CHIEF COMPLAINT: Nausea, chest heaviness.

PRESENT ILLNESS: Patient is a 60 year-old male
with 50 plus pack year history of smoking, otherwise no past
medical history.  He presented to [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] emergency
and AVF on electrocardiogram. Patient reports he was sleeping
the night prior to admission when the pain awoke him from
sleep, described as a chest heaviness as if an animal was
sitting on his chest accompanied by nausea and vomiting.  He
had no shortness of breath, no diaphoresis.  He was in his
otherwise usual state of health until this episode. At the
[**Hospital1 **] emergency department patient was found to be bradycardic
to the 40s with a blood pressure in the 90s to 110s, O2
saturation 97 percent.  He was guaiac negative and was started on
nitroglycerin, morphine, aspirin, Reopro and Reteplase with 5
units intravenous times two given at around 3 o'clock in the
morning.  By about 5 in the morning he was pain-free.  On the day
of admission patient underwent cardiac catheterization at [**Hospital1 1444**] and was found to have the
following hemodynamics:  right atrial pressure mean of 9, right
ventricular pressure of 27/11, pulmonary artery pressure 26/16,
wedge of 16.  Left sided catheterization showed LAD with mild
segmental disease, left circumflex nondominant, no critical
lesions, RCA which is dominant showed distal 99 percent occlusion
which was stented.  There was no reflow following stenting.
The patient was given intracoronary nitroglycerin and diltiazem
which resulted in TIMI 3 flow.  However, there was persistence of
ST elevation in the inferior leads and the patient was admitted
to the Cardiac Care Unit for monitoring.

MEDICAL HISTORY: Is significant for 50 plus packing
year smoking history.  No history of diabetes mellitus,
hypertension or coronary artery disease.

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with hypertension, father with
possible history of coronary artery disease per patient.

SOCIAL HISTORY: Current smoker, about two packs per day, no
alcohol use.  Married and is currently an active landscaper.
Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified disease of pericardium,Other and unspecified hyperlipidemia
AMI inferior wall, init,Crnry athrscl natve vssl,Pericardial disease NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2181-11-8**]     Discharge Date:  [**2181-11-12**]

Date of Birth:   [**2121-6-9**]     Sex:  M

Service:  CCU
CHIEF COMPLAINT:  Nausea, chest heaviness.

HISTORY OF PRESENT ILLNESS:  Patient is a 60 year-old male
with 50 plus pack year history of smoking, otherwise no past
medical history.  He presented to [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] emergency
and AVF on electrocardiogram. Patient reports he was sleeping
the night prior to admission when the pain awoke him from
sleep, described as a chest heaviness as if an animal was
sitting on his chest accompanied by nausea and vomiting.  He
had no shortness of breath, no diaphoresis.  He was in his
otherwise usual state of health until this episode. At the
[**Hospital1 **] emergency department patient was found to be bradycardic
to the 40s with a blood pressure in the 90s to 110s, O2
saturation 97 percent.  He was guaiac negative and was started on
nitroglycerin, morphine, aspirin, Reopro and Reteplase with 5
units intravenous times two given at around 3 o'clock in the
morning.  By about 5 in the morning he was pain-free.  On the day
of admission patient underwent cardiac catheterization at [**Hospital1 1444**] and was found to have the
following hemodynamics:  right atrial pressure mean of 9, right
ventricular pressure of 27/11, pulmonary artery pressure 26/16,
wedge of 16.  Left sided catheterization showed LAD with mild
segmental disease, left circumflex nondominant, no critical
lesions, RCA which is dominant showed distal 99 percent occlusion
which was stented.  There was no reflow following stenting.
The patient was given intracoronary nitroglycerin and diltiazem
which resulted in TIMI 3 flow.  However, there was persistence of
ST elevation in the inferior leads and the patient was admitted
to the Cardiac Care Unit for monitoring.

PAST MEDICAL HISTORY:  Is significant for 50 plus packing
year smoking history.  No history of diabetes mellitus,
hypertension or coronary artery disease.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  None.

SOCIAL HISTORY:  Current smoker, about two packs per day, no
alcohol use.  Married and is currently an active landscaper.

FAMILY HISTORY:  Mother with hypertension, father with
possible history of coronary artery disease per patient.

PHYSICAL EXAMINATION:  On admission temperature 97.8, blood
pressure 108/54, heart rate in the 70s, O2 maturation 93 to
100 percent on room air.  General:  somewhat somnolent in no
acute distress.  Head, eyes, ears, nose and throat
examination: jugular venous pulses difficult to assess as
patient is lying down and unable to sit up due to recent
catheterization.  Cardiovascular examination: Regular rate
and rhythm, normal S1, S2, II/VI systolic ejection left upper
sternal border.  Abdomen soft, nontender, nondistended,
normal active bowel sounds. Extremities warm, no edema, 2+
dorsalis pedis, posterior tibialis pulses bilaterally.  Lungs
clear to auscultation bilaterally.

LABORATORIES FROM ADMISSION:  Sodium 141, potassium 4.5,
chloride 110, bicarbonate 23, BUN 16, creatinine 0.7, glucose
108.  White blood count 13.3, hematocrit 39.4, platelets 261,
INR 1.2, PTT 47.1.  Alk phos 40, AST 178, total bilirubin is
0.5, ALT 46.  Calcium 7.8, phos 3.1, magnesium 1.6.  CK 1864
with an MB of 167, MBI of 9, troponin greater than 50.
Electrocardiogram showed ST elevations in 2,3 and AVF with ST
depression in V1 through V3, bradycardia in the 40s.

IMPRESSION:  Patient is a 60 year-old male with past medical
history of smoking who presents with acute inferior wall
myocardial infarction likely due to critical RCA lesion,
status post catheterization now with no reflow immediately
after intervention with TIMI 3 flow after nitroglycerin and
diltiazem.

HOSPITAL COURSE:  1) Cardiovascular:  Post catheterization
patient was started on Plavix, aspirin, Lopressor, Captopril
and had no further chest heaviness or shortness of breath.
Patient underwent an echocardiogram on [**11-12**] the results of
which are pending at this time. He was started on Captopril
for afterload reduction.  Patient was also noted to have some
chest soreness on [**2181-11-10**] accompanied by a friction
rub consistent with acute pericarditis. He was given Motrin for
one day with relief of his pain and resolution of the pericardial
friction rub by the following day.  Patient was started on
Lipitor 10 mg p.o. q.d.  Echocardiogram revealed no pericardial
effusion, EF 50-55% with inferior-posterior akinesis.  Signal
Averaged ECG was performed and was positive, however the
patient's risk of life threatening ventricular arrhythmias was
felt to be fairly low given his minimally depressed LV systolic
function.  Medical therapy with beta blockers and ACE inhibitors
was initiated.

2) Heme:  He was initially started on Reopro which was
continued for 18 hours post catheterization with no
significant bleeding.  There was noted to be a small right
groin hematoma at the catheterization site.  However,
there was no bruit and distal pulses were intact.

DISCHARGE DIAGNOSIS:
1.      Acute inferior myocardial infarction.
2.      Acute pericarditis.

DISCHARGE CONDITION:  Good.  Patient is feeling back to his
usual state of health, no longer having any chest heaviness
or soreness and has plans to follow up with his cardiologist,
Dr. [**Last Name (STitle) **], as an outpatient within the next week.

DISCHARGE MEDICATIONS:  Lipitor 10 mg p.o. q day, Lisinopril
5 mg p.o. q day, Lopressor 25 mg p.o. b.i.d., aspirin 325 mg
p.o. q. day, Plavix 75 mg p.o. q day times one year




                          [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3812**]

Dictated By:[**Name8 (MD) 4630**]

MEDQUIST36

D:  [**2181-11-12**]  08:38
T:  [**2181-11-20**]  11:25
JOB#:  [**Job Number 36789**]







Admission Date:  [**2181-11-8**]     Discharge Date:  [**2181-11-12**]

Date of Birth:   [**2121-6-9**]     Sex:  M

Service:  CICU

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 47106**] is a 60-year-old
gentlemen with 60 plus pack year history of smoking,
otherwise, no past medical history, who presented to [**Hospital1 **]
elevations in leads II, III and aVF.  Patient reports that he
his chest that woke him up accompanied by nausea and
vomiting, but denied shortness of breath, diaphoresis.
Patient reports that he was in his usual state of health
until this episode.  At the [**Hospital1 **] Emergency Department, the
patient was noted to be bradycardic to the 40s, blood pressure
97%.  He was guaiac negative and started on nitroglycerin,
morphine, aspirin, repro, heparin and received two doses of
pain free at around 5 in the morning.

That following morning, the patient was transferred to [**Hospital6 1760**] where he underwent a cardiac
catheterization which showed a right atrial mean pressure of 9,
right ventricular pressure of 27/11, pulmonary artery
pressures of 27/16, wedge pressure of 13.  His left anterior
descending artery had a midsegment disease, left circumflex
was nondominant, no aortic lesions.  The right coronary
artery was dominant with a distal 99% occlusion, which was
stented with no reflow.  The patient had persistent ST elevations
following the catheterization in leads II, III and aVF.

PAST MEDICAL HISTORY:  Patient denies any diabetes,
hypertension or coronary artery disease.

ALLERGIES:  No known drug allergies.

MEDICATIONS AT HOME:  None.

SOCIAL HISTORY:  Smokes currently, 50 plus pack year, two
packs a day.  Denies alcohol use.  He is married, works for a
landscaper and mortgage broker.

FAMILY HISTORY:  Mother with hypertension and father with
possible coronary artery disease.

PHYSICAL EXAMINATION:  The patient, on presentation, had the
following vital signs:  Temperature 97.8. Blood pressure
108/54.  Oxygen saturation 93-100% on room air.  General:  He
was somnolent but in no acute distress.  Head, eyes, ears,
nose and throat:  Jugular venous distention to the mandible.
Cardiovascular:  Regular rate and rhythm, normal S1, S2, 3/6
systolic ejection murmur at the left upper sternal border.
Abdomen:  Soft, nontender, nondistended, normal bowel sounds.
Extremities:  Warm, no edema, 2+ pulses, dorsalis pedis and
posterior tibial.  Lungs were clear to auscultation
bilaterally.

LABORATORY DATA FROM THE OUTSIDE HOSPITAL:  White blood cell
count 14.4, hematocrit 45.5.  He had a sodium of 140,
potassium of 5.1, chloride 100, BUN 18, creatinine 1, glucose
129, troponin of less than 0.2 and a CK-MB of 2.6.

Electrocardiogram at the outside hospital showed ST
elevations in II,III and aVF, ST depressions in V1 through V3
and bradycardia in the 40s.

LABORATORY VALUES AT [**Hospital6 **]:
White blood cell count 13.5, hematocrit 39.4, platelet count
261,000.  INR 1.2.  PTT 47.1, CK of 1864, MB index of 9.0,
troponin greater than 50.  His Chem-7 showed sodium of 141,
potassium 4.5, chloride 100, bicarbonate 23, BUN 16,
creatinine 0.7, glucose 108.  AST 178, ALT 42, alkaline
phosphatase 40, T bilirubin 0.5, calcium 7.8, magnesium 1.6,
phosphorus 2.1.

The patient underwent echocardiogram which demonstrated the
following:  On the day of discharge, the patient had this
transthoracic echocardiogram which showed left ventricular
ejection fraction of 50-55%, mildly dilated left atrium,
normal right atrium, normal ventricular size, mildly
depressed left ventricular systolic function, right
ventricular size and free wall motion normal, aortic root
normal, aortic valve leaflets are mildly thickened, mitral
valve leaflets mildly thickened, trivial mitral regurgitation
and a left ventricular inflow pattern suggesting impaired
relaxation.  The tricuspid valve was normal with trivial
regurgitation and there was no pericardial effusion.

During his stay, the patient had a signal averaged
electrocardiogram which was positive, however given his
minimally impaired LV EF he was felt to be at relatively low
risk for ventricular arrhythmias. In addition, the patient
continued to have persistent ST elevations 1 mm to .5 a mm in the
inferior leads despite the RCA stenting.

HOSPITAL COURSE:

1.  Cardiovascular:  The patient underwent cardiac
catheterization with a stent placed in the right coronary
artery at the site of the 99% occlusion but with no reflow
phenomenon. The patient was treated with aspirin, beta-blocker
and 18 hours of Integrilin and an ACE inhibitor.  He was pain
free the following 24 hours after cardiac catheterization.
However, subsequently patient developed what he called a
chest soreness located across his chest that he said was
significantly different from the pain he experienced the
prior day.  Electrocardiogram was unchanged.  Initially the
pain was thought possibly due to the coronary lesions,
however, the patient, on hospital day number three, developed
friction rub on physical examination and it was determined
that his persistent pain was likely due to pericarditis.  At
that point, patient was treated with nonsteroidal anti-
inflammatory drugs with complete relief of pain.  He
remained hemodynamically throughout and had no evidence of
tamponade physiology.  The patient's cardiac enzymes were
peaked at 21.  His CK peaked at 2103 on the 19th and had
dropped to 489 on the 21st.

CONDITION AT DISCHARGE:  The patient was in good condition at
discharge.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease, 99% right coronary occlusion,
status post stent without restoration of flow.
2.  Mildly depressed left ventricular ejection fraction.
3.  Pericarditis.
4.  Hyperlipidemia with an LDL of 141.

DISCHARGE MEDICATIONS:  Patient had the following discharge
medications:
1.  Plavix 75 mg po q.d. for 12 months.
2.  Lipitor 10 mg po q.d.
3.  Lopressor 25 mg po b.i.d.
4.  Lisinopril 5 mg po q.d.
5.  Enteric coated aspirin 325 mg po q.d.

FOLLOW-UP PLANS:  The patient is to follow-up his cardiologist at
[**Hospital **] Hospital within two weeks of discharge and with his
primary care physician within two weeks of discharge.







                          [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3812**]

Dictated By:[**First Name3 (LF) 33319**]

MEDQUIST36

D:  [**2181-11-12**]  15:27
T:  [**2181-11-19**]  19:11
JOB#:  [**Job Number 47107**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified disease of pericardium,Other and unspecified hyperlipidemia'}


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: Nausea, chest heaviness.

PRESENT ILLNESS: Patient is a 60 year-old male
with 50 plus pack year history of smoking, otherwise no past
medical history.  He presented to [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] emergency
and AVF on electrocardiogram. Patient reports he was sleeping
the night prior to admission when the pain awoke him from
sleep, described as a chest heaviness as if an animal was
sitting on his chest accompanied by nausea and vomiting.  He
had no shortness of breath, no diaphoresis.  He was in his
otherwise usual state of health until this episode. At the
[**Hospital1 **] emergency department patient was found to be bradycardic
to the 40s with a blood pressure in the 90s to 110s, O2
saturation 97 percent.  He was guaiac negative and was started on
nitroglycerin, morphine, aspirin, Reopro and Reteplase with 5
units intravenous times two given at around 3 o'clock in the
morning.  By about 5 in the morning he was pain-free.  On the day
of admission patient underwent cardiac catheterization at [**Hospital1 1444**] and was found to have the
following hemodynamics:  right atrial pressure mean of 9, right
ventricular pressure of 27/11, pulmonary artery pressure 26/16,
wedge of 16.  Left sided catheterization showed LAD with mild
segmental disease, left circumflex nondominant, no critical
lesions, RCA which is dominant showed distal 99 percent occlusion
which was stented.  There was no reflow following stenting.
The patient was given intracoronary nitroglycerin and diltiazem
which resulted in TIMI 3 flow.  However, there was persistence of
ST elevation in the inferior leads and the patient was admitted
to the Cardiac Care Unit for monitoring.

MEDICAL HISTORY: Is significant for 50 plus packing
year smoking history.  No history of diabetes mellitus,
hypertension or coronary artery disease.

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother with hypertension, father with
possible history of coronary artery disease per patient.

SOCIAL HISTORY: Current smoker, about two packs per day, no
alcohol use.  Married and is currently an active landscaper. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified disease of pericardium,Other and unspecified hyperlipidemia'}
