CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: This is a 67 year old woman with a history of rheumatic fever,
COPD, and gastric ulcer who presented to [**Hospital3 **] with
chest pain. The pain started at around 3pm while she was sitting
at rest. She first noticed bilaterally arm pain, along with
substernal chest pressure. There was no associated SOB, N/V, or
diaphoresis. She has never had chest pain like this before.
.
She went to the ED at [**Hospital3 4107**], where she received SL NTG
x3 which helped the pain somewhat but did not relieve it
completely. EKG at the OSH showed aflutter with a rate in the
70s, with 1-1.5mm ST elevations in leads II, III, and aVF. At
the OSH she also received asa, metoprolol 5mg IV x1, lipitor
80mg, plavix 300mg, and heparin and integrillin gtt were
started. She was then transferred to [**Hospital1 18**] for cath.
.
In the cath lab here, she was found to have a 50% mid-RCA
lesions as well as [**2-13**]+MR. [**Name13 (STitle) **] further intervention was done.
.
Of note, she had a recent admission to S. [**Hospital **] hospital for
SOB, and she was treated for a COPD flare. On that admission she
was also told that she had a "leaky valve."
.
Currently, she denies CP/SOB, cough, F/C, abd pain, diarrhea.
She does complain of nausea.

MEDICAL HISTORY: asthma/COPD
h/o gastric ulcer
h/o rheumatic fever

MEDICATION ON ADMISSION: lasix 20mg
diltiazem CD 120mg
albuterol prn
spiriva
advair 500/50 [**Hospital1 **]
prilosec 20

ALLERGIES: Codeine

PHYSICAL EXAM: VS: T 97.5, BP 124/54, HR 76, RR 19, 97% on 2L
Gen: NAD at rest, lying flat in bed
HEENT: PERRL, EOMI, MMM, OP clear
Neck: Supple, no JVD
Lungs: CTAB anteriorly
Heart: regular, II/VI soft systolic murmur at apex
Abd: +BS, soft, NT/ND
Extrem: no edema, 2+DP pulses

FAMILY HISTORY: Sister had several valve surgeries due to rheumatic fever. No FH
of CAD.

SOCIAL HISTORY: Lives with her husband. Smoked ~[**12-14**] ppd for 40 years (quit 1.5
weeks ago). Occasional alcohol.
Multiple involvement of mitral and aortic valves,Subendocardial infarction, initial episode of care,Rheumatic heart failure (congestive),Atrial fibrillation,Chronic obstructive asthma, unspecified,Abdominal pain, other specified site,Osteoporosis, unspecified
Mitr/aortic mult involv,Subendo infarct, initial,Rheumatic heart failure,Atrial fibrillation,Chronic obst asthma NOS,Abdmnal pain oth spcf st,Osteoporosis NOS
Admission Date:  [**2179-7-24**]              Discharge Date:   [**2179-8-2**]

Date of Birth:  [**2112-7-6**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
Cardiac Cath
Mitral valve replacement (#27 St. [**Male First Name (un) 923**] Mechanical)
MAZE (RF Ablation)
Repair coronary sinus
LAA Stapling


History of Present Illness:
This is a 67 year old woman with a history of rheumatic fever,
COPD, and gastric ulcer who presented to [**Hospital3 **] with
chest pain. The pain started at around 3pm while she was sitting
at rest. She first noticed bilaterally arm pain, along with
substernal chest pressure. There was no associated SOB, N/V, or
diaphoresis. She has never had chest pain like this before.
.
She went to the ED at [**Hospital3 4107**], where she received SL NTG
x3 which helped the pain somewhat but did not relieve it
completely. EKG at the OSH showed aflutter with a rate in the
70s, with 1-1.5mm ST elevations in leads II, III, and aVF. At
the OSH she also received asa, metoprolol 5mg IV x1, lipitor
80mg, plavix 300mg, and heparin and integrillin gtt were
started. She was then transferred to [**Hospital1 18**] for cath.
.
In the cath lab here, she was found to have a 50% mid-RCA
lesions as well as [**2-13**]+MR. [**Name13 (STitle) **] further intervention was done.
.
Of note, she had a recent admission to S. [**Hospital **] hospital for
SOB, and she was treated for a COPD flare. On that admission she
was also told that she had a "leaky valve."
.
Currently, she denies CP/SOB, cough, F/C, abd pain, diarrhea.
She does complain of nausea.

Past Medical History:
asthma/COPD
h/o gastric ulcer
h/o rheumatic fever

Social History:
Lives with her husband. Smoked ~[**12-14**] ppd for 40 years (quit 1.5
weeks ago). Occasional alcohol.

Family History:
Sister had several valve surgeries due to rheumatic fever. No FH
of CAD.

Physical Exam:
VS: T 97.5, BP 124/54, HR 76, RR 19, 97% on 2L
Gen: NAD at rest, lying flat in bed
HEENT: PERRL, EOMI, MMM, OP clear
Neck: Supple, no JVD
Lungs: CTAB anteriorly
Heart: regular, II/VI soft systolic murmur at apex
Abd: +BS, soft, NT/ND
Extrem: no edema, 2+DP pulses

Pertinent Results:
EKG:
OSH: aflutter, rate ~70s, nl axis, nl intervals. 1mm ST
elevation in II, III, aVF (also possibly interpreted as buried
flutter waves in those areas).
.
ADMIT LABS:
[**2179-7-24**] 09:43PM BLOOD WBC-9.9 RBC-4.03* Hgb-11.7* Hct-34.7*
MCV-86# MCH-29.0 MCHC-33.6 RDW-14.9 Plt Ct-282
[**2179-7-25**] 12:05AM BLOOD Neuts-87.9* Bands-0 Lymphs-7.2* Monos-3.7
Eos-0.5 Baso-0.6
[**2179-7-24**] 09:43PM BLOOD Plt Ct-282
[**2179-7-25**] 07:33AM BLOOD PT-12.3 PTT-29.9 INR(PT)-1.1
[**2179-7-24**] 09:43PM BLOOD K-4.4
[**2179-7-25**] 12:05AM BLOOD ALT-20 AST-21 LD(LDH)-186 AlkPhos-66
Amylase-40 TotBili-0.4
[**2179-7-25**] 12:05AM BLOOD Lipase-23
[**2179-7-24**] 09:43PM BLOOD Mg-2.2
[**2179-7-25**] 07:33AM BLOOD Calcium-8.5 Phos-4.1 Mg-2.2
.
CARDIAC ENZYMES:
OSH Labs: [**7-24**] 4:30pm TnI 0.02
[**2179-7-25**] 01:25PM BLOOD CK-MB-21* MB Indx-9.5* cTropnT-0.62*
[**2179-8-2**] 07:15AM BLOOD WBC-12.2* RBC-2.96* Hgb-9.0* Hct-26.0*
MCV-88 MCH-30.6 MCHC-34.7 RDW-18.0* Plt Ct-334#
[**2179-7-31**] 04:50AM BLOOD WBC-12.1* RBC-3.32* Hgb-10.0* Hct-28.8*
MCV-87 MCH-30.1 MCHC-34.7 RDW-16.3* Plt Ct-215
[**2179-8-2**] 07:15AM BLOOD Glucose-95 UreaN-20 Creat-0.8 Na-135
K-4.2 Cl-96 HCO3-28 AnGap-15
[**2179-8-2**] 07:15AM BLOOD PT-34.2* PTT-37.8* INR(PT)-3.7*
[**2179-8-1**] 04:45AM BLOOD PT-25.1* PTT-77.4* INR(PT)-2.5*
[**2179-7-31**] 04:50AM BLOOD PT-20.9* PTT-47.3* INR(PT)-2.0*

Brief Hospital Course:
Ms. [**Known lastname 17870**] was taken to the operating room on [**2179-7-27**] where she
underwent a Mechanical Mitral valve replacement, a MAZE
procedure, a coronary sinus repair and stapling of [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**].
She was transferred to the SICU in critical but stable condition
on dobutamine and propofol drips. She was extubated  and weaned
from her vasoactive drips the same day. She received 2 units
PRBCs for a HCT of 24. She was bolused with amiodarone and
started on a amiodarone drip as well as coumadin  for her atrial
fibrillation. She was transferred to the floor on POD #1.She was
started on heparin for her mechanical valve while her INR was
subtherapeutic. She received an additional unit of PRBCs for an
HCT of 22, with a repeat HCT of 26. She remained in the hospital
while she was anticoagulated for an INR goal of 2.5-3.5. She was
discharged to home on POD #6. She had continued problems with
nausea as she did prior to surgery, and was given compazine on
discharge and asked to follow up with her PCP.

Medications on Admission:
lasix 20mg
diltiazem CD 120mg
albuterol prn
spiriva
advair 500/50 [**Hospital1 **]
prilosec 20

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Aspirin 81 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:*0*
3. Pantoprazole 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:*0*
4. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
Disp:*30 Cap(s)* Refills:*0*
5. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*0*
6. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
400 mg daily x 1 week, then 200 mg daily ongoing.
Disp:*60 Tablet(s)* Refills:*0*
7. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily) for
2 doses.
Disp:*90 Tablet(s)* Refills:*0*
8. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
10. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*0*
11. Compazine 5 mg Tablet Sig: One (1) Tablet PO Q8H:PRN as
needed for nausea.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Mitral regurgitation
Aflutter
Asthma/COPD
h/o gastirc ulcer
h/o rheumatic fever
NSTEMI
osteoporosis
c-section
? abdominal surgery


Discharge Condition:
Good.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
No lifting more than 10 pounds for ten weeks, or driving until
follow up with surgeon.
Shower, no baths, no lotions, creams or powders to incisions.

Followup Instructions:
Dr. [**Last Name (STitle) **] 4 weeks
Dr. [**Last Name (STitle) 17871**] Wednesday [**8-4**] at 2:00pm for INR check and coumadin
dosing.



Completed by:[**2179-8-2**]
{'Multiple involvement of mitral and aortic valves,Subendocardial infarction, initial episode of care,Rheumatic heart failure (congestive),Atrial fibrillation,Chronic obstructive asthma, unspecified,Abdominal pain, other specified site,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: Chest Pain

PRESENT ILLNESS: This is a 67 year old woman with a history of rheumatic fever,
COPD, and gastric ulcer who presented to [**Hospital3 **] with
chest pain. The pain started at around 3pm while she was sitting
at rest. She first noticed bilaterally arm pain, along with
substernal chest pressure. There was no associated SOB, N/V, or
diaphoresis. She has never had chest pain like this before.
.
She went to the ED at [**Hospital3 4107**], where she received SL NTG
x3 which helped the pain somewhat but did not relieve it
completely. EKG at the OSH showed aflutter with a rate in the
70s, with 1-1.5mm ST elevations in leads II, III, and aVF. At
the OSH she also received asa, metoprolol 5mg IV x1, lipitor
80mg, plavix 300mg, and heparin and integrillin gtt were
started. She was then transferred to [**Hospital1 18**] for cath.
.
In the cath lab here, she was found to have a 50% mid-RCA
lesions as well as [**2-13**]+MR. [**Name13 (STitle) **] further intervention was done.
.
Of note, she had a recent admission to S. [**Hospital **] hospital for
SOB, and she was treated for a COPD flare. On that admission she
was also told that she had a "leaky valve."
.
Currently, she denies CP/SOB, cough, F/C, abd pain, diarrhea.
She does complain of nausea.

MEDICAL HISTORY: asthma/COPD
h/o gastric ulcer
h/o rheumatic fever

MEDICATION ON ADMISSION: lasix 20mg
diltiazem CD 120mg
albuterol prn
spiriva
advair 500/50 [**Hospital1 **]
prilosec 20

ALLERGIES: Codeine

PHYSICAL EXAM: VS: T 97.5, BP 124/54, HR 76, RR 19, 97% on 2L
Gen: NAD at rest, lying flat in bed
HEENT: PERRL, EOMI, MMM, OP clear
Neck: Supple, no JVD
Lungs: CTAB anteriorly
Heart: regular, II/VI soft systolic murmur at apex
Abd: +BS, soft, NT/ND
Extrem: no edema, 2+DP pulses

FAMILY HISTORY: Sister had several valve surgeries due to rheumatic fever. No FH
of CAD.

SOCIAL HISTORY: Lives with her husband. Smoked ~[**12-14**] ppd for 40 years (quit 1.5
weeks ago). Occasional alcohol. 

### Response:
{'Multiple involvement of mitral and aortic valves,Subendocardial infarction, initial episode of care,Rheumatic heart failure (congestive),Atrial fibrillation,Chronic obstructive asthma, unspecified,Abdominal pain, other specified site,Osteoporosis, unspecified'}
