CHIEF COMPLAINT: Substernal chest pain

PRESENT ILLNESS: 60yo man with h/o high cholesterol, GERD, OSA, BPH, presented
with 4/10 SSCP with radiations down his L arm, dizziness. Pt
reports that symptoms of SSCP and dizziness started 3d PTA, were
not exacerbated by activity, resolving on their own within
minutes.  He notes that his dizziness was worse at night and had
caused him to walk into his bedroom door one night.

MEDICAL HISTORY: 1. high cholesterol
2. GERD
3. OSA
4. BPH
5. Erectile dysfunction

MEDICATION ON ADMISSION: AMBIEN 5MG QHS
MOTRIN 600MG PRN
NAPROXEN SODIUM 550MG PRN
NEXIUM 20MG QAM
CARDURA 4MG QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:
Gen: pt lying flat in bed, pleasant, NAD, smiling and talking
with his family
HEENT: PERRL, EOMI, OP clear, dry MM
Skin: warm and dry; scabs on right forearm
CV: RRR, nl s1,s2, no MGR, JVP 8-9cm H20
Lungs: CTA anteriorly, unable to move pt to auscultate posterior
chest
Abd: muscular, not obese, soft, nt, nd, no HSM
Groin: right groin with line in place, dressing CDI, no evid of
hematoma
Ext: FROM x 4, no LE edema, no CCE
Pulses: 2+ DP, PT pulses b/l; 2+ radial pulses b/l
Neuro/Psych: nonfocal, A+Ox3, full affect

FAMILY HISTORY: Mother - CAD, DM2
Father - CVA later in life
Sister - no known medical issues

SOCIAL HISTORY: Pt works as roof inspector/builder.
Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux
Subendo infarct, initial,Parox ventric tachycard,Crnry athrscl natve vssl,Hypertension NOS,Esophageal reflux
Admission Date:  [**2145-9-10**]              Discharge Date:   [**2145-9-14**]

Date of Birth:  [**2085-7-25**]             Sex:   M

Service: [**Hospital Unit Name 196**]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4765**]
Chief Complaint:
Substernal chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization with drug-eluting stent placement

History of Present Illness:
60yo man with h/o high cholesterol, GERD, OSA, BPH, presented
with 4/10 SSCP with radiations down his L arm, dizziness. Pt
reports that symptoms of SSCP and dizziness started 3d PTA, were
not exacerbated by activity, resolving on their own within
minutes.  He notes that his dizziness was worse at night and had
caused him to walk into his bedroom door one night.

On the AM of admit, however, the pt noted while working in his
job as a roof inspector/builder that his pain was worse than
previously and that it radiated down his L arm, which was new,
and that he was diaphoretic.  He was exerting himself as usual,
climbing ladders and some equipment but nothing particularly
straining.  He also notes that he was working with fiberglass
insulation this AM.

He went to the ER at an OSH (arrived 70 min after symptoms
began), where his HR 48-50, O2 sat 98%, CP was [**4-17**], EKG with ST
elevations in II,III, aVF. He was given bridging Retavasc total
20 units, a heparin [**Last Name (LF) 1868**], [**First Name3 (LF) **], morphine, and sent to [**Hospital1 18**] for
catheterization.

Past Medical History:
1. high cholesterol
2. GERD
3. OSA
4. BPH
5. Erectile dysfunction

Social History:
Pt works as roof inspector/builder.

Tob: 2 packs/day x "many years" (20-30y), quit 16y PTA
Etoh: "recovering alcoholic," last drink 20y PTA
Other Drugs: none; no cocaine use, no IVDA

Family History:
Mother - CAD, DM2
Father - CVA later in life
Sister - no known medical issues

Physical Exam:
Vitals:
Gen: pt lying flat in bed, pleasant, NAD, smiling and talking
with his family
HEENT: PERRL, EOMI, OP clear, dry MM
Skin: warm and dry; scabs on right forearm
CV: RRR, nl s1,s2, no MGR, JVP 8-9cm H20
Lungs: CTA anteriorly, unable to move pt to auscultate posterior
chest
Abd: muscular, not obese, soft, nt, nd, no HSM
Groin: right groin with line in place, dressing CDI, no evid of
hematoma
Ext: FROM x 4, no LE edema, no CCE
Pulses: 2+ DP, PT pulses b/l; 2+ radial pulses b/l
Neuro/Psych: nonfocal, A+Ox3, full affect

Pertinent Results:
[**2145-9-10**] 05:54PM BLOOD WBC-11.3*# RBC-4.56* Hgb-14.5 Hct-39.0*
MCV-85 MCH-31.7 MCHC-37.1* RDW-12.6 Plt Ct-153
[**2145-9-11**] 06:21AM BLOOD Hct-38.3* Plt Ct-168
[**2145-9-12**] 06:45AM BLOOD WBC-12.3* RBC-4.13* Hgb-12.7* Hct-36.4*
MCV-88 MCH-30.9 MCHC-35.0 RDW-12.5 Plt Ct-124*
[**2145-9-13**] 06:25AM BLOOD WBC-9.1 RBC-3.95* Hgb-12.5* Hct-34.6*
MCV-88 MCH-31.7 MCHC-36.2* RDW-12.5 Plt Ct-134*
[**2145-9-10**] 05:54PM BLOOD Plt Ct-153
[**2145-9-10**] 11:27PM BLOOD Plt Ct-170
[**2145-9-11**] 06:21AM BLOOD Plt Ct-168
[**2145-9-12**] 06:45AM BLOOD Plt Ct-124*
[**2145-9-12**] 03:35PM BLOOD Plt Ct-137*
[**2145-9-13**] 06:25AM BLOOD PT-13.0 PTT-27.5 INR(PT)-1.1
[**2145-9-13**] 06:25AM BLOOD Plt Ct-134*
[**2145-9-10**] 05:54PM BLOOD Glucose-172* UreaN-19 Creat-1.1 Na-140
K-4.8 Cl-107 HCO3-24 AnGap-14
[**2145-9-12**] 06:45AM BLOOD Glucose-136* UreaN-24* Creat-0.8 Na-138
K-4.2 Cl-102 HCO3-25 AnGap-15
[**2145-9-13**] 06:25AM BLOOD Glucose-105 UreaN-18 Creat-0.8 Na-139
K-4.0 Cl-103 HCO3-27 AnGap-13
[**2145-9-10**] 11:27PM BLOOD CK(CPK)-3233*
[**2145-9-11**] 06:21AM BLOOD CK(CPK)-[**2142**]*
[**2145-9-12**] 06:45AM BLOOD CK(CPK)-592*
[**2145-9-12**] 03:35PM BLOOD CK(CPK)-447*
[**2145-9-13**] 06:25AM BLOOD CK(CPK)-265*
[**2145-9-11**] 06:21AM BLOOD CK-MB-366* MB Indx-18.3*
[**2145-9-12**] 06:45AM BLOOD CK-MB-46* MB Indx-7.8* cTropnT-5.17*
[**2145-9-12**] 03:35PM BLOOD CK-MB-21* MB Indx-4.7 cTropnT-4.57*
[**2145-9-13**] 06:25AM BLOOD CK-MB-10 MB Indx-3.8 cTropnT-4.68*
[**2145-9-10**] 05:54PM BLOOD Calcium-8.9 Phos-2.8 Mg-1.9
[**2145-9-11**] 06:21AM BLOOD Cholest-176
[**2145-9-12**] 06:45AM BLOOD Calcium-9.1 Phos-1.9* Mg-1.7
[**2145-9-13**] 06:25AM BLOOD Calcium-9.2 Phos-2.7 Mg-1.9
[**2145-9-11**] 06:21AM BLOOD Triglyc-254* HDL-38 CHOL/HD-4.6
LDLcalc-87

Brief Hospital Course:
Pt arrived at [**Hospital1 18**] from OSH and was sent immediately to cath
lab. Though his ECG implied likely RCA disease, his cath results
were as follows:

FINAL DIAGNOSIS:
1. One vessel coronary artery disease.
2. Normal ventricular function.
COMMENTS:
1. Selective coronary angiography shows that the LMCA has no
obstructive
disease, the LAD has minimal disease, the LCX is totatlly
occluded
proximally, and there is a small nondominant R CA which has
minimal
disease.
2. Hemodynamics on entry show mildly elevated right and left
sided
pressures.
3. The patient developed itchiness during the study after having
received IV contrast [**Last Name (LF) **], [**First Name3 (LF) **] he was given prednisone, benedryl,
and
pepcid. His symptoms did not progress.

He received a drug-eluting stent to his LCx artery, with good
result. He tolerated the procedure well and had no
complications. The patient was noted to have an elevated wedge
pressure during the procedure and as a result he was sent to the
CCU for closer monitoring.  He was noted to have occassional PVC
couplets on arrival to the CCU, consistent with reperfusion to
his myocardial tissue.  His vitals were stable, and the patient
was eager to eat and to learn when he could leave the hospital.

The patient was started on [**First Name3 (LF) **], Plavix, Lipitor and Lopressor
after his stent placement. An ACEI would have been added, but
his SBP would not tolerate it and the beta blocker was felt to
be of greater benefit post-IWMI. The patient's CK (3233), CK-MB
(>500), troponin (5.17) all peaked on [**2145-9-10**] (day of admit). He
had some complaints of mild chest pain which he attributed to a
cough he had prior to admission and felt was not the same as the
pain he had that brought him to the hospital. This pain resolved
overnight on its own.

On telemetry the patient was noted to be bradycardic as per his
longstanding rhythm per the medical records. He was asymptomatic
in this rhythm.

The patient noted that his doxazosin at 2mg qhs was not helping
his BPH, that he had to get up to urinate 5-6 times overnight.
He requested increasing the dose, but as his SBP would go down
to 90 around midnight this request was not granted.  He did not
want Flomax as he had a bad sinus reaction to this med in the
past, and Hytrin (terazosin) was considered but ultimately not
tried given the need to ramp up this med and his upcoming
discharge.  Pt advised to readdress with his PCP.

Prior to discharge, pt had a TTE performed with the following
results:
"The left atrium is mildly dilated. Left ventricular wall
thicknesses and cavity size are normal. There is moderate
regional left ventricular systolic dysfunction with severe
hypokinesis/near akinesis of the basal 2/3rds of the inferior
and inferolateral walls. The remaining segments contract well.
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. The mitral
valve leaflets are structurally normal. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. There is mild
pulmonary artery systolic hypertension. There is a very small
circumferential pericardial effusion without evidence for
hemodynamic compromise.
IMPRESSION: Regional left ventricular systolic dysfunction c/w
CAD. Mild mitral regurgitation."

Pt was informed of results and discharged for follow up with his
PCP and Dr. [**Last Name (STitle) 911**] for Cardiology.

Medications on Admission:
AMBIEN 5MG QHS
MOTRIN 600MG PRN
NAPROXEN SODIUM 550MG PRN
NEXIUM 20MG QAM
CARDURA 4MG QHS

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO QD (once a day).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO QD
(once a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO QD
(once a day).
Disp:*60 Tablet(s)* Refills:*2*
4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
5. Doxazosin Mesylate 2 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Myocardial infarction (STEMI)


Discharge Condition:
Stable

Discharge Instructions:
Please take all medications as prescribed, as they are extremely
important in keeping the arteries to your heart open and free of
the clots that could cause another heart attack.  Also, avoid
biking or running in the next week to prevent disruption of your
right groin wound. You can return to other activities in your
daily life as tolerated.

Please attend all appointments scheduled for you, as you will
need close follow up in the next few weeks. You will be
scheduled for appointments with both your Primary Care doctor,
Dr. [**Last Name (STitle) 3029**], as well as a Cardiologist to evaluate your heart
function.

Followup Instructions:
Please follow up in the Cardiology Clinic in two weeks for
re-evaluation after your recent procedure.

1. Dr. [**Last Name (STitle) 3029**]
2. Cardiology
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux'}


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: Substernal chest pain

PRESENT ILLNESS: 60yo man with h/o high cholesterol, GERD, OSA, BPH, presented
with 4/10 SSCP with radiations down his L arm, dizziness. Pt
reports that symptoms of SSCP and dizziness started 3d PTA, were
not exacerbated by activity, resolving on their own within
minutes.  He notes that his dizziness was worse at night and had
caused him to walk into his bedroom door one night.

MEDICAL HISTORY: 1. high cholesterol
2. GERD
3. OSA
4. BPH
5. Erectile dysfunction

MEDICATION ON ADMISSION: AMBIEN 5MG QHS
MOTRIN 600MG PRN
NAPROXEN SODIUM 550MG PRN
NEXIUM 20MG QAM
CARDURA 4MG QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:
Gen: pt lying flat in bed, pleasant, NAD, smiling and talking
with his family
HEENT: PERRL, EOMI, OP clear, dry MM
Skin: warm and dry; scabs on right forearm
CV: RRR, nl s1,s2, no MGR, JVP 8-9cm H20
Lungs: CTA anteriorly, unable to move pt to auscultate posterior
chest
Abd: muscular, not obese, soft, nt, nd, no HSM
Groin: right groin with line in place, dressing CDI, no evid of
hematoma
Ext: FROM x 4, no LE edema, no CCE
Pulses: 2+ DP, PT pulses b/l; 2+ radial pulses b/l
Neuro/Psych: nonfocal, A+Ox3, full affect

FAMILY HISTORY: Mother - CAD, DM2
Father - CVA later in life
Sister - no known medical issues

SOCIAL HISTORY: Pt works as roof inspector/builder. 

### Response:
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux'}
