CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 59-year-old gentleman
who has a history of multiple myocardial infarctions in the
past including an inferior myocardial infarction in [**2171**] and
a non-Q-wave myocardial infarction in [**2176-11-19**] who is
admitted from [**Hospital6 33**] with an unstable anginal
syndrome, a positive troponin, and negative creatine kinases.

MEDICAL HISTORY: 1.  Coronary artery disease; status post inferior myocardial
infarction in [**2171**], status post non-Q-wave myocardial
infarction in [**2176-11-19**].  Most recent intervention in
[**2176-11-19**].
2.  Hypercholesterolemia.
3.  Hypertension.
4.  Cluster headaches.

MEDICATION ON ADMISSION: Aspirin 325 mg p.o. q.d.,
Cardizem 240 mg p.o. q.d., Lipitor 10 mg p.o. q.d.,
Paxil 10 mg p.o. q.d., multivitamin.

ALLERGIES: BETA BLOCKER apparently causing bronchospasm.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history notable for coronary artery
disease and diabetes in multiple family members.

SOCIAL HISTORY: The patient is a divorced high school
teacher with six children.  He does not smoke.  There is no
illicit drug use such as cocaine.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Old myocardial infarction,Anxiety state, unspecified,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Comp-oth cardiac device,Parox ventric tachycard,Hematoma complic proc,Old myocardial infarct,Anxiety state NOS,Pure hypercholesterolem
Admission Date:  [**2177-2-25**]     Discharge Date:  [**2177-2-28**]

Date of Birth:   [**2117-9-30**]     Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  This is a 59-year-old gentleman
who has a history of multiple myocardial infarctions in the
past including an inferior myocardial infarction in [**2171**] and
a non-Q-wave myocardial infarction in [**2176-11-19**] who is
admitted from [**Hospital6 33**] with an unstable anginal
syndrome, a positive troponin, and negative creatine kinases.

The patient had been having several days of worsening
exertional chest pain associated with some shortness of
breath, diaphoresis; his typical anginal symptoms which led
him to present to the outside hospital, at which time his
studies became concerning for an acute coronary syndrome.  He
was started on Lopressor, Plavix, aspirin, Integrilin, and
nitroglycerin and transferred to [**Hospital1 190**] for further care.

The patient's most recent cardiac catheterization prior to
this admission revealed the following:  an ejection fraction
of 38%, a normal left main, a 60% tubular middle left
anterior descending artery with a totally occluded first
diagonal, faint left-to-left collaterals, a distal left
anterior descending artery of 90%, a small ramus with a
proximal 70%, circumflex system with a 90% first obtuse
marginal inferior lesion, and a 70% superior pole lesion, a
diffusely diseased third obtuse marginal.  The right coronary
artery had mild diffuse disease with a moderate in-stent
restenosis on previously placed posterior descending artery
stent; unchanged from [**2175-8-20**] catheterization, and a
posterior left ventricle that was totally occluded and filled
by right-to-right collaterals.  Left ventricular
end-diastolic pressure was 20 mm; and at that time the
patient had stent to the first obtuse marginal with
additional percutaneous transluminal coronary angioplasty of
the upper pole of the first obtuse marginal.  The proximal to
middle left anterior descending artery lesion underwent
successful percutaneous transluminal coronary angioplasty and
stenting, and the distal left anterior descending artery was
treated with a stent also.  The first diagonal which had an
in-stent restenosis could not be treated at that time.

The patient was directly admitted to the catheterization
laboratory at [**Hospital6 33**], at which time he
underwent a limited study notable for in-stent restenosis of
the proximal left anterior descending artery stent placed in
[**2175-8-20**] and a 90% distal left anterior descending
artery occlusion, and a distal left anterior descending
artery that was subtotally occluded immediately proximal to a
prior distal left anterior descending artery stent.  The
proximal left anterior descending artery 80% in-stent
restenosis underwent successful brachy therapy, and a stent
was placed in the distal left anterior descending artery
proximal to a prior stent to treat a restenosis.  The
procedure was complicated by hypotension in to the 70s with
bradycardia into the 40s, in a sinus rhythm.

An echocardiogram done on the catheterization table revealed
no evidence of tamponade.  It was felt that the patient was
having an severe vagal reaction.  He was started on dopamine
which was eventually increased to 10 mcg/kg per minute, and
the Coronary Care Unit team was then asked to evaluate and
observe the patient overnight while peripheral anatropes were
weaned.

PAST MEDICAL HISTORY:
1.  Coronary artery disease; status post inferior myocardial
infarction in [**2171**], status post non-Q-wave myocardial
infarction in [**2176-11-19**].  Most recent intervention in
[**2176-11-19**].
2.  Hypercholesterolemia.
3.  Hypertension.
4.  Cluster headaches.

MEDICATIONS ON ADMISSION:  Aspirin 325 mg p.o. q.d.,
Cardizem 240 mg p.o. q.d., Lipitor 10 mg p.o. q.d.,
Paxil 10 mg p.o. q.d., multivitamin.

ALLERGIES:  BETA BLOCKER apparently causing bronchospasm.

FAMILY HISTORY:  Family history notable for coronary artery
disease and diabetes in multiple family members.

SOCIAL HISTORY:  The patient is a divorced high school
teacher with six children.  He does not smoke.  There is no
illicit drug use such as cocaine.

PHYSICAL EXAMINATION ON PRESENTATION:   Admission physical
examination with vital signs revealing afebrile, blood
pressure of 100/60, pulse of 80s on 10 mcg/kg per minute of
dopamine, respiratory rate of 12, oxygen saturation of 98% on
room air.  In general, alert and oriented times three.
Cranial nerves II through XII were intact.  Head, eyes, ears,
nose, and throat revealed pupils were equal, round, and
reactive to light.  Extraocular movements were intact.
Sclerae were anicteric.  The oropharynx was clear.  Neck was
supple, no lymphadenopathy, no jugular venous distention.
Chest was clear to auscultation bilaterally.  Cardiovascular
revealed a regular rhythm with a normal rate.  No murmurs,
rubs or gallops.  Abdomen was soft, nontender, and
nondistended, normal active bowel sounds.  Extremities
revealed soaked dressing, no femoral bruits.  No firmness or
ecchymosis consistent with a hematoma, preserved distal
pulses.

PERTINENT LABORATORY DATA ON PRESENTATION:  Admission
laboratories from the outside hospital revealed troponin
of 0.29, creatine kinases were flat.  First creatine kinase
at [**Hospital1 69**] was 94.

RADIOLOGY/IMAGING:  CT of the abdomen, pelvis, and leg
revealed a 1.5-cm X 1.5-cm hematoma with surrounding fat
stranding.  No evidence of an acute hemorrhage or continued
extravasation of fluid.

HOSPITAL COURSE:  The patient was admitted to the Coronary
Care Unit for management of hypotension, for which the short
differential included active blood loss which was effectively
ruled out by the CT study and a vagal response necessitating
inotropic support.

Over the course of the first evening in the Coronary Care
Unit the patient became progressively anxious and reported
difficulty urinating, and eventually was given 1 mg of
Ativan.  After the dose of Ativan, the patient's dopamine
requirement decreased from 9 mcg/kg per minute to 2 mcg/kg
per minute over the course of an hour and a half.

The following morning, dopamine was discontinued.  The
patient had excellent blood pressures, and the groin appeared
stable.  The patient's hematocrit was also stable, and
subsequent creatine kinases remained flat.  Electrocardiogram
showed no evolving changes.

The patient did suffer nonsustained ventricular tachycardia
while in house.

DISCHARGE DIAGNOSES:
1.  Three vessel coronary artery disease; status post left
anterior descending artery intervention times two on current
admission.
2.  Hypertension.
3.  Exuberant vagal response.
4.  Nonsustained ventricular tachycardia in the setting of
unstable angina.

MEDICATIONS ON DISCHARGE:
1.  Aspirin 325 mg p.o. q.d.
2.  Cardizem 240 mg p.o. q.d.
3.  Lipitor 10 mg p.o. q.d.
4.  Paxil 10 mg p.o. q.d.
5.  Multivitamin.
6.  Plavix 75 mg p.o. q.d. (indefinitely).
7.  Folate 1 mg p.o. q.d.

DISCHARGE FOLLOWUP:  The patient was to follow up for an
electrophysiology study as an outpatient on [**2177-3-6**].
Otherwise, the patient was to follow up with his
cardiologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], for further followup.





                         DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 12-463

Dictated By:[**Name8 (MD) 2653**]

MEDQUIST36

D:  [**2177-3-3**]  13:48
T:  [**2177-3-4**]  12:27
JOB#:  [**Job Number 99685**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Old myocardial infarction,Anxiety state, unspecified,Pure hypercholesterolemia'}


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: 

PRESENT ILLNESS: This is a 59-year-old gentleman
who has a history of multiple myocardial infarctions in the
past including an inferior myocardial infarction in [**2171**] and
a non-Q-wave myocardial infarction in [**2176-11-19**] who is
admitted from [**Hospital6 33**] with an unstable anginal
syndrome, a positive troponin, and negative creatine kinases.

MEDICAL HISTORY: 1.  Coronary artery disease; status post inferior myocardial
infarction in [**2171**], status post non-Q-wave myocardial
infarction in [**2176-11-19**].  Most recent intervention in
[**2176-11-19**].
2.  Hypercholesterolemia.
3.  Hypertension.
4.  Cluster headaches.

MEDICATION ON ADMISSION: Aspirin 325 mg p.o. q.d.,
Cardizem 240 mg p.o. q.d., Lipitor 10 mg p.o. q.d.,
Paxil 10 mg p.o. q.d., multivitamin.

ALLERGIES: BETA BLOCKER apparently causing bronchospasm.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history notable for coronary artery
disease and diabetes in multiple family members.

SOCIAL HISTORY: The patient is a divorced high school
teacher with six children.  He does not smoke.  There is no
illicit drug use such as cocaine. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Paroxysmal ventricular tachycardia,Hematoma complicating a procedure,Old myocardial infarction,Anxiety state, unspecified,Pure hypercholesterolemia'}
