CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 77 year old male who presented [**2171-1-23**] to [**Hospital3 **] with
CP. Patient reported that on day of admission, he was eating
breakfast when he developed mid-sternal Chest pain, +radiation
to jaw and arms a/w weakness, without
nausea/diaphoresis/palpitations. Initial labs were significant
for WCC 8.2, HCT 39.4, Cr 1.0, Troponin 7. EKG was unchanged.
Patient was admitted to the floor for further evaluation. While
there, patient had single episode of sinoatrial pause lasting 6
seconds on telemetry, prompting a transfer of the patient to the
ICU. Trop peaked 15.4. He was then transferred to [**Hospital1 18**] for
cardiac catheterization. Cath revealed severe coronary disease
and he was referred for cardiac surgery.

MEDICAL HISTORY: Diabetes
Dyslipidemia
Gastroesophageal reflux diease and peptic ulcer
Macular degeneration
Prostate Cancer
Tobacco abuse(one pack a day smoker)
Osteoprosis
s/p prostectomy
Bilateral Hearing loss

MEDICATION ON ADMISSION: Glyburide 2.5mg PRN per patient

ALLERGIES: Percodan / Metformin / Codeine

PHYSICAL EXAM: Pulse:52 Resp:14  O2 sat:97/RA
B/P  Left:146/70
Height:5'[**70**]"     Weight:144 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:edentulous
Lives with:wife
Occupation:[**Name2 (NI) 88145**] worker
Tobacco:1ppdx 70 years
ETOH:1 drink every 3-4 weeks
Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Drug-induced delirium,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Aneurysm of artery of lower extremity,Phlebitis and thrombophlebitis of upper extremities, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Esophageal reflux,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified analgesics and antipyretics causing adverse effects in therapeutic use,Osteoporosis, unspecified,Macular degeneration (senile), unspecified,Unspecified hearing loss,Tobacco use disorder,Personal history of malignant neoplasm of prostate
Subendo infarct, initial,Surg comp-peri vasc syst,Drug-induced delirium,Crnry athrscl natve vssl,Atrial fibrillation,Lower extremity aneurysm,Phlbts vn NOS up extrm,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Esophageal reflux,Peptic ulcer NOS,Abn react-cardiac cath,Adv eff analgesics NEC,Osteoporosis NOS,Macular degeneration NOS,Hearing loss NOS,Tobacco use disorder,Hx-prostatic malignancy
Admission Date:  [**2171-1-24**]              Discharge Date:   [**2171-2-4**]

Date of Birth:  [**2093-6-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Percodan / Metformin / Codeine

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2171-1-28**] Coronary artery bypass graft x3, with the left internal
mammary artery to the left anterior descending artery and
reversed saphenous vein grafts to the posterior descending
artery and the diagonal artery.
[**2171-1-24**] Cardiac cath


History of Present Illness:
77 year old male who presented [**2171-1-23**] to [**Hospital3 **] with
CP. Patient reported that on day of admission, he was eating
breakfast when he developed mid-sternal Chest pain, +radiation
to jaw and arms a/w weakness, without
nausea/diaphoresis/palpitations. Initial labs were significant
for WCC 8.2, HCT 39.4, Cr 1.0, Troponin 7. EKG was unchanged.
Patient was admitted to the floor for further evaluation. While
there, patient had single episode of sinoatrial pause lasting 6
seconds on telemetry, prompting a transfer of the patient to the
ICU. Trop peaked 15.4. He was then transferred to [**Hospital1 18**] for
cardiac catheterization. Cath revealed severe coronary disease
and he was referred for cardiac surgery.

Past Medical History:
Diabetes
Dyslipidemia
Gastroesophageal reflux diease and peptic ulcer
Macular degeneration
Prostate Cancer
Tobacco abuse(one pack a day smoker)
Osteoprosis
s/p prostectomy
Bilateral Hearing loss

Social History:
Race:caucasian
Last Dental Exam:edentulous
Lives with:wife
Occupation:[**Name2 (NI) 88145**] worker
Tobacco:1ppdx 70 years
ETOH:1 drink every 3-4 weeks

Family History:
non-contributory

Physical Exam:
Pulse:52 Resp:14  O2 sat:97/RA
B/P  Left:146/70
Height:5'[**70**]"     Weight:144 lbs

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally, anteriorly [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact[x]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right: -   Left: -

Pertinent Results:
[**2171-1-24**] Cardiac Cath: 1.  Coronary angiography in this right
dominant system revealed three-vessel disease.  The LMCA had no
angiographically apparent disease.  The LAD had 70% stenosis in
the mid-portion prior to an aneurysm.  The D1 had a 70% ostial
stenosis. The LCx had a small ostial OM1 stenosis of 70%.  The
RCA had a 95% ostial stenosis. 2.  Resting hemodynamics revealed
elevated left-sided filling pressure with an LVEDP of 18 mmHg.
There was mild systemic arterial systolic hypertension with an
aortic blood pressure of 145/52 mmHg.  There was no aortic valve
gradient seen on careful pullback from left ventricle to aorta.
3. Left ventriculography revealed an EF of 50% with
inferobasilar hypokinesis.

[**2171-1-28**] Echo: The left atrium is normal in size. No atrial septal
defect is seen by 2D or color Doppler. Left ventricular wall
thicknesses and cavity size are normal. Right ventricular
chamber size and free wall motion are normal. There are simple
atheroma in the ascending aorta. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is no
pericardial effusion.
Post: The patient is now s/p CABGX3. The patient is now on a
neosynephrine drip @0.6mcg/kg/min. LV function is preserved
@55%. There is persistent mild mitral regurgitation. The aorta
is similar to prebypass with no dissection flaps observed.

[**2171-1-24**] 04:00PM BLOOD WBC-9.5 RBC-3.92* Hgb-11.3* Hct-34.0*
MCV-87 MCH-28.8 MCHC-33.2 RDW-14.2 Plt Ct-334
[**2171-2-2**] 06:20AM BLOOD WBC-8.6 RBC-3.36* Hgb-9.6* Hct-28.7*
MCV-85 MCH-28.7 MCHC-33.6 RDW-14.3 Plt Ct-555*
[**2171-1-24**] 04:00PM BLOOD PT-13.4 INR(PT)-1.1
[**2171-1-28**] 12:47PM BLOOD PT-14.1* PTT-39.7* INR(PT)-1.2*
[**2171-1-24**] 04:00PM BLOOD Glucose-102* UreaN-18 Creat-0.9 Na-136
K-3.6 Cl-105 HCO3-24 AnGap-11
[**2171-2-2**] 06:20AM BLOOD Glucose-128* UreaN-25* Creat-1.2 Na-139
K-4.3 Cl-102 HCO3-28 AnGap-13
[**2171-1-25**] 06:05AM BLOOD Calcium-8.7 Phos-3.4 Mg-1.8
[**2171-2-1**] 05:00AM BLOOD Mg-2.0
[**2171-1-24**] 04:00PM BLOOD Triglyc-120 HDL-37 CHOL/HD-4.7
LDLcalc-112
[**2171-1-24**] 04:00PM BLOOD %HbA1c-6.6* eAG-143*

Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname 42086**] was transferred to [**Hospital1 18**]
for cardiac cath. Cath revealed severe three vessel coronary
disease. Following cath he was admitted for pending surgery. He
underwent usual cardiac surgery work-up, along with medical
management and awaiting Plavix washout. Mr. [**Known lastname 42086**] was brought
to the operating room on [**1-28**] for coronary bypass grafting x 3.
Please see operative report for details. He tolerated the
operation well and was transferred to the cardiac surgery ICU
for invasive monitoring in stable condition. Within 24 hours he
was weaned from sedation and pressors, awoke neurologically
intact and extubated. His chest tubes were removed and he was
transferred to the surgical step down floor on post-op day one.
He experienced atrial fibrillation and was placed on amiodarone,
after which he converted to a sinus rhythm. He worked with
physical therapy for strength and mobility. He made good
progress and on post-operative day five he was ready for
discharge to rehab ([**Location (un) **] House) with the appropriate
medications and follow-up appointments.

Medications on Admission:
Glyburide 2.5mg PRN per patient

MEDICATIONS ON TRANSFER
Protonix 40mg daily
Insulin sliding scale
Nictine patch 14mg
Glyburide 1.25mg qAM
ASA 325mg daily
Plavix 75mg daily
Lipitor 80mg daily
Heparin IV
Morphine 1mg q4hr prn pain

Plavix - last dose:600 mg [**2171-1-24**]

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
7. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days.

8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
9. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
10. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Please take 400mg twice daily x 7 days. Then 200mg twice
daily x 7 days. Finally, 200mg daily until stopped by
cardiologist.
11. Insulin-Insulin sliding scale per attached sheet

Discharge Disposition:
Home With Service

Facility:
[**Hospital3 3765**] Hospice Program

Discharge Diagnosis:
Coronary artery disease s/p Coronary Artery Bypass Graft x3
Past Medical History:
Diabetes
Dyslipidemia
Gastroesophageal reflux diease and peptic ulcer
Macular degeneration
Prostate Cancer
Tobacco abuse(one pack a day smoker)
Osteoprosis
s/p prostectomy

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Tylenol
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema-2+

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
Please call to schedule appointments with your
Surgeon: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 170**] in 3 weeks
Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7756**] [**Telephone/Fax (1) 71179**] in [**3-29**] weeks
Primary Care Dr [**Last Name (STitle) 3390**]: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 21637**] in [**4-30**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Completed by:[**2171-2-2**]

Name:  [**Known lastname 13983**],[**Known firstname 33**]                  Unit No:   [**Numeric Identifier 13984**]

Admission Date:  [**2171-1-24**]              Discharge Date:   [**2171-2-4**]

Date of Birth:  [**2093-6-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Percodan / Metformin / Codeine

Attending:[**First Name3 (LF) 135**]
Addendum:
Pt was cleared for discharge to home ( not rehab) on POD #7.
( see brief hospital course).

Brief Hospital Course:
He developed RUE phlebitis and was started on keflex for a one
week course. He was cleared for discharge to home ( instead of
rehab) on POD #7.F/U appts were advised.

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*1*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
3. aspirin 81 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*
4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
6. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
7. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
Disp:*50 Tablet(s)* Refills:*0*
9. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
10. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Please take 400mg twice daily x 7 days. Then 200mg twice
daily x 7 days. Finally, 200mg daily until stopped by
cardiologist.
Disp:*100 Tablet(s)* Refills:*1*
11. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours) as needed for phlebitis for 1 weeks.
Disp:*21 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 13985**] Hospice Program

Discharge Diagnosis:
Coronary artery disease s/p Coronary Artery Bypass Graft x3
Past Medical History:
Diabetes
Dyslipidemia
Gastroesophageal reflux diease and peptic ulcer
Macular degeneration
Prostate Cancer
Tobacco abuse(one pack a day smoker)
Osteoprosis
s/p prostectomy
postop RUE phelebitis

                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern4) 137**] MD [**MD Number(2) 138**]

Completed by:[**2171-2-4**]
{'Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Drug-induced delirium,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Aneurysm of artery of lower extremity,Phlebitis and thrombophlebitis of upper extremities, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Esophageal reflux,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified analgesics and antipyretics causing adverse effects in therapeutic use,Osteoporosis, unspecified,Macular degeneration (senile), unspecified,Unspecified hearing loss,Tobacco use disorder,Personal history of malignant neoplasm of prostate'}


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: 77 year old male who presented [**2171-1-23**] to [**Hospital3 **] with
CP. Patient reported that on day of admission, he was eating
breakfast when he developed mid-sternal Chest pain, +radiation
to jaw and arms a/w weakness, without
nausea/diaphoresis/palpitations. Initial labs were significant
for WCC 8.2, HCT 39.4, Cr 1.0, Troponin 7. EKG was unchanged.
Patient was admitted to the floor for further evaluation. While
there, patient had single episode of sinoatrial pause lasting 6
seconds on telemetry, prompting a transfer of the patient to the
ICU. Trop peaked 15.4. He was then transferred to [**Hospital1 18**] for
cardiac catheterization. Cath revealed severe coronary disease
and he was referred for cardiac surgery.

MEDICAL HISTORY: Diabetes
Dyslipidemia
Gastroesophageal reflux diease and peptic ulcer
Macular degeneration
Prostate Cancer
Tobacco abuse(one pack a day smoker)
Osteoprosis
s/p prostectomy
Bilateral Hearing loss

MEDICATION ON ADMISSION: Glyburide 2.5mg PRN per patient

ALLERGIES: Percodan / Metformin / Codeine

PHYSICAL EXAM: Pulse:52 Resp:14  O2 sat:97/RA
B/P  Left:146/70
Height:5'[**70**]"     Weight:144 lbs

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:edentulous
Lives with:wife
Occupation:[**Name2 (NI) 88145**] worker
Tobacco:1ppdx 70 years
ETOH:1 drink every 3-4 weeks 

### Response:
{'Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Drug-induced delirium,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Aneurysm of artery of lower extremity,Phlebitis and thrombophlebitis of upper extremities, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Esophageal reflux,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other specified analgesics and antipyretics causing adverse effects in therapeutic use,Osteoporosis, unspecified,Macular degeneration (senile), unspecified,Unspecified hearing loss,Tobacco use disorder,Personal history of malignant neoplasm of prostate'}
