CHIEF COMPLAINT: chest pain - pressure, heaviness

PRESENT ILLNESS: 74 year old female presented to OSH with chest pressure and
heaviness.  Pain lasted 20-25 minutes, denies any associsted
symptoms.  Transferred for further cardiac workup.

MEDICAL HISTORY: Coronary Artery Disease s/p CABG
Hypertension
Diabetes Mellitus
Hyperlipidemia
Chronic renal insufficiency Baseline 1.6
TIA
Aortic stenosis
tonsillectomy
Polio with residual right sided weakness
Dementia

MEDICATION ON ADMISSION: ASA, Lovenox, Atenolol, Glyburide, lipitor, Norvasc, Oscal,
Zantac, Zoloft, plavix, lisinopril

ALLERGIES: Codeine / Morphine

PHYSICAL EXAM: Admission
General NAD
Vitals HR 60, RR 17, 197/68 right arm B/P
Pulm CTA
Cardiac RRR no murmur/rub/gallop
Neck supple full ROM
Abd soft, nontender, nondistended
Ext warm well perfused pulses +2
Neuro decrease strength RLE some confusion re: situation, walks
with cane

FAMILY HISTORY: NC

SOCIAL HISTORY: smoked quit 20 years ago
ETOH 1 watered down port per day
Lives with son
Subendocardial infarction, initial episode of care,Late effects of acute poliomyelitis,Mitral valve disorders,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Other persistent mental disorders due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Subendo infarct, initial,Late effect acute polio,Mitral valve disorder,Chronic kidney dis NOS,Crnry athrscl natve vssl,Mental disor NEC oth dis,Hy kid NOS w cr kid I-IV,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2166-11-17**]              Discharge Date:   [**2166-11-24**]

Date of Birth:  [**2087-4-9**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Morphine

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
chest pain - pressure, heaviness

Major Surgical or Invasive Procedure:
Cardiac Catherization [**2166-11-17**]
Coronary Artery Bypass Graft x3 (Left internal mammary artery ->
left anterior descending, saphenous vein graft -> obtuse
marginal. saphenous vein graft -> right coronary artery) [**2166-11-18**]


History of Present Illness:
74 year old female presented to OSH with chest pressure and
heaviness.  Pain lasted 20-25 minutes, denies any associsted
symptoms.  Transferred for further cardiac workup.

Past Medical History:
Coronary Artery Disease s/p CABG
Hypertension
Diabetes Mellitus
Hyperlipidemia
Chronic renal insufficiency Baseline 1.6
TIA
Aortic stenosis
tonsillectomy
Polio with residual right sided weakness
Dementia

Social History:
smoked quit 20 years ago
ETOH 1 watered down port per day
Lives with son


Family History:
NC

Physical Exam:
Admission
General NAD
Vitals HR 60, RR 17, 197/68 right arm B/P
Pulm CTA
Cardiac RRR no murmur/rub/gallop
Neck supple full ROM
Abd soft, nontender, nondistended
Ext warm well perfused pulses +2
Neuro decrease strength RLE some confusion re: situation, walks
with cane


Pertinent Results:
[**2166-11-21**] 05:50AM BLOOD WBC-11.4* RBC-2.99* Hgb-9.4* Hct-27.3*
MCV-92 MCH-31.5 MCHC-34.4 RDW-14.3 Plt Ct-146*
[**2166-11-17**] 02:25PM BLOOD WBC-7.9 RBC-4.60 Hgb-14.6 Hct-43.3 MCV-94
MCH-31.8 MCHC-33.8 RDW-13.3 Plt Ct-220
[**2166-11-17**] 04:20PM BLOOD Neuts-57.9 Lymphs-33.6 Monos-5.9 Eos-2.2
Baso-0.4
[**2166-11-21**] 05:50AM BLOOD Plt Ct-146*
[**2166-11-20**] 04:00AM BLOOD PT-12.9 PTT-33.9 INR(PT)-1.1
[**2166-11-17**] 02:25PM BLOOD Plt Ct-220
[**2166-11-17**] 02:25PM BLOOD PT-12.3 PTT-30.1 INR(PT)-1.1
[**2166-11-21**] 05:50AM BLOOD Glucose-264* UreaN-12 Creat-0.8 Na-136
K-3.3 Cl-100 HCO3-31 AnGap-8

[**2166-11-17**] 02:25PM BLOOD Glucose-82 UreaN-17 Creat-0.8 Na-140
K-3.8 Cl-102 HCO3-29 AnGap-13
[**2166-11-17**] 04:20PM BLOOD ALT-29 AST-43* AlkPhos-68 Amylase-46
TotBili-0.3

TEE [**11-18**]

Conclusions:
PRE-CPB The left atrium is moderately dilated. Mild spontaneous
echo contrast
is seen in the body of the left atrium. No atrial septal defect
is seen by 2D
or color Doppler. There is mild symmetric left ventricular
hypertrophy. There
is mild regional left ventricular systolic dysfunction with mild
hypokinesis
of the inferior wall. The remaining left ventricular segments
contract
normally. Overall left ventricular systolic function is normal.
Right
ventricular chamber size and free wall motion are normal. There
are simple
atheroma in the ascending aorta. There are simple atheroma in
the aortic arch.
There are complex (>4mm) atheroma in the descending thoracic
aorta. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present.
Trace aortic regurgitation is seen. The mitral valve leaflets
are mildly
thickened. Mild (1+) mitral regurgitation is seen.


Brief Hospital Course:
Transferred from OSH for cardiac catherization [**2166-11-17**] which
revealed LM and 3 Vessel CAD and was referred to cardiac
surgery.  She underwent preoperative work up and on [**2166-11-18**] was
transferred to the operating room for coronary artery bypass
graft surgery.  Please see operative report for further details.
 She was transfered to the cardiac surgery recover unit for
further hemodynamic monitoring. In the first 24 hours she awoke
and was extubated without difficulty.  She was alert and
following commands but unable to answer questions.  On
postoperative day 2 she was weaned from IV nitroglycerin and was
transferred to [**Hospital Ward Name **] 2.  She has continued to progress working
with physical therapy.  Neurologically she remains oriented to
person not place and time. On postoperative day 4 she was ready
for discharge to rehab, but did not get a bed until postop day
6. Discharged on [**11-24**]. Pt. to make all follow-up appts. as per
discharge instructions.

Medications on Admission:
ASA, Lovenox, Atenolol, Glyburide, lipitor, Norvasc, Oscal,
Zantac, Zoloft, plavix, lisinopril

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
9. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 7 days.
11. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO once a day for 7 days.
12. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
13. Haloperidol 1 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 2 mg [**Hospital1 **] for 2 days, then 1 mg [**Hospital1 **] for 2 days then D/c.



Discharge Disposition:
Extended Care

Facility:
[**Hospital6 25759**] & Rehab Center - [**Location (un) **]

Discharge Diagnosis:
Coronary Artery Disease s/p CABG
Hypertension
Diabetes Mellitus
Hyperlipidemia
Chronic renal insufficiency Basline 1.6
TIA
Aortic stenosis
tonsillectomy
Polio with residual right sided weakness
Dementia


Discharge Condition:
Good


Discharge Instructions:
[**Month (only) 116**] shower, no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr [**Last Name (Prefixes) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for
appointment
Dr [**Last Name (STitle) 17863**] in 1 week ([**Telephone/Fax (1) 29933**]) please call for appointment
Dr [**Last Name (STitle) 11493**] in [**1-17**] weeks  ([**Telephone/Fax (1) 11650**]) please call for
appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])



Completed by:[**2166-11-24**]
{'Subendocardial infarction, initial episode of care,Late effects of acute poliomyelitis,Mitral valve disorders,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Other persistent mental disorders due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,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 - pressure, heaviness

PRESENT ILLNESS: 74 year old female presented to OSH with chest pressure and
heaviness.  Pain lasted 20-25 minutes, denies any associsted
symptoms.  Transferred for further cardiac workup.

MEDICAL HISTORY: Coronary Artery Disease s/p CABG
Hypertension
Diabetes Mellitus
Hyperlipidemia
Chronic renal insufficiency Baseline 1.6
TIA
Aortic stenosis
tonsillectomy
Polio with residual right sided weakness
Dementia

MEDICATION ON ADMISSION: ASA, Lovenox, Atenolol, Glyburide, lipitor, Norvasc, Oscal,
Zantac, Zoloft, plavix, lisinopril

ALLERGIES: Codeine / Morphine

PHYSICAL EXAM: Admission
General NAD
Vitals HR 60, RR 17, 197/68 right arm B/P
Pulm CTA
Cardiac RRR no murmur/rub/gallop
Neck supple full ROM
Abd soft, nontender, nondistended
Ext warm well perfused pulses +2
Neuro decrease strength RLE some confusion re: situation, walks
with cane

FAMILY HISTORY: NC

SOCIAL HISTORY: smoked quit 20 years ago
ETOH 1 watered down port per day
Lives with son 

### Response:
{'Subendocardial infarction, initial episode of care,Late effects of acute poliomyelitis,Mitral valve disorders,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Other persistent mental disorders due to conditions classified elsewhere,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
