CHIEF COMPLAINT: Acute myocardial infarction.

PRESENT ILLNESS: This 64 year old gentleman was admitted elsewhere with a NSTEMI.
He had experienced a head spinning feeling on [**Holiday **] Eve
while he was sitting down. This lasted approximately 10 minutes.
He was being workup up as out patient for vertigo. He
experienced similar symptom the day of admission, lasting 5
minutes while he was standing. He had associated nausea and
shortness of breath. He denied any chest pain, palpitations,
abdominal pain or vomiting.
.
He does report chest pressure that has been occuring with
exertion over the past 2 months.  This pressure was particularly
bad during the last 4 days while he was shoveling snow and
working around the house.  He described it as a crushing
sensation which lasted approximately 30 minutes.  and was
diagnosed Transfered here for possible intervention.
.
In the [**Hospital1 18**] ED his vitals were T 97.2 BP 142/112 HR 70 RR 22
and glucose of 166. He received ASA 325 mg, Atorvastatin 80 mg,
Plavix 600 mg,a heparin bolus and drip and Metoprolol 2.5 mg. He
was started on integrillin bolus and  drip in the [**Hospital1 18**] ED.

MEDICAL HISTORY: hypertension
insulin dependent diabetes mellitus
Dyslipidemia
Active [**Hospital1 1818**]
obstructive sleep apnea
degenerative disc disease

MEDICATION ON ADMISSION: Atorvastatin 40 mg daily
Diovan/HCTZ 160/12.5 [**Hospital1 **]
Pentoxyfylline 400 mg [**Hospital1 **]
Metformin 500 mg [**Hospital1 **]
Norvasc 10 mg daily
Inspra 25 mg daily
HISS
[**Name (NI) **] - pt estimates 56 units qam and 26 units qpm

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS - BP 144/78 HR 86 RR 16 97% on 2LNC
Gen: WDWN middle aged male in NAD. Mood, affect appropriate.
Following commands.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with JVP of 7 cm.
CV: RR, normal S1, S2. II/VI holosystolic murmur at LLSB and
apex.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Mild wheezes diffusely.
No crackles.
Abd: Obese, Soft, NTND. No HSM or tenderness.
Ext: No c/c/e.
Neuro: spontaneously moves all 4 ext.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: He lives at home with his wife.
Active [**Name2 (NI) 1818**] for more than 30 years. Used to smoke 2.5 packs
per day. Now down to 0.75 pack/day.
Heavy drinker in the past- ETOH one week ago.
Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Spondylosis of unspecified site, without mention of myelopathy,Benign essential hypertension,Aneurysm of artery of lower extremity,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Atrial fibrillation,Atherosclerosis of native arteries of the extremities with intermittent claudication,Tobacco use disorder,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia
Subendo infarct, initial,Surg comp-peri vasc syst,Hyposmolality,DMII wo cmp uncntrld,Crnry athrscl natve vssl,Spondylos NOS w/o myelop,Benign hypertension,Lower extremity aneurysm,Abn react-cardiac cath,Atrial fibrillation,Ath ext ntv at w claudct,Tobacco use disorder,Obstructive sleep apnea,Hyperlipidemia NEC/NOS
Admission Date:  [**2126-12-18**]              Discharge Date:   [**2126-12-30**]

Date of Birth:  [**2062-8-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Acute myocardial infarction.

Major Surgical or Invasive Procedure:
coronary artey bypass grafts x 4(LIMA-LAD, SVG-DG, SVG-OM1-OM2)
[**12-23**]
left heart catheterization, coronary angiography [**12-19**]


History of Present Illness:
This 64 year old gentleman was admitted elsewhere with a NSTEMI.
He had experienced a head spinning feeling on [**Holiday **] Eve
while he was sitting down. This lasted approximately 10 minutes.
He was being workup up as out patient for vertigo. He
experienced similar symptom the day of admission, lasting 5
minutes while he was standing. He had associated nausea and
shortness of breath. He denied any chest pain, palpitations,
abdominal pain or vomiting.
.
He does report chest pressure that has been occuring with
exertion over the past 2 months.  This pressure was particularly
bad during the last 4 days while he was shoveling snow and
working around the house.  He described it as a crushing
sensation which lasted approximately 30 minutes.  and was
diagnosed Transfered here for possible intervention.
.
In the [**Hospital1 18**] ED his vitals were T 97.2 BP 142/112 HR 70 RR 22
and glucose of 166. He received ASA 325 mg, Atorvastatin 80 mg,
Plavix 600 mg,a heparin bolus and drip and Metoprolol 2.5 mg. He
was started on integrillin bolus and  drip in the [**Hospital1 18**] ED.



Past Medical History:
hypertension
insulin dependent diabetes mellitus
Dyslipidemia
Active [**Hospital1 1818**]
obstructive sleep apnea
degenerative disc disease

Social History:
He lives at home with his wife.
Active [**Name2 (NI) 1818**] for more than 30 years. Used to smoke 2.5 packs
per day. Now down to 0.75 pack/day.
Heavy drinker in the past- ETOH one week ago.

Family History:
non contributory

Physical Exam:
Admission:
VS - BP 144/78 HR 86 RR 16 97% on 2LNC
Gen: WDWN middle aged male in NAD. Mood, affect appropriate.
Following commands.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with JVP of 7 cm.
CV: RR, normal S1, S2. II/VI holosystolic murmur at LLSB and
apex.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Mild wheezes diffusely.
No crackles.
Abd: Obese, Soft, NTND. No HSM or tenderness.
Ext: No c/c/e.
Neuro: spontaneously moves all 4 ext.


Pertinent Results:
Hematology
COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2126-12-29**] 06:15AM    9.3 3.64* 11.3* 32.7* 90 31.1 34.6 13.8
480*
BASIC COAGULATION (PT, PTT, PLT, INR) Plt Ct
[**2126-12-29**] 06:15AM    480*

Chemistry
RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2126-12-29**] 06:15AM    142* 14 1.1 140 4.8 99 33* 13
CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron
[**2126-12-29**] 06:15AM              2.4


[**Known lastname **],[**Known firstname **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Medical Record Number 81207**] M  64  [**2062-8-18**]

Radiology Report CHEST (PA & LAT) Study Date of [**2126-12-28**] 11:03
AM


[**Last Name (LF) **],[**First Name3 (LF) **] CSURG FA6A [**2126-12-28**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 81208**]
Reason: interval chnage



[**Hospital 93**] MEDICAL CONDITION:
   64 year old man with Cabg x4



Final Report
HISTORY: CABG.

PA and lateral radiographs of the chest demonstrate very mild
elevation of the
left hemidiaphragm, less conspicuous than seen on [**2126-12-17**].
There is
persistent bibasilar atelectasis. No consolidation is
identified. There is a
small left-sided pleural effusion. When compared to the previous
study, there
is little interval change.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 6892**]
Approved: SUN [**2126-12-29**] 12:01 PM


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 81209**]
(Complete) Done [**2126-12-23**] at 10:02:03 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2062-8-18**]
Age (years): 64 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Abnormal ECG. Chest pain. Coronary artery disease.
Hypertension.
ICD-9 Codes: 402.90, 786.51, 440.0, 424.0
Test Information
Date/Time: [**2126-12-23**] at 10:02    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW3-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55% to 60%  >= 55%

Findings
LEFT ATRIUM: Normal LA size. No spontaneous echo contrast in the
body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. No
spontaneous echo contrast is seen in the LAA. Good (>20 cm/s)
LAA ejection velocity.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA and extending into the RV. No
spontaneous echo contrast in the RAA. No ASD by 2D or color
Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Normal regional LV systolic function.

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

AORTA: Normal aortic diameter at the sinus level. Simple
atheroma in aortic root. Normal ascending aorta diameter. Normal
aortic arch diameter. Simple atheroma in aortic arch. Normal
descending aorta diameter. Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets. No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Moderate
mitral annular calcification. No MS. Mild (1+) MR. Normal LV
inflow pattern for age.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
patient.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-CPB:1. The left atrium is normal in size. No spontaneous
echo contrast is seen in the body of the left atrium or left
atrial appendage. No mass/thrombus is seen in the left atrium or
left atrial appendage. No spontaneous echo contrast is seen in
the left atrial appendage.
2. No atrial septal defect is seen by 2D or color Doppler.
3. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Regional left ventricular
wall motion is normal.
4. Right ventricular chamber size and free wall motion are
normal.
5. There are simple atheroma in the aortic root. There are
simple atheroma in the aortic arch. There are simple atheroma in
the descending thoracic aorta.
6. There are three aortic valve leaflets. The aortic valve
leaflets are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen.
7. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen.
Dr. [**Last Name (STitle) **] was notified in person of the results.

POST-CPB: On infusion of
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2126-12-26**] 12:33


[**Known lastname **],[**Known firstname **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Medical Record Number 81207**] M  64  [**2062-8-18**]

Cardiology Report C.CATH Study Date of [**2126-12-19**]



BRIEF HISTORY:
This 64 year old man with diabetes, hypertension, dyslipidemia,
active
[**Date Range 1818**], peripheral vascular disease (R>L calf claudication, h/o
abnormal
ABIs), presents with 2 episodes of vertigo at rest over the past
3
weeks, associated with dyspnea and nausea. A recent MRI brain
was
negative for infarcts. MRA neck revealed L external carotid
artery
stenosis. The last (index) episode occurred on the day of
admission,
and lasted 1 hour. Cardiac biomarkers were elevated on admission
(TnI
0.69, CK 196, MB 5), without EKG changes. The patient also
endorses 2
months of stable exertional chest discomfort precipitated by
shoveling
snow.

INDICATIONS FOR CATHETERIZATION:
1. NSTEMI.


PROCEDURE:
Left Heart Catheterization: was performed by percutaneous entry
of the
right femoral artery, using a 5 French angled pigtail catheter,
advanced
to the left ventricle through a 5 French introducing sheath.
Coronary Angiography: was performed in multiple projections
using a 5
French JL4 and a 5 French JR4 catheter, with manual contrast
injections.
Left Ventriculography: was performed in the 30 degrees [**Doctor Last Name **]
projection,
using 33 ml of contrast injected at 11 ml/sec, through the
angled
pigtail catheter.
Conscious Sedation:  was provided with appropriate monitoring
performed by
a member of the nursing staff.

HEMODYNAMICS RESULTS BODY SURFACE AREA:  2.13 m2
  HEMOGLOBIN: gms %
  REST
**PRESSURES
LEFT VENTRICLE {s/ed} 156/23
AORTA {s/d/m} 156/75/83
**CARDIAC OUTPUT
HEART RATE {beats/min} 63
RHYTHM SINUS




LEFT VENTRICULOGRAPHY:
Volumetric data:
          LV end diastolic volume index (nl 50-90 ml/m2).   42
          LV end systolic volume index (nl 15-30 ml/m2).    16
          LV stroke volume index (nl 35-75 ml/m2).          26
          LV ejection fraction (nl 50%-80%).                62
Qualitative wall motion:
[**Doctor Last Name **]:
          1. Antero basal -    normal
          2. Antero lateral -  normal
          3. Apical -          normal
          4. Inferior -        normal
          5. Postero basal -   normal
Other findings:
Mitral valve was normal.


**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**RIGHT CORONARY
1) PROXIMAL RCA   DIFFUSELY DISEASED
2) MID RCA   DIFFUSELY DISEASED
2A) ACUTE MARGINAL   DIFFUSELY DISEASED
3) DISTAL RCA   DIFFUSELY DISEASED

**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**LEFT CORONARY
5) LEFT MAIN   DISCRETE 80
6) PROXIMAL LAD   DIFFUSELY DISEASED
7) MID-LAD   DIFFUSELY DISEASED 100
8) DISTAL LAD   DIFFUSELY DISEASED 100
9) DIAGONAL-1   DIFFUSELY DISEASED
10) DIAGONAL-2   DIFFUSELY DISEASED
12) PROXIMAL CX   DISCRETE 60
13) MID CX   DISCRETE 90
13A) DISTAL CX   NORMAL
14) OBTUSE MARGINAL-1   NORMAL


TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 23 minutes.
Arterial time = 18 minutes.
Fluoro time = 4.8 minutes.
Contrast injected:
          Non-ionic low osmolar (isovue, optiray...), vol 88 ml,
Indications - Renal
Premedications:
          Fentanyl 25mcg IV
          Versed 0.5mg IV
Anesthesia:
          1% Lidocaine subq.
Anticoagulation:
Other medication:
          Integrilin 11.4mg/hr IV
Cardiac Cath Supplies Used:
          - ALLEGIANCE, CUSTOM STERILE PACK
          - [**Company **], LEFT HEART KIT
          5FR [**Company **], MULTIPACK


COMMENTS:
1. Selective coronary angiography of this left dominant system
revealed
multi-vessel and left main CAD. The LMCA had a distal 80%
stenosis. The
LAD was occluded after D2, with distal LAD filling via the conus
branch
of the RCA. The LCX had an ostial 60% stenosis and mid 90%
stenosis. The
RCA was non-dominant with diffuse disease.
2. Limited resting hemodynamics demonstrated systemic arterial
hypertension (145/68 mmHg) and mildly elevated left sided
filling
pressures (LVEDP 23mmHg). There was no transaortic gradient on
pullback
of catheter from LV to aorta.
3. Left ventriculography demonstrated normal LV wall motion and
a
calculated LVEF of 60%. THere was no mitral regurgitation.

FINAL DIAGNOSIS:
1. Multi-vessel and left main coronary artery disease.
2. Mild LV diastolic dysfunction.
3. Normal LV systolic function.


ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].
REFERRING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].
CARDIOLOGY FELLOW: [**Last Name (LF) **],[**First Name3 (LF) **] Y.
ATTENDING STAFF: [**Last Name (LF) **],[**First Name3 (LF) **] P.





Brief Hospital Course:
Following admission he remained stable. A catheterization on
[**12-19**] revealed 80% distal left main and triple vessel disease.
he was referrred for surgical revascularization. LV function was
preserved.

On [**12-23**] he went to the Operating Room where bypass surgery was
undertaken.  He tolerated the operation well, weaning from
bypass on low dose phenylephrine and Propofol.  He was easily
extubated and weaned from pressors.  He transferred to the floor
on the day after surgery.

He became hyperglycemic on the floor, necessitating transfer to
the ICU for insulin infusion. Glucoses were brought under
control and he was maintained on AM glargine dosing with sliding
scale coverage.  He was again transferred to the floor on POD 4.
[**Last Name (un) **] was following his glucose management for uncontrolled
blood sugars. He was euglycemic at discharge and was d/c'd on
his home glucose management.
He was diuresisng and was d/c'd to home on one week of lasix w/
potassium supplementation.

He developed a pseudoaneurysm after catheterization which is
being followed by the Vascular Surgical serce. He requires a
follow up ultrasound in another week after discharge.


Medications on Admission:
Atorvastatin 40 mg daily
Diovan/HCTZ 160/12.5 [**Hospital1 **]
Pentoxyfylline 400 mg [**Hospital1 **]
Metformin 500 mg [**Hospital1 **]
Norvasc 10 mg daily
Inspra 25 mg daily
HISS
[**Name (NI) **] - pt estimates 56 units qam and 26 units qpm


Discharge Medications:
1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 1 weeks.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Aspirin 81 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:*2*
5. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*75 Tablet(s)* Refills:*0*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
10. levemire
as directed
11. humalog
per sliding scale


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
coronary artery disease
s/p coronary artery bypass grafts x4
insulin dependent diabetes
hypertension
hyperlipidemia
degenerative disc disease
obstructive sleep apnea


Discharge Condition:
good


Discharge Instructions:
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
shower daily, no baths or swimming
no lotions, creams or powders to incisions
report any redness of, or drainage fro mincisions
report any weight gain greater than 2 pounds a day or 5 pounds a
week
report any fever greater than 100.5
take all medications as directed

Followup Instructions:
Follow up femoral ultrasound of the right femoral artery in 2
weeks from [**2126-12-20**] to re-evaluate A-V fistula.
Sleep study - send home on CPAP
Dr.[**First Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
wound clinic in 2 weeks
Dr. [**Last Name (STitle) **] [**Name (STitle) 17369**] in [**11-29**] weeks ([**Telephone/Fax (1) 17368**])
Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] in 2 weeks
please call for appointments


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2126-12-30**]
{'Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Spondylosis of unspecified site, without mention of myelopathy,Benign essential hypertension,Aneurysm of artery of lower extremity,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Atrial fibrillation,Atherosclerosis of native arteries of the extremities with intermittent claudication,Tobacco use disorder,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia'}


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: Acute myocardial infarction.

PRESENT ILLNESS: This 64 year old gentleman was admitted elsewhere with a NSTEMI.
He had experienced a head spinning feeling on [**Holiday **] Eve
while he was sitting down. This lasted approximately 10 minutes.
He was being workup up as out patient for vertigo. He
experienced similar symptom the day of admission, lasting 5
minutes while he was standing. He had associated nausea and
shortness of breath. He denied any chest pain, palpitations,
abdominal pain or vomiting.
.
He does report chest pressure that has been occuring with
exertion over the past 2 months.  This pressure was particularly
bad during the last 4 days while he was shoveling snow and
working around the house.  He described it as a crushing
sensation which lasted approximately 30 minutes.  and was
diagnosed Transfered here for possible intervention.
.
In the [**Hospital1 18**] ED his vitals were T 97.2 BP 142/112 HR 70 RR 22
and glucose of 166. He received ASA 325 mg, Atorvastatin 80 mg,
Plavix 600 mg,a heparin bolus and drip and Metoprolol 2.5 mg. He
was started on integrillin bolus and  drip in the [**Hospital1 18**] ED.

MEDICAL HISTORY: hypertension
insulin dependent diabetes mellitus
Dyslipidemia
Active [**Hospital1 1818**]
obstructive sleep apnea
degenerative disc disease

MEDICATION ON ADMISSION: Atorvastatin 40 mg daily
Diovan/HCTZ 160/12.5 [**Hospital1 **]
Pentoxyfylline 400 mg [**Hospital1 **]
Metformin 500 mg [**Hospital1 **]
Norvasc 10 mg daily
Inspra 25 mg daily
HISS
[**Name (NI) **] - pt estimates 56 units qam and 26 units qpm

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS - BP 144/78 HR 86 RR 16 97% on 2LNC
Gen: WDWN middle aged male in NAD. Mood, affect appropriate.
Following commands.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with JVP of 7 cm.
CV: RR, normal S1, S2. II/VI holosystolic murmur at LLSB and
apex.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Mild wheezes diffusely.
No crackles.
Abd: Obese, Soft, NTND. No HSM or tenderness.
Ext: No c/c/e.
Neuro: spontaneously moves all 4 ext.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: He lives at home with his wife.
Active [**Name2 (NI) 1818**] for more than 30 years. Used to smoke 2.5 packs
per day. Now down to 0.75 pack/day.
Heavy drinker in the past- ETOH one week ago. 

### Response:
{'Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Spondylosis of unspecified site, without mention of myelopathy,Benign essential hypertension,Aneurysm of artery of lower extremity,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Atrial fibrillation,Atherosclerosis of native arteries of the extremities with intermittent claudication,Tobacco use disorder,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia'}
