CHIEF COMPLAINT: Chest pain, Syncope

PRESENT ILLNESS: 59 year old man with hyperlipidemia was working out on his
treadmill the morning of admission when he developed a feeling
of "indigestion" associated with L arm tingling.  He then
developed bilateral arm tingling, lightheadedness, and felt
generally unwell. 911 was called. EMS arrived at 11:41AM and at
11:43 the patient became unresponsive. He was found to be in
coarse VFIB, shocked 200 J x 1 to sinus tachycardia with
multiple PVC's. Given 90mg IV lidocaine and drip started at 2.

MEDICAL HISTORY: Cardiac Risk Factors: -Diabetes, +Dyslipidemia, -Hypertension
Cardiac History: NONE
Other PMH
Hyperlipidemia
Mild asthma
Cervical spine fusion
Hip surgery (?ruptured quad tendon)
3rd degree burns to b/l LE ([**Country 3992**]) s/p mult skin grafts
eye operations x 2 as a child

MEDICATION ON ADMISSION: Zocor 10
Singulair
MVI

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Neosporin / Codeine /
Animal Hair/Dander

PHYSICAL EXAM: VS: T 97.1, BP 117/70, HR 77, RR 14, O2 100% on RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. Mucous membranes
dry.
Neck: Supple.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3. Soft SEM at LUSB.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi on anterior exam.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits. Sheath in place in R groin. No
bruit.
Skin: Extensive scarring over b/l LE. Abrasion over L achilles
tendon.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP
2+PT
[**Name (NI) 2325**]: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP
2+PT

FAMILY HISTORY: His father had an MI at age 52, and later died of lung Ca.
Mother had a pituitary tumor (?benign), lung ca and DM. He has 2
older sisters who are A+W.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is retired, used
to work for the government. He exercises for 1 hour daily,
walking on the treadmill and doing calisthenics.
Acute myocardial infarction of other anterior wall, initial episode of care,Ventricular fibrillation,Other specified hypotension,Asthma, unspecified type, unspecified,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Pain in joint, shoulder region,Other chronic pain
AMI anterior wall, init,Ventricular fibrillation,Hypotension NEC,Asthma NOS,Esophageal reflux,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Joint pain-shlder,Chronic pain NEC
Admission Date:  [**2164-2-17**]              Discharge Date:   [**2164-2-20**]

Date of Birth:  [**2104-3-6**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamides) / Neosporin / Codeine /
Animal Hair/Dander

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Chest pain, Syncope

Major Surgical or Invasive Procedure:
Coronary angioplasty
Bare metal stent placement to LAD x 2


History of Present Illness:
59 year old man with hyperlipidemia was working out on his
treadmill the morning of admission when he developed a feeling
of "indigestion" associated with L arm tingling.  He then
developed bilateral arm tingling, lightheadedness, and felt
generally unwell. 911 was called. EMS arrived at 11:41AM and at
11:43 the patient became unresponsive. He was found to be in
coarse VFIB, shocked 200 J x 1 to sinus tachycardia with
multiple PVC's. Given 90mg IV lidocaine and drip started at 2.

Upon arrival to [**Hospital1 46**] ER, patient was pain free with intact
mental status.  Vitals 108/62, HR 60's SR without ectopy, sats
100% on 100% NRB. Labs at OSH significant for CPK 144, Trop .05,
K 3.6, Cr 1.4, INR normal, Hct 41, Plt 149.  He then developed
recurrent chest pain.  EKG with hyperdynamic T's across the
precordium. IV lido stopped; given Aspirin 324mg, Plavix 600 mg,
SL Nitro x2, Heparin gtt, Reglan 10 mg, Morphine 2 mg IV.  CXR
WNL.  He was transported to [**Hospital1 18**] for cath. ng for transport,
patient with 2/10 chest tightness, .
Upon arrival to [**Hospital1 18**] he was taken directly to the cath lab
where he was found to have 95% LAD lesion.  BMS placed. He was
transferred to the CCU
.
On review of symptoms, he 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. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.
.
*** Cardiac review of systems is notable for absence of chest
pain, dyspnea on exertion, paroxysmal nocturnal dyspnea,
orthopnea, ankle edema, palpitations, syncope or presyncope.
.
Of note, he started an exercise regimen in [**9-23**], currently walks
1 hour daily on the treadmill and performs calisthenics.  He has
lost 27 lbs with this regimen in the past 4 months.

Past Medical History:
Cardiac Risk Factors: -Diabetes, +Dyslipidemia, -Hypertension
Cardiac History: NONE
Other PMH
Hyperlipidemia
Mild asthma
Cervical spine fusion
Hip surgery (?ruptured quad tendon)
3rd degree burns to b/l LE ([**Country 3992**]) s/p mult skin grafts
eye operations x 2 as a child

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is retired, used
to work for the government. He exercises for 1 hour daily,
walking on the treadmill and doing calisthenics.

Family History:
His father had an MI at age 52, and later died of lung Ca.
Mother had a pituitary tumor (?benign), lung ca and DM. He has 2
older sisters who are A+W.

Physical Exam:
VS: T 97.1, BP 117/70, HR 77, RR 14, O2 100% on RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. Mucous membranes
dry.
Neck: Supple.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3. Soft SEM at LUSB.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi on anterior exam.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits. Sheath in place in R groin. No
bruit.
Skin: Extensive scarring over b/l LE. Abrasion over L achilles
tendon.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP
2+PT
[**Name (NI) 2325**]: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP
2+PT


Pertinent Results:
CARDIAC CATH performed on [**2164-2-17**] demonstrated:
LM: WNL
LCx: OM1 40%
LAD: 95% lesion extending beyond D1-> BMS placed. 50% lesion
more proximal.
RCA: 30% proximal.

----------------
ADMISSION LABS
----------------

9.5 \ ____ / 149
    / 36.6 \

139 | 106 | 14
---------------<  113
3.7 | 23  | 0.9

====================
CARDIAC CATH
===================
COMMENTS:
1. Coronary angiography in this right dominant system
demonstrated
single vessel disease. The LMCA had no significant disease. The
LAD had
a 95% thrombotic lesion extending beyond the D1 and a 50%
eccentric
lesion more proximally. The LCX system had a 40% OM1 lesion and
the RCA
had a 30% proximal lesion.
2. Resting hemodynamics revealed a SBP of 105mmHg and a DBP of
64mmHg.
3. Successful PCI/stent to the proximal LAD with 2 Vision bare
metal
stents (3.0x23mm distal and 3.5x12mm proximal with overlap).
Normal flow
down vessel and no residual stenosis at end of procedure.

FINAL DIAGNOSIS:
1. Thrombotic lesion in proximal LAD
2. Successful PTCA/stent to proximal LAD with 2 bare metal
stents.

==================
CARDIAC ECHO (TTE)
==================
The left atrium is normal in size. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is mildly
depressed (LVEF= 40-50 %) secondary to mild hypokinesis of the
anterior septum, anterior free wall, and apex. There is no
ventricular septal defect. Right ventricular chamber size and
free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
The mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. There is mild
pulmonary artery systolic hypertension. There is no pericardial
effusion.

IMPRESSION: anteroapical hypokinesis with relatively
well-preserved overall left ventricular ejection fraction


Brief Hospital Course:
59 male with hyperlipidemia and +FH presented with STEMI/VF
arrest, now s/p BMS to LAD.
.
# CAD/Ischemia: Upon presentation, the patient was found to have
STEMI due to LAD lesion. The patient underwent successful PTCA
with BMSx2 to the LAD with good TIMI flow and with resolution of
symptoms. Patient will be discharged with scheduled follow up
and with a medical regimen consisting of ASA 325mg, plavix 75mg,
lipitor 80mg, metoprolol 12.5mg twice daily and lisinopril 2.5mg
daily. The patient did not tolerate higher doses of beta-blocker
and ACEi due to some hypotension. He was also given a
prescription for sublingual nitroglycerin for use as necessary
for chest pain. The patient was given prescriptions for blood
draws to be completed at his PCP's office for electrolyte check
(including K and BUN/Cr) [**Date Range 13835**] 1 week after discharge
and another blood draw to be completed 8 weeks after discharge
for monitoring of LFT's and cholesterol panel.
.
# VF arrest: Arrhythmia appears to be Secondary to STEMI.
Patient was immediately cardioverted with restoration of sinus
rhythm. Patient has maintained normal sinus rhythm on telemetry
and has not exhibited appreciable neurocognitive deficits.
.
# Systolic Function: Per TTE obtained this admission, minimally
diminished ejection fraction, likely secondary to stunned
myocardium. Would consider repeat echo and stress test as
outpatient.
.
# Shoulder pain: Patient suffers from chronic pain and had good
symptom control with tyelenol and oxycodone as needed.
.
#Asthma: We continued home dose of singulair and administered
nebulizer treatments as necessary.
.
# GERD. The patient had complaints of GERD type symptoms and was
started on a PPI.
.
# Code: The patient was FULL code throughout this admission.

Medications on Admission:
Zocor 10
Singulair
MVI


Discharge Medications:
1. Aspirin 325 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:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. 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:*2*
6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
7. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Outpatient Lab Work
Please have blood drawn at your follow-up appointment with your
primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 13835**] 1 week: Chemistry panel
(including K and BUN/Cr).
9. Outpatient Lab Work
Please have blood drawn at follow-up with your primary care
doctor [**First Name (Titles) **] [**Last Name (Titles) 13835**] 8 weeks: LFT's and cholesterol panel.
10. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1)
Sublingual Q5minutes as needed for chest pain: Place one pill
under the tongue every 5 minutes for chest pain. Call an
ambulance if your pain is not relieved after 3 pills.
Disp:*20 Tablet* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
ST elevation myocardial infarction


Discharge Condition:
Stable, afebrile, chest pain free, ambulating without
assistance.


Discharge Instructions:
You were admitted to the hospital because of a heart attack. You
had 2 stents placed in a blocked artery around your heart.

Please take all medications as scheduled and keep all doctors
[**Name5 (PTitle) 4314**]. You must continue to take aspirin 325mg daily and
clopidogrel (also called plavix) 75mg daily without
interruption. If you are told to discontinue or hold these 2
medications by another physician contact your cardiologist
before doing so. Additional new medications for your heart
include atorvastatin (also called lipitor) 80mg daily,
lisinopril (also called zestril) 2.5mg daily and metoprolol
12.5mg twice daily. You may take a dissolving nitroglycerin pill
as prescribed as necessary for chest pain. You are also being
given a prescription for pantoprazole 40mg daily for
reflux/indigestion. Please discontinue the simvastatin (also
called zocor) you were taking prior admission.

Due to new medications, you must have blood drawn by your
primary care doctor in 1 week for chemistry monitoring,
including K (potassium) and BUN/Cr. You must also have blood
drawn  by your primary care doctor in 8 weeks for monitoring of
liver function tests and a cholesterol panel.

If you experience new chest pain, shortness of breath, nausea,
vomiting or any other symptom that concerns you, please seek
medical attention.

Followup Instructions:
Dr. [**Last Name (STitle) 1617**], [**2164-3-1**] 3:15PM.

You must be seen by the cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3321**]
([**Telephone/Fax (1) **]), 2 weeks after discharge. You should be contact[**Name (NI) **]
by his office for the date and time of this appointment. If you
do not hear from his office in the next 2 days, please call the
number provided to schedule this appointment.
{'Acute myocardial infarction of other anterior wall, initial episode of care,Ventricular fibrillation,Other specified hypotension,Asthma, unspecified type, unspecified,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Pain in joint, shoulder region,Other chronic pain'}


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, Syncope

PRESENT ILLNESS: 59 year old man with hyperlipidemia was working out on his
treadmill the morning of admission when he developed a feeling
of "indigestion" associated with L arm tingling.  He then
developed bilateral arm tingling, lightheadedness, and felt
generally unwell. 911 was called. EMS arrived at 11:41AM and at
11:43 the patient became unresponsive. He was found to be in
coarse VFIB, shocked 200 J x 1 to sinus tachycardia with
multiple PVC's. Given 90mg IV lidocaine and drip started at 2.

MEDICAL HISTORY: Cardiac Risk Factors: -Diabetes, +Dyslipidemia, -Hypertension
Cardiac History: NONE
Other PMH
Hyperlipidemia
Mild asthma
Cervical spine fusion
Hip surgery (?ruptured quad tendon)
3rd degree burns to b/l LE ([**Country 3992**]) s/p mult skin grafts
eye operations x 2 as a child

MEDICATION ON ADMISSION: Zocor 10
Singulair
MVI

ALLERGIES: Penicillins / Sulfa (Sulfonamides) / Neosporin / Codeine /
Animal Hair/Dander

PHYSICAL EXAM: VS: T 97.1, BP 117/70, HR 77, RR 14, O2 100% on RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. Mucous membranes
dry.
Neck: Supple.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3. Soft SEM at LUSB.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi on anterior exam.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits. Sheath in place in R groin. No
bruit.
Skin: Extensive scarring over b/l LE. Abrasion over L achilles
tendon.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP
2+PT
[**Name (NI) 2325**]: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP
2+PT

FAMILY HISTORY: His father had an MI at age 52, and later died of lung Ca.
Mother had a pituitary tumor (?benign), lung ca and DM. He has 2
older sisters who are A+W.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is retired, used
to work for the government. He exercises for 1 hour daily,
walking on the treadmill and doing calisthenics. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Ventricular fibrillation,Other specified hypotension,Asthma, unspecified type, unspecified,Esophageal reflux,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Pain in joint, shoulder region,Other chronic pain'}
