CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Patient is a 56 year old male with no significant past medical
history presents with substernal chest pain radiating to back
since 11 am this morning. Patient was doing work on his cottage
in [**Location (un) 945**] and began to feel some "intense heart burn" and took
several tums with no improvement. He describes the pain as
substernal chest pressure ranging from [**2130-5-10**] throughout the day
with intermittent nausea, vomiting and radiation to the back.
Denies associated shortness of breath or dizziness. Patient also
describes fatigue, malaise and anxiety. He was feeling not well,
drove home and then to [**Hospital3 4107**] as the pressure worsened
to [**8-12**]. Patient states he has not seen his primary care doctor
in > 1 year.
.
At [**Hospital3 **] ED BP 136/84, P 82, RR 20, 99% RA. EKG
demonstrated ST elevation V2, V3 and a reported troponin level
of 8.24 (no documentation). Started on Heparin drip, Nitro drip,
Integrillin bolus and drip, lopressor and aspirin. After
receiving nitro SBP decreased to 76, responded to IVF bolus.
Patient directly transferred to [**Hospital1 18**] cath [**Hospital1 **].
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.
On review of systems, denies any prior history of stroke, TIA,
deep venous thrombosis, pulmonary embolism, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
All of the other review of systems were negative.

MEDICAL HISTORY: PAST MEDICAL HISTORY: Dirverticulatis.
1. CARDIAC RISK FACTORS:: Denies: Diabetes, Dyslipidemia,
Hypertension.
2. CARDIAC HISTORY: None prior

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T= 98.6 BP= 119/69 HR= 81 RR= 14 O2 sat= 99% RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI. Mother age 86 secondary severe
arthritis. Brother with CAD. Denies history of DM, HTN,
hyperlipidemia.
.

SOCIAL HISTORY: -Tobacco history: 2 ppd for > 30 years.
-ETOH: Quit drinking 5 years ago. Reports drinking several beers
a day prior.
-Illicit drugs: Denies.
Acute myocardial infarction of anterolateral wall, initial episode of care,Systolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Tobacco use disorder
AMI anterolateral, init,Systolic hrt failure NOS,Crnry athrscl natve vssl,Tobacco use disorder
Admission Date:  [**2128-11-17**]              Discharge Date:   [**2128-11-20**]

Date of Birth:  [**2072-11-16**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2736**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization with Drug Eluting stents to Left
anterior Descending Artery. 80% left Cirumflex artery was not
intervened on.


History of Present Illness:
Patient is a 56 year old male with no significant past medical
history presents with substernal chest pain radiating to back
since 11 am this morning. Patient was doing work on his cottage
in [**Location (un) 945**] and began to feel some "intense heart burn" and took
several tums with no improvement. He describes the pain as
substernal chest pressure ranging from [**2130-5-10**] throughout the day
with intermittent nausea, vomiting and radiation to the back.
Denies associated shortness of breath or dizziness. Patient also
describes fatigue, malaise and anxiety. He was feeling not well,
drove home and then to [**Hospital3 4107**] as the pressure worsened
to [**8-12**]. Patient states he has not seen his primary care doctor
in > 1 year.
.
At [**Hospital3 **] ED BP 136/84, P 82, RR 20, 99% RA. EKG
demonstrated ST elevation V2, V3 and a reported troponin level
of 8.24 (no documentation). Started on Heparin drip, Nitro drip,
Integrillin bolus and drip, lopressor and aspirin. After
receiving nitro SBP decreased to 76, responded to IVF bolus.
Patient directly transferred to [**Hospital1 18**] cath [**Hospital1 **].
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.
On review of systems, denies any prior history of stroke, TIA,
deep venous thrombosis, pulmonary embolism, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
All of the other review of systems were negative.


Past Medical History:
PAST MEDICAL HISTORY: Dirverticulatis.
1. CARDIAC RISK FACTORS:: Denies: Diabetes, Dyslipidemia,
Hypertension.
2. CARDIAC HISTORY: None prior

Social History:
-Tobacco history: 2 ppd for > 30 years.
-ETOH: Quit drinking 5 years ago. Reports drinking several beers
a day prior.
-Illicit drugs: Denies.

Family History:
No family history of early MI. Mother age 86 secondary severe
arthritis. Brother with CAD. Denies history of DM, HTN,
hyperlipidemia.
.


Physical Exam:
VS: T= 98.6 BP= 119/69 HR= 81 RR= 14 O2 sat= 99% RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: JVP not appreciated above clavicle.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
.
Physical Exam at discharge unchanged from admission. Systolic
blood pressure in the 100-110 range

Pertinent Results:
[**2128-11-17**] 04:17AM BLOOD WBC-14.6* RBC-4.91 Hgb-15.1 Hct-41.6
MCV-85 MCH-30.7 MCHC-36.3* RDW-13.5 Plt Ct-198
[**2128-11-18**] 04:26AM BLOOD WBC-12.8* RBC-4.51* Hgb-13.8* Hct-38.4*
MCV-85 MCH-30.6 MCHC-35.8* RDW-13.4 Plt Ct-173
[**2128-11-19**] 06:50AM BLOOD WBC-12.1* RBC-4.54* Hgb-13.6* Hct-38.7*
MCV-85 MCH-29.9 MCHC-35.0 RDW-13.4 Plt Ct-206
[**2128-11-20**] 06:08AM BLOOD WBC-10.3 RBC-4.55* Hgb-14.1 Hct-38.9*
MCV-86 MCH-31.0 MCHC-36.2* RDW-13.5 Plt Ct-205
[**2128-11-17**] 04:17AM BLOOD PT-13.5* INR(PT)-1.2*
[**2128-11-20**] 06:08AM BLOOD PT-19.9* INR(PT)-1.9*
[**2128-11-17**] 04:17AM BLOOD Glucose-95 UreaN-11 Creat-0.6 Na-137
K-4.2 Cl-103 HCO3-24 AnGap-14
[**2128-11-20**] 06:08AM BLOOD Glucose-91 UreaN-13 Creat-0.8 Na-139
K-4.6 Cl-104 HCO3-27 AnGap-13
[**2128-11-17**] 04:17AM BLOOD ALT-48* AST-167* LD(LDH)-673*
CK(CPK)-2725* AlkPhos-67 TotBili-0.8
[**2128-11-17**] 12:51PM BLOOD CK(CPK)-2135*
[**2128-11-17**] 09:04PM BLOOD CK(CPK)-1474*
[**2128-11-18**] 04:26AM BLOOD ALT-38 AST-79* LD(LDH)-685* CK(CPK)-900*
AlkPhos-56 TotBili-0.6
[**2128-11-17**] 04:17AM BLOOD CK-MB-349* MB Indx-12.8* cTropnT-6.05*
[**2128-11-17**] 12:51PM BLOOD CK-MB-153* MB Indx-7.2* cTropnT-3.28*
[**2128-11-17**] 09:04PM BLOOD CK-MB-74* MB Indx-5.0 cTropnT-2.18*
[**2128-11-18**] 04:26AM BLOOD CK-MB-40* MB Indx-4.4
[**2128-11-17**] 04:17AM BLOOD Triglyc-122 HDL-44 CHOL/HD-3.9
LDLcalc-105
[**2128-11-17**] 04:17AM BLOOD %HbA1c-5.5

Cath Report:
LMCA: 40% ostial
LAD: 99% mid
LCX: 60% ostial, 70% OM1, 80% mid circumflex
RCA: no significant disease
2 [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 10157**] placed in LAD.
.
EKG: [**Hospital1 **]: ST elevation V2-V3 with Q waves. [**Hospital1 18**]: ST
elevation V2-V6.

Echo ([**11-17**])
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy with normal cavity size. There is mild
to moderate regional left ventricular systolic dysfunction with
moderate hypokinesis of the mid to distal anterior and
anteroseptal segments and the apex. There is no ventricular
septal defect. Right ventricular chamber size and free wall
motion are normal. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. The mitral valve
leaflets are mildly thickened. There is no mitral valve
prolapse. Trivial mitral regurgitation is seen. The estimated
pulmonary artery systolic pressure is normal. There is no
pericardial effusion.

IMPRESSION: Mild symmetric LVH with moderate regional LV
systolic dysfunction consistent with CAD of the LAD. No
significant valvular pathology seen.

Brief Hospital Course:
 ASSESSMENT AND PLAN: 56 year old male transferred to BIMDC for
anterolateral STEMI s/p 2 DES to the LAD. Requiring 3-6 months
coumadin for akinetic wall.
.
# CORONARIES: Patient presented with anterolateral MI, s/p 2 DES
to the LAD (99% occlusion). Patient with circumflex lesions (60%
ostial, 70% OM1, 80% mid circumflex).
- Discharged on ASA, Plavix
- Atorvastatin 80 mg (despite elevated AST--needs to be
followed)
- Beta blocker, ACE inhibitor as pressure tolerates.
- Stress test with MIBI in 6 weeks to assess burden of
circumflex dz and f/u with Dr. [**Last Name (STitle) **] after.
.
# PUMP: No signs of heart failure on exam (no crackles, JVD,
edema). Significantly depressed EF with hypokinetic wall on
echo.
- Pt will require 3-6 months of anticoagulation with coumadin to
prevent LV thrombus. INR=1.9 at time of discharge, pt discharged
with Rx for 5mg dose, he will have his INR checked two days
post-discharge and sent to his PCP who will follow his INR
thereafter.
- [**Name (NI) 8863**] [**Name (NI) 8864**]
- Pt instructed to discuss with his PCP [**Last Name (NamePattern4) **]: cardiac rehab
available through his insurance network in the area
.
# RHYTHM: Normal sinus rhythm with occasional accelerated
idioventricular rhythm (6 beat max). Re-perfusion rhythm.
.
# Tobacco use: Pt given Rx for Chantix and given material re:
smoking cessation


Medications on Admission:
none

Discharge Medications:
1. Outpatient [**Name (NI) **] Work
PT/INR and chem-10 to be drawn on Monday, [**11-22**].
Please have results called to Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) 18323**] in [**Hospital1 **], phone
([**Telephone/Fax (1) 79920**]
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Take every day for one year, do not stop taking unless
Dr. [**Last Name (STitle) **] tells you to. .
Disp:*30 Tablet(s)* Refills:*11*
4. Warfarin 2 mg Tablet Sig: 2.5 Tablets PO once a day.
Disp:*100 Tablet(s)* Refills:*2*
5. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1)
Sublingual every 5 minutes x3  total as needed for chest pain.
Disp:*1 bottle* Refills:*1*
8. Chantix 0.5(11)-1(3X14) mg Tablets, Dose Pack Sig: One (1)
Package PO as directed: For dosing, please follow directions in
packet.
Disp:*1 Dose Pack* Refills:*2*
9. Zocor 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
ST Elevation Anterior Myocardial Infarction
Accelerated Idioventricular Rhythm
Compendsated Left Ventricular Systolic Dysfunction: EF 35-40%


Discharge Condition:
stable.
Hct 38.7
creat 0.7
WBC 12.8
CK 257


Discharge Instructions:
You had a heart attack and your heart function is weak. We think
that your heart function may improve over the next few weeks. A
stress test has been scheduled for you before you see Dr.
[**Last Name (STitle) **]. it is very important that you go to cardiac
rehabilitation and take all of your medicines as prescribed.
New medicines:
1. Plavix: to prevent blood clots and future heart attacks. This
keeps your stents open. Take this every day for one year, do not
miss a dose.
2. [**Last Name (STitle) 8863**] XL: a beta blocker which rests your heart and promotes
healing. Slows your heart rate.
3. Lisinopril: lowers blood pressure and rests your heart.
4. Aspirin: prevents blood clots and another heart attack.
5. Atorvastatin: to lower your cholesterol and prevent another
heart attack.
6. Warfarin: to prevent blood clots because your heart is not
pumping well. You will take this every day but the drug level in
your blood needs to be monitored. The goal warfarin level (INR)
is 2.0-3.0. You will get your INR checked on Monday--you must
make sure that Dr. [**Last Name (STitle) 18323**] gets the result and you must discuss
how much coumadin you should take with him.
.
Please stop smoking. This is the single most important thing you
can do for your health. Information was given to you on
admission regarding smoking cessation.
.
Please call Dr. [**Last Name (STitle) **] if you have any chest pain, trouble
breathing, nausea, vomiting, groin pain or tenderness.
.
If you have chest pain:
1. sit down
2. take 1 sublingual nitroglycerin every 5 minutes for total of
3 doses. If you have chest pain after 3 doses, call 911.

Followup Instructions:
Please get your blood work done on Monday [**11-22**].  You
should contact your Primary care physician about the results.

Also, call your PCP on MONDAY [**2128-11-22**] to discuss your blood
test results and to set up a convenient way for you to get your
INR checked regularly. Make a follow up appointment within 1
week of your discharge from the hospital.

You have the following appoitment with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] ([**Telephone/Fax (1) 3942**] from Cardiology on [**1-5**] at 1 p.m. in [**Hospital Ward Name 23**]
building [**Location (un) 436**].

You have a stress test planned for [**12-31**] at 10 a.m., no
eating or drinking for 2 hours prior to the stress test.  No
caffeine for 12 hours prior to stress test.  This is located in
the [**Hospital Ward Name 23**] Building at the [**Hospital3 **] on the [**Location (un) **].



Completed by:[**2128-11-21**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Systolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Tobacco use disorder'}


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: Patient is a 56 year old male with no significant past medical
history presents with substernal chest pain radiating to back
since 11 am this morning. Patient was doing work on his cottage
in [**Location (un) 945**] and began to feel some "intense heart burn" and took
several tums with no improvement. He describes the pain as
substernal chest pressure ranging from [**2130-5-10**] throughout the day
with intermittent nausea, vomiting and radiation to the back.
Denies associated shortness of breath or dizziness. Patient also
describes fatigue, malaise and anxiety. He was feeling not well,
drove home and then to [**Hospital3 4107**] as the pressure worsened
to [**8-12**]. Patient states he has not seen his primary care doctor
in > 1 year.
.
At [**Hospital3 **] ED BP 136/84, P 82, RR 20, 99% RA. EKG
demonstrated ST elevation V2, V3 and a reported troponin level
of 8.24 (no documentation). Started on Heparin drip, Nitro drip,
Integrillin bolus and drip, lopressor and aspirin. After
receiving nitro SBP decreased to 76, responded to IVF bolus.
Patient directly transferred to [**Hospital1 18**] cath [**Hospital1 **].
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.
On review of systems, denies any prior history of stroke, TIA,
deep venous thrombosis, pulmonary embolism, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
All of the other review of systems were negative.

MEDICAL HISTORY: PAST MEDICAL HISTORY: Dirverticulatis.
1. CARDIAC RISK FACTORS:: Denies: Diabetes, Dyslipidemia,
Hypertension.
2. CARDIAC HISTORY: None prior

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T= 98.6 BP= 119/69 HR= 81 RR= 14 O2 sat= 99% RA
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI. Mother age 86 secondary severe
arthritis. Brother with CAD. Denies history of DM, HTN,
hyperlipidemia.
.

SOCIAL HISTORY: -Tobacco history: 2 ppd for > 30 years.
-ETOH: Quit drinking 5 years ago. Reports drinking several beers
a day prior.
-Illicit drugs: Denies. 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Systolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Tobacco use disorder'}
