CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: Patient is a 65 yo male Gastroenterologist with h/o HTN,
hypercholesterolemia, former smoker, and GERD who presents with
chest pain. Two days PTA developed stuttering substernal chest
'pressure' with nausea that he attributed to longstanding GERD.
Denies radiation or associated SOB, diaphoresis. At 7pm the day
PTA, the pain became constant and he presented to the OSH for
evaluation.

MEDICAL HISTORY: 1)HTN
2)Hypercholesterolemia
3)tobacco abuse
4)GERD
5)Gout
6)BPH

MEDICATION ON ADMISSION: Atenolol 25mg [**Hospital1 **]
Zocor 20mg qd
Hytrin 5mg qd
Omeprazole 20mg qd
Allopurinol 300mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals T 97.4 HR 70 BP 128/72 RR 14 SaO2 97% RA
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD
Cardiac: RRR, s1s2 normal, no m/r/g, no JVD
Pulmonary: CTAB
Abdomen: +BS, soft, nontender, nondistended, no HSM
Extremities: warm, 2+ DP pulses, no edema
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities

FAMILY HISTORY: MI in brother (50's) and father (40's)

SOCIAL HISTORY: Retired gasterenterologist. Former smoker. Occ EtOH. No IVDA.
Acute myocardial infarction of other inferior wall, initial episode of care,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Esophageal reflux
AMI inferior wall, init,Surg compl-heart,Crnry athrscl natve vssl,Cardiac dysrhythmias NEC,Hypertension NOS,Esophageal reflux
Admission Date:  [**2199-10-16**]              Discharge Date:   [**2199-10-18**]

Date of Birth:  [**2134-5-3**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 11495**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization

History of Present Illness:
Patient is a 65 yo male Gastroenterologist with h/o HTN,
hypercholesterolemia, former smoker, and GERD who presents with
chest pain. Two days PTA developed stuttering substernal chest
'pressure' with nausea that he attributed to longstanding GERD.
Denies radiation or associated SOB, diaphoresis. At 7pm the day
PTA, the pain became constant and he presented to the OSH for
evaluation.

At OSH, ECG revealed ST elevations in III & AVf with ST
depressions in AVl & V3-V6 concerning for ACS. Cardiac enzymes
were elevated (CK 524, MB 45, TnI 2.8). He was given ASA 325mg,
Plavix 600mg load, and heparin/integrillin/nitro gtt's and
transferred to [**Hospital1 18**] for cardiac catheterization.

Cardiac catheterization revealed totally occluded RCA with
thrombus and 90% proximal LAD lesion. Thrombectomy was attempted
but aborted as clot nearly dislodged during extraction. Angiojet
was performed with distal embolization of the thrombus which was
then stented with a cypher. Final recanalization revealed TIMI 3
flow with distal PDA cutoff likely due to thrombus.

Of note, during the cath the patient was in sinus bradycardia
and briefly developed junctional escape rhythm in the 30's
requiring atropine. He is transferred to the CCU for close
monitoring for heart block in the setting of STEMI and
complicated cath.

ROS: Reports exercise (3 miles walking without CP, SOB). Denies
orthopnea, PND, edema. Has had h/o palpitations that resolved
with BB.

Past Medical History:
1)HTN
2)Hypercholesterolemia
3)tobacco abuse
4)GERD
5)Gout
6)BPH

Social History:
Retired gasterenterologist. Former smoker. Occ EtOH. No IVDA.

Family History:
MI in brother (50's) and father (40's)

Physical Exam:
vitals T 97.4 HR 70 BP 128/72 RR 14 SaO2 97% RA
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD
Cardiac: RRR, s1s2 normal, no m/r/g, no JVD
Pulmonary: CTAB
Abdomen: +BS, soft, nontender, nondistended, no HSM
Extremities: warm, 2+ DP pulses, no edema
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities


Pertinent Results:
Laboratory Results:
[**2199-10-16**] 11:20AM   GLUCOSE-146* UREA N-15 CREAT-0.9 SODIUM-134
POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-21* ANION GAP-12
[**2199-10-16**] 11:20AM   CK(CPK)-715*
[**2199-10-16**] 11:20AM   CK-MB-71* MB INDX-9.9* cTropnT-0.61*
[**2199-10-16**] 11:20AM   CHOLEST-140
[**2199-10-16**] 11:20AM   TRIGLYCER-60 HDL CHOL-58 CHOL/HDL-2.4
LDL(CALC)-70
[**2199-10-16**] 01:20PM   PLT COUNT-209
[**2199-10-16**] 05:55PM   CK-MB-85* MB INDX-7.4* cTropnT-1.93*
[**2199-10-16**] 05:55PM   CK(CPK)-1142*
[**2199-10-16**] 05:55PM   POTASSIUM-3.7
[**2199-10-17**] 05:23AM BLOOD WBC-6.6 RBC-3.76* Hgb-11.8* Hct-34.5*
MCV-92 MCH-31.5 MCHC-34.3 RDW-14.5 Plt Ct-191
[**2199-10-18**] 05:25AM BLOOD WBC-7.7 RBC-3.77* Hgb-12.0* Hct-34.4*
MCV-91 MCH-31.8 MCHC-34.8 RDW-14.8 Plt Ct-169
[**2199-10-18**] 05:25AM BLOOD Plt Ct-169
[**2199-10-18**] 05:25AM BLOOD Glucose-94 UreaN-12 Creat-1.1 Na-141
K-3.5 Cl-104 HCO3-30 AnGap-11
[**2199-10-18**] 05:25AM BLOOD CK(CPK)-291*
[**2199-10-18**] 05:25AM BLOOD CK-MB-9 cTropnT-1.78*
[**2199-10-18**] 05:25AM BLOOD Calcium-8.4 Phos-3.7 Mg-1.9

Relevant Imaging:
1)Cardiac catheterization ([**10-16**]): Two vessel coronary artery
disease. Successful PTCA, thrombectomy, and stenting of the mid
RCA with a
drug eluting stent. 3. Plan PCI of the LAD in [**3-28**] weeks.

2)ECHO ([**10-17**]):The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy with normal cavity size
and systolic function (LVEF>55%). Regional left ventricular wall
motion is normal. Right ventricular chamber size and free wall
motion are normal. The aortic root, ascending aorta, and the
aortic arch are mildly dilated. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. No
aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no mitral valve prolapse. The estimated pulmonary artery
systolic pressure is normal. There is a small pericardial
effusion.


Brief Hospital Course:
Mr. [**Known lastname 12933**] is a 65 yo male with HTN, hypercholesterolemia, former
smoker who presents with STEMI s/p DES to RCA. Found to have
sinus bradycardia with occasional junctional escape rhythm.
Transferred to CCU for close monitoring.

1) STEMI: Patient presented with substernal chest pressure with
new EKG changes and elevated cardiac enzymes consistent with an
STEMI. He was given ASA & Plavix and started on an Integrillin
gtt. He underwent cardiac catheterization, now s/p PCI of RCA
with DES. He has a residual 90% LAD lesion that was not
intervened upon on this admission. He was initially transferred
to the CCU for closer monitoring. His medical regimen was
optimized with ASA, Plavix, Lipitor, Lopressor, and Lisinopril.
He was noted to be in sinus bradycardia with occasional
juntional escape rhythm on telemetry. He was asymptomatic and
there was no evidence of AV block. Post cath ECHO showed
preserved EF. Patient will return in 1 month for repeat PCI of
LAD lesion.

2)Hypertension: Patient on Atenolol at home. This was changed to
Lopressor after cath; tolerated well.

3)Hyperlipidemia: Patient on Zocor at home. This was changed to
high-dose Atorvastatin given acute coronary syndrome.

4)GERD: Continued on PPI.

5)Gout: Continued on home regimen of Allopurinol. Remained
asymptomatic.

6)BPH: Continued on Hytrin.

Medications on Admission:
Atenolol 25mg [**Hospital1 **]
Zocor 20mg qd
Hytrin 5mg qd
Omeprazole 20mg qd
Allopurinol 300mg qd

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. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Terazosin 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
8. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Inferior STEMI, with thrombus in RCA and PDA
2. Residual CAD: 90% proximal LAD stenosis


Discharge Condition:
Hemodynamically stable


Discharge Instructions:
1)Please continue to take all your medications as prescribed.

2)Please scheduled follow up with your cardiologist at
[**Hospital1 **].

3)If you develop chest pain, shortness of breath, a slow heart
rate, dizziness, lightheadedness, bleeding or any other
concerning symptoms, please call 911 and go to the nearest
Emergency Room immediately.

4)Of note, you have been started on several new medications,
including some that make your blood thin and predispose to
bleeding, and some that lower your heart rate and blood
pressure.  If you develop any side effects from these new
medications, please contact your doctor immediately.

Followup Instructions:
Please call to set up a follow up appointment with your
cardiologist for the week after your discharge.

You still have a 90% lesion in your proximal left anterior
descending (LAD) coronary artery which may need an intervention
in the near future.  Please discuss this further with your
cardiologist.
{'Acute myocardial infarction of other inferior wall, initial episode of care,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Esophageal reflux'}


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: Patient is a 65 yo male Gastroenterologist with h/o HTN,
hypercholesterolemia, former smoker, and GERD who presents with
chest pain. Two days PTA developed stuttering substernal chest
'pressure' with nausea that he attributed to longstanding GERD.
Denies radiation or associated SOB, diaphoresis. At 7pm the day
PTA, the pain became constant and he presented to the OSH for
evaluation.

MEDICAL HISTORY: 1)HTN
2)Hypercholesterolemia
3)tobacco abuse
4)GERD
5)Gout
6)BPH

MEDICATION ON ADMISSION: Atenolol 25mg [**Hospital1 **]
Zocor 20mg qd
Hytrin 5mg qd
Omeprazole 20mg qd
Allopurinol 300mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals T 97.4 HR 70 BP 128/72 RR 14 SaO2 97% RA
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD
Cardiac: RRR, s1s2 normal, no m/r/g, no JVD
Pulmonary: CTAB
Abdomen: +BS, soft, nontender, nondistended, no HSM
Extremities: warm, 2+ DP pulses, no edema
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities

FAMILY HISTORY: MI in brother (50's) and father (40's)

SOCIAL HISTORY: Retired gasterenterologist. Former smoker. Occ EtOH. No IVDA. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Esophageal reflux'}
