CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 65 year old man with diabetes and hypertension who developed
chest discomfort at 11 PM last night. The discomfort radiated to
the jaw left arm. He took one sublingual nitroglycerin and the
pain improved, but never went away. At 2:30 PM he went to [**Hospital1 **] for further evaluation at the advice of his
endocrinologist. He had a positive troponin and a concerning
EKG. He received one dose of SL nitro. He left AMA because he
had to take care of his mother. [**Name (NI) **] then took a cab to the ED
here. He reported lots of anterior chest pain when walking in to
the ED.
.
In the ED, initial vital signs were 98 73 144/89 18 98% ra. A
code STEMI was activated with ST elevations in I, avL, V2 and ST
depressions in II, III, V5, V6, and avF. He was started on
heparin and loaded with plavix 600 mg. He was taken to the cath
lab and noted to have an LAD proximal lesion. He had two drug
eluting stents placed.
.
Following the procedure he was chest pain free. He denied any
shortness of breath, edema, jaw pain, or lower extremity edema.
He reports a chronic dry cough related to lisinopril. Denies any
prior history of stroke, TIA, deep venous thrombosis, pulmonary
embolism, bleeding at the time of surgery, myalgias, joint
pains, cough, hemoptysis, black stools or red stools. Denies
recent fevers, chills or rigors.

MEDICAL HISTORY: Hypertension
Diabetes Mellitus (diagnosed about 7 years ago, does not take
his blood glucose regularly)
s/p knee surgery one year ago
BPH

MEDICATION ON ADMISSION: metformin [**2124**] mg
lisinopril 20 mg
aspirin 81 mg
vitamin D 5000 units
saw [**Location (un) 6485**]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98.3 BP 142/78 (systolic 118-142) P 58-67 RR 18 97% RA
General: Well appearing, NAD, AAOx3
Neck: JVP 8-9 cm
CV: RRR, 2/6 systolic murmur heard across precordium best at
RUSB and LLSB and apex without radiation (unchanged).
Lungs: Good air entry, clear to auscultation b/l, no w/ra/rh
Extremities: Trace edema, good pulses

FAMILY HISTORY: Father with MI, CVA, and diabetes. Multiple other family members
on father's side with history of CVA and diabetes.

SOCIAL HISTORY: Lives with [**Age over 90 **] year old mother. [**Name (NI) 1403**] as a mechanic fixing
equipment for companies such as the postal service. Reports
being active and climbing up and down equipment without
difficulty. Occasionally smokes cigars. No cigarettes. Has
approximately one alcoholic beverage per year on [**Holiday **].
Denies recent illicits.
Acute myocardial infarction of anterolateral wall, initial episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
AMI anterolateral, init,DMII wo cmp uncntrld,Crnry athrscl natve vssl,Hypertension NOS,BPH w/o urinary obs/LUTS
Admission Date:  [**2137-3-22**]              Discharge Date:   [**2137-3-25**]

Date of Birth:  [**2071-12-1**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1899**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
CARDIAC CATHETERIZATION WITH STENT PLACEMENT

History of Present Illness:
65 year old man with diabetes and hypertension who developed
chest discomfort at 11 PM last night. The discomfort radiated to
the jaw left arm. He took one sublingual nitroglycerin and the
pain improved, but never went away. At 2:30 PM he went to [**Hospital1 **] for further evaluation at the advice of his
endocrinologist. He had a positive troponin and a concerning
EKG. He received one dose of SL nitro. He left AMA because he
had to take care of his mother. [**Name (NI) **] then took a cab to the ED
here. He reported lots of anterior chest pain when walking in to
the ED.
.
In the ED, initial vital signs were 98 73 144/89 18 98% ra. A
code STEMI was activated with ST elevations in I, avL, V2 and ST
depressions in II, III, V5, V6, and avF. He was started on
heparin and loaded with plavix 600 mg. He was taken to the cath
lab and noted to have an LAD proximal lesion. He had two drug
eluting stents placed.
.
Following the procedure he was chest pain free. He denied any
shortness of breath, edema, jaw pain, or lower extremity edema.
He reports a chronic dry cough related to lisinopril. Denies any
prior history of stroke, TIA, deep venous thrombosis, pulmonary
embolism, bleeding at the time of surgery, myalgias, joint
pains, cough, hemoptysis, black stools or red stools. Denies
recent fevers, chills or rigors.


Past Medical History:
Hypertension
Diabetes Mellitus (diagnosed about 7 years ago, does not take
his blood glucose regularly)
s/p knee surgery one year ago
BPH


Social History:
Lives with [**Age over 90 **] year old mother. [**Name (NI) 1403**] as a mechanic fixing
equipment for companies such as the postal service. Reports
being active and climbing up and down equipment without
difficulty. Occasionally smokes cigars. No cigarettes. Has
approximately one alcoholic beverage per year on [**Holiday **].
Denies recent illicits.

Family History:
Father with MI, CVA, and diabetes. Multiple other family members
on father's side with history of CVA and diabetes.

Physical Exam:
T 98.3 BP 142/78 (systolic 118-142) P 58-67 RR 18 97% RA
General: Well appearing, NAD, AAOx3
Neck: JVP 8-9 cm
CV: RRR, 2/6 systolic murmur heard across precordium best at
RUSB and LLSB and apex without radiation (unchanged).
Lungs: Good air entry, clear to auscultation b/l, no w/ra/rh
Extremities: Trace edema, good pulses

Pertinent Results:
[**2137-3-25**] 06:50AM BLOOD WBC-7.8 RBC-4.12* Hgb-12.8* Hct-40.2
MCV-98 MCH-31.0 MCHC-31.7 RDW-12.9 Plt Ct-213
[**2137-3-23**] 04:26AM BLOOD PT-11.7 PTT-27.2 INR(PT)-1.1
[**2137-3-25**] 06:50AM BLOOD Glucose-164* UreaN-16 Creat-0.8 Na-136
K-3.8 Cl-101 HCO3-27 AnGap-12
[**2137-3-23**] 04:26AM BLOOD ALT-40 AST-155* LD(LDH)-518*
CK(CPK)-1480* AlkPhos-42 TotBili-1.1
[**2137-3-23**] 04:26AM BLOOD CK-MB-99*  MB Indx-6.7* cTropnT-4.00*
[**2137-3-22**] 09:51PM BLOOD CK-MB-146* MB Indx-8.2* cTropnT-10.23*
[**2137-3-22**] 06:50PM BLOOD CK-MB-74*  MB Indx-8.4* cTropnT-0.79*

[**2137-3-25**] ECHO
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is mild regional left ventricular systolic
dysfunction with distal septal hypokinesis (distal anterior wall
and true apex are not well seen). No masses or thrombi are seen
in the left ventricle. There is no ventricular septal defect.
The ascending aorta is mildly dilated. The aortic valve leaflets
(3) are mildly thickened. There is a minimally increased
gradient consistent with minimal aortic valve stenosis. Mild
(1+) aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Mild (1+)
mitral regurgitation is seen. The tricuspid valve leaflets are
mildly thickened. There is borderline pulmonary artery systolic
hypertension. There is a small pericardial effusion. There are
no echocardiographic signs of tamponade.


Brief Hospital Course:
65 year old man with hypertension and diabetes s/p STEMI on
[**2137-3-22**].
.
# CAD:
He had a ruptured plaque with 80-90% stenosis of the LAD with
successful PCI of the proximal and mid LAD with nonoverlapping
3.0 x 12 mm Promus Element [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 7930**] to 3.25 mm (distal)
and 3.75 x 16 mm Promus Element [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 7930**] to 3.75 mm
(proximal). He was chest pain free after cath and admitted to
the CCU. Biomarkers peaked at MB 146, trops 10, and have since
downtrended . He will remain on aspirin 325 mg, clopidogrel 75
mg [**Hospital1 **], atorvastatin 80 mg, continue home lisinopril 40 mg,
Metop 25 [**Hospital1 **]. Echo was performed and showed an LVEF of 50% with
mild hypokinesis.
.
# Hypertension: Continued on home lisinopril. Well controlled
.
# Diabetes: He is on metformin at home. However, given his
recent contrast load, he was placed on insulin sliding scale and
add glipizide 5 mg [**Hospital1 **]. He was discharged back on metformin with
plan to followup with outpatient endocrinologist.
.
# BPH: Patient reports having symptoms of BPH. He takes saw
[**Location (un) 6485**] at home.


Medications on Admission:
metformin [**2124**] mg
lisinopril 20 mg
aspirin 81 mg
vitamin D 5000 units
saw [**Location (un) 6485**]

Discharge Medications:
1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
4. Vitamin D3 5,000 unit Tablet Sig: One (1) Tablet PO once a
day.
5. saw [**Location (un) 6485**]  Oral
6. metformin 1,000 mg Tablet Sig: Two (2) Tablet PO once a day.

7. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*0*
8. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 4 days: then 1 tablet once daily.
Disp:*38 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
ST-ELEVATION MYOCARDIAL INFRACTION
DIABETES MELLTIUS
HYPERTENSION

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
Dear Mr [**Known lastname **],

It was a pleasure taking care of you at the [**Hospital1 18**]. You were
admitted with chest pain and were found to be having a heart
attack. You were taken to the cath lab where you got a stent to
open up your blocked heart vessels. You were discharged home in
a stable condition.

It is important for you to note the importance of taking ALL of
your medications. We have gone extensively through your
medications and you are only on medications that have been
proven extensively to prolong and save lives. Do NOT stop taking
any of these medications without first consulting with your
cardiologist.

NEW MEDICATIONS:
1. ASPIRIN 325MG ONCE DAILY
2. CLOPIDOGREL (PLAVIX) 75mg TWICE DAILY FOR 4 DAYS, then ONCE
DAILY
3. ATORVASTATIN 80 ONCE DAILY
4. METOPROLOL 50 ONCE DAILY

MEDICATIONS CHANGED:
1. LISINOPRIL: INCREASED FROM 20 TO 40MG ONCE DAILY
2. ASPIRIN: INCREASED FROM 81 TO 325 MG OCNE DAILY


Followup Instructions:
Department: [**Hospital3 249**]
When: MONDAY [**2137-4-1**] at 3:45 PM
With: ARA [**Name8 (MD) 66526**], MD [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
**Dr [**Last Name (STitle) **] is your new physician at [**Name9 (PRE) 191**].  He works closely
with Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **], [**First Name3 (LF) **] both will be involved in your care.**

Department: CARDIAC SERVICES
When: WEDNESDAY [**2137-4-10**] at 1:40 PM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Please contact your Endocrinologist for followup regarding your
diabetes care and adjustment of your medications.

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 1905**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: 65 year old man with diabetes and hypertension who developed
chest discomfort at 11 PM last night. The discomfort radiated to
the jaw left arm. He took one sublingual nitroglycerin and the
pain improved, but never went away. At 2:30 PM he went to [**Hospital1 **] for further evaluation at the advice of his
endocrinologist. He had a positive troponin and a concerning
EKG. He received one dose of SL nitro. He left AMA because he
had to take care of his mother. [**Name (NI) **] then took a cab to the ED
here. He reported lots of anterior chest pain when walking in to
the ED.
.
In the ED, initial vital signs were 98 73 144/89 18 98% ra. A
code STEMI was activated with ST elevations in I, avL, V2 and ST
depressions in II, III, V5, V6, and avF. He was started on
heparin and loaded with plavix 600 mg. He was taken to the cath
lab and noted to have an LAD proximal lesion. He had two drug
eluting stents placed.
.
Following the procedure he was chest pain free. He denied any
shortness of breath, edema, jaw pain, or lower extremity edema.
He reports a chronic dry cough related to lisinopril. Denies any
prior history of stroke, TIA, deep venous thrombosis, pulmonary
embolism, bleeding at the time of surgery, myalgias, joint
pains, cough, hemoptysis, black stools or red stools. Denies
recent fevers, chills or rigors.

MEDICAL HISTORY: Hypertension
Diabetes Mellitus (diagnosed about 7 years ago, does not take
his blood glucose regularly)
s/p knee surgery one year ago
BPH

MEDICATION ON ADMISSION: metformin [**2124**] mg
lisinopril 20 mg
aspirin 81 mg
vitamin D 5000 units
saw [**Location (un) 6485**]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98.3 BP 142/78 (systolic 118-142) P 58-67 RR 18 97% RA
General: Well appearing, NAD, AAOx3
Neck: JVP 8-9 cm
CV: RRR, 2/6 systolic murmur heard across precordium best at
RUSB and LLSB and apex without radiation (unchanged).
Lungs: Good air entry, clear to auscultation b/l, no w/ra/rh
Extremities: Trace edema, good pulses

FAMILY HISTORY: Father with MI, CVA, and diabetes. Multiple other family members
on father's side with history of CVA and diabetes.

SOCIAL HISTORY: Lives with [**Age over 90 **] year old mother. [**Name (NI) 1403**] as a mechanic fixing
equipment for companies such as the postal service. Reports
being active and climbing up and down equipment without
difficulty. Occasionally smokes cigars. No cigarettes. Has
approximately one alcoholic beverage per year on [**Holiday **].
Denies recent illicits. 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
