CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 60 yo M with DM2, hypercholesterolemia, alchoholism, HTN, CAD
s/p MI with stent to RCA in '[**83**] with residual EF of 54% ([**12-26**])
who suddenly developed N/V and [**10-4**] pain across Right and Left
chest wall after taking two shots of vodka while on antabuse.
The CP was associated with diaphoresis and lightheadedness. The
pain did not radiate and he never felt SOB. The pain did not
resolve after one hour and he called 911. While on route to the
ED he was given [**Month/Year (2) **], NTG, and morphine. In the ED he received
NTG, lopressor, [**Month/Year (2) **], morphine, heparin, integrilin and taken
emergently to the cath lab.

MEDICAL HISTORY: 1. CAD s/p MI with stent to RCA in '[**83**] with residual EF of 54%
([**12-26**])
2. DM2
3. HTN
4. hypercholesterolemia
5. gout
6. alcoholism on antabuse

MEDICATION ON ADMISSION: Diovan, Glucaphage, [**Last Name (LF) 17339**], [**First Name3 (LF) **], antabuse

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 96, BP 164/73, RR i6, 99% 4L, Wt 228, Ht 5'[**94**]"
gen: smells of EtOH
HEENT: MMM, EOMI, PERRL
neck: JVD 12 cm
CV: RRR, Nl S1S1, No M/R/G
Lungs: CTAB
Abd: obese, distended/NT, pos hepatomegaly, nl BS
Ext: no pedal edema, strong DP pulses

FAMILY HISTORY: Mother died at age 66 from MI, brother had MI at age 52.

SOCIAL HISTORY: Quit tob 20 yrs ago. H/O EtOH abuse, continues to drink
intermittently despite being on antabuse. Married for 31 yrs.
Has 2 children.
Subendocardial infarction, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other and unspecified alcohol dependence, unspecified
Subendo infarct, initial,Atrial fibrillation,Crnry athrscl natve vssl,Alcoh dep NEC/NOS-unspec
Admission Date:  [**2189-8-16**]              Discharge Date:   [**2189-8-19**]

Date of Birth:  [**2129-5-18**]             Sex:   M

Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9554**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Cardiac Cath


History of Present Illness:
60 yo M with DM2, hypercholesterolemia, alchoholism, HTN, CAD
s/p MI with stent to RCA in '[**83**] with residual EF of 54% ([**12-26**])
who suddenly developed N/V and [**10-4**] pain across Right and Left
chest wall after taking two shots of vodka while on antabuse.
The CP was associated with diaphoresis and lightheadedness. The
pain did not radiate and he never felt SOB. The pain did not
resolve after one hour and he called 911. While on route to the
ED he was given [**Month/Year (2) **], NTG, and morphine. In the ED he received
NTG, lopressor, [**Month/Year (2) **], morphine, heparin, integrilin and taken
emergently to the cath lab.

Past Medical History:
1. CAD s/p MI with stent to RCA in '[**83**] with residual EF of 54%
([**12-26**])
2. DM2
3. HTN
4. hypercholesterolemia
5. gout
6. alcoholism on antabuse


Social History:
Quit tob 20 yrs ago. H/O EtOH abuse, continues to drink
intermittently despite being on antabuse. Married for 31 yrs.
Has 2 children.

Family History:
Mother died at age 66 from MI, brother had MI at age 52.

Physical Exam:
HR 96, BP 164/73, RR i6, 99% 4L, Wt 228, Ht 5'[**94**]"
gen: smells of EtOH
HEENT: MMM, EOMI, PERRL
neck: JVD 12 cm
CV: RRR, Nl S1S1, No M/R/G
Lungs: CTAB
Abd: obese, distended/NT, pos hepatomegaly, nl BS
Ext: no pedal edema, strong DP pulses

Pertinent Results:
[**2189-8-16**] 10:22PM   POTASSIUM-5.3*
[**2189-8-16**] 10:22PM   CK(CPK)-237*
[**2189-8-16**] 10:22PM   CK-MB-18* MB INDX-7.6*
[**2189-8-16**] 10:22PM   CALCIUM-8.0* MAGNESIUM-1.6
[**2189-8-16**] 08:53PM   GLUCOSE-160* UREA N-12 CREAT-1.0 SODIUM-137
POTASSIUM-5.4* CHLORIDE-103 TOTAL CO2-22 ANION GAP-17
[**2189-8-16**] 08:53PM   CK(CPK)-233*
[**2189-8-16**] 08:53PM   CK-MB-15* MB INDX-6.4* cTropnT-0.14*
[**2189-8-16**] 08:53PM   CALCIUM-7.8* PHOSPHATE-2.6* MAGNESIUM-1.5*
[**2189-8-16**] 08:53PM   WBC-12.8* RBC-3.97* HGB-12.4* HCT-34.1*
MCV-86 MCH-31.2 MCHC-36.3* RDW-12.9
[**2189-8-16**] 08:53PM   PLT COUNT-283
[**2189-8-16**] 08:53PM   PT-12.5 PTT-25.7 INR(PT)-1.0
[**2189-8-16**] 05:44PM   TYPE-ART PO2-99 PCO2-36 PH-7.34* TOTAL
CO2-20* BASE XS--5
[**2189-8-16**] 05:44PM   O2 SAT-97
[**2189-8-16**] 05:35PM   ALT(SGPT)-3 AST(SGOT)-15 LD(LDH)-176 ALK
PHOS-52 TOT BILI-0.1
[**2189-8-16**] 05:35PM   CHOLEST-113
[**2189-8-16**] 05:35PM   TRIGLYCER-30 HDL CHOL-48 CHOL/HDL-2.4
LDL(CALC)-59
[**2189-8-16**] 05:35PM   [**Month/Day/Year **]-NEG ETHANOL-13* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2189-8-16**] 03:53PM URINE  HOURS-RANDOM
[**2189-8-16**] 03:53PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2189-8-16**] 03:52PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2189-8-16**] 03:52PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-250 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2189-8-16**] 03:15PM   GLUCOSE-219* UREA N-14 CREAT-1.2 SODIUM-139
POTASSIUM-3.1* CHLORIDE-101 TOTAL CO2-19* ANION GAP-22*
[**2189-8-16**] 03:15PM   CK(CPK)-178*
[**2189-8-16**] 03:15PM   cTropnT-<0.01
[**2189-8-16**] 03:15PM   CK-MB-4
[**2189-8-16**] 03:15PM   CALCIUM-9.1 PHOSPHATE-2.5* MAGNESIUM-1.6
[**2189-8-16**] 03:15PM   WBC-15.7*# RBC-4.36* HGB-13.5* HCT-37.0*
MCV-85 MCH-30.9 MCHC-36.5* RDW-12.8
[**2189-8-16**] 03:15PM   NEUTS-77.5* LYMPHS-16.4* MONOS-4.4 EOS-1.4
BASOS-0.2
[**2189-8-16**] 03:15PM   PLT COUNT-383
[**2189-8-16**] 03:15PM   PT-12.0 PTT-23.4 INR(PT)-0.9

Brief Hospital Course:
60 year old male with DM2, hypercholesterolemia, alchoholism,
HTN, history of CAD, S/P PTCA/PCI of RCA in [**2183**], who presents
with acute STEMI with inferior ST elevations.  The patient
developed chest pain one hour prior to presentation to the ED.
He was taken emergently to cardiac cath. His initial EtOH level
was found to be 13.

Cath Findings:

1. Selective coronary angiography revealed a right-dominant
system.  The
LMCA was angiographically normal.  The LAD had minimal disease.
The LCx
had minimal disease throughout with a ghost of an OM1 with late
filling.
This small vessel cound not be crossed with a wire.  The RCA had
an 80%
mid-RCA lesion after a patent [**Doctor First Name 10788**] stent.
2.  Left ventriculography revealed a normal estimated ejection
fraction.
There were no focal wall motion abnormalities.  There was no
mitral
regurgitation.
3.  Aortography revealed an angiographically normal ascending
aorta with
no evidence for dissection.
4. Hemodynamic assessment revealed a moderately elevated
left-sided
filling pressure (LVEDP 25mmHg).  The right-sided filling
pressures were
moderately elevated (RA mean 14mmHg, PVEDP 17mmHg).  The
calculated
cardiac output was supranormal.
5. Successful direct stenting of the RCA with a 3.0 x 18 mm
Cypher DES.
Final angiogrpahy demonstrated no residual stenosis, no apparent

dissection, and normal flow.

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Normal systolic ventricular function with moderate diastolic
dysfunction.
3. Acute myocardial infarction managed by primary PCI and
placement of a
drug-eluting stent in the RCA.

During the procedure his BP and HR were labile and he had an
episode of Afib which resolved spontaneously. He had a 20 minute
period of altered MS associated with shaking and emesis. A head
CT obtained was negative for a bleed. The stroke team was
consulted and felt that it was secondary to a toxic/metabolic
problem.

A CTA of his neck was also obtained b/c the pt continued to have
CP post cath. It revealed: 1. No evidence of aortic dissection
or dissection extending into the neck vessels. 2. Patchy areas
of opacity within the superior segments of both lower lobes
which could be due to aspiration or early pneumonia.

1. CAD s/p inf MI. His symptoms resolved and he was initially
kept in the CCU for observation. He received post cath hydration
with Na Bicarb. Nitro was avoided secondary to Right sided MI.
He was allowed to diurses on his own. He was placed on [**Doctor First Name **],
plavix, [**Doctor First Name 17339**], B-B, and ACEI. Repeat echo post cath revealed
the left atrium to be moderately dilated. There is mild regional
left ventricular systolic dysfunction (ejection fraction 50%)
with mild hypokinesis of the basal and mid inferior wall. The
right ventricular cavity is mildly dilated. Right ventricular
systolic function appears depressed. The ascending aorta is
moderately dilated. The aortic valve leaflets (3) are mildly
thickened but not stenotic. No aortic regurgitation is seen.
Mild (1+) mitral regurgitation is seen. There is borderline
pulmonary artery systolic hypertension. He was discharged home
with instructions to attend cardiac rehab.

2. Asp pna. He was started on Clinda for 14 days for possible
aspiration pna.

3. Altered MS. Resolved. Likely secondary to EtOH abuse on
antabuse. No evidence of stroke. He did not experience any
symptoms of withdrawal during his stay.

4. Episode of Afib. He was monitored on tele and did not
experience any further episodes of Afib. The arrythemia was felt
to be secondary to ischemia or EtOH abuse, he was not placed on
anti-coagulation.

5. DM2. He was maintained on a regular insulin sliding scale
during his stay. Glucaphage was held secondary to concern for
lactic acidosis, but continued at discharge.


Medications on Admission:
Diovan, Glucaphage, [**Last Name (LF) 17339**], [**First Name3 (LF) **], antabuse

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day) for 30 days.
Disp:*30 Tablet(s)* Refills:*0*
3. Clindamycin HCl 150 mg Capsule Sig: Two (2) Capsule PO Q6H
(every 6 hours) for 14 days: please take until all pills are
gone.
Disp:*96 Capsule(s)* Refills:*0*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Disulfiram 250 mg Tablet Sig: Two (2) Tablet PO QD (once a
day).
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. [**First Name3 (LF) **] 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*2*
9. Metformin HCl 500 mg Tablet Sig: One (1) Tablet PO once a
day.


Discharge Disposition:
Home

Discharge Diagnosis:
Acute MI with stenting to his Right Coronary Artery
Mental Status Changes
HTN
Diabetes


Discharge Condition:
Stable

Discharge Instructions:
Please call your primary care physician or return to the
hospital if you experience chest pain, shortness of breath, or
any other problems.  Avoid driving for 1 week. Avoid strenuous
activity for 2 weeks.

Followup Instructions:
1. Appointment with Dr. [**Last Name (STitle) 2903**] on Friday [**2189-8-21**] at 12:45 pm.
Please set up cardiac rehab at that time.
2. Please call [**Telephone/Fax (1) 62**] to make an outpatient cardiology
appointment at [**Hospital1 18**]. Please discuss with Dr. [**Last Name (STitle) 2903**].


                             [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2139**]
{'Subendocardial infarction, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other and unspecified alcohol dependence, 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: chest pain

PRESENT ILLNESS: 60 yo M with DM2, hypercholesterolemia, alchoholism, HTN, CAD
s/p MI with stent to RCA in '[**83**] with residual EF of 54% ([**12-26**])
who suddenly developed N/V and [**10-4**] pain across Right and Left
chest wall after taking two shots of vodka while on antabuse.
The CP was associated with diaphoresis and lightheadedness. The
pain did not radiate and he never felt SOB. The pain did not
resolve after one hour and he called 911. While on route to the
ED he was given [**Month/Year (2) **], NTG, and morphine. In the ED he received
NTG, lopressor, [**Month/Year (2) **], morphine, heparin, integrilin and taken
emergently to the cath lab.

MEDICAL HISTORY: 1. CAD s/p MI with stent to RCA in '[**83**] with residual EF of 54%
([**12-26**])
2. DM2
3. HTN
4. hypercholesterolemia
5. gout
6. alcoholism on antabuse

MEDICATION ON ADMISSION: Diovan, Glucaphage, [**Last Name (LF) 17339**], [**First Name3 (LF) **], antabuse

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 96, BP 164/73, RR i6, 99% 4L, Wt 228, Ht 5'[**94**]"
gen: smells of EtOH
HEENT: MMM, EOMI, PERRL
neck: JVD 12 cm
CV: RRR, Nl S1S1, No M/R/G
Lungs: CTAB
Abd: obese, distended/NT, pos hepatomegaly, nl BS
Ext: no pedal edema, strong DP pulses

FAMILY HISTORY: Mother died at age 66 from MI, brother had MI at age 52.

SOCIAL HISTORY: Quit tob 20 yrs ago. H/O EtOH abuse, continues to drink
intermittently despite being on antabuse. Married for 31 yrs.
Has 2 children. 

### Response:
{'Subendocardial infarction, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other and unspecified alcohol dependence, unspecified'}
