CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 76 year-old
female with hypertension and hyperlipidemia who presents with
acute inferoposterior myocardial infarction.  The patient
reports she has had stuttering chest pain for the past two
weeks but was constant since 8 P.M. on the day of admission.
The patient reports that the pain was in her left arm and was
associated with diaphoresis.  The patient went to [**Hospital3 418**] Emergency Room where an EKG showed 2 to [**Street Address(2) 2051**]
elevations in 2, 3 and F and posterior ST elevations.
Patient was noted to be bradycardic to the 40s, was given
Atropine with rate to the 90s.  Patient was also given
aspirin, heparin and a 2B3A. Patient was pain free on
transfer.  Cardiac catheterization at [**Hospital3 **] revealed
single vessel disease.  A stent to the RCA was attempted but
they were unable to cross the RCA lesion and the procedure
was aborted.  The ST elevations persisted but the patient
remained pain-free.

MEDICAL HISTORY: 1) Total abdominal hysterectomy.  2)
Status post appendectomy.  3) Mastoid surgery.  4)
Hypertension.  5) Hypercholesterolemia.

MEDICATION ON ADMISSION: Lescol XL 40 q day.  No known drug
allergies.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has three daughters and one son.
She currently smokes [**1-26**] pack per day for the past 50 years.
Denies alcohol and denies drug use.
Acute myocardial infarction of inferoposterior wall, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Peripheral vascular complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified,Pure hypercholesterolemia,Unspecified disorder of kidney and ureter,Tobacco use disorder
AMI inferopost, initial,Accidental op laceration,Surg comp-peri vasc syst,Crnry athrscl natve vssl,Hypertension NOS,Anemia NOS,Pure hypercholesterolem,Renal & ureteral dis NOS,Tobacco use disorder
Admission Date:  [**2120-5-23**]       Discharge Date:  [**2120-5-26**]

Date of Birth:   [**2043-7-14**]       Sex:  F

Service:  Cardiac Care Unit

HISTORY OF PRESENT ILLNESS:  The patient is a 76 year-old
female with hypertension and hyperlipidemia who presents with
acute inferoposterior myocardial infarction.  The patient
reports she has had stuttering chest pain for the past two
weeks but was constant since 8 P.M. on the day of admission.
The patient reports that the pain was in her left arm and was
associated with diaphoresis.  The patient went to [**Hospital3 418**] Emergency Room where an EKG showed 2 to [**Street Address(2) 2051**]
elevations in 2, 3 and F and posterior ST elevations.
Patient was noted to be bradycardic to the 40s, was given
Atropine with rate to the 90s.  Patient was also given
aspirin, heparin and a 2B3A. Patient was pain free on
transfer.  Cardiac catheterization at [**Hospital3 **] revealed
single vessel disease.  A stent to the RCA was attempted but
they were unable to cross the RCA lesion and the procedure
was aborted.  The ST elevations persisted but the patient
remained pain-free.

REVIEW OF SYSTEMS:  The patient denied dyspnea on exertion,
denied paroxysmal nocturnal dyspnea or orthopnea.  She had
reported chest pain as previously described.  Patient also
reported any syncopal or presyncopal episodes. Patient
reported past medical history of hypercholesterolemia and
hypertension but no other known coronary artery disease.

PAST MEDICAL HISTORY:  1) Total abdominal hysterectomy.  2)
Status post appendectomy.  3) Mastoid surgery.  4)
Hypertension.  5) Hypercholesterolemia.

SOCIAL HISTORY:  The patient has three daughters and one son.
She currently smokes [**1-26**] pack per day for the past 50 years.
Denies alcohol and denies drug use.

MEDICATIONS ON ADMISSION:  Lescol XL 40 q day.  No known drug
allergies.

PHYSICAL EXAMINATION:  On admission the patient was afebrile,
blood pressure 190/106, heart rate in the 80s, respirations
16.  She was a well appearing female in no acute distress.
Her cardiac examination was regular rhythm with no murmurs.
There was an S4 but no rubs.  The lungs were clear to
auscultation.  Her abdomen was soft, nontender, nondistended.
There was no lower extremity edema and her pulses were intact
bilaterally.

An EKG on presentation was normal sinus rhythm at 92, ST
elevations in 2, 3 and F with elevations in 3 greater than 2.
She had ST depressions in 1, L and V1 through V4.  Post
cardiac catheterization she had persistent ST elevations.

LABORATORY VALUES ON ADMISSION:  White count 9.9, hematocrit
32, platelets are 214, INR 1.0.  Chem-7: sodium 140, K of
3.6, chloride 105, bicarb 24, BUN 27, creatinine 1.2.  Chest
x-ray at the outside hospital revealed a calcified aorta, no
evidence of congestive heart failure.  It did show a hiatal
hernia.

SUMMARY OF HOSPITAL COURSE:
1.  Cardiac, coronary artery disease:  The patient had an
inferoposterior myocardial infarction with ST elevations.
She was brought to the catheterization laboratory but there
was an unsuccessful attempt at revascularization of the RCA.
The patient had persistent ST elevations post cardiac
catheterization.  Also at cardiac catheterization she was
found to have a PA pressure of 20/7.  Cardiac output was 4.9,
cardiac index 2.6.  She had a wedge of 7.  The patient was
given aspirin and a statin.  She was also started on
aggressive beta blockade and this was increased as tolerated.
She was initially started on an ACE inhibitor.  However, she
had a rising creatinine at the time during the
hospitalization and therefore the ACE inhibitor was held at
the time of discharge.  Patient had no residual lesions, no
LAD or left circumflex lesions and the patient will follow up
with Dr. [**Last Name (STitle) 284**] for her cardiology care.

2.  Blood pressure:  The patient was very hypertensive on
admission.  She was started on a nitro drip at 4 mcg per
kilogram per minute.  The patient was given intravenous
Lopressor as well as p.o. Lopressor and the nitroglycerine
was successfully titrated off.  The patient's blood pressure
was well controlled on her beta blocker.

3.  Vascular:  The patient was noted to have a bruit over her
right groin after the cardiac catheterization.  Femoral
ultrasound revealed a small common femoral AV fistula on the
right.  Vascular surgery was consulted.  Per their report the
patient will follow up in six weeks time for a repeat
ultrasound and will follow up with Dr. [**Last Name (STitle) 43230**] for further
monitoring.

4.  Anemia:  The patient has a baseline anemia with a
hematocrit on admission of 31.  Her iron studies reveal
anemia of chronic disease.  The patient's hematocrit dropped
to 26 on [**5-24**] for an unclear reason.  The patient was
given 2 units of packed red blood cells with appropriate
bumps.  She had no evidence for active bleeding.  Patient's
hematocrit bumped appropriately and should be further
monitored as an outpatient.

5.  Chronic renal insufficiency:  The patient had an elevated
creatinine to 1.5 on the day of discharge.  This was likely
due to a component of dehydration as well as post cardiac
catheterization after receiving [**Male First Name (un) **].  The patient was given a
500 cc bolus and her creatinine decreased to 1.4 just prior
to discharge.  The patient will follow up with her primary
care physician in the week following discharge for further
monitoring of her hematocrit as well as her creatinine.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:
ST elevation myocardial infarction.
Total occlusion of RCA.
Anemia.
AV femoral fistula.

DISCHARGE MEDICATIONS:  Aspirin 325 q day, Atorvastatin 80 q
day, Toprol XL 150 q day, Ambien p.r.n..

FOLLOW UP PLANS:  Patient will follow up with her primary
care physician in the week following discharge for further
monitoring of her hematocrit as well as her renal function.
The patient will follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 284**] in
four weeks time for cardiology follow up.  The patient will
also follow up with vascular surgery with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in
six weeks times.






                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5214**]

Dictated By:[**Name8 (MD) 12502**]
MEDQUIST36

D:  [**2120-5-26**]  17:30
T:  [**2120-5-28**]  07:51
JOB#:  [**Job Number 55969**]
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Peripheral vascular complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified,Pure hypercholesterolemia,Unspecified disorder of kidney and ureter,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: 

PRESENT ILLNESS: The patient is a 76 year-old
female with hypertension and hyperlipidemia who presents with
acute inferoposterior myocardial infarction.  The patient
reports she has had stuttering chest pain for the past two
weeks but was constant since 8 P.M. on the day of admission.
The patient reports that the pain was in her left arm and was
associated with diaphoresis.  The patient went to [**Hospital3 418**] Emergency Room where an EKG showed 2 to [**Street Address(2) 2051**]
elevations in 2, 3 and F and posterior ST elevations.
Patient was noted to be bradycardic to the 40s, was given
Atropine with rate to the 90s.  Patient was also given
aspirin, heparin and a 2B3A. Patient was pain free on
transfer.  Cardiac catheterization at [**Hospital3 **] revealed
single vessel disease.  A stent to the RCA was attempted but
they were unable to cross the RCA lesion and the procedure
was aborted.  The ST elevations persisted but the patient
remained pain-free.

MEDICAL HISTORY: 1) Total abdominal hysterectomy.  2)
Status post appendectomy.  3) Mastoid surgery.  4)
Hypertension.  5) Hypercholesterolemia.

MEDICATION ON ADMISSION: Lescol XL 40 q day.  No known drug
allergies.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has three daughters and one son.
She currently smokes [**1-26**] pack per day for the past 50 years.
Denies alcohol and denies drug use. 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Accidental puncture or laceration during a procedure, not elsewhere classified,Peripheral vascular complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified,Pure hypercholesterolemia,Unspecified disorder of kidney and ureter,Tobacco use disorder'}
