CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 47 yo M presented with 8/10 mid-sternal chest pain x40 min to
outside hospital.  Pt was getting ready to go to bed when he
developed chest pain around 11:20pm, unremitting, lasted 20 min,
then wife drove him to [**Name (NI) **] ([**Street Address(2) 74176**]).  + association with
diaphoresis, no n/v/sob/palpitations.  Initial EKG with T wave
inversions.  Subsequently reportedly had VT, started on
lidocaine 2nd EKG with STE's.  On admission pt hypertensive to
238/145, started on labetalol drip, also hyperglycemic to 400s.
Started on lidocaine, heparin, integrillin, nitro drips.  Also
received lopressor 5mg IV x2, ASA 162mg, plavix 600mg.
On arrival pt went to cardiac cath where he was found to have
3VD with RCA and LCx occlusions.  Unable to cross RCA lesions,
LCx lesions stented x2 BMS.
Pt seen after cath, denies further chest pain.  He states his
chest pain resolved en route by ambulance from outside hospital.
 He also had jaw pain which resolved after stent placement.
Pt also states that he has been having intermittent episodes of
chest discomfort lasting 10min, with exertion or with rest for
the last 2 weeks.

MEDICAL HISTORY: CAD s/p MI [**2137**] - medically treated
HTN
Hypercholesterolemia
Osteoarthritis - chronic low back, hip, knee, ankle pain

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: BP 117/80 HR 81 RR 14 O2 96 % on 2L NC, Wt 106 kg
Gen: middle aged male obese male, appears comfortable, slightly
somnolent. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Pupils 2mm, mildly reactive,
EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral
mucosa. No xanthalesma.
Neck: Supple, thick, unable to see JVP.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTA anteriorly, no
crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.
R groin with sheath in place, no hematoma
R leg cooler than L, slow capillary refill (sheath in place),
pulses dopplerable
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: Father history CAD, CABG at 64 yo, no known MI.
Mother with hx HTN, died from cerebral hemorrhage at 54 yo.

SOCIAL HISTORY: Denies any hx tobacco, etoh use.  Works as truck driver.  Lives
at home with wife and 11 year old twins.
Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Pain in joint, lower leg,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Subendo infarct, initial,Hematoma complic proc,Crnry athrscl natve vssl,Old myocardial infarct,Hypertension NOS,Pure hypercholesterolem,Osteoarthros NOS-pelvis,Joint pain-l/leg,DMII wo cmp nt st uncntr
Admission Date:  [**2142-6-27**]              Discharge Date:   [**2142-7-4**]

Date of Birth:  [**2095-3-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
s/p cardiac catheterization and bare metal stent to Left
circumflex artery


History of Present Illness:
47 yo M presented with 8/10 mid-sternal chest pain x40 min to
outside hospital.  Pt was getting ready to go to bed when he
developed chest pain around 11:20pm, unremitting, lasted 20 min,
then wife drove him to [**Name (NI) **] ([**Street Address(2) 74176**]).  + association with
diaphoresis, no n/v/sob/palpitations.  Initial EKG with T wave
inversions.  Subsequently reportedly had VT, started on
lidocaine 2nd EKG with STE's.  On admission pt hypertensive to
238/145, started on labetalol drip, also hyperglycemic to 400s.
Started on lidocaine, heparin, integrillin, nitro drips.  Also
received lopressor 5mg IV x2, ASA 162mg, plavix 600mg.
On arrival pt went to cardiac cath where he was found to have
3VD with RCA and LCx occlusions.  Unable to cross RCA lesions,
LCx lesions stented x2 BMS.
Pt seen after cath, denies further chest pain.  He states his
chest pain resolved en route by ambulance from outside hospital.
 He also had jaw pain which resolved after stent placement.
Pt also states that he has been having intermittent episodes of
chest discomfort lasting 10min, with exertion or with rest for
the last 2 weeks.


Past Medical History:
CAD s/p MI [**2137**] - medically treated
HTN
Hypercholesterolemia
Osteoarthritis - chronic low back, hip, knee, ankle pain

Social History:
Denies any hx tobacco, etoh use.  Works as truck driver.  Lives
at home with wife and 11 year old twins.

Family History:
Father history CAD, CABG at 64 yo, no known MI.
Mother with hx HTN, died from cerebral hemorrhage at 54 yo.

Physical Exam:
VS: BP 117/80 HR 81 RR 14 O2 96 % on 2L NC, Wt 106 kg
Gen: middle aged male obese male, appears comfortable, slightly
somnolent. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Pupils 2mm, mildly reactive,
EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral
mucosa. No xanthalesma.
Neck: Supple, thick, unable to see JVP.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTA anteriorly, no
crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.
R groin with sheath in place, no hematoma
R leg cooler than L, slow capillary refill (sheath in place),
pulses dopplerable
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

Pertinent Results:
[**2142-6-27**]  WBC-17.4* Hgb-13.9* Hct-40.0 Plt Ct-305
[**2142-6-27**]  PT-12.0 PTT-26.3 INR(PT)-1.0
[**2142-6-27**]  Glucose-437* UreaN-25* Creat-1.5* Na-132* K-6.4* Cl-99
HCO3-24
.
[**2142-6-29**]  Hct-28.8*
[**2142-7-2**]  Hct-26.8*
[**2142-7-3**]  Hct-33.7*
.
[**2142-7-3**] 07:20AM BLOOD Fibrino-722*
[**2142-7-2**] 06:20AM BLOOD Ret Aut-5.9*
.
[**2142-6-27**] 08:00AM CK(CPK)-4311* CK-MB-295* MB Indx-6.8*
cTropnT-16.6*
[**2142-6-27**] 02:17PM CK(CPK)-2801* CK-MB-221* MB Indx-7.9*
cTropnT-12.41*
[**2142-7-2**] ALT-34 AST-34 LD(LDH)-568* AlkPhos-113 Amylase-24
TotBili-1.9*
.
[**2142-7-2**] Albumin-3.4 Iron-42* calTIBC-250* VitB12-459 Folate-9.2

Hapto-228* Ferritn-192 TRF-192*
.
[**2142-6-29**] 05:10PM BLOOD %HbA1c-7.7*
[**2142-6-29**] 05:10PM BLOOD Triglyc-324* HDL-34 LDLcalc-44
.
[**2142-6-27**] Cardiac catheterization:
1. Severe three vessel coronary artery disease. LAd had 70% at
proximal-mid segment and the origin of the first diagonal had
80%
stenosis. the LCX was occluded at mid vessel. The OM3 had a hazy
50%
lesion. The RCA was totally and chronically occluded proximally.
The
PDA and RPL received collaterals from the left coronary
circulation.
2. The proximal RCA TO was not treated as we could not deliver
any
balloon/exchelon catheter.
3. The mid LCX lesion stented with two 3.0 mm bare metal stents.
.
[**2142-6-29**] CXR: No pneumonia or congestive failure
.
[**2142-7-2**] ECHOCARDIOGRAM: EF 40%. Mild symmetric LVH with normal
cavity size, mild regional LV systolic dysfunction with severe
hypokinesis of the basal half of the inferior and inferolateral
walls. RV chamber size and free wall motion are normal.
.
[**2142-7-2**] CT ABD/PELVIS: Large right retroperitoneal hematoma.
.
[**2142-7-2**] CXR: Congestive heart failure.
.
[**2142-7-2**] DUPLEX CAROTID US: No significant atherosclerotic plaque
was seen.

Brief Hospital Course:
#) STEMI:  The patient presented with an inferior STEMI and went
urgently to the cath lab. He was found to have 3 vessel disease.
Initially he was thought to have an RCA lesion, however stenting
of the LCx revealed collaterals to the RCA suggesting subacute
occlusion.  Two bare metal stents were placed to the LCx.  He
was chest pain free s/p catheterization. He was treated
medically with ASA, plavix, high dose statin, BB, and ACEI.
Patient will follow-up with Dr. [**Last Name (STitle) **] as an outpatient, and will
have a stress test done at that time to determine whether CABG
is indicated.
.
#) Rhythm:  During the admission, he remained in normal sinus
rhythm with occasional episodes of NSVT.  Records reveal
bigeminy, initially started on lidocaine which has been
discontinued.  Likely ischemic in origin.
.
#) Pump:  TTE revealed an EF of 40% with mild to moderate
regional left ventricular systolic dysfunction with inferior and
infero-lateral hypokinesis to akinesis. The patient had mild
inspiratory crackles on exam (first noted on [**6-30**] and CXR on [**7-2**]
revealed congestive heart failure. He was diuresed with lasix
and responded well.
.
#) R retroperitoneal bleed: Pt noted to have a hct drop on [**7-2**]
(was 40 on admission, dropped to 26.8 by [**7-2**]). CT abd/pelvis on
[**7-2**] revealed a large retroperitoneal hematoma, likely secondary
to his catheterization. He received 2u RBC on [**7-2**] with an
appropriate bump in his hct. He has been hemodynamically stable
throughout. Hematocrit has been stable since receiving the
transfusion, on discharge = 32.7.
.
#) Hyperlipidemia:  Lipid profile revealed elevated total
cholesterol and triglycerides. He was treated with high-dose
statin and tricor.
.
#) HTN: For his hypertension, the patient was treated with
metoprolol and lisinopril.
.
#) DM: The patient received a new diagnosis of diabetes on this
admission. HBA1c was 8.4. He was followed closely by [**Last Name (un) **]
during his hospital stay and his regimen was adjusted as
necessary. His regimen on discharge is glargine 38u at 8pm with
a humalog sliding scale. The patient and his wife received
intensive DM education while in house. He will follow-up with
[**Last Name (un) **] as an outpatient.
.
#) Low back pain: The patient c/o low back pain above his hips
s/p cath that was worse with movement and when lying in bed. He
reported having a "bad back" for several years, however the RP
bleed (see above) likely also contributed to his discomfort. The
pain was well-controlled with percocet prn. LFTs within normal
limits.
.

Medications on Admission:
none

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. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO twice a
day.
Disp:*90 Tablet(s)* Refills:*2*
6. Fenofibrate Micronized 48 mg Tablet Sig: One (1) Tablet PO
daily ().
Disp:*30 Tablet(s)* Refills:*2*
7. blood glucose test strips  Sig: One (1)   four times a day.
Disp:*150 * Refills:*2*
8. Insulin Syringe 0.5cc/28G     Syringe Sig: One (1)
Miscellaneous five times a day.
Disp:*150 * Refills:*2*
9. Insulin Glargine 100 unit/mL Solution Sig: One (1) 38
Subcutaneous once a day: take at 8pm.
Disp:*3 vials* Refills:*2*
10. Insulin Lispro (Human) 100 unit/mL Solution Sig: One (1)
Subcutaneous four times a day as needed for as needed according
to the insulin sliding scale.
Disp:*2 vials* Refills:*2*
11. Lancets     Misc Sig: One (1)  Miscellaneous four times a
day.
Disp:*120 * Refills:*2*


Discharge Disposition:
Home With Service

Facility:
Bayada Nurses Inc

Discharge Diagnosis:
inferior ST elevation myocardial infarction
coronary artery disease
diabetes mellitus
hypertension
hypercholesterolemia


Discharge Condition:
stable, ambulating


Discharge Instructions:
You were admitted to the hospital for a heart attack, which was
treated with cardiac catheterization. At that time, 2 bare metal
stents were placed in one of the arteries of your heart. You
were also found to have a new diagnosis of diabetes mellitus.
During this admission you have been started on new medications,
which you will need to take at home as directed. It is very
important that you take the plavix every day to keep the stent
in your heart open. If you are not able to take pills by  mouth
for any reason, this is an emergency and you need to go to the
nearest ER so that your aspirin and plavix can be administered
intravenously. Please continue to check your blood sugars four
times daily.

Please call your primary care physician or call 911 if you
experience chest pain, shortness of breath, fevers, abdominal
pain, high blood sugars, blurry vision, weakness or other
concerning symptoms.

Followup Instructions:
Please follow up with the [**Hospital **] Clinic for your diabetes
management. You have an appointment with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1557**] on [**7-11**]
at 10am.

Please schedule follow-up with your primary care physician
within the next 1-2 weeks.

Please call to schedule follow-up with cardiology, Dr. [**Last Name (STitle) **]
([**Telephone/Fax (1) 5909**] within the next 2-4 weeks.
{'Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Pain in joint, lower leg,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 47 yo M presented with 8/10 mid-sternal chest pain x40 min to
outside hospital.  Pt was getting ready to go to bed when he
developed chest pain around 11:20pm, unremitting, lasted 20 min,
then wife drove him to [**Name (NI) **] ([**Street Address(2) 74176**]).  + association with
diaphoresis, no n/v/sob/palpitations.  Initial EKG with T wave
inversions.  Subsequently reportedly had VT, started on
lidocaine 2nd EKG with STE's.  On admission pt hypertensive to
238/145, started on labetalol drip, also hyperglycemic to 400s.
Started on lidocaine, heparin, integrillin, nitro drips.  Also
received lopressor 5mg IV x2, ASA 162mg, plavix 600mg.
On arrival pt went to cardiac cath where he was found to have
3VD with RCA and LCx occlusions.  Unable to cross RCA lesions,
LCx lesions stented x2 BMS.
Pt seen after cath, denies further chest pain.  He states his
chest pain resolved en route by ambulance from outside hospital.
 He also had jaw pain which resolved after stent placement.
Pt also states that he has been having intermittent episodes of
chest discomfort lasting 10min, with exertion or with rest for
the last 2 weeks.

MEDICAL HISTORY: CAD s/p MI [**2137**] - medically treated
HTN
Hypercholesterolemia
Osteoarthritis - chronic low back, hip, knee, ankle pain

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: BP 117/80 HR 81 RR 14 O2 96 % on 2L NC, Wt 106 kg
Gen: middle aged male obese male, appears comfortable, slightly
somnolent. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Pupils 2mm, mildly reactive,
EOMI. Conjunctiva were pink, no pallor or cyanosis of the oral
mucosa. No xanthalesma.
Neck: Supple, thick, unable to see JVP.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTA anteriorly, no
crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.
R groin with sheath in place, no hematoma
R leg cooler than L, slow capillary refill (sheath in place),
pulses dopplerable
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: Father history CAD, CABG at 64 yo, no known MI.
Mother with hx HTN, died from cerebral hemorrhage at 54 yo.

SOCIAL HISTORY: Denies any hx tobacco, etoh use.  Works as truck driver.  Lives
at home with wife and 11 year old twins. 

### Response:
{'Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Pain in joint, lower leg,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
