CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 70 M w/ DM, HTN, high cholesterol here with 3-4 weeks CP,
pleuritic chest pain (no radiation, diaphoresis), intermittently
relieved by " anti-inflammatory/ pain killers" prescribed 3
weeks ago by PCP and Tylenol. Day of admission, pt went for
usual daily am walk x 30 min w/o CP, SOB. In afternoon, while
eating, CP returned [**9-24**]-> OSH where CT showed significant
pericardial effusion. At OSH, given ASA, NTG x3 w/ transient BP
drop to 50's. Given Morphine 16 mg IV w/o CP relief beyond [**7-25**].
Tx to [**Hospital1 18**] for further care. Here at [**Hospital1 18**], given dilaudid 4 mg
IV w/ pain relief to [**2192-4-19**]. Pt became nauseated after
dilaudid/morphine. Bedside echo done by ED--> no obvious RV
collapse.
No pulsus paradoxicus at the time of admission.

MEDICAL HISTORY: HTN
DM
Hypercholesterolemia
Colonoscopy two years ago (polyps removed)

MEDICATION ON ADMISSION: Glucotrol 10mg
Accupril 10mg
Lipitor 10mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.2 136/69 84 16 94%RA, Pulsus=6mmHg
General: NAD, sitting up in bed, comfortable appearing
HEENT: NCAT, PERRL, EOMI, OMMM
CV: S1, S2, no S3 or S4.  Reg, no murmurs, no knock, JVP ~3cm
above notch
Lungs: rare bibasilar rales
Abdomen: Soft, NT, ND, no rebound or guarding
Ext: Groin - no ecchymosis.  PPD placed on left forearm- flat.
Warm, no CCE.  DP pulses 2+ bilat.
Neuro: A/O X 3, moving all four ext.  Strength and sensation
grossly intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Immigrated from the Azores ~30 years ago.
Drinks one glass of wine two to three times per week.
Does not smoke.
Acute idiopathic pericarditis,Pure hypercholesterolemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Ac idiopath pericarditis,Pure hypercholesterolem,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2187-5-10**]              Discharge Date:   [**2187-5-12**]

Date of Birth:  [**2116-11-17**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2074**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Right Heart Catherization
Pericardiocentesis


History of Present Illness:
70 M w/ DM, HTN, high cholesterol here with 3-4 weeks CP,
pleuritic chest pain (no radiation, diaphoresis), intermittently
relieved by " anti-inflammatory/ pain killers" prescribed 3
weeks ago by PCP and Tylenol. Day of admission, pt went for
usual daily am walk x 30 min w/o CP, SOB. In afternoon, while
eating, CP returned [**9-24**]-> OSH where CT showed significant
pericardial effusion. At OSH, given ASA, NTG x3 w/ transient BP
drop to 50's. Given Morphine 16 mg IV w/o CP relief beyond [**7-25**].
Tx to [**Hospital1 18**] for further care. Here at [**Hospital1 18**], given dilaudid 4 mg
IV w/ pain relief to [**2192-4-19**]. Pt became nauseated after
dilaudid/morphine. Bedside echo done by ED--> no obvious RV
collapse.
No pulsus paradoxicus at the time of admission.

ROS: negative for F/C/ myalgias/wt loss/ nightsweats/ cough/
recent viral symptoms/ GIB/ exertional CP. Pain free without
deep breaths.


Past Medical History:
HTN
DM
Hypercholesterolemia
Colonoscopy two years ago (polyps removed)

Social History:
Immigrated from the Azores ~30 years ago.
Drinks one glass of wine two to three times per week.
Does not smoke.

Family History:
non-contributory

Physical Exam:
98.2 136/69 84 16 94%RA, Pulsus=6mmHg
General: NAD, sitting up in bed, comfortable appearing
HEENT: NCAT, PERRL, EOMI, OMMM
CV: S1, S2, no S3 or S4.  Reg, no murmurs, no knock, JVP ~3cm
above notch
Lungs: rare bibasilar rales
Abdomen: Soft, NT, ND, no rebound or guarding
Ext: Groin - no ecchymosis.  PPD placed on left forearm- flat.
Warm, no CCE.  DP pulses 2+ bilat.
Neuro: A/O X 3, moving all four ext.  Strength and sensation
grossly intact.


Pertinent Results:
[**2187-5-10**] 03:00PM   CK(CPK)-56
[**2187-5-10**] 03:00PM   CK-MB-NotDone cTropnT-<0.01
[**2187-5-10**] 01:30PM OTHER BODY FLUID  TOT PROT-5.4 GLUCOSE-171
LD(LDH)-436 AMYLASE-28 ALBUMIN-3.4
[**2187-5-10**] 01:30PM OTHER BODY FLUID  WBC-[**Numeric Identifier 30501**]* HCT-8* POLYS-78*
LYMPHS-9* MONOS-13*
[**2187-5-10**] 09:30AM   GLUCOSE-231* UREA N-16 CREAT-0.8 SODIUM-138
POTASSIUM-4.4 CHLORIDE-106 TOTAL CO2-23 ANION GAP-13
[**2187-5-10**] 09:30AM   LD(LDH)-153 CK(CPK)-47
[**2187-5-10**] 09:30AM   CK-MB-NotDone cTropnT-<0.01
[**2187-5-10**] 09:30AM   TOT PROT-6.7 CALCIUM-8.2* PHOSPHATE-3.0
MAGNESIUM-2.0
[**2187-5-10**] 09:30AM   TSH-1.6
[**2187-5-10**] 09:30AM   [**Doctor First Name **]-NEGATIVE
[**2187-5-10**] 09:30AM   RHEU FACT-7
[**2187-5-10**] 09:30AM   WBC-9.8 RBC-4.79 HGB-14.5 HCT-42.4 MCV-89
MCH-30.3 MCHC-34.2 RDW-13.2
[**2187-5-10**] 09:30AM   NEUTS-90.8* LYMPHS-5.3* MONOS-3.7 EOS-0.1
BASOS-0.1
[**2187-5-10**] 09:30AM   PLT COUNT-138*
[**2187-5-10**] 09:30AM   SED RATE-8
[**2187-5-10**] 01:25AM   GLUCOSE-242* UREA N-15 CREAT-0.8 SODIUM-139
POTASSIUM-4.9 CHLORIDE-105 TOTAL CO2-23 ANION GAP-16
[**2187-5-10**] 01:25AM   CK(CPK)-71
[**2187-5-10**] 01:25AM   cTropnT-<0.01
[**2187-5-10**] 01:25AM   CK-MB-NotDone
[**2187-5-10**] 01:25AM   WBC-12.7* RBC-5.17 HGB-15.7 HCT-45.6 MCV-88
MCH-30.3 MCHC-34.3 RDW-13.1
[**2187-5-10**] 01:25AM   NEUTS-92.9* BANDS-0 LYMPHS-3.9* MONOS-3.0
EOS-0.1 BASOS-0
[**2187-5-10**] 01:25AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2187-5-10**] 01:25AM   PLT SMR-NORMAL PLT COUNT-170
[**2187-5-10**] 01:25AM   PT-12.1 PTT-21.7* INR(PT)-1.0

ECG Study Date of [**2187-5-10**]  1:04:30 AM
Sinus tachycardia. Low voltage. Mild J point and ST segment
elevation particularly in the lateral leads. PR segment and
elevation in lead aVR which raise question of pericarditis. No
previous tracing available for comparison.

ECHO Study Date of [**2187-5-10**]
The left atrium is normal in size. Left ventricular wall
thicknesses are
normal. The left ventricular cavity is unusually small. Left
ventricular
systolic function is hyperdynamic (EF>75%). No masses or thrombi
are seen in the left ventricle. 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. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Trivial mitral regurgitation is seen. There is a
moderate sized pericardial effusion. The effusion appears
circumferential. No right ventricular diastolic collapse is
seen. There is sustained right atrial collapse, consistent with
low filling pressures or early tamponade. There is left atrial
diastolic collapse.

Cardiac Catheterization Study Date of [**2187-5-10**]  :
1.  Resting hemodynamics revealed elevated right- and left-sided
filling pressures (mean RA 17 mmHg, mean PCW 22 mmHg).
Significant blunting of the Y-descent on the right atrial and
pulmonary capillary wedge pressure hemodynamic tracings was
noted.  Pulmonary artery pressure was minimally elevated (mean
PA 21 mmHg).  Systemic arterial pressures were normal with a 10
mmHg respirophasic variation in systolic pressure (borderline
pulsus paradoxus).  Cardiac index was normal at 2.9 L/min/m2.
2.  Successful placement of a pericardial catheter via the
subxyphoid approach with aspiration of 400 cc of bloody fluid.
3.  Upon entry of the pericardial catheter into the pericardial
space, mean pericardial pressure was 19 mmHg, slightly greater
than measured right atrial pressure (mean 17 mmHg).  After
drainage of 400 cc of fluid, right atrial pressures decreased to
13 mmHg with return of normal Y-descent.  Mean pericardial
pressure decreased to 11 mmHg with respirophasic variation and
inspiratory pressures near zero.  Cardiac index increased to 3.8
L/min/m2.
4.  Cardiac echo performed in the cath lab after drainage showed
a very small residual pericardial effusion.


Brief Hospital Course:
70M DM, no CAD, here with cardiac tamponade.

Although patient initially had no obvious pulsus paradoxus at
the time of admission, approximately 6 hours later on hospital
day one, patient had a pulsus of approximately 15mm, which was
confirmed later that morning by echocardiogram (sustained RV
diastolic collapse) and right heart catherization (equalization
of pressures, respiratory variation, and pericardial pressures
17-20mmHg).

In the cath lab, patient had 400cc of serosanguinous fluid
drained.  Pericardial drain was left in place and continued to
yield ~25cc the first day, then ~65cc of serosanguinous fluid
the next day upon removal of the drain.  Prior to removal of
drain, echocardiogram revealed no signs of tamponade, but a
continued small residual echodense pericardial effusion.  Of
note, pulsus had been reduced to 6mmHg following drainage in the
cath lab on hospital day one and continued to remain stable at
6mmHg throughout remainder of hospitalization.

In pursuit of etiology of effusion, a PPD was placed (flat @ 48
hours), AFB stain of fluid was negative, and no organisms were
seen.  However, the fluid did reveal 38,000 white cells with
neutrophil predominance.  Nonetheless, patient was in excellent
clinical condition following drainage and was afebrile
throughout course, suggesting that the effusion was less likely
purulent.  Malignancy seemed unlikely, as patient was up-to-date
on health screening (per patient).  Therefore, given prodromic
symptoms, it was thought that effusion was most likely secondary
to viral/idiopathic cause.

With the pericardial drain in place, patient continued to have
significant pleuritic pain, which was treated to good effect
with indomethacin 50mg TID.  Patient required 75mcg of Fentanyl
and 1mg of Versed at the time of removal of the drain.  However,
following removal of drain, patient was virtually pain free.
Furthermore, given no further symptoms of pericardial
constriction, it was felt that further workup for pericardial
constriction was unnecessary at this time.

At the time of discharge, patient was able to ambulate
independently without any dyspnea on exertion.  Furthermore,
pulsus continued to remain at 6mmHg making recurrence of
effusion unlikely.

Patient was discharged with instructions to return for
echocardiogram within one week of discharge, to see PCP in
followup for chemistries and CBC (while on indomethacin) within
one week, and to return to see Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in cardiology
within two weeks to review echocardiogram results.  Coverage for
PCP was notified of patient's condition/discharge and pertinent
followup issues.

Medications on Admission:
Glucotrol 10mg
Accupril 10mg
Lipitor 10mg

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. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
4. Quinapril HCl 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Glipizide 10 mg Tab, Sust Release Osmotic Push Sig: One (1)
Tab, Sust Release Osmotic Push PO DAILY (Daily).
Disp:*30 Tab, Sust Release Osmotic Push(s)* Refills:*2*
6. Indomethacin 50 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) for 7 days.
Disp:*21 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Cardiac Tamponade
Probable Viral Pericarditis
Diabetes Mellitus Type II
Hypertension


Discharge Condition:
Good - Ambulating, Pulsus paradoxus 6mm Hg and stable.

Discharge Instructions:
Continue taking indomethacin for pain as needed.  If you
continue to have chest pain after one week, call your doctor to
discuss continuing the medication.

If you have lightheadedness or worsening chest pain, call your
doctor or 911.  If you pass out, have someone call 911 and have
an ambulance bring you to the emergency room immediately.

Call to make an appointment to see Dr. [**Last Name (STitle) 61740**] within one week
of discharge.

Call to schedule an echocardiogram at [**Hospital3 **] [**Telephone/Fax (1) 128**]
for Thursday [**2187-5-17**].  Call Dr. [**Last Name (STitle) 61740**] for a referral for
insurance purposes.

Call to schedule an appointment to see a cardiologist at [**Hospital 61**] (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) ([**Telephone/Fax (1) 62**]) within two weeks of
discharge.  She will review your echocardiogram results with you
at that time.

Followup Instructions:
Call Dr. [**Last Name (STitle) 61740**] ([**Telephone/Fax (1) 62076**]) to schedule a followup
appointment within one week of discharge.  You will need to have
your CBC and Chem 7 drawn to follow your blood count and
creatinine while on indomethacin.  Cytology of your pericardial
fluid is currently pending, and will need to be followed by Dr.
[**Last Name (STitle) 61740**].

Call to schedule an echocardiogram at [**Hospital3 **] [**Telephone/Fax (1) 128**]
for Thursday [**2187-5-17**].  Call Dr. [**Last Name (STitle) 61740**] for a referral for
insurance purposes.

Call to schedule an appointment to see a cardiologist at [**Hospital 61**] (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]) ([**Telephone/Fax (1) 62**]) within two weeks of
discharge.  She will review your echocardiogram results with you
at that time.
{'Acute idiopathic pericarditis,Pure hypercholesterolemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 70 M w/ DM, HTN, high cholesterol here with 3-4 weeks CP,
pleuritic chest pain (no radiation, diaphoresis), intermittently
relieved by " anti-inflammatory/ pain killers" prescribed 3
weeks ago by PCP and Tylenol. Day of admission, pt went for
usual daily am walk x 30 min w/o CP, SOB. In afternoon, while
eating, CP returned [**9-24**]-> OSH where CT showed significant
pericardial effusion. At OSH, given ASA, NTG x3 w/ transient BP
drop to 50's. Given Morphine 16 mg IV w/o CP relief beyond [**7-25**].
Tx to [**Hospital1 18**] for further care. Here at [**Hospital1 18**], given dilaudid 4 mg
IV w/ pain relief to [**2192-4-19**]. Pt became nauseated after
dilaudid/morphine. Bedside echo done by ED--> no obvious RV
collapse.
No pulsus paradoxicus at the time of admission.

MEDICAL HISTORY: HTN
DM
Hypercholesterolemia
Colonoscopy two years ago (polyps removed)

MEDICATION ON ADMISSION: Glucotrol 10mg
Accupril 10mg
Lipitor 10mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.2 136/69 84 16 94%RA, Pulsus=6mmHg
General: NAD, sitting up in bed, comfortable appearing
HEENT: NCAT, PERRL, EOMI, OMMM
CV: S1, S2, no S3 or S4.  Reg, no murmurs, no knock, JVP ~3cm
above notch
Lungs: rare bibasilar rales
Abdomen: Soft, NT, ND, no rebound or guarding
Ext: Groin - no ecchymosis.  PPD placed on left forearm- flat.
Warm, no CCE.  DP pulses 2+ bilat.
Neuro: A/O X 3, moving all four ext.  Strength and sensation
grossly intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Immigrated from the Azores ~30 years ago.
Drinks one glass of wine two to three times per week.
Does not smoke. 

### Response:
{'Acute idiopathic pericarditis,Pure hypercholesterolemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
