CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is a 59 yo male with a history of hypertension who
presented to [**Hospital1 18**] [**Location (un) 620**] with chest discomfort on evening of
[**2105-12-28**]. He had 2 prior episodes of chest discomfort, 1 year
ago and 3 days ago. The episode 3 days ago occurred while
patient was in bed, and he doesn't know the duration because he
went back to sleep. At 22:15 on [**12-28**] he had chest pain while
lying in bed radiating to left arm, with no associated
diaphoresis, nausea, or dyspnea. This episode was much worse
compared to the previous [**Last Name (LF) 102931**], [**First Name3 (LF) **] patient's wife drove him
to the [**Name (NI) **]. At [**Location (un) 620**], he was found to have ST elevations in
inferior leads with reciprocal changes in I and aVL. Biomarkers
were pending at the time of transfer. He received ASA325mg, SL
NTG x 3 (pain free), clopidogrel 600mg, heparin 5000 units bolus
with 1000/hr gtt, and eptifibatide 180mcg/kg bolus with
2mcg/kg/min gtt, and was transferred to [**Hospital1 18**]. Diagnostic
catheterization showed occlusion of mid-LAD with distal filling
via L-L collaterals, mid-RCA occlusion with L-R collaterals, and
80% OM1 with diffuse distal LCx disease. IABP was inserted and
patient was transferred to CCU for further management, pain
free.

MEDICAL HISTORY: Hypertension
prostate hypertrophy
finger dislocation

MEDICATION ON ADMISSION: Hydochlorothiazide 12.5mg daily
Lisinopril 20mg daily
ASA

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: BP: 132/74, HR:94, O2Sat:97%
GENERAL: Middle-laged male, NAD
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, otherwise non-contributory

SOCIAL HISTORY: -Occupation:Telecommunications sales
-Married
-Tobacco history: Quit smoking: in [**2084**]
-ETOH: 2 drinks per week
-Illicit drugs: None
Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
AMI inferior wall, init,Crnry athrscl natve vssl,Hypertension NOS,BPH w/o urinary obs/LUTS
Admission Date:  [**2105-12-29**]              Discharge Date:   [**2106-1-2**]

Date of Birth:  [**2046-12-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Sulfa (Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
coronary artery bypass x 5 /intra-aortic balloon pump [**2105-12-29**]
(LIMA to LAD, SVG to OM1, SVG to OM2, SVG to PDA, sequenced to
PLV)


History of Present Illness:
This is a 59 yo male with a history of hypertension who
presented to [**Hospital1 18**] [**Location (un) 620**] with chest discomfort on evening of
[**2105-12-28**]. He had 2 prior episodes of chest discomfort, 1 year
ago and 3 days ago. The episode 3 days ago occurred while
patient was in bed, and he doesn't know the duration because he
went back to sleep. At 22:15 on [**12-28**] he had chest pain while
lying in bed radiating to left arm, with no associated
diaphoresis, nausea, or dyspnea. This episode was much worse
compared to the previous [**Last Name (LF) 102931**], [**First Name3 (LF) **] patient's wife drove him
to the [**Name (NI) **]. At [**Location (un) 620**], he was found to have ST elevations in
inferior leads with reciprocal changes in I and aVL. Biomarkers
were pending at the time of transfer. He received ASA325mg, SL
NTG x 3 (pain free), clopidogrel 600mg, heparin 5000 units bolus
with 1000/hr gtt, and eptifibatide 180mcg/kg bolus with
2mcg/kg/min gtt, and was transferred to [**Hospital1 18**]. Diagnostic
catheterization showed occlusion of mid-LAD with distal filling
via L-L collaterals, mid-RCA occlusion with L-R collaterals, and
80% OM1 with diffuse distal LCx disease. IABP was inserted and
patient was transferred to CCU for further management, pain
free.

On review of systems, 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 dyspnea on
exertion, palpitations, syncope or presyncope.


Past Medical History:
Hypertension
prostate hypertrophy
finger dislocation

Social History:
-Occupation:Telecommunications sales
-Married
-Tobacco history: Quit smoking: in [**2084**]
-ETOH: 2 drinks per week
-Illicit drugs: None


Family History:
No family history of early MI, otherwise non-contributory

Physical Exam:
BP: 132/74, HR:94, O2Sat:97%
GENERAL: Middle-laged male, NAD
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with no JVD
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominal bruits.
EXTREMITIES: No c/c/e. Right groin sheath with IABP
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+


Pertinent Results:
[**2105-12-29**] 06:10AM BLOOD WBC-14.0* RBC-4.73 Hgb-13.8* Hct-39.1*
MCV-83 MCH-29.1 MCHC-35.1* RDW-13.2 Plt Ct-239
[**2105-12-29**] 01:00AM BLOOD WBC-11.4* RBC-4.43* Hgb-13.4* Hct-36.8*
MCV-83 MCH-30.2 MCHC-36.3* RDW-13.1 Plt Ct-227
[**2105-12-29**] 06:10AM BLOOD PT-13.8* PTT-41.5* INR(PT)-1.2*
[**2105-12-29**] 01:00AM BLOOD Neuts-70.8* Lymphs-21.9 Monos-4.9 Eos-2.0
Baso-0.3
[**2105-12-29**] 01:00AM BLOOD Glucose-159* UreaN-15 Creat-0.9 Na-137
K-3.6 Cl-103 HCO3-25 AnGap-13
[**2105-12-29**] 01:00AM BLOOD ALT-27 AST-51* CK(CPK)-325* AlkPhos-91
Amylase-34 TotBili-0.4 DirBili-0.1 IndBili-0.3
[**2105-12-29**] 01:00AM BLOOD CK-MB-19* MB Indx-5.8 cTropnT-0.74*
[**2105-12-29**] 01:00AM BLOOD Albumin-3.5 Mg-1.9 Cholest-PND

Conclusions
Pre-CPB:
There is moderate LV systolic dysfxn. The base generally
functions well, but all mid-papillary segments are hypokinetic,
and the apex is akinetic.
No spontaneous echo contrast is seen in the left atrial
appendage.
Moderate global RV hypokinesis.
The ascending aorta is mildly dilated. The descending thoracic
aorta is mildly dilated. There are simple atheroma in the
descending thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. There is no aortic valve stenosis. No
aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen.
There is no pericardial effusion.
An IABP is in the proximal ascending aorta.

Post Bypass:
The patient is in NSR, on low-dose phenylephrine.
Improved biventricular systolic fxn. The RV is now very mildly
globally depressed. The LV shows improved mid papillary fxn. The
inferior wall is still hypokinetic, but the anterior wall is
improved. The apex remains akinetic.
Trace MR, no AI. Aorta intact.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2105-12-29**] 12:57


[**2106-1-1**] 06:40AM BLOOD WBC-10.9 RBC-2.96* Hgb-8.8* Hct-25.1*
MCV-85 MCH-29.8 MCHC-35.2* RDW-13.3 Plt Ct-152
[**2106-1-1**] 06:40AM BLOOD Glucose-121* UreaN-18 Creat-0.8 Na-137
K-4.3 Cl-101 HCO3-27 AnGap-13
[**2106-1-1**] 06:40AM BLOOD WBC-10.9 RBC-2.96* Hgb-8.8* Hct-25.1*
MCV-85 MCH-29.8 MCHC-35.2* RDW-13.3 Plt Ct-152
[**2106-1-1**] 06:40AM BLOOD Glucose-121* UreaN-18 Creat-0.8 Na-137
K-4.3 Cl-101 HCO3-27 AnGap-13

Brief Hospital Course:
Mr. [**Known lastname **] [**Last Name (Titles) 1834**] a diagnostic cardiac catheterization
showing mid-RCA occlusion with collaterals, mid-LAD occlusion
with collaterals, 80% OM1 and 70% diffuse distal LCx disease.
An intra aortic balloon pump was inserted and he went to OR for
CABG x5 the same day. This procedure was performed by Dr.
[**Last Name (STitle) 914**].  He tolerated the procedure well and was transferred to
the CVICU in stable condition.  His balloon was removed and he
was extubated on POD #1.  His chest tubes were removed and his
pressors weaned.  By post-operative day two he was transferred
to the surgical step down floor.  His epicardial wires were
removed and he was seen by physical therapy.  By post-operative
day four he was ready for discharge home.

Medications on Admission:
Hydochlorothiazide 12.5mg daily
Lisinopril 20mg daily
ASA

Discharge Medications:
1. Aspirin 81 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:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every 4-6 hours as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
8. Hydrochlorothiazide 12.5 mg Tablet Sig: One (1) Tablet PO
once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
acute myocardial infarction
coronary artery disease s/p cabg
hypertension
prostate hypertrophy
finger dislocation


Discharge Condition:
good


Discharge Instructions:
no lotions, creams or powders on any incision
shower daily and pat incisions dry
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100.5, redness, drainage, or weight
gain of 2 pounds in 2 days

Followup Instructions:
see Dr. [**Last Name (STitle) 7842**] in [**11-20**] weeks
see Dr. [**Last Name (STitle) **] in [**12-22**] weeks
see Dr. [**Last Name (STitle) 914**] in 4 weeks  [**Telephone/Fax (1) 170**]
please call for appts.



Completed by:[**2106-1-2**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,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: This is a 59 yo male with a history of hypertension who
presented to [**Hospital1 18**] [**Location (un) 620**] with chest discomfort on evening of
[**2105-12-28**]. He had 2 prior episodes of chest discomfort, 1 year
ago and 3 days ago. The episode 3 days ago occurred while
patient was in bed, and he doesn't know the duration because he
went back to sleep. At 22:15 on [**12-28**] he had chest pain while
lying in bed radiating to left arm, with no associated
diaphoresis, nausea, or dyspnea. This episode was much worse
compared to the previous [**Last Name (LF) 102931**], [**First Name3 (LF) **] patient's wife drove him
to the [**Name (NI) **]. At [**Location (un) 620**], he was found to have ST elevations in
inferior leads with reciprocal changes in I and aVL. Biomarkers
were pending at the time of transfer. He received ASA325mg, SL
NTG x 3 (pain free), clopidogrel 600mg, heparin 5000 units bolus
with 1000/hr gtt, and eptifibatide 180mcg/kg bolus with
2mcg/kg/min gtt, and was transferred to [**Hospital1 18**]. Diagnostic
catheterization showed occlusion of mid-LAD with distal filling
via L-L collaterals, mid-RCA occlusion with L-R collaterals, and
80% OM1 with diffuse distal LCx disease. IABP was inserted and
patient was transferred to CCU for further management, pain
free.

MEDICAL HISTORY: Hypertension
prostate hypertrophy
finger dislocation

MEDICATION ON ADMISSION: Hydochlorothiazide 12.5mg daily
Lisinopril 20mg daily
ASA

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics)

PHYSICAL EXAM: BP: 132/74, HR:94, O2Sat:97%
GENERAL: Middle-laged male, NAD
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: No family history of early MI, otherwise non-contributory

SOCIAL HISTORY: -Occupation:Telecommunications sales
-Married
-Tobacco history: Quit smoking: in [**2084**]
-ETOH: 2 drinks per week
-Illicit drugs: None 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
