CHIEF COMPLAINT: Transferred from [**Location (un) **] with shortness of breath and elevated
Trop to 11 for further management

PRESENT ILLNESS: 55 year old man with history of multiple PCIs ([**2133**], [**2135**]), 4
vessel CABG in [**2138**] (LIMA to LAD, SVG grafts to RPDA, OM1,
Diag), cath in [**2144**] revealing all SVG grafts occluded, LIMA to
LAD patent, DM, HTN, HL, PVD who presented to [**Location (un) **] [**2-25**] after
increasing DOE and weight gain, initially treated for CHF
exacerbation with IV diuresis and left AMA [**2-27**] AM and was found
to have a troponin of 0.9 ([**2-25**]) -> 11 ([**2-27**]) and was asked to
return to the ED and was transferred to [**Hospital1 18**] from [**Location (un) **] ED
for C.Cath.
.
Patient was in USOH until ~ 1mo ago when he noted increasing SOB
w/ exertion that was intermittent.  This was a progressive
change and he had no orthopnea or PND. In addition, noted
increasin LE edema and weight gain (states subjectively going
from 230->250s).  On [**2-24**] he had a mechanical fall from the
wheelchair and upon returning felt worsening SOB to the point
that he had a difficult time moving in the chair.  Called
primary cardiologist who recommended he go to the ED.  He was
admitted to [**Location (un) **] on [**2-24**] and was treated for CHF with IV
diuresis (amt of weight loss unknown).  He underwent a stress
showing a fixed inferoposterolateral defect w/ dilated cavity
and 19% EF.

MEDICAL HISTORY: history of Dm2 with neuropathy, insulin dependant, uncontrolled
hisitory of coronary artery disease s/p MI1998,S/p CABG"sx4
'[**38**],s/p PCI w stenting '[**35**]
history of PVD s/p rt. fem-pt bpg with #3 toe amputation [**5-23**]
historyof HTN
historyof systolic/dastolic CHF, chronic, compensated
historyof dyslipdemia
history of COPD/emphysema-inhalers
history of depression/anxiety
history of Bell's palsey? side
historoy of tonsillectomy
history of

MEDICATION ON ADMISSION: per OSH record, pt. does not recall the doses.
- Furosemide 80 mg [**Hospital1 **].
- Metoprolol Succinate 50 mg daily
- Spironolactone 25 mg daily.
- Digoxin 125 mcg EOD
- Isosorbide 15mg daily.
- Januvia 50mg daily
- MgOxide 400mg [**Hospital1 **]
- Advair 250/50 [**Hospital1 **]
- Crestor 40mg daily
- Combivent 2puff TID
- Plavix 75mg daily
- Paxil 40mg daily
- Amaryl 4mgdaily
- Prilosec 20mg daily
- ISS
- ASA 325mg daily
- MVI daily
- Remeron 30mg daily
- Ativan 0.5mg prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission:
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: Obese neck. NCAT. Sclera anicteric. PERRL, EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.
No xanthalesma.
NECK: Supple with JVP of 5 cm.
CARDIAC: PMI located in 5th intercostal space. RR, normal S1,
S2. [**1-19**] cres/decr. murmur best at 3th LICS.  No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. Crackles
bilaterally.
ABDOMEN: Obese, soft, NTND. No HSM or tenderness. No abdominial
bruits.
EXTREMITIES: 1+ edema at LLE, R BKA. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Femoral 2+
Left: Femoral 2+ DP/PT -> dopplerable
.
Patient left AMA within 16 hours of admission and so Discharge
physical was same as admission physical.

FAMILY HISTORY: - Father - positive for MI @ age 48
- Mother - positive for MI @ age 64 w/b CHF

SOCIAL HISTORY: Lives in an apt alone.  Half sister is HCP.
# Smoker for > 30 years 2-3 packs a day
# Alcohol use until 9 years ago (unclear how much)
# Cocaine until 9 years ago
Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Other emphysema,Long-term (current) use of insulin,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified
Subendo infarct, initial,Chr syst/diastl hrt fail,Emphysema NEC,Long-term use of insulin,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypertension NOS,Hyperlipidemia NEC/NOS,Periph vascular dis NOS
Admission Date:  [**2149-2-27**]              Discharge Date:   [**2149-2-28**]

Date of Birth:  [**2093-9-6**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (NamePattern1) 1167**]
Chief Complaint:
Transferred from [**Location (un) **] with shortness of breath and elevated
Trop to 11 for further management

Major Surgical or Invasive Procedure:
None

History of Present Illness:
55 year old man with history of multiple PCIs ([**2133**], [**2135**]), 4
vessel CABG in [**2138**] (LIMA to LAD, SVG grafts to RPDA, OM1,
Diag), cath in [**2144**] revealing all SVG grafts occluded, LIMA to
LAD patent, DM, HTN, HL, PVD who presented to [**Location (un) **] [**2-25**] after
increasing DOE and weight gain, initially treated for CHF
exacerbation with IV diuresis and left AMA [**2-27**] AM and was found
to have a troponin of 0.9 ([**2-25**]) -> 11 ([**2-27**]) and was asked to
return to the ED and was transferred to [**Hospital1 18**] from [**Location (un) **] ED
for C.Cath.
.
Patient was in USOH until ~ 1mo ago when he noted increasing SOB
w/ exertion that was intermittent.  This was a progressive
change and he had no orthopnea or PND. In addition, noted
increasin LE edema and weight gain (states subjectively going
from 230->250s).  On [**2-24**] he had a mechanical fall from the
wheelchair and upon returning felt worsening SOB to the point
that he had a difficult time moving in the chair.  Called
primary cardiologist who recommended he go to the ED.  He was
admitted to [**Location (un) **] on [**2-24**] and was treated for CHF with IV
diuresis (amt of weight loss unknown).  He underwent a stress
showing a fixed inferoposterolateral defect w/ dilated cavity
and 19% EF.

Overnight [**2-26**] -> [**2-27**] he developed chest pressure anteriorly
more focused on the left subareolar space.  This was tightness,
not pain, w/o SOB but w/ diaphoresis. CXR there previously
showed only cardiomegaly without effusions.  Patient requested
transfer here for further care.   He was treated with "patch"
w/o improvement and finally noted resolution with administration
of NTG SL after 10 mins.  Unfortunately, patient left AMA that
morning b/c he felt better and there was no one taking care of
his cat.  When AM labs returned, his troponin was noted to be
11, CBC 6.5 w/ 12 bands, and he was asked to return to the ED.
Upon return to [**Location (un) **] ED today, EKG reportedly showing ST
depressions in V3, V4, and V5. Wt 250lbs. CBC 6.5/29/113, BMP
141/4.6/101/32/53/1.7 (Cr. peaked at 2.4). He was started on
heparin gtt and transferred to [**Hospital1 18**] ED.  He denies any recent
dietary indiscretions (though noted in H/P from OSH), skipping
medication doses or preceeding CP or pressure.
.
In [**Hospital1 18**] the ED, initial vitals were Temp 97.7, HR 74, BP
146/83, RR 18, O2 Sat 98% on 2L. He received ASA, continued on
heparin gtt.  CXR showed cardiomegaly and pulm edema, EKG w/ SR
and RBBB w/ inferior TwI and STd V3, 4, 5.  He was CP free.
Admitted to CCU as there were no beds on Fa3.
.
In the CCU VS were 97.4 74 138/68 96% on 2L NC.  He had no sx.


Past Medical History:
history of Dm2 with neuropathy, insulin dependant, uncontrolled
hisitory of coronary artery disease s/p MI1998,S/p CABG"sx4
'[**38**],s/p PCI w stenting '[**35**]
history of PVD s/p rt. fem-pt bpg with #3 toe amputation [**5-23**]
historyof HTN
historyof systolic/dastolic CHF, chronic, compensated
historyof dyslipdemia
history of COPD/emphysema-inhalers
history of depression/anxiety
history of Bell's palsey? side
historoy of tonsillectomy
history of


Social History:
Lives in an apt alone.  Half sister is HCP.
# Smoker for > 30 years 2-3 packs a day
# Alcohol use until 9 years ago (unclear how much)
# Cocaine until 9 years ago

Family History:
- Father - positive for MI @ age 48
- Mother - positive for MI @ age 64 w/b CHF

Physical Exam:
Admission:
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: Obese neck. NCAT. Sclera anicteric. PERRL, EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.
No xanthalesma.
NECK: Supple with JVP of 5 cm.
CARDIAC: PMI located in 5th intercostal space. RR, normal S1,
S2. [**1-19**] cres/decr. murmur best at 3th LICS.  No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. Crackles
bilaterally.
ABDOMEN: Obese, soft, NTND. No HSM or tenderness. No abdominial
bruits.
EXTREMITIES: 1+ edema at LLE, R BKA. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Femoral 2+
Left: Femoral 2+ DP/PT -> dopplerable
.
Patient left AMA within 16 hours of admission and so Discharge
physical was same as admission physical.

Pertinent Results:
[**2149-2-27**] 04:00PM BLOOD WBC-6.8 RBC-3.71* Hgb-10.6* Hct-31.8*
MCV-86 MCH-28.7 MCHC-33.4 RDW-15.5 Plt Ct-143*#
[**2149-2-28**] 05:59AM BLOOD WBC-6.5 RBC-3.71* Hgb-10.8* Hct-32.2*
MCV-87 MCH-29.0 MCHC-33.5 RDW-15.3 Plt Ct-142*
[**2149-2-27**] 04:00PM BLOOD PT-16.6* PTT-131.6* INR(PT)-1.5*
[**2149-2-27**] 11:41PM BLOOD PT-15.1* PTT-48.1* INR(PT)-1.3*
[**2149-2-28**] 05:59AM BLOOD PT-15.6* PTT-53.3* INR(PT)-1.4*
.
#####################################################
IMAGING:
ECHO [**2149-2-28**]:
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity is
moderately dilated. Overall left ventricular systolic function
is moderately depressed (LVEF= 30 %) with global hypokinesis and
inferior/infero-lateral akinesis. No masses or thrombi are seen
in the left ventricle. There is no ventricular septal defect.
The right ventricular cavity is dilated with depressed free wall
contractility. The ascending aorta is mildly dilated. The aortic
valve leaflets are moderately thickened. There is moderate
aortic valve stenosis (valve area 1.0-1.2cm2). No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Trivial mitral regurgitation is seen. The tricuspid
valve leaflets are mildly thickened. There is mild pulmonary
artery systolic hypertension. There is no pericardial effusion.
.
CXR [**2149-2-27**]
The lung volumes are low with secondary widening of the
cardiomediastinal
silhouette. There is no pleural effusion and no pneumothorax. No
pulmonary
edema. ICD leads end in the right atrium and right ventricle.


Brief Hospital Course:
Mr. [**Known lastname **] went down for cardiac catheterization on [**2149-2-28**].
He was scheduled to go for cath, but because of two emergent
STEMI that required intervention his scheduled time was pushed
back.  He became enraged that he was not being given priority
and wanted to leave AMA.  Dr. [**First Name (STitle) 31469**] came and spoke with him and
explained the risk of death if he left since we suspects he had
and acute cardiac event.  He listened to the risks of leaving
and understood them well, but still demanded that he leave.  He
was rude to the nurses and other physicians in the waiting area
and so he was sent back to the CCU.  When he arrived in the CCU,
I was unaware of the conversations that occurred in the cath
waiting area.  I spoke with the patient as did Dr. [**Last Name (STitle) 10755**] and,
initially, he decided to stay and wait for cardiac
catheterization.  After about an hour he changed his mind and
wanted to leave AMA.  We spoke with him again and he was willing
to take his risks because he was not happy with waiting to get a
cardiac catheterization.  Our attending, Dr. [**First Name (STitle) 437**], was kept
informed of the events throughout the whole day.  We also
e-mailed his primary cardiologist Dr. [**Last Name (STitle) 93346**] to inform him of
what occurred.


Medications on Admission:
per OSH record, pt. does not recall the doses.
- Furosemide 80 mg [**Hospital1 **].
- Metoprolol Succinate 50 mg daily
- Spironolactone 25 mg daily.
- Digoxin 125 mcg EOD
- Isosorbide 15mg daily.
- Januvia 50mg daily
- MgOxide 400mg [**Hospital1 **]
- Advair 250/50 [**Hospital1 **]
- Crestor 40mg daily
- Combivent 2puff TID
- Plavix 75mg daily
- Paxil 40mg daily
- Amaryl 4mgdaily
- Prilosec 20mg daily
- ISS
- ASA 325mg daily
- MVI daily
- Remeron 30mg daily
- Ativan 0.5mg prn

Discharge Medications:
Pt left AMA and so we are assuming he restarted his home
medications

Discharge Disposition:
Home

Discharge Diagnosis:
Non ST elevation Myocardial infarction

Discharge Condition:
Unstable.  THe patient left prior to cardiac catheterization.

PATIENT LEFT AGAINST MEDICAL ADVICE.

Discharge Instructions:
WE INSTRUCTED THE PATIENT NOT TO LEAVE THE HOSPITAL AS HE WAS
NOT MEDICALLY STABLE

Followup Instructions:
TO CALL 911 IF ANY SYMPTOMS RECUR.
{'Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Other emphysema,Long-term (current) use of insulin,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified'}


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: Transferred from [**Location (un) **] with shortness of breath and elevated
Trop to 11 for further management

PRESENT ILLNESS: 55 year old man with history of multiple PCIs ([**2133**], [**2135**]), 4
vessel CABG in [**2138**] (LIMA to LAD, SVG grafts to RPDA, OM1,
Diag), cath in [**2144**] revealing all SVG grafts occluded, LIMA to
LAD patent, DM, HTN, HL, PVD who presented to [**Location (un) **] [**2-25**] after
increasing DOE and weight gain, initially treated for CHF
exacerbation with IV diuresis and left AMA [**2-27**] AM and was found
to have a troponin of 0.9 ([**2-25**]) -> 11 ([**2-27**]) and was asked to
return to the ED and was transferred to [**Hospital1 18**] from [**Location (un) **] ED
for C.Cath.
.
Patient was in USOH until ~ 1mo ago when he noted increasing SOB
w/ exertion that was intermittent.  This was a progressive
change and he had no orthopnea or PND. In addition, noted
increasin LE edema and weight gain (states subjectively going
from 230->250s).  On [**2-24**] he had a mechanical fall from the
wheelchair and upon returning felt worsening SOB to the point
that he had a difficult time moving in the chair.  Called
primary cardiologist who recommended he go to the ED.  He was
admitted to [**Location (un) **] on [**2-24**] and was treated for CHF with IV
diuresis (amt of weight loss unknown).  He underwent a stress
showing a fixed inferoposterolateral defect w/ dilated cavity
and 19% EF.

MEDICAL HISTORY: history of Dm2 with neuropathy, insulin dependant, uncontrolled
hisitory of coronary artery disease s/p MI1998,S/p CABG"sx4
'[**38**],s/p PCI w stenting '[**35**]
history of PVD s/p rt. fem-pt bpg with #3 toe amputation [**5-23**]
historyof HTN
historyof systolic/dastolic CHF, chronic, compensated
historyof dyslipdemia
history of COPD/emphysema-inhalers
history of depression/anxiety
history of Bell's palsey? side
historoy of tonsillectomy
history of

MEDICATION ON ADMISSION: per OSH record, pt. does not recall the doses.
- Furosemide 80 mg [**Hospital1 **].
- Metoprolol Succinate 50 mg daily
- Spironolactone 25 mg daily.
- Digoxin 125 mcg EOD
- Isosorbide 15mg daily.
- Januvia 50mg daily
- MgOxide 400mg [**Hospital1 **]
- Advair 250/50 [**Hospital1 **]
- Crestor 40mg daily
- Combivent 2puff TID
- Plavix 75mg daily
- Paxil 40mg daily
- Amaryl 4mgdaily
- Prilosec 20mg daily
- ISS
- ASA 325mg daily
- MVI daily
- Remeron 30mg daily
- Ativan 0.5mg prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission:
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: Obese neck. NCAT. Sclera anicteric. PERRL, EOMI.
Conjunctiva were pink, no pallor or cyanosis of the oral mucosa.
No xanthalesma.
NECK: Supple with JVP of 5 cm.
CARDIAC: PMI located in 5th intercostal space. RR, normal S1,
S2. [**1-19**] cres/decr. murmur best at 3th LICS.  No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. Crackles
bilaterally.
ABDOMEN: Obese, soft, NTND. No HSM or tenderness. No abdominial
bruits.
EXTREMITIES: 1+ edema at LLE, R BKA. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Femoral 2+
Left: Femoral 2+ DP/PT -> dopplerable
.
Patient left AMA within 16 hours of admission and so Discharge
physical was same as admission physical.

FAMILY HISTORY: - Father - positive for MI @ age 48
- Mother - positive for MI @ age 64 w/b CHF

SOCIAL HISTORY: Lives in an apt alone.  Half sister is HCP.
# Smoker for > 30 years 2-3 packs a day
# Alcohol use until 9 years ago (unclear how much)
# Cocaine until 9 years ago 

### Response:
{'Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Other emphysema,Long-term (current) use of insulin,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified'}
