CHIEF COMPLAINT: CP

PRESENT ILLNESS: 68-year-old woman haitian Crecole speaking only with history of
type 2 DM, hypertension and hyperlidpedemia who presented to
[**Hospital1 18**] ED with 3 days of chest pain.  Patient reports that about
three days ago while she was putting her clothes in the laundry
she had suddedn onset of substernal chest pain with radiation to
her neck, right arm and her abdomen.  She attributed this pain
to indigestion.  The pain was [**4-16**] and remained constant.  Today
at 6:30am patient patient acutely worsened [**9-16**] associated with
nasuea, diaphoresis and shonrtess of breaht.
.
In the ED, initial vitals were 45 96/45 16 100% RA.  ECG showed
ST Elevation Myocardial Infarction in inferior leads. She was
given aspirin 325 mg, plavix 600 mg, eptifibatide 180 mcg/kg x 1
and heparin 4000 units IV bolus. She was noted to be bradycardic
and hypotensive and thus given atropine 1mgx2 and started on
dopamine gtt which improved her blood pressure.  She was
transfer to Cath lab.
.
In the Cath lab, she was noted to acute mid RCA occlusion which
was treated with angioplasty x 3 (10 mm/12 mm/14 mm) with
residual thrombus which was exported and Promus DES was placed
in mid RCA.  His cath lab course was complicated by intermittent
complete heart block requiring temporary pacemaker pre-stenting
though she was conducting 1:1 in NSR after stenting.  She was
also noted to have AIVR.  Dopamine at 5 mcg/kg/min was turned
off at the end of her cath lab course.  A small 1.5cm hematoma
was visible at the RFV access site after the case, and manual
pressure was applied for 10 minutes.
.
In the CCU, she did not report chest pain, discomfort,
palpatations or shortness of breath.  She desnies any history of
chest pain.

MEDICAL HISTORY: DM2
HTN
TB
peripheral neuropathy
aseptic thrombophlebitis of the left internal jugular in [**2130**].

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Aspirin 81 mg PO DAILY
2. Amlodipine 10 mg PO DAILY
3. Chlorthalidone 25 mg PO DAILY
4. Lisinopril 40 mg PO DAILY
5. MetFORMIN (Glucophage) 1000 mg PO BID
6. Ranitidine 150 mg PO BID
7. NPH 32 Units Breakfast
NPH 22 Units Dinner

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical:
GENERAL: Appears well NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL. MMM
NECK: Supple with no JVD
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Wamr and well perfused No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with husband, ha two children who live in [**Country 2045**]. Creole
speaking from [**Country 2045**] 14 years ago.  Three children.  No history
of tobacco, ETOH or illicit.
Acute myocardial infarction of inferolateral wall, initial episode of care,Acute systolic heart failure,Cardiogenic shock,Atrioventricular block, complete,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
AMI inferolateral, init,Ac systolic hrt failure,Cardiogenic shock,Atriovent block complete,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,DMII neuro nt st uncntrl,Neuropathy in diabetes,Diabetic retinopathy NOS,Nephritis NOS in oth dis,Chronic kidney dis NOS,Hy kid NOS w cr kid I-IV
Admission Date:  [**2144-8-1**]              Discharge Date:   [**2144-8-6**]

Date of Birth:  [**2075-9-18**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (un) 2888**]
Chief Complaint:
CP

Major Surgical or Invasive Procedure:
PCI with angioplasty and DES to Mid-RCA

History of Present Illness:
68-year-old woman haitian Crecole speaking only with history of
type 2 DM, hypertension and hyperlidpedemia who presented to
[**Hospital1 18**] ED with 3 days of chest pain.  Patient reports that about
three days ago while she was putting her clothes in the laundry
she had suddedn onset of substernal chest pain with radiation to
her neck, right arm and her abdomen.  She attributed this pain
to indigestion.  The pain was [**4-16**] and remained constant.  Today
at 6:30am patient patient acutely worsened [**9-16**] associated with
nasuea, diaphoresis and shonrtess of breaht.
.
In the ED, initial vitals were 45 96/45 16 100% RA.  ECG showed
ST Elevation Myocardial Infarction in inferior leads. She was
given aspirin 325 mg, plavix 600 mg, eptifibatide 180 mcg/kg x 1
and heparin 4000 units IV bolus. She was noted to be bradycardic
and hypotensive and thus given atropine 1mgx2 and started on
dopamine gtt which improved her blood pressure.  She was
transfer to Cath lab.
.
In the Cath lab, she was noted to acute mid RCA occlusion which
was treated with angioplasty x 3 (10 mm/12 mm/14 mm) with
residual thrombus which was exported and Promus DES was placed
in mid RCA.  His cath lab course was complicated by intermittent
complete heart block requiring temporary pacemaker pre-stenting
though she was conducting 1:1 in NSR after stenting.  She was
also noted to have AIVR.  Dopamine at 5 mcg/kg/min was turned
off at the end of her cath lab course.  A small 1.5cm hematoma
was visible at the RFV access site after the case, and manual
pressure was applied for 10 minutes.
.
In the CCU, she did not report chest pain, discomfort,
palpatations or shortness of breath.  She desnies any history of
chest pain.

Past Medical History:
DM2
HTN
TB
peripheral neuropathy
aseptic thrombophlebitis of the left internal jugular in [**2130**].

Social History:
Lives with husband, ha two children who live in [**Country 2045**]. Creole
speaking from [**Country 2045**] 14 years ago.  Three children.  No history
of tobacco, ETOH or illicit.


Family History:
non-contributory

Physical Exam:
Admission Physical:
GENERAL: Appears well NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL. MMM
NECK: Supple with no JVD
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Wamr and well perfused No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

Pertinent Results:
Admission Labs:
[**2144-8-1**] 11:35AM BLOOD WBC-10.8# RBC-3.35* Hgb-10.3* Hct-30.8*
MCV-92 MCH-30.7 MCHC-33.4 RDW-12.8 Plt Ct-178
[**2144-8-1**] 11:35AM BLOOD PT-12.5 PTT-30.7 INR(PT)-1.2*
[**2144-8-1**] 11:35AM BLOOD Glucose-394* UreaN-22* Creat-1.2* Na-135
K-4.0 Cl-99 HCO3-25 AnGap-15

[**2144-8-1**] 11:35AM BLOOD CK-MB-11* MB Indx-1.2
[**2144-8-1**] 05:15PM BLOOD CK-MB-16* MB Indx-1.9
[**2144-8-2**] 05:28AM BLOOD CK-MB-10 MB Indx-1.8 cTropnT-3.44*
[**2144-8-1**] 11:35AM BLOOD CK(CPK)-891*
[**2144-8-1**] 05:15PM BLOOD CK(CPK)-821*
[**2144-8-2**] 05:28AM BLOOD CK(CPK)-555*

Cardiac Cath
1) Selective coronary angiography of this co-dominant system
demonstrated three-vessel coronary artery disease. The LMCA had
mild
luminal irregularities. The proximal-mid LAD had an 80%
trifurcation
lesion that was tightest at the large diagonal branch takeoff;
there was
a high diagonal branch (functionally a ramus) that had diffuse
proximal
70% stenosis. The LCx was a diffusely-diseased vessel with a
likely
stump-occluded OM2 and severely diseased distal vessel; it
provided a
smaller left PDA.  The mid-RCA was 100% occluded without
anterograde
flow into the distal vessel; there was also haziness noted at
the AM
origin.  The ostial RCA had a 30-40% stenosis.
2)
3) During the procedure, and given the degeneration of the
conduction
disease to high-grade heart block associated with hypotension, a

temporary pacing wire was inserted through the 5 French venous
sheath
with successful capture at 80 bpm and [**7-17**] mA.  After the PCI,
pacing
was discontinued, and the patient remained in sinus rhythm with
1:1
conduction at a rate of 80 bpm with normotensive blood
pressures.  The
temporary pacing wire was therefore removed and the dopamine was

discontinued.
4) After the procedure, the 6 French right femoral arteriotomy
site was
AngioSealed with adequate hemostasis. The 5 French right femoral
venous
sheath was left in place in case of worsening conduction disease

overnight.  A small 1.5cm hematoma was noted after the
procedure.

FINAL DIAGNOSIS:
1. Inferior wall STEMI with high-grade AV block.
2. Successful emergent primary PCI of occluded mid RCA with
PTCA, export
thrombectomy, and Promus drug eluting stent.
3. Emergent temporary pacing wire placement with active pacing
during
the procedure.
.
TTE: [**2144-8-3**]:
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy with normal cavity size. There is mild
regional left ventricular systolic dysfunction with severe
hypokinesis of the inferolateral wall. The remaining segments
contract normally (LVEF = 40 %). Right ventricular chamber size
and free wall motion are normal. The diameters of aorta at the
sinus, ascending and arch levels are normal. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. There is no aortic regurgitation. The mitral valve
leaflets are structurally normal. There is no mitral valve
prolapse. Mild to moderate ([**12-9**]+) mitral regurgitation is seen.
There is moderate pulmonary artery systolic hypertension. There
is no pericardial effusion.
.
IMPRESSION: Mild symmetric left ventricular hypertrophy with
regional systolic dysfunction c/w CAD (PDA distribution).
Mild-moderate mitral regurgitation most likely due to papillary
muscle dysfunction. Pulmonary artery hypertension.
.
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.
.
Discharge Labs:


Brief Hospital Course:
68-year-old woman, Haitian-Creole speaking, with history of type
2 DM, hypertension, and hyperlidpedemia, presented with inferior
STEMI now s/p DES to mid RCA.
.
# STEMI: Patient with multiple cardiovascular risk factors
(uncontrolled diabetes, uncontrolled hypertension and
hyperlidemia) presented with worsening chest pain. ECG was
consistent with ST elevation myocardial infarction in inferior
leads. She was given aspirin 325 mg, plavix 600 mg, eptifibatide
180 mcg/kg x 1 and heparin 4000 units IV bolus. She was noted to
be bradycardic and hypotensive and thus given atropine 1mgx2 and
started on dopamine gtt which improved her blood pressure.  She
was transfer to the Cath lab.  In the Cath lab, she was noted to
have acute mid RCA occlusion which was treated with angioplasty
x 3 (10 mm/12 mm/14 mm) with residual thrombus, which was
removed, and Promus DES was placed in the mid RCA.  Her Cath lab
course was complicated by intermittent complete heart block
requiring temporary pacemaker pre-stenting though she was
conducting 1:1 in NSR after stenting.  She was also noted to
have AIVR.  Dopamine at 5 mcg/kg/min was turned off at the end
of her Cath lab course. She had an ECHO report that showed mild
regional left ventricular systolic dysfunction with severe
hypokinesis of the inferolateral wall with EF 40%.  Mild
symmetric left ventricular hypertrophy with regional systolic
dysfunction c/w CAD (PDA distribution). Mild-moderate mitral
regurgitation most likely due to papillary muscle dysfunction.
Pulmonary artery hypertension.

During her CCU course, patient had one episode of shortness of
breath and increased respiratory rate with bilateral crackles on
exam.  She was treated with Lasix which improved her sxs and she
had no further episodes of chest pain or shortness of breath
during her hospital stay. Patient was evaluated by physical
therapy on the day of discharge and determined safe to go home.
Patient will follow up with Dr. [**Last Name (STitle) 10156**] in Cardiology and
with her PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) **].  She was discharged on the
following medications: Lasix, metoprolol, lisinopril,
atorvastatin, and Plavix.
.
# Arrythmia: Patient had bradycardia with dropped beats and
atrial ectopy likely in the setting of reperfusion post [**Name Prefix (Prefixes) **]
[**Last Name (Prefixes) 10157**].  She did not have any symptomatic episodes of
bradycardia during her CCU course.  She was also started on low
dose metoprolol which she tolerated very well.
.
# Diabetes Type 2: Poorly controlled and complicated by diabetic
nephropathy, retinopathy, and neuropathy. Last A1c was 8.7 in
3/[**2143**]. She was continued on 11units of NPH and insulin sliding
scale.  On discharge, she was put on ----.
.
#  Anemia: Hematocrit during this admission was around 30.
Prior HCT on OMR from [**2141**] shows HCT of 37.9.  Unclear etiology.
No source of obvious bleeding and normal coags. Patient will
follow up with PCP for further management.
.
#  Hypertension: Patient blood pressure was well controlled on
low dose metoprolol.  Her home chorthalidone, amlodopine, and
lisinopril were initally held due to low bps.  She was
discharged on metoprolol, lisinopril and lasix.
.
#  Hyperlidemia: Started atorvastain 80mg daily.
.
Transitional Issues:
- needs close follow-up with Cardiology, PCP
[**Name Initial (PRE) **] [**Name10 (NameIs) **] recommend [**Last Name (un) **] consultation for DM

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Aspirin 81 mg PO DAILY
2. Amlodipine 10 mg PO DAILY
3. Chlorthalidone 25 mg PO DAILY
4. Lisinopril 40 mg PO DAILY
5. MetFORMIN (Glucophage) 1000 mg PO BID
6. Ranitidine 150 mg PO BID
7. NPH 32 Units Breakfast
NPH 22 Units Dinner


Discharge Medications:
1. Aspirin EC 325 mg PO DAILY
RX *aspirin [Enteric Coated Aspirin] 325 mg one tablet(s) by
mouth daily Disp #*30 Tablet Refills:*2
2. Ranitidine 150 mg PO BID
3. Atorvastatin 80 mg PO DAILY
RX *atorvastatin 80 mg one tablet(s) by mouth daily Disp #*30
Tablet Refills:*2
4. Clopidogrel 75 mg PO DAILY
for the recommended duration
RX *clopidogrel 75 mg one tablet(s) by mouth daily Disp #*30
Tablet Refills:*2
5. Metoprolol Succinate XL 50 mg PO DAILY
RX *metoprolol succinate 50 mg one tablet(s) by mouth daily Disp
#*30 Tablet Refills:*2
6. MetFORMIN (Glucophage) 1000 mg PO BID
7. NPH 32 Units Breakfast
NPH 22 Units Dinner
8. Lisinopril 20 mg PO DAILY
RX *lisinopril 40 mg 0.5 (One half) tablet(s) by mouth daily
Disp #*15 Tablet Refills:*2
9. Furosemide 20 mg PO DAILY
RX *furosemide 20 mg one tablets by mouth daily Disp #*30 Tablet
Refills:*2
10. Outpatient Lab Work
Please check Chem-7 at [**Hospital6 733**] on [**2144-8-11**] with
results to Dr. [**Last Name (STitle) 6215**] at Phone: [**Telephone/Fax (1) 2010**]
Fax: [**Telephone/Fax (1) 4004**]
ICD-9 428


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Inferolateral ST elevation myocardial infarction
acute systolic congestive heart failure
hypertension
diabetes


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mrs. [**Known lastname 10158**],
It was a pleasure taking care of your during your admission at
[**Hospital1 18**].  You were admitted because you were having chest pain and
you were found to have a heart attack for which you had a stent
placed in your heart. You have also been started on new
medications (aspirin and clopidogrel) to prevent the stenting of
the clot which you should continue to take unless told otherwise
by your cardiologist.
Weigh yourself every day before breakfast. Call Dr. [**Last Name (STitle) **] if
weight increases more than 3 pounds in 1 day or 5 pounds in 3
days.
The visiting nurse will help you with a low salt diet.
.
Please continue to take your medications as directed in your
discharge medication sheet.  Please do not stop any medication
especially clopidogrel unless told by your cardiologist. You
risk having a heart attack if you do not take this medicine
every day.

Followup Instructions:
Department: CARDIAC SERVICES
When: THURSDAY [**2144-9-3**] at 1 PM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: [**Hospital **] HEALTH CENTER
When: TUESDAY [**2144-8-11**] at 11:50 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Acute myocardial infarction of inferolateral wall, initial episode of care,Acute systolic heart failure,Cardiogenic shock,Atrioventricular block, complete,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}


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: CP

PRESENT ILLNESS: 68-year-old woman haitian Crecole speaking only with history of
type 2 DM, hypertension and hyperlidpedemia who presented to
[**Hospital1 18**] ED with 3 days of chest pain.  Patient reports that about
three days ago while she was putting her clothes in the laundry
she had suddedn onset of substernal chest pain with radiation to
her neck, right arm and her abdomen.  She attributed this pain
to indigestion.  The pain was [**4-16**] and remained constant.  Today
at 6:30am patient patient acutely worsened [**9-16**] associated with
nasuea, diaphoresis and shonrtess of breaht.
.
In the ED, initial vitals were 45 96/45 16 100% RA.  ECG showed
ST Elevation Myocardial Infarction in inferior leads. She was
given aspirin 325 mg, plavix 600 mg, eptifibatide 180 mcg/kg x 1
and heparin 4000 units IV bolus. She was noted to be bradycardic
and hypotensive and thus given atropine 1mgx2 and started on
dopamine gtt which improved her blood pressure.  She was
transfer to Cath lab.
.
In the Cath lab, she was noted to acute mid RCA occlusion which
was treated with angioplasty x 3 (10 mm/12 mm/14 mm) with
residual thrombus which was exported and Promus DES was placed
in mid RCA.  His cath lab course was complicated by intermittent
complete heart block requiring temporary pacemaker pre-stenting
though she was conducting 1:1 in NSR after stenting.  She was
also noted to have AIVR.  Dopamine at 5 mcg/kg/min was turned
off at the end of her cath lab course.  A small 1.5cm hematoma
was visible at the RFV access site after the case, and manual
pressure was applied for 10 minutes.
.
In the CCU, she did not report chest pain, discomfort,
palpatations or shortness of breath.  She desnies any history of
chest pain.

MEDICAL HISTORY: DM2
HTN
TB
peripheral neuropathy
aseptic thrombophlebitis of the left internal jugular in [**2130**].

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Aspirin 81 mg PO DAILY
2. Amlodipine 10 mg PO DAILY
3. Chlorthalidone 25 mg PO DAILY
4. Lisinopril 40 mg PO DAILY
5. MetFORMIN (Glucophage) 1000 mg PO BID
6. Ranitidine 150 mg PO BID
7. NPH 32 Units Breakfast
NPH 22 Units Dinner

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical:
GENERAL: Appears well NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL. MMM
NECK: Supple with no JVD
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Wamr and well perfused No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with husband, ha two children who live in [**Country 2045**]. Creole
speaking from [**Country 2045**] 14 years ago.  Three children.  No history
of tobacco, ETOH or illicit. 

### Response:
{'Acute myocardial infarction of inferolateral wall, initial episode of care,Acute systolic heart failure,Cardiogenic shock,Atrioventricular block, complete,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Chronic kidney disease, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
