CHIEF COMPLAINT: STEMI.

PRESENT ILLNESS: Ms. [**Known lastname **] is a generally healthy 54-year-old woman who is
admitted to the CCU following emergent cardiac catheterization.
On the afternoon prior to admission, the patient had acute onset
of a burning substernal CP with a pressure sensation radiating
to her left shoulder. She did not have associated symptoms such
as nausea, SOB or diaphoresis. She thought this might have been
indigestion or pain from her neck, and her symptoms did improve
with antiacids. The discomfort then waxed and waned over the
course of the day; the patient eventually felt well enough to go
to sleep. Around 1AM she was awakened from sleep by an acute
worsening of her symptoms. She presented to [**Hospital 4199**] Hospital
where her ECG was notable for STE in I, aVL, V5 and V6 as well
as STD in III and V1 through V4. Initial TropI was elevated at
0.51 (initial CK not available). The patient was treated with
ASA, IV heparin and IV NTG, which resulted in transient
resolution of her pain. She was transferred to the [**Hospital1 18**] ED,
where she additionally received Integrillin and 600mg Plavix. As
she was having recurrent discomfort in the [**Hospital1 18**] ED, she was
taken for urgent cardiac cath, performed with radial access,
which demonstrated a tight OM lesion. This lesion was treated
with a DES; a small proximal dissection was noted, and this was
then treated with a second DES. The was excellent flow
post-procedure.

MEDICAL HISTORY: 1. Upper back pain, s/p spinal fusion

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: Well appearing adult female, no acute distress.
HEENT: PERRL, EOMI. MMM. OP clear. Conjunctiva well pigmented.
Neck: Supple, without adenopathy or JVD.
Chest: Lungs clear to auscultation with normal respiratory
effort.
Cor: Normal S1, S2. RRR. No murmurs appreciated.
Abdomen: Soft, non-tender and non-distended. +BS, no HSM.
Extremity: Small hematoma at right radial access cath site.
Otherwise warm, without edema. 2+ DP pulses bilaterally.
Neuro: Alert and oriented. CN 2-12 intact. Motor strength intact
in all extremities. Sensation intact grossly.

FAMILY HISTORY: The patient's mother suffered an MI in her early 40s, but is now
in her 80s and doing well. The patient's father required
multi-vessle cardiac bypass surgery in his late 60s.

SOCIAL HISTORY: The patient reports being under a moderate amount of
psychosocial stress recently. She works in HR for the Social
Security Administration.
-Tobacco history: Prior smoker, quit for 14 years, now smoking a
few ciggarettes per day.
-ETOH: Rare
-Illicit drugs: denies
Acute myocardial infarction of other lateral wall, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Leukocytosis, unspecified,Tobacco use disorder
AMI lateral NEC, initial,Accidental op laceration,Abn react-cardiac cath,Crnry athrscl natve vssl,Hypertension NOS,Leukocytosis NOS,Tobacco use disorder
Admission Date:  [**2189-2-26**]              Discharge Date:   [**2189-2-28**]

Date of Birth:  [**2134-8-29**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
STEMI.

Major Surgical or Invasive Procedure:
Cardiac catheterization with angioplasty and stenting (2 x DES
to OM1), [**2189-2-26**].


History of Present Illness:
  Ms. [**Known lastname **] is a generally healthy 54-year-old woman who is
admitted to the CCU following emergent cardiac catheterization.
On the afternoon prior to admission, the patient had acute onset
of a burning substernal CP with a pressure sensation radiating
to her left shoulder. She did not have associated symptoms such
as nausea, SOB or diaphoresis. She thought this might have been
indigestion or pain from her neck, and her symptoms did improve
with antiacids. The discomfort then waxed and waned over the
course of the day; the patient eventually felt well enough to go
to sleep. Around 1AM she was awakened from sleep by an acute
worsening of her symptoms. She presented to [**Hospital 4199**] Hospital
where her ECG was notable for STE in I, aVL, V5 and V6 as well
as STD in III and V1 through V4. Initial TropI was elevated at
0.51 (initial CK not available). The patient was treated with
ASA, IV heparin and IV NTG, which resulted in transient
resolution of her pain. She was transferred to the [**Hospital1 18**] ED,
where she additionally received Integrillin and 600mg Plavix. As
she was having recurrent discomfort in the [**Hospital1 18**] ED, she was
taken for urgent cardiac cath, performed with radial access,
which demonstrated a tight OM lesion. This lesion was treated
with a DES; a small proximal dissection was noted, and this was
then treated with a second DES. The was excellent flow
post-procedure.

  On arrival to the CCU, the patient reports being pain free and
feeling entirely well.

  On review of systems, she denies any recent fever, chills,
change in weight, nausea, vomiting, abdominal pain, change to
bowel or bladder habbits, arthalgia, myaglia, dizziness,
numbness or weakness. Cardiac review of systems is notable for
absence of chest pain, dyspnea on exertion, paroxysmal nocturnal
dyspnea, orthopnea, ankle edema, palpitations, syncope or
presyncope.

Past Medical History:
1. Upper back pain, s/p spinal fusion

Social History:
The patient reports being under a moderate amount of
psychosocial stress recently. She works in HR for the Social
Security Administration.
-Tobacco history: Prior smoker, quit for 14 years, now smoking a
few ciggarettes per day.
-ETOH: Rare
-Illicit drugs: denies


Family History:
The patient's mother suffered an MI in her early 40s, but is now
in her 80s and doing well. The patient's father required
multi-vessle cardiac bypass surgery in his late 60s.

Physical Exam:
Gen: Well appearing adult female, no acute distress.
HEENT: PERRL, EOMI. MMM. OP clear. Conjunctiva well pigmented.
Neck: Supple, without adenopathy or JVD.
Chest: Lungs clear to auscultation with normal respiratory
effort.
Cor: Normal S1, S2. RRR. No murmurs appreciated.
Abdomen: Soft, non-tender and non-distended. +BS, no HSM.
Extremity: Small hematoma at right radial access cath site.
Otherwise warm, without edema. 2+ DP pulses bilaterally.
Neuro: Alert and oriented. CN 2-12 intact. Motor strength intact
in all extremities. Sensation intact grossly.

On the day of discharge vital signs were 97.9 F (98.2 F
maximum), 93/55 mmHg (range 92/62 to 106/56 mmHg), 56 BPM (range
55 to 72 BPM), RR of 18 and 100 % O2 Sat. on room air. Physical
exam findings were unchanged from those above, except for some
resolution of hematoma.


Pertinent Results:
Laboratory Data at Admission:
[**2189-2-26**] 04:45AM BLOOD WBC-11.5* RBC-4.55 Hgb-14.7 Hct-41.6
MCV-91 MCH-32.3* MCHC-35.4* RDW-12.4 Plt Ct-224
[**2189-2-26**] 04:45AM BLOOD Neuts-72.8* Bands-0 Lymphs-21.0 Monos-3.7
Eos-1.8 Baso-0.8
[**2189-2-26**] 04:45AM BLOOD Hypochr-NORMAL Anisocy-NORMAL
Poiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL
[**2189-2-26**] 04:45AM BLOOD PT-12.3 PTT-150* INR(PT)-1.0
[**2189-2-26**] 04:45AM BLOOD Glucose-117* UreaN-17 Creat-0.7 Na-142
K-4.0 Cl-108 HCO3-23 AnGap-15
[**2189-2-26**] 04:45AM BLOOD CK(CPK)-176
[**2189-2-26**] 05:03PM BLOOD CK(CPK)-1690*
[**2189-2-27**] 04:22AM BLOOD CK(CPK)-1142*
[**2189-2-26**] 04:45AM BLOOD CK-MB-15* MB Indx-8.5*
[**2189-2-26**] 04:45AM BLOOD cTropnT-0.12*
[**2189-2-26**] 05:03PM BLOOD CK-MB-166* MB Indx-9.8*
[**2189-2-27**] 04:22AM BLOOD CK-MB-65* MB Indx-5.7
[**2189-2-26**] 04:45AM BLOOD Cholest-69
[**2189-2-26**] 05:03PM BLOOD %HbA1c-5.7 eAG-117
[**2189-2-26**] 04:45AM BLOOD Triglyc-53 HDL-45 CHOL/HD-1.5 LDLcalc-13

Laboratory Data at Discharge:
[**2189-2-28**] 06:40AM BLOOD WBC-7.8 RBC-4.49 Hgb-14.0 Hct-40.1 MCV-89
MCH-31.2 MCHC-35.0 RDW-13.7 Plt Ct-212
[**2189-2-28**] 06:40AM BLOOD Glucose-98 UreaN-16 Creat-0.8 Na-143
K-4.5 Cl-105 HCO3-29 AnGap-14
[**2189-2-28**] 06:40AM BLOOD Calcium-9.3 Phos-3.9 Mg-2.1

EKG [**2-26**]
Sinus rhythm. ST-T wave configuration consistent with acute
ischemic injury (question posterolateral). Clinical correlation
is suggested. No previous tracing available for comparison.
Rate PR QRS QT/QTc P QRS T
77 162 84 [**Telephone/Fax (2) 109722**] 30

Cardiac Catheterization (radial) [**2-26**]
BRIEF HISTORY:   This 54 year old female with a family history
of
premature coronary artery disease and current tobacco use
presented to
[**Hospital 4199**] Hospital with intermittent resting substernal chest pain
that
started the day prior. The patient awoke on the day of admission
at 2am
with recurrent chest discomfort and presented to the hospital
where ECG
revealed anterolateral ST elevations and an elevated troponin of
0.52.
She was treated with aspirin, heparin, and nitroglycerin with
resolution
of her pain and ST changes. Transfer was catheterization was
initiated
and following arrival to the [**Hospital1 18**] ED she developed recurrent
chest
discomfort, was given integrilin and plavix, and taken urgently
to the
catheterization laboratory.

INDICATIONS FOR CATHETERIZATION:
STEMI.

PROCEDURE:
Left Heart Catheterization: was performed by percutaneous entry
of the
right radial artery, using a 5 French Jacky radial catheter,
advanced
to the ascending aorta through a 6 French introducing sheath.
Coronary Angiography: was performed in multiple projections
using a 5
French JACKY RADIAL catheter, with manual contrast injections.
Percutaneous coronary revascularization was performed using
placement of
drug-eluting stent(s).

HEMODYNAMICS RESULTS BODY SURFACE AREA:  1.84 m2
  HEMOGLOBIN: 14.7 gms %
  REST
**PRESSURES
LEFT VENTRICLE {s/ed} 154/25
AORTA {s/d/m} 154/83/113
**CARDIAC OUTPUT
HEART RATE {beats/min} 72
RHYTHM SINUS

**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**RIGHT CORONARY
1) PROXIMAL RCA   DIFFUSELY DISEASED 70
2) MID RCA   DIFFUSELY DISEASED 70
2A) ACUTE MARGINAL   NORMAL
3) DISTAL RCA   NORMAL
4) R-PDA   NORMAL
4A) R-POST-LAT   NORMAL

**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**LEFT CORONARY
5) LEFT MAIN   NORMAL
6) PROXIMAL LAD   NORMAL
6A) SEPTAL-1   NORMAL
7) MID-LAD   DISCRETE 50
8) DISTAL LAD   NORMAL
9) DIAGONAL-1   NORMAL
12) PROXIMAL CX   NORMAL
13) MID CX   NORMAL
13A) DISTAL CX   NORMAL
14) OBTUSE MARGINAL-1   DISCRETE 100
15) OBTUSE MARGINAL-2   NORMAL

**PTCA RESULTS
  CX

PTCA COMMENTS:     Initial angiography revealed a 100% occlusion
in a
large OM branch. We planned to treat this with PTCA and
stenting.
Heparin and Integrillin were given prophylactically. A 6F XB3.0
guide
provided good support. A BMW wire crossed the stenosis without
difficulty. We dottered with a 2.0x12mm Sprinter balloon and
then
predilated at 12 and 14atm. A 2.5x23mm Promus DES was then
deployed at
14atm and post-dilated with a 3.0x15mm Quantum Maverick at 20atm
and a
3.25x12mm Quantum Maverick at 22atm (mid/distal) and 14atm
(proximal).
After the final balloon inflation there was a proximal cap
dissection
that was covered with a 2.5x8mm Promus DES, deployed at 16atm,
and
post-dilated to 3.25mm at 20atm.  Final angiography revealed no
residual
stenosis, TIMI 3 flow, and no apparent dissection.

TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 1 hour 13 minutes.
Arterial time = 1 hour 8 minutes.
Fluoro time = 26.6 minutes.
Contrast injected:
          Non-ionic low osmolar (isovue, optiray...), vol 270 ml

Premedications:
          Midazolam 1 mg IV
          Fentanyl 25 mcg IV, 50 mcg IV
          ASA 325 mg P.O.
          Clopidogrel 600 mg PO
Anesthesia:
          1% Lidocaine subq.
Anticoagulation:
          Heparin 3000 units IV
Other medication:
          Verapamil 2.5 mg IA
          Integrilin (2mg/ml) 6.8 ml IV bolus, 11.7 ml/hr IV
drip
          Nitroglycerin 200 mcg IC x2
Cardiac Cath Supplies Used:
          .035IN [**Company **], MAGIC TORQUE 180CM
          .014IN [**Doctor Last Name **], BMW UNIVERSAL 300CM
          2.0MM [**Company **], SPRINTER 12MM
          3.0MM [**Company **], QUANTUM MAVERICK 15MM
          3.25MM [**Company **], QUANTUM MAVERICK 12MM
          3.0MM [**Company **], QUANTUM MAVERICK RX 12MM
          3.25MM [**Company **], QUANTUM MAVERICK RX 08MM
          6FR CORDIS, XB 3.0
          - ALLEGIANCE, CUSTOM STERILE PACK
          - [**Company **], LEFT HEART KIT
          - [**Company **], RIGHT HEART KIT
          6FR ARROW, TRANSRADIAL ARTERY ACCESS KIT
          - [**Doctor Last Name **], PRIORITY PACK 20/30
          2.5MM [**Company **], PROMUS OTW 23MM
          2.5MM [**Company **], PROMUS OTW 08MM
          - TERUMO, TR BAND LARGE

COMMENTS:
1. Coronary angiography in this right dominant system
demonstrated three
vessel disease. The LMCA was without angiographically apparent
disease.
The LAD had 50% mid vessel stenosis. The LCx had a 100%
occlusion of a
large OM1. The RCA had diffuse disease 60-70% in the proximal
and mid
vessel and was a large caliber artery.
2. Resting hemodynamics revealed mild systemic arterial systolic

hypertension with SBP 154 mmHg. The left ventricular filling
pressure
was elevated at LVEDP 25 mmHg. There was no significant pressure

gradient across the aortic valve.
3. Successful PCI of the occluded OM with overlapping 2.5x8mm
(prox) and
2.5x23mm (distal) Promus DES. The entire length of stent was
post-dilated to 3.25mm.

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Elevated left ventricular filling pressure.
3. Successful PCI of the LCx with DES.

ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].
REFERRING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].
CARDIOLOGY FELLOW: [**Last Name (LF) **],[**First Name3 (LF) 640**] A.
  [**Last Name (LF) **],[**First Name3 (LF) **] M.

Echocardiography [**2-26**]
The left atrium is mildly dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is low normal
(LVEF 50%) secondary to hypokinesis of the posterior and lateral
walls. Right ventricular chamber size and free wall motion are
normal. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. The pulmonary
artery systolic pressure could not be determined. There is no
pericardial effusion. There is an anterior space which most
likely represents a promient fat pad.

CXR [**2-26**]
COMPARISON: None.
PORTABLE UPRIGHT CHEST RADIOGRAPH: There is no focal
consolidation and no  effusion or pneumothorax. The pleural
surfaces are smooth. The hilar and cardiomediastinal contours
are normal. Cervical fixation hardware is incompletely
visualized. There is no acute osseous abnormality, and the
surrounding soft tissues and upper abdomen are normal.
IMPRESSION: No acute cardiopulmonary process.

EKG [**2-27**]
Sinus rhythm. Right axis deviation. Non-specific ST-T wave
changes, although ischemia or infarction cannot be excluded. Low
voltage in the limb leads. Compared to the previous tracing ST-T
wave changes are more diffuse and more marked.
Rate PR QRS QT/QTc P QRS T
66 164 78 [**Telephone/Fax (2) 109723**]8 135

Brief Hospital Course:
Coronary Artery Disease
  STEMI, with EKG concerning enough for activation of the cath
lab prior to large enzyme and myocardial damage. Enzymes peaked
late on the day of admission and were trending down by [**2-27**]. PCI
with two drug-eluting stents placed in OM1. Posterolateral
hypokinesis was noted on echo, resulting from the present event
and associated with a mildly depressed left-ventricular ejection
fraction of 50%. She was monitored with telemetry without any
significant events, except for very occasional ectopy. ECG
changes progressed slightly (see above). A1c was not indicative
of diabetes as a potential risk factor, nor were lipids
particularly abnormal. Smoking is likely the primary indentified
inciting factor for this patient. However, the patient's mother
had early coronary disease, in her 40s, suggesting a genetic
predisposition that is as yet unidentified in this pedigree,
possibly polygenic. Agressive lipid lowering is indicated, along
with antiplatelet agents, particularly after drug-eluting stent
placement. Therefore, her medication regimen includes
atorvastatin (80 mg PO QD), Plavix (75 mg PO BID for one week
then QD), aspirin (325 mg PO QD). A beta-blocker, metoprolol
succinate (25 mg PO QD) was also added.

Hypertension
  Mrs. [**Known lastname **] was mildly hypertensive on the first day of
admission, with blood pressure range up to 150/89 mmHg.
Lisinopril was commenced at an introductory dose (2.5 mg PO QD).
Metoprolol, as above, likely also has a mildly anti-hypertensive
effect.

Leukocytosis
  Likely stress demargination in the context of ACS. Resolved
spontaneously during the hospital stay.

Medications on Admission:
None.

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO twice a day
for 7 days: After 7 days, switch to once daily in the morning.
Disp:*38 Tablet(s)* Refills:*5*
2. Aspirin 325 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:*5*
4. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*15 Tablet(s)* Refills:*5*
5. 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:*5*


Discharge Disposition:
Home

Discharge Diagnosis:
ST elevation MI (heart attack)


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted with chest pain which was found to be due to a
heart attack. Your blocked blood vessel was opened using
agioplasty and with the placement of two drug coated stents. You
are now safe for discharge home. It is very important that you
take all of your medications as directed and keep your follow-up
appointments.

Followup Instructions:
Please call to schedule a follow-up appointment with a
cardiologist. In the hospital, you have been cared for by Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. Dr.[**Name (NI) 32659**] office number is ([**Telephone/Fax (1) 2037**].
{'Acute myocardial infarction of other lateral wall, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Leukocytosis, unspecified,Tobacco use disorder'}


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: STEMI.

PRESENT ILLNESS: Ms. [**Known lastname **] is a generally healthy 54-year-old woman who is
admitted to the CCU following emergent cardiac catheterization.
On the afternoon prior to admission, the patient had acute onset
of a burning substernal CP with a pressure sensation radiating
to her left shoulder. She did not have associated symptoms such
as nausea, SOB or diaphoresis. She thought this might have been
indigestion or pain from her neck, and her symptoms did improve
with antiacids. The discomfort then waxed and waned over the
course of the day; the patient eventually felt well enough to go
to sleep. Around 1AM she was awakened from sleep by an acute
worsening of her symptoms. She presented to [**Hospital 4199**] Hospital
where her ECG was notable for STE in I, aVL, V5 and V6 as well
as STD in III and V1 through V4. Initial TropI was elevated at
0.51 (initial CK not available). The patient was treated with
ASA, IV heparin and IV NTG, which resulted in transient
resolution of her pain. She was transferred to the [**Hospital1 18**] ED,
where she additionally received Integrillin and 600mg Plavix. As
she was having recurrent discomfort in the [**Hospital1 18**] ED, she was
taken for urgent cardiac cath, performed with radial access,
which demonstrated a tight OM lesion. This lesion was treated
with a DES; a small proximal dissection was noted, and this was
then treated with a second DES. The was excellent flow
post-procedure.

MEDICAL HISTORY: 1. Upper back pain, s/p spinal fusion

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: Well appearing adult female, no acute distress.
HEENT: PERRL, EOMI. MMM. OP clear. Conjunctiva well pigmented.
Neck: Supple, without adenopathy or JVD.
Chest: Lungs clear to auscultation with normal respiratory
effort.
Cor: Normal S1, S2. RRR. No murmurs appreciated.
Abdomen: Soft, non-tender and non-distended. +BS, no HSM.
Extremity: Small hematoma at right radial access cath site.
Otherwise warm, without edema. 2+ DP pulses bilaterally.
Neuro: Alert and oriented. CN 2-12 intact. Motor strength intact
in all extremities. Sensation intact grossly.

FAMILY HISTORY: The patient's mother suffered an MI in her early 40s, but is now
in her 80s and doing well. The patient's father required
multi-vessle cardiac bypass surgery in his late 60s.

SOCIAL HISTORY: The patient reports being under a moderate amount of
psychosocial stress recently. She works in HR for the Social
Security Administration.
-Tobacco history: Prior smoker, quit for 14 years, now smoking a
few ciggarettes per day.
-ETOH: Rare
-Illicit drugs: denies 

### Response:
{'Acute myocardial infarction of other lateral wall, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Leukocytosis, unspecified,Tobacco use disorder'}
