CHIEF COMPLAINT: NSTEMI - being transferred for cath

PRESENT ILLNESS: 87 yo female with history of hypertension who presented to
[**Hospital1 **] with chest pain for 2 days and found to have a NSTEMI
as per cardiac enzymes. Peak Trop I was 0.96 although CKs have
remained flat as per outside hospital. Patient continued to have
episodes of chest pain that were being treated with SL NTG with
improvement. Denies any other associated symptoms including
nausea, vomiting, diaphoresis. However, did note that the pain
radiated to both of her arms. Patient went into mild heart
failure yesterday after getting IVF but seems to be improving
with IV Lasix. Was seen by Cardiology this morning, and was
started on Lipitor, Heparin gtt and Integrillin gtt and
requested to be transferred here for cath. She refused Lipitor
because she is allergic to it. Being transferred here for cath
and further management.

MEDICAL HISTORY: 1. Hypertension
2. Hypothyroidism
3. Atrial Fibrillation
4. Sick Sinus Syndrome s/p pacemaker
5. Hyperlipidemia
6. Congestive Heart Failure
7. Myocardial Infarction x 2 prior episodes (as per patient)
8. chronic mesenteric ischemia - followed by a
gastroenterologist

MEDICATION ON ADMISSION: 1. Aspirin 81mg po daily
2. Synthroid 25mcg po daily
3. Enalapril 20mg po daily
4. Lopressor 100mg po bid
5. Protonix 40mg po daily
6. Methyldopa 750mg po tid
7. Lasix 20mg po daily
8. Hydrea 500mg po bid

ALLERGIES: Lipitor / Codeine / Procardia / Iodine / Pepcid / Catapres

PHYSICAL EXAM: VS: Temp 98.9, Pulse 64, BP 145/55, RR 18, O2 sat 97% on 2
liters
GEN: comfortable, NAD
HEENT: OP clear, EOMI, PERRLA
NECK: no JVD noted, supple
LUNGS: CTA bilateral
HEART: S1, S2, RRR, no murmurs, rubs, gallops
ABD: soft, ND, NT, no HSM, + bowel sounds
EXTREM: no edema, cyanosis, clubbing
NEURO: AAO x3, CN II-XII tested and grossly intact

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Patient lives with her elder son who was recently diagnosed with
lng cancer; patient denies any tobacco, EtOH of recreational
drug use
Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Atrial fibrillation,Blood in stool,Acute kidney failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other left bundle branch block,Cardiac pacemaker in situ,Old myocardial infarction,Anemia, unspecified,Unspecified diseases of blood and blood-forming organs,Nausea with vomiting,Unspecified acquired hypothyroidism,Pure hypercholesterolemia
Subendo infarct, initial,Systolic hrt failure NOS,Atrial fibrillation,Blood in stool,Acute kidney failure NOS,Adv eff medicinal NEC,Crnry athrscl natve vssl,Hypertension NOS,Left bb block NEC,Status cardiac pacemaker,Old myocardial infarct,Anemia NOS,Blood disease NOS,Nausea with vomiting,Hypothyroidism NOS,Pure hypercholesterolem
Admission Date:  [**2104-6-1**]              Discharge Date:   [**2104-6-9**]


Service: MEDICINE

Allergies:
Lipitor / Codeine / Procardia / Iodine / Pepcid / Catapres

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
NSTEMI - being transferred for cath

Major Surgical or Invasive Procedure:
cardiac cath

History of Present Illness:
87 yo female with history of hypertension who presented to
[**Hospital1 **] with chest pain for 2 days and found to have a NSTEMI
as per cardiac enzymes. Peak Trop I was 0.96 although CKs have
remained flat as per outside hospital. Patient continued to have
episodes of chest pain that were being treated with SL NTG with
improvement. Denies any other associated symptoms including
nausea, vomiting, diaphoresis. However, did note that the pain
radiated to both of her arms. Patient went into mild heart
failure yesterday after getting IVF but seems to be improving
with IV Lasix. Was seen by Cardiology this morning, and was
started on Lipitor, Heparin gtt and Integrillin gtt and
requested to be transferred here for cath. She refused Lipitor
because she is allergic to it. Being transferred here for cath
and further management.


Past Medical History:
1. Hypertension
2. Hypothyroidism
3. Atrial Fibrillation
4. Sick Sinus Syndrome s/p pacemaker
5. Hyperlipidemia
6. Congestive Heart Failure
7. Myocardial Infarction x 2 prior episodes (as per patient)
8. chronic mesenteric ischemia - followed by a
gastroenterologist

Social History:
Patient lives with her elder son who was recently diagnosed with
lng cancer; patient denies any tobacco, EtOH of recreational
drug use


Family History:
Non contributory

Physical Exam:
VS: Temp 98.9, Pulse 64, BP 145/55, RR 18, O2 sat 97% on 2
liters
GEN: comfortable, NAD
HEENT: OP clear, EOMI, PERRLA
NECK: no JVD noted, supple
LUNGS: CTA bilateral
HEART: S1, S2, RRR, no murmurs, rubs, gallops
ABD: soft, ND, NT, no HSM, + bowel sounds
EXTREM: no edema, cyanosis, clubbing
NEURO: AAO x3, CN II-XII tested and grossly intact

Pertinent Results:
[**2104-6-1**] 03:58PM   GLUCOSE-128* UREA N-26* CREAT-1.3* SODIUM-140
POTASSIUM-4.4 CHLORIDE-105 TOTAL CO2-22 ANION GAP-17
[**2104-6-1**] 03:58PM   CK(CPK)-31
[**2104-6-1**] 03:58PM   CK-MB-NotDone cTropnT-0.29*
[**2104-6-1**] 03:58PM   CALCIUM-8.7 PHOSPHATE-3.8 MAGNESIUM-1.4*
[**2104-6-1**] 03:58PM   WBC-5.3 RBC-3.00* HGB-10.5* HCT-32.4*
MCV-108* MCH-34.9* MCHC-32.3 RDW-16.8*
[**2104-6-1**] 03:58PM   PLT COUNT-471*
[**2104-6-1**] 03:58PM   PT-14.4* PTT-28.7 INR(PT)-1.3

EKG: a-v paced with a rate around 65, LBBB

CHEST (PORTABLE AP)

Reason: please assess interval change

[**Hospital 93**] MEDICAL CONDITION:
87 year old woman with NSTEMI, new onset shortness of breath now
s/p diuresis
REASON FOR THIS EXAMINATION:
please assess interval change
INDICATION: 87-year-old with congestive heart failure.

Portable upright frontal radiograph. Comparison is made to one
day earlier and study performed 6 hours earlier.

FINDINGS:
Compared to the study of 6 hours earlier, there has been an
improvement in the congestive heart failure pattern with
decreased upper zone redistribution. There is stable
cardiomegaly. Clips are seen in the right upper quadrant, likely
from prior cholecystectomy. The aorta is calcified, and
calcifications are also seen in the splenic artery.

IMPRESSION:
Improving congestive heart failure.

1.  Coronary angiography of this right dominant system revealed
three
vessel coronary artery disease.  The left main coronary artery
had a 20%
stenosis.  The LAD had a 90% stenosis at the origin.  The LCX
had a 60%
stenosis of the OM1.  The RCA was totally occluded.
2.  Resting hemodynamics revealed mildly elevated right sided
filling
pressures (mean RA pressure was 9 mm Hg and RVEDP was 10 mm Hg).

Pulmonary artery pressures were mildly elevated (PA pressure was
47/18
mm Hg).  Left sided filling pressures were moderately elevated
(mean PCW
pressure was 21 mm Hg).  Central arterial pressure was mildy
elevated
(aortic pressure was 150/63 mm Hg).  Cardiac index was low (at
2.2
L/min/m2).
3. Successful PTCA/stenting of the proximal LAD with a 3.0x13mm
Cypher
DES. Final angiography revealed no residual stenosis, no
dissection and
TIMI-3 flow (see PTCA comments).

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Moderately elevated left sided filling pressures.
3. PCI of the LAD.

ECHO
MEASUREMENTS:
Left Atrium - Long Axis Dimension: *5.0 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: *5.5 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: *5.7 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: *1.4 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Inferolateral Thickness: *1.3 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 4.1 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: *<= 30% (nl >=55%)
Aorta - Valve Level: 2.8 cm (nl <= 3.6 cm)
Aorta - Ascending: 3.2 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: 1.7 m/sec (nl <= 2.0 m/sec)
Mitral Valve - E Wave: 0.7 m/sec
Mitral Valve - A Wave: 1.1 m/sec
Mitral Valve - E/A Ratio: 0.64
Mitral Valve - E Wave Deceleration Time: 455 msec
TR Gradient (+ RA = PASP): *30 to 36 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

LEFT ATRIUM: Moderate LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is
seen in the RA.

LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size.
Severely depressed
LVEF.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic root diameter.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AR.


MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular
calcification. Moderate (2+) MR. LV inflow pattern c/w impaired
relaxation.

TRICUSPID VALVE: Mild PA systolic hypertension.

PERICARDIUM: Small pericardial effusion.

Conclusions:
1. The left atrium is moderately dilated.
2. There is mild symmetric left ventricular hypertrophy. The
left ventricular
cavity size is normal. Overall left ventricular systolic
function is severely
depressed. Anterior, septal, apical, distal inferior, and distal
lateral
severe hypokinesis to akinesis is present.
3. The aortic valve leaflets (3) are mildly thickened.
4. The mitral valve leaflets are mildly thickened. Moderate
mitral
regurgitation is present.
5. There is mild pulmonary artery systolic hypertension.
6. There is a small pericardial effusion.


Brief Hospital Course:
# CHF - The arrived slightly fluid overloaded then had flash
pulmonary edema in the setting of hypertension and fluid
administration on the floor. She was transferred to the ICU for
[**Last Name (un) 62089**] monitoring but did not require intubation. Her echo showed
an EF of less than 30%, 2+ MR, overall left ventricular systolic
function was severely
depressed. Anterior, septal, apical, distal inferior, and distal
lateral
severe hypokinesis to akinesis was present.  She diuresed well
and became euvolemic with a base weight of 49.8kg. She will be
discharged on only Lasix 20mg.
.
# CAD- The patient was transferred here from [**Hospital1 **] for an
NSTEMI. Her cath showed 20% LMCA, 90% LAD which was stented, and
a 60% OM1 lesion. Her RCA was totally occluded.  Her peak
troponin 1.07 and peak CK of 354. She was continued on a ASA
B-blocker, and ACEi.  She was given Crestor because she said she
was allergic to Lipitor and tolerated this well. If her diarrhea
persists, consider stopping Crestor. She should remain on Plavix
for at least 6-9 months.
.
# LBBB. AV paced.  The paitent had a 16 beat run of VT on the
tele monitor here. She was asymotpaitc. She should be evaulated
by her cardiologist for a Biv/ICD pacer if nnecessary.
.
# Acute renal failure- The patient had an increase in her Cr
here thought to be due to contrast. Peak was 1.5 and began to
decrease before discharge. Recheck in [**2-10**] weeks.
.
# Anemia and thrombocytosis: She takes hydrea for essential
thrombocytosis. Also takes procrit as outpt to counteract
hydrea.  Initially her Plavix was doubles to 150 since she has
thrombocytosis, but then she had an episode of blood-streaked
stool therefore her Plavix was reduced to 75. Her HCT decreased
to 26 ans she was transfused 1 unit to a HCT of 32.
.
# Abdominal Pain: The paitent had abdominal pain, nausea, and
vomiting daily at home and this continued here. She is under tha
care of a gastroenterologist as an outpaitent and should make an
appointment as soon as possible. In addition, she had one stool
that was streaked with blood here in the setting of 150 of
Plavix. She then sunsequently had Guiac neg stools. She should
have a colonoscopy as an outpaitent and a HCT checked in 1 week.

Medications on Admission:
1. Aspirin 81mg po daily
2. Synthroid 25mcg po daily
3. Enalapril 20mg po daily
4. Lopressor 100mg po bid
5. Protonix 40mg po daily
6. Methyldopa 750mg po tid
7. Lasix 20mg po daily
8. Hydrea 500mg po bid

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
4. Levothyroxine Sodium 25 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
5. Rosuvastatin Calcium 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Hydroxyurea 500 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Enalapril Maleate 10 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
8. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
9. Methyldopa 250 mg Tablet Sig: Three (3) Tablet PO Q8H (every
8 hours).
10. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
 Injection TID (3 times a day): Continue until the patient is
walking at least TID.
11. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for heartburn.
12. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: Two (2) Tablet Sustained Release 24HR PO DAILY (Daily):
Hold for SBP < 100 and HR < 50   .
13. Loperamide HCl 2 mg Capsule Sig: One (1) Capsule PO every
other day as needed for diarrhea.
14. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily): Do not stop the medication unless you speak with
your cardiologist.
15. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 6 days.
Disp:*6 Tablet(s)* Refills:*0*
16. Epogen 20,000 unit/2 mL Solution Sig: One (1) mL Injection
qMOWEFR: 10,000U qMOWEFR.
17. Pramoxine-Mineral Oil-Zinc 1-12.5 % Ointment Sig: One (1)
Appl Rectal [**Hospital1 **] (2 times a day) as needed.
18. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Discharge Diagnosis:
congestive heart failure
NSTEMI
acute renal failure
diarrhea
sick sinus syndrome


Discharge Condition:
good

Discharge Instructions:
You should weigh yourself daily. Call your PCP if you have a
increase in your weight by more than 3 lbs.
Maintain a 2 L fluid restriction
DO NOT STOP YOUR PLAVIX under any circumstances before speaking
with your cardiologist in the next 9 months.

Followup Instructions:
You have an appointment with Dr. [**First Name (STitle) **], your cardiologist, on
3Pm [**7-4**]. The phone number is ([**Telephone/Fax (1) 20259**].

You should follow up with your gastroenterologist as soon as
possible.
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Atrial fibrillation,Blood in stool,Acute kidney failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other left bundle branch block,Cardiac pacemaker in situ,Old myocardial infarction,Anemia, unspecified,Unspecified diseases of blood and blood-forming organs,Nausea with vomiting,Unspecified acquired hypothyroidism,Pure hypercholesterolemia'}


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: NSTEMI - being transferred for cath

PRESENT ILLNESS: 87 yo female with history of hypertension who presented to
[**Hospital1 **] with chest pain for 2 days and found to have a NSTEMI
as per cardiac enzymes. Peak Trop I was 0.96 although CKs have
remained flat as per outside hospital. Patient continued to have
episodes of chest pain that were being treated with SL NTG with
improvement. Denies any other associated symptoms including
nausea, vomiting, diaphoresis. However, did note that the pain
radiated to both of her arms. Patient went into mild heart
failure yesterday after getting IVF but seems to be improving
with IV Lasix. Was seen by Cardiology this morning, and was
started on Lipitor, Heparin gtt and Integrillin gtt and
requested to be transferred here for cath. She refused Lipitor
because she is allergic to it. Being transferred here for cath
and further management.

MEDICAL HISTORY: 1. Hypertension
2. Hypothyroidism
3. Atrial Fibrillation
4. Sick Sinus Syndrome s/p pacemaker
5. Hyperlipidemia
6. Congestive Heart Failure
7. Myocardial Infarction x 2 prior episodes (as per patient)
8. chronic mesenteric ischemia - followed by a
gastroenterologist

MEDICATION ON ADMISSION: 1. Aspirin 81mg po daily
2. Synthroid 25mcg po daily
3. Enalapril 20mg po daily
4. Lopressor 100mg po bid
5. Protonix 40mg po daily
6. Methyldopa 750mg po tid
7. Lasix 20mg po daily
8. Hydrea 500mg po bid

ALLERGIES: Lipitor / Codeine / Procardia / Iodine / Pepcid / Catapres

PHYSICAL EXAM: VS: Temp 98.9, Pulse 64, BP 145/55, RR 18, O2 sat 97% on 2
liters
GEN: comfortable, NAD
HEENT: OP clear, EOMI, PERRLA
NECK: no JVD noted, supple
LUNGS: CTA bilateral
HEART: S1, S2, RRR, no murmurs, rubs, gallops
ABD: soft, ND, NT, no HSM, + bowel sounds
EXTREM: no edema, cyanosis, clubbing
NEURO: AAO x3, CN II-XII tested and grossly intact

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Patient lives with her elder son who was recently diagnosed with
lng cancer; patient denies any tobacco, EtOH of recreational
drug use 

### Response:
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Atrial fibrillation,Blood in stool,Acute kidney failure, unspecified,Other drugs and medicinal substances causing adverse effects in therapeutic use,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other left bundle branch block,Cardiac pacemaker in situ,Old myocardial infarction,Anemia, unspecified,Unspecified diseases of blood and blood-forming organs,Nausea with vomiting,Unspecified acquired hypothyroidism,Pure hypercholesterolemia'}
