CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Patient is a 57 year old male with past medical history of idet
controlled hypertension who presented to [**Hospital1 **] ER with 7/10
chest pain located mid-sternal starting about 2 hours prior to
admission with radiation to the jaw. Patient was working at a
paint store when this started and he began to feel diaphortic.
Denies any nausea, vomiting, parastheias in his arm or radiation
to the back. Patient denied any shortness of breath,
palpitations, syncope, or presyncope. The pain gradualy worsened
and he drove himself to the hospital. Patient recieved an EKG
showing ST elevations in the inferior leads and sinus
bradycardia to 55 bpm. He recieved three (3) sublingual
nitroglycerine and pain improved to [**5-15**]. He recieved 325mg of
aspirin, 600mg Plavix, Heparin 4000 unit bolus followed by
Heparin drip. He recieved an integrillin bolus of 6.2cc followed
by a drip and 1mg of ativan. He was given 80mg of Atorvastatin
and transfered to [**Hospital1 18**] for emergent cardiac cath. Patient was
taken to the cath lab and was found to have a right dominant
system with 95% stenosis to the mid RCA with TIMI 2 flow and 50%
distal RCA stenosis. LAD 50% proximal and 60% mid. Left
Circumflex had 60% OM1. Patient was given a 3.0 33 Cypher tot he
RCA. An acute marginal branch which had 80% stenosis and TIMI 2
flow became occluded after stenting and could not be reopened.
Patient had transient hypotension during the procedure requiring
Dopamine IV for approximatly 20 minutes. During and after the
procedure in recovery the patient had 9 beat runs of VT and
multiple PVCs consistant with reperfusion. Patient remained
hemodynamically stable and was transfered to the CCU.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, excessive
bleeding, myalgias, joint pains, cough, hemoptysis, black stools
or red stools. He denies recent fevers, chills or rigors. He
denies exertional buttock or calf pain. All of the other review
of systems were negative.

MEDICAL HISTORY: HTN which normalised with lifestyle changes

MEDICATION ON ADMISSION: aspirin 162

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.1, BP 119/88, HR 50, RR 15, O2 99% on 2L NC
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with no appreciable JVP.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. Audible S4, no m/r/g
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: No c/c/e. No femoral bruits. Dressing to the right groin is
clean dry and intact.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death, DM, HTN.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use with a 40 pack year history. There is no history of alcohol
abuse.
Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of tobacco use,Other iatrogenic hypotension,Other specified cardiac dysrhythmias
AMI inferior wall, init,Crnry athrscl natve vssl,Hypertension NOS,History of tobacco use,Iatrogenc hypotnsion NEC,Cardiac dysrhythmias NEC
Admission Date:  [**2138-10-30**]              Discharge Date:   [**2138-11-2**]

Date of Birth:  [**2081-5-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7651**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Coronary catheterization


History of Present Illness:
Patient is a 57 year old male with past medical history of idet
controlled hypertension who presented to [**Hospital1 **] ER with 7/10
chest pain located mid-sternal starting about 2 hours prior to
admission with radiation to the jaw. Patient was working at a
paint store when this started and he began to feel diaphortic.
Denies any nausea, vomiting, parastheias in his arm or radiation
to the back. Patient denied any shortness of breath,
palpitations, syncope, or presyncope. The pain gradualy worsened
and he drove himself to the hospital. Patient recieved an EKG
showing ST elevations in the inferior leads and sinus
bradycardia to 55 bpm. He recieved three (3) sublingual
nitroglycerine and pain improved to [**5-15**]. He recieved 325mg of
aspirin, 600mg Plavix, Heparin 4000 unit bolus followed by
Heparin drip. He recieved an integrillin bolus of 6.2cc followed
by a drip and 1mg of ativan. He was given 80mg of Atorvastatin
and transfered to [**Hospital1 18**] for emergent cardiac cath. Patient was
taken to the cath lab and was found to have a right dominant
system with 95% stenosis to the mid RCA with TIMI 2 flow and 50%
distal RCA stenosis. LAD 50% proximal and 60% mid. Left
Circumflex had 60% OM1. Patient was given a 3.0 33 Cypher tot he
RCA. An acute marginal branch which had 80% stenosis and TIMI 2
flow became occluded after stenting and could not be reopened.
Patient had transient hypotension during the procedure requiring
Dopamine IV for approximatly 20 minutes. During and after the
procedure in recovery the patient had 9 beat runs of VT and
multiple PVCs consistant with reperfusion. Patient remained
hemodynamically stable and was transfered to the CCU.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, excessive
bleeding, myalgias, joint pains, cough, hemoptysis, black stools
or red stools. He denies recent fevers, chills or rigors. He
denies exertional buttock or calf pain. All of the other review
of systems were negative.

Past Medical History:
HTN which normalised with lifestyle changes

Social History:
Social history is significant for the absence of current tobacco
use with a 40 pack year history. There is no history of alcohol
abuse.

Family History:
There is no family history of premature coronary artery disease
or sudden death, DM, HTN.

Physical Exam:
VS: T 98.1, BP 119/88, HR 50, RR 15, O2 99% on 2L NC
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with no appreciable JVP.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. Audible S4, no m/r/g
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: No c/c/e. No femoral bruits. Dressing to the right groin is
clean dry and intact.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP


Pertinent Results:
[**2138-10-30**] 11:29PM   POTASSIUM-3.8
[**2138-10-30**] 11:29PM   CK(CPK)-1367*
[**2138-10-30**] 11:29PM   CK-MB-215* MB INDX-15.7*
[**2138-10-30**] 10:22PM   POTASSIUM-7.4*
[**2138-10-30**] 10:22PM   CK(CPK)-1424*
[**2138-10-30**] 10:22PM   CK-MB-226* MB INDX-15.9*
[**2138-10-30**] 10:22PM   PLT COUNT-211
[**2138-10-30**] 05:15PM   GLUCOSE-111* UREA N-12 CREAT-0.8 SODIUM-138
POTASSIUM-3.8 CHLORIDE-105 TOTAL CO2-25 ANION GAP-12
[**2138-10-30**] 05:15PM   estGFR-Using this
[**2138-10-30**] 05:15PM   estGFR-Using this
[**2138-10-30**] 05:15PM   HCT-36.8*
[**2138-10-30**] 05:15PM   HCT-36.8*
.
Coronary catheterization ([**2138-10-30**]):
1.  Selective coronary angiography of this right dominant system

demonstrated multivessel coronary artery disease.  The left main

demonstrated no angiographically apparent dissection with normal
flow
throughout.  The left anterior descending artery had minor
disease
throughout including a 50% proximal and 60% mid vessel lesion.
The left
cirucmflex demonstrated an OM1 with a 60% lesion.  The right
coronary
artery demonstrated a mid 95% ulcerated lesion with TIMI II flow
distal
to the lesion.
2.  LV ventriculography was deferred.
3.  Limited resting hemodynamics demonstrated normal left (mean
PCWP 14
atm) and right (RVEDP 10 atm) heart filling pressures. The
cardiac index
measured via the FICK method was preserved at 2.6 L/min/m2.
4.  Rhythm throughout the procedure was sinus rhythm and AVIR.
The
patient was hypotensive requiring transient dopamine infustion
during
periods of AVIR.
5.  Successful PTCA and stenting of the mid RCA with a Cypher
(3x33mm)
drug eluting stent postdilated with a 3.25 mm balloon.  Final
angiography demonstrated a jailed acute marginal with no flow
that could
not be rescued.  No angiographically apparent dissection and
TIMI III
flow throughout the native right coronary artery (see PTCA
comments).
FINAL DIAGNOSIS:
1. Two vessel coronary artery disease.
2. Acute inferior ST elevation myocardial infarction.
3. Preserved cardiac index.
4. Successful PTCA and stenting of the mid RCA with a Cypher
drug
eluting stent postdilated with a 3.25mm balloon.  Jailed acute
marginal
with no flow.
.
Echo ([**2138-10-31**]):
The left atrium is normal in size. The estimated right atrial
pressure is 0-5mmHg. Left ventricular wall thicknesses and
cavity size are normal. There is mild regional left ventricular
systolic dysfunction with hypokinesis of the basal half of the
inferior wall. The remaining segments contract normally (LVEF =
45-50 %). Right ventricular chamber size and free wall motion
are normal. The aortic root is mildly dilated at the sinus
level. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve appears structurally normal with trivial mitral
regurgitation.The pulmonary artery systolic pressure could not
be determined. There is no pericardial effusion.

IMPRESSION: Mild regional left ventricular systolic dysfunction
c/w CAD.Mildly dilated aortic root.

CLINICAL IMPLICATIONS:
Based on [**2138**] AHA endocarditis prophylaxis recommendations, the
echo findings indicate prophylaxis is NOT recommended. Clinical
decisions regarding the need for prophylaxis should be based on
clinical and echocardiographic data.


Brief Hospital Course:
Pt was admitted to [**Hospital1 18**] and taken straight to the cath lab and
was found to have a right dominant system with 95% stenosis to
the mid RCA with TIMI 2 flow and 50% distal RCA stenosis. LAD
50% proximal and 60% mid. Left Circumflex had 60% OM1. Patient
was given a 3.0 33 Cypher to the RCA. An acute marginal branch
which had 80% stenosis and TIMI 2 flow became occluded after
stenting and could not be reopened. Patient had transient
hypotension during the procedure requiring Dopamine IV for
approximatly 20 minutes. During and after the procedure in
recovery the patient had 9 beat runs of VT and multiple PVCs
consistant with reperfusion. Patient remained hemodynamically
stable and was transfered to the CCU. In the CCU pt did weel
without any further arrhythmias.  He was monitored on telemetry
and cardiac enzymes were trended initially, peaking at CK-MB 226
and MB index 15.9.
Cholesterol panel was checked with the following results: LDL
97, HDL 47, total chol 167.  His medical managment was optimized
with ASA 325mg, lisinopril 2.5mg, metoprolol 12.5 [**Hospital1 **],
atorvastatin 80mg, and plavix 75 mg.  Pt was instructed to not
take the metoprolol if the systolic blood pressure was less than
<90.  Pt remained cp free and without other symptoms, saturating
well on room air, voiding on own, taking good po.  The plan was
for folllow-up care with PCP and dr.[**Doctor Last Name 3733**] within [**1-7**]
weeks.


Medications on Admission:
aspirin 162

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(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. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day:
PLEASE DO NOT TAKE IF SYSTOLIC BLOOD PRESSURE IS BELOW 90.
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Tartrate 25 mg Tablet Sig: [**1-7**] Tablet PO twice a
day: please do not take if systolic blood pressure <90.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
ST elevation myocardial infarction


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to [**Hospital1 18**] with an ST elevation myocardial
infarction.
Please take your previous medications as prescribed. The
following changes has been made to your medications:
- please start taking aspirin 325mg daily for secondary
cardiovascular prevention (to prevent another heart attack)
instead of the lower dose of aspirin
- Please start taking atorvastatin 80mg daily for your heart and
for your cholesterol.
- Please start taking lisinopril 2.5 mg daily for your heart and
blood pressure (prevents remodelling of the heart)
- Please start taking metoprolol 12.5mg daily for your heart and
blood pressure (prevents remodelling of the heart) ***BUT PLEASE
MEASURE YOUR BLOOD PRESSURE EVERY DAY FOR THE FIRST 2 WEEKS AND
STOP TAKING IF SYSTOLIC BLOOD PRESSURE IS LESS THAN 90***
- Please start taking clopidogrel (Plavix) 75 mg daily.
If you develop chest pain, jaw pain, or chest pressure with pain
radiating into arm, or if you for any reason become concerned
about your medical condition please call 911 or present to
nearest ED.
**DO NOT STOP TAKING THE ASPIRIN OR PLAVIX UNLESS INSTRUCTED TO
DO SO BY YOUR CARDIOLOGIST EVEN IF ANOTHER DOCTOR TELLS YOU TO**


Followup Instructions:
Please call your PCP for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 702**] appointment to be seen
within 1-2 weeks
Please schedule and appointment with Dr.[**Doctor Last Name 3733**] within [**1-7**]
weeks
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of tobacco use,Other iatrogenic hypotension,Other specified cardiac dysrhythmias'}


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

PRESENT ILLNESS: Patient is a 57 year old male with past medical history of idet
controlled hypertension who presented to [**Hospital1 **] ER with 7/10
chest pain located mid-sternal starting about 2 hours prior to
admission with radiation to the jaw. Patient was working at a
paint store when this started and he began to feel diaphortic.
Denies any nausea, vomiting, parastheias in his arm or radiation
to the back. Patient denied any shortness of breath,
palpitations, syncope, or presyncope. The pain gradualy worsened
and he drove himself to the hospital. Patient recieved an EKG
showing ST elevations in the inferior leads and sinus
bradycardia to 55 bpm. He recieved three (3) sublingual
nitroglycerine and pain improved to [**5-15**]. He recieved 325mg of
aspirin, 600mg Plavix, Heparin 4000 unit bolus followed by
Heparin drip. He recieved an integrillin bolus of 6.2cc followed
by a drip and 1mg of ativan. He was given 80mg of Atorvastatin
and transfered to [**Hospital1 18**] for emergent cardiac cath. Patient was
taken to the cath lab and was found to have a right dominant
system with 95% stenosis to the mid RCA with TIMI 2 flow and 50%
distal RCA stenosis. LAD 50% proximal and 60% mid. Left
Circumflex had 60% OM1. Patient was given a 3.0 33 Cypher tot he
RCA. An acute marginal branch which had 80% stenosis and TIMI 2
flow became occluded after stenting and could not be reopened.
Patient had transient hypotension during the procedure requiring
Dopamine IV for approximatly 20 minutes. During and after the
procedure in recovery the patient had 9 beat runs of VT and
multiple PVCs consistant with reperfusion. Patient remained
hemodynamically stable and was transfered to the CCU.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, excessive
bleeding, myalgias, joint pains, cough, hemoptysis, black stools
or red stools. He denies recent fevers, chills or rigors. He
denies exertional buttock or calf pain. All of the other review
of systems were negative.

MEDICAL HISTORY: HTN which normalised with lifestyle changes

MEDICATION ON ADMISSION: aspirin 162

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.1, BP 119/88, HR 50, RR 15, O2 99% on 2L NC
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with no appreciable JVP.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. Audible S4, no m/r/g
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Soft, NTND, No HSM or tenderness. No abdominial bruits.
Ext: No c/c/e. No femoral bruits. Dressing to the right groin is
clean dry and intact.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death, DM, HTN.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use with a 40 pack year history. There is no history of alcohol
abuse. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Personal history of tobacco use,Other iatrogenic hypotension,Other specified cardiac dysrhythmias'}
