CHIEF COMPLAINT: Acute AMI s/p thrombolysis

PRESENT ILLNESS: Mr. [**Known lastname **] is a 54 yoM with minimal PMH who was mowing lawn at 11
AM [**2171-11-9**] and suddenly experienced accelerating exertional
7/10 intensity SSCP.  Symptoms initally attributed to
"swallowing air," and patient self-induced eructation with
minimal relief.  Continued mowing lawn despite increasing pain,
noted diaphoresis and feeling of warmth.  No dyspnea, nor
lightheadedness.  Single episode of nausea spontaneously
relieved after one minute.

MEDICAL HISTORY: Hypertension diagnosed 2 years ago, no treatment.  Patient has
minimal past medical history, but does not see a physician
[**Name Initial (PRE) 30449**].

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  140/72.  P68r  R12
 Gen:  Alert, overweight male in no distress
 CV:  S1 S2 with no S3/S4.  No bruit.
 Lungs:  Clear anterior and posterior fields bilaterally.
 Abd:  Overweight, no HSM.
 Ext:  Trace edema bilaterally.  2+ pulses TP and DP
bilaterally..
.

FAMILY HISTORY: Father with CVA in age 60's.  No significant history of CAD in
family.

SOCIAL HISTORY: Quit tobacco ~30 years ago after brief 1 ppd history.  Rare
social alcohol use.  No IVDA.  Lives with wife, owns UPS store.
Subendocardial infarction, initial episode of care,Diastolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension
Subendo infarct, initial,Diastolc hrt failure NOS,Crnry athrscl natve vssl,Hypertension NOS
Admission Date:  [**2171-11-9**]              Discharge Date:   [**2171-11-13**]

Date of Birth:  [**2116-12-19**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 45**]
Chief Complaint:
Acute AMI s/p thrombolysis

Major Surgical or Invasive Procedure:
Cardiac cath with stent placement [**2171-11-12**]

History of Present Illness:
Mr. [**Known lastname **] is a 54 yoM with minimal PMH who was mowing lawn at 11
AM [**2171-11-9**] and suddenly experienced accelerating exertional
7/10 intensity SSCP.  Symptoms initally attributed to
"swallowing air," and patient self-induced eructation with
minimal relief.  Continued mowing lawn despite increasing pain,
noted diaphoresis and feeling of warmth.  No dyspnea, nor
lightheadedness.  Single episode of nausea spontaneously
relieved after one minute.

Patient returned to house with continuous chest discomfort,
unsuccessfully "trying to find comfortable position."  Describes
burning SSCP [**2176-7-18**], with weakness in arms.  No other symptoms.

At 4 PM, patient called wife and related continuing symptoms,
and EMS was activated to transport patient to [**Hospital3 1443**]
Hospital.

Per OSH records:  At [**Hospital3 **]:  SBP 122/84 P68 R20 on
arrival at 1700h.  Given lopressor IV (5mg x2), reglan, morphine
IV.  10 units retavase x 2 (17:29), heparin 4k bolus, 1k/hr
maintenance.  Started on nitroglycerin gtt for BP control.

Past Medical History:
Hypertension diagnosed 2 years ago, no treatment.  Patient has
minimal past medical history, but does not see a physician
[**Name Initial (PRE) 30449**].

Social History:
Quit tobacco ~30 years ago after brief 1 ppd history.  Rare
social alcohol use.  No IVDA.  Lives with wife, owns UPS store.

Family History:
Father with CVA in age 60's.  No significant history of CAD in
family.

Physical Exam:
VS:  140/72.  P68r  R12
 Gen:  Alert, overweight male in no distress
 CV:  S1 S2 with no S3/S4.  No bruit.
 Lungs:  Clear anterior and posterior fields bilaterally.
 Abd:  Overweight, no HSM.
 Ext:  Trace edema bilaterally.  2+ pulses TP and DP
bilaterally..
.


Pertinent Results:
Labs:  TropT 17.2.  139 | 4.1 | 101 | 24 | 18 | 1.1 < 118
       15.9 > 15.0 / 41.3 < 231     Ca 8.9, Mg 1.9 PO4 3.5.
       PT 14.7 PTT 34.8 INR 1.5
       CK 3392, MB 483

EKG:  At LGH:  1600h:  4 mm STE V3-V4, Q waves II and III.
        1744h  ~1.5 mm STE V3-V5, axis 90 degrees.  Q waves
II-III.
      At [**Hospital1 18**]: 1930h NSR 64 1mm STE V2-V4 with biphasic t waves
in this distribution.

CXR:  Pending.
.
Cath [**2171-11-11**]:
LMCA: mild plaquing
LAD: diffuse dz, worsening to focal 90%, D1 w/ 60-70% stenosis.
LCx: small diffusely dz AV vessel w/ modest OM
Ramus: large w/ irregularities
RCA: proximal diffuse plaques
.
Hemo:
PCW: 20
RA: 14
PA: 41/22 (30)
LV: 129/34
RV: 41/21


Brief Hospital Course:
A&P:  54 year old male with large AMI s/p thrombolysis at OSH.
On presentation to [**Hospital1 18**] pain free with resolving ST segment
changes.  Revascularization with retavase at OSH with resolving
ST segments.
.
##Cardiac
CAD - Initially patient continued on ASA, and heparin (goal
50-70) given bleeding diathesis after thrombolytics.  No
GPIIb/IIIa inhibitor was used.  No plavix given upcoming cath
and possibility of surgical management.
  - Also started on Lipitor 80 mg po qd, beta blocker
(metoprolol) and captopril
  - Patient markedly hypertensive (SBP 160) on arrival -
received IV NTG gtt for pressure control which was weaned off
and ACEI and BB titrated up appropriately.
Peak CK ~3392.
- Pt under went a cardiac cath which revealed LAD lesion which
was stented with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) **].
.
Pump - no previous estimates of heart function.  No signs of
heart failure on exam. Echo done post cath with EF 35%.  Given
EF of 35% and apical, inferior and lateral apical akinesis pt
started on coumadin for likely 3 month course.  D/C home with
lovenox until coumadin therapeutic.
.
Rhythm - sinus, recurrent bradycardia into 50's, asymptomatic.
#  Respiratory - pt noted to have apnea alarms at night on tele
as well as during the cardiac cath.  He will likely need full
work up for OSA with sleep study as outpatient.
.


Medications on Admission:
none

Discharge Medications:
1. Toprol XL 25 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day: For blood pressure
control and heart protection.
[**Last Name (Prefixes) **]:*30 Tablet Sustained Release 24HR(s)* Refills:*2*
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): To reduce cholesterol.
[**Last Name (Prefixes) **]:*30 Tablet(s)* Refills:*2*
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Warfarin 1 mg Tablet Sig: Five (5) Tablet PO once a day: 5
tablets as directed - adjust dose as instructed for proper
anti-coagulation.
[**Last Name (Prefixes) **]:*150 Tablet(s)* Refills:*0*
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): To prevent stent re-stenosis.
[**Last Name (Prefixes) **]:*90 Tablet(s)* Refills:*3*
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
For blood pressure control.
[**Last Name (Prefixes) **]:*30 Tablet(s)* Refills:*2*
7. Enoxaparin 100 mg/mL Syringe Sig: One (1) injection
Subcutaneous Q12H (every 12 hours): For anti-coagulation.  Use
as directed until instructed to stop by your physician.
[**Name Initial (NameIs) **]:*14 injection* Refills:*2*
8. Outpatient Lab Work
INR - please draw labs and have them sent to Dr. [**First Name8 (NamePattern2) 6381**] [**Name (STitle) **] at
[**Hospital 18**] [**Hospital 191**] clinic.  Telephone ([**Telephone/Fax (1) 1300**].

Please draw on [**2171-11-15**]

9. Outpatient Lab Work
INR - please draw and send results to Dr. [**First Name8 (NamePattern2) 6381**] [**Name (STitle) **] at [**Hospital 18**]
[**Hospital 191**] clinic.  ([**Telephone/Fax (1) 1300**].

Please draw on [**2171-11-22**].
10. Outpatient Lab Work
INR - please draw and send results to Dr. [**First Name8 (NamePattern2) 6381**] [**Name (STitle) **] at [**Hospital 18**]
[**Hospital 191**] clinic.  ([**Telephone/Fax (1) 1300**].

Please draw on [**2171-11-29**].
11. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1)
Sublingual once a day: take in case of chest pain and call your
physician.
[**Name Initial (NameIs) **]:*20 tablets* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Myocardial infarction
Hypertension


Discharge Condition:
Stable and pain free


Discharge Instructions:
You were admitted to the hospital with a heart attack.  You
underwent coronary artery stenting to re-open the coronary
artery, but your heart sustained some damage from the event.
You will need continuing care from a primary care physician and
[**Name Initial (PRE) **] cardiologist to ensure proper management of your health
issues.

You will follow-up with Dr. [**First Name8 (NamePattern2) 6381**] [**Name (STitle) **] as your primary care
physician on [**12-2**] at 2pm in the South Suite of the [**Location (un) 6750**] of the [**Hospital Ward Name 23**] Building.  Please call the office to
confirm this appointment.  ([**Telephone/Fax (1) 62552**].

You will follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in cardiology on
[**11-21**] at 1:30 pm.  The address is [**Street Address(2) 3001**].
[**Telephone/Fax (1) 4105**].

You will need to have lab work checked each Friday for the next
3 weeks to monitor your coumadin level.  You will have your
blood drawn by a nurse at Dr.[**Name (NI) 62553**] office and he will review
the results and let you know if any adjustments are needed in
your coumadin dose.  You have a prescription for these blood
draws.  His office is located in the [**Hospital Ward Name 23**] Building on the
[**Hospital Ward Name 516**] of [**Hospital3 **].  It is in the South Suite on the [**Location (un) 6750**].  The address of the [**Hospital Ward Name 23**] Building is [**Location (un) 3387**].

If you develop chest pain, shortness of breath, lightheadedness,
severe dizziness, persistent or worrisome abdominal pain, or
other worrisome symptoms, seek immediate medical attention.


Followup Instructions:
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - cardiology follow-up and cardiac
rehabilitation.

Dr. [**First Name8 (NamePattern2) 6381**] [**Name (STitle) **] - primary care.  Monitoring of INR.

Coumadin Nurse - [**Company 191**] on Fridays - results to [**First Name8 (NamePattern2) 6381**] [**Doctor Last Name **].


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**Doctor First Name 63**]

Completed by:[**2171-11-13**]
{'Subendocardial infarction, initial episode of care,Diastolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}


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: Acute AMI s/p thrombolysis

PRESENT ILLNESS: Mr. [**Known lastname **] is a 54 yoM with minimal PMH who was mowing lawn at 11
AM [**2171-11-9**] and suddenly experienced accelerating exertional
7/10 intensity SSCP.  Symptoms initally attributed to
"swallowing air," and patient self-induced eructation with
minimal relief.  Continued mowing lawn despite increasing pain,
noted diaphoresis and feeling of warmth.  No dyspnea, nor
lightheadedness.  Single episode of nausea spontaneously
relieved after one minute.

MEDICAL HISTORY: Hypertension diagnosed 2 years ago, no treatment.  Patient has
minimal past medical history, but does not see a physician
[**Name Initial (PRE) 30449**].

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  140/72.  P68r  R12
 Gen:  Alert, overweight male in no distress
 CV:  S1 S2 with no S3/S4.  No bruit.
 Lungs:  Clear anterior and posterior fields bilaterally.
 Abd:  Overweight, no HSM.
 Ext:  Trace edema bilaterally.  2+ pulses TP and DP
bilaterally..
.

FAMILY HISTORY: Father with CVA in age 60's.  No significant history of CAD in
family.

SOCIAL HISTORY: Quit tobacco ~30 years ago after brief 1 ppd history.  Rare
social alcohol use.  No IVDA.  Lives with wife, owns UPS store. 

### Response:
{'Subendocardial infarction, initial episode of care,Diastolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}
