CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 76 year old female with a history of CAD s/p MI [**12-29**] with
stenting x 5 (likely RCA) c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] on HD, DM, HTN, CVA [**2167**]
presented this afternoon to [**Hospital1 18**] [**Location (un) 620**] with Chest Pain. The
patient reports that at 5 pm, while she was at rest and lying
down, she began to experience sharp, non-radiating, substernal
pain. The patient also became diaphoretic. When she asked for
some ginger ale, the patient noticed that she was nauseated. The
patient had never experience this constellation of symptoms
before. By 10pm, the pain had significantly worsened, and an
ambulance was called. She was given ASA and NTG en route. On
arrival at [**Location (un) 620**], her EKG demonstrated NSR with STD in V5, V6,
STE in V1, aVR. She was initially placed on a NTG drip, but this
was discontinued once it was noted that the patient has a
history of AS. She was transferred to [**Hospital1 18**] [**Location (un) 86**] for urgent
cardiac catheterization.
.
On cath, a 70% stenosis of the left main was treated with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]
2. An 80% lesion of the LAD was treated with one DES. A 90%
stenosis was nboted in the RCA, but intervention was deferred.
She was chest pain free after the procedure and transferred to
the CCU for further management.
.
The patient recently had a fall that resulted in damage to her
knee. During her previous catheterization at [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 108**] hospital,
she experienced kindey failure witha creatinine that peaked at
8.
On review of systems, the patient endorses regular diarrhea with
occasional bouts of constipation. She also reports that she
often feels diaphoretic and hot at night. The patient reports
easy bruising, but has been told it is a sequela to her ASA
therapy. The patient denies any changes to eyesight, sinus
congestion, dysphagia, cough. The patient also denies dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations,
syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Hyperlipidemia, Hypertension

MEDICATION ON ADMISSION: confirmed with Daughter [**Name (NI) **]
AMLODIPINE [NORVASC] 5 mg PO qhs
ATORVASTATIN [LIPITOR] 80 mg PO daily
METOPROLOL Succs 25 mg PO daily
CLOPIDOGREL [[**Name (NI) **]] - 75 mg Tablet PO daily
ISOSORBIDE MONONITRATE - 60 mg PO daily
METFORMIN - 500 mg PO daily
OLMESARTAN [BENICAR] - 20mg PO daily
OMEPRAZOLE - 20 mg Capsule PO daily prn
TRAZODONE - 75mg PO daily
ASPIRIN - 325 mg PO daily

ALLERGIES: Penicillins / Univasc

PHYSICAL EXAM: Gen:alert, talkative, NAD lying in bed
HEENT: supple, no JVD
CV: RRR, 3/6 systolic murmur at RUSB
RESP: [**Month (only) **] BS left side, no crackles,
ABD: soft, NT
EXTR: no peripheral edema, pulses palp
NEURO: alert, oriented x2, denies hallucinations or
Extremeties: Groin
Pulses:
Right: DP 1+ PT 1+
Left: DP 2+ PT 1+
Skin: stage 1 ulcer on coccyx, chronic per pt.

FAMILY HISTORY: Mother had CAD and MI. Father died at a young age of MI.

SOCIAL HISTORY: Widowed, daughter lives with her. Previously independent.
The patient denies tobacco history.
EtOH: Will have one drink when she goes out to dinner.
Has long history of depression and bipolar disorder, on multiple
meds in the past
Subendocardial infarction, initial episode of care,Acute kidney failure with other specified pathological lesion in kidney,Acute on chronic diastolic heart failure,End stage renal disease,Acute posthemorrhagic anemia,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Celiac artery compression syndrome,Other complications due to renal dialysis device, implant, and graft,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Other drugs and medicinal substances causing adverse effects in therapeutic use,Other respiratory abnormalities,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Aortic valve disorders,Other alteration of consciousness,Atherosclerosis of renal artery,Other and unspecified hyperlipidemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other and unspecified ovarian cyst,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Subendo infarct, initial,Acute kidney failure NEC,Ac on chr diast hrt fail,End stage renal disease,Ac posthemorrhag anemia,Bipol I cur depres NOS,Celiac art compress syn,Comp-ren dialys dev/grft,Crnry athrscl natve vssl,Status-post ptca,Old myocardial infarct,Adv eff medicinal NEC,Respiratory abnorm NEC,Hy kid NOS w cr kid I-IV,Aortic valve disorder,Other alter consciousnes,Renal artery atheroscler,Hyperlipidemia NEC/NOS,Migrne unsp wo ntrc mgrn,Gstr/ddnts NOS w/o hmrhg,Ovarian cyst NEC/NOS,Abn react-procedure NEC
Admission Date:  [**2172-11-11**]              Discharge Date:   [**2172-11-19**]

Date of Birth:  [**2096-3-12**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Univasc

Attending:[**First Name3 (LF) 7333**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization with drug eluting stents to left main
artery and Left anterior descending artery


History of Present Illness:
76 year old female with a history of CAD s/p MI [**12-29**] with
stenting x 5 (likely RCA) c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] on HD, DM, HTN, CVA [**2167**]
presented this afternoon to [**Hospital1 18**] [**Location (un) 620**] with Chest Pain. The
patient reports that at 5 pm, while she was at rest and lying
down, she began to experience sharp, non-radiating, substernal
pain. The patient also became diaphoretic. When she asked for
some ginger ale, the patient noticed that she was nauseated. The
patient had never experience this constellation of symptoms
before. By 10pm, the pain had significantly worsened, and an
ambulance was called. She was given ASA and NTG en route. On
arrival at [**Location (un) 620**], her EKG demonstrated NSR with STD in V5, V6,
STE in V1, aVR. She was initially placed on a NTG drip, but this
was discontinued once it was noted that the patient has a
history of AS. She was transferred to [**Hospital1 18**] [**Location (un) 86**] for urgent
cardiac catheterization.
.
On cath, a 70% stenosis of the left main was treated with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]
2. An 80% lesion of the LAD was treated with one DES. A 90%
stenosis was nboted in the RCA, but intervention was deferred.
She was chest pain free after the procedure and transferred to
the CCU for further management.
.
The patient recently had a fall that resulted in damage to her
knee. During her previous catheterization at [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 108**] hospital,
she experienced kindey failure witha creatinine that peaked at
8.
On review of systems, the patient endorses regular diarrhea with
occasional bouts of constipation. She also reports that she
often feels diaphoretic and hot at night. The patient reports
easy bruising, but has been told it is a sequela to her ASA
therapy. The patient denies any changes to eyesight, sinus
congestion, dysphagia, cough. The patient also denies dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations,
syncope or presyncope.


Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes, Hyperlipidemia, Hypertension

2. CARDIAC HISTORY:
-CABG: None
-PERCUTANEOUS CORONARY INTERVENTIONS: None
-PACING/ICD: None
3. OTHER PAST MEDICAL HISTORY:
# H/o CVA [**2157**]
# Visceral stenosis (70% stenosis of the celiac, SMA, and
[**Female First Name (un) 899**] followed by [**Doctor Last Name **])
# PVD
# DM II - not on insulin, most recent A1c 7.1 in [**6-25**]
# Hypertension
# Migraine headaches
# Gastritis - no peptic ulcer disease history.
# Depression x30 years, initially reactive.


Social History:
Widowed, daughter lives with her. Previously independent.
The patient denies tobacco history.
EtOH: Will have one drink when she goes out to dinner.
Has long history of depression and bipolar disorder, on multiple
meds in the past

Family History:
Mother had CAD and MI. Father died at a young age of MI.

Physical Exam:
Gen:alert, talkative, NAD lying in bed
HEENT: supple, no JVD
CV: RRR, 3/6 systolic murmur at RUSB
RESP: [**Month (only) **] BS left side, no crackles,
ABD: soft, NT
EXTR: no peripheral edema, pulses palp
NEURO: alert, oriented x2, denies hallucinations or
Extremeties: Groin
Pulses:
Right: DP 1+ PT 1+
Left: DP 2+ PT 1+
Skin: stage 1 ulcer on coccyx, chronic per pt.


Pertinent Results:
Labs on Admission:
[**2172-11-11**]
04:23AM BLOOD WBC-11.8*# RBC-3.11* Hgb-10.1* Hct-28.6* MCV-92
MCH-32.3* MCHC-35.1* RDW-13.2 Plt Ct-343
[**2172-11-11**] 04:23AM BLOOD Neuts-91.4* Lymphs-7.7* Monos-0.5*
Eos-0.3 Baso-0.2
[**2172-11-11**] 04:23AM BLOOD PT-12.5 PTT-29.6 INR(PT)-1.1
[**2172-11-11**] 04:23AM BLOOD Glucose-277* UreaN-26* Creat-1.1 Na-136
K-5.4* Cl-107 HCO3-20* AnGap-14
[**2172-11-11**] 04:23AM BLOOD ALT-26 AST-33 CK(CPK)-127 AlkPhos-180*
TotBili-0.2
[**2172-11-11**] 04:23AM BLOOD CK-MB-9 cTropnT-0.18*
[**2172-11-11**] 01:01PM BLOOD CK-MB-11* MB Indx-8.9* cTropnT-0.39*
[**2172-11-11**] 04:23AM BLOOD Calcium-8.9 Phos-3.7 Mg-2.7* Cholest-174
[**2172-11-14**] 04:56AM BLOOD VitB12-424
[**2172-11-12**] 04:38AM BLOOD Hapto-121
[**2172-11-11**] 04:23AM BLOOD Triglyc-223* HDL-63 CHOL/HD-2.8
LDLcalc-66
.
Labs on Discharge:

[**2172-11-18**] 05:20AM BLOOD WBC-10.7 RBC-3.40* Hgb-10.3* Hct-30.8*
MCV-91 MCH-30.4 MCHC-33.6 RDW-14.8 Plt Ct-352
[**2172-11-14**] 04:56AM BLOOD Neuts-74.6* Lymphs-15.4* Monos-8.4
Eos-1.4 Baso-0.1
[**2172-11-18**] 05:20AM BLOOD Glucose-113* UreaN-37* Creat-2.1* Na-140
K-3.7 Cl-106 HCO3-24 AnGap-14
URINE CULTURE PENDING
.
ECG [**11-17**]:
Sinus rhythm. Inferolateral lead ST-T wave abnormalities are
non-specific but
cannot exclude myocardial ischemia. Clinical correlation is
suggested. Since
the previous tracing of [**2172-11-16**] there is probably no
significant change.
TRACING #2
.
ECHO [**2172-11-11**]:
The left atrium and right atrium are normal in cavity size. The
estimated right atrial pressure is 0-5 mmHg. Left ventricular
wall thickness, cavity size and regional/global systolic
function are normal (LVEF >55%). Right ventricular chamber size
and free wall motion are normal. The diameters of aorta at the
sinus, ascending and arch levels are normal. The aortic valve
leaflets are moderately thickened. There is mild aortic valve
stenosis (valve area 1.2-1.9cm2). Mild (1+) aortic regurgitation
is seen. The mitral valve leaflets are mildly thickened. There
is no mitral valve prolapse. Trivial mitral regurgitation is
seen. There is borderline pulmonary artery systolic
hypertension. There is no pericardial effusion.

IMPRESSION: Mild aortic valve stenosis. Normal biventricular
cavity sizes with preserved global and regional biventricular
systolic function.
Compared with the prior study (images reviewed) of [**2171-5-14**],
the aortic valve gradient has increased. Regional and global
left ventricular systolic function are similar.

.
Cardiac catheterization [**2172-11-11**]:
FINAL DIAGNOSIS:
1. Patent stents in LMCA and mid LAD
2. Successful PTCA/stenting of mid RCA with Endeavor drug
eluting stent.
3. Patent bilateral renal arteries with 20% proximal left renal
artery
stenosis.
Additional Cardiac cath [**11-13**]:
IVUS guided ENDEAVOR stent mid RCA 3.5 X 15 mm.
LMCA and LAD stent patent
.
Chest CT [**2172-11-18**]: Unsigned at discharge. But, "there are two
featuers whcih are concerning for diagnosis other than a serous
pleural effusion. The first is a roughly 15x33 mmm wide
elliptical region in the anterior costal pleural space adjacent
to the ligula, [**Doctor Last Name **] 46, which could be a mass or a resudila
hematoma. The second is a 28mm wide elliptical op-acity probably
in the left lower lobe up against the major fissure wich
contains pleural effusion. [**Month (only) 116**] be consistent with mass or
atelectasis. "




Brief Hospital Course:
A/P:
76 year old female with a history of CAD, hx [**Last Name (un) **] on HD, DM, HTN,
CVA [**2167**] transferred from [**Location (un) 620**] for cardiac cath, found to
have 70% stenosis of the left main treated with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 2, 80%
lesion of the LAD treated with one DES, and 90% stenosis of RCA,
but intervention was deferred. Post-cath course c/b continued
chest pain associated with SOB and hypertension, [**Last Name (un) **] req UF,
delerium.
.
# NSTEMI: s/p DES to LM, LAD and RCA during the course of two
catheterizations.  Minimal CK leak but pos trop. No further
chest pain. She was continued on aspirin and [**Last Name (LF) **], [**First Name3 (LF) **] likely
need these medicines indefinitely. BP was quite high and
responded to Hydralazine 50 mg TID. She may require additional
Hydralazine IV for SBP > 190. Imdur was continued at 120 mg.
Olmesartan was held because of kidney function and Metoprolol
was increased to 300 mg daily. Additionally, Norvasc was
increased to 10 mg daily. Goal SBP is 120. Atorvastatin was
continued at 80 mg.
.
# HCT drop: Transfused [**11-14**] for total 2U pRBCs during LOS. S/P
angioseal failure, no retroperitoneal bleed by CT scan. Right
groin site stable. Given extensive cardiac history, hct should
be maintained > 24.
.
# Acute on Chronic Renal Failure: Related to contrast load in
cardiac cath, required ultrafiltration in CCU and has been
followed by nephrology. No evidence of renal artery stenosis.
She has required sevelamer to treat high phosphate levels.
Creatinine down dramatically in the last few days. UOP has been
stable. Please monitor creatinine every few days until at
baseline of 1.0.
.
# Hypertension: See above. Now on Hydralazine and increased
Metoprolol. Olmesartan has been held due to renal function but
can restart once creatinine nl and taper down somewhat on
Metoprolol.
.
# Acute Diastolic dysfunction: CXR [**11-17**] showed improving
pulmonary [**Month/Year (2) 1106**] congestion, thought [**1-21**] ischemia. Received
Lasix IV in CCU for pulmonary edema and hypoxia. Now on RA. ECHO
with preserved global and regional biventricular systolic
function (EF>55%). No sig edema. Weight stable. CXR with ? LLL
collapse. Non contrast chest CT performed to further evaluation
and final read was not available at time of discharge, but there
were several areas concerning for possible masses that could
look like atelectasis, thus it would be prudent to obtain a
chest CT in 1 month as an outpatient. Would continue daily
weights and low Na diet.
.
# RHYTHM: Patient in normal sinus rhythm.
- Telemetry
.
# Aortic stenosis. Stable. Echocardiogram shows Mild AS, mild
AR.
.
# Hyperlipidemia: Atorvastatin 80 mg daily continued
.
# Diabetes: Held home PO meds and started on Glargine 10 units
for blood sugar control. Would continue this during
rehabilitation stay and convert back to oral medicines once
ready to discharge home. Humalog sliding scale attached.
.
# Right hip pain/cramping: Unknown cause, now resolved. Can
continue Baclofen prn.
.
# Depression: Hx of depression and bipolar on mult meds in the
past. Was delerious in the CCU, slowly clearing after transfer
to the floor. Unable to access recent psych notes in OMR.
Restarted on home dose of Trazadone and wellbutrin. Contact[**Name (NI) **]
[**Name2 (NI) 3782**] geriatric psychiatrist Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 77126**] who did not call
back at time of discharge. She will need to follow up with this
doctor as an outpatient.
.
FEN: Heart-healthy, carb-consistent diet
.
Prophylaxis: Heparin SC BID and bowel regimen.
.
CODE: Full
.
*****Incidental Finding on Abdominal CT:
finding of left ovarian lesion, likely cyst, recommend f/u U/S
as [**Last Name (NamePattern1) 3782**].

*****Incidental Finding on Chest CT:
there are two featuers whcih are concerning for diagnosis other
than a serous pleural effusion. The first is a roughly 15x33 mmm
wide elliptical region in the anterior costal pleural space
adjacent to the ligula, [**Doctor Last Name **] 46, which could be a mass or a
resudila hematoma. The second is a 28mm wide elliptical op-acity
probably in the left lower lobe up against the major fissure
wich contains pleural effusion. [**Month (only) 116**] be consistent with mass or
atelectasis.
recommend f/u Chest CT in one month as an [**Month (only) 3782**].

Medications on Admission:
confirmed with Daughter [**Name (NI) **]
AMLODIPINE [NORVASC] 5 mg PO qhs
ATORVASTATIN [LIPITOR] 80 mg PO daily
METOPROLOL Succs 25 mg PO daily
CLOPIDOGREL [[**Name (NI) **]] - 75 mg Tablet PO daily
ISOSORBIDE MONONITRATE - 60 mg PO daily
METFORMIN - 500 mg PO daily
OLMESARTAN [BENICAR] - 20mg PO daily
OMEPRAZOLE - 20 mg Capsule PO daily prn
TRAZODONE - 75mg PO daily
ASPIRIN - 325 mg PO daily


Discharge Medications:
1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. isosorbide mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
5. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day) as needed for pain.
6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. baclofen 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times a day)
as needed for muscle cramping.
9. hydralazine 50 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day): Hold SBP< 100.
10. trazodone 50 mg Tablet Sig: 1.5 Tablets PO at bedtime.
11. metoprolol succinate 100 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily):
Hols SBP < 100, HR < 55.
12. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
syringe Injection twice a day.
13. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
14. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed for constipation.
15. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for Chest pain.

16. bupropion HCl 100 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO BID (2 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Location (un) 1110**]

Discharge Diagnosis:
Hypertension
ST elevation Myocardial Infarction
Coronary Artery Disease
Acute Diastolic dysfunction
Acute blood loss Anemia
Delerium
Acute Kidney Injury
Diabetes Mellitus type 2
Depression


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
You had chest pain at home and [**Hospital1 **] [**Location (un) 620**]
transferred you to [**Hospital1 18**] for a cardiac catheterization. You had
a heart attack and needed 3 drug eluting stents to open up
blockages in your coronary arteries. You were in the CCU with
acute kidney failure, diastolic heart dysfunction, high blood
pressure and anemia. All of these problems are resolving. An
abdominal CT scan was done to check for bleeding and a mass was
seen on the left ovary. This is probably a cyst but an
ultrasound should be performed after you leave rehabilitation to
further assess the mass.
We made the following changes in your medicines:
1. STOP taking Olmesartan and Metformin because your kidney
function is worse, as your kidneys improve, these medications
can be restarted
2. Start taking nitrogycerin as needed to treat your chest pain
3. Start taking heparin injections to prevent a blood clot
4. Increase your Metoprolol to 300 mg daily
5. Increase your Norvasc (Amlodipine) to 10 mg daily
6. Increase the Imdur to 120 mg daily
7. Start Tylenol as needed for pain
8. Start Baclofen as needed for muscle cramps
9. Start Hydralazine three times a day to control your blood
pressure
10. Start a long acting insulin to be taken every day and a
short acting insulin before meals.
11. Start taking Buproprion (Wellbutrin) to help your
depression.
12. Start taking Sevelamer_________
.
Weigh yourself every morning, call Dr. [**Last Name (STitle) **] if weight goes up
more than 3 lbs in 1 day or 6 pounds in 3 days.

Followup Instructions:
Name: [**Last Name (LF) **], [**First Name7 (NamePattern1) 122**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Location: [**Location (un) **]CARDIOLOGY
Address: [**Location (un) **], 7TH FL, [**Location (un) **],[**Numeric Identifier 6422**]
Phone: [**Telephone/Fax (1) 5068**]
Appt: [**11-30**] at 8:40am
.

Please follow up with Dr. [**Last Name (STitle) 77126**] (outpatient Psychiatrist)
regarding your psychiatric medications.
 [**Apartment Address(1) 99914**]
  [**Location (un) 745**], [**Numeric Identifier 99915**]
  Phone:  ([**Telephone/Fax (1) 99916**]

Please follow up with your primary care provider regarding the
CT findings, as you may need a follow up CT scan of your chest.


Pt should have ultrasound to assess left ovarian mass


Completed by:[**2172-11-19**]
{'Subendocardial infarction, initial episode of care,Acute kidney failure with other specified pathological lesion in kidney,Acute on chronic diastolic heart failure,End stage renal disease,Acute posthemorrhagic anemia,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Celiac artery compression syndrome,Other complications due to renal dialysis device, implant, and graft,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Other drugs and medicinal substances causing adverse effects in therapeutic use,Other respiratory abnormalities,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Aortic valve disorders,Other alteration of consciousness,Atherosclerosis of renal artery,Other and unspecified hyperlipidemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other and unspecified ovarian cyst,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: 76 year old female with a history of CAD s/p MI [**12-29**] with
stenting x 5 (likely RCA) c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] on HD, DM, HTN, CVA [**2167**]
presented this afternoon to [**Hospital1 18**] [**Location (un) 620**] with Chest Pain. The
patient reports that at 5 pm, while she was at rest and lying
down, she began to experience sharp, non-radiating, substernal
pain. The patient also became diaphoretic. When she asked for
some ginger ale, the patient noticed that she was nauseated. The
patient had never experience this constellation of symptoms
before. By 10pm, the pain had significantly worsened, and an
ambulance was called. She was given ASA and NTG en route. On
arrival at [**Location (un) 620**], her EKG demonstrated NSR with STD in V5, V6,
STE in V1, aVR. She was initially placed on a NTG drip, but this
was discontinued once it was noted that the patient has a
history of AS. She was transferred to [**Hospital1 18**] [**Location (un) 86**] for urgent
cardiac catheterization.
.
On cath, a 70% stenosis of the left main was treated with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]
2. An 80% lesion of the LAD was treated with one DES. A 90%
stenosis was nboted in the RCA, but intervention was deferred.
She was chest pain free after the procedure and transferred to
the CCU for further management.
.
The patient recently had a fall that resulted in damage to her
knee. During her previous catheterization at [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 108**] hospital,
she experienced kindey failure witha creatinine that peaked at
8.
On review of systems, the patient endorses regular diarrhea with
occasional bouts of constipation. She also reports that she
often feels diaphoretic and hot at night. The patient reports
easy bruising, but has been told it is a sequela to her ASA
therapy. The patient denies any changes to eyesight, sinus
congestion, dysphagia, cough. The patient also denies dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations,
syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Hyperlipidemia, Hypertension

MEDICATION ON ADMISSION: confirmed with Daughter [**Name (NI) **]
AMLODIPINE [NORVASC] 5 mg PO qhs
ATORVASTATIN [LIPITOR] 80 mg PO daily
METOPROLOL Succs 25 mg PO daily
CLOPIDOGREL [[**Name (NI) **]] - 75 mg Tablet PO daily
ISOSORBIDE MONONITRATE - 60 mg PO daily
METFORMIN - 500 mg PO daily
OLMESARTAN [BENICAR] - 20mg PO daily
OMEPRAZOLE - 20 mg Capsule PO daily prn
TRAZODONE - 75mg PO daily
ASPIRIN - 325 mg PO daily

ALLERGIES: Penicillins / Univasc

PHYSICAL EXAM: Gen:alert, talkative, NAD lying in bed
HEENT: supple, no JVD
CV: RRR, 3/6 systolic murmur at RUSB
RESP: [**Month (only) **] BS left side, no crackles,
ABD: soft, NT
EXTR: no peripheral edema, pulses palp
NEURO: alert, oriented x2, denies hallucinations or
Extremeties: Groin
Pulses:
Right: DP 1+ PT 1+
Left: DP 2+ PT 1+
Skin: stage 1 ulcer on coccyx, chronic per pt.

FAMILY HISTORY: Mother had CAD and MI. Father died at a young age of MI.

SOCIAL HISTORY: Widowed, daughter lives with her. Previously independent.
The patient denies tobacco history.
EtOH: Will have one drink when she goes out to dinner.
Has long history of depression and bipolar disorder, on multiple
meds in the past 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure with other specified pathological lesion in kidney,Acute on chronic diastolic heart failure,End stage renal disease,Acute posthemorrhagic anemia,Bipolar I disorder, most recent episode (or current) depressed, unspecified,Celiac artery compression syndrome,Other complications due to renal dialysis device, implant, and graft,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Other drugs and medicinal substances causing adverse effects in therapeutic use,Other respiratory abnormalities,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Aortic valve disorders,Other alteration of consciousness,Atherosclerosis of renal artery,Other and unspecified hyperlipidemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Other and unspecified ovarian cyst,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
