CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 73-year-old
with hypertension, diabetes mellitus, who was admitted with
chest pain and found to have ST elevations and was sent to
CCU for emergent cath.  For at least past several months the
patient has been noticing some dyspnea on exertion, unclear
exertion.  She can still walk up the stairs or walk a block
but has been getting slowly worse recently.  Also
intermittent chest pain, not severe, which resolves on its
own.  Four days prior to admission she began having more
severe chest pain.  The pain started at 3 o'clock. This was
associated with nausea, and radiation up to neck and to the
left breast.  Denies diaphoresis.  She complains of some
feel slightly better.  This lasted several hours before
resolving.  The pain did not seem to wax and wane during this
time.  On the morning of admission the same pain was noticed
more severe but with cold sweats were experienced and the
patient was taken to the Emergency Room.  The patient reports
that she previously felt well, otherwise, had recent episode
of flu.  Also received flu shot.  She sleeps on one pillow,
no PND.

MEDICAL HISTORY: Hypertension, history of congestive
heart failure thought to be secondary to hypertension, no
history of stress test or echocardiogram.  Diabetes mellitus,
elevated lipids, right knee arthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for history of myocardial
infarction.

SOCIAL HISTORY: No tobacco or alcohol use.  She has three
daughters and one son, takes care of husband with [**Name (NI) 2481**]
disease.
Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Mitral valve disorders,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Pure hypercholesterolemia
AMI inferior wall, init,CHF NOS,Mitral valve disorder,Urin tract infection NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Chr pulmon heart dis NEC,Pure hypercholesterolem
Admission Date:  [**2147-2-4**]       Discharge Date:  [**2147-2-8**]

Date of Birth:   [**2073-5-10**]       Sex:  F

Service:  CCU
HISTORY OF PRESENT ILLNESS:  The patient is a 73-year-old
with hypertension, diabetes mellitus, who was admitted with
chest pain and found to have ST elevations and was sent to
CCU for emergent cath.  For at least past several months the
patient has been noticing some dyspnea on exertion, unclear
exertion.  She can still walk up the stairs or walk a block
but has been getting slowly worse recently.  Also
intermittent chest pain, not severe, which resolves on its
own.  Four days prior to admission she began having more
severe chest pain.  The pain started at 3 o'clock. This was
associated with nausea, and radiation up to neck and to the
left breast.  Denies diaphoresis.  She complains of some
feel slightly better.  This lasted several hours before
resolving.  The pain did not seem to wax and wane during this
time.  On the morning of admission the same pain was noticed
more severe but with cold sweats were experienced and the
patient was taken to the Emergency Room.  The patient reports
that she previously felt well, otherwise, had recent episode
of flu.  Also received flu shot.  She sleeps on one pillow,
no PND.

At the outside hospital Emergency Room she was chest pain
free but with  EKG changes.  Pain recurred.  Patient received
Morphine Sulfate, Nitroglycerin, Aggrastat, Heparin and Lasix
which made her pain free.

Labs were significant for troponin 3.79, creatinine 1.1,
hematocrit 41. She was then transferred from [**Location (un) 31315**],
[**State 350**] by [**Location (un) **] to [**Hospital1 188**] cath lab.  In cath lab she had a wedge of 28 with a V
wave of 40 left ventricular end diastolic pressure measured
24.  She had a low normal ejection fraction with inferior
wall motion abnormality and 4+ MR.  LAD was seen with 80%
stenosis at first septal and was not intervened upon at this
point.  Left circumflex showed 60% stenosis OM1, RCA with 90%
proximal PDA and 95% RCA before PDA with avulsed plaque and
thrombus as well as 70% stenosis of mid RCA.  Three stents
placed in right coronary artery and the patient was sent to
the ICU.

In the ICU the patient denied chest pain, shortness of
breath, diaphoresis or nausea.

PAST MEDICAL HISTORY:  Hypertension, history of congestive
heart failure thought to be secondary to hypertension, no
history of stress test or echocardiogram.  Diabetes mellitus,
elevated lipids, right knee arthritis.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  At home, Lopressor 100 mg q d, Lisinopril 20 mg
[**Hospital1 **], enteric coated Aspirin 81 mg once a day, Lipitor 10 mg
once a day, Zantac prn, Indocin prn, Glucophage 1,000 mg [**Hospital1 **],
Glucotrol 10 mg [**Hospital1 **], Hydrochlorothiazide 25 mg once a day and
Cartia XT 240 mg once a day.

SOCIAL HISTORY:  No tobacco or alcohol use.  She has three
daughters and one son, takes care of husband with [**Name (NI) 2481**]
disease.

FAMILY HISTORY:  Significant for history of myocardial
infarction.

PHYSICAL EXAMINATION:  Weight 82 kg, temperature 96.3, pulse
95, blood pressure 149/96, oxygen saturation 96% on three
liters.  In general, obese, not in acute distress, alert.
Pupils equal, round and reactive to light and accommodation,
bilateral extraocular movements intact.  Neck supple.  JVP
elevated.  Cardiac, regular rhythm and rate, normal S1 and
S2, [**4-20**] holosystolic murmur throughout precordium, unable to
auscultate well at the axilla anteriorly.  Pulmonary, clear
to auscultation with some decreased breath sounds at the
bases.  Abdomen, positive bowel sounds, mild tenderness in
the left lower quadrant, no guarding, no rebound, trace lower
extremity edema.

LABORATORY DATA:  At the outside hospital white cell count
12.5, hematocrit 44.9, platelet count 269,000, CK 131, MB
4.1, troponin 3.79.  Chem 7, sodium 139, potassium 3.7,
chloride 104, CO2 27.8, BUN 18, creatinine 1.1, glucose 223.
EKG prior to the catheterization as below with ST elevations
inferior leads with 0.5 to 1 mm and 3 mm depression in
anterior leads as well as T wave flattening laterally.  Post
cath normal sinus rhythm at 87, normal axis, normal
intervals, question of left atrial enlargement, Q waves in
lead 3 and small Q wave in AVF, 0.[**Street Address(2) 1755**] elevation in lead 3
with biphasic T waves inferiorly, ST depression of 2 mm
anteriorly with early R wave progression as well as T wave
inversions.

HOSPITAL COURSE:  The patient was admitted to the CCU.  She
was continued on Aspirin and Plavix and Aggrastat, Lipitor,
ACE inhibitor and beta blocker.  She was diuresed with Lasix.
Echo at the bedside was done and showed no flail leaflet.  On
[**2-6**] she was transferred to the regular floor, had no
complaints of chest pain or shortness of breath.  She was
taken back to the cath lab on [**2-6**] for LAD intervention.
Her LAD was stented. Cardiac catheterization showed pulmonary
capillary wedge of 20 and ejection fraction of more than 60.
Cardiac echo done on [**2-6**] showed mild dilation of left atrium,
LVEF more than 55%, mildly thickened aortic valve leaflets and
mitral valve leaflets as well as trivial pericardial effusion.
She was discharged to home on [**2147-2-8**] on a cardiac healthy diet
in good condition.

DISCHARGE MEDICATIONS:  Lipitor 10 mg once a day, Aspirin 162
mg once a day, Hydrochlorothiazide 25 mg once a day, Cartia
200 40 mg po q d, Lopressor 100 mg po tid, Zestril 20 mg po
bid, Glucophage 1 gm po bid and Glucotrol 100 mg po tid,
Ciprofloxacin 500 mg po bid for 7 day course for a urinary
tract infection and Plavix 75 mg po q d for 12 months.

FOLLOW-UP:  The patient will follow-up with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 284**] within 1-2 weeks from discharge.

DISCHARGE DIAGNOSIS:
1.  Myocardial infarction, status post RCA stenting times
three and LCA stenting times one.
2.  Diabetes.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Congestive heart failure.
6.  Gout.




                    [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3812**]

Dictated By:[**Doctor Last Name 47224**]
MEDQUIST36

D:  [**2147-2-8**]  11:20
T:  [**2147-2-8**]  12:32
JOB#:  [**Job Number 47225**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Mitral valve disorders,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other chronic pulmonary heart diseases,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: 

PRESENT ILLNESS: The patient is a 73-year-old
with hypertension, diabetes mellitus, who was admitted with
chest pain and found to have ST elevations and was sent to
CCU for emergent cath.  For at least past several months the
patient has been noticing some dyspnea on exertion, unclear
exertion.  She can still walk up the stairs or walk a block
but has been getting slowly worse recently.  Also
intermittent chest pain, not severe, which resolves on its
own.  Four days prior to admission she began having more
severe chest pain.  The pain started at 3 o'clock. This was
associated with nausea, and radiation up to neck and to the
left breast.  Denies diaphoresis.  She complains of some
feel slightly better.  This lasted several hours before
resolving.  The pain did not seem to wax and wane during this
time.  On the morning of admission the same pain was noticed
more severe but with cold sweats were experienced and the
patient was taken to the Emergency Room.  The patient reports
that she previously felt well, otherwise, had recent episode
of flu.  Also received flu shot.  She sleeps on one pillow,
no PND.

MEDICAL HISTORY: Hypertension, history of congestive
heart failure thought to be secondary to hypertension, no
history of stress test or echocardiogram.  Diabetes mellitus,
elevated lipids, right knee arthritis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for history of myocardial
infarction.

SOCIAL HISTORY: No tobacco or alcohol use.  She has three
daughters and one son, takes care of husband with [**Name (NI) 2481**]
disease. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Mitral valve disorders,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other chronic pulmonary heart diseases,Pure hypercholesterolemia'}
