CHIEF COMPLAINT: Chest pain, caused by anterior STEMI.

PRESENT ILLNESS: 52M w/no signif PMH, developed left arm discomfort at 1pm today
while in scout classes, [**2-18**], no SOB, no LH/Dizzyness, no
diaphoresis, no N/V. Paid no attention, discomfort started to
move up along arm to shoulder and then LACW as day progressed.
By 8pm patient had decided to rest, lay in bed to relieve
discomfort but to no avail, pain at that time had increased to
[**7-20**] and very noticible in the chest area. Called EMS and taken
to [**Hospital6 33**] (arrived at 940pm). ECG there
demonstrated STE in I,aVL, V1 with hyperacute T waves in V2-V5,
ST depressions in II, III, F with TWI III, F, all consistent
with anterior transmural infarction. He rec'd ASA 325mg, plavix
300mg, iv heparin, and eptifibatide (single bolus and infusion).
Also rec'd nitroglycerin x1 which decreased pain from [**7-20**] to
[**2-18**].

MEDICAL HISTORY: Anxiety, per PCP.

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: NAD, comfortable, A/Ox3.
V/S: 98.8 (afeb) 64 96/44 20 98%RA
HEENT: HNCAT
CV Pump: nl S1,S2. No m/r/g.
CV Rhythm: RRR with occasional rare infrequent PVCs.
Pulm: CTAB. Respirations comfortable.
Abd: S/NT/ND.
Vasc: Hematoma at R femoral access site continues to resolve.

FAMILY HISTORY: FM: father with MI in 70's, GF both paternal and maternal with
MI in 60-70's.

SOCIAL HISTORY: SOH: neg x 3, good exercise and diet.
Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other specified conduction disorders
AMI anterior wall, init,Parox ventric tachycard,Crnry athrscl natve vssl,Conduction disorder NEC
Admission Date:  [**2175-9-25**]              Discharge Date:   [**2175-9-29**]

Date of Birth:  [**2123-6-11**]             Sex:   M

Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 425**]
Chief Complaint:
Chest pain, caused by anterior STEMI.

Major Surgical or Invasive Procedure:
Emergent cardiac catheterization.
Removal of thrombus from the LAD coronary artery.
Placement of a drug-eluting stent in the proximal LAD.


History of Present Illness:
52M w/no signif PMH, developed left arm discomfort at 1pm today
while in scout classes, [**2-18**], no SOB, no LH/Dizzyness, no
diaphoresis, no N/V. Paid no attention, discomfort started to
move up along arm to shoulder and then LACW as day progressed.
By 8pm patient had decided to rest, lay in bed to relieve
discomfort but to no avail, pain at that time had increased to
[**7-20**] and very noticible in the chest area. Called EMS and taken
to [**Hospital6 33**] (arrived at 940pm). ECG there
demonstrated STE in I,aVL, V1 with hyperacute T waves in V2-V5,
ST depressions in II, III, F with TWI III, F, all consistent
with anterior transmural infarction. He rec'd ASA 325mg, plavix
300mg, iv heparin, and eptifibatide (single bolus and infusion).
Also rec'd nitroglycerin x1 which decreased pain from [**7-20**] to
[**2-18**].

Transferred to [**Hospital1 18**] for emergent cath and continuing care.


Past Medical History:
Anxiety, per PCP.

Social History:
SOH: neg x 3, good exercise and diet.

Family History:
FM: father with MI in 70's, GF both paternal and maternal with
MI in 60-70's.

Physical Exam:
Gen: NAD, comfortable, A/Ox3.
V/S: 98.8 (afeb) 64 96/44 20 98%RA
HEENT: HNCAT
CV Pump: nl S1,S2. No m/r/g.
CV Rhythm: RRR with occasional rare infrequent PVCs.
Pulm: CTAB. Respirations comfortable.
Abd: S/NT/ND.
Vasc: Hematoma at R femoral access site continues to resolve.

Pertinent Results:
Cadiac Cath: 100% occluded pLAD; Cypher stent 3.5x13 placed by
PTCA.
Hemodynamics: RA mean 15/a wave 17/v wave 18/, RV 38/11/17, PCW
mean 30/ v wave 37/ a wave 27, Ao 102/76/89, Pa sat 71%.

Peak cardiac enzymes: CPK 3169, CK-MB 494, Troponin-T 8.23.
Lipid profile: HDL 41, LDL(calc) 101, TG 110 (all wnl).


Brief Hospital Course:
100% occluded pLAD found at emergent cath, cleared by
thrombectomy.
Cypher stent 3.5x13 placed by PTCA.
Patient noted to have AIVR w/ mild hemodynamic intolerance
during AV dysyncrony. IABP was placed [**3-13**] persistent borderline
hypotension. Patient's hemodynamics remained stable and the IABP
was removed approximately 18 hours later.
The patient was noted have brief runs of NSVT on telemetry, in
the range of [**12-4**] beats. These were likely secondary to
reperfusion irritability, and have subsequently subsided without
further intervention.
Echocardiogram revealed anterior wall hypokinesis and apical
akinesis.
Patient was begun on tailored
ASA/Plavix/Lipitor/ACE-inhibitor/Metroprolol medication regimen,
and also on coumadin for anticoagulation in the setting of wall
hypokinesis.

Medications on Admission:
None.

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO QD
(once a day).
Disp:*60 Tablet(s)* Refills:*2*
4. Warfarin Sodium 5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
6. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO QD (once a day).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
7. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
8. Lovenox 80 mg/0.8 mL Syringe Sig: One (1) 80mg Subcutaneous
twice a day for 2 weeks.
Disp:*28 syringes* Refills:*0*
9. Outpatient Lab Work
Check Hct% and INR on Monday [**2175-10-2**].
Please send results to Dr.[**Last Name (STitle) 57699**] at [**Hospital6 33**].
[**Telephone/Fax (1) 57700**].
10. Outpatient Lab Work
Check Hct% and INR on Thursday [**2175-10-5**].
Please send results to Dr.[**Last Name (STitle) 57699**] at [**Hospital6 33**].
[**Telephone/Fax (1) 57700**].


Discharge Disposition:
Home

Discharge Diagnosis:
Anterior MI.


Discharge Condition:
Good.

Discharge Instructions:
Please return to the emergency department for re-evaluation if
you experience chest pain, nausea, shortness of breath,
dizziness, disorientation or any other symptoms that concern
you.

It is essential that you remember to take all your medications
on time as prescribed. Remember to keep your appointments.

Followup Instructions:
Follow up with your primary care physician, [**Last Name (NamePattern4) **].[**Last Name (STitle) 57699**]
([**Telephone/Fax (1) 57700**]) to achieve appropriate coumadin levels. Your
appointment wiht Dr.[**Last Name (STitle) 57699**] is scheduled for 11.30am on
Monday [**2175-10-2**]. Follow-up cardiology care has been arranged
with Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 45945**] ([**Telephone/Fax (1) 14967**]). You have an appointment
to see him at 3.15pm on Tuesday [**2175-10-3**]. Dr[**Last Name (un) 57701**]
practice is located at [**Street Address(2) **] in [**Location (un) 936**], in the
old [**Last Name (un) 14223**] Shoe Building. Please remember to bring your [**Company 57702**] card.


Completed by:[**2175-9-29**]

Name:  [**Known lastname 10714**],[**Known firstname 77**]                  Unit No:   [**Numeric Identifier 10715**]

Admission Date:  [**2175-9-25**]              Discharge Date:   [**2175-9-29**]

Date of Birth:  [**2123-6-11**]             Sex:   M

Service: [**Hospital Unit Name 319**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 296**]
Chief Complaint:
Chest pain due to anterior MI.

Major Surgical or Invasive Procedure:
Emergent cardiac catheterization.
Removal of thrombus from the LAD coronary artery.
Placement of a drug-eluting stent in the proximal LAD.


Pertinent Results:
Echo on [**2175-9-27**]:
Left Atrium - Long Axis Dimension: 3.7 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: *5.8 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: 4.6 cm (nl <= 5.0 cm)
Left Ventricle - Diastolic Dimension: 4.7 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: 35% (nl >=55%)
Aorta - Valve Level: 3.0 cm (nl <= 3.6 cm)
Aorta - Arch: 1.9 cm (nl <= 3.0 cm)
Mitral Valve - E Wave: 0.7 m/sec
Mitral Valve - A Wave: 0.8 m/sec
Mitral Valve - E/A Ratio: 0.88
Mitral Valve - E Wave Deceleration Time: 200 msec
TR Gradient (+ RA = PASP): 21 mm Hg (nl <= 25 mm Hg)


Brief Hospital Course:
No addendum.

Discharge Disposition:
Home

Discharge Diagnosis:
Anterior MI.


Discharge Condition:
Good.

Discharge Instructions:
Please return to the emergency department for re-evaluation if
you experience chest pain, nausea, shortness of breath,
dizziness, disorientation or any other symptoms that concern
you.

It is essential that you remember to take all your medications
on time as prescribed. Remember to keep your appointments.

Followup Instructions:
Follow up with your primary care physician, [**Last Name (NamePattern4) **].[**Last Name (STitle) 10716**]
([**Telephone/Fax (1) 10717**]) to achieve appropriate coumadin levels. Your
appointment wiht Dr.[**Last Name (STitle) 10716**] is scheduled for 11.30am on
Monday [**2175-10-2**]. Follow-up cardiology care has been arranged
with Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10718**] ([**Telephone/Fax (1) 10719**]). You have an appointment
to see him at 3.15pm on Tuesday [**2175-10-3**]. Dr[**Last Name (un) 10720**]
practice is located at [**Street Address(2) 10721**] in [**Location (un) 10722**], in the
old [**Last Name (un) 10723**] Shoe Building. Please remember to bring your [**Company 10724**] card.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 297**] MD [**MD Number(1) 298**]

Completed by:[**2175-9-29**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other specified conduction disorders'}


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, caused by anterior STEMI.

PRESENT ILLNESS: 52M w/no signif PMH, developed left arm discomfort at 1pm today
while in scout classes, [**2-18**], no SOB, no LH/Dizzyness, no
diaphoresis, no N/V. Paid no attention, discomfort started to
move up along arm to shoulder and then LACW as day progressed.
By 8pm patient had decided to rest, lay in bed to relieve
discomfort but to no avail, pain at that time had increased to
[**7-20**] and very noticible in the chest area. Called EMS and taken
to [**Hospital6 33**] (arrived at 940pm). ECG there
demonstrated STE in I,aVL, V1 with hyperacute T waves in V2-V5,
ST depressions in II, III, F with TWI III, F, all consistent
with anterior transmural infarction. He rec'd ASA 325mg, plavix
300mg, iv heparin, and eptifibatide (single bolus and infusion).
Also rec'd nitroglycerin x1 which decreased pain from [**7-20**] to
[**2-18**].

MEDICAL HISTORY: Anxiety, per PCP.

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: NAD, comfortable, A/Ox3.
V/S: 98.8 (afeb) 64 96/44 20 98%RA
HEENT: HNCAT
CV Pump: nl S1,S2. No m/r/g.
CV Rhythm: RRR with occasional rare infrequent PVCs.
Pulm: CTAB. Respirations comfortable.
Abd: S/NT/ND.
Vasc: Hematoma at R femoral access site continues to resolve.

FAMILY HISTORY: FM: father with MI in 70's, GF both paternal and maternal with
MI in 60-70's.

SOCIAL HISTORY: SOH: neg x 3, good exercise and diet. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Other specified conduction disorders'}
