CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 86 y/o female with DM2, HTN, Hyperlipidemia, Breast Ca who
presents with chest tightness. Reports that she has been having
SSCP off and on for several weeks. Pain is unrelated to exertion
or food. There is no radiation, although she reports some
associated back pain today. Has associated nausea and vomited
today. Denies SOB, diaphoresis. Pain not pleuritic. Also
reported transient right ankle swelling. Uses pepcid which helps
the discomfort. Had a cardiac cath about 3 yrs ago which showed
40% narrowing of the proximal LAD w/ at least 40% stenosis 1st
diagonal, tortuosity of the epicardial coronary vessels [**3-12**] HTN,
nl LV size, function and contraction pattern; this was medically
managed. She had no change in these symptoms but called her PCP
here in [**Name9 (PRE) 86**] today who sent her to the ED due to above sx.
.
At this time, the patient denies frank CP, chest tightness, n/v,
sob, or HA but does report a tightness at the skin level that
she compares to a tight brazier.
.
In ED, received IV hydral 10mg X 1, mucomyst, bicarb, esmolol
gtt and nipride gtt.  CT [**Doctor First Name **] was consulted and recommended
medical management.  Has not yet received regular PM meds.

MEDICAL HISTORY: 1.  Type 2 DM--diet controlled
2.  HTN
3.  H/o ?Pancreatitis [**10-12**]; normal MRCP [**11-11**]
4.  Hyperlipidemia
5.  BRCA dx'd [**2145**] s/p Lumpectomy and XRT
6. R>L RAS
7. herniated disc
8. cri (baseline 1.2-1.6)

MEDICATION ON ADMISSION: Medications:
Aspirin 325 QD
HCTZ 25 QD
Toprol XL 100AM 50QPM
Sular (nisoldipine) 20 QD
Lovastatin 40mg QHS
Claritin
NSAID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.3  66  168/49  12  100RA
Pleasant woman in NAD
Neck supple, M&O moist and clear, no LAD
JVP @ 9cm; Nl S1/S2
CTAB
Soft, NT, ND, NABS
Warm X 4 w/pulses X 4; bipedal trace edema @ ankles
...
On DC:
97.4  170/76  84  96ra
Pleasant woman in NAD
Neck supple, M&O moist and clear, no LAD
JVP @ 6cm; Nl S1/S2
CTAB
Soft, NT, ND, NABS
Warm X 4 w/pulses X 4; bipedal trace edema @ ankles

FAMILY HISTORY: NC

SOCIAL HISTORY: lives in [**State **]; 3-+py tob. husband deceased and then 2nd
partneser deceased 1.5 yrs ago
Former work at [**First Name8 (NamePattern2) **] [**Doctor Last Name 1104**]
Atherosclerosis of aorta,Congestive heart failure, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Rupture of artery,Personal history of malignant neoplasm of breast,Unspecified disorder of kidney and ureter,Other iatrogenic hypotension
Aortic atherosclerosis,CHF NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Rupture of artery,Hx of breast malignancy,Renal & ureteral dis NOS,Iatrogenc hypotnsion NEC
Admission Date:  [**2160-7-17**]              Discharge Date:   [**2160-7-21**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2698**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
none

History of Present Illness:
86 y/o female with DM2, HTN, Hyperlipidemia, Breast Ca who
presents with chest tightness. Reports that she has been having
SSCP off and on for several weeks. Pain is unrelated to exertion
or food. There is no radiation, although she reports some
associated back pain today. Has associated nausea and vomited
today. Denies SOB, diaphoresis. Pain not pleuritic. Also
reported transient right ankle swelling. Uses pepcid which helps
the discomfort. Had a cardiac cath about 3 yrs ago which showed
40% narrowing of the proximal LAD w/ at least 40% stenosis 1st
diagonal, tortuosity of the epicardial coronary vessels [**3-12**] HTN,
nl LV size, function and contraction pattern; this was medically
managed. She had no change in these symptoms but called her PCP
here in [**Name9 (PRE) 86**] today who sent her to the ED due to above sx.
.
At this time, the patient denies frank CP, chest tightness, n/v,
sob, or HA but does report a tightness at the skin level that
she compares to a tight brazier.
.
In ED, received IV hydral 10mg X 1, mucomyst, bicarb, esmolol
gtt and nipride gtt.  CT [**Doctor First Name **] was consulted and recommended
medical management.  Has not yet received regular PM meds.


Past Medical History:
1.  Type 2 DM--diet controlled
2.  HTN
3.  H/o ?Pancreatitis [**10-12**]; normal MRCP [**11-11**]
4.  Hyperlipidemia
5.  BRCA dx'd [**2145**] s/p Lumpectomy and XRT
6. R>L RAS
7. herniated disc
8. cri (baseline 1.2-1.6)

Social History:
lives in [**State **]; 3-+py tob. husband deceased and then 2nd
partneser deceased 1.5 yrs ago
Former work at [**First Name8 (NamePattern2) **] [**Doctor Last Name 1104**]


Family History:
NC

Physical Exam:
97.3  66  168/49  12  100RA
Pleasant woman in NAD
Neck supple, M&O moist and clear, no LAD
JVP @ 9cm; Nl S1/S2
CTAB
Soft, NT, ND, NABS
Warm X 4 w/pulses X 4; bipedal trace edema @ ankles
...
On DC:
97.4  170/76  84  96ra
Pleasant woman in NAD
Neck supple, M&O moist and clear, no LAD
JVP @ 6cm; Nl S1/S2
CTAB
Soft, NT, ND, NABS
Warm X 4 w/pulses X 4; bipedal trace edema @ ankles

Pertinent Results:
[**2160-7-17**] 08:30PM   CK(CPK)-75
[**2160-7-17**] 08:30PM   CK-MB-NotDone cTropnT-<0.01
[**2160-7-17**] 01:30PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.008
[**2160-7-17**] 01:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2160-7-17**] 12:30PM   GLUCOSE-126* UREA N-43* CREAT-1.5* SODIUM-140
POTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-27 ANION GAP-17
[**2160-7-17**] 12:30PM   CK(CPK)-92
[**2160-7-17**] 12:30PM   CK-MB-NotDone cTropnT-<0.01
[**2160-7-17**] 12:30PM   NEUTS-63.6 LYMPHS-22.4 MONOS-6.6 EOS-6.8*
BASOS-0.5
[**2160-7-17**] 12:30PM   WBC-11.0# RBC-4.83 HGB-14.4 HCT-42.1 MCV-87
MCH-29.9 MCHC-34.3 RDW-14.6
[**2160-7-17**] 12:30PM   PLT COUNT-289
[**2160-7-17**] 12:30PM   D-DIMER-1279*

CTA chest:
1. Extensive atherosclerotic disease of the thoracic aorta with
diffuse irregularity of the aortic wall contour with multiple
possible areas of penetrating ulceration notably with a
penetrating ulcer located in the descending thoracic aorta at
the level of the tracheal bifurcation after the take off of the
great vessels.
2. No evidence of pulmonary embolism.
3. Small right thyroid nodule.
...
ECG: Sinus brady @ 54bpm w/ prolonged QTc @ .452 and LAD.
Flipped T in II, 1mm ST elevation V2, 2mm ST elevation in V3 old
compared to [**2160-1-12**].  Interpreation: LAD w/LAFB and LVH.  No
ischemia.
.
Bil LENIs: No DVT
.
[**7-11**] echo:
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The aortic valve leaflets are mildly thickened.
There is no aortic valve stenosis. Trace aortic regurgitation is
seen. The mitral valve appears structurally normal with trivial
mitral regurgitation. The left ventricular inflow pattern
suggests impaired relaxation. There is moderate pulmonary artery
systolic hypertension. There is no pericardial effusion.


Brief Hospital Course:
This 86 y/o female with DM, HTN, and high chol presented with
extensive ulcerated atherosclerotic disease of the aorta and
with intermittent chest pain and poorly controlled blood
pressure.
.
Chest pain: Diff dx at presentation included angina, dissection
(given high BP), PE (+Ddimer, ?right ankle swelling, relatively
recent plane trip), GI cause (relieved by pepcid).  2w time
course was felt most c/w GERD and most concerning for slow
dissection.  Ultimately felt likely [**3-12**] GERD, HTN.
- Ruled out for MI with serial enzymes, EKGs
- Continued ASA, bblocker, statin
- Agressive BP control as below in detail
- CTA negative for PE; FU CTA 1month for atherosclerotic
lesions; negative LENI studies
-PPI
-Plan for atherosclerotic lesions is repeat CTA in one month and
followup with Dr. [**First Name (STitle) **].
.
HTN: Likely [**3-12**] RAS.  RA US performed pre-DC for better
characterization to aid outpatient managment.  Much improved on
HCTZ, and labetalol with [**Last Name (un) **] added on day of DC.  Control still
not optimal; to be seen as epi @ [**Company 191**] this week, with likely
addition of CCB at that time.
.
CRI: Cr at baseline.
.
LE swelling- In context of positive D-Dimer in a patient w/hx
malignancy, was concerning for DVT; LENIs negative.  Likely mild
CHF.
.
DM: HSS, [**Doctor First Name **] diet
.
FC
.
FEN- Cardiac/DM diet
.
PPx- SQ heparin, PPI
.
Access- Currently PIV
.
[**Name (NI) **] Pt
.
Dispo- Discharged to home.  FU w/Dr. [**First Name (STitle) **], Dr. [**First Name (STitle) **].

Medications on Admission:
Medications:
Aspirin 325 QD
HCTZ 25 QD
Toprol XL 100AM 50QPM
Sular (nisoldipine) 20 QD
Lovastatin 40mg QHS
Claritin
NSAID

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Lovastatin 20 mg Tablet Sig: Two (2) Tablet PO qD ().
3. Meloxicam 7.5 mg Tablet Sig: One (1) Tablet PO qD ().
4. Pantoprazole Sodium 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*
5. Labetalol HCl 200 mg Tablet Sig: Five (5) Tablet PO BID (2
times a day).
Disp:*300 Tablet(s)* Refills:*2*
6. Valsartan 160 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
1. Atherosclerotic disease of the thoracic aorta with evidence
of ulceration
2. HTN
Secondary Diagnosis:
1. Type 2 DM--diet controlled
2. CRI (BL 1.2-1.6)
3. H/o ?Pancreatitis [**10-12**]; normal MRCP [**11-11**]
4. Hyperlipidemia
5. BRCA dx'd [**2145**] s/p Lumpectomy and XRT
6. R> L Renal Artery Stenosis


Discharge Condition:
fair

Discharge Instructions:
Please call your PCP or return to the emergency department if
you develop chest pain, shortness of breath, headaches, or other
worrisome symptom.
Please take all medications as prescribed.
Please follow up with all appointments as listed below.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5250**], M.D. Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 5251**] Date/Time:[**2160-8-8**] 10:30

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1843**], RN Where: [**Hospital6 29**] CARDIAC
SERVICES Phone:[**Telephone/Fax (1) 2207**] Date/Time:[**2160-8-8**] 11:00



Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 5912**], MD Where: [**Hospital6 29**] [**Hospital **] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2160-8-13**] 1:30

Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Where: [**Hospital6 29**]
[**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2160-7-23**] 3:30

Please call Dr.[**Name (NI) 3101**] office at [**Telephone/Fax (1) 920**] to schedule a
follow up appointment in one month. At that time, a follow up CT
scan to evaluate aorta and further recommendations will be
discussed.
{'Atherosclerosis of aorta,Congestive heart failure, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Rupture of artery,Personal history of malignant neoplasm of breast,Unspecified disorder of kidney and ureter,Other iatrogenic hypotension'}


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: 86 y/o female with DM2, HTN, Hyperlipidemia, Breast Ca who
presents with chest tightness. Reports that she has been having
SSCP off and on for several weeks. Pain is unrelated to exertion
or food. There is no radiation, although she reports some
associated back pain today. Has associated nausea and vomited
today. Denies SOB, diaphoresis. Pain not pleuritic. Also
reported transient right ankle swelling. Uses pepcid which helps
the discomfort. Had a cardiac cath about 3 yrs ago which showed
40% narrowing of the proximal LAD w/ at least 40% stenosis 1st
diagonal, tortuosity of the epicardial coronary vessels [**3-12**] HTN,
nl LV size, function and contraction pattern; this was medically
managed. She had no change in these symptoms but called her PCP
here in [**Name9 (PRE) 86**] today who sent her to the ED due to above sx.
.
At this time, the patient denies frank CP, chest tightness, n/v,
sob, or HA but does report a tightness at the skin level that
she compares to a tight brazier.
.
In ED, received IV hydral 10mg X 1, mucomyst, bicarb, esmolol
gtt and nipride gtt.  CT [**Doctor First Name **] was consulted and recommended
medical management.  Has not yet received regular PM meds.

MEDICAL HISTORY: 1.  Type 2 DM--diet controlled
2.  HTN
3.  H/o ?Pancreatitis [**10-12**]; normal MRCP [**11-11**]
4.  Hyperlipidemia
5.  BRCA dx'd [**2145**] s/p Lumpectomy and XRT
6. R>L RAS
7. herniated disc
8. cri (baseline 1.2-1.6)

MEDICATION ON ADMISSION: Medications:
Aspirin 325 QD
HCTZ 25 QD
Toprol XL 100AM 50QPM
Sular (nisoldipine) 20 QD
Lovastatin 40mg QHS
Claritin
NSAID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.3  66  168/49  12  100RA
Pleasant woman in NAD
Neck supple, M&O moist and clear, no LAD
JVP @ 9cm; Nl S1/S2
CTAB
Soft, NT, ND, NABS
Warm X 4 w/pulses X 4; bipedal trace edema @ ankles
...
On DC:
97.4  170/76  84  96ra
Pleasant woman in NAD
Neck supple, M&O moist and clear, no LAD
JVP @ 6cm; Nl S1/S2
CTAB
Soft, NT, ND, NABS
Warm X 4 w/pulses X 4; bipedal trace edema @ ankles

FAMILY HISTORY: NC

SOCIAL HISTORY: lives in [**State **]; 3-+py tob. husband deceased and then 2nd
partneser deceased 1.5 yrs ago
Former work at [**First Name8 (NamePattern2) **] [**Doctor Last Name 1104**] 

### Response:
{'Atherosclerosis of aorta,Congestive heart failure, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Rupture of artery,Personal history of malignant neoplasm of breast,Unspecified disorder of kidney and ureter,Other iatrogenic hypotension'}
