CHIEF COMPLAINT: Chest Pain and shortness of breath

PRESENT ILLNESS: This is a [**Age over 90 **] year-old female with history of hypertension who
was admitted with an ST elevation myocardial infarction.  A few
days prior to presentation, she developed intermittent back and
shoulder pain.  The night prior to presentation, she awoke from
sleep with more severe shoulder and neck pain.  She applied
bengay without improvement.  She also felt short of breath and
was able to catch her breath.  She presented to an outside
hospital at which she was noted to have a new right bundle
branch block with ST elevations in leads V2-V5.  She was
hypertensive to the 200s systolic.  A nitro drip was started and
dropped her pressures.  She was then treated with nitro paste,
aspirin, lopressor, enalopril, heparin drip, morphine, and
lasix.  She was transfered to the [**Hospital1 18**] for cardiac
catherization.  She had a stent placed to her left anterior
descending artery and was admitted to the Coronary Care Unit.
At that time, she denied any residual pain or shortness of
breath.

MEDICAL HISTORY: 1. Hyeprtension
2. Gastroesophageal reflux disease
3. Osteoarthritis

MEDICATION ON ADMISSION: inderal
hydrochlorothiazide
pravachol
timoptic eye drops
colcept eye drops

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: Blood Pressure:132/61 Pulse:85 Respiratory Rate:21
Oxygen Saturation:100% on 2L nasal canula.
General: Pleasant elderly female in no acute distress.
HEENT: Pupils equal and reactive, extraoccular movements intact,

FAMILY HISTORY: She has 2 brothers who had coronary artery disease in their 90s.

SOCIAL HISTORY: She lives with her daughter in [**Name (NI) 3844**].  She doesn't drink
alcohol or smoke.
Acute myocardial infarction of other anterior wall, initial episode of care,Systolic heart failure, unspecified,Diseases of tricuspid valve,Right bundle branch block,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Anemia, unspecified,Other chronic pulmonary heart diseases,Abnormal coagulation profile
AMI anterior wall, init,Systolic hrt failure NOS,Tricuspid valve disease,Rt bundle branch block,Crnry athrscl natve vssl,Hypertension NOS,Esophageal reflux,Anemia NOS,Chr pulmon heart dis NEC,Abnrml coagultion prfile
Admission Date:  [**2109-5-21**]              Discharge Date:   [**2109-5-26**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
Chest Pain and shortness of breath

Major Surgical or Invasive Procedure:
Cardiac catherization with stent placement.


History of Present Illness:
This is a [**Age over 90 **] year-old female with history of hypertension who
was admitted with an ST elevation myocardial infarction.  A few
days prior to presentation, she developed intermittent back and
shoulder pain.  The night prior to presentation, she awoke from
sleep with more severe shoulder and neck pain.  She applied
bengay without improvement.  She also felt short of breath and
was able to catch her breath.  She presented to an outside
hospital at which she was noted to have a new right bundle
branch block with ST elevations in leads V2-V5.  She was
hypertensive to the 200s systolic.  A nitro drip was started and
dropped her pressures.  She was then treated with nitro paste,
aspirin, lopressor, enalopril, heparin drip, morphine, and
lasix.  She was transfered to the [**Hospital1 18**] for cardiac
catherization.  She had a stent placed to her left anterior
descending artery and was admitted to the Coronary Care Unit.
At that time, she denied any residual pain or shortness of
breath.

Past Medical History:
1. Hyeprtension
2. Gastroesophageal reflux disease
3. Osteoarthritis


Social History:
She lives with her daughter in [**Name (NI) 3844**].  She doesn't drink
alcohol or smoke.

Family History:
She has 2 brothers who had coronary artery disease in their 90s.

Physical Exam:
Vitals: Blood Pressure:132/61 Pulse:85 Respiratory Rate:21
Oxygen Saturation:100% on 2L nasal canula.
General: Pleasant elderly female in no acute distress.
HEENT: Pupils equal and reactive, extraoccular movements intact,

moist mucous membranes, anicteric sclera.
Pulmonary: Clear to auscultation bilaterally.
Cardiac: Regular rate and rhythm, s1, s2, without murmurs, rubs,
or gallops.
Abdomen: Soft, nontender, nondistended with normoactive bowel
sounds.
Extremities: Warm and well perfused without cyanosis or edema.
Right groin site dressing clean and intact without oozing,
hematoma, or bruit.

Pertinent Results:
Hematology:
WBC-17.4 HGB-11.0 HCT-31.9 PLT COUNT-377
NEUTS-90.9 BANDS-0 LYMPHS-6.0 MONOS-3.1 EOS-0.1 BASOS-0
.
Chemistries:
SODIUM-135 POTASSIUM-3.3 CHLORIDE-98 TOTAL CO2-20 UREA N-31
CREAT-1.1 GLUCOSE-125
ALBUMIN-3.0 CALCIUM-7.9 PHOSPHATE-5.4 MAGNESIUM-1.1
.
Coagulation:
INR(PT)-1.7
.
Arterial Blood Gases:
PO2-146 PCO2-48 PH-7.35 TOTAL CO2-28 BASE XS-0
.
Cardiac Enzymes:
Outside Hospital - CK-103, CKMB-12.5, MB index-12.1, tropI-1.82
7PM - CK(CPK)-890 CK-MB-119 MB INDX-13.4 cTropnT-7.74
.
EKG: Right bundle branch block with ST elevations and prominent
Q-waves in the anterior leads.
.
Cardiac Catherization: The left main coronary had mild diffuse
disease.  The mid left anterior descending artery had a focal
99% stenosis.  The left circumflex had a 60-70% stenosis.  The
right coronary was free of disease.
.
Hemodynamics: Pulmonary artery pressures were 28/10/19.  Wedge
pressure was 14.  Cardiac output was 3.8 with an index of 2.6.
.
Intervention: A drug eluting stent was placed to the mid LAD
lesion without complication.

Brief Hospital Course:
This is a [**Age over 90 **] year-old female who presented with an anterior ST
elevation myocardial infarction and had a stent placed to the
LAD.
.
1. STEMI: On arrival to the [**Hospital1 18**], she was pain free.  Given the
prominent Q waves on her EKG, it was felt that she had completed
her infarction.  At catherization, she was found to have 2
vessel disease with a 99% stenosis of the mid-left anterior
descending artery.  A drug eluting stent was placed over this
lesion with good resultant flow.  She may eventually need
intervention to the 60-70% stenosis in the circumflex.  She was
started on aspirin, Plavix and a high dose Statin.  Metoprolol
and lisinopril were titrated up as her blood pressure tolerated.
 She had no further episodes of chest pain throughout the
admission.
.
2. Congestive Heart Failure: A post-catherization echocardiogram
showed severe left ventricular dysfunction with an ejection
fraction of 20-25% and anterior and apical akinesis.  She was
started on Coumadin with a heparin bridge for anticoagulation.
After discussions with her outside physician, [**Name10 (NameIs) **] was decided not
to anticoagulate her for her apical akinesis because the risk of
bleeding at her age.  During this admission, she had one episode
of flash pulmonary edema after receiving a unit of blood.  She
became acutely short of breath and hypertensive.  She received
Lasix and diuresed 2 litres.  She was started on maintenance
Lasix.
.
3. Elevation INR: She had received 2 doses of Coumadin for
apical akinesis as above.  At the time of discharge, her she had
a supratherapeutic INR at 6.6.  She received vitamin K.  She
will had her INR checked in 1 day post discharge.
.
4. Anemia: She had a hematocrit of 24 post-catherization.  She
received 2 units of red cells with an appropriate bump.
.
5. Hypertension: Her blood pressure was controlled with
lisinopril and metoprolol as above.
.
6. GERD: She was maintained on a PPI.
.
7. Access: Peripheral IVs.
.
8. FEN: She was maintained on a cardiac diet.  Her magnesium and
potassium were repleted.  She was diuresed as above.
.
9. Prophylaxis: Anticoagulation as above, bowel regimen, and
PPI.
.
10. Code: Full.
.
11. Dispo: She was discharged to home with home physical
therapy.

Medications on Admission:
inderal
hydrochlorothiazide
pravachol
timoptic eye drops
colcept eye drops

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic  [**Hospital1 **]
(2 times a day).
5. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic  [**Hospital1 **] (2 times a day).
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Toprol XL 200 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
community health vna

Discharge Diagnosis:
ST elevation myocardial infarction
Congestive heart failure
Hypertension


Discharge Condition:
Stable.  She had no recurrent chest pain.


Discharge Instructions:
Please take all medications as prescribed.  You were started on
aspirin and plavix for your stent.  You were also started on
atorvastatin, metoprolol, lisinopril, and furosimide for your
heart.

Please keep all follow-up appointments.

Seek medical attention if you have recurrent chest pain,
shortness of breath, nausea, vomiting, or anything else that you
find worrisome.

Followup Instructions:
You should follow-up with your primary care physician [**Last Name (NamePattern4) **] [**1-7**]
weeks, call Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 5699**] at [**Telephone/Fax (1) 67087**] for a follow up
appointment.

You should keep your appointment with your cardiologist on
Monday [**2109-5-27**] in [**Location (un) 3844**]. Please call Dr. [**First Name4 (NamePattern1) 11249**]
[**Last Name (NamePattern1) 11250**] at [**Telephone/Fax (1) 11254**] (Have your blood drawn at your
Cardiologist visit to check your INR level on Monday)



Completed by:[**2109-5-27**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Systolic heart failure, unspecified,Diseases of tricuspid valve,Right bundle branch block,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Anemia, unspecified,Other chronic pulmonary heart diseases,Abnormal coagulation profile'}


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: Chest Pain and shortness of breath

PRESENT ILLNESS: This is a [**Age over 90 **] year-old female with history of hypertension who
was admitted with an ST elevation myocardial infarction.  A few
days prior to presentation, she developed intermittent back and
shoulder pain.  The night prior to presentation, she awoke from
sleep with more severe shoulder and neck pain.  She applied
bengay without improvement.  She also felt short of breath and
was able to catch her breath.  She presented to an outside
hospital at which she was noted to have a new right bundle
branch block with ST elevations in leads V2-V5.  She was
hypertensive to the 200s systolic.  A nitro drip was started and
dropped her pressures.  She was then treated with nitro paste,
aspirin, lopressor, enalopril, heparin drip, morphine, and
lasix.  She was transfered to the [**Hospital1 18**] for cardiac
catherization.  She had a stent placed to her left anterior
descending artery and was admitted to the Coronary Care Unit.
At that time, she denied any residual pain or shortness of
breath.

MEDICAL HISTORY: 1. Hyeprtension
2. Gastroesophageal reflux disease
3. Osteoarthritis

MEDICATION ON ADMISSION: inderal
hydrochlorothiazide
pravachol
timoptic eye drops
colcept eye drops

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: Blood Pressure:132/61 Pulse:85 Respiratory Rate:21
Oxygen Saturation:100% on 2L nasal canula.
General: Pleasant elderly female in no acute distress.
HEENT: Pupils equal and reactive, extraoccular movements intact,

FAMILY HISTORY: She has 2 brothers who had coronary artery disease in their 90s.

SOCIAL HISTORY: She lives with her daughter in [**Name (NI) 3844**].  She doesn't drink
alcohol or smoke. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Systolic heart failure, unspecified,Diseases of tricuspid valve,Right bundle branch block,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Anemia, unspecified,Other chronic pulmonary heart diseases,Abnormal coagulation profile'}
