CHIEF COMPLAINT: Transfer for STEMI

PRESENT ILLNESS: HPI:  69 Year old man with a PMH of STEMI w/ stents to the LAD
in [**2160**] presents today after transfer via [**Location (un) **] from [**Location (un) **]
where he came this am with chest pain determined via ECG to be
an anterior MI.  His pain was relieved by Nitroglycerin.  In the
cath lab at [**Hospital1 18**], he had a cypher stent placed to the LAD where
the previous stent had re-stenosed.  The right side was also
found to be stenotic approx. 90% but this was not stented today.
 The pt. denies SOB, CP, DOE, PND, orthopnea, cough, nausea,
vomiting.  Plan is to return to cath lab in 2 days for stenting
of the right sided lesion(s).  The patient is now resting
comfortably in NAD and no CP.

MEDICAL HISTORY: S/P STEMI in [**2160**] with stent to the LAD
HTN
S/P broken ribs (L)
Former alcoholic
S/P Macular repair
Alcohol withdrawl syndrome
GI bleeding

MEDICATION ON ADMISSION: Atenolol 25, Lipitor 10 Daily, Norvasc 5 4x/day, [**Last Name (STitle) **] 325, Vit
B1, Occuvite

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- 102/65  56   14  T 99.4
HEENT- PERRL, EOMI, MMM
CV- RRR, No M/R/G S1, S2, S3 present; 2+ puluses DP, PT, Radial,
Carotid; No carotid bruits.
Lung- CTA Bilat.
Abd- NT, ND, BSNA, No HSM, No Masses
Ext- No C/C/E
Neuro- A and O x 3, CN II-XII intact

FAMILY HISTORY: Father had MI age 89
Brother with [**Name (NI) 10563**] Lymphoma
Sister with Leukemia
Macular Degeneration

SOCIAL HISTORY: Golf course attendant; married; current smoker 1ppd x >30 pack
years.  1 [**1-27**] Glasses of red wine per day (but prior hx of heavy
drinking)
Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Coronary atherosclerosis of native coronary artery,Other and unspecified alcohol dependence, in remission,Unspecified essential hypertension
AMI anterior wall, init,Comp-oth cardiac device,Crnry athrscl natve vssl,Alcoh dep NEC/NOS-remiss,Hypertension NOS
Admission Date:  [**2165-9-23**]              Discharge Date:   [**2165-9-26**]

Date of Birth:  [**2095-10-31**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2078**]
Chief Complaint:
Transfer for STEMI

Major Surgical or Invasive Procedure:
Caridac catheterizations on [**9-23**] and [**9-25**]


History of Present Illness:
HPI:  69 Year old man with a PMH of STEMI w/ stents to the LAD
in [**2160**] presents today after transfer via [**Location (un) **] from [**Location (un) **]
where he came this am with chest pain determined via ECG to be
an anterior MI.  His pain was relieved by Nitroglycerin.  In the
cath lab at [**Hospital1 18**], he had a cypher stent placed to the LAD where
the previous stent had re-stenosed.  The right side was also
found to be stenotic approx. 90% but this was not stented today.
 The pt. denies SOB, CP, DOE, PND, orthopnea, cough, nausea,
vomiting.  Plan is to return to cath lab in 2 days for stenting
of the right sided lesion(s).  The patient is now resting
comfortably in NAD and no CP.


Past Medical History:
S/P STEMI in [**2160**] with stent to the LAD
HTN
S/P broken ribs (L)
Former alcoholic
S/P Macular repair
Alcohol withdrawl syndrome
GI bleeding


Social History:
Golf course attendant; married; current smoker 1ppd x >30 pack
years.  1 [**1-27**] Glasses of red wine per day (but prior hx of heavy
drinking)


Family History:
Father had MI age 89
Brother with [**Name (NI) 10563**] Lymphoma
Sister with Leukemia
Macular Degeneration

Physical Exam:
Vitals- 102/65  56   14  T 99.4
HEENT- PERRL, EOMI, MMM
CV- RRR, No M/R/G S1, S2, S3 present; 2+ puluses DP, PT, Radial,
Carotid; No carotid bruits.
Lung- CTA Bilat.
Abd- NT, ND, BSNA, No HSM, No Masses
Ext- No C/C/E
Neuro- A and O x 3, CN II-XII intact

Pertinent Results:
[**2165-9-23**] 11:16PM   POTASSIUM-4.2
[**2165-9-23**] 11:16PM   CK(CPK)-803*
[**2165-9-23**] 11:16PM   CK-MB-87* MB INDX-10.8* cTropnT-4.38*
[**2165-9-23**] 11:16PM   PLT COUNT-135*
[**2165-9-23**] 01:32PM   TYPE-ART O2 FLOW-2 PO2-70* PCO2-40 PH-7.37
TOTAL CO2-24 BASE XS--1 INTUBATED-NOT INTUBA
[**2165-9-23**] 01:32PM   GLUCOSE-142* K+-3.7
[**2165-9-23**] 01:32PM   HGB-14.1 calcHCT-42 O2 SAT-90
[**2165-9-23**] 01:30PM   GLUCOSE-150* UREA N-16 CREAT-1.3* SODIUM-141
POTASSIUM-3.8 CHLORIDE-109* TOTAL CO2-22 ANION GAP-14
[**2165-9-23**] 01:30PM   ALT(SGPT)-22 AST(SGOT)-21 CK(CPK)-63 ALK
PHOS-88 AMYLASE-94 TOT BILI-0.4
[**2165-9-23**] 01:30PM   CK-MB-NotDone cTropnT-<0.01
[**2165-9-23**] 01:30PM   ALBUMIN-3.9 CHOLEST-142
[**2165-9-23**] 01:30PM   %HbA1c-5.6 [Hgb]-DONE [A1c]-DONE
[**2165-9-23**] 01:30PM   TRIGLYCER-53 HDL CHOL-54 CHOL/HDL-2.6
LDL(CALC)-77 LDL([**Last Name (un) **])-85
[**2165-9-23**] 01:30PM   WBC-14.9*# RBC-4.87# HGB-14.9# HCT-43.9#
MCV-90 MCH-30.6 MCHC-34.0 RDW-13.0
[**2165-9-23**] 01:30PM   NEUTS-84.3* LYMPHS-12.0* MONOS-3.4 EOS-0.3
BASOS-0.1
[**2165-9-23**] 01:30PM   PLT COUNT-147*
[**2165-9-23**] 01:30PM   PT-14.7* PTT->150* INR(PT)-1.4

Brief Hospital Course:
Assessment: 69 Year old man with a PMH of STEMI w/ stents to the
LAD presents today with STEMI requiring stents to LAD and plan
to re-cath with Right sided stents in 2 days.
.
Plan:
1) CAD.  STEMI on EKG done at [**Hospital6 **].
Enzymes as follows:  1st set (OSH), CK 53 Trpo <0.04; 2nd set
([**Hospital1 18**]) CK 63
Trop <0.01; 3rd Set CK 803  MB 87 Trop 4.38; 4th set CK 478  MB
50  Trop 2.42
.
Cardiac catheterization revealed the following on [**9-23**]:
1. Selective coronary angiography of this right dominany system
revealed two vessel coronary artery disease. The left main
coronary artery was without angiographyically apparent flow
limiting stenosis. The left anterior descending coronary artery
had stent in the proximal segment. The proximal portion of the
stent was patent, but there was a 99% in-stent restenosis in the
distal portion of the stent beyond the origin of D1. There was
TIMI I flow beyond the lesion. The left circumflex coronary
artery was patent in the proximal, mid, and distal segments. The
right coronary artery was the dominant vessel and had a focal
90% stenosis in the proximal segment. The mid and distal RCA
were without angiographically apparent flow limiting stenoses.
2. Right heart catheterization revealed mildly elevated right
sided
pressures. The pulmonary capillary wedge pressures mean was 20
mmgh.
3. There was a preserved cardiac output and index.
4. Successful stent was placed to the LAD on [**9-23**] with a 3.0 x
23 mm Cypher drug-eluting stent
.
Cardiac catheterization revealed the following on [**9-25**]:
1. Coronary angiography of this right-dominat circulation showed
single-vessel CAD. The LMCA, LAD and LCX were free of
flow-limiting
disease. The LAD stent was widely patent. The RCA had an 80%
proximal
and a 30% mid vessel stenosis.
2. Resting hemodynamics showed normal central aortic pressures.
3. Successful stenting of the RCA with a 3.5 mm Cypher
drug-eluting
stent, which was post-dilated to 4.0 mm. Final angiography
showed no
residual stenosis, no dissection and normal flow (see PTCA
comments).
.
Pt is doing well s/p stent placement to L and R sided lesion.
  - [**Last Name (LF) **], [**First Name3 (LF) **], Atorvastatin, tirofiban
  - Will restart Beta Blocker once HR increases a bit
  - CP free for now.  All cardiac enzymes negative.
.
Echo done [**9-25**] revealed the following:
The left atrium is normal in size. Left ventricular wall
thicknesses are normal. The left ventricular cavity is mildly
dilated. Overall left ventricular systolic function is mildly
depressed with severe hypokinesis of the mid to distal septum
and apex. EF 45%.  No masses or thrombi are seen in the left
ventricle. Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
There is no aortic valve stenosis. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Trivial
mitral regurgitation is seen. The estimated pulmonary artery
systolic pressure is normal. There is no pericardial effusion.
.
2) Decreased K+
  - Repleated throughout visit for K <4.0.  Can follow
electrolytes with Dr. [**Last Name (STitle) **].
.
3) Pump
  - EF 45% on [**2165-9-25**] (35% in [**1-26**]). HR low in 40s-50s.  Held
Beta blocker for low HR on days [**1-27**].  Restarted day 3.
Discharged on Toprol XL 50mg daily.  Also added lisinopril at
2.5mg daily.  Can titrate up at visit with Dr. [**Last Name (STitle) **] at LGH.
.
4) FEN
  - Cardiac diet; Checked and repleated electrolytes as needed
.
5) Code Status: FULL CODE




Medications on Admission:
Atenolol 25, Lipitor 10 Daily, Norvasc 5 4x/day, [**Last Name (STitle) **] 325, Vit
B1, Occuvite

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*5*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*5*
3. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*5*
4. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
5. B-Complex with Vitamin C     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 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:*5*
7. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*5*


Discharge Disposition:
Home

Discharge Diagnosis:
STEMI with cath and stent placement


Discharge Condition:
Good


Discharge Instructions:
Take all meds as prescribed.  Please call Dr.[**Name (NI) 34583**] office if
any new symptoms arise including chest pain, fevers, shortness
of breath, arm or jaw pain, etc.  If pain in groin, swelling or
bruising persists, please call your physician and seek medical
attention immediately.

Followup Instructions:
Dr. [**Last Name (STitle) **] (Cardiologist in [**Hospital1 189**]) on Monday [**10-7**] at 2:30pm
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Coronary atherosclerosis of native coronary artery,Other and unspecified alcohol dependence, in remission,Unspecified essential hypertension'}


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: Transfer for STEMI

PRESENT ILLNESS: HPI:  69 Year old man with a PMH of STEMI w/ stents to the LAD
in [**2160**] presents today after transfer via [**Location (un) **] from [**Location (un) **]
where he came this am with chest pain determined via ECG to be
an anterior MI.  His pain was relieved by Nitroglycerin.  In the
cath lab at [**Hospital1 18**], he had a cypher stent placed to the LAD where
the previous stent had re-stenosed.  The right side was also
found to be stenotic approx. 90% but this was not stented today.
 The pt. denies SOB, CP, DOE, PND, orthopnea, cough, nausea,
vomiting.  Plan is to return to cath lab in 2 days for stenting
of the right sided lesion(s).  The patient is now resting
comfortably in NAD and no CP.

MEDICAL HISTORY: S/P STEMI in [**2160**] with stent to the LAD
HTN
S/P broken ribs (L)
Former alcoholic
S/P Macular repair
Alcohol withdrawl syndrome
GI bleeding

MEDICATION ON ADMISSION: Atenolol 25, Lipitor 10 Daily, Norvasc 5 4x/day, [**Last Name (STitle) **] 325, Vit
B1, Occuvite

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- 102/65  56   14  T 99.4
HEENT- PERRL, EOMI, MMM
CV- RRR, No M/R/G S1, S2, S3 present; 2+ puluses DP, PT, Radial,
Carotid; No carotid bruits.
Lung- CTA Bilat.
Abd- NT, ND, BSNA, No HSM, No Masses
Ext- No C/C/E
Neuro- A and O x 3, CN II-XII intact

FAMILY HISTORY: Father had MI age 89
Brother with [**Name (NI) 10563**] Lymphoma
Sister with Leukemia
Macular Degeneration

SOCIAL HISTORY: Golf course attendant; married; current smoker 1ppd x >30 pack
years.  1 [**1-27**] Glasses of red wine per day (but prior hx of heavy
drinking) 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Coronary atherosclerosis of native coronary artery,Other and unspecified alcohol dependence, in remission,Unspecified essential hypertension'}
