CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient's presenting illness
was substernal chest pain that began the day before admission
after the patient was mowing his lawn.  He described the pain
to be 6 out of 10 severe substernal chest pain/pressure.  The
pain diminished to a 3 out of 10 after some rest later that
day.  Over the course of the day the pain increased again to
a severity of 6 to 7 out of 10.  He presented to an outside
hospital and demonstrated electrocardiogram changes that were
dynamic as well as continued substernal chest pain at that
time.  At that point he was started on nitro times three,
aspirin, morphine and his pain diminished to 1 out of 10.
Overnight, the patient had diminished chest pain, which
resolved while he was on an addition of heparin as well as
Integrilin drips.  Overnight the patient experienced 1 out of
10 chest pain discomfort and at some point during the
evening his pain returned to a severity of 3 or 4 out of 10.

MEDICAL HISTORY: Significant for elevated cholesterol,
mild hypertension as well as approximately a fifteen pack
year history of smoking.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Pure hypercholesterolemia
AMI inferior wall, init,Crnry athrscl natve vssl,Hypertension NOS,Tobacco use disorder,Pure hypercholesterolem
Admission Date:  [**2130-11-4**]     Discharge Date:  [**2130-11-7**]

Date of Birth:   [**2085-10-20**]     Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  The patient's presenting illness
was substernal chest pain that began the day before admission
after the patient was mowing his lawn.  He described the pain
to be 6 out of 10 severe substernal chest pain/pressure.  The
pain diminished to a 3 out of 10 after some rest later that
day.  Over the course of the day the pain increased again to
a severity of 6 to 7 out of 10.  He presented to an outside
hospital and demonstrated electrocardiogram changes that were
dynamic as well as continued substernal chest pain at that
time.  At that point he was started on nitro times three,
aspirin, morphine and his pain diminished to 1 out of 10.
Overnight, the patient had diminished chest pain, which
resolved while he was on an addition of heparin as well as
Integrilin drips.  Overnight the patient experienced 1 out of
10 chest pain discomfort and at some point during the
evening his pain returned to a severity of 3 or 4 out of 10.

At that point he was transferred to our hospital for
continued chest pain, rising cardiac enzymes and dynamically
changing electrocardiograms with ST and T wave changes.  His
enzymes had been trending up from a baseline at admission of
CKs of 133, CKMB of 12.7 and troponins of 1.4.  At the time
of arrival at our hospital the next day he had CKs of 223,
CKMB 22.7 and troponin of 2.8 at that point.  The patient at
that point was noted to have electrocardiogram changes
significant for normal systolic rhythm of 77, ST elevations
in V1 through V3 as well as having a J point elevation of
approximately 2.5 mm.  His electrocardiograms from the prior
institution demonstrated inverted T waves inferiorly with Q
waves in lead 3 and AVF.  The Q wave had resolved by the time
we evaluated the patient at out institution.  The patient was
complaining of continued chest pain/pressure, which was in
the severity of 1 to 2 out of 10.  During all of these
episodes the patient never experienced diaphoresis, nausea,
vomiting, lightheadedness or radiation of his pain or
pressure to his extremities or to his jaw.  At that time the
patient was evaluated and deemed necessary to be taken to
catheterization for diagnostic as well as possible
intervention at that point.

PAST MEDICAL HISTORY:  Significant for elevated cholesterol,
mild hypertension as well as approximately a fifteen pack
year history of smoking.

PHYSICAL EXAMINATION:  On arrival at our institution the
patient's heart rate was approximately in the 80s, 84.  Blood
pressure 112/70.  Breathing at 16 breaths per minute and
sating 98% on room air.  The patient was in no acute
distress.  His JVP was at the level of the clavicle.  He was
noted to have no bruits.  His cardiovascular examination
demonstrated regular rate and rhythm.  Normal S1 and S2 and a
2 out of 6 systolic ejection murmur that radiated to the
axilla.  It was a holosystolic murmur.  His lungs were clear
bilaterally except for bilateral basilar crackles right
greater then left.  His abdomen was benign with normoactive
bowel sounds.  Extremities, he had 2+ femoral pulses
bilaterally.  He had no clubbing, cyanosis or edema.  He had
1+ dorsalis pedis pulses bilateral lower extremities and 2+
radial pulses.

LABORATORY:  His cardiac enzymes on admission to the outside
hospital were originally as follows:  CK of 133, CKMB 12.7,
troponin I of 1.4.  That evening on arrival to our
institution his enzymes had risen to CK of 244, CKMB 32, and
a troponin I of 11.7.  His chem 7 as well as his CBC were
normal and his INR was noted to be 1.1 and his PTT was noted
to be 69.  A chest x-ray was done, which demonstrated no
cardiomegaly.  No infiltrates were seen.  No pulmonary edema
was noted.

The patient was at that point taken to the catheterization
laboratory.  At the catheterization laboratory the patient
was noted to have left main coronary artery, left anterior
descending coronary artery and circumflex that demonstrated
no disease and an obtuse marginal one that demonstrated an
80% lesion and a right coronary artery that demonstrated
total occlusion.  At that point intervention was deemed
appropriate and the patient underwent angioplasty as well as
angiojet with thrombectomy and had two stents placed in his
right coronary artery at that point.  The patient tolerated
the procedure well and was hemodynamically stable and brought
back to the Coronary Care Unit for continued monitoring.  The
patient experienced overnight no chest pain, nausea,
vomiting, lightheadedness and all chest pressure discomfort
had resolved at that point.

Over the course of the next day the patient continued to have
no episodes of chest pain.  Hemodynamically his heart rate
was in the 70s.  His pressures were in the low 100s/70s.  The
patient's chem 7 as well as CBC remained stable.  The
patient's cardiac enzymes post catheterization were noted to
be a CK of 232, CKMB of 31 and troponin I of 13.4.  The
patient at that point was medicated with a statin, aspirin,
Plavix, beta blocker and at that point was started on
Captopril for after load reduction.  Two days post
catheterization an echocardiogram was performed on [**11-6**].
His left ventricular ejection fraction was noted to be
greater then 60%.  His left ventricular wall motion was
within normal limits.  The echocardiogram was noted to have
1+ MR.  His aortic root was noted to be mildly dilated.  The
patient remained hemodynamically stable with heart rate in
the 70s and blood pressure in the low 100s over 60 to 70s.
The patient remained sating 95% on room air and remained
afebrile throughout his hospital course.  His physical
examination had remained unchanged and the patient was noted
to have no recurrence of chest pain, lightheadedness, nausea,
vomiting or any other associated symptoms.

The patient was discharged on [**2130-11-7**] and his condition was
stable at that time.  The patient was instructed to follow up
with his primary care physician within one weeks time for
continued monitoring of his condition as well as to set up a
cardiology appointment within the next three weeks.  It was
discussed with the patient that he would have cardiac rehab
follow up as an outpatient and that this would be arranged
through his primary care physician or through his appointment
with the cardiologist.

DISCHARGE MEDICATIONS:  The patient was discharged on
Lopressor 25 mg po b.i.d., Lipitor 10 mg po q day, aspirin
325 mg po q day, Plavix 75 mg po q day for a total of 26 days
after his hospitalization.  The patient was also started on
Zestril 2.5 mg po q day.

The patient was also instructed to maintain a cardiac diet as
well as given education about the need for cessation of his
smoking.

DISCHARGE DIAGNOSIS:
Acute myocardial infarction status post catheterization with
stenting times two of his right coronary artery.






                          [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 5219**]

Dictated By:[**Last Name (NamePattern1) **]

MEDQUIST36

D:  [**2130-11-7**]  15:36
T:  [**2130-11-8**]  09:44
JOB#:  [**Job Number 36740**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,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: The patient's presenting illness
was substernal chest pain that began the day before admission
after the patient was mowing his lawn.  He described the pain
to be 6 out of 10 severe substernal chest pain/pressure.  The
pain diminished to a 3 out of 10 after some rest later that
day.  Over the course of the day the pain increased again to
a severity of 6 to 7 out of 10.  He presented to an outside
hospital and demonstrated electrocardiogram changes that were
dynamic as well as continued substernal chest pain at that
time.  At that point he was started on nitro times three,
aspirin, morphine and his pain diminished to 1 out of 10.
Overnight, the patient had diminished chest pain, which
resolved while he was on an addition of heparin as well as
Integrilin drips.  Overnight the patient experienced 1 out of
10 chest pain discomfort and at some point during the
evening his pain returned to a severity of 3 or 4 out of 10.

MEDICAL HISTORY: Significant for elevated cholesterol,
mild hypertension as well as approximately a fifteen pack
year history of smoking.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Pure hypercholesterolemia'}
