CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 72 year old male s/p CABG in [**2114**], graft failure
[**2115-4-11**] undergoing cypher(DES) stenting of LAD and LCx, and
three prior Vision (BMS) placed in mid and proximal LAD and one
to the proximal circumflex arteries. He recently presented to
[**Hospital6 **] with precordial chest "heaviness" [**9-20**],
on [**2116-5-5**]. He concomitantly had shortness of breath with chest
pain but denied nausea, vomiting, diaphoresis, and presyncope.
No radiation of pain. He was noted to have new 2mm ST
depressions v4-v6, TWI v3-v6. He received IV morphine, NTG x3,
and was started on weight based enoxaparin regimen. He was
already on Plavix. Pain was controlled to point where he was
chest pain free in ED. He ruled in for a NSTEMI. Initial neg
trop 0.04, that rose to 1.26, then 1.34. CK peak at OSH was 94.
He was stablized on medical therapy and was transferred to [**Hospital1 18**]
after diagnosis of NSTEMI so that he could be managed by his
primary cardiologist Dr. [**First Name (STitle) **]. On arrival to [**Hospital1 18**], patient
was chest pain free. Pt had ECG w/ new 1-2mm ST elevation in
V1-V2, and 2mm ST depression v4-v6, TWI v3-v6. 1mm ST depression
and TWI in I & avl are old. Pt was started on Heparin and
Integrillin on arrival to [**Hospital1 18**].

MEDICAL HISTORY: Coronary Artery Disease, History of CABG [**2114**]
(LIMA to LAD, SVG to RCA, sequential SVG to D1 and OM1)
Recent NSTEMI [**2116-4-11**]
Ischemic Cardiomyopathy/Chronic Systolic Heart Failure
Hypertension
Elevated Cholesterol
Type II Diabetes Mellitus
History of renal cancer status post left nephrectomy in [**2105**].
History of bilateral cataracts with repair.

MEDICATION ON ADMISSION: -Aspirin 325 mg once daily
-Imdur 30 once daily
-Plavix 75 once daily
-Zocor 40 once daily
-Diovan 80 mg daily
-Toprol 150 mg daily
-Feosol 65 mg daily
-insulin per protocol
-Colace 100 mg daily
-senna 2 mg daily
-sublingual nitroglycerin 0.03 mg p.r.n.

ALLERGIES: Lisinopril

PHYSICAL EXAM: PREOP EXAM:
VS - T 96.7, BP 109/49, HR 63, RR 16, 97% RA.
Gen: Indian male, No chest pain, resting comfortably.
HEENT: NCAT. PERRL, EOMI. Conjunctiva were pink, good dental
hygeine
Neck: Supple with JVP of 12 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: Crackles at the bases bilaterally. poor air movement. No
rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No edema. Nontender, 1+ weak DP/PT bilat.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+

FAMILY HISTORY: Family history is significant for a brother with a CABG at the
age of 65. Parents died of old age.

SOCIAL HISTORY: Patient is originally from [**Country 11150**], where he worked in
agriculture. He denies ever smoking, drinking etoh or using
illicit drugs. He came to the US in [**2094**], but returns frequently
to [**Country 11150**]. Last trip to [**2116-3-13**]. Pt lives with son and wife in
[**State 350**].
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Other complications due to other cardiac device, implant, and graft,Chronic systolic heart failure,Anemia, unspecified,Other iatrogenic hypotension,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Subendo infarct, initial,Crn ath atlg vn bps grft,Comp-oth cardiac device,Chr systolic hrt failure,Anemia NOS,Iatrogenc hypotnsion NEC,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr
Admission Date:  [**2116-5-6**]              Discharge Date:   [**2116-5-12**]

Date of Birth:  [**2043-8-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lisinopril

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2116-5-8**] Redo Sternotomy, Redo Coronary Artery Bypass Grafting
with saphenous vein grafts to left anterior descending, obtuse
marginal, and right coronary arteries.


History of Present Illness:
Mr. [**Known lastname **] is a 72 year old male s/p CABG in [**2114**], graft failure
[**2115-4-11**] undergoing cypher(DES) stenting of LAD and LCx, and
three prior Vision (BMS) placed in mid and proximal LAD and one
to the proximal circumflex arteries. He recently presented to
[**Hospital6 **] with precordial chest "heaviness" [**9-20**],
on [**2116-5-5**]. He concomitantly had shortness of breath with chest
pain but denied nausea, vomiting, diaphoresis, and presyncope.
No radiation of pain. He was noted to have new 2mm ST
depressions v4-v6, TWI v3-v6. He received IV morphine, NTG x3,
and was started on weight based enoxaparin regimen. He was
already on Plavix. Pain was controlled to point where he was
chest pain free in ED. He ruled in for a NSTEMI. Initial neg
trop 0.04, that rose to 1.26, then 1.34. CK peak at OSH was 94.
He was stablized on medical therapy and was transferred to [**Hospital1 18**]
after diagnosis of NSTEMI so that he could be managed by his
primary cardiologist Dr. [**First Name (STitle) **]. On arrival to [**Hospital1 18**], patient
was chest pain free. Pt had ECG w/ new 1-2mm ST elevation in
V1-V2, and 2mm ST depression v4-v6, TWI v3-v6. 1mm ST depression
and TWI in I & avl are old. Pt was started on Heparin and
Integrillin on arrival to [**Hospital1 18**].

Past Medical History:
Coronary Artery Disease, History of CABG [**2114**]
(LIMA to LAD, SVG to RCA, sequential SVG to D1 and OM1)
Recent NSTEMI [**2116-4-11**]
Ischemic Cardiomyopathy/Chronic Systolic Heart Failure
Hypertension
Elevated Cholesterol
Type II Diabetes Mellitus
History of renal cancer status post left nephrectomy in [**2105**].
History of bilateral cataracts with repair.


Social History:
Patient is originally from [**Country 11150**], where he worked in
agriculture. He denies ever smoking, drinking etoh or using
illicit drugs. He came to the US in [**2094**], but returns frequently
to [**Country 11150**]. Last trip to [**2116-3-13**]. Pt lives with son and wife in
[**State 350**].

Family History:
Family history is significant for a brother with a CABG at the
age of 65. Parents died of old age.

Physical Exam:
PREOP EXAM:
VS - T 96.7, BP 109/49, HR 63, RR 16, 97% RA.
Gen: Indian male, No chest pain, resting comfortably.
HEENT: NCAT. PERRL, EOMI. Conjunctiva were pink, good dental
hygeine
Neck: Supple with JVP of 12 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: Crackles at the bases bilaterally. poor air movement. No
rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No edema. Nontender, 1+ weak DP/PT bilat.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+

Discharge
VS T98.4  HR 104ST  BP 109/57  RR 18  O2sat 96% 2LNP
Gen NAD
Neuro Alert, orientedx3, non focal exam
Pulm CTA bilat
CV RRR-tachy, sternum stable, incision CDI
Abdm soft NT/+BS
Ext warm well perfused. 1+ pedal edema bilat

Pertinent Results:
[**2116-5-7**] Cardiac Cath:
1.  Limited coronary angiography of this right dominant system
demonstrated severe three (3) vessel coronary artery disease.
The right
coronary artery was diffusely diseased with pressure damping
upon
engaging.  The RCA had a 70% proximal lesion. The left main was
diffusely diseased with a 70% distal lesion.  The left
circumflex
demonstrated 70% in-stent restenosis of the proximal stent.  The
left
anterior descending artery was diffusely diseased with a tight
95%
proximal lesion along with serial 90% in-stent restenotic
lesions in the
proximally placed stent.
2.  Arterial conduit angiography was deferred - LIMA-LAD known
atretic.
Venous conduit angiography was also deferred since both grafts
known to
be occluded.
3.  LV ventriculography was deferred.
4.  Limited resting hemodynamics demonstrated moderate central
aortic
(160/73mm Hg) hypertension.
[**2116-5-7**] Carotid Ultrasound:
Less than 40% internal carotid artery stenosis bilaterally.
Findings suggesting distal left vertebral artery occlusion.
[**2116-5-8**] Intraop TEE:
Pre-CPB: No spontaneous echo contrast is seen in the left atrial
appendage. Overall left ventricular systolic function is
severely depressed (LVEF= 20 - 25 %). There moderate global RV
hypokinesis. There are simple atheroma in the descending
thoracic aorta. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. The mitral valve leaflets are moderately
thickened. Mild to moderate ([**2-12**]+) mitral regurgitation is seen.
There is no pericardial effusion.

Post- CPB: The patient is on an infusion of Epinephrine. RV
systolic fxn is normal. LV systolic fxn is moderately globally
depressed. MR is 1+.
No AI. Aorta intact.
[**2116-5-6**] 06:10PM BLOOD WBC-6.8 RBC-4.27* Hgb-13.1* Hct-38.6*
MCV-90 MCH-30.7 MCHC-34.0 RDW-12.3 Plt Ct-126*
[**2116-5-6**] 06:10PM BLOOD PT-15.3* PTT-45.6* INR(PT)-1.3*
[**2116-5-6**] 06:10PM BLOOD Glucose-180* UreaN-19 Creat-1.3* Na-140
K-4.8 Cl-105 HCO3-27 AnGap-13
[**2116-5-6**] 06:10PM BLOOD ALT-19 AST-21 CK(CPK)-66 AlkPhos-58
[**2116-5-6**] 06:10PM BLOOD CK-MB-NotDone cTropnT-0.09*
[**2116-5-7**] 12:30AM BLOOD CK-MB-NotDone cTropnT-0.08*
[**2116-5-7**] 04:00AM BLOOD CK-MB-NotDone cTropnT-0.06*
[**2116-5-6**] 06:10PM BLOOD Albumin-3.4 Calcium-8.7 Phos-2.5* Mg-2.1
[**2116-5-7**] 11:50AM BLOOD %HbA1c-7.5*
[**2116-5-12**] 09:19AM BLOOD Hct-25.5*
[**2116-5-12**] 04:33AM BLOOD Plt Ct-109*
[**2116-5-11**] 03:36AM BLOOD PT-17.2* PTT-35.0 INR(PT)-1.6*
[**2116-5-12**] 04:33AM BLOOD Glucose-185* UreaN-29* Creat-1.5* Na-134
K-3.8 Cl-100 HCO3-29 AnGap-9
RADIOLOGY   Preliminary Report
CHEST (PA & LAT)  [**2116-5-12**] 2:02 PM
CHEST (PA & LAT)
Reason: ? effusion
[**Hospital 93**] MEDICAL CONDITION:
72 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
? effusion
HISTORY: Status post CABG.
FINDINGS: In comparison with study of [**5-11**], the chest tubes have
been removed. No evidence of acute pneumothorax. Extensive
opacification at the left base is consistent with pleural fluid
and underlying atelectasis, though the possibility of
supervening pneumonia cannot be excluded.
DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**]


Brief Hospital Course:
Pt is a 72 y/o M w/ DM, HTN, s/p CABGx4V [**2114**], graft failure
[**4-17**],w/ multiple stents, most recent cath shows occluded SVGs
and LIMA-LAD arterial conduit, who is transferred to [**Hospital1 18**] from
OSH w/ NSTEMI,
Cardiac Cath: [**5-7**]
LMCA: Distal 70% lesion
LAD: Origin 95% lesion w/ serial 90% lesion ISRS in the previous
DES. The origin D1 has mild restenosis.
LCX: Non-Dominant vessel w/ 70% origin ISRS in the previous DES.
The OM1 origin is widely patent.
RCA: Dominant vessel with proximal 70% lesion at previous mild
lesion. There are r-l collaterals to the LAD and distal OM.
.
#Pump: Patients last echo [**10-18**] showed EF of 35-40%, with mild to
moderate regional left ventricular systolic dysfunction with
hypokinesis of the inferolateral and inferoseptal walls and
apex.

Cardiac Surgery
Pt brought to operating room for redo CABG on [**5-8**]. Please see
OR note for details, in summary patient had redo CABG x3 with
SVG>LCX, SVG>LAD, SVG>PDA, his bypass time was 109 minutes with
a crossclamp of 74 minutes. He did well in the immediate postop
period, was kept sedated throughout the night and was extubated
on POD #1. Additionally his swan was removed. His mediastinal
tubes were taken out POD #2. Cordis was replaced with a triple
lumen catheter due to difficulty with peripheral access.  Pt was
transferred to the floor on POD #3.  Once on the floor he had an
uneventful post operative course, his activity level was
advanced and medications adjusted. On POD4 it was decided he was
ready for discharge to rehabilitation at Palm [**Hospital 731**]
rehabilitation in [**Location (un) 15749**], MA

Medications on Admission:
-Aspirin 325 mg once daily
-Imdur 30 once daily
-Plavix 75 once daily
-Zocor 40 once daily
-Diovan 80 mg daily
-Toprol 150 mg daily
-Feosol 65 mg daily
-insulin per protocol
-Colace 100 mg daily
-senna 2 mg daily
-sublingual nitroglycerin 0.03 mg p.r.n.

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*100 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 10 days: then 20mg QD.
8. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 10 days: then 20mEq QD.
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.
12. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
13. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
15. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily):
75mg total.
16. Ferrous Gluconate 325 mg (37.5 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
17. Lantus 100 unit/mL Solution Sig: Fifteen (15) units
Subcutaneous at bedtime.
18. Humalog 100 unit/mL Solution Sig: Ten (10) units
Subcutaneous Q breakfast/lunch/dinner.
19. Insulin Regular Human 100 unit/mL Solution Sig: sliding
scale  Injection QAC&HS.


Discharge Disposition:
Extended Care

Facility:
Palm [**Hospital 731**] Nursing Home

Discharge Diagnosis:
Coronary Artery Disease, History of CABG [**2114**] - s/p Redo
CABGx3(SVG-LAD,SVG-OM,SVG-RCA)[**5-8**]
Ischemic Cardiomyopathy/Chronic Systolic Heart Failure
Recent NSTEMI [**2116-4-11**]
Hypertension
Elevated Cholesterol
Type II Diabetes Mellitus
History of Renal Cancer, s/p Left Nephrectomy


Discharge Condition:
Good


Discharge Instructions:
1)Please shower daily. No baths. Pat dry incisions, do not rub.
2)Avoid creams and lotions to surgical incisions.
3)Call cardiac surgeon if there is concern for wound infection,
redness or drainage from wound.
4)No lifting more than 10 lbs for at least 10 weeks from
surgical date.
5)No driving for at least one month.


Followup Instructions:
Dr. [**Last Name (STitle) **] in [**5-16**] weeks, call for appt
Dr. [**First Name (STitle) **] in [**3-15**] weeks, call for appt
Dr. [**Known lastname **] in [**3-15**] weeks, call for appt



Completed by:[**2116-5-12**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Other complications due to other cardiac device, implant, and graft,Chronic systolic heart failure,Anemia, unspecified,Other iatrogenic hypotension,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Mr. [**Known lastname **] is a 72 year old male s/p CABG in [**2114**], graft failure
[**2115-4-11**] undergoing cypher(DES) stenting of LAD and LCx, and
three prior Vision (BMS) placed in mid and proximal LAD and one
to the proximal circumflex arteries. He recently presented to
[**Hospital6 **] with precordial chest "heaviness" [**9-20**],
on [**2116-5-5**]. He concomitantly had shortness of breath with chest
pain but denied nausea, vomiting, diaphoresis, and presyncope.
No radiation of pain. He was noted to have new 2mm ST
depressions v4-v6, TWI v3-v6. He received IV morphine, NTG x3,
and was started on weight based enoxaparin regimen. He was
already on Plavix. Pain was controlled to point where he was
chest pain free in ED. He ruled in for a NSTEMI. Initial neg
trop 0.04, that rose to 1.26, then 1.34. CK peak at OSH was 94.
He was stablized on medical therapy and was transferred to [**Hospital1 18**]
after diagnosis of NSTEMI so that he could be managed by his
primary cardiologist Dr. [**First Name (STitle) **]. On arrival to [**Hospital1 18**], patient
was chest pain free. Pt had ECG w/ new 1-2mm ST elevation in
V1-V2, and 2mm ST depression v4-v6, TWI v3-v6. 1mm ST depression
and TWI in I & avl are old. Pt was started on Heparin and
Integrillin on arrival to [**Hospital1 18**].

MEDICAL HISTORY: Coronary Artery Disease, History of CABG [**2114**]
(LIMA to LAD, SVG to RCA, sequential SVG to D1 and OM1)
Recent NSTEMI [**2116-4-11**]
Ischemic Cardiomyopathy/Chronic Systolic Heart Failure
Hypertension
Elevated Cholesterol
Type II Diabetes Mellitus
History of renal cancer status post left nephrectomy in [**2105**].
History of bilateral cataracts with repair.

MEDICATION ON ADMISSION: -Aspirin 325 mg once daily
-Imdur 30 once daily
-Plavix 75 once daily
-Zocor 40 once daily
-Diovan 80 mg daily
-Toprol 150 mg daily
-Feosol 65 mg daily
-insulin per protocol
-Colace 100 mg daily
-senna 2 mg daily
-sublingual nitroglycerin 0.03 mg p.r.n.

ALLERGIES: Lisinopril

PHYSICAL EXAM: PREOP EXAM:
VS - T 96.7, BP 109/49, HR 63, RR 16, 97% RA.
Gen: Indian male, No chest pain, resting comfortably.
HEENT: NCAT. PERRL, EOMI. Conjunctiva were pink, good dental
hygeine
Neck: Supple with JVP of 12 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: Crackles at the bases bilaterally. poor air movement. No
rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No edema. Nontender, 1+ weak DP/PT bilat.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+

FAMILY HISTORY: Family history is significant for a brother with a CABG at the
age of 65. Parents died of old age.

SOCIAL HISTORY: Patient is originally from [**Country 11150**], where he worked in
agriculture. He denies ever smoking, drinking etoh or using
illicit drugs. He came to the US in [**2094**], but returns frequently
to [**Country 11150**]. Last trip to [**2116-3-13**]. Pt lives with son and wife in
[**State 350**]. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Other complications due to other cardiac device, implant, and graft,Chronic systolic heart failure,Anemia, unspecified,Other iatrogenic hypotension,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
