CHIEF COMPLAINT: motor vehicle accident with chest pain

PRESENT ILLNESS: 71M with h/o bipolar d/o, no known CAD who was the restrained
driver involved in a two car MVA at 8PM on [**2146-8-16**]. Pt does not
recall event but stated that he was wearing seatbelt and airbag
deployed. Pt c/o severe anterior and substernal CP at OSH which
was relieved w/ med rx. Noted to have bruising in lateral left
chest wall. ECG at [**Hospital3 **] had ST elevation anteriorly
(2-3mm, in leads V1-3 w/ hyperacute T waves). Pt transferred to
[**Hospital1 18**] for trauma and MI. In [**Name (NI) **] pt received UFH 5000 Units bolus
plus 1000 Units/hr, IV lopressor 5 mg, ASA 600 mg PR. Bedside
echo revealed depressed LVEF.
CKs peaked at 4773 on admission.

MEDICAL HISTORY: bipolar disorder, stable on lithium.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: intubated, sedated man with obvious facial laceration and
ecchymosis
HEENT: ETT in place, trachea midline
Neck: difficult to assess JVD
Heart: S1S2 tachycardic, no murmurs appreciated
Lungs: loud upper airway sounds
Abdomen: obese, soft, nondistended
Extremities: no edema, 2+ pulses
Neuro: sedated

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other specified open wounds of ocular adnexa,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Closed fracture of unspecified part of humerus,Coronary atherosclerosis of native coronary artery,Bipolar I disorder, most recent episode (or current) unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle
Subendo infarct, initial,CHF NOS,Opn wnd ocular adnex NEC,Acute kidney failure NOS,Lung contusion-closed,Fx humerus NOS-closed,Crnry athrscl natve vssl,Bipolor I current NOS,Mv collision NOS-driver
Admission Date:  [**2146-8-17**]              Discharge Date:   [**2146-8-23**]

Date of Birth:  [**2075-4-5**]             Sex:   M

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

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
motor vehicle accident with chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization with stent placement


History of Present Illness:
71M with h/o bipolar d/o, no known CAD who was the restrained
driver involved in a two car MVA at 8PM on [**2146-8-16**]. Pt does not
recall event but stated that he was wearing seatbelt and airbag
deployed. Pt c/o severe anterior and substernal CP at OSH which
was relieved w/ med rx. Noted to have bruising in lateral left
chest wall. ECG at [**Hospital3 **] had ST elevation anteriorly
(2-3mm, in leads V1-3 w/ hyperacute T waves). Pt transferred to
[**Hospital1 18**] for trauma and MI. In [**Name (NI) **] pt received UFH 5000 Units bolus
plus 1000 Units/hr, IV lopressor 5 mg, ASA 600 mg PR. Bedside
echo revealed depressed LVEF.
CKs peaked at 4773 on admission.

HomeMeds: Lithium 300 mg qd

Past Medical History:
bipolar disorder, stable on lithium.

Physical Exam:
Gen: intubated, sedated man with obvious facial laceration and
ecchymosis
HEENT: ETT in place, trachea midline
Neck: difficult to assess JVD
Heart: S1S2 tachycardic, no murmurs appreciated
Lungs: loud upper airway sounds
Abdomen: obese, soft, nondistended
Extremities: no edema, 2+ pulses
Neuro: sedated

Pertinent Results:
-peak CK 4773 at admission on [**2146-8-17**];
-baseline creatinine in high 1 range, increased to low 2 range
this hospitalization but stable;
-total cholesterol 242, TG 605, HDL 30 on [**2146-8-16**]

Brief Hospital Course:
71 yo M w/ h/o bipolar d/o, no known CAD who was involved in a
two car MVA on [**2146-8-16**] intubated.  ECG on admission showed [**3-10**]
mm STE V1-V4 w/Q waves, [**Street Address(2) 4793**] depression II, III, AVF.
Emergently brought to cath lab which showed LM distal 40%, prox
LAD 80% stenosis, subtotal mid, diffuse dz distally; LCx: 2.0 mm
OM1 w/ 90% stenosis and 50% stenoses in long OM2; RCA
chronically occluded mid vessel w/collaterals from LCA. S/p
Hepacoat stent to prox LAD and mid LAD.  Wedge 28. PA diastolic
26.

1. CAD: s/p cath with stents x2 of prox LAD and mid LAD.  Pt
started on ASA, Plavix x1 month, s/p Integrilin x18 hrs. Started
metoprolol and titrated to 75 mg [**Hospital1 **] (changed to Toprol XL 150
qd prior to discharge). Lipids elevated including triglycerides
605.  Started Lipitor 80 mg qd, plan outpt follow-up.

2. CHF: elevated L-sided filling pressures at cath. Clinically
also overloaded initially. Echo ([**8-18**]) showed LV cavity
moderately dilated, LV syst fxn severely depressed with EF 20%;
severe hypokinesis of anterior free wall, interventricular
septum, and posterior wall; dyskinesis of the apex. Focal
hypokinesis of the apical free wall of the right ventricle.
2+MR. [**First Name (Titles) **] [**Last Name (Titles) 29640**] which was switched to lisinopril 5 qd at
discharge.  Creatinine bumped slightly so spoke to PCP who will
check in [**2-8**] days after discharge. Pt was given lasix for
diuresis in hospital but stable without lasix x 2 days and
creatinine slightly increased as above so not discharged on
Lasix.  Plan outpt follow-up including renal checks.

3. Rhythm: plan outpatient follow-up with electrophysiology
clinic for evaluation regarding ICD given severe LV dysfxn.
Etiology of blackout prior to accident most likely massive MI,
which may have caused arrhythmia.  Stable on telemetry in
hospital.

4. Anticoagulation: on heparin due to anterior akinesis seen on
echo and started on coumadin.  INR close to therapeutic at
discharge, plan outpt follow-up with INR checks.

5. Trauma: from MVA. Spine was cleared by trauma surgery.
Plastic surgery sutured face laceration.  Given pain medications
as needed.

6. Bipolar d/o.  Pt's outpt lithium initially held peri-accident
but restarated & pt tolerated well.  Plan follow-up with outpt
psychiatrist.

7. Pulm. Pt was stable on ventilator & successfully extubated 1
day after admission.  Pt stable on room air for remainder of
hospital stay.  Pulm contusion likely contributing to initial
dyspnea.

8. Code status: Full.

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. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation: as needed for
constipation.
Disp:*60 Capsule(s)* Refills:*2*
4. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Lipitor 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO QD (once a
day).
Disp:*30 Tablet(s)* Refills:*2*
7. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: Three (3)
Tablet Sustained Release 24HR PO once a day.
Disp:*90 Tablet Sustained Release 24HR(s)* Refills:*2*
8. Lithium Carbonate 300 mg Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO QD (once a day).
Disp:*30 Tablet Sustained Release(s)* Refills:*2*
9. Warfarin Sodium 2.5 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime): you must have blood levels checked within 3 days of
discharge.
Disp:*120 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
acute myocardial infarction
congestive heart failure
hyperlipidemia
bipolar disorder


Discharge Condition:
stable

Discharge Instructions:
contact MD or go to emergency room if you develop chest pain,
shortness of breath, palpitations, or other concerning symptoms

Followup Instructions:
1. Please go to your PCP's office on Thurs [**2146-8-25**] for blood
tests to evaluate your coumadin dosing and renal function.
Please call your PCP [**Last Name (NamePattern4) **] [**Telephone/Fax (1) 29641**] for results either Thurs
afternoon or Friday.

2. Follow-up with your PCP (Dr. [**Last Name (STitle) 1683**] on Tues [**2146-8-30**] at 4:00
PM. Please call the office at [**Telephone/Fax (1) 19968**] if you need to change
the appointment.

3. Electrophysiology study with possible ICD placement
tentatively scheduled for Monday [**2146-8-29**] with Dr. [**Last Name (STitle) **].
Someone will contact you with the exact details prior to your
appointment.


Completed by:[**2146-8-23**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other specified open wounds of ocular adnexa,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Closed fracture of unspecified part of humerus,Coronary atherosclerosis of native coronary artery,Bipolar I disorder, most recent episode (or current) unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}


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: motor vehicle accident with chest pain

PRESENT ILLNESS: 71M with h/o bipolar d/o, no known CAD who was the restrained
driver involved in a two car MVA at 8PM on [**2146-8-16**]. Pt does not
recall event but stated that he was wearing seatbelt and airbag
deployed. Pt c/o severe anterior and substernal CP at OSH which
was relieved w/ med rx. Noted to have bruising in lateral left
chest wall. ECG at [**Hospital3 **] had ST elevation anteriorly
(2-3mm, in leads V1-3 w/ hyperacute T waves). Pt transferred to
[**Hospital1 18**] for trauma and MI. In [**Name (NI) **] pt received UFH 5000 Units bolus
plus 1000 Units/hr, IV lopressor 5 mg, ASA 600 mg PR. Bedside
echo revealed depressed LVEF.
CKs peaked at 4773 on admission.

MEDICAL HISTORY: bipolar disorder, stable on lithium.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: intubated, sedated man with obvious facial laceration and
ecchymosis
HEENT: ETT in place, trachea midline
Neck: difficult to assess JVD
Heart: S1S2 tachycardic, no murmurs appreciated
Lungs: loud upper airway sounds
Abdomen: obese, soft, nondistended
Extremities: no edema, 2+ pulses
Neuro: sedated

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other specified open wounds of ocular adnexa,Acute kidney failure, unspecified,Contusion of lung without mention of open wound into thorax,Closed fracture of unspecified part of humerus,Coronary atherosclerosis of native coronary artery,Bipolar I disorder, most recent episode (or current) unspecified,Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}
