CHIEF COMPLAINT: ST elevation myocardial infarction status post catheterization
complicated by groin hematoma

PRESENT ILLNESS: Ms. [**Known lastname 1007**] is 78 year old female with PMH significant for
hypercholesterolemia, GERD, and arthritis but no CAD history who
presented to an OSH with back pain radiating to L arm and L jaw.
The patient has a history of upper L back pain, which has
worsened in the last 2 weeks. She presented to her PCP on the
morning of admission and was given [**Doctor First Name **] for symptoms
attributed to allergies. The pain then increased in intensity
over the course of the day and began to radiate to L arm/jaw
while the patient was working in her kitchen. Pain did not
alleviate with rest and she called her son who took her to the
[**Hospital3 **] ED.
.
At [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], she was noted to have ST elevations in inferior
leads with a troponin of 0.55. There, she received ASA 325 x1,
Plavix 600, atorvstatin 80 x 1, ativan 1 mg, integrilin, SL NTG
x2, IV lopressor 5 mg * 3, heparin bolus + drip. She was then
transfered here for catheterization.
.
In the cath lab, the patient was noted to have RCA 99% ostial
stenosis; this lesion was stented with bare metal stent with
good result. Her catheterization was complicated by multiple
attempts at venous access which yielded arterial blood. She
developed a large hematoma during the case. Following her cath,
she went to the CCU chest pain free, hemodynamically stable, but
with a large right groin hematoma.
.
On arrival to the floor, the patient denies chest pain, back
pain, shortness of breath, diaphoresis, nausea, and vomiting.
She does have a large ecchymosis in the right groin and thigh
area. She is not having problems walking and states that the
area seems improved. She does not have pain in the right leg.

MEDICAL HISTORY: Hypercholesterolemia
GERD
Arthritis
Osteoporosis

MEDICATION ON ADMISSION: Ranitidine
Fexofenadine
Calcium Supplements
Risedronate

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS- 97.0, 122/51, 84, 18, 99% RA
HEENT- Normocephalic. PERRL. EOMI. MMM & OP clear.
LUNGS- clear to auscultation bilaterally.
HEART- RRR, 2/6 systolic murmur radiating to apex
ABD- soft, ND, NT; 4-5 cm midline scar with distorted umbilicus

FAMILY HISTORY: Denies CAD hx

SOCIAL HISTORY: Nonsmoker, no EtOH, lives alone, son + his family nearby.
Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux,Osteoporosis, unspecified
AMI inferior wall, init,Crnry athrscl natve vssl,Pure hypercholesterolem,Esophageal reflux,Osteoporosis NOS
Admission Date:  [**2196-10-21**]              Discharge Date:   [**2196-10-24**]

Date of Birth:  [**2118-5-3**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
ST elevation myocardial infarction status post catheterization
complicated by groin hematoma

Major Surgical or Invasive Procedure:
Cardiac catheterization on [**2196-10-21**]

History of Present Illness:
Ms. [**Known lastname 1007**] is 78 year old female with PMH significant for
hypercholesterolemia, GERD, and arthritis but no CAD history who
presented to an OSH with back pain radiating to L arm and L jaw.
The patient has a history of upper L back pain, which has
worsened in the last 2 weeks. She presented to her PCP on the
morning of admission and was given [**Doctor First Name **] for symptoms
attributed to allergies. The pain then increased in intensity
over the course of the day and began to radiate to L arm/jaw
while the patient was working in her kitchen. Pain did not
alleviate with rest and she called her son who took her to the
[**Hospital3 **] ED.
.
At [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], she was noted to have ST elevations in inferior
leads with a troponin of 0.55. There, she received ASA 325 x1,
Plavix 600, atorvstatin 80 x 1, ativan 1 mg, integrilin, SL NTG
x2, IV lopressor 5 mg * 3, heparin bolus + drip. She was then
transfered here for catheterization.
.
In the cath lab, the patient was noted to have RCA 99% ostial
stenosis; this lesion was stented with bare metal stent with
good result. Her catheterization was complicated by multiple
attempts at venous access which yielded arterial blood. She
developed a large hematoma during the case. Following her cath,
she went to the CCU chest pain free, hemodynamically stable, but
with a large right groin hematoma.
.
On arrival to the floor, the patient denies chest pain, back
pain, shortness of breath, diaphoresis, nausea, and vomiting.
She does have a large ecchymosis in the right groin and thigh
area. She is not having problems walking and states that the
area seems improved. She does not have pain in the right leg.


Past Medical History:
Hypercholesterolemia
GERD
Arthritis
Osteoporosis


Social History:
Nonsmoker, no EtOH, lives alone, son + his family nearby.

Family History:
Denies CAD hx

Physical Exam:
VS- 97.0, 122/51, 84, 18, 99% RA
HEENT- Normocephalic. PERRL. EOMI. MMM & OP clear.
LUNGS- clear to auscultation bilaterally.
HEART- RRR, 2/6 systolic murmur radiating to apex
ABD- soft, ND, NT; 4-5 cm midline scar with distorted umbilicus

EXT- warm. 2+ DP pulses bilaterally. large R groin ecchymosis
covering most of medial thigh and lower abdomen. Small, firm
area in the right groin 3 cm by 3 cm at catheterization site.
Otherwise, soft. Non tender to palpation and non-pulsatile. no
accompanying bruit.
.


Pertinent Results:
labs on admission: significant for HCT 29.1
ekg-
- [**10-21**] 22:43 - NSR 80, nl axis, nl intervals, no LVH/LAE, 1 mm
STE in V2/V3, T wave inversion 3/F; no clear anatomic
distribution of ischemia.
- [**10-21**] 19:00 - NSR 90, nl axis, nl intervals, 2 mm STE in II/III
c ST elevation III > II. T wave inversion in III.
.
Cardiac enzymes: CK peak 472, trending down following cath
CK MB peak 69
Troponin peak 1.29
.
Cardiac catheterization ([**10-21**]): 1. Selective coronary
angiography of this right dominant system revealed 1 vessel
coronary artery disease.  The LMCA is free of angiographically
apparent disease.  The LAD has 30% stenosis in its mid-portion.
The LCx has mild, diffuse disease.  The RCA has a 90% ostial
steosis with moderate diffuse disease. 2. Successful primary
PTCA and stenting of the ostial and proximal RCA with a 2.5 BMS
post dilated with a 3.0 balloon. There was a 20% residual with
TIMI III flow in the distal vessel and no angiographic evidence
of dissection, embolization or peforation. (See PTCA comments)

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Normal ventricular function.
3. Acute inferior myocardial infarction, managed by primary PCI
of the
RCA.
.
Femoral ultrasound ([**10-22**]): Hematoma. No evidence of AV fistula
or pseudoaneurysm.
CXR ([**10-22**]): 1. No acute pulmonary process identified. In
particular, no pneumonic infiltrate is identified. Minimal
scarring at right base noted. 2. Lobulated appearance to the
aortic arch - - while this could be an artifact of positioning,
focal aneurysmal dilatation can also account for this
appearance. Evaluation with a dedicated PA and lateral view is
recommended.
ECHO ([**10-22**]): 1. The left atrium is normal in size. 2.There is
mild symmetric left ventricular hypertrophy. The left
ventricular cavity size is normal. Regional left ventricular
wall motion is normal. Left ventricular systolic function is
hyperdynamic (EF>75%). 3. Right ventricular chamber size is
normal. Right ventricular systolic function is normal. 4.The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion. Trace aortic regurgitation is seen. 5.The
mitral valve leaflets are mildly thickened. No MR seen. 6.There
is an anterior space which most likely represents a fat pad,
though a loculated anterior pericardial effusion cannot be
excluded.
.
Labs at discharge: WBC 6.4, Hgb 12.1, Hct 34.6 (stable),
Platelets 147,000
BMP unremarkable
Cholesterol 162, TG 94, HDL 45, LDL 98

Brief Hospital Course:
Ms. [**Known lastname 1007**] is a 78 year old female with inferior ST elevation
myocardial infarction now status post catheterization
complicated by a large right groin hematoma.
.
#) Status post inferior STEMI - The patient's RCA was found to
be 99% stenosed at catheterization. At that time, she had a bare
metal stent placed with good result.
- She should continue ASA (lifelong) and plavix (for at least
one month and perhaps longer at the discretion of her primary
cardiologist).
- Her groin hematoma on the day of discharge was stable and not
impeding her movement in any way. Her hematocrit at discharge
was stable, though she did require three units of blood
immediately following her catheterization due to falling
hematocrit at that time.
- She should continue atorvastatin 80 mg daily. Her lipids are
near goal with LDL 98.
- She was discharged on Toprol XL 50 mg to be taken daily as
well as a low-dose ACE inhibitor as she is post myocardial
infarction.
- Her echocardiogram does demonstrate a hyperdynamic ejection
fraction. See the full report for details.
- Ms. [**Known lastname 1007**] did not have any concerning arrhythmias on telemetry
during her hospitalization.
- She will follow up with Dr. [**Last Name (STitle) 4469**], who is her primary care
physician as well as a cardiologist, on [**11-1**]. She will
have labs drawn on [**Last Name (LF) 2974**], [**10-28**], to assess her
electrolytes and renal function.
- Ms. [**Known lastname 1007**] was evaluated by physical therapy and deemed safe
for discharge. At the time of discharge, she was hemodynamically
stable and comfortable on room air.
.
#) Right groin hematoma - As above, the area of eccymosis on day
of discharge was large but stable. There was no evidence of
pseudoaneurysm on physical exam or on ultrasound performed on
[**10-22**]. Her hematocrit was stable on day of discharge, and the
patient's movement was not impeded in any way.
- Immediately following her catheterization, she did received
blood transfusions as above.
.
#) GERD - We continued her H2 blocker as per outpatient regimen.

.
#) Code - full
.
#) Prophylaxis - She was kept on aspirin and plavix but no
heparin due to the hematoma. She did receive an H2 blocker
(ranitidine) as above. She was ambulating following her
catheterization.
.
#) FEN - The patient tolerated a cardiac diet without problem.
She had her electrolytes repleted as necesssary.
.
#) Communication - The patient's son is [**Name (NI) **] [**Name (NI) 1007**] H [**Telephone/Fax (1) 68866**],
C [**Telephone/Fax (1) 68867**].


Medications on Admission:
Ranitidine
Fexofenadine
Calcium Supplements
Risedronate


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:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
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:*0*
7. Outpatient Lab Work
Please have your kidney function (creatinine), electrolytes
checked on [**Last Name (LF) 2974**], [**10-28**]. Fax results to Dr. [**Last Name (STitle) 4469**] at
[**Telephone/Fax (1) 11321**].


Discharge Disposition:
Home

Discharge Diagnosis:
ST elevation myocardial infarction, status post catheterization
with stent placed in the right coronary artery


Discharge Condition:
Hemodynamically stable, with stable red blood cell count, and
comfortable on room air


Discharge Instructions:
Please take all your medications as prescribed.
Please call your doctor or return to the emergency room should
you develop any of the following symptoms: recurrent back pain,
chest pain or shortness of breath, bleeding from your
catheterization site, increased area of tenderness or firmness
in your groin, numbness or tingling of the right leg or foot,
bleeding from your gums or blood in your stool or urine, or any
other concerns.

Followup Instructions:
Please follow up with your primary care doctor & cardiologist,
Dr. [**Last Name (STitle) 4469**], on [**2196-11-1**] at 2:00 pm. Please have your
kidney function and electrolytes checked on [**Last Name (LF) 2974**], [**10-28**]. Fax the results to Dr. [**Last Name (STitle) 4469**] at [**Telephone/Fax (1) 11321**].



Completed by:[**2196-10-25**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux,Osteoporosis, 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: ST elevation myocardial infarction status post catheterization
complicated by groin hematoma

PRESENT ILLNESS: Ms. [**Known lastname 1007**] is 78 year old female with PMH significant for
hypercholesterolemia, GERD, and arthritis but no CAD history who
presented to an OSH with back pain radiating to L arm and L jaw.
The patient has a history of upper L back pain, which has
worsened in the last 2 weeks. She presented to her PCP on the
morning of admission and was given [**Doctor First Name **] for symptoms
attributed to allergies. The pain then increased in intensity
over the course of the day and began to radiate to L arm/jaw
while the patient was working in her kitchen. Pain did not
alleviate with rest and she called her son who took her to the
[**Hospital3 **] ED.
.
At [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], she was noted to have ST elevations in inferior
leads with a troponin of 0.55. There, she received ASA 325 x1,
Plavix 600, atorvstatin 80 x 1, ativan 1 mg, integrilin, SL NTG
x2, IV lopressor 5 mg * 3, heparin bolus + drip. She was then
transfered here for catheterization.
.
In the cath lab, the patient was noted to have RCA 99% ostial
stenosis; this lesion was stented with bare metal stent with
good result. Her catheterization was complicated by multiple
attempts at venous access which yielded arterial blood. She
developed a large hematoma during the case. Following her cath,
she went to the CCU chest pain free, hemodynamically stable, but
with a large right groin hematoma.
.
On arrival to the floor, the patient denies chest pain, back
pain, shortness of breath, diaphoresis, nausea, and vomiting.
She does have a large ecchymosis in the right groin and thigh
area. She is not having problems walking and states that the
area seems improved. She does not have pain in the right leg.

MEDICAL HISTORY: Hypercholesterolemia
GERD
Arthritis
Osteoporosis

MEDICATION ON ADMISSION: Ranitidine
Fexofenadine
Calcium Supplements
Risedronate

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS- 97.0, 122/51, 84, 18, 99% RA
HEENT- Normocephalic. PERRL. EOMI. MMM & OP clear.
LUNGS- clear to auscultation bilaterally.
HEART- RRR, 2/6 systolic murmur radiating to apex
ABD- soft, ND, NT; 4-5 cm midline scar with distorted umbilicus

FAMILY HISTORY: Denies CAD hx

SOCIAL HISTORY: Nonsmoker, no EtOH, lives alone, son + his family nearby. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Esophageal reflux,Osteoporosis, unspecified'}
