CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a [**Age over 90 **]-year-old woman with
chest pain and abdominal pain over the past 3-4 days prior to
admission.  She describes the chest pain and pressure as vague
with possible radiation to the left upper extremity,
lightheadedness, but no nausea, vomiting, diaphoresis, dyspnea or
palpitations.  The symptoms
worsened around 7 p.m. the evening of admission with some
cognitive changes.  For this reason an ambulance was called
and EKG was done.  The EKG revealed normal sinus rhythm at 75
with left axis deviation, right bundle branch block, pattern
consistent with left anterior fascicular block, wide QRS
complex and ST elevations in 1, AVF and V2 through V4.  The
hemodynamically stable and was given sublingual Nitroglycerin
times three and Aspirin.  Chest pain improved.  The patient
ambulates short distances at baseline, also had an episode of
chest pain one month prior to admission and patient was
admitted for medical management with consideration for
catheterization if the patient decompensated.

MEDICAL HISTORY: Hypertension of unknown duration,
arthritis and dementia.

MEDICATION ON ADMISSION: 

ALLERGIES: Sulfa, Darvocet, Tegretol and Aspirin which
causes GI upset.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Negative for tobacco, alcohol and IV drug
use.  She lives at the Springhous [**Hospital3 400**] Home.
Acute myocardial infarction of anterolateral wall, initial episode of care,Encounter for palliative care,Congestive heart failure, unspecified,Other bilateral bundle branch block,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Vascular dementia, uncomplicated
AMI anterolateral, init,Encountr palliative care,CHF NOS,Bilat bb block NEC,Acute kidney failure NOS,Urin tract infection NOS,Crnry athrscl natve vssl,Chr pulmon heart dis NEC,Vascular dementia,uncomp
Admission Date:  [**2187-7-13**]       Discharge Date:  [**2187-7-19**]



HISTORY OF PRESENT ILLNESS:  This is a [**Age over 90 **]-year-old woman with
chest pain and abdominal pain over the past 3-4 days prior to
admission.  She describes the chest pain and pressure as vague
with possible radiation to the left upper extremity,
lightheadedness, but no nausea, vomiting, diaphoresis, dyspnea or
palpitations.  The symptoms
worsened around 7 p.m. the evening of admission with some
cognitive changes.  For this reason an ambulance was called
and EKG was done.  The EKG revealed normal sinus rhythm at 75
with left axis deviation, right bundle branch block, pattern
consistent with left anterior fascicular block, wide QRS
complex and ST elevations in 1, AVF and V2 through V4.  The
hemodynamically stable and was given sublingual Nitroglycerin
times three and Aspirin.  Chest pain improved.  The patient
ambulates short distances at baseline, also had an episode of
chest pain one month prior to admission and patient was
admitted for medical management with consideration for
catheterization if the patient decompensated.

PAST MEDICAL HISTORY:  Hypertension of unknown duration,
arthritis and dementia.

MEDICATIONS:  On admission, Aricept 5 mg po q d, Atenolol 25
mg po bid, Cozaar 50 mg po bid, Haldol 0.25 mg po q h.s.,
Motrin 600 mg po q 6 hours prn pain.

ALLERGIES:  Sulfa, Darvocet, Tegretol and Aspirin which
causes GI upset.

FAMILY HISTORY:  Noncontributory.

SOCIAL HISTORY:  Negative for tobacco, alcohol and IV drug
use.  She lives at the Springhous [**Hospital3 400**] Home.

PHYSICAL EXAMINATION:  In general she was awake, alert and
oriented times two and slightly anxious.  Vital signs,
temperature 97, blood pressure 140/80, pulse 70, respirations
18.  HEENT: Mucus membranes are slightly dry but there was no
lymphadenopathy.  Neck, no jugulovenous distension or carotid
bruits present.  Chest, posterior crackles right greater than
left but no wheezing.  Heart, regular rate and rhythm, no
murmurs, rubs or gallops.  Distant heart sounds.  Abdomen
soft, nontender, normal active bowel sounds.  Extremities, 1+
pitting edema bilaterally at the ankles with palpable
dorsalis pedis pulses bilaterally.  Neuro exam was non focal.
She was able to move all four extremities.

LABORATORY DATA:  On admission white blood count 12.5,
hematocrit 22.8, platelet count 282,000, normal differential.
Chem 7, 138, 4.8, 106, 18, 45, 2.5 and 125, normal coags.
EKG as described previously and initial enzymes with CK of
136 with MB of 7, troponin of 14.8.  Chest x-ray revealed no
mediastinal widening and question of chronic interstitial
disease.

HOSPITAL COURSE:  The patient was admitted to the CCU for
monitoring and medical treatment of her acute anterolateral
myocardial infarction.  She received Aspirin and IV
Nitroglycerin initially with Heparin drip.  She did not go to
the catheterization lab because of anemia as well as her
elevated creatinine.  However, the plan was that if she
became acutely unstable she may go to the cath laboratory for
angioplasty or stenting of the culprit vessel.  On [**7-16**] the
patient had new chest pain and new EKG changes including
increased ST elevations in the lateral precordial leads V4
through V6, increased ST elevation in 1 and AVL and slight
increased ST depression in the inferior leads which was
believed to be due to a second myocardial infarction or
infarct extension.  Extensive discussion was had with the
family as well as the patient's primary care physician and
catheterization was withheld.  However, after this event the
patient's cardiovascular status appeared to worsen.  She was
unable to keep pressures greater than 90 systolic and
echocardiogram revealed an ejection fraction of approximately
15%.  Her BUN and creatinine continued to increase and her
urine output decreased, however, we stopped given her fluid
boluses because of the plan for comfort measures and to keep
the patient as comfortable as possible.  The patient received
a blood transfusion on admission and from that point on the
patient's hematocrit remained stable at approximately 30.
The patient remained stable on [**7-17**] and [**7-18**] and the plan was
made for patient to go to hospice.

DISCHARGE STATUS:  Stable.

DISCHARGE PLAN:  To daughter's home with hospice care .

DISCHARGE MEDICATIONS:  Aspirin 325 mg po q d, Plavix 75 mg
po q d, Isordil 10 mg po tid as well as Lipitor 10 mg po q
h.s. and Haldol, Colace and Aricept as she had previously
been taking.

FINAL DIAGNOSIS:
1.  Acute anterolateral MI with cardiac decompensation.

FOLLOW-UP:  Patient to follow-up with Dr. [**Last Name (STitle) **], her primary
care physician as previously planned.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1589**], M.D.  [**MD Number(1) 1590**]

Dictated By:[**Name8 (MD) 6069**]
MEDQUIST36

D:  [**2187-7-18**]  14:35
T:  [**2187-7-18**]  15:25
JOB#:  [**Job Number 96741**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Encounter for palliative care,Congestive heart failure, unspecified,Other bilateral bundle branch block,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Vascular dementia, uncomplicated'}


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: This is a [**Age over 90 **]-year-old woman with
chest pain and abdominal pain over the past 3-4 days prior to
admission.  She describes the chest pain and pressure as vague
with possible radiation to the left upper extremity,
lightheadedness, but no nausea, vomiting, diaphoresis, dyspnea or
palpitations.  The symptoms
worsened around 7 p.m. the evening of admission with some
cognitive changes.  For this reason an ambulance was called
and EKG was done.  The EKG revealed normal sinus rhythm at 75
with left axis deviation, right bundle branch block, pattern
consistent with left anterior fascicular block, wide QRS
complex and ST elevations in 1, AVF and V2 through V4.  The
hemodynamically stable and was given sublingual Nitroglycerin
times three and Aspirin.  Chest pain improved.  The patient
ambulates short distances at baseline, also had an episode of
chest pain one month prior to admission and patient was
admitted for medical management with consideration for
catheterization if the patient decompensated.

MEDICAL HISTORY: Hypertension of unknown duration,
arthritis and dementia.

MEDICATION ON ADMISSION: 

ALLERGIES: Sulfa, Darvocet, Tegretol and Aspirin which
causes GI upset.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Negative for tobacco, alcohol and IV drug
use.  She lives at the Springhous [**Hospital3 400**] Home. 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Encounter for palliative care,Congestive heart failure, unspecified,Other bilateral bundle branch block,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Vascular dementia, uncomplicated'}
