CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 71-year-old
female with a history of ST-elevation myocardial infarction
one year ago with a left anterior descending artery stent
placed at that time.  She also has a history of paroxysmal
atrial fibrillation, a stroke in [**2118**], hypertension, and
hypercholesterolemia who presented with 9/10 substernal chest
pain to an outside hospital with mild associated nausea.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: CODEINE and PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Drug-induced delirium,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified late effects of cerebrovascular disease,Long-term (current) use of anticoagulants
Subendo infarct, initial,Crnry athrscl natve vssl,Atrial fibrillation,Drug-induced delirium,Hypertension NOS,Pure hypercholesterolem,Late effect CV dis NOS,Long-term use anticoagul
Admission Date:  [**2119-5-12**]     Discharge Date:  [**2119-5-18**]

Date of Birth:   [**2047-7-28**]     Sex:  F

Service:  Coronary Care Unit

HISTORY OF PRESENT ILLNESS:  The patient is a 71-year-old
female with a history of ST-elevation myocardial infarction
one year ago with a left anterior descending artery stent
placed at that time.  She also has a history of paroxysmal
atrial fibrillation, a stroke in [**2118**], hypertension, and
hypercholesterolemia who presented with 9/10 substernal chest
pain to an outside hospital with mild associated nausea.

She reported this to be her anginal equivalent.  She denied
any shortness of breath or diaphoresis.  At the outside
hospital she was reported to have 1-mm to 2-mm ST elevations
initially in III and aVF.  After receiving a sublingual
nitroglycerin, her electrocardiogram changes resolved.  She
received an intravenous heparin drip and was transferred to
[**Hospital1 69**] for catheterization.

She had remained pain free since transfer.  At
catheterization, she was noted to have a patent left anterior
descending artery stent and an 80% ulcerated distal right
coronary artery lesion which was stented.

ALLERGIES:  CODEINE and PENICILLIN.

MEDICATIONS AT HOME:
1.  Amiodarone 200 mg by mouth once per day.
2.  Indomethacin 50 mg by mouth three times per day.
3.  Lasix 40 mg by mouth once per day.
4.  Lisinopril 10 mg by mouth once per day.
5.  Lopressor 50 mg by mouth twice per day.
6.  Zoloft 100 mg by mouth once per day.
7.  Aspirin 325 mg by mouth once per day.
8.  Imdur 60 mg by mouth once per day.

PHYSICAL EXAMINATION ON PRESENTATION:  Temperature was 96.3
degrees Fahrenheit, her heart rate was 74, her blood pressure
was 126/80, her respiratory rate was 16, and she was
saturating 96% on 3 liters nasal cannula.  Generally, she was
comfortable and in no acute distress.  Head, eyes, ears,
nose, and throat examination revealed no jugular venous
distention.  Cardiovascular examination revealed a regular
rate and rhythm.  No murmurs, rubs, or gallops.  Pulmonary
examination revealed clear to auscultation bilaterally.  The
abdomen was soft, nontender, and nondistended.  There were
normal active bowel sounds.  Extremities revealed no edema.

PERTINENT LABORATORY VALUES ON PRESENTATION:  White blood
cell count was 17.3, her hematocrit was 39.4, and her
platelets were 287.  Her creatinine was 1.3.  Prothrombin
time was 13.  Creatine kinase was 99.  Troponin was 0.04.

PERTINENT RADIOLOGY/IMAGING:  An electrocardiogram showed a
normal sinus rhythm at 70 beats per minute, normal axis, no
ST changes.  T wave inversions in III and aVF.

A chest x-ray showed cardiomegaly.  No congestive heart
failure.  No obvious infiltrates.

Cardiac catheterization revealed right atrial pressures of
10, pulmonary artery pressures of 29/15, pulmonary capillary
wedge pressure of 15, cardiac output of 4.48, and cardiac
index of 2.5.  Left anterior descending artery stent was
patent with a 50% distal left anterior descending artery
lesion, 80% ostial AV groove, left circumflex lesion, and an
80% ulcerated distal right coronary artery plaque which was
stented.  Ejection fraction on echocardiogram was 75% with
trivial mitral regurgitation.

BRIEF SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM:

1.  NON-ST-ELEVATION MYOCARDIAL INFARCTION ISSUES:  The
patient remained pain free since transfer.  She was found to
have a patent left anterior descending artery stent and 80%
ulcerated distal right coronary artery lesion which was
stented.  Her peak creatine kinase was 664 on [**2119-5-12**];
and her echocardiogram revealed a preserved ejection fraction
and trivial mitral regurgitation.

The patient was continued on Lopressor 100 mg by mouth twice
per day, lisinopril 30 mg by mouth once per day, and
hydrochlorothiazide.  She was to follow up with Dr. [**Last Name (STitle) 44051**]
after discharge from rehabilitation.

2.  ATRIAL FIBRILLATION ISSUES:  The patient with an episode
of atrial fibrillation with a rapid ventricular response, so
her Lopressor was increased for better rate control.  She
will not be a candidate for anticoagulation as she has a
history of intercerebral hemorrhage on Coumadin in [**2118**].  She
was continued on amiodarone.

3.  HYPERTENSION ISSUES:  The patient was initially on
Nipride since the crisis.  Now her blood pressure is much
better controlled on an increased dose of Lopressor 100 mg by
mouth twice per day, hydrochlorothiazide, and lisinopril 30
mg by mouth once per day.

4.  URINARY TRACT INFECTION ISSUES:  Initial urinalysis was
positive, so she was started on treatment with levofloxacin
for four days, but her urine cultures came back no growth so
this was discontinued.

5.  MENTAL STATUS CHANGE ISSUES:  The patient was initially
delirious after cardiac catheterization with an unclear
etiology; possibly related to medications during
catheterization.  She was also given Ativan initially, as she
had been on 1 mg three times per day of Ativan at home.
However, there was no further evidence of withdrawal, and she
has been off Ativan for two days.

She had some initial insomnia which responded well to p.m.
Benadryl.  We will avoid any further benzodiazepines in the
future.

6.  DIARRHEA ISSUES:  Diarrhea noted on [**2119-5-15**].  Sent
Clostridium difficile specimen; although likely since she had
just been on levofloxacin for antibiotics.  Her diarrhea
could be antibiotic related or secondary to higher dose
Lipitor.  Therefore, we discontinued her levofloxacin and
decreased to her Lipitor dose to 40 mg.

7.  DISPOSITION ISSUES:  The patient was to be discharged to
rehabilitation.

DISCHARGE STATUS:   To rehabilitation.

CONDITION AT DISCHARGE:  Stable; ambulatory; and saturating
well on room air.

MEDICATIONS ON DISCHARGE:
1.  Lopressor 100 mg by mouth twice per day.
2.  Lisinopril 30 mg by mouth once per day.
3.  Aspirin 325 mg by mouth once per day.
4.  Plavix 75 mg by mouth once per day.
5.  Lipitor 40 mg by mouth once per day.
6.  Amiodarone 200 mg by mouth once per day.
7.  Zoloft 100 mg by mouth once per day.
8.  Hydrochlorothiazide 25 mg by mouth once per day.
9.  Benadryl 25 mg by mouth at hour of sleep as needed.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with her
cardiologist (Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 44051**]) in one to two weeks after
discharge from rehabilitation.
2.  The patient was also instructed to follow up with her
primary care provider in one to two weeks after discharge
from rehabilitation.





                          [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7169**]

Dictated By:[**Last Name (NamePattern1) 5819**]

MEDQUIST36

D:  [**2119-5-18**]  12:26
T:  [**2119-5-22**]  15:09
JOB#:  [**Job Number 44052**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Drug-induced delirium,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified late effects of cerebrovascular disease,Long-term (current) use of anticoagulants'}


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 is a 71-year-old
female with a history of ST-elevation myocardial infarction
one year ago with a left anterior descending artery stent
placed at that time.  She also has a history of paroxysmal
atrial fibrillation, a stroke in [**2118**], hypertension, and
hypercholesterolemia who presented with 9/10 substernal chest
pain to an outside hospital with mild associated nausea.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: CODEINE and PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Drug-induced delirium,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified late effects of cerebrovascular disease,Long-term (current) use of anticoagulants'}
