CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 60 y/o M without significant pmh presented this AM to the [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] with increased frequency and severity of chest pain. Pt
describes a history of increasing chest pain over the last few
weeks, specifically noting that 6 days ago pain increased in
frequency and severity. He describes it as squeezing pressure
located over the sternum which began occurring several times a
day and is associated with shortness of breath. Pain occurs
occasionally at rest as well as with activity. Denies
n/v/diaphoresis/PND/peripheral edema/orthopnea. In [**Name (NI) **] [**Name (NI) **], pt
was found to have ST elevations in the inferior leads, 4mm ST
elevations in II, 5mm elevations in III and aVF. Also with 2mm
depression in I, 3mm depression aVL, 1mm dep in V1, 3mm dep in
V2 2 mm depression V3, 1mm dep v4, V5, 3mm dep in V6. Right
sided leads showed significantly decreased voltage in V4,5,6. Pt
was also noted to be in complete heart block at that time. Pt
was transferred to [**Hospital1 18**] ER where labs showed trop <0.01 and
went to the cath lab where he was found to have single vessel
CAD of the RCA with TIMI 1 flow. proximal 60% and mid 90%
stenosis. balloon to mid lesion, 2 Promus [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 64218**] to
cover diseased segment, afterwards with TIMI 3 flow. During
stenting of the artery pt became bradycardic/hypotensive
(Bezold-Jerisch reflex) and required 1 dose dose of atropine. He
was given aspirin, prasugrel, bivalirudin. ECG at that time
showed NSR at 95bpm, ST changes resolved, now with 1mm q waves
in II, III, aVF, V4/5/6. Pt remained stable afterwards and was
transferred to the CCU.
.
In the CCU on arrival BP 127/79 and HR 74. Pt without
complaints, denied chest pain or SOB, in fact said he felt well.
Pt was in sinus rhythm per tele. Appeared comfortable on 2L NC.
Cath site c/d/i, no evidence of bleeding.
.
Of note, pt had a normal stress test on [**2147-2-8**] in the setting
of having developed chest pain over the last few weeks. Pts
brother had an MI at the age of 60. He reports that he was told
he has "prediabetes" and has a 47 pack year smoking history,
still smoking currently.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for, dyspnea on exertion,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: -? "fistula" repair age 23, pt states he had a "tail"
-prediabetes

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam
VS: T=AF BP=124/79 HR=74 RR=16 O2 sat= 99% on 2L NC
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - Brother with MI age 60
- No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: - Tobacco history: 47 pack year history
- ETOH:  denies
- Illicit drugs: denies
works in auto repair
Subendocardial infarction, initial episode of care,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Tobacco use disorder
Subendo infarct, initial,Atriovent block complete,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Tobacco use disorder
Admission Date:  [**2147-2-13**]              Discharge Date:   [**2147-2-16**]

Date of Birth:  [**2086-6-22**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1145**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization with drug eluting stents to the right
coronary artery


History of Present Illness:
60 y/o M without significant pmh presented this AM to the [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] with increased frequency and severity of chest pain. Pt
describes a history of increasing chest pain over the last few
weeks, specifically noting that 6 days ago pain increased in
frequency and severity. He describes it as squeezing pressure
located over the sternum which began occurring several times a
day and is associated with shortness of breath. Pain occurs
occasionally at rest as well as with activity. Denies
n/v/diaphoresis/PND/peripheral edema/orthopnea. In [**Name (NI) **] [**Name (NI) **], pt
was found to have ST elevations in the inferior leads, 4mm ST
elevations in II, 5mm elevations in III and aVF. Also with 2mm
depression in I, 3mm depression aVL, 1mm dep in V1, 3mm dep in
V2 2 mm depression V3, 1mm dep v4, V5, 3mm dep in V6. Right
sided leads showed significantly decreased voltage in V4,5,6. Pt
was also noted to be in complete heart block at that time. Pt
was transferred to [**Hospital1 18**] ER where labs showed trop <0.01 and
went to the cath lab where he was found to have single vessel
CAD of the RCA with TIMI 1 flow. proximal 60% and mid 90%
stenosis. balloon to mid lesion, 2 Promus [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 64218**] to
cover diseased segment, afterwards with TIMI 3 flow. During
stenting of the artery pt became bradycardic/hypotensive
(Bezold-Jerisch reflex) and required 1 dose dose of atropine. He
was given aspirin, prasugrel, bivalirudin. ECG at that time
showed NSR at 95bpm, ST changes resolved, now with 1mm q waves
in II, III, aVF, V4/5/6. Pt remained stable afterwards and was
transferred to the CCU.
.
In the CCU on arrival BP 127/79 and HR 74. Pt without
complaints, denied chest pain or SOB, in fact said he felt well.
Pt was in sinus rhythm per tele. Appeared comfortable on 2L NC.
Cath site c/d/i, no evidence of bleeding.
.
Of note, pt had a normal stress test on [**2147-2-8**] in the setting
of having developed chest pain over the last few weeks. Pts
brother had an MI at the age of 60. He reports that he was told
he has "prediabetes" and has a 47 pack year smoking history,
still smoking currently.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for, dyspnea on exertion,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

Past Medical History:
-? "fistula" repair age 23, pt states he had a "tail"
-prediabetes

Social History:
- Tobacco history: 47 pack year history
- ETOH:  denies
- Illicit drugs: denies
works in auto repair

Family History:
- Brother with MI age 60
- No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.

Physical Exam:
Admission Exam
VS: T=AF BP=124/79 HR=74 RR=16 O2 sat= 99% on 2L NC
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple without significant JVP.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

Discharge Exam
GENERAL: 60 yo M in no acute distress
HEENT: mucous membs moist, no lymphadenopathy, JVP non elevated

CHEST: CTABL no wheezes, no rales, no rhonchi
CV: S1 S2 Normal in quality and intensity RRR no murmurs rubs or
gallops
ABD: soft, non-tender, non-distended, BS normoactive.
EXT: wwp, no edema. DPs, PTs 2+. right groin with no erythema
and minimal ecchymosis.
NEURO: 5/5 strength in U/L extremities. gait WNL.
SKIN: no rash
PSYCH: A/O, pleasant

Pertinent Results:
[**2147-2-13**] 11:10AM BLOOD WBC-10.9 RBC-4.51* Hgb-14.6 Hct-42.1
MCV-93 MCH-32.4* MCHC-34.8 RDW-12.7 Plt Ct-236
[**2147-2-13**] 05:57PM BLOOD Hct-39.9* Plt Ct-226
[**2147-2-14**] 05:12AM BLOOD WBC-12.3* RBC-4.46* Hgb-14.1 Hct-40.9
MCV-92 MCH-31.6 MCHC-34.5 RDW-13.3 Plt Ct-228
[**2147-2-15**] 06:20AM BLOOD WBC-10.3 RBC-4.49* Hgb-13.8* Hct-40.8
MCV-91 MCH-30.8 MCHC-33.9 RDW-13.4 Plt Ct-222
[**2147-2-16**] 06:35AM BLOOD WBC-10.0 RBC-4.37* Hgb-13.6* Hct-40.3
MCV-92 MCH-31.2 MCHC-33.8 RDW-12.7 Plt Ct-232
[**2147-2-14**] 05:12AM BLOOD Glucose-128* UreaN-13 Creat-0.7 Na-136
K-4.3 Cl-105 HCO3-24 AnGap-11
[**2147-2-15**] 06:20AM BLOOD Glucose-100 UreaN-17 Creat-0.8 Na-142
K-4.2 Cl-107 HCO3-27 AnGap-12
[**2147-2-16**] 06:35AM BLOOD Glucose-100 UreaN-21* Creat-0.9 Na-142
K-4.6 Cl-105 HCO3-30 AnGap-12
[**2147-2-13**] 11:10AM BLOOD cTropnT-<0.01
[**2147-2-13**] 05:57PM BLOOD CK-MB-140* cTropnT-1.81*
[**2147-2-14**] 05:12AM BLOOD CK-MB-95* MB Indx-15.5* cTropnT-1.50*
[**2147-2-13**] 11:10AM BLOOD %HbA1c-5.9 eAG-123
[**2147-2-13**] 11:10AM BLOOD Triglyc-106 HDL-56 CHOL/HD-3.8
LDLcalc-137*

[**2147-2-14**] ECHO
The left atrium is normal in size. The estimated right atrial
pressure is 0-5 mmHg. Left ventricular wall thicknesses are
normal. The left ventricular cavity size is normal. There is
mild regional left ventricular systolic dysfunction with basal
to mid inferior/inferolateral hypokinesis and an EF of 50-55%.
There is no ventricular septal defect. Right ventricular chamber
size and free wall motion are normal. The diameters of aorta at
the sinus, ascending and arch levels are normal. The aortic
valve leaflets (3) are mildly thickened. There is no aortic
valve stenosis. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. The estimated pulmonary artery systolic
pressure is normal. There is no pericardial effusion.

Brief Hospital Course:
60 y/o M no significant past medical history p/w 1wk of chest
pain, found with ECG evidence of STEMI and complete heart block.
DES to RCA at [**Hospital1 18**] cath lab, pt now back in sinus stable in the
CCU.
.
#STEMI - Had EKG with marked ST elevations in the inferior leads
(III>II) and depressions in I/AVL and the precordial leads.  Was
transferred to [**Hospital1 18**] ER where labs showed trop <0.01 and went to
the cath lab where he was found to have single vessel CAD of the
RCA with TIMI 1 flow, a proximal 60% and mid 90% stenosis.
Balloon applied to mid lesion, 2 Promus DES placed overlapping
to cover diseased segment, afterwards with TIMI 3 flow. During
stenting of the artery he became bradycardic/hypotensive
(Bezold-Jerisch reflex) and required 1 dose dose of atropine
transiently. He was given aspirin, prasugrel, bivalirudin. ECG
after stenting showed NSR at 95bpm, ST changes resolved, now
with 1mm q waves in II, III, aVF. Pt remained stable afterwards
and was transferred to the CCU.  In the CCU he had an uneventful
course.  He was started on a beta blocker that was uptitrated
till his heart rate was reliably 60-70 and maintained on ASA,
prasugrel and full dose statin.  He had some focal wall motion
abnormality but his overall ejection fraction was preserved so
an ACE inhibitor was not started.  He remained pain free after
his stent placement and at the time of discharge.
.
# RHYTHM: pt in complete heart block on presentation to OSH due
to AV nodal ischemia from his RCA thrombus.  He presented to the
cath lab in sinus rhythm and maintained it throughout his
hospitalization without any ectopy or further arrhythmia.
.
#h/o prediabetes - A1c 5.9 here.

Medications on Admission:
None

Discharge Medications:
1. prasugrel 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. aspirin 81 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*
4. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*30 Patch 24 hr(s)* Refills:*2*
5. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
1.5 Tablet Extended Release 24 hrs PO DAILY (Daily).
Disp:*45 Tablet Extended Release 24 hr(s)* Refills:*2*
6. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual as directed as needed for chest pain.
Disp:*25 tablets* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
ST Elevation Myocardial Infaction
Complete Heart block
Dyslipidemia


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


Discharge Instructions:
YOu had chest pain and was found to be having a heart attack.
You were transferred to [**Hospital1 18**] for a cardiac catheterization
which showed a blockage in your right coronary artery that was
fixed with two drug eluting stents. You had a slow heart rate
because of the heart attack that has now resolved. An
echocardiogram showed a small area of damage from the heart
attack but your heart remains strong. You will need to take your
new medicines regularly to help your heart recover from the
heart attack and prevent another heart attack. You also need to
stop smoking. This is the most important thing you can do for
your health and your heart.
.
We have started the following medicines:
1. START taking Prasugrel and aspirin every day to prevent the
stents from clotting off. You will need to take these medicines
every day without fail. Do not stop taking these medicines or
miss [**First Name (Titles) 691**] [**Last Name (Titles) 4319**] unless Dr. [**Last Name (STitle) 4469**] tells you it is OK.
2. START taking metoprolol to slow your heart rate and help your
heart recover from the heart attack.
3. START taking atorvastatin to lower your cholesterol.
4. START taking lisinopril at night to lower your blood pressure
and help your heart recover from the heart attack.
5. START using the nicotine patch to help your quit smoking.
6. Take nitroglycerin for any chest pain that is similar to the
chest pain during your heart attack. You can take one tablet
under your tongue, wait 5 minutes, then take another tablet if
you still have chest pain. Call 911 if you still have chest pain
after 2 tablets. Call Dr. [**Last Name (STitle) 4469**] or the Heartline if you are
having any chest pain at all.

Followup Instructions:
**Your demographic and insurance information is incomplete in
our system. Please contact our Registration department at
[**Telephone/Fax (1) 10676**] Monday - Friday between the hours of 7:30AM -
6PM.**
.
Primary Care and Cardiology:
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4469**]
Location: [**Hospital3 **] INTERNAL MEDICINE ASSOCIATES
Address: [**Street Address(2) 4472**], [**Apartment Address(1) 4473**], [**Hospital1 **],[**Numeric Identifier 9331**]
Phone: [**Telephone/Fax (1) 4475**]
Fax: [**Telephone/Fax (1) 29683**]
Dte/Time: Tuesday [**2-28**] at 2:45
.
Department: CARDIAC SERVICES
When: MONDAY [**2147-3-13**] at 3:20 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Subendocardial infarction, initial episode of care,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,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: chest pain

PRESENT ILLNESS: 60 y/o M without significant pmh presented this AM to the [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] with increased frequency and severity of chest pain. Pt
describes a history of increasing chest pain over the last few
weeks, specifically noting that 6 days ago pain increased in
frequency and severity. He describes it as squeezing pressure
located over the sternum which began occurring several times a
day and is associated with shortness of breath. Pain occurs
occasionally at rest as well as with activity. Denies
n/v/diaphoresis/PND/peripheral edema/orthopnea. In [**Name (NI) **] [**Name (NI) **], pt
was found to have ST elevations in the inferior leads, 4mm ST
elevations in II, 5mm elevations in III and aVF. Also with 2mm
depression in I, 3mm depression aVL, 1mm dep in V1, 3mm dep in
V2 2 mm depression V3, 1mm dep v4, V5, 3mm dep in V6. Right
sided leads showed significantly decreased voltage in V4,5,6. Pt
was also noted to be in complete heart block at that time. Pt
was transferred to [**Hospital1 18**] ER where labs showed trop <0.01 and
went to the cath lab where he was found to have single vessel
CAD of the RCA with TIMI 1 flow. proximal 60% and mid 90%
stenosis. balloon to mid lesion, 2 Promus [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 64218**] to
cover diseased segment, afterwards with TIMI 3 flow. During
stenting of the artery pt became bradycardic/hypotensive
(Bezold-Jerisch reflex) and required 1 dose dose of atropine. He
was given aspirin, prasugrel, bivalirudin. ECG at that time
showed NSR at 95bpm, ST changes resolved, now with 1mm q waves
in II, III, aVF, V4/5/6. Pt remained stable afterwards and was
transferred to the CCU.
.
In the CCU on arrival BP 127/79 and HR 74. Pt without
complaints, denied chest pain or SOB, in fact said he felt well.
Pt was in sinus rhythm per tele. Appeared comfortable on 2L NC.
Cath site c/d/i, no evidence of bleeding.
.
Of note, pt had a normal stress test on [**2147-2-8**] in the setting
of having developed chest pain over the last few weeks. Pts
brother had an MI at the age of 60. He reports that he was told
he has "prediabetes" and has a 47 pack year smoking history,
still smoking currently.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
Cardiac review of systems is notable for, dyspnea on exertion,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.

MEDICAL HISTORY: -? "fistula" repair age 23, pt states he had a "tail"
-prediabetes

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Exam
VS: T=AF BP=124/79 HR=74 RR=16 O2 sat= 99% on 2L NC
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - Brother with MI age 60
- No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: - Tobacco history: 47 pack year history
- ETOH:  denies
- Illicit drugs: denies
works in auto repair 

### Response:
{'Subendocardial infarction, initial episode of care,Atrioventricular block, complete,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Tobacco use disorder'}
