CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: This is a 43 year-old male with no known coronary artery
disease, history of hyperlipidemia, tobacco use, family history
of premature coronary artery disease, who had a gradual onset of
rest pain at 5 pm on the day of presentation.  Within 10
minutes, his pain progressed to [**11-6**] with associated
diaphoresis and nausea.  He was taken to the [**Location (un) 47**]
emergency department.  His EKG showed 1.[**Street Address(2) **] elevations in
V2, 0.[**Street Address(2) 1755**] elevations in V3, and ST depression in III and
aVL. Cardiac enzymes were notable for a CK of 327, MB of 4, and
a troponin-I of 0.04.  He was given aspirin, plavix (600),
heparin, integrillin, and nitro drip and was subsequently pain
free. He had recurrent, intermittent chest pain of [**2107-3-3**]. He
continued to have similar ST elevations. He was transfered to
the [**Hospital1 18**] for further evaluation.  Upon arrival, he continued to
be chest pain free.  He denies shortness of breath, nausea,
vomiting, or diaphoresis.

MEDICAL HISTORY: 1. Hyperlipidemia
2. Status post back surgery for fracture

MEDICATION ON ADMISSION: Lipitor 15 po qd (stopped taking in [**Month (only) 404**] on his own)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: Temperature: Pulse:71 Blood Pressure:125/85 Respiratory
Rate: Oxygen Saturation: 99% on 2L nasal cannula
General: Pleasant gentleman in no acute distress.
HEENT: Pupils equal and reactive, extraoccular movements intact,
moist mucous membranes, anicteric sclera.
Pulmonary: Clear to auscultation bilaterally.
Cardiac: Regular rate and rhythm, s1, s2, withou murmurs, rubs,
or gallops.
Abdomen: Soft, nontender, nondistended with normoactive bowel
sounds.
Extremities: Warm and well perfused without cyanosis or edema.
Skin: Numerous tattoes throughout torso and upper extremities.

FAMILY HISTORY: His brother had congenital heart disease and died of a
myocardial infarction at he age of 47.  His father had a mild
myocardial infarction in his 60s.  His mother had a myocardial
infarction in the setting of a brain hemorrhage.

SOCIAL HISTORY: He is currently working as a painter.  He quit drinking alcohol
in high school.  He has been smoking 1.5 packs per day for over
30 years but has recently decreased to 5 cigarretes per day in
attempt to quit recently.  He never used IV drugs.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Tobacco use disorder,Family history of ischemic heart disease
Subendo infarct, initial,Crnry athrscl natve vssl,Pure hypercholesterolem,Tobacco use disorder,Fam hx-ischem heart dis
Admission Date:  [**2103-6-19**]              Discharge Date:   [**2103-6-21**]

Date of Birth:  [**2060-4-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2074**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
Cardiac Catherization with stent placement

History of Present Illness:
This is a 43 year-old male with no known coronary artery
disease, history of hyperlipidemia, tobacco use, family history
of premature coronary artery disease, who had a gradual onset of
rest pain at 5 pm on the day of presentation.  Within 10
minutes, his pain progressed to [**11-6**] with associated
diaphoresis and nausea.  He was taken to the [**Location (un) 47**]
emergency department.  His EKG showed 1.[**Street Address(2) **] elevations in
V2, 0.[**Street Address(2) 1755**] elevations in V3, and ST depression in III and
aVL. Cardiac enzymes were notable for a CK of 327, MB of 4, and
a troponin-I of 0.04.  He was given aspirin, plavix (600),
heparin, integrillin, and nitro drip and was subsequently pain
free. He had recurrent, intermittent chest pain of [**2107-3-3**]. He
continued to have similar ST elevations. He was transfered to
the [**Hospital1 18**] for further evaluation.  Upon arrival, he continued to
be chest pain free.  He denies shortness of breath, nausea,
vomiting, or diaphoresis.

Past Medical History:
1. Hyperlipidemia
2. Status post back surgery for fracture

Social History:
He is currently working as a painter.  He quit drinking alcohol
in high school.  He has been smoking 1.5 packs per day for over
30 years but has recently decreased to 5 cigarretes per day in
attempt to quit recently.  He never used IV drugs.

Family History:
His brother had congenital heart disease and died of a
myocardial infarction at he age of 47.  His father had a mild
myocardial infarction in his 60s.  His mother had a myocardial
infarction in the setting of a brain hemorrhage.

Physical Exam:
Vitals: Temperature: Pulse:71 Blood Pressure:125/85 Respiratory
Rate: Oxygen Saturation: 99% on 2L nasal cannula
General: Pleasant gentleman in no acute distress.
HEENT: Pupils equal and reactive, extraoccular movements intact,
moist mucous membranes, anicteric sclera.
Pulmonary: Clear to auscultation bilaterally.
Cardiac: Regular rate and rhythm, s1, s2, withou murmurs, rubs,
or gallops.
Abdomen: Soft, nontender, nondistended with normoactive bowel
sounds.
Extremities: Warm and well perfused without cyanosis or edema.
Skin: Numerous tattoes throughout torso and upper extremities.

Pertinent Results:
Hematology:
WBC-12.2 HGB-15.2 HCT-40.9 PLT COUNT-264
NEUTS-66.7 LYMPHS-26.9 MONOS-5.4 EOS-0.9 BASOS-0.2
.
Chemistries:
SODIUM-139 POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-22 UREA N-14
CREAT-0.8 GLUCOSE-114
CALCIUM-9.5 PHOSPHATE-4.4 MAGNESIUM-2.2
.
Cardiac Enzymes:
CK(CPK)-301 CK-MB-10 MB INDX-3.3 cTropnT-0.72
.
Coagulation: PT-13.2 PTT-64.9 INR(PT)-1.2
.
Lipid Panel:
CHOLEST-264 TRIGLYCER-122 HDL CHOL-46 CHOL/HDL-5.7 LDL(CALC)-194
.
Diabetes:
%HbA1c-6.2
.
Echocardiogram: Normal left ventricular function.
.
EKG: Normal sinus at about 70 beats per minute. 1-1.[**Street Address(2) 1755**]
elevations in V2, [**Street Address(2) 4793**] elevations in V3.
.
Catherization:This left main and the circumflex had no apparent
disease.  The LAD had a 70% mid stenosis and a 90% stenosis at
the bifurcation of a twin LAD/diagonal. The right coronary was
small and nondominant with no apparent disease.
.
Hemodynamics: He had normal hemodynamics.
.
Intervention: He had a stent placed from the LAD into the
diagonal with balloon dilation of the LAD branch.

Brief Hospital Course:
This is a 43 year-old male with history of hyperlipidemia
admitted with NSTEMI.
.
1. NSTEMI: His chest pain has resolved on aspirin, Plavix,
heparin, Integrilin, and Nitro drip in the emergency department.
He likely had some reperfusion on the anticoagulants.  He did
not meet criteria for an ST elevation myocardial infarction.  As
he had normal left ventricular function on echocardiogram in the
emergency department, he was admitted to the CCU for monitoring
prior to catherization.  His admission troponin was elevated.
Overnight, he had recurrent low grade chest pain (0.5-2/10)that
did not resolve with increased nitroglycerin, morphine, and
metoprolol.  He was taken to the catherization lab.  He had a
stenosis at the bifurcation of the LAD and the diagonal.  He had
a stent placed from the LAD into the diagonal with balloon
dilation of the LAD.  His CKs peaked at 301.  Post-intervention,
he was maintained on aspirin, Plavix, and high dose Lipitor.  He
was also started on an ace-inhibitor and a beta-blocker.  A
post-intervention echocardiogram showed normal left ventricular
function with mild pulmonary artery hypertension.
.
2. Smoking Cessation: He has been cutting down on smoking with
the desire to quit.  He was conselled about smoking cessation
and was started on a nicotine patch.
.
3. ?Diabetes: His fasting blood sugar was slightly elevated.
His hemoglobin A1c was 6.2.  He should be followed for the
possibility of early diabetes.
.
4. FEN: He was maintained on a regular diet.
.
5. Access: Peripheral IV.
.
6. Prophylaxis: He was maintained on subcutaneous heparin and a
PPI.
.
7. Dispo: He was discharged to home with follow-up at the [**Hospital 3856**] Heart Center.

Medications on Admission:
Lipitor 15 po qd (stopped taking in [**Month (only) 404**] on his own)

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(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. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Nicotine 7 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).
Disp:*15 Patch 24HR(s)* Refills:*2*
6. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Myocardial Infarction


Discharge Condition:
Stable.  He had no further chest pain after his intervention.


Discharge Instructions:
Please take all medications as prescribed.  You must take
aspirin and pavix everyday or else your stent may become blocked
and you could suffer a very severe heart attack.

Seek medical attention immediately if you experience new
symptoms including chest pain, shortness of breath, arm or jaw
pain, numbness, fatigue, fainting, nausea/vomiting or other new
concerning symptoms.

Follow up as per below.

Followup Instructions:
You should follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 20683**] at the [**Hospital1 **]
Heart Center.  His office will give you a call to set up an
appointment.  If you have any questions, please call
([**Telephone/Fax (1) 6256**].



Completed by:[**2103-6-21**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Tobacco use disorder,Family history of ischemic heart 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 Pain

PRESENT ILLNESS: This is a 43 year-old male with no known coronary artery
disease, history of hyperlipidemia, tobacco use, family history
of premature coronary artery disease, who had a gradual onset of
rest pain at 5 pm on the day of presentation.  Within 10
minutes, his pain progressed to [**11-6**] with associated
diaphoresis and nausea.  He was taken to the [**Location (un) 47**]
emergency department.  His EKG showed 1.[**Street Address(2) **] elevations in
V2, 0.[**Street Address(2) 1755**] elevations in V3, and ST depression in III and
aVL. Cardiac enzymes were notable for a CK of 327, MB of 4, and
a troponin-I of 0.04.  He was given aspirin, plavix (600),
heparin, integrillin, and nitro drip and was subsequently pain
free. He had recurrent, intermittent chest pain of [**2107-3-3**]. He
continued to have similar ST elevations. He was transfered to
the [**Hospital1 18**] for further evaluation.  Upon arrival, he continued to
be chest pain free.  He denies shortness of breath, nausea,
vomiting, or diaphoresis.

MEDICAL HISTORY: 1. Hyperlipidemia
2. Status post back surgery for fracture

MEDICATION ON ADMISSION: Lipitor 15 po qd (stopped taking in [**Month (only) 404**] on his own)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: Temperature: Pulse:71 Blood Pressure:125/85 Respiratory
Rate: Oxygen Saturation: 99% on 2L nasal cannula
General: Pleasant gentleman in no acute distress.
HEENT: Pupils equal and reactive, extraoccular movements intact,
moist mucous membranes, anicteric sclera.
Pulmonary: Clear to auscultation bilaterally.
Cardiac: Regular rate and rhythm, s1, s2, withou murmurs, rubs,
or gallops.
Abdomen: Soft, nontender, nondistended with normoactive bowel
sounds.
Extremities: Warm and well perfused without cyanosis or edema.
Skin: Numerous tattoes throughout torso and upper extremities.

FAMILY HISTORY: His brother had congenital heart disease and died of a
myocardial infarction at he age of 47.  His father had a mild
myocardial infarction in his 60s.  His mother had a myocardial
infarction in the setting of a brain hemorrhage.

SOCIAL HISTORY: He is currently working as a painter.  He quit drinking alcohol
in high school.  He has been smoking 1.5 packs per day for over
30 years but has recently decreased to 5 cigarretes per day in
attempt to quit recently.  He never used IV drugs. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Tobacco use disorder,Family history of ischemic heart disease'}
