CHIEF COMPLAINT: Transfer from [**Location (un) **] ER with anterior STEMI

PRESENT ILLNESS: Mr. [**Known lastname **] is a 60 year old male with a hx of an inferior MI in
[**12/2165**] s/p overlapping velocity hepacoat stents to the RCA (no
other significant CAD was noted at that time) who was
transferred form [**Location (un) **] ER with an anterior STEMI.  He has
cardiac risk factors positive for being a previous smoker who
quit in [**2165**] with a 30 pack year tobacco history, HTN, and HLD
not currently on a statin due to muscle weakness.  He has
remained chest pain free with an unlimited exercise tolerance
until this 12:15PM when he was climbing a ladder and had [**11-14**]
right-sided crushing substernal chest pain radiating down both
arms with associated nausea and excessive diaphoresis.  He took
two aspirin which did not resolve his chest pain and called the
ambulance.  He arrived at [**Location (un) **] ER at 12:30 and was given
morphine, dilaudid, ativan and started on a nitro drip which
resolved his pain.  He was given 600mg plavix started on a
heparin and aggrostat drip, and transferred to the [**Hospital1 **] for
cardiac cath.  Right heart cath showed RA=17, RV=59/18 mean 27,
PA=48/25 mean 36, PCW=23 with a CO of 10.85 and an index of
5.25.  Coronary angiography showed a right dominant system with
patent stents in the RCA; 30-40% proximal, 40% distal RCA
lesions, 90% proximal LAD with TIMI 2 flow and no significant
LMCA or LCX lesions.  The 90% proximal LAD underwent successful
PCI with a 3.0 x 18mm cypher DES and a 3.0 x 8mm overlapping
cypher DES resulting in 0% occlusion and TIMI III flow.

MEDICAL HISTORY: 1. Hypercholesterolemia
2. L knee surgery [**88**] years ago for skiing accident
3. Transurethral resection of prostate

MEDICATION ON ADMISSION: aspirin 325mg qd
lisinopril 5mg qd
toprol xl 25mg qd

ALLERGIES: Tetracyclines / Iodine; Iodine Containing / Percocet

PHYSICAL EXAM: -Vitals: Temp=afebrile, BP=118/49, HR=75 NSR, O2sat=98% on 2L nc
-Gen: Patient lying flat in bed.  He is conversational and
speaking in full sentences with no shortness of breath.
Cooperative, pleasant and in NAD.
-CV: NRRR, no s3 or s4, no m,g,r. No JVD, no carotid bruit
-Resp: CTAB
-Abd: Abdomen is tight (patient states that it is normal for
him), but non-tender.  No abdominal bruit
-Ext: Cath site is c/d/i with no evidence of hematoma, flank
tenderness and good distal pulses.  No edema or cyanosis.

FAMILY HISTORY: Father died of CHF at 75 y/o with no hx of MI
Mother died of brain cancer with no hx of MI

SOCIAL HISTORY: The patient lives with his wife.  [**Name (NI) **] is a contractor.  He quit
smoking after his first MI in [**2165**] after a 30 pack year history.
 He drinks about one alcoholic beverage a day and denies any
illegal drug use.
Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Old myocardial infarction,Unspecified essential hypertension
AMI anterior wall, init,Parox ventric tachycard,Crnry athrscl natve vssl,Pure hypercholesterolem,Old myocardial infarct,Hypertension NOS
Admission Date:  [**2169-10-31**]              Discharge Date:   [**2169-11-3**]

Date of Birth:  [**2109-2-22**]             Sex:   M

Service: MEDICINE

Allergies:
Tetracyclines / Iodine; Iodine Containing / Percocet

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
Transfer from [**Location (un) **] ER with anterior STEMI

Major Surgical or Invasive Procedure:
cardiac catheterization with Cypher stent to proximal LAD


History of Present Illness:
Mr. [**Known lastname **] is a 60 year old male with a hx of an inferior MI in
[**12/2165**] s/p overlapping velocity hepacoat stents to the RCA (no
other significant CAD was noted at that time) who was
transferred form [**Location (un) **] ER with an anterior STEMI.  He has
cardiac risk factors positive for being a previous smoker who
quit in [**2165**] with a 30 pack year tobacco history, HTN, and HLD
not currently on a statin due to muscle weakness.  He has
remained chest pain free with an unlimited exercise tolerance
until this 12:15PM when he was climbing a ladder and had [**11-14**]
right-sided crushing substernal chest pain radiating down both
arms with associated nausea and excessive diaphoresis.  He took
two aspirin which did not resolve his chest pain and called the
ambulance.  He arrived at [**Location (un) **] ER at 12:30 and was given
morphine, dilaudid, ativan and started on a nitro drip which
resolved his pain.  He was given 600mg plavix started on a
heparin and aggrostat drip, and transferred to the [**Hospital1 **] for
cardiac cath.  Right heart cath showed RA=17, RV=59/18 mean 27,
PA=48/25 mean 36, PCW=23 with a CO of 10.85 and an index of
5.25.  Coronary angiography showed a right dominant system with
patent stents in the RCA; 30-40% proximal, 40% distal RCA
lesions, 90% proximal LAD with TIMI 2 flow and no significant
LMCA or LCX lesions.  The 90% proximal LAD underwent successful
PCI with a 3.0 x 18mm cypher DES and a 3.0 x 8mm overlapping
cypher DES resulting in 0% occlusion and TIMI III flow.

Past Medical History:
1. Hypercholesterolemia
2. L knee surgery [**88**] years ago for skiing accident
3. Transurethral resection of prostate


Social History:
The patient lives with his wife.  [**Name (NI) **] is a contractor.  He quit
smoking after his first MI in [**2165**] after a 30 pack year history.
 He drinks about one alcoholic beverage a day and denies any
illegal drug use.


Family History:
Father died of CHF at 75 y/o with no hx of MI
Mother died of brain cancer with no hx of MI


Physical Exam:
-Vitals: Temp=afebrile, BP=118/49, HR=75 NSR, O2sat=98% on 2L nc
-Gen: Patient lying flat in bed.  He is conversational and
speaking in full sentences with no shortness of breath.
Cooperative, pleasant and in NAD.
-CV: NRRR, no s3 or s4, no m,g,r. No JVD, no carotid bruit
-Resp: CTAB
-Abd: Abdomen is tight (patient states that it is normal for
him), but non-tender.  No abdominal bruit
-Ext: Cath site is c/d/i with no evidence of hematoma, flank
tenderness and good distal pulses.  No edema or cyanosis.


Pertinent Results:
[**2169-11-1**] 11:41AM BLOOD CK(CPK)-816*
[**2169-11-1**] 08:30PM BLOOD CK(CPK)-859*
[**2169-11-2**] 04:45AM BLOOD CK(CPK)-657*
[**2169-10-31**] 06:22PM BLOOD Triglyc-69 HDL-54 CHOL/HD-4.5
LDLcalc-177*
[**2169-11-2**] 04:45AM BLOOD WBC-11.3* RBC-4.02* Hgb-12.6* Hct-35.4*
MCV-88 MCH-31.3 MCHC-35.5* RDW-13.2 Plt Ct-163

TTE [**2169-11-1**]:
EF 40-45%
1.The left atrium is mildly dilated. The left atrium is
elongated.
2. Left ventricular wall thicknesses are normal. The left
ventricular cavity
size is normal. Overall left ventricular systolic function is
mildly
depressed. Resting regional wall motion abnormalities include
distal anterior,
apical, and mid and distal septal as well as very distal
(apical) inferior and
inferolateral akinesis.
3. Right ventricular chamber size is normal. Right ventricular
systolic
function is normal.
4.The aortic root is moderately dilated.
5.The aortic valve leaflets are mildly thickened. No aortic
regurgitation is
seen.
6.The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation
is seen.
7.There is moderate pulmonary artery systolic hypertension.
8.There is no pericardial effusion.

Compared to the previous study of [**2165-12-12**], the right
ventricular and
inferior wall function has normalized while there are new
anterior, septal and
apical akinesis is new. Consider mid LAD occlusion.

Cardiac Cath Report [**2170-10-31**]:
COMMENTS:
1. Selective coronary angiography revealed a right dominant
system with
LMCA that was free of angiographically significant disease. The
LAD had
a proximal 90% stenosis with TIMI 2 flow. LCX had  no
significant
disease and RCA stents were patent with 30-40% proximal and
distal
lesions in the vessels.
2. Left ventriculogram was deferred.
3. Hemodynamic assessment showed elevated left and right sided
filling
pressures and preserved cardiac index.
4. Successful PCI of the proximal to mid LAD with overlapping
Cypher
drug eluting stents (3.0x18mm proximal to a 3.0x8mm with post
dilation
to 3.5mm in the mid portion).

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Moderate diastolic ventricular dysfunction.
3. Acute anterior myocardial infarction, managed by acute ptca.
 PTCA of  vessel.
4. Successful PCI of the proximal to mid LAD with overlapping
Cypher
drug eluting stents (3.0x18mm proximal to a 3.0x8mm).


Brief Hospital Course:
Mr. [**Known lastname **] is a 60 year old male with hx of previous MI in [**2165**]
who presents with an acute anterior STEMI s/p successful PCI
with cypher-DES to LAD.
.
1.  CARDIOVASCULAR SYSTEM:  (a)  Coronaries:  Cardiac cath
showed 90% proximal LAD lesion which underwent succesful PCI to
the LAD with cypher-DES resulting in 0% occlusion and TIMI III
flow.  His peak CPK was 859.  The patient was placed on aspirin,
Plavix, and aggrostat for 12 hours status post catheterization.
The patient was also placed on pravastatin since he had muscle
weakness from other statins.  His lipid profile showed an LDL of
177 and HDL of 54.  We increased his toprol xl to 50mg qd and
kept his lisinopril at 5mg qday.  He maintained a HR in the 60's
and BP in the 110's/60's.  We discussed the importance of
keeping up with his medical regimen and following a low salt and
low fat diet.

(b) Pump:  The patient had a transthoracic echocardiogram on the
day following his myocardial infarction.  This revealed a left
ventricular ejection fraction of 40-45%, with anterior, septal
and apical akinesis.  We started him on coumadin with Lovenox
bridge for 6 months for prophylaxis against intramural thrombus
formation.  The patient did not have symptoms of heart failure
throughout his admission.  He was maintained at even fluid
balance without event.

(c)  Rhythm:  The patient had several runs of non-sustained
ventricular tachycardia during the 24 hours after his
catheterization.  Thereafter, he did not have any ventricular
tachycardia and remained in a sinus rhythm for the duration of
his admission.


Medications on Admission:
aspirin 325mg qd
lisinopril 5mg qd
toprol xl 25mg qd

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*6*
2. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*6*
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*6*
4. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*6*
5. Warfarin 2.5 mg Tablet Sig: Two (2) Tablet PO at bedtime.
Disp:*60 Tablet(s)* Refills:*2*
6. Outpatient Lab Work
Please check patient INR on Monday, [**2169-11-6**].  Please
fax results to Dr. [**First Name8 (NamePattern2) 15179**] [**Last Name (NamePattern1) 15180**] at [**Telephone/Fax (1) 15181**]. Thanks
7. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) injection
Subcutaneous every twelve (12) hours for 5 days.
Disp:*10 syringes* Refills:*0*
8. Aspirin 162 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*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Anterior ST elevation myocardial infarction
Secondary: 1. Hypercholesterolemia
           2. Hypertension

Discharge Condition:
Stable.  Ambulating without assistance.  Tolerating PO well.
Breathing well on RA.


Discharge Instructions:
You were admitted for a heart attack and you had a stent placed
for a blockage in your coronary arteries.  If you experience
chest discomfort, shortness of breath, lightheadedness, or
episodes of loss of consciousness, please return to the ED.  You
have been started on cardiac medications.  Please make sure you
continue your medications as prescribed.  You should continue a
low salt and low fat diet.  Activity: no heavy (more than 25lbs)
lifting for two weeks.

Followup Instructions:
1. Appointment with Dr. [**Last Name (STitle) 15180**] on [**2169-11-8**] at 2:45 PM
2. Please go to Dr.[**Name (NI) 15182**] office on [**2169-11-6**] during
normal office hours for a blood test.
3. Appointment with Dr. [**Last Name (STitle) 15183**] [**Name (STitle) 2974**] [**2169-12-8**] at 3:30 PM.
{'Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Old myocardial infarction,Unspecified essential hypertension'}


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: Transfer from [**Location (un) **] ER with anterior STEMI

PRESENT ILLNESS: Mr. [**Known lastname **] is a 60 year old male with a hx of an inferior MI in
[**12/2165**] s/p overlapping velocity hepacoat stents to the RCA (no
other significant CAD was noted at that time) who was
transferred form [**Location (un) **] ER with an anterior STEMI.  He has
cardiac risk factors positive for being a previous smoker who
quit in [**2165**] with a 30 pack year tobacco history, HTN, and HLD
not currently on a statin due to muscle weakness.  He has
remained chest pain free with an unlimited exercise tolerance
until this 12:15PM when he was climbing a ladder and had [**11-14**]
right-sided crushing substernal chest pain radiating down both
arms with associated nausea and excessive diaphoresis.  He took
two aspirin which did not resolve his chest pain and called the
ambulance.  He arrived at [**Location (un) **] ER at 12:30 and was given
morphine, dilaudid, ativan and started on a nitro drip which
resolved his pain.  He was given 600mg plavix started on a
heparin and aggrostat drip, and transferred to the [**Hospital1 **] for
cardiac cath.  Right heart cath showed RA=17, RV=59/18 mean 27,
PA=48/25 mean 36, PCW=23 with a CO of 10.85 and an index of
5.25.  Coronary angiography showed a right dominant system with
patent stents in the RCA; 30-40% proximal, 40% distal RCA
lesions, 90% proximal LAD with TIMI 2 flow and no significant
LMCA or LCX lesions.  The 90% proximal LAD underwent successful
PCI with a 3.0 x 18mm cypher DES and a 3.0 x 8mm overlapping
cypher DES resulting in 0% occlusion and TIMI III flow.

MEDICAL HISTORY: 1. Hypercholesterolemia
2. L knee surgery [**88**] years ago for skiing accident
3. Transurethral resection of prostate

MEDICATION ON ADMISSION: aspirin 325mg qd
lisinopril 5mg qd
toprol xl 25mg qd

ALLERGIES: Tetracyclines / Iodine; Iodine Containing / Percocet

PHYSICAL EXAM: -Vitals: Temp=afebrile, BP=118/49, HR=75 NSR, O2sat=98% on 2L nc
-Gen: Patient lying flat in bed.  He is conversational and
speaking in full sentences with no shortness of breath.
Cooperative, pleasant and in NAD.
-CV: NRRR, no s3 or s4, no m,g,r. No JVD, no carotid bruit
-Resp: CTAB
-Abd: Abdomen is tight (patient states that it is normal for
him), but non-tender.  No abdominal bruit
-Ext: Cath site is c/d/i with no evidence of hematoma, flank
tenderness and good distal pulses.  No edema or cyanosis.

FAMILY HISTORY: Father died of CHF at 75 y/o with no hx of MI
Mother died of brain cancer with no hx of MI

SOCIAL HISTORY: The patient lives with his wife.  [**Name (NI) **] is a contractor.  He quit
smoking after his first MI in [**2165**] after a 30 pack year history.
 He drinks about one alcoholic beverage a day and denies any
illegal drug use. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Old myocardial infarction,Unspecified essential hypertension'}
