteric coated) 325mg daily for your heart
disease
--> START Atorvastatin 80mg daily for your high cholesterol
--> START Nitroglycerin 0.3mg sublingual AS NEEDED for chest
pain. You can take this every 5 minutes, but go to the emergency
department if chest pain persists or you are taking many
tablets.
--> START Plavix (Clopidogrel) 75mg daily for your stent. It is
especially important you take this medication for one year to
keep your vessels open.
--> STOP Nexium: With your new stent and Plavix, it is important
that you do not take this medication. Nexium and other proton
pump inhibitors can make Plavix less effective. Take Ranitidine
instead.
--> STOP Baby Aspirin (81mg)
--> CONTINUE Toprol XL 25mg daily
.
-Contact your doctor or come to the Emergency Room should your
symptoms return. Also seek medical attention if you develop any
new fever, chills, trouble breathing, chest pain, nausea,
vomiting or unusual stools. Also contact your doctor if you
notice increased swelling or pain in the right groin site.
- No driving for 48 hrs, no bathing/swimming pools for a week.
You can shower.

Followup Instructions:
- Please follow-up with your primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 2331**]
[**Last Name (NamePattern1) **] within 1-2 weeks. You can call the office to make an
appointment at: ([**Telephone/Fax (1) 83357**].
.
- Please follow-up with the cardiologist, Dr. [**First Name4 (NamePattern1) 4597**] [**Last Name (NamePattern1) 5017**]
within 1-2 weeks. You can call to make an appointment at: ([**Telephone/Fax (1) 72870**]. They are aware you were just in the hospital and need
follow-up in their office.
{'Subendocardial infarction, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified angina pectoris,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: The patient is a 41 yo man with h/o GERD and 3-week history of
stable angina who presented s/p cardiac catheterization with
possible RV perforation.  The patient states that his symptoms
began 3 weeks ago, when he began to experience chest pain with
exertion.  The chest pain was a pressure, [**4-3**], exacerbated with
exertion, which radiated to his left shoulder.  The pain
resolved with rest.  Given the patient's extensive cardiac
history, he presented to his brother's cardiologist, who
recommended an exercise stress test.  The patient underwent the
ETT last Tuesday, where he exercised 4-5 minutes before
repoducing the same chest pain.  The pain continued for
approximately 4 minutes of rest after the test was stopped.  He
was started on Toprol XL a nd presented to [**Hospital3 19345**] today for elective cardiac catheterization.  During the
catheterization, a 90% stenosis was found in the LAD, so the
patient was transferred to [**Hospital1 18**] for PCI.
.
During the cardiac catheterization at [**Hospital1 18**], the patient was
found to have a 99% stenosis in the LAD and an apical occlusion.
 A wire was advance through the apical occlusion in [**Doctor First Name **] to
restore flow, and there was a contrast stain worrisome for
microperforation.  The patient had a TTE at this time which did
not show any evidence of effusion.  He was thus admitted to the
CCU for further observation and evaluation.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (-) Diabetes, (+) Dyslipidemia,
(+)Hypertension
2. OTHER PAST MEDICAL HISTORY:
GERD
Hypertension
Hyperlipidemia

MEDICATION ON ADMISSION: Nexium
Toprol XL 25 mg daily
Aspirin 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.2, BP 132/74, R 16, P 88, O2 99% RA
GENERAL: Middle aged man, pleasant, in NAD.  Oriented x3. Mood,
affect appropriate.
HEENT: PERRL, EOMI, Sclera anicteric. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with JVP of 8 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, 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. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.  Right femoral
incision site c/d/i.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: DP 2+ PT 2+
Left: DP 2+ PT 2+

FAMILY HISTORY: The patient's mother had angioplasty in her 60s.  His father had
bypass surgery in his 60s.  No other known history of CAD or
sudden death.

SOCIAL HISTORY: The patient is married and lives in [**Hospital1 3597**], NH with his wife and
three children.  He works with his family as the owner of a
jewelry store.
-Tobacco history:  Never smoked
-ETOH: Rare EtOH use
-Illicit drugs:  None 

### Response:
{'Subendocardial infarction, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified angina pectoris,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
