CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 56 y/o female with a h/o hyperlipidemia who presented to an OSH
on the AM of [**2131-10-7**] with 10/10 substernal and left-sided chest
pain, radiating down the left arm. Per patient, she noted the
onset of SSCP Friday AM at work. The pain lasted for about an
hour and resolved without any intervention. Was not associated
with any SOB or other symptoms. Subsequently, on Saturday
afternoon, she again developed the same SSCP, this time
radiating to her left arm, associated with nausea. Denied
associated SOB. Pain persisted until Sunday AM when she finally
presented to the OSH. EKG there revealed STE in V2-V4. She was
given SL nitro x 3, Lopressor 5 mg IV x 3, ASA, Plavix loaded,
heparin bolus + gtt, and integrillin bolus + drip. She was
transferred to [**Hospital1 18**] urgently for cardiac catheterization.

MEDICAL HISTORY: Tobacco abuse (12 py history)
Depression
Hyperlipidemia

MEDICATION ON ADMISSION: Lipitor 20 mg PO daily
Ibuprofen PRN
Cod liver oil
Geritol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Well nourished, NAD, Overweight, Anxious
HEENT: PERRL, MMM, no JVD
Cardiovascular: nl PMI, s1 s2 no m/r/g, no thrills
Respiratory / Chest: Crackles @ Bases
Abdominal: Soft, Obese, Non-tender, Non-distended, BS present,
no HSM
Groin:
Extremities: 2+ distal pulses, warm well perfused, no edema.
Initially had IABP placed in right femoral artery with a Swan
Ganz catheter in right femoral vein.
Neurologic: Attentive, Follows simple commands

FAMILY HISTORY: Mother with MI at age 74. Brother and sister with [**Name (NI) 10322**].

SOCIAL HISTORY: -Tobacco history: Smokes [**4-3**] cigarettes daily for the past 25
years
-ETOH: None
-Illicit drugs: None
Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other iatrogenic hypotension,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder,Depressive disorder, not elsewhere classified
AMI anterolateral, init,Cardiogenic shock,Crnry athrscl natve vssl,CHF NOS,Iatrogenc hypotnsion NEC,Thrombocytopenia NOS,Hyperlipidemia NEC/NOS,Tobacco use disorder,Depressive disorder NEC
Admission Date:  [**2131-10-7**]              Discharge Date:   [**2131-10-14**]

Date of Birth:  [**2075-6-24**]             Sex:   F

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:
Cardiac Catheterization, Stent placement, Intra-Aortic Balloon
Pump placement and removal, swan placement and removal.

History of Present Illness:
56 y/o female with a h/o hyperlipidemia who presented to an OSH
on the AM of [**2131-10-7**] with 10/10 substernal and left-sided chest
pain, radiating down the left arm. Per patient, she noted the
onset of SSCP Friday AM at work. The pain lasted for about an
hour and resolved without any intervention. Was not associated
with any SOB or other symptoms. Subsequently, on Saturday
afternoon, she again developed the same SSCP, this time
radiating to her left arm, associated with nausea. Denied
associated SOB. Pain persisted until Sunday AM when she finally
presented to the OSH. EKG there revealed STE in V2-V4. She was
given SL nitro x 3, Lopressor 5 mg IV x 3, ASA, Plavix loaded,
heparin bolus + gtt, and integrillin bolus + drip. She was
transferred to [**Hospital1 18**] urgently for cardiac catheterization.

In the cath lab, she was found to have a totally occluded
proximal LAD. She had two stents placed to her LAD. She then
became hypotensive and was resuscitated with IVF. An IABP was
placed along with a femoral Swan.

Upon arrival to the CCU, she was hemodynamically stable and
chest pain free. She had no complaints.




Past Medical History:
Tobacco abuse (12 py history)
Depression
Hyperlipidemia

Social History:
-Tobacco history: Smokes [**4-3**] cigarettes daily for the past 25
years
-ETOH: None
-Illicit drugs: None

Daughter is nurse [**First Name (Titles) **] [**Last Name (Titles) 121**] 3

Family History:
Mother with MI at age 74. Brother and sister with [**Name (NI) 10322**].

Physical Exam:
General Appearance: Well nourished, NAD, Overweight, Anxious
HEENT: PERRL, MMM, no JVD
Cardiovascular: nl PMI, s1 s2 no m/r/g, no thrills
Respiratory / Chest: Crackles @ Bases
Abdominal: Soft, Obese, Non-tender, Non-distended, BS present,
no HSM
Groin:
Extremities: 2+ distal pulses, warm well perfused, no edema.
Initially had IABP placed in right femoral artery with a Swan
Ganz catheter in right femoral vein.
Neurologic: Attentive, Follows simple commands

Pertinent Results:
Cath [**2131-10-7**]:
1. Two vessel vessel coronary artery disease.
2. STEMI secondary to occluded LAD.
3. Cadiogenic shock.
4. Successful stenting of the LAD.
5. Insertion of IABP with improvement of cardiac output.

ECHO [**2131-10-9**]:
Mild regional left ventricular systolic dysfunction with severe
hypokinesis of the anterior wall, anterior septum and apex and
mild hypokinesis of the anterolateral wall. Overall left
ventricular systolic function is mild to moderately depressed
(LVEF= 40 %).  The remaining left ventricular segments contract
normally.Tissue Doppler imaging suggests an increased left
ventricular filling pressure (PCWP>18mmHg).
Right ventricular chamber size and free wall motion are normal.
No AS, AI, trivial MR. [**First Name (Titles) 11718**] [**Last Name (Titles) 11719**] thickened but no
stenosis. No MVP.

[**2131-10-7**] 01:27PM BLOOD WBC-13.8* RBC-4.54 Hgb-13.2 Hct-39.3
MCV-87 MCH-29.2 MCHC-33.7 RDW-13.6 Plt Ct-192
[**2131-10-8**] 06:03AM BLOOD WBC-12.1* RBC-4.05* Hgb-11.8* Hct-34.6*
MCV-85 MCH-29.1 MCHC-34.1 RDW-13.9 Plt Ct-159
[**2131-10-14**] 05:30AM BLOOD WBC-9.4 RBC-3.22* Hgb-9.4* Hct-26.8*
MCV-83 MCH-29.3 MCHC-35.2* RDW-13.6 Plt Ct-236
[**2131-10-7**] 01:27PM BLOOD Neuts-86.8* Lymphs-9.9* Monos-3.1 Eos-0.1
Baso-0.1
[**2131-10-14**] 05:30AM BLOOD PT-23.2* PTT-28.9 INR(PT)-2.2*
[**2131-10-14**] 05:30AM BLOOD Glucose-97 UreaN-21* Creat-0.8 Na-137
K-4.2 Cl-100 HCO3-24 AnGap-17
[**2131-10-7**] 01:27PM BLOOD ALT-113* AST-480* CK(CPK)-6137*
AlkPhos-129* TotBili-0.5
[**2131-10-11**] 06:20AM BLOOD CK(CPK)-167*
[**2131-10-7**] 01:27PM BLOOD CK-MB-GREATER TH cTropnT-7.95*
[**2131-10-11**] 06:20AM BLOOD CK-MB-4 cTropnT-6.29*
[**2131-10-14**] 05:30AM BLOOD Calcium-8.6 Phos-4.0 Mg-2.0
[**2131-10-7**] 10:47AM BLOOD Type-ART FiO2-100 pO2-80* pCO2-39 pH-7.41
calTCO2-26 Base XS-0 AADO2-610 REQ O2-97 Intubat-NOT INTUBA
[**2131-10-7**] 10:47AM BLOOD Glucose-123* Lactate-1.5 K-3.9
[**2131-10-10**] 03:36PM BLOOD Hgb-10.9* calcHCT-33 O2 Sat-65

[**10-8**] - BCx, UCx neg

Brief Hospital Course:
56 y/o female with hyperlipidemia who presented with chest pain
and found to have a STEMI [**12-30**] to an occluded LAD.

STEMI: Pt presented with chest pain and found on cath to have
occluded LAD. Occlusion was stented but pt required IABP
placement for cardiogenic shock (cardiac index of 1.3)
indicative of cardiogenic shock and requiring IABP.  ECHO
confirmed large anterior infarction and severe LV dysfunction.
Pt required IABP for several days, at which point she was weaned
and IABP and swan removed. Pt did not have any furthur
complications including mechanical or arrhythmic. She did have 2
episodes of chest pain thought to be either noncardiac or
secondary to reperfusion which responded to NTG and were not
associated with EKG changes or further enzyme leak. She
tolerated the addition of ASA, plavix, high dose statin, lasix,
ACE inhibitor and beta-blocker, titrated up as tolerated by MAP
and pt's symptoms. On discharge pt's SBP were consistently in
the 80s, without any symptoms of lightheadedness or dizziness
and this was deemed acceptable as pt will be unlikely to mount
higher BPs given her large MI. Pt was also started on
anticoagulation with coumadin given the large area of infarct
and akinetic/hypokinetic anterior/apical wall. She will need
close monitoring of her INR.

TOBACCO ABUSE ?????? Pt counseled extensively by team and social work
about smoking cessation.

ANEMIA - Pt's hematocrit dropped from admission (39) to
discharge (26). This was thought to be initially due to some
blood loss from cath, and frequent blood draws. There was no
sign of active bleeding and pt remained asymptomatic. Pt was not
transfused and stool guaiac was not checked as pt did not have
any bowel movements.  Pt was asked to follow up with her PCP for
[**Name Initial (PRE) **] Hct check.

HYPERLIPIDEMIA - Pt was switched to high dose statin.


Medications on Admission:
Lipitor 20 mg PO daily
Ibuprofen PRN
Cod liver oil
Geritol

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
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. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
Disp:*30 Tablet(s)* Refills:*2*
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Primary Diagnosis: Inferior STEMI
Secondary: Hyperlipidemia
           Tobacco use


Discharge Condition:
Vital signs stable


Discharge Instructions:
You were admitted to the hospital with a heart attack. You had a
drug-eluting stent placed in your coronary artery (left anterior
descending) to open up the blockage in your heart. You were
started on several new medications including aspirin and plavix.
You must take these medications daily because they keep your
stent open. Do not stop this medication unless directed by your
cardiologist only. You were also started on a medication called
warfarin. This medication is a blood thinner to prevent blood
clots. You will need to have blood test to monitor your warfarin
level.

You were started on the following medications:
Aspirin 325 mg daily (prevent future heart attacks)
Plavix 75mg daily (Keeps stent open)
Lipitor 80mg daily (Stops plaque formation and reduces
cholesterol)
Lasix 20mg daily (Water pill)
Lisinopril 10mg daily (blood pressure)
Toprol XL 75mg daily (Blood pressure and heart rate)
Warfarin (blood thinner)

Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Please stop smoking. This can reduce your risk of future heart
attacks and strokes!! Information was reviewed with you on
admission regarding smoking cessation.

Please contact your doctor or return to the emergency room with
any worrisome symptoms such as chest pain, shortness of breath,
lightheadedness, weakness or numbness, difficulty with speech,
bleeding, etc.

Followup Instructions:
Follow up with Dr.[**Doctor Last Name 3733**] in cardiology. Please call ([**Telephone/Fax (1) 3942**] to make an appointment in [**12-31**] weeks.
Follow up with your primary care provider, [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1683**], ([**Telephone/Fax (1) 11720**] to make a follow up appointment in [**11-29**] weeks.
You need to have your INR checked on Tuesday [**2131-10-16**]. Please
have VNA services fax results to Dr. [**Last Name (STitle) 1683**]  at [**Telephone/Fax (1) 6443**]



Completed by:[**2131-10-14**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other iatrogenic hypotension,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder,Depressive disorder, not elsewhere classified'}


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: 56 y/o female with a h/o hyperlipidemia who presented to an OSH
on the AM of [**2131-10-7**] with 10/10 substernal and left-sided chest
pain, radiating down the left arm. Per patient, she noted the
onset of SSCP Friday AM at work. The pain lasted for about an
hour and resolved without any intervention. Was not associated
with any SOB or other symptoms. Subsequently, on Saturday
afternoon, she again developed the same SSCP, this time
radiating to her left arm, associated with nausea. Denied
associated SOB. Pain persisted until Sunday AM when she finally
presented to the OSH. EKG there revealed STE in V2-V4. She was
given SL nitro x 3, Lopressor 5 mg IV x 3, ASA, Plavix loaded,
heparin bolus + gtt, and integrillin bolus + drip. She was
transferred to [**Hospital1 18**] urgently for cardiac catheterization.

MEDICAL HISTORY: Tobacco abuse (12 py history)
Depression
Hyperlipidemia

MEDICATION ON ADMISSION: Lipitor 20 mg PO daily
Ibuprofen PRN
Cod liver oil
Geritol

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General Appearance: Well nourished, NAD, Overweight, Anxious
HEENT: PERRL, MMM, no JVD
Cardiovascular: nl PMI, s1 s2 no m/r/g, no thrills
Respiratory / Chest: Crackles @ Bases
Abdominal: Soft, Obese, Non-tender, Non-distended, BS present,
no HSM
Groin:
Extremities: 2+ distal pulses, warm well perfused, no edema.
Initially had IABP placed in right femoral artery with a Swan
Ganz catheter in right femoral vein.
Neurologic: Attentive, Follows simple commands

FAMILY HISTORY: Mother with MI at age 74. Brother and sister with [**Name (NI) 10322**].

SOCIAL HISTORY: -Tobacco history: Smokes [**4-3**] cigarettes daily for the past 25
years
-ETOH: None
-Illicit drugs: None 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Cardiogenic shock,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other iatrogenic hypotension,Thrombocytopenia, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder,Depressive disorder, not elsewhere classified'}
