CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 56-year-old
woman who developed chest pain at approximately 7 p.m. on the
night of admission.  She went to the [**Location (un) 47**] emergency
room where she was found to have anterior hyper-acute
T-waves.  At that time she was started on a nitroglycerin
drip, Integrilin, aspirin, Plavix, heparin drip.  The patient
continued to have chest pain.  She was transferred to the
[**Hospital1 69**] for emergent cardiac
catheterization.  The cardiac catheterization revealed apical
and inferoapical dyskinesis.  The LAD had a distal occlusion
consistent with spontaneous dissection versus local coronary
embolus.  Attempts to re-vascularize the LAD were
unsuccessful.  The patient was transferred to the CCU for
close monitoring of a myocardial infarction.  Upon arrival to
the CCU the patient had 1 to 2 out of 10 chest pain.  She
denied palpitations, shortness of breath, nausea or vomiting.
She stated that her chest pain was significantly decreased on
her medical regimen as it had been out 10 out of 10
previously.

MEDICAL HISTORY: 1.  Hemachromatosis.
2.  GERD.
4.  Colon polyps.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes a rash.  Morphine causes
lightheadedness.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of coronary artery disease.

SOCIAL HISTORY: The patient is a nonsmoker.  She rarely
drinks alcohol.  She lives with her husband and family.
Acute myocardial infarction of other anterior wall, initial episode of care,Dissection of coronary artery,Paroxysmal ventricular tachycardia,Esophageal reflux,Surgical or other procedure not carried out because of contraindication
AMI anterior wall, init,Dissection cor artery,Parox ventric tachycard,Esophageal reflux,No proc/contraindication
Admission Date:  [**2190-12-3**]     Discharge Date:  [**2190-12-6**]

Date of Birth:   [**2134-4-29**]     Sex:  F

Service:  CCU

ADMITTING DIAGNOSIS:  Acute anterior MI.

HISTORY OF PRESENT ILLNESS:  The patient is a 56-year-old
woman who developed chest pain at approximately 7 p.m. on the
night of admission.  She went to the [**Location (un) 47**] emergency
room where she was found to have anterior hyper-acute
T-waves.  At that time she was started on a nitroglycerin
drip, Integrilin, aspirin, Plavix, heparin drip.  The patient
continued to have chest pain.  She was transferred to the
[**Hospital1 69**] for emergent cardiac
catheterization.  The cardiac catheterization revealed apical
and inferoapical dyskinesis.  The LAD had a distal occlusion
consistent with spontaneous dissection versus local coronary
embolus.  Attempts to re-vascularize the LAD were
unsuccessful.  The patient was transferred to the CCU for
close monitoring of a myocardial infarction.  Upon arrival to
the CCU the patient had 1 to 2 out of 10 chest pain.  She
denied palpitations, shortness of breath, nausea or vomiting.
She stated that her chest pain was significantly decreased on
her medical regimen as it had been out 10 out of 10
previously.

PAST MEDICAL HISTORY:
1.  Hemachromatosis.
2.  GERD.
4.  Colon polyps.

MEDICATIONS AT HOME:  Zantac, Motrin, multi-vitamin.

ALLERGIES:  Penicillin causes a rash.  Morphine causes
lightheadedness.

SOCIAL HISTORY:  The patient is a nonsmoker.  She rarely
drinks alcohol.  She lives with her husband and family.

FAMILY HISTORY:  No history of coronary artery disease.

PHYSICAL EXAMINATION UPON ADMISSION:  The heart rate was 100,
blood pressure 130/74, respiratory rate 14, satting 98% on
two liters by nasal cannula.  The patient was in no apparent
distress.  She appeared fatigue.  The chest was clear to
auscultation anteriorly.  Heart had a regular rate and
rhythm.  There were no murmurs, rubs or gallops.  The abdomen
was soft, nontender, nondistended.  Bowel sounds were
present.  The extremities were without edema.  The dorsalis
pedis pulses were 2+ bilaterally.  The right groin had a
sheath in it.  The were pupils equal, round and reactive to
light bilaterally.  The extraocular muscles intact.  The
mucous membranes were moist.  There was no jugular venous
distention.

LABORATORIES UPON ADMISSION:  An arterial blood gas was
7.35/52/234.  Hematocrit 35.

CARDIAC CATHETERIZATION DATA:  The cardiac output was 5.2, RA
9, RV 48/11, PA 44/12, wedge 22.  The ejection fraction was
calculated at 25-30% with apical and inferoapical dyskinesis.
The LAD had a cut-off distally consistent with spontaneous
dissection.

An EKG pre-procedure showed normal sinus rhythm at a rate of
75.  There was normal axis.  The intervals were normal.
There were hyper-acute T-waves in leads V2 through V5.

COURSE IN HOSPITAL:  The patient was admitted to the cardiac
care unit after unsuccessful re-vascularization with an acute
anterior myocardial infarction.  The patient was treated with
aspirin, beta blocker and an ACE inhibitor.  A statin was
started.  Integrilin was continued for 18 hours.  The
patient continued to have chest pain for her first 24 hours
in the hospital.  This was treated symptomatically with
Fentanyl and morphine with good effect.  After 24 hours the
patient remained pain free in hospital. The CK peaked at 1350.

PUMP:  On cardiac catheterization the ejection fraction was
calculated at 20-25% with apical akinesis.  The patient
underwent an echo the day after admission, which revealed an
ejection fraction of 40-45% with distal anterior, septal,
apical hypokinesis, akinesis with 1+ mitral regurgitation and
2+ tricuspid regurgitation.  There was mild PA systolic
hypertension.  The patient remained euvolemic throughout her
stay in the hospital.  She should have a follow up echo in 4
to 6 weeks as an outpatient to assess her ejection fraction.

RHYTHM:  The patient was maintained on telemetry throughout
her stay in the hospital.  For 24 hours after her
presentation she had short runs of NSVT.  She was maintained
on a beta blocker.  By 24 hours after her event she no longer
had NSVT.

GERD:  The patient was maintained on proton pump inhibitor
throughout her stay in the hospital.

At the end the patient was maintained on and tolerated a
cardiac diet.

DISCHARGE DIAGNOSES:
1.  Anterior MI, status post unsuccessful re-vascularization
attempt.
2.  Ejection fraction of 40-45%.
3.  Hemachromatosis.
4.  GERD.
5.  Colon polyp.

DISCHARGE MEDICATIONS:  Aspirin 325 mg p.o. q.d.,
atorvastatin 10 mg p.o. q.h.s., lisinopril 2.5 mg p.o. q.d.,
Toprol XL 25 mg p.o. q.d., nitroglycerin 0.3 mg sublingual
p.r.n. q5 minutes for chest pain.

DISCHARGE FOLLOW UP:  The patient is being discharged home.
She will follow up with a cardiologist.  She will need to
have a cholesterol panel and a CRP checked in 6 weeks time.
She will also need an echo as an outpatient in 4 to 6 weeks
time.

DISCHARGE CONDITION:  Good.







                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1523**], M.D.  [**MD Number(1) 9615**]

Dictated By:[**Last Name (NamePattern1) 222**]

MEDQUIST36

D:  [**2190-12-5**]  16:31
T:  [**2190-12-6**]  11:47
JOB#:  [**Job Number 25147**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Dissection of coronary artery,Paroxysmal ventricular tachycardia,Esophageal reflux,Surgical or other procedure not carried out because of contraindication'}


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: 

PRESENT ILLNESS: The patient is a 56-year-old
woman who developed chest pain at approximately 7 p.m. on the
night of admission.  She went to the [**Location (un) 47**] emergency
room where she was found to have anterior hyper-acute
T-waves.  At that time she was started on a nitroglycerin
drip, Integrilin, aspirin, Plavix, heparin drip.  The patient
continued to have chest pain.  She was transferred to the
[**Hospital1 69**] for emergent cardiac
catheterization.  The cardiac catheterization revealed apical
and inferoapical dyskinesis.  The LAD had a distal occlusion
consistent with spontaneous dissection versus local coronary
embolus.  Attempts to re-vascularize the LAD were
unsuccessful.  The patient was transferred to the CCU for
close monitoring of a myocardial infarction.  Upon arrival to
the CCU the patient had 1 to 2 out of 10 chest pain.  She
denied palpitations, shortness of breath, nausea or vomiting.
She stated that her chest pain was significantly decreased on
her medical regimen as it had been out 10 out of 10
previously.

MEDICAL HISTORY: 1.  Hemachromatosis.
2.  GERD.
4.  Colon polyps.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes a rash.  Morphine causes
lightheadedness.

PHYSICAL EXAM: 

FAMILY HISTORY: No history of coronary artery disease.

SOCIAL HISTORY: The patient is a nonsmoker.  She rarely
drinks alcohol.  She lives with her husband and family. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Dissection of coronary artery,Paroxysmal ventricular tachycardia,Esophageal reflux,Surgical or other procedure not carried out because of contraindication'}
