CHIEF COMPLAINT: chest pressure, s/p LAD stent placement

PRESENT ILLNESS: 86 yo F with h/o HTN, CAD s/p Lcx stent [**2093**] after MI, CKD
baseline Cr 1.8-2 presented initially to [**Hospital3 19345**] on [**1-6**] with chest pain.  She had chest pressure
intermittently with exertion for several weeks prior, worsening
in the 4 days prior to admission with shortness of breath as
well.  Day of admission, had chest pain at rest with shortness
of breath so presented to LGH ER.  In the ER, she experienced
cardiopulmonary arrest with asystole, improved with atropine and
CPR.  Was intubated and in ICU from [**Date range (1) 9396**], and ruled in
for NQWMI, with trop 2.15, CPK 63, EKG suggestive of anterior
MI.  BNP was 2718, was diuresed with IV lasix.  Initially INR
was elevated, which delayed cath.  Cath was done prior to
arrival today, [**1-15**], which showed total occlusion of LAD,
patent LCx stent and RCA with 70-80% stenosis.  She was
transferred here for LAD intervention.
.
At cath lab, got BMS in LAD with proximal dissection, stented
again with overlapping BMS.  On arrival to floor, sheath remains
in place in R femoral.  She has no chest pain, shortness of
breath, nausea or other complaints.
.
On review of systems, s/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. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  LCx stent [**2093**], s/p MI
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
-CAD s/p MI in [**2093**] PTCA/stent to LCX in [**2093**]. Repeat cath in
[**2095**] showed patent stent, rca small, 95% small diagonal.
-diabetes with peripheral neuropathy and nephropathy
-atrial arrythmia on coumadin
-pneumonia in the past
-temporal arteritis
-s/p CCY
-dCHF with EF 60% in [**2100**]

MEDICATION ON ADMISSION: Aspirin 325 mg daily
Plavix 75 mg daily (started at OSH)
Metoprolol 100 mg [**Hospital1 **]
Warfarin 1 mg daily
Doxazosin 1 mg [**Hospital1 **]
Zetia 10 mg daily
Procrit as directed
Lasix 20 mg daily
Lantus 35-40 units QHS
Novolog SSI TID
Simvastatin 20 mg daily
Calcium 500 mg [**Hospital1 **]
Ferrous sulfate 150 mg daily

ALLERGIES: Protonix

PHYSICAL EXAM: On admission:
VS: 86 100/61 99% 2L
GENERAL: WDWN F in 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: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history:  denies
-ETOH:  denies
-Illicit drugs: denies
Subendocardial infarction, initial episode of care,Acute on chronic combined systolic and diastolic heart failure,Atrial flutter,Acidosis,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiogenic shock,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Long-term (current) use of anticoagulants,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Personal history of sudden cardiac arrest,Polyneuropathy in diabetes,Examination of participant in clinical trial,Anemia in chronic kidney disease
Subendo infarct, initial,Ac/chr syst/dia hrt fail,Atrial flutter,Acidosis,Crnry athrscl natve vssl,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Cardiogenic shock,Hyperlipidemia NEC/NOS,Status-post ptca,Old myocardial infarct,Long-term use anticoagul,DMII neuro nt st uncntrl,Nephritis NOS in oth dis,Hx sudden cardiac arrest,Neuropathy in diabetes,Exam-clincal trial,Anemia in chr kidney dis
Admission Date:  [**2103-1-15**]              Discharge Date:   [**2103-1-18**]


Service: MEDICINE

Allergies:
Protonix

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
chest pressure, s/p LAD stent placement

Major Surgical or Invasive Procedure:
cardiac catheterization with BMS x 2 placed in LAD

History of Present Illness:
86 yo F with h/o HTN, CAD s/p Lcx stent [**2093**] after MI, CKD
baseline Cr 1.8-2 presented initially to [**Hospital3 19345**] on [**1-6**] with chest pain.  She had chest pressure
intermittently with exertion for several weeks prior, worsening
in the 4 days prior to admission with shortness of breath as
well.  Day of admission, had chest pain at rest with shortness
of breath so presented to LGH ER.  In the ER, she experienced
cardiopulmonary arrest with asystole, improved with atropine and
CPR.  Was intubated and in ICU from [**Date range (1) 9396**], and ruled in
for NQWMI, with trop 2.15, CPK 63, EKG suggestive of anterior
MI.  BNP was 2718, was diuresed with IV lasix.  Initially INR
was elevated, which delayed cath.  Cath was done prior to
arrival today, [**1-15**], which showed total occlusion of LAD,
patent LCx stent and RCA with 70-80% stenosis.  She was
transferred here for LAD intervention.
.
At cath lab, got BMS in LAD with proximal dissection, stented
again with overlapping BMS.  On arrival to floor, sheath remains
in place in R femoral.  She has no chest pain, shortness of
breath, nausea or other complaints.
.
On review of systems, s/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. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.


Past Medical History:
1. CARDIAC RISK FACTORS: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  LCx stent [**2093**], s/p MI
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
-CAD s/p MI in [**2093**] PTCA/stent to LCX in [**2093**]. Repeat cath in
[**2095**] showed patent stent, rca small, 95% small diagonal.
-diabetes with peripheral neuropathy and nephropathy
-atrial arrythmia on coumadin
-pneumonia in the past
-temporal arteritis
-s/p CCY
-dCHF with EF 60% in [**2100**]

Social History:
-Tobacco history:  denies
-ETOH:  denies
-Illicit drugs: denies

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

Physical Exam:
On admission:
VS: 86 100/61 99% 2L
GENERAL: WDWN F in 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 with JVP of 5 cm.
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. Decreased breath sounds
at bases, no wheezes
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: + stasis dermatitis LLE, no ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+  DP dopplerable PT 1+
Left: Carotid 2+ Femoral 2+ DP dopplerable PT 1+

Pertinent Results:
[**2103-1-15**] 11:50PM   SODIUM-136 POTASSIUM-3.4 CHLORIDE-89*
[**2103-1-15**] 11:50PM   CK(CPK)-120
[**2103-1-15**] 11:50PM   CK-MB-6 cTropnT-1.19*
[**2103-1-15**] 11:50PM   PLT COUNT-249
[**2103-1-15**] 07:45PM   GLUCOSE-157* UREA N-73* CREAT-2.4* SODIUM-138
POTASSIUM-3.8 CHLORIDE-90* TOTAL CO2-29 ANION GAP-23*
[**2103-1-15**] 07:45PM   CALCIUM-9.2 PHOSPHATE-6.1* MAGNESIUM-1.5*
[**2103-1-15**] 07:45PM   WBC-9.8 RBC-4.06* HGB-11.5* HCT-35.1* MCV-87
MCH-28.4 MCHC-32.9 RDW-16.7*

Cardiac Cath [**1-15**]:
COMMENTS:
1. Limited coronary angiography of this right dominant system
revealed
one vessel coronary artery disease. The LMCA had no
angiographically
apparent disease. The LAD had a 99% proximal stenosis. The Lcx
had minor
luminal irregularities with a patent stent. The RCA was not
engaged and
known to have a 70% stenosis from prior angiography.
2. Limited hemodynamics revealed normal central pressure of
121/74 mmHg.
3. Successful PTCA and stenting of proximal LAD with overlapping

2.5x18mm Integrity bare metal stent (more distal) and 2.5x12mm
Integrity
bare metal stent (more proximally).

FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Normal blood pressure.
3. Successful PCI of proximal LAD with two overlapping BMS.
4. ASA indefinitely, Plavix 2-4 weeks.


Brief Hospital Course:
86 yo F with h/o HTN, CAD s/p Lcx stent [**2093**] after MI, CKD
baseline Cr 2.4 presented initially to [**Hospital6 3105**]
on [**1-6**] with chest pain, s/p cardiac arrest and asystole
resucitated after CPR and atropine. Now s/p cath with BMS x2 for
99% LAD occlusion.

# CARDIAC ARREST: During cardioversion, Ms. [**Known lastname **] went into
asystole, she was resuscitated and transferred to the CCU. She
was intubated and she had a temporary pacer placed, and was
started on pressor support for blood pressure maintenance.  On
the morning of [**2103-1-18**], her blood pressure dropped to the
50s/30s, and required triple pressors to increase blood
pressure. She had been following commands that morning, and
moving all extremities (6am). Shortly after (8-9am) she was
noted to have hemiparesis and an upgoing toe, likely secondary
to a new stroke. She was being anticoagulated throughout the
event, so thrombotic stroke was less likely, and it was thought
to possibly be due to watershed infarct in the setting of the
severe hypotension. Her family was called, and her status was
discussed with her HCP. She was made DNR/DNI (she had been
DNR/DNI, and reversed for the cardioversion), and the decision
was made to terminally extubate. She expired in the early
afternoon on [**2103-1-18**].

THE REST OF THE ADMISSION WAS AS BELOW.

# CORONARIES:  At OSH, LAD occlusion of 99% was noted and she
was transferred here for intervention.  BMX x 2 were placed in
LAD.  Cardiac enzymes were trending down on arrival and patient
had no complaints of chest pain, shortness of breaht, or anginal
type sx.  Home aspirin metoprolol, and simvastatin were
continued, along with plavix which was started at [**Hospital3 12748**].  She will cont these meds as outpatient and
f/u with her outpatient cardiologist, Dr. [**Last Name (STitle) 29070**].

# PUMP:  Pt has h/o diastolic CHF with EF 60% per OSH records,
and was on lasix at home.  On [**1-8**], f/u TTE was done at
[**Hospital3 **] that showed decreased EF to 30% and
anteroapical hypokinesis.  On initial exam, she had lower ext
edema and decreased breath sounds at bases.  Was diuresed with
IV lasix initially, then was transitioned to <<<<<<<<>>>>>>>.
ACE or [**Last Name (un) **] was considered to optimize CHF regimen, but pt with
[**Last Name (un) **] and discussion with PCP revealed that [**Name9 (PRE) **] had been tried
in the past but was stopped because of hyperkalemia.  Instead,
isosorbide dinitrate and hydralazine were started.  As they were
well tolerated, isosorbide mononitrate instead of dinitrate was
started because of once a day dosing.

# RHYTHM:  Has a h/o afib on coumadin at home, with rate control
with metoprolol 100 mg [**Hospital1 **].  EKG showed RBBB and LAFB,
alternating with IVCD without RBBB so EP was consulted.
Recommended TEE cardioversion and starting amiodarone, baseilne
TSH nl and AST/ALT slightly elevated but trending downwards.
Coumadin had been held at OSH and was restarted along wtih a
heparin gtt, for her high risk of clot in the setting of afib
with apical wall motion anormality.
During TEE cardioversion, on [**1-17**], pt went into asystole, was
resuscitated and transferred to CCU

# DM: continued home glargine and SSI

# HTN: Home doxazosin was discontinued and instead isosorbide
mononitrate and hydralazine were started, as described above.

# HLD: continued statin

# Anemia: procrit as outpatient

# Acute on chronic renal disease: baseline Cr 1.8-2, now with Cr
of 2.4 on transfer from OSH.  Likely [**2-28**] diuresis at OSH, and
also had two caths in one day.

Medications on Admission:
Aspirin 325 mg daily
Plavix 75 mg daily (started at OSH)
Metoprolol 100 mg [**Hospital1 **]
Warfarin 1 mg daily
Doxazosin 1 mg [**Hospital1 **]
Zetia 10 mg daily
Procrit as directed
Lasix 20 mg daily
Lantus 35-40 units QHS
Novolog SSI TID
Simvastatin 20 mg daily
Calcium 500 mg [**Hospital1 **]
Ferrous sulfate 150 mg daily

Discharge Medications:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO BID (2 times a day).
4. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
5. gabapentin 100 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
6. warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
7. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. insulin glargine 100 unit/mL Solution Sig: Thirty Five (35)
Subcutaneous at bedtime.
9. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
10. hydralazine 25 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
11. isosorbide dinitrate 10 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
12. senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

13. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
14. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain.
15. ferrous sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).


Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired


Completed by:[**2103-1-22**]
{'Subendocardial infarction, initial episode of care,Acute on chronic combined systolic and diastolic heart failure,Atrial flutter,Acidosis,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiogenic shock,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Long-term (current) use of anticoagulants,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Personal history of sudden cardiac arrest,Polyneuropathy in diabetes,Examination of participant in clinical trial,Anemia in chronic kidney disease'}


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 pressure, s/p LAD stent placement

PRESENT ILLNESS: 86 yo F with h/o HTN, CAD s/p Lcx stent [**2093**] after MI, CKD
baseline Cr 1.8-2 presented initially to [**Hospital3 19345**] on [**1-6**] with chest pain.  She had chest pressure
intermittently with exertion for several weeks prior, worsening
in the 4 days prior to admission with shortness of breath as
well.  Day of admission, had chest pain at rest with shortness
of breath so presented to LGH ER.  In the ER, she experienced
cardiopulmonary arrest with asystole, improved with atropine and
CPR.  Was intubated and in ICU from [**Date range (1) 9396**], and ruled in
for NQWMI, with trop 2.15, CPK 63, EKG suggestive of anterior
MI.  BNP was 2718, was diuresed with IV lasix.  Initially INR
was elevated, which delayed cath.  Cath was done prior to
arrival today, [**1-15**], which showed total occlusion of LAD,
patent LCx stent and RCA with 70-80% stenosis.  She was
transferred here for LAD intervention.
.
At cath lab, got BMS in LAD with proximal dissection, stented
again with overlapping BMS.  On arrival to floor, sheath remains
in place in R femoral.  She has no chest pain, shortness of
breath, nausea or other complaints.
.
On review of systems, s/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. S/he denies recent fevers, chills or
rigors. S/he denies exertional buttock or calf pain. All of the
other review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
-CABG:  none
-PERCUTANEOUS CORONARY INTERVENTIONS:  LCx stent [**2093**], s/p MI
-PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
-CAD s/p MI in [**2093**] PTCA/stent to LCX in [**2093**]. Repeat cath in
[**2095**] showed patent stent, rca small, 95% small diagonal.
-diabetes with peripheral neuropathy and nephropathy
-atrial arrythmia on coumadin
-pneumonia in the past
-temporal arteritis
-s/p CCY
-dCHF with EF 60% in [**2100**]

MEDICATION ON ADMISSION: Aspirin 325 mg daily
Plavix 75 mg daily (started at OSH)
Metoprolol 100 mg [**Hospital1 **]
Warfarin 1 mg daily
Doxazosin 1 mg [**Hospital1 **]
Zetia 10 mg daily
Procrit as directed
Lasix 20 mg daily
Lantus 35-40 units QHS
Novolog SSI TID
Simvastatin 20 mg daily
Calcium 500 mg [**Hospital1 **]
Ferrous sulfate 150 mg daily

ALLERGIES: Protonix

PHYSICAL EXAM: On admission:
VS: 86 100/61 99% 2L
GENERAL: WDWN F in 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: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Tobacco history:  denies
-ETOH:  denies
-Illicit drugs: denies 

### Response:
{'Subendocardial infarction, initial episode of care,Acute on chronic combined systolic and diastolic heart failure,Atrial flutter,Acidosis,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Cardiogenic shock,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Long-term (current) use of anticoagulants,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Personal history of sudden cardiac arrest,Polyneuropathy in diabetes,Examination of participant in clinical trial,Anemia in chronic kidney disease'}
