CHIEF COMPLAINT: Chest Pain.

PRESENT ILLNESS: This is a 19 year old college student with no significant past
medical history, who presented with chest pain starting on the
morning of admission.  He had recently had a sore throat with
frontal bilateral squeezing headache on Thursday/Friday,
sleeping most of Friday and experiencing some "cold sweats".  He
also noted myalgias and rhinorrhea.  He felt better on Saturday
and went out with friends and had 8 drinks.  The next day, the
day of admission, he woke up and had sharp chest pains. This
pain was not positional.
.
He was seen on the day of admission at his college health
services.  He was noted to have diffuse ST elevations on his EKG
and was sent to the [**Hospital1 18**] ED.  He denies palpitations; he denies
diarrhea, nausea or vomiting; he denies any sick contacts; his
family lives in a rural high-tick area; he has traveled only to
[**Location (un) **] two weeks ago but nowhere else.
.
In the emergency department, his vitals on arrival were 96.3,
75, 98/58, 19, 100% RA. He received 2L NS; GI cocktail of 30 cc
maalox, 15 cc lidocaine; ibuprofen 600 mg (appears to be x2 for
total of 1200), morphine 2 mg IV x2, and an additional morphine
2 mg listed as PO but likely to be an additional dose of IV,
zofran 4 mg IV.  On subsequent blood pressure check, he was
noted to be hypotensive to SBP 70s, and was given 2 L IVF with
BP to 100s.  He had an echocardiogram in ED by cardiology fellow
and was noted to have trace pericardial effusion with normal
systolic function.  Cardiac enzymes were positive with trop T of
1.29 and CK 1324 with MBI 9.1.  He was admitted to the [**Hospital Unit Name 196**]
service with myocarditis.

MEDICAL HISTORY: Bilateral [**Last Name (un) **]-Calve-Parthes with right hip surgery 3 years ago

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
VS: 102, 110/60, 74, 18, 100% Non-rebreather
GENERAL: Young well-nourished male in discomfort
HEENT: NCAT. Sclera anicteric. EOMI. No erythema or exudate.
NECK: Supple, JVP elevated to ~10-12 cm
CARDIAC: RRR, normal S1, S2. No rub. No murmurs or gallops.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use.  Bibasilar crackles.
ABDOMEN: Soft, ND, BS+. Mildly tender to palpation.
EXTREMITIES: No c/c/e.
SKIN: No lesions or rashes on extremities or torso.
PULSES:
Right: DP 2+
Left: DP 2+

FAMILY HISTORY: Aunt with lupus.  No family history of early MI or diabetes.

SOCIAL HISTORY: He had a sexual encounter with a woman five days ago; denies any
oral sex and used condoms for intercourse; he denies any sex
with men.
-Tobacco history: none
-ETOH: drinks socially; last night had "6 beers and 2 shots";
says this is a typical night out for him; does not drink on
nights he does not go out with friends; typically goes out with
friends on weekends except in summer when he goes out more.
-Illicit drugs: denies any; specifically denies cocaine
Acute idiopathic pericarditis,Pulmonary congestion and hypostasis,Combined systolic and diastolic heart failure, unspecified,Juvenile osteochondrosis of hip and pelvis,Hypotension, unspecified,Hypoxemia,Other specified cardiac dysrhythmias
Ac idiopath pericarditis,Pulm congest/hypostasis,Syst/diast hrt fail NOS,Juv osteochondros pelvis,Hypotension NOS,Hypoxemia,Cardiac dysrhythmias NEC
Admission Date:  [**2120-9-15**]              Discharge Date:   [**2120-9-19**]

Date of Birth:  [**2101-4-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
Chest Pain.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
This is a 19 year old college student with no significant past
medical history, who presented with chest pain starting on the
morning of admission.  He had recently had a sore throat with
frontal bilateral squeezing headache on Thursday/Friday,
sleeping most of Friday and experiencing some "cold sweats".  He
also noted myalgias and rhinorrhea.  He felt better on Saturday
and went out with friends and had 8 drinks.  The next day, the
day of admission, he woke up and had sharp chest pains. This
pain was not positional.
.
He was seen on the day of admission at his college health
services.  He was noted to have diffuse ST elevations on his EKG
and was sent to the [**Hospital1 18**] ED.  He denies palpitations; he denies
diarrhea, nausea or vomiting; he denies any sick contacts; his
family lives in a rural high-tick area; he has traveled only to
[**Location (un) **] two weeks ago but nowhere else.
.
In the emergency department, his vitals on arrival were 96.3,
75, 98/58, 19, 100% RA. He received 2L NS; GI cocktail of 30 cc
maalox, 15 cc lidocaine; ibuprofen 600 mg (appears to be x2 for
total of 1200), morphine 2 mg IV x2, and an additional morphine
2 mg listed as PO but likely to be an additional dose of IV,
zofran 4 mg IV.  On subsequent blood pressure check, he was
noted to be hypotensive to SBP 70s, and was given 2 L IVF with
BP to 100s.  He had an echocardiogram in ED by cardiology fellow
and was noted to have trace pericardial effusion with normal
systolic function.  Cardiac enzymes were positive with trop T of
1.29 and CK 1324 with MBI 9.1.  He was admitted to the [**Hospital Unit Name 196**]
service with myocarditis.

Past Medical History:
Bilateral [**Last Name (un) **]-Calve-Parthes with right hip surgery 3 years ago


Social History:
He had a sexual encounter with a woman five days ago; denies any
oral sex and used condoms for intercourse; he denies any sex
with men.
-Tobacco history: none
-ETOH: drinks socially; last night had "6 beers and 2 shots";
says this is a typical night out for him; does not drink on
nights he does not go out with friends; typically goes out with
friends on weekends except in summer when he goes out more.
-Illicit drugs: denies any; specifically denies cocaine

Family History:
Aunt with lupus.  No family history of early MI or diabetes.

Physical Exam:
On Admission:
VS: 102, 110/60, 74, 18, 100% Non-rebreather
GENERAL: Young well-nourished male in discomfort
HEENT: NCAT. Sclera anicteric. EOMI. No erythema or exudate.
NECK: Supple, JVP elevated to ~10-12 cm
CARDIAC: RRR, normal S1, S2. No rub. No murmurs or gallops.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use.  Bibasilar crackles.
ABDOMEN: Soft, ND, BS+. Mildly tender to palpation.
EXTREMITIES: No c/c/e.
SKIN: No lesions or rashes on extremities or torso.
PULSES:
Right: DP 2+
Left: DP 2+

On Discharge:
VS Tm 98.3, BP 112/63/ HR 58, RR 18, O2 Sat 98% on RA
Exam otherwise not significantly different from on admission
except lung exam reveals clear to auscultation bilaterally and
no further JVD, otherwise exam unchanged and benign.

Pertinent Results:
ON ADMISSION
WBC-11.6* RBC-4.78 Hgb-14.2 Hct-40.5 MCV-85 Plt Ct-206
Neuts-81.8* Lymphs-13.6* Monos-4.2 Eos-0.3 Baso-0.2
Glucose-95 UreaN-7 Creat-0.7 Na-141 K-3.7 Cl-103 HCO3-23
ALT-29 AST-145*  AlkPhos-126* TotBili-0.4
Lipase-14
CK(CPK)-1324*, cTropnT-1.29* CK-MB-118* MB Indx-9.8*
.
ON DISCHARGE:
WBC-6.4 RBC-4.14* Hgb-13.2* Hct-36.0* MCV-87 Plt Ct-346
Neuts-79.5* Lymphs-15.1* Monos-4.4 Eos-0.8 Baso-0.2
Glucose-102 UreaN-12 Creat-0.8 Na-140 K-4.3 Cl-105 HCO3-25
Calcium-8.3* Phos-3.7 Mg-1.6
BLOOD CK(CPK)-40, cTropnT-0.78* CK-MB-NotDone
.
OTHER LABS OF NOTE:
TSH-5.5*, Free T4-1.5
calTIBC-283 Ferritn-212 TRF-218
[**Doctor First Name **]= negative
..
RADIOGRAPHIC STUDIES:
.
CXR ([**2120-9-15**])
The cardiomediastinal silhouette is unremarkable. The lungs are
clear. There is no pleural effusion or focal pulmonary
consolidation.
CONCLUSION: No acute cardiopulmonary process
.
CXR ([**2120-9-16**])
In comparison with the study of earlier in this date, there is
extensive opacification at both bases consistent with pleural
effusions. No definite pulmonary vascular congestion is
appreciated. Of course, the possibility of some supervening
aspiration cannot be unequivocally excluded in the absence of a
lateral view.
.
CXR ([**2120-9-18**])
IMPRESSION: AP chest compared to [**9-16**] and 9: Previous
pleural effusions have decreased, small on both sides. Heart
size normal. Lungs clear.
.
CXR ([**2120-9-19**])
IMPRESSION: Heart size and pulmonary vascularity are normal, and
lungs are clear. No pleural effusions.
..
ECHOCARDIOGRAMS:
.
TTE ([**2120-9-15**])
CONCLUSIONS:  The left atrium is normal in cavity size. Left
ventricular wall thicknesses and cavity size are normal. Global
systolic function is good (cannot assess regional function).
Overall systolic function is good (LVEF >40%). Right ventricular
chamber size is normal. There is no pericardial effusion.
.
TTE ([**2120-9-16**])
CONCLUSIONS:  The left atrium and right atrium are normal in
cavity size. The estimated right atrial pressure is 0-5 mmHg.
Left ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). The estimated cardiac
index is normal (>=2.5L/min/m2). Transmitral and tissue Doppler
imaging suggests normal diastolic function, and a normal left
ventricular filling pressure (PCWP<12mmHg). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve leaflets
are structurally normal. There is no mitral valve prolapse. Mild
(1+) mitral regurgitation is seen. The estimated pulmonary
artery systolic pressure is normal. There is no pericardial
effusion.
IMPRESSION: Preserved global and regional biventricular systolic
function. Mild mitral regurgitation with normal valve
morphology. Compared with the prior study (images reviewed) of
[**2120-9-15**], biventricular systolic function is better defined on
the current study and appears to be normal.
.
TTE ([**2120-9-18**])
CONCLUSIONS: The left atrium is normal in size. No atrial septal
defect is seen by 2D or color Doppler. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. There is no
aortic valve stenosis. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is no mitral
valve prolapse. There is borderline pulmonary artery systolic
hypertension. There is no pericardial effusion. Compared with
the prior study (images reviewed) of [**2120-9-16**], no change.
..
ELECTROCARDIOGRAM ([**2120-9-15**])
Sinus arrhythmia. Extensive ST segment elevation suggests
pericarditis.
No previous tracing available for comparison.

Brief Hospital Course:
In summary, this is a 19-year old young man with no significant
past medical history, who presented with chest pain and
dramatically elevated cardiac enzymes and diffuse ST changes
consistent with pericarditis with myocardial involvment.

# MYOCARDITIS/PERICARDITIS:  The patient's initial presentation
as a young, otherwise healthy man with chest pain and diffuse ST
elevations was quite consistent with pericarditis.  Grossly
elevated cardiac enzymes and signs of fluid overload/ increased
oxygen requirement suggested myocardial involvement as well.
Initial suspicion was for idiopathic or viral
myocarditis/pericarditis given epidemiology and history of viral
prodromal symptoms (sore throat, headache) as well as fever.
.
Despite this presumptive diagnosis other etiologies were
excluded with negative [**Doctor First Name **] (given family history of lupus),
negative lyme titers, normal iron studies (providing evidence
against hemochromatosis), and normal T4 (suggesting no thyroid
abnormality despite elevated TSH).
.
Regarding management, on initial presentation he was quite
tachycardic on the floor so he was given multiple fluid boluses
with the presumption of dehydration as cause.  This did not seem
to help tachycardia, but the patient did have increasing oxygen
requirement leading to his transfer to the CCU after requiring
time on non-rebreather.  In the CCU he received furosemide in 10
mg doses in order to help with presumptive fluid overload and
over the next day he was negative over two liters in his overall
fluid balance.  He was also initially hypotensive but as this
resolved he was started on Captopril for afterload reduction so
as to not stress the heart in the acute phase of his illness.
Captopril should be continued for 3 to 6 weeks in the setting of
myocardial inflammation to prevent remodeling and ventricular
dysfunction.
.
He initially continued to have worsening chest radiographs
showing increasing pulmonary edema and by the second CCU day he
appeared quite toxic on morning exam becoming winded with as
little effort as rising from recumbent to seated.  He was
diuresed and was also started on Azithromycin as mycoplasma is
one potentially treatable etiology of myocarditis/pericarditis
(mycoplasma titers pending at discharge).
.
On his third day in the CCU he began to show considerable
improvement in his symptoms with decreasing pain and dyspnea as
well as smalled oxygen requirements.  His tachycardia also began
to resolve and chest radiographs improved with less dramatic
pleural effusions and interstitial markings.  He had sequential
echos which repeatedly showed globally preserved systolic
function and normal EF without pericardial effusion.  His pain
was well-controlled with oxycodone initially and then
acetaminophen.  By the day before discharge he was maintaining
95% oxygen saturations on room air and on the day of discharge
he was pain free without analgesics and his chest radiograph had
basically resolved.  He was transitioned to once a day
lisinopril at discharge for afterload reduction and
cardioprotection.  He will complete one more day of a five day
course of azithromycin.  He will follow up with Dr. [**Last Name (STitle) **] in
cardiology clinic.
..
# HYPOTENSION:  He was hypotensive with SBP's into the 80's on
his first and second hospital days, but this improved with fluid
boluses.  This did not recur.
..
# He was ordered for a cardiac, heart healthy diet.
Subcutaneous heparin for DVT prophylaxis.  He remained full code
throughout the hospital course.

Medications on Admission:
None

Discharge Medications:
1. Azithromycin 250 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
Disp:*2 Tablet(s)* Refills:*0*
2. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.


Discharge Disposition:
Home

Discharge Diagnosis:
PRIMARY DIAGNOSIS
Pericarditis with myocardial involvement


Discharge Condition:
Vital signs stable; normal oxygen saturations on room air,
afebrile and pain free.


Discharge Instructions:
You were admitted due to chest pain and shortness of breath.
This was due to an inflammatory condition that affected your
heart and the lining around it.  This inflammation led to fluid
accumulating in your lungs, which made you short of breath.  We
gave you medications to help get rid of this fluid and started
medications to help keep your blood pressure from being high and
stressing your heart.  We let you go home to complete your
recovery after we felt safe that your heart wasn't being further
damaged and you no longer needed supplementary oxygen.
.
You were started on medications to control your blood pressure
and protect your heart.  You will be sent home on LISINOPRIL,
which is a once a day version of this type of medication.
Please continue to take this medication until you are told to
stop doing so by a cardiologist.  You have also been started on
AZITHROMYCIN, which can treat one particular type of infection
that can cause inflammation of the heart and the sac around it.
You will need to take one more day of this antibiotic after
discharge.  You may continue to take tylenol for pain control.
You can take up to 1 gram of tylenol each four hours in order
control your fever and pain.  Please do not exceed this dose.
Do not drink alcohol while you are taking this much tylenol.
.
Please limit your exertion in the coming weeks.  It is important
you don't exert yourself over the next few weeks in order to
allow your heart to heal.
.
Please keep all scheduled follow-up appointments as these are
important to manage your health.
.
Please return to the ED or call your doctor if you have fever
>101, increasing shortness of breath, worsening of your chest
pain, lower extremity swelling, or any other distressing changes
to your health.

Followup Instructions:
CARDIOLOGY
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone: [**Telephone/Fax (1) 62**] Date/time:
[**9-30**] at 4:20pm. [**Hospital Ward Name 23**] building, [**Location (un) 436**], [**Hospital Ward Name **].



Completed by:[**2120-9-20**]
{'Acute idiopathic pericarditis,Pulmonary congestion and hypostasis,Combined systolic and diastolic heart failure, unspecified,Juvenile osteochondrosis of hip and pelvis,Hypotension, unspecified,Hypoxemia,Other specified cardiac dysrhythmias'}


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 is a 19 year old college student with no significant past
medical history, who presented with chest pain starting on the
morning of admission.  He had recently had a sore throat with
frontal bilateral squeezing headache on Thursday/Friday,
sleeping most of Friday and experiencing some "cold sweats".  He
also noted myalgias and rhinorrhea.  He felt better on Saturday
and went out with friends and had 8 drinks.  The next day, the
day of admission, he woke up and had sharp chest pains. This
pain was not positional.
.
He was seen on the day of admission at his college health
services.  He was noted to have diffuse ST elevations on his EKG
and was sent to the [**Hospital1 18**] ED.  He denies palpitations; he denies
diarrhea, nausea or vomiting; he denies any sick contacts; his
family lives in a rural high-tick area; he has traveled only to
[**Location (un) **] two weeks ago but nowhere else.
.
In the emergency department, his vitals on arrival were 96.3,
75, 98/58, 19, 100% RA. He received 2L NS; GI cocktail of 30 cc
maalox, 15 cc lidocaine; ibuprofen 600 mg (appears to be x2 for
total of 1200), morphine 2 mg IV x2, and an additional morphine
2 mg listed as PO but likely to be an additional dose of IV,
zofran 4 mg IV.  On subsequent blood pressure check, he was
noted to be hypotensive to SBP 70s, and was given 2 L IVF with
BP to 100s.  He had an echocardiogram in ED by cardiology fellow
and was noted to have trace pericardial effusion with normal
systolic function.  Cardiac enzymes were positive with trop T of
1.29 and CK 1324 with MBI 9.1.  He was admitted to the [**Hospital Unit Name 196**]
service with myocarditis.

MEDICAL HISTORY: Bilateral [**Last Name (un) **]-Calve-Parthes with right hip surgery 3 years ago

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
VS: 102, 110/60, 74, 18, 100% Non-rebreather
GENERAL: Young well-nourished male in discomfort
HEENT: NCAT. Sclera anicteric. EOMI. No erythema or exudate.
NECK: Supple, JVP elevated to ~10-12 cm
CARDIAC: RRR, normal S1, S2. No rub. No murmurs or gallops.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use.  Bibasilar crackles.
ABDOMEN: Soft, ND, BS+. Mildly tender to palpation.
EXTREMITIES: No c/c/e.
SKIN: No lesions or rashes on extremities or torso.
PULSES:
Right: DP 2+
Left: DP 2+

FAMILY HISTORY: Aunt with lupus.  No family history of early MI or diabetes.

SOCIAL HISTORY: He had a sexual encounter with a woman five days ago; denies any
oral sex and used condoms for intercourse; he denies any sex
with men.
-Tobacco history: none
-ETOH: drinks socially; last night had "6 beers and 2 shots";
says this is a typical night out for him; does not drink on
nights he does not go out with friends; typically goes out with
friends on weekends except in summer when he goes out more.
-Illicit drugs: denies any; specifically denies cocaine 

### Response:
{'Acute idiopathic pericarditis,Pulmonary congestion and hypostasis,Combined systolic and diastolic heart failure, unspecified,Juvenile osteochondrosis of hip and pelvis,Hypotension, unspecified,Hypoxemia,Other specified cardiac dysrhythmias'}
