CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: This 60-year-old male with a
history of hypercholesterolemia and extensive tobacco history
presents with sudden onset of chest pain and nausea along
with diaphoresis and shortness of breath.  Emergency medical
response was called and went into V fib arrest in the
ambulance and shocked back into normal sinus rhythm and
cycled into ventricular fibrillation three more times and
shocked back into sinus rhythm for a total of four cycles.
The patient was then started on an Amio drip.  EKG revealed
ST elevations in V3 and V4 and new left anterior hemiblock.
The patient was given Lopressor, Dopamine drip,
Nitroglycerin, Integrilin and Aspirin at [**Hospital 47**] Hospital
and immediately MedFlighted chest pain free to [**Hospital1 346**] for emergent catheterization.
Catheterization revealed a 90% mid LAD lesion which was
subsequently stented with all of the vessels disease free.
In the catheterization lab the patient was noted to have
profound hypotension with a cardiac index of 1.45 on Levophed
and Dopamine drip and also started on Dobutamine and an
intra-aortic balloon pump was placed.  The patient also had
three episodes of hematemesis and was transfused two units of
packed red blood cells in the catheterization lab.

MEDICAL HISTORY: Includes history of GI ulcers,
hypercholesterolemia, who has been previously on Lipitor
which was discontinued recently.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for coronary artery disease.

SOCIAL HISTORY: The patient smokes about one pack per day
since the age of 9, has social alcohol and has used marijuana
in the past.
Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Paroxysmal ventricular tachycardia,Bacteremia,Hematemesis,Cellulitis and abscess of trunk,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site
AMI anterior wall, init,Cardiogenic shock,Parox ventric tachycard,Bacteremia,Hematemesis,Cellulitis of trunk,CHF NOS,Crnry athrscl natve vssl,Mth sus Stph aur els/NOS
Name:  [**Known lastname 8113**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 8114**]

Admission Date:  [**2143-9-22**]     Discharge Date:  [**2143-10-8**]

Date of Birth:   [**2082-12-13**]     Sex:  M

Service:  CCU

Patient completed his 14 day course of antibiotics during his
hospital stay.  Surveillance cultures were taken throughout
his hospital admission as well as his last day of
antibiotics.  He is to followup with Dr. [**First Name (STitle) **] in
approximately 2-3 weeks for medication tailoring as well as
lower extremity calf studies.  He is also to followup with
Dr. [**Last Name (STitle) 86**] to schedule an appointment in [**2143-10-29**]
for an electrophysiology study.

He will be sent home on an anticoagulative regimen of
Coumadin and Plavix which he will continue Plavix for a
life-long therapy.  After six months of Coumadin treatment,
he will switch off of Coumadin and continue aspirin for
life-long therapy.  He will also follow up with his primary
care physician with regards to maintaining a therapeutic
regimen of Coumadin and will also require follow up with his
primary care physician for an appropriate cardiac
rehabilitation program.

DISCHARGE MEDICATIONS:  Plavix 75 mg po q day, atenolol 12.5
mg po q day, lisinopril 10 mg po q day, Protonix 40 mg po
bid, atorvastatin 10 mg po q day, Coumadin 3 mg po q hs,
Lasix 20 mg po q day.






                          [**First Name11 (Name Pattern1) 448**] [**Last Name (NamePattern4) 2130**], M.D. [**MD Number(1) 2131**]

Dictated By:[**Name8 (MD) 1554**]

MEDQUIST36

D:  [**2143-10-8**]  11:42
T:  [**2143-10-14**]  08:02
JOB#:  [**Job Number **]


Admission Date:  [**2143-9-22**]     Discharge Date:  [**2143-10-8**]

Date of Birth:   [**2082-12-13**]     Sex:  M

Service:  CCU

CHIEF COMPLAINT:  Chest pain.

HISTORY OF PRESENT ILLNESS:  This 60-year-old male with a
history of hypercholesterolemia and extensive tobacco history
presents with sudden onset of chest pain and nausea along
with diaphoresis and shortness of breath.  Emergency medical
response was called and went into V fib arrest in the
ambulance and shocked back into normal sinus rhythm and
cycled into ventricular fibrillation three more times and
shocked back into sinus rhythm for a total of four cycles.
The patient was then started on an Amio drip.  EKG revealed
ST elevations in V3 and V4 and new left anterior hemiblock.
The patient was given Lopressor, Dopamine drip,
Nitroglycerin, Integrilin and Aspirin at [**Hospital 47**] Hospital
and immediately MedFlighted chest pain free to [**Hospital1 346**] for emergent catheterization.
Catheterization revealed a 90% mid LAD lesion which was
subsequently stented with all of the vessels disease free.
In the catheterization lab the patient was noted to have
profound hypotension with a cardiac index of 1.45 on Levophed
and Dopamine drip and also started on Dobutamine and an
intra-aortic balloon pump was placed.  The patient also had
three episodes of hematemesis and was transfused two units of
packed red blood cells in the catheterization lab.

PAST MEDICAL HISTORY:  Includes history of GI ulcers,
hypercholesterolemia, who has been previously on Lipitor
which was discontinued recently.

MEDICATIONS:  On admission, Vitamin E.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  The patient smokes about one pack per day
since the age of 9, has social alcohol and has used marijuana
in the past.

FAMILY HISTORY:  Significant for coronary artery disease.

PHYSICAL EXAMINATION:  Temperature 96.8, blood pressure
102/46, heart rate 124, respiratory rate 18, 90% on a 4 liter
nasal cannula with 100% non rebreather.  In general, patient
is lying in bed, talkative and in no apparent distress.
HEENT:  Pupils are equal, round, and reactive to light,
extraocular movements intact, patent nares, normal dentition,
mucus membranes moist.  Neck exam, no carotid bruits, no
thyromegaly, no lymphadenopathy.  Lungs with diffuse
expiratory wheezing with poor air entry bilaterally.
Cardiovascular exam, regular rate and rhythm, distant S1 and
S2, no murmurs, rubs or gallops.  Abdomen mildly distended,
soft, nontender, normal abdominal bowel sounds.  Extremities,
no clubbing, cyanosis or edema, no calf tenderness, 1+
dorsalis pedis pulses on the left, 2+ dorsalis pedis pulses
on the right.  Groin with a mild groin hematoma with slight
oozing.  Neurological exam alert and oriented times three,
normal mentation, cranial nerves II through XII intact.  Deep
tendon reflexes and mental status not assessed.  Downgoing
toes bilaterally.

LABORATORY DATA:  On arrival, hematocrit 46, sodium 141,
potassium 3.5, chloride 100, glucose 197.  EKG on admission
revealed normal sinus rhythm at 80 beats per minute, left
axis deviation with a right bundle branch block and left
anterior fascicular block, T wave inversions in 1 and [**Last Name (LF) **], [**First Name3 (LF) **]
elevations in V1 through V5 with Q waves in V1 through V4.

HOSPITAL COURSE:
1.  Cardiovascular:  Cardiac catheterization revealed a 90%
mid LAD stenosis which was subsequently stented.  The patient
was found to be in cardiogenic shock and required inotropic
support including an intra-aortic balloon pump.  His
inotropic support was eventually weaned as was his
intra-aortic balloon pump and was maintaining an adequate
cardiac index.  An echocardiogram was performed after cardiac
catheterization which revealed normal left ventricular cavity
size with anterior septal and apical akinesis with
preservation of basolateral and basoposterior walls, with an
estimated ejection fraction of 25-30%.  He was continued on
Aspirin, Plavix and Lipitor after his cardiac
catheterization.  The first 24 hours after cardiac
catheterization the patient experienced multiple episodes of
ventricular ectopy requiring an Amiodarone drip to be started
and was eventually weaned over the next 24-36 hours.
Captopril and Lopressor were started as his blood pressure
trended towards normotensive ranges.  Repeat echocardiogram
was performed on hospital day #10 which revealed an ejection
fraction of 30% with mildly dilated left atrium, severely
depressed left ventricular systolic function, severely
hypokinetic ventricular and apical segments of anterior
septum and anterior free wall, apical akinesis, mild
aneurysmal dilatation, no thrombus was seen with mild to
moderate mitral regurgitation.  A signal average ECG was
performed which resulted in a normal exam.  Based on his last
echocardiogram, it as decided to pursue anticoagulation and
was started on loading dose of Coumadin to achieve
therapeutic ranges of an INR between [**3-3**].  His blood pressure
medications were changed to once daily dosing.  His pressures
remained in normotensive ranges.  There was no more
ventricular ectopy on telemetry and the patient's cardiac
status stabilized.  He is to be seen as an outpatient for a
follow-up study, electrophysiology test for inducible
ventricular tachycardia and will follow-up with Dr. [**Last Name (STitle) **]
in approximately one month.

2.  Infectious Disease:  On hospital day #3 the patient had a
temperature to 102.0.  Physical exam revealed erythema of the
right groin site where the intra-aortic balloon pump was
placed.  Blood cultures taken at that time revealed 4/4
bottles positive for Methicillin sensitive staph aureus.  The
patient was initially started on Vancomycin and switched to
Oxacillin which resolved his groin erythema as well as his
fever.  Surveillance cultures were negative.  The patient
will continue on a 14 day course of Oxacillin and will obtain
blood cultures after completion of his antibiotic course to
rule out possible seeding of staph aureus.

3.  Gastrointestinal:  The patient was noted to have
hematemesis during his cardiac catheterization procedure.  He
continued to have occasional episodes of hematemesis as well
as two bouts of melena.  An EGD study was performed which
revealed a hiatal hernia with mild erosion at the
gastroesophageal junction.  The patient was placed on
Protonix 40 mg [**Hospital1 **] with no further episodes of hematemesis or
melena and will continue on this course while being
anticoagulated.

4.  Hematology:  The patient was noted to have
thrombocytopenia during the duration of his intra-aortic
balloon pump.  Heparin induced thrombocytopenia antibodies
were sent which resulted as negative.  His thrombocytopenia
was thought to be related to destruction of platelets due to
intra-aortic balloon pump.  Once his intra-aortic balloon
pump was pulled, his platelet count responded accordingly and
increased and continued to climb throughout the rest of his
hospital admission.  His hematocrit was also known to have
dropped, requiring two units of packed red blood cells
transfusion during his hospital course.  Based on his rising
platelet count, the patient may require life long Plavix
therapy.  A concern, however, is bleeding risk considering he
will be on Coumadin, Plavix and Aspirin and if his platelet
count continues to climb he will continue on Coumadin and
Plavix and Aspirin will be discontinued.  However, if his
platelets start to down trend, Plavix will be stopped after
30 days and Aspirin and Coumadin will be continued.  This
situation will be clarified with Dr. [**First Name (STitle) **] as his primary
cardiologist.  He will also be started on Coumadin to achieve
a therapeutic INR of [**3-3**] and will follow-up with his primary
care physician for strict monitoring of Coumadin dosage
adjustments.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Patient will be discharged to home with
VNA services for IV antibiotics.  He will continue Oxacillin
for a total of 14 days which will be discontinued on [**2143-10-8**].
The patient will have close Coumadin dosage monitoring with
his primary care physician.  [**Name10 (NameIs) **] will also get two blood
cultures after completing his 14 days of antibiotics.  He
will also follow-up with Dr. [**Last Name (STitle) **] for a follow-up
electrophysiology study in approximately one month.  He will
also follow-up with Dr. [**First Name (STitle) **] in approximately 2-3 weeks for
adjustment of his medications and claudication studies.

DISCHARGE MEDICATIONS:  Oxacillin 2 gm IV q 6 hours which
will be discontinued on [**2143-10-8**], Coumadin 5 mg po q h.s.,
Atenolol 12.5 mg po q d, Lisinopril 10 mg po q d, Protonix 40
mg po bid, Plavix 75 mg po q d, Atorvastatin 10 mg po q d.

DISCHARGE DIAGNOSIS:
1.  Anterior myocardial infarction.
2.  Staph aureus bacteremia.
3.  Hiatal hernia.
4.  Ischemic cardiomyopathy requiring anticoagulation.
5.  Anemia requiring blood transfusions.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 5211**]

Dictated By:[**Name8 (MD) 5406**]

MEDQUIST36

D:  [**2143-10-5**]  01:37
T:  [**2143-10-13**]  08:34
JOB#:  [**Job Number 44370**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Paroxysmal ventricular tachycardia,Bacteremia,Hematemesis,Cellulitis and abscess of trunk,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}


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.

PRESENT ILLNESS: This 60-year-old male with a
history of hypercholesterolemia and extensive tobacco history
presents with sudden onset of chest pain and nausea along
with diaphoresis and shortness of breath.  Emergency medical
response was called and went into V fib arrest in the
ambulance and shocked back into normal sinus rhythm and
cycled into ventricular fibrillation three more times and
shocked back into sinus rhythm for a total of four cycles.
The patient was then started on an Amio drip.  EKG revealed
ST elevations in V3 and V4 and new left anterior hemiblock.
The patient was given Lopressor, Dopamine drip,
Nitroglycerin, Integrilin and Aspirin at [**Hospital 47**] Hospital
and immediately MedFlighted chest pain free to [**Hospital1 346**] for emergent catheterization.
Catheterization revealed a 90% mid LAD lesion which was
subsequently stented with all of the vessels disease free.
In the catheterization lab the patient was noted to have
profound hypotension with a cardiac index of 1.45 on Levophed
and Dopamine drip and also started on Dobutamine and an
intra-aortic balloon pump was placed.  The patient also had
three episodes of hematemesis and was transfused two units of
packed red blood cells in the catheterization lab.

MEDICAL HISTORY: Includes history of GI ulcers,
hypercholesterolemia, who has been previously on Lipitor
which was discontinued recently.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for coronary artery disease.

SOCIAL HISTORY: The patient smokes about one pack per day
since the age of 9, has social alcohol and has used marijuana
in the past. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Cardiogenic shock,Paroxysmal ventricular tachycardia,Bacteremia,Hematemesis,Cellulitis and abscess of trunk,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}
