CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: This is an 81 year old woman
with chest pain brought to [**Hospital1 188**] via Med-flight from [**Hospital3 417**] Hospital after
presenting with chest pain beginning at 2:00 a.m. on the day
of admission.  Her pain improved spontaneously at 7:00 a.m.,
however, recurred when she returned from church approximately
11:00 a.m., six out of ten.  The patient presented to outside
hospital at 2:00 p.m. and electrocardiogram showed 2.[**Street Address(2) 27948**] elevations in leads III, aVF and 1.[**Street Address(2) 35043**] elevation in V4 and V5, Q waves in III, aVF.  The patient
initially treated with Heparin, Integrilin, Aspirin,
Nitroglycerin, and transferred to [**Hospital1 190**] Catheterization Laboratory.  The patient
underwent cardiac catheterization demonstrating total
occlusion of the right coronary artery proximally, left main
coronary artery normal, left anterior descending severe
proximal enlargement, no stenosis, left circumflex with mild
proximal ectasia.  The patient underwent treatment of her
right coronary artery clot with Angiojet thrombectomy, PCI,
stenting.  The patient had no angina
postprocedure.  Cardiac output 4.31, index 2.18, pulmonary
artery 26/14, pulmonary capillary wedge pressure 14.

MEDICAL HISTORY: 1.  Hypothyroidism.
2.  Fibroid tumor.
3.  Lumpectomy of left breast with radiation.
4.  Pulmonary embolism seven years ago.

MEDICATION ON ADMISSION: 1.  Synthroid.
2.  Vitamin D.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Widow, lives alone.
Acute myocardial infarction of other inferior wall, initial episode of care,Paroxysmal ventricular tachycardia,Hematemesis,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Family history of ischemic heart disease
AMI inferior wall, init,Parox ventric tachycard,Hematemesis,Food/vomit pneumonitis,Crnry athrscl natve vssl,Hypothyroidism NOS,Fam hx-ischem heart dis
Admission Date:  [**2119-4-9**]     Discharge Date:  [**2119-4-17**]


Service:  CCU

CHIEF COMPLAINT:  Chest pain.

HISTORY OF PRESENT ILLNESS:  This is an 81 year old woman
with chest pain brought to [**Hospital1 188**] via Med-flight from [**Hospital3 417**] Hospital after
presenting with chest pain beginning at 2:00 a.m. on the day
of admission.  Her pain improved spontaneously at 7:00 a.m.,
however, recurred when she returned from church approximately
11:00 a.m., six out of ten.  The patient presented to outside
hospital at 2:00 p.m. and electrocardiogram showed 2.[**Street Address(2) 27948**] elevations in leads III, aVF and 1.[**Street Address(2) 35043**] elevation in V4 and V5, Q waves in III, aVF.  The patient
initially treated with Heparin, Integrilin, Aspirin,
Nitroglycerin, and transferred to [**Hospital1 190**] Catheterization Laboratory.  The patient
underwent cardiac catheterization demonstrating total
occlusion of the right coronary artery proximally, left main
coronary artery normal, left anterior descending severe
proximal enlargement, no stenosis, left circumflex with mild
proximal ectasia.  The patient underwent treatment of her
right coronary artery clot with Angiojet thrombectomy, PCI,
stenting.  The patient had no angina
postprocedure.  Cardiac output 4.31, index 2.18, pulmonary
artery 26/14, pulmonary capillary wedge pressure 14.

PAST MEDICAL HISTORY:
1.  Hypothyroidism.
2.  Fibroid tumor.
3.  Lumpectomy of left breast with radiation.
4.  Pulmonary embolism seven years ago.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Synthroid.
2.  Vitamin D.

SOCIAL HISTORY:  Widow, lives alone.

PHYSICAL EXAMINATION:  The patient is afebrile, heart rate
junctional rhythm at 70 beats per minute, blood pressure
100/57, oxygen saturation 98% on two liters nasal cannula.
In general, an elderly woman in no acute distress.  Head,
eyes, ears, nose and throat - moist mucous membranes.
Extraocular movements are intact.  The pupils are equal,
round, and reactive to light and accommodation.  Jugular
venous pressure at 10 centimeters.  Lungs are clear to
auscultation anteriorly.  Cor is regular rate and rhythm.
Abdomen is soft, nontender, nondistended, normoactive bowel
sounds.  Extremities - pulses 1+ bilaterally, dorsalis pedis,
posterior tibial.  Cardiovascular examination - no murmurs.
Neurologically, the patient is alert, oriented and
appropriate.

LABORATORY DATA:  White blood cell count 10.6, hematocrit
39.0, platelet count 279,000.  Sodium 140, potassium 4.5,
chloride 101, bicarbonate 27, blood urea nitrogen 17,
creatinine 0.8, platelet count 123,000.  CK 922, MB 160,
troponin 10.8 with peak CK at 2204.

HOSPITAL COURSE:
1.  Cardiovascular - The patient was transferred to Cardiac
Care Unit status post catheterization for monitoring given
her large right ventricular infarct.  The patient was status
post right coronary artery revascularization.  Post
catheterization course was complicated by hypotension
requiring Dopamine, atrial fibrillation and junctional
rhythm.  On the morning of hospital day one, the patient
developed a junctional bradycardia.  The patient was
continued on her Aspirin and Plavix therapy post
catheterization and started on Lipitor 10 mg once daily.  Her
ischemic regimen was eventually expanded as her hypotension
resolved to include Metoprolol 50 mg three times a day with
plans to add ace inhibitor in the outpatient setting.

2.  Cardiac function - The patient initially with
hypotension, cardiogenic shock requiring Dopamine, however,
this was able to be weaned on [**2119-4-14**].  Echocardiogram
demonstrated an ejection fraction of 50 to 55%, mild right
atrial dilatation, mid inferior and inferior apical
hypokinesis, marked dilatation of the right ventricle with
depressed function, 1+ tricuspid regurgitation.

3.  Rhythm - The patient with transient atrial fibrillation
while on Dopamine which did not recur outside of acute
myocardial infarction setting.  Recommend continued follow-up
with cardiology.

4.  Pulmonary - The patient with left lower lobe
consolidation with collapse on chest x-ray post
catheterization.   She had witnessed aspiration of
emesis/coffee grounds during cardiac catheterization.  She
was begun on Levofloxacin and Flagyl and will continue to
complete a fourteen day course.

5.  Endocrine - The patient was maintained on Levothyroxine.

6.  Gastrointestinal - The patient with stable hematocrit and
single episode of coffee ground emesis while in cardiac
catheterization laboratory.  Diet is no added salt diet.

7.  Prophylaxis - The patient maintained on Protonix,
intravenous Heparin and pneumatic boots until ambulatory.

CONDITION ON DISCHARGE:  Fair.

DISCHARGE DIAGNOSIS:  Acute myocardial infarction.

MEDICATIONS ON DISCHARGE:
1.  Plavix 75 mg p.o. once daily times nine months.
2.  Enteric Coated Aspirin 325 mg p.o. once daily.
3.  Toprol XL 50 mg p.o. once daily.
4.  Lipitor 10 mg p.o. once daily.
5.  Levothyroxine 75 mcg p.o. once daily.
6.  Protonix 40 mg p.o. once daily.
7.  Metronidazole 500 mg p.o. three times a day times seven
days.
8.  Levofloxacin 500 mg p.o. times seven days.

DISCHARGE STATUS:  The patient was discharged to home with
services.




                          [**First Name11 (Name Pattern1) 420**] [**Last Name (NamePattern4) 421**], M.D.  [**MD Number(1) 422**]

Dictated By:[**Last Name (NamePattern1) 7485**]

MEDQUIST36

D:  [**2119-5-14**]  16:01
T:  [**2119-5-16**]  20:46
JOB#:  [**Job Number 40128**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Paroxysmal ventricular tachycardia,Hematemesis,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Family history of ischemic heart disease'}


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: This is an 81 year old woman
with chest pain brought to [**Hospital1 188**] via Med-flight from [**Hospital3 417**] Hospital after
presenting with chest pain beginning at 2:00 a.m. on the day
of admission.  Her pain improved spontaneously at 7:00 a.m.,
however, recurred when she returned from church approximately
11:00 a.m., six out of ten.  The patient presented to outside
hospital at 2:00 p.m. and electrocardiogram showed 2.[**Street Address(2) 27948**] elevations in leads III, aVF and 1.[**Street Address(2) 35043**] elevation in V4 and V5, Q waves in III, aVF.  The patient
initially treated with Heparin, Integrilin, Aspirin,
Nitroglycerin, and transferred to [**Hospital1 190**] Catheterization Laboratory.  The patient
underwent cardiac catheterization demonstrating total
occlusion of the right coronary artery proximally, left main
coronary artery normal, left anterior descending severe
proximal enlargement, no stenosis, left circumflex with mild
proximal ectasia.  The patient underwent treatment of her
right coronary artery clot with Angiojet thrombectomy, PCI,
stenting.  The patient had no angina
postprocedure.  Cardiac output 4.31, index 2.18, pulmonary
artery 26/14, pulmonary capillary wedge pressure 14.

MEDICAL HISTORY: 1.  Hypothyroidism.
2.  Fibroid tumor.
3.  Lumpectomy of left breast with radiation.
4.  Pulmonary embolism seven years ago.

MEDICATION ON ADMISSION: 1.  Synthroid.
2.  Vitamin D.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Widow, lives alone. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Paroxysmal ventricular tachycardia,Hematemesis,Pneumonitis due to inhalation of food or vomitus,Coronary atherosclerosis of native coronary artery,Unspecified acquired hypothyroidism,Family history of ischemic heart disease'}
