CHIEF COMPLAINT: Few months of progressive shortness of
breath, atrial fibrillation for more than two weeks, inferior
myocardial infarction by EKG, and transferred here for
catheterization.

PRESENT ILLNESS: This is a 78 year old man with
cardiac risk factors of sex, age, hypertension, with
reportedly negative cardiac work-up which included stress
test in [**2127**] as part of preoperative evaluation, who presents
with two months of progressive shortness of breath.  He
reportedly presented to his primary care physician about two
weeks prior to admission with shortness of breath.  The
patient reported being treated for asthma and hay fever with
inhalers (question of Albuterol) at that time.  Questionable
EKG showed atrial fibrillation at that time.

MEDICAL HISTORY: 1.  Penectomy and scrotoplasty for squamous cell carcinoma at
the penis in [**2127**].
2.  Spinal stenosis.
3.  Hypertension, borderline.
4.  Right leg fracture.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Questionable heart disease.  Mother had
diabetes mellitus.

SOCIAL HISTORY: Twenty pack year tobacco history; stopped in
[**2092**].  Alcohol with one drink per month.  Retired factory
owner.  Two children; lives with wife.  Active, plays tennis
twice a week.
Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery
AMI inferior wall, init,CHF NOS,Atrial fibrillation,Urin tract infection NOS,Crnry athrscl natve vssl
Admission Date:  [**2131-10-11**]     Discharge Date:  [**2131-10-15**]


Service:  CCU

CHIEF COMPLAINT:    Few months of progressive shortness of
breath, atrial fibrillation for more than two weeks, inferior
myocardial infarction by EKG, and transferred here for
catheterization.

HISTORY OF PRESENT ILLNESS:  This is a 78 year old man with
cardiac risk factors of sex, age, hypertension, with
reportedly negative cardiac work-up which included stress
test in [**2127**] as part of preoperative evaluation, who presents
with two months of progressive shortness of breath.  He
reportedly presented to his primary care physician about two
weeks prior to admission with shortness of breath.  The
patient reported being treated for asthma and hay fever with
inhalers (question of Albuterol) at that time.  Questionable
EKG showed atrial fibrillation at that time.

He continued to have increased shortness of breath with
dyspnea on exertion with difficulty playing tennis.  The last
two days, he also had difficulty with stairs at home (ten
steps).  He also reported one week of chest heaviness,
worsened with exertion and one day of chest discomfort
radiating to the neck (at rest when in bed).  He also had
paroxysmal nocturnal dyspnea, orthopnea but no palpitations.

His wife reportedly was taking his pulses and they were
irregular in the 80s for about two weeks.  He presented to
the [**Hospital3 3834**] with moderate respiratory distress and
atrial fibrillation with rapid ventricular rate.  His initial
O2 saturation was 88%.  He was given Lasix 30 mg
intravenously, digoxin 0.25 mg, Nitroglycerin drip with very
good response.  Diltiazem was also started for rate control.

His EKG showed an IMR pattern.  He was then started on
heparin.  His initial CK there was 323, CK MB 11, MB index
3.4 and troponin 16.2.  He was transferred to [**Hospital1 346**] for percutaneous transluminal
coronary angioplasty.

PAST MEDICAL HISTORY:
1.  Penectomy and scrotoplasty for squamous cell carcinoma at
the penis in [**2127**].
2.  Spinal stenosis.
3.  Hypertension, borderline.
4.  Right leg fracture.

MEDICATIONS:
1.  Aspirin p.r.n.
2.  Inhalers, questionable Albuterol, q. six.

ALLERGIES:   No known drug allergies.

FAMILY HISTORY:  Questionable heart disease.  Mother had
diabetes mellitus.

SOCIAL HISTORY:  Twenty pack year tobacco history; stopped in
[**2092**].  Alcohol with one drink per month.  Retired factory
owner.  Two children; lives with wife.  Active, plays tennis
twice a week.

REVIEW OF SYSTEMS:   No bright red blood per rectum.  No
fevers, chills, no melena.  No abdominal pain; no fever or
chills, no nausea or vomiting, no diarrhea.

PHYSICAL EXAMINATION:  On admission to Cardiac Care Unit,
temperature 98.9 F.; pulse 87 to 90, irregular; blood
pressure 106/53; respiratory rate 24; O2 saturation 93%.  In
general, tachypneic while lying flat in bed but able to talk.
Head and Neck examination with moist mucous membranes.
Oropharynx clear.  Pupils equally round and reactive to
light.  Neck with jugular venous distention about ten cm;
carotids without bruits.  Cardiovascular:  Irregularly
irregular rate, II/VI systolic murmur radiating to the apex.
Lungs with bilateral basilar crackles; no wheezes.  Abdomen
soft, nondistended, nontender.  No hepatosplenomegaly.  Right
groin sheath.  Extremities with distal pulses one plus
bilaterally.  No edema.  Lines: Foley catheter to gravity,
right groin arterial sheath.

LABORATORY:  At [**Hospital3 3834**] [**Hospital3 **], white blood cell
count 16.3, hematocrit 39.8, platelets 214.  Sodium 134,
potassium 4.6, chloride 98, bicarbonate 28, BUN 27,
creatinine 1.5, glucose 135.

ALT 55, AST 146, alkaline phosphatase 156, albumin 3.5, total
bilirubin 0.8.  CK 323, CK MB 11, troponin 16.7, TSH 6.36.

LABORATORY:  At [**Hospital1 69**] are
white blood cell count 17.7, hematocrit 40, platelets 223, PT
14.5, PTT 35.5, INR 1.4.

Urinalysis with small amount of blood, negative nitrites,
small amount of leukocyte esterase.  Negative protein,
glucose, ketones or bilirubin.  Zero to two white blood
cells, 21 to 50 white blood cells, moderate bacteria, no
yeast, zero to two epithelials.

Chem-7 is sodium 132, potassium 4.0, chloride 95, bicarbonate
25, BUN 26, creatinine 1.3, glucose 175.  CK 285, CK MB 12,
MB index 4.2.  Calcium 8.7, magnesium 1.7, phosphorus 3.6.
Triglycerides 61, HDL 46, LDL 63.

His urinalysis, urine cultures came back to be greater than
100,000 E. coli, pan sensitive.

Chest x-ray with bilateral patchy interstitial blurring
consistent with pulmonary edema, left lower lobe
atelectasis/infiltrates, with possible left sided pleural
effusion.

HOSPITAL COURSE:  Catheterization report:  Two vessel
coronary artery disease.  Successful primary stenting of the
distal right coronary artery, successful stenting of the left
PLV, coronary angiograph of the right dominant system reveals
severe two vessel coronary artery disease.  The left main
coronary artery had no angiographic evidence of stenosis.
The left anterior descending artery had a 40% mid-segment
stenosis.  The circumflex system revealed the first obtuse
marginal branch with a 50% stenosis at its origin.  The
posterior lateral branch of the circumflex showed a 90%
stenosis.  The right coronary artery revealed total occlusion
just after origin of the posterior descending artery.

Hemodynamic evaluation revealed evidence of elevated right
and left heart filling pressure with mean right atrial
pressure of 12 and wedge of 20.  Successful lytic
thrombectomy and stenting of the distal right coronary artery
with a 3.5 x 28 mm Express tube stent.  No residual stenosis.
TIMI II test fast flow.  Successful percutaneous
transluminal coronary angioplasty and stenting of the L-TLV
was performed using a 2.5 x 18 mm pigtail stent resulting in
no residual stenosis, no apparent dissection and normal flow.

Transthoracic echocardiogram with ejection fraction of 25%.
The left atrium is mildly dilated.  There is moderate
symmetrical left ventricular hypertrophy.  The left
ventricular cavity size is normal.  Overall, left ventricular
systolic function severely depressed.  Left ventricular wall
motion abnormality including inferior septal, inferior and
posterior lateral akinesis.  The remaining left ventricular
segments are hypokinetic.  Right ventricular chamber size is
normal.  There is severe global right ventricular free wall
hypokinesis.  The ascending aorta is mildly dilated.  The
aortic valve ..................; no aortic regurgitation is
seen.  Moderate two plus mitral regurgitation is seen.  There
is no pericardial effusion.

HOSPITAL COURSE:  The patient remained stable without
complaints in the hospital.  He started to trend down in the
hospital from a peak CK of 285 on admission.  He remained in
atrial fibrillation on Telemetry and was started on
Metoprolol with good rate control.

His transthoracic echocardiogram showed an ejection fraction
of 25%.  He was started on an anti-coagulation regimen with
heparin and Coumadin for atrial fibrillation and low ejection
fraction.  His respiratory status was also improved with some
gentle diuresis.  His INR was still subtherapeutic on the day
of discharge, therefore, he was sent home on Lovenox and
Coumadin.  A [**Hospital6 407**] was arranged for
daily Lovenox injections.

While in-house he was also treated with a five day course of
Levaquin for asymptomatic urinary tract infection.  His most
recent labs before discharge were white blood cell count of
15.5, hematocrit of 39.2, platelets 278, PT 14.4, PTT 59.7,
INR 1.4.

CONDITION AT DISCHARGE:   Stable.

DISCHARGE STATUS:  Home.

DISCHARGE DIAGNOSES:
1.  Status post acute inferior myocardial infarction.
2.  Status post left circumflex stent and right coronary
artery stent.
3.  Coronary artery disease.
4.  Urinary tract infection.
5.  Penile cancer status post total resection.

DISCHARGE MEDICATIONS:
1.  Lisinopril 5 mg q. day.
2.  Metoprolol 25 mg twice a day.
3.  Furosemide 20 mg q. day.
4.  Lovenox 100 mg subcutaneously q. day until INR greater
than 2.0.
5.  Levofloxacin 250 mg q. day for two more days until
[**10-16**].
6.  Warfarin 5 mg q. h.s.
7.  Plavix 75 mg q. day for 30 days until [**2131-11-11**].
8.  Aspirin 325 mg q. day.

DISCHARGE INSTRUCTIONS:
1.  The patient's primary care physician is [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 12585**]
at [**Telephone/Fax (1) 44991**].  The patient does not have a Cardiologist.
He needs a Cardiologist for his outpatient follow-up.  Dr.
[**Last Name (STitle) **] will recommend a Cardiologist for his outpatient
follow-up.
2.  He will also have his INR checked on Wednesday [**2131-10-17**].  The goal of his INR would be 2.0 to 3.0.


                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Last Name (NamePattern1) 225**]

MEDQUIST36

D:  [**2131-10-14**]  20:08
T:  [**2131-10-17**]  15:03
JOB#:  [**Job Number 44992**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery'}


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: Few months of progressive shortness of
breath, atrial fibrillation for more than two weeks, inferior
myocardial infarction by EKG, and transferred here for
catheterization.

PRESENT ILLNESS: This is a 78 year old man with
cardiac risk factors of sex, age, hypertension, with
reportedly negative cardiac work-up which included stress
test in [**2127**] as part of preoperative evaluation, who presents
with two months of progressive shortness of breath.  He
reportedly presented to his primary care physician about two
weeks prior to admission with shortness of breath.  The
patient reported being treated for asthma and hay fever with
inhalers (question of Albuterol) at that time.  Questionable
EKG showed atrial fibrillation at that time.

MEDICAL HISTORY: 1.  Penectomy and scrotoplasty for squamous cell carcinoma at
the penis in [**2127**].
2.  Spinal stenosis.
3.  Hypertension, borderline.
4.  Right leg fracture.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Questionable heart disease.  Mother had
diabetes mellitus.

SOCIAL HISTORY: Twenty pack year tobacco history; stopped in
[**2092**].  Alcohol with one drink per month.  Retired factory
owner.  Two children; lives with wife.  Active, plays tennis
twice a week. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Atrial fibrillation,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery'}
