CHIEF COMPLAINT: Substernal chest pain.

PRESENT ILLNESS: This is an 85 year-old female
with known coronary artery disease status post an inferior
myocardial infarction in [**2161**], hypertension, increased
cholesterol, tobacco, who presented with three days of
substernal chest pain.  She went to her primary care
physician and was found to have electrocardiogram changes
(deepened T wave inversions in V1 through V6, 2, 3, AVL).
She was chest pain free throughout her primary care
physician's visit.  She was sent to the [**Hospital1 190**] Emergency Room, where she had increasing chest
pressure 7 out of 10 substernally with associated
diaphoresis, sinus bradycardia at 45 beats per minute,
systolic blood pressure dropped to the 70s and her
electrocardiogram was notable for 2 to [**Street Address(2) 1755**] elevations in
V1 through V6 and additionally reciprocal T wave inversions
in 2, 3, and AVF.  She received half dose of Integrilin,
heparin, aspirin, beta blocker, and was taken directly to the
cardiac catheterization laboratory.  There she was found to
have left main coronary artery disease that was short, a left
anterior descending artery that had a proximal tubular lesion
to 80% prior to diagonal, mild to moderate diffuse disease,
mid left anterior descending coronary artery, TIMI two flow
slowly distally.  The left circumflex had diffuse disease to
40% involving CX and obtuse marginal, collateral to right
coronary artery.  The right coronary artery was mildly
calcified, tubular 80 to 90% proximal to the mid stenoses,
competitive flow seen in RPL, diffuse disease in the mid
right coronary artery.  The proximal left anterior descending
coronary artery was dilated with 2.5 by 15 mm open sail at 6
atmospheres and was stented.  There was no residual stenosis,
TIMI two fast flow was observed.  The cardiac catheterization
was also notable for a cardiac output of 2.7, cardiac index
of 1.8, wedge pressure of 29, elevated filling pressures with
a PA diastolic pressure of 26.  The left ventriculogram was
not performed.  The patient received intravenous Lasix and
was transferred to the Coronary Care Unit.  She was
hemodynamically stable throughout her catheterization.

MEDICAL HISTORY: 1.  The patient has a history of
coronary artery disease with an myocardial infarction in
[**2163**].  2.  Increased cholesterol.  3.  Hypertension.  4.
Osteoporosis.

MEDICATION ON ADMISSION: Aspirin 325 mg po q.d.,
Digoxin 0.25 mg po q.d., Atenolol 25 mg po q.d., Lipitor 20
mg po q.d.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of anterolateral wall, initial episode of care,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction
AMI anterolateral, init,Chr airway obstruct NEC,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Old myocardial infarct
Admission Date:  [**2163-10-14**]     Discharge Date:  [**2163-10-17**]


Service:  CCU

CHIEF COMPLAINT:  Substernal chest pain.

HISTORY OF PRESENT ILLNESS:  This is an 85 year-old female
with known coronary artery disease status post an inferior
myocardial infarction in [**2161**], hypertension, increased
cholesterol, tobacco, who presented with three days of
substernal chest pain.  She went to her primary care
physician and was found to have electrocardiogram changes
(deepened T wave inversions in V1 through V6, 2, 3, AVL).
She was chest pain free throughout her primary care
physician's visit.  She was sent to the [**Hospital1 190**] Emergency Room, where she had increasing chest
pressure 7 out of 10 substernally with associated
diaphoresis, sinus bradycardia at 45 beats per minute,
systolic blood pressure dropped to the 70s and her
electrocardiogram was notable for 2 to [**Street Address(2) 1755**] elevations in
V1 through V6 and additionally reciprocal T wave inversions
in 2, 3, and AVF.  She received half dose of Integrilin,
heparin, aspirin, beta blocker, and was taken directly to the
cardiac catheterization laboratory.  There she was found to
have left main coronary artery disease that was short, a left
anterior descending artery that had a proximal tubular lesion
to 80% prior to diagonal, mild to moderate diffuse disease,
mid left anterior descending coronary artery, TIMI two flow
slowly distally.  The left circumflex had diffuse disease to
40% involving CX and obtuse marginal, collateral to right
coronary artery.  The right coronary artery was mildly
calcified, tubular 80 to 90% proximal to the mid stenoses,
competitive flow seen in RPL, diffuse disease in the mid
right coronary artery.  The proximal left anterior descending
coronary artery was dilated with 2.5 by 15 mm open sail at 6
atmospheres and was stented.  There was no residual stenosis,
TIMI two fast flow was observed.  The cardiac catheterization
was also notable for a cardiac output of 2.7, cardiac index
of 1.8, wedge pressure of 29, elevated filling pressures with
a PA diastolic pressure of 26.  The left ventriculogram was
not performed.  The patient received intravenous Lasix and
was transferred to the Coronary Care Unit.  She was
hemodynamically stable throughout her catheterization.

PHYSICAL EXAMINATION:  Vital signs on admission, temperature
96.5.  Blood pressure 108/38.  Heart rate 56.  Respiratory
rate 15 to 20 sating 95 to 97% on 2 liters.  In general, the
patient was talkative and in no acute distress.  Her
oropharynx was clear without lesions.  She had no JVD.  No
carotid bruits.  She had a regular rate and rhythm with mild
2 out of 6 early systolic ejection murmur at the bilateral
sternal borders as well as a positive S3.  Her lungs were
clear to auscultation.  She was without wheezes.  Her abdomen
was soft, nontender, nondistended.  She had normoactive bowel
sounds and no organomegaly.  Her right groin had a small
hematoma without a bruit.  She had 1+ pedal pulses
bilaterally and no edema.

PAST MEDICAL HISTORY:  1.  The patient has a history of
coronary artery disease with an myocardial infarction in
[**2163**].  2.  Increased cholesterol.  3.  Hypertension.  4.
Osteoporosis.

CARDIAC MEDICATIONS ON ADMISSION:  Aspirin 325 mg po q.d.,
Digoxin 0.25 mg po q.d., Atenolol 25 mg po q.d., Lipitor 20
mg po q.d.

SIGNIFICANT LABORATORY FINDINGS ON ADMISSION:  Her white
blood cell count was 11.3, hematocrit 41.3, platelets 239.
Chemistries sodium 140, potassium 5.3, BUN 24, creatinine
0.9, glucose 125, CK on admission 136, MB fraction 8,
troponin 6.3.  ALT 24, AST 19.  Electrocardiogram on
admission as stated above in the history of present illness.

HOSPITAL COURSE:  1.  Cardiac:  Ischemia; the patient
finished her course of Integrilin and heparin.  She was
maintained on aspirin, Plavix and Lipitor.  She remained
chest pain free subsequent to her initial presentation in the
Emergency Department.  Her peak CKs were 260, her peak MB was
28 and her peak cardiac index was 10.8.  She had no further
dynamic electrocardiogram changes throughout her stay.  Given
the minimal CK leak presumably the patient had an interrupted
acute myocardial infarction that was amenable to angioplasty
of the proximal left anterior descending coronary artery.

Pump; the patient was noted to have high filling pressures
intracath.  She was diuresed adequately and started on an ace
inhibitor as well as a beta blocker when her pressures
tolerated it.  Her outpatient Digoxin was not continued on
admission, nor included in her outpatient regimen.  The
patient had an echocardiogram performed on [**2163-10-17**].
The ejection fraction was notably 30 to 35%.  She had
moderate symmetric left ventricular hypertrophy, moderate
global left ventricular hypokinesis, inferior severe
hypokinesis.  Overall her left ventricular systolic function
was moderately decreased.  She had 2+ aortic insufficiency.
Also the ascending aorta was noted to be mildly thickened.

Rhythm; the patient had some episodes of sinus bradycardia
during sleep as low as 40 beats per minute.  These sinus
bradycardic episodes were asymptomatic and resolved with
awakening and activity.

2.  Pulmonary:  The patient had no supplemental oxygen
requirements during her hospitalization and did well from a
pulmonary standpoint.  The patient was seen by physical
therapy during this hospitalization and was able to ambulate
back to her baseline level of function.  The patient was also
advised repeatedly on this admission to quit smoking
cigarettes.  The patient was not ready to quit at this time.

FOLLOW UP APPOINTMENTS:  The patient will follow up with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 111570**] in Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] clinic.  The patient will
be called on [**2163-10-18**] with the appointment time and
place.  The patient was also instructed to call her primary
care physician, [**First Name4 (NamePattern1) 401**] [**Last Name (NamePattern1) 410**], and set up a follow up
appointment with him in the ensuing weeks.

FOLLOW UP ISSUES:  1.  The patient was provided with visiting
home nurse services in order to obtain some medication
teaching.

ALLERGIES ON DISCHARGE:  The patient has no known drug
allergies.

DISCHARGE MEDICATIONS:  1.  Aspirin 325 mg po q day.  2.
Plavix 75 mg po q.d. to complete a thirty day course and the
patient was written a prescription for an additional 26 days
to complete thirty days.  3.  Lipitor 20 mg po q day.  4.
Zestril 2.5 mg po q.d.  5.  Atenolol 25 mg po q day.  6.
Miacalcin 2200 IU per ml.  7.  Multivitamin.  8.  Calcium
carbonate.  9.  Vitamin D as she was taking before.  10.  The
patient's Digoxin was discontinued and she will not be
resuming this medication.

CODE STATUS:  Full code.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1013**], M.D.  [**MD Number(1) 1014**]

Dictated By:[**Doctor Last Name 111571**]

MEDQUIST36

D:  [**2163-10-18**]  15:22
T:  [**2163-10-21**]  09:04
JOB#:  [**Job Number 7070**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction'}


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: This is an 85 year-old female
with known coronary artery disease status post an inferior
myocardial infarction in [**2161**], hypertension, increased
cholesterol, tobacco, who presented with three days of
substernal chest pain.  She went to her primary care
physician and was found to have electrocardiogram changes
(deepened T wave inversions in V1 through V6, 2, 3, AVL).
She was chest pain free throughout her primary care
physician's visit.  She was sent to the [**Hospital1 190**] Emergency Room, where she had increasing chest
pressure 7 out of 10 substernally with associated
diaphoresis, sinus bradycardia at 45 beats per minute,
systolic blood pressure dropped to the 70s and her
electrocardiogram was notable for 2 to [**Street Address(2) 1755**] elevations in
V1 through V6 and additionally reciprocal T wave inversions
in 2, 3, and AVF.  She received half dose of Integrilin,
heparin, aspirin, beta blocker, and was taken directly to the
cardiac catheterization laboratory.  There she was found to
have left main coronary artery disease that was short, a left
anterior descending artery that had a proximal tubular lesion
to 80% prior to diagonal, mild to moderate diffuse disease,
mid left anterior descending coronary artery, TIMI two flow
slowly distally.  The left circumflex had diffuse disease to
40% involving CX and obtuse marginal, collateral to right
coronary artery.  The right coronary artery was mildly
calcified, tubular 80 to 90% proximal to the mid stenoses,
competitive flow seen in RPL, diffuse disease in the mid
right coronary artery.  The proximal left anterior descending
coronary artery was dilated with 2.5 by 15 mm open sail at 6
atmospheres and was stented.  There was no residual stenosis,
TIMI two fast flow was observed.  The cardiac catheterization
was also notable for a cardiac output of 2.7, cardiac index
of 1.8, wedge pressure of 29, elevated filling pressures with
a PA diastolic pressure of 26.  The left ventriculogram was
not performed.  The patient received intravenous Lasix and
was transferred to the Coronary Care Unit.  She was
hemodynamically stable throughout her catheterization.

MEDICAL HISTORY: 1.  The patient has a history of
coronary artery disease with an myocardial infarction in
[**2163**].  2.  Increased cholesterol.  3.  Hypertension.  4.
Osteoporosis.

MEDICATION ON ADMISSION: Aspirin 325 mg po q.d.,
Digoxin 0.25 mg po q.d., Atenolol 25 mg po q.d., Lipitor 20
mg po q.d.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction'}
