CHIEF COMPLAINT: Chief Complaint: chest pain

PRESENT ILLNESS: 56 yo M with pmh of HTN, hyperlipidemia, transferred from an OSH
where he presented with severe chest pain, diaphoresis,
shortness of breath of sudden onset this AM. He initially
attributed the chest pain to heart burn, however, the pain
worsened and moved to the left chest and he began to have pain
radiating to the neck and down the left arm. By EMS, he was
given 4 baby ASA, 4mg morphine and 1 SL NTG which provided some
relief of pain. Initial EKG showed 3-[**Street Address(2) 5366**] elevations in II,
III, AVF and ST depressions in I and AVL.  On arrival at the OSH
he was started on a NTG gtt, heparin gtt, aggrastat gtt and
loaded with plavix 600mg. He was then transferred to [**Hospital1 18**] for
cardiac
catheterization. In the Cath lab he was found to have a 100% mid
cx acute occlusion with thrombus at the bifurcation of the Om
and CX. 2 bare metal stents were deployed to the LCX. Following
the procedure the pt. was hypoxic requiring 02 and had AIVR with
reperfusion of his coronaries. Therefore, he was transferred to
the CCU for further monitoring.
.
On review of symptoms, 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 sudden onset of chest
pain, SOB, diaphoresis and the absence of dyspnea on exertion,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
EKG following catheterization demonstrated resolution of the ST
elevation and depressions and Q waves developing inferiorly.

MEDICAL HISTORY: hypertension
hyper lipidemia

MEDICATION ON ADMISSION: Diovan 80 qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Blood pressure was 136/93 mm Hg while seated.  Pulse was 81
beats/min and regular, respiratory rate was 19 breaths/min on a
NRB. Generally the patient was well developed, well nourished
and
well groomed. The patient was oriented to person, place and
time.
The patient's mood and affect were not inappropriate.

FAMILY HISTORY: Father- [**Name (NI) 1291**], vascular surgery of lower ext., macular
degeneration
Mother- breast CA (expired)

SOCIAL HISTORY: married, lives with wife. Owns a home heating business. no
tobacco/etoh/IVDA
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Headache,Coronary atherosclerosis of native coronary artery,Hypoxemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Subendo infarct, initial,CHF NOS,Headache,Crnry athrscl natve vssl,Hypoxemia,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2172-6-16**]              Discharge Date:   [**2172-6-19**]

Date of Birth:  [**2116-2-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 134**]
Chief Complaint:
Chief Complaint: chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization


History of Present Illness:
56 yo M with pmh of HTN, hyperlipidemia, transferred from an OSH
where he presented with severe chest pain, diaphoresis,
shortness of breath of sudden onset this AM. He initially
attributed the chest pain to heart burn, however, the pain
worsened and moved to the left chest and he began to have pain
radiating to the neck and down the left arm. By EMS, he was
given 4 baby ASA, 4mg morphine and 1 SL NTG which provided some
relief of pain. Initial EKG showed 3-[**Street Address(2) 5366**] elevations in II,
III, AVF and ST depressions in I and AVL.  On arrival at the OSH
he was started on a NTG gtt, heparin gtt, aggrastat gtt and
loaded with plavix 600mg. He was then transferred to [**Hospital1 18**] for
cardiac
catheterization. In the Cath lab he was found to have a 100% mid
cx acute occlusion with thrombus at the bifurcation of the Om
and CX. 2 bare metal stents were deployed to the LCX. Following
the procedure the pt. was hypoxic requiring 02 and had AIVR with
reperfusion of his coronaries. Therefore, he was transferred to
the CCU for further monitoring.
.
On review of symptoms, 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 sudden onset of chest
pain, SOB, diaphoresis and the absence of dyspnea on exertion,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
EKG following catheterization demonstrated resolution of the ST
elevation and depressions and Q waves developing inferiorly.

Past Medical History:
hypertension
hyper lipidemia


Social History:
married, lives with wife. Owns a home heating business. no
tobacco/etoh/IVDA


Family History:
Father- [**Name (NI) 1291**], vascular surgery of lower ext., macular
degeneration
Mother- breast CA (expired)


Physical Exam:
Blood pressure was 136/93 mm Hg while seated.  Pulse was 81
beats/min and regular, respiratory rate was 19 breaths/min on a
NRB. Generally the patient was well developed, well nourished
and
well groomed. The patient was oriented to person, place and
time.
The patient's mood and affect were not inappropriate.

There was no xanthalesma and conjunctiva were pink with no
pallor
or cyanosis of the oral mucosa.  The neck was supple without
detectable JVP.  The carotid waveform was normal.  There was no
thyromegaly. The were no chest wall deformities, scoliosis or
kyphosis.  The respirations were not labored and there were no
use of accessory muscles. The lungs were clear to ascultation
bilaterally with normal breath sounds and no adventitial sounds
or rubs.

Palpation of the heart revealed the PMI to be located in the 5th
intercostal space, mid clavicular line.  There were no thrills,
lifts or palpable S3 or S4.  The heart sounds revealed a normal
S1 and the S2 was normal. There were no rubs, murmurs, clicks or
gallops.

The abdomen was soft nontender and nondistended. The extremities
had no pallor, cyanosis, clubbing or edema. There were no
abdominal, femoral or carotid bruits. Inspection and/or
palpation
of skin and subcutaneous tissue showed no stasis dermatitis,
ulcers, scars, or xanthomas.
The catheterization site is dressed, non-erythematous, no bruit
auscultated and no hematoma was palpated.

Pulses:
Right: dopplerable DP and PT
[**Name (NI) 2325**]:  dopplerable DP and PT


Pertinent Results:
Cath report [**2172-6-16**]:
1. Selective coronary angiuoplasty of this left dominant system
demonstrated single vessel coronary artery disease. The LMCA was
free
from angiographically-apparent disease. The LAD had mild luminal

irregularities. The LCX was a large vessel with 100% total
occlusion and
thrombus at mid segment extending into the proximal portion of a
large
OM1. The RCA was a small vessel without obstructive disease.
2. Limited resting hemodynamic assessment revealed elevated
right heart
filling pressures with mean PCWP of 24 mmHg. There was mild
pulmonary
hypertension with systolic pulmonary arterial pressure was of 37
mmHg.
Systemic blood pressure was normal (123/78 mmHg).
3. Left ventriculography was deferred.
FINAL DIAGNOSIS:
1. One vessel coronary artery disease with abrupt occlusion of a
large
.
2D-ECHOCARDIOGRAM: [**2172-6-16**]
Conclusions:  The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy with normal cavity size.
There is mild regional left ventricular systolic dysfunction
with
akinesis of the basal and mid inferior/inferolateral
walls, and mid-lateral wall (LVEF 40-45%), consistent with
coronary disease in the left circumflex territory. Right
ventricular chamber size and free wall motion are normal. The
aortic root is moderately dilated at the sinus level. The aortic
valve leaflets (3) appear structurally normal with good leaflet

excursion and no aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. The
pulmonary artery systolic pressure could not be determined.
There
is no pericardial effusion. Limited study.
IMPRESSION: Mild regional left ventricular systolic dysfunction,
c/w CAD. Dilated thoracic aorta.
.
CARDIAC CATH performed on [**2172-6-16**] demonstrated: LMCA- normal,
LAD-mild disease, RCA-SMALL, LCX- 100% LCX and OM occlusion. 2
bare metal stents were deployed. Stented main LCX and rescued OM
with resulting 0% occlusion in the LCX and 30-40% in the OM with
normal flow.
.
LABORATORY DATA:
.
141   110     11                 14.4
---|-------|------< 106    13.1>------< 266
4     22      0.9                40.5
.
[**2172-6-16**] 01:39PM   CK-MB-339* MB INDX-8.4* cTropnT-8.43*
[**2172-6-16**] 01:39PM   CK(CPK)-4046*
[**2172-6-16**] 09:42PM   CK-MB-217* MB INDX-7.5* cTropnT-12.07*
[**2172-6-16**] 09:42PM   CK(CPK)-2880*

Brief Hospital Course:
This is a 56 yo male with a pmh of HTN, hyperlipidemia who was
transferred to [**Hospital1 18**] for cardiac catheterization for an inferior
STEMI now s/p cardiac catheterization and stenting to the circ.
and OM, he was admitted to the CCU for STEMI, hypoxia and AIVR
following cardiac catheterization.

1. CAD/STEMI: The patient presented with signs and symptoms
consistent with an anterior STEMI. He was transferred from an
OSH for cardiac catheterization. In the cath lab  ePt. presented
with a STEMI now s/p PTCA with stenting (bare metal) of
the LCX and rescue of the OM. Following the catheterization he
had an episode of AIVR and was hypoxic [**3-13**] to volume
overload/CHF. He was initially requiring a NRB which was weaned
off along with diuresis. For his CAD he was started on plavix 75
qday which will need to be continued for a minimum of 1 year. He
will also need to continue ASA 32 qday, atorvstatin 80, toprol
xl (d/c'd on 100 qday).
.
2. Congestive heart failure: The patient required significant
supplemental 02 likely [**3-13**] to CHF in setting of acute MI. His EF
by echo was 40-45%. He was diuresed aggressively and his 02 was
weaned. He was discharged on po lasix.
.
3. Glucose intolerance: The patient had an elevated BG
throughout his stay. He will follow up with his primary care
physician regarding possible [**Name9 (PRE) 2320**].
.
4. PPX: bowel reg., pneumoboots
.
5. FEN: heart healthy diet. PT consult
.
6. Code: full

Medications on Admission:
Diovan 80 qday


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. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1. Acute ST-elevation myocardial infarction
2. Glucose intolerance
3. Congestive heart failure


Discharge Condition:
good, pain free


Discharge Instructions:
You had a heart attack and had a stent placed in an artery in
your heart.

Followup Instructions:
Please follow-up with your cardiologist Dr. [**Last Name (STitle) 11493**] on Monday

Your fasting blood sugar was elevated, putting you at risk for
diabetes.  You should mention this to your PCP.



Completed by:[**2172-6-19**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Headache,Coronary atherosclerosis of native coronary artery,Hypoxemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: Chief Complaint: chest pain

PRESENT ILLNESS: 56 yo M with pmh of HTN, hyperlipidemia, transferred from an OSH
where he presented with severe chest pain, diaphoresis,
shortness of breath of sudden onset this AM. He initially
attributed the chest pain to heart burn, however, the pain
worsened and moved to the left chest and he began to have pain
radiating to the neck and down the left arm. By EMS, he was
given 4 baby ASA, 4mg morphine and 1 SL NTG which provided some
relief of pain. Initial EKG showed 3-[**Street Address(2) 5366**] elevations in II,
III, AVF and ST depressions in I and AVL.  On arrival at the OSH
he was started on a NTG gtt, heparin gtt, aggrastat gtt and
loaded with plavix 600mg. He was then transferred to [**Hospital1 18**] for
cardiac
catheterization. In the Cath lab he was found to have a 100% mid
cx acute occlusion with thrombus at the bifurcation of the Om
and CX. 2 bare metal stents were deployed to the LCX. Following
the procedure the pt. was hypoxic requiring 02 and had AIVR with
reperfusion of his coronaries. Therefore, he was transferred to
the CCU for further monitoring.
.
On review of symptoms, 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 sudden onset of chest
pain, SOB, diaphoresis and the absence of dyspnea on exertion,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
EKG following catheterization demonstrated resolution of the ST
elevation and depressions and Q waves developing inferiorly.

MEDICAL HISTORY: hypertension
hyper lipidemia

MEDICATION ON ADMISSION: Diovan 80 qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Blood pressure was 136/93 mm Hg while seated.  Pulse was 81
beats/min and regular, respiratory rate was 19 breaths/min on a
NRB. Generally the patient was well developed, well nourished
and
well groomed. The patient was oriented to person, place and
time.
The patient's mood and affect were not inappropriate.

FAMILY HISTORY: Father- [**Name (NI) 1291**], vascular surgery of lower ext., macular
degeneration
Mother- breast CA (expired)

SOCIAL HISTORY: married, lives with wife. Owns a home heating business. no
tobacco/etoh/IVDA 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Headache,Coronary atherosclerosis of native coronary artery,Hypoxemia,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
