CHIEF COMPLAINT: chest pain, transferred from outside hospital

PRESENT ILLNESS: 85 F with HTN who p/w extertional substernal CP to [**Hospital1 3325**]. +Lightheadedness but no SOB, N, V, diaphoresis, or
radiation. Noted to have STE of 2-3mm in V2-4 so started on
heparin gtt, nitroglycerine gtt, given reapro, lopressor, ASA,
and morphine sulfate. Transferred to [**Hospital1 18**] for emergent cath.
ROS otherwise noncontributory.

MEDICAL HISTORY: hypertension
s/p appendectomy
s/p bilateral cataract surgery

MEDICATION ON ADMISSION: hydrochlorothiazide, unknown dose

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP 133/105, HR 94, RR 16, 96% O2 sat on RA
Gen: elderly F in no apparent distress
Skin: L lower extremity with large ulcer
HEENT: NCAT, nl JVD, full ROM
Heart: irregularly irregular rate & rhythm, S1S2, no murmurs
appreciated
Lungs: CTA bilaterally
Abdomen: benign
Extremities: 2+ pulses, no edema, full ROM
Neuro: A&Ox3, conversant, appropriate. CN2-12 intact. [**5-16**]
strength throughout.

FAMILY HISTORY: Father died from lung CA in 50s. Mother died at age 82 from AAA.
Brother with MI at age [**Age over 90 **].

SOCIAL HISTORY: Independent in ADLs. Lives alone.
Acute myocardial infarction of other anterior wall, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified
AMI anterior wall, init,Atrial fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Anemia NOS
Admission Date:  [**2164-8-21**]              Discharge Date:   [**2164-8-26**]


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

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
chest pain, transferred from outside hospital

Major Surgical or Invasive Procedure:
cardiac catheterization with stents placed


History of Present Illness:
85 F with HTN who p/w extertional substernal CP to [**Hospital1 3325**]. +Lightheadedness but no SOB, N, V, diaphoresis, or
radiation. Noted to have STE of 2-3mm in V2-4 so started on
heparin gtt, nitroglycerine gtt, given reapro, lopressor, ASA,
and morphine sulfate. Transferred to [**Hospital1 18**] for emergent cath.
ROS otherwise noncontributory.

Past Medical History:
hypertension
s/p appendectomy
s/p bilateral cataract surgery

Social History:
Independent in ADLs. Lives alone.

Family History:
Father died from lung CA in 50s. Mother died at age 82 from AAA.
Brother with MI at age [**Age over 90 **].

Physical Exam:
BP 133/105, HR 94, RR 16, 96% O2 sat on RA
Gen: elderly F in no apparent distress
Skin: L lower extremity with large ulcer
HEENT: NCAT, nl JVD, full ROM
Heart: irregularly irregular rate & rhythm, S1S2, no murmurs
appreciated
Lungs: CTA bilaterally
Abdomen: benign
Extremities: 2+ pulses, no edema, full ROM
Neuro: A&Ox3, conversant, appropriate. CN2-12 intact. [**5-16**]
strength throughout.

Pertinent Results:
CK peak [**2090**] (at admission on [**2164-8-21**])
Creatinine remained WNL throughout hospital stay
CBC WNL

Brief Hospital Course:
85 F with HTN who p/w extertional substernal CP to outside
hospital & noted to have STE of 2-3mm in V2-4. Started on
heparin gtt, nitroglycerine gtt, given reapro, lopressor, ASA,
MSO4, and transferred here for emergent cath.

C. Cath ([**2164-8-21**]) showed: Mid RCA 80%, acute marginal 80%, Mid
LAD 100%, diag-1 diffusely diseased. Hepacoat stent->mid LAD &
D1, & 3rd in overlapping manner with mid LAD stent. PTCA to prox
LAD. Residual 10% in pLAD and 20% in origin of Diag. PCWP of 25
mm Hg. Right-sided filling pressures normal, RA 6mmHg and an
RVEDP of 4 mm Hg. PA pres 30/20 mm Hg. CI by Fick 1.6. IABP
placed due to low CI.

Pt was then admitted to CCU for close monitoring & medical
management.

## CAD: pt transferred here with STEMI s/p catheterization with
stents & intraaortic balloon pump (IABP) placement as described
above.  Pt was weaned off of IABP within 24 hours after arrival
to CCU.  Pt had only been on HCTZ at home.  She was started on
captopril, metoprolol, and atorvastatin for secondary cardiac
prevention.  She was also continued on aspirin and plavix.  Pt
to follow-up with cardiologist at [**Hospital3 3583**].  Recommend
considering reintervention of RCA at later date.

## PUMP: Echocardiogram on [**2164-8-22**] revealed EF35-40%; biatrial
enlargement; distal ant septum, distal ant wall, distal inf
wall, and apex are AK; mild concentric LVH; mild AR, mild MR,
mild TR.  Given akinesis, recommend anticoagulation for at least
2 months.  Recommend outpatient rechecking of echo in [**1-13**] months
to reassess LV recovery after MI.

## Rhythm: Pt noted to be in atrial fibrillation here. Pt was
initially on heparin drip for afib and for IABP. Pt started on
coumadin and was near-therapeutic on this at discharge.  Given
relatively low daily risk of event from this, pt was continued
on coumadin at discharge with plan to follow-up with PCP for
continued titration with goal INR [**2-14**].

## HTN: started metoprolol (changed to Toprol XL at discharge),
captopril (changed to lisinopril at d/c). Continue to monitor as
outpatient.

## Left lower leg ulcer: very likely malignancy given 10 yr hx.
Dermatology was consulted and believe that this is likely basal
cell carcinoma.  Biopsy done and results pending.  Pt has appt
with Dr. [**Last Name (STitle) **] of oncology for outpt follow-up after discharge.

## Prophylaxis: Pt on anticoagulation as above.  Pt also on
colace, ranitidine.

## Contact: [**Name (NI) **] [**Name (NI) **]: home [**Telephone/Fax (1) 58289**], work [**Telephone/Fax (1) 58290**]

Medications on Admission:
hydrochlorothiazide, unknown dose

Discharge Medications:
1. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
2. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO QD
(once a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Warfarin Sodium 1 mg Tablet Sig: Five (5) Tablet PO at
bedtime: please have blood checked (INR) within 1 week.
Disp:*180 Tablet(s)* Refills:*2*
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day): for upset stomach.
Disp:*60 Tablet(s)* Refills:*2*
6. Toprol XL 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*
7. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
acute myocardial infarction
atrial fibrillation
lower extremity ulcer (~2 inch diameter) likely basal cell
carcinoma


Discharge Condition:
stable

Discharge Instructions:
contact MD or go to emergency room if you develop: fever/chills,
chest pain, shortness of breath, or other concerning symptoms

please have blood test drawn within 1 week (to check INR to see
how well the warfarin is working)

Followup Instructions:
follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5310**] of Cardiology at [**Hospital1 3325**] ([**Telephone/Fax (1) 5315**]; [**Last Name (un) 34851**] [**Location (un) **], [**Numeric Identifier **])
within 2-4 weeks

follow-up with primary care physician [**Name Initial (PRE) 176**] 1 week to have
blood checked for INR

Provider: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]/CUT. ONC. DERM. Where: CUTANEOUS
ONCOLOGY Date/Time:[**2164-8-29**] 11:30



Completed by:[**2164-8-26**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified'}


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, transferred from outside hospital

PRESENT ILLNESS: 85 F with HTN who p/w extertional substernal CP to [**Hospital1 3325**]. +Lightheadedness but no SOB, N, V, diaphoresis, or
radiation. Noted to have STE of 2-3mm in V2-4 so started on
heparin gtt, nitroglycerine gtt, given reapro, lopressor, ASA,
and morphine sulfate. Transferred to [**Hospital1 18**] for emergent cath.
ROS otherwise noncontributory.

MEDICAL HISTORY: hypertension
s/p appendectomy
s/p bilateral cataract surgery

MEDICATION ON ADMISSION: hydrochlorothiazide, unknown dose

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP 133/105, HR 94, RR 16, 96% O2 sat on RA
Gen: elderly F in no apparent distress
Skin: L lower extremity with large ulcer
HEENT: NCAT, nl JVD, full ROM
Heart: irregularly irregular rate & rhythm, S1S2, no murmurs
appreciated
Lungs: CTA bilaterally
Abdomen: benign
Extremities: 2+ pulses, no edema, full ROM
Neuro: A&Ox3, conversant, appropriate. CN2-12 intact. [**5-16**]
strength throughout.

FAMILY HISTORY: Father died from lung CA in 50s. Mother died at age 82 from AAA.
Brother with MI at age [**Age over 90 **].

SOCIAL HISTORY: Independent in ADLs. Lives alone. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Anemia, unspecified'}
