CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 64 yo M with complaints of chest burning while shoveling with
+ETT today, sent directly for cardiac catheterization. Admitted
for CABG

MEDICAL HISTORY: Hyperlipidemia
Asthma
GERD
Gout
testicular CA

MEDICATION ON ADMISSION: 1. Albuterol Sulfate 1-2 Puffs Q6H/PRN for wheezing.
2. Allopurinol 100 mg DAILY
3. Doxazosin 1 mg QHS
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk  [**Hospital1 **]
5. Metoprolol Tartrate 12.5 mg [**Hospital1 **]
6. Nitroglycerin 0.3 mg (1)PRN for chest pain:
7. Simvastatin 10 mg DAILY
8. Aspirin 325 mg DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse: Resp:  O2 sat:
B/P  Right:167/99    Left:165/101
Height:180 lbs     Weight:5'5"

FAMILY HISTORY: - Father CAD age 62.
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Born and lives in [**Location 3146**], MA
-Occupation: Telecommunications technician
-Tobacco history: Quit cigars >10 years ago
-ETOH: Infrequent
-Illicit drugs: None
Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Gout, unspecified,Personal history of malignant neoplasm of testis,Other postprocedural status
Crnry athrscl natve vssl,Asthma NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Gout NOS,Hx-testicular malignancy,Post-proc states NEC
Admission Date:  [**2198-3-16**]              Discharge Date:   [**2198-3-20**]

Date of Birth:  [**2134-1-4**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest pain


Major Surgical or Invasive Procedure:
[**2198-3-16**]
1.Coronary artery bypass graft x4, left internal mammary
    artery to left anterior descending artery, and saphenous
    vein grafts to diagonal obtuse ramus artery and the
    right coronary artery.
2. Endoscopic harvesting of the long saphenous vein.


History of Present Illness:
64 yo M with complaints of chest burning while shoveling with
+ETT today, sent directly for cardiac catheterization. Admitted
for CABG

Past Medical History:
Hyperlipidemia
Asthma
GERD
Gout
testicular CA

Past Surgical History:
s/p testicular surgery


Social History:
-Born and lives in [**Location 3146**], MA
-Occupation: Telecommunications technician
-Tobacco history: Quit cigars >10 years ago
-ETOH: Infrequent
-Illicit drugs: None


Family History:
- Father CAD age 62.
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
Pulse: Resp:  O2 sat:
B/P  Right:167/99    Left:165/101
Height:180 lbs     Weight:5'5"

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

Carotid Bruit        Right: -    Left: -


Pertinent Results:
[**2198-3-16**] 07:34AM   HGB-13.1* calcHCT-39
[**2198-3-16**] 07:34AM   GLUCOSE-107* LACTATE-1.2 NA+-141 K+-4.0
CL--104
[**2198-3-16**] 12:20PM   FIBRINOGE-112*
[**2198-3-16**] 12:20PM   PT-15.3* PTT-28.1 INR(PT)-1.3*
[**2198-3-16**] 12:20PM   PLT COUNT-175
[**2198-3-16**] 12:20PM   WBC-18.1*# RBC-3.52* HGB-9.8* HCT-28.2*
MCV-80* MCH-27.7 MCHC-34.6 RDW-13.7
[**2198-3-16**] 01:14PM   UREA N-15 CREAT-0.8 CHLORIDE-110* TOTAL
CO2-23
[**2198-3-20**] 05:50AM BLOOD WBC-11.5* RBC-3.47* Hgb-9.6* Hct-28.1*
MCV-81* MCH-27.8 MCHC-34.2 RDW-14.0 Plt Ct-221
[**2198-3-20**] 05:50AM BLOOD Plt Ct-221
[**2198-3-16**] 01:14PM BLOOD PT-13.8* PTT-28.9 INR(PT)-1.2*
[**2198-3-20**] 05:50AM BLOOD Glucose-124* UreaN-26* Creat-1.0 Na-136
K-4.6 Cl-94* HCO3-29 AnGap-18
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 107122**]
FINDINGS: In comparison with the study of [**3-18**], there is no
convincing
evidence of pneumothorax at this time. Right central catheter
remains in
place. Persistent opacification at the left base is again
consistent with
atelectasis and effusion.
DR. [**First Name11 (Name Pattern1) 1569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 11006**]
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *5.0 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  5.0 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.0 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Sinus Level:  3.5 cm  <= 3.6 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.0 m/sec  <= 2.0 m/sec
Findings
LEFT ATRIUM: Dilated LA. No spontaneous echo contrast or
thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal
interatrial septum. No ASD by 2D or color Doppler. Prominent
Eustachian valve (normal variant).
LEFT VENTRICLE: Mildly depressed LVEF.
RIGHT VENTRICLE: Normal RV chamber size. Borderline normal RV
systolic function.
AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Simple atheroma in descending aorta.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
MITRAL VALVE: Normal mitral valve leaflets. Mild (1+) MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized.
No PS. Physiologic PR.
PERICARDIUM: Trivial/physiologic pericardial effusion.
GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications. The patient appears to be in sinus rhythm. See
Conclusions for post-bypass data
REGIONAL LEFT VENTRICULAR WALL MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Pre-bypass:
The left atrium is normal in size. No spontaneous echo contrast
or thrombus is seen in the body of the left atrium or left
atrial appendage. No atrial septal defect is seen by 2D or color
Doppler. Overall left ventricular systolic function is mildly
depressed (LVEF= 45-50 %). Right ventricular chamber size is
normal. with borderline normal free wall function. There are
simple atheroma in the aortic arch. 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 structurally
normal. There is no prolapse or flail leaflets. Even with T
[**Doctor Last Name **], MR remains mild. Mild (1+) mitral regurgitation is seen.
There is a trivial/physiologic pericardial effusion.
Post-bypass:
Intact thoracic aorta.
Mild MR.
LVEF 45-50%
Preserved Right ventricular systolic function. LV similar
toprebypass.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2198-3-16**] 12:10



Brief Hospital Course:
Mr [**Known lastname 107121**] was a same day admit to the operating room for
coronary bypass grafting. Please see operative report for
details in summary he had coronary bypass graftinf x4 with:1.
left internal mammary artery to left anterior descending artery,
and saphenous vein grafts to diagonal obtuse ramus artery and
the right coronary artery.
2. Endoscopic harvesting of the long saphenous vein. His bypass
time was 155 minutes with a crossclamp time of 95 minutes. He
tolerated the operation well and was transferred from the
operating room to the cardiac surgery ICU in stable condition.
In the immediate post operative period he remained
hemodynamically stable, woke neurologically intact and was
extubated. On POD1 he was transferred from the ICU to the
stepdown floor for continued care and physical recovery. All
tubes lines and drains were removed according to cardiac surgery
protocol. The remainder of his hospital course was uneventful,
his activity level advanced and on POD4 he was discharged home
with visiting nurses. Followup with Dr [**Last Name (STitle) 7772**] in 4 weeks.


Medications on Admission:
1. Albuterol Sulfate 1-2 Puffs Q6H/PRN for wheezing.
2. Allopurinol 100 mg DAILY
3. Doxazosin 1 mg QHS
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk  [**Hospital1 **]
5. Metoprolol Tartrate 12.5 mg [**Hospital1 **]
6. Nitroglycerin 0.3 mg (1)PRN for chest pain:
7. Simvastatin 10 mg DAILY
8. Aspirin 325 mg DAILY


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:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Puff/Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Doxazosin 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*2*
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day
for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
11. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) puffs Inhalation prn as needed for shortness of breath
or wheezing.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
s/p CABG X4 (LIMA to LAD, SVG to Diag-Ramus-RCA
PMH:
Hyperlipidemia, Asthma, GERD, Gout, testicular CA, s/p
testicular surgery


Discharge Condition:
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Activity Status:Ambulatory - Independent
Sternal wound healing well, no erythema or drainage.


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge


Followup Instructions:
Dr [**Last Name (STitle) 7772**] on [**4-16**] @1:45PM
Please call to schedule appointments with:
PCP: [**Name10 (NameIs) 1576**],[**Name11 (NameIs) 1575**] [**Telephone/Fax (1) 1579**] in [**3-7**] weeks
Cardiologist: Dr [**First Name (STitle) **] [**Name (STitle) 1911**] in [**3-7**] weeks
[**Hospital 409**] clinic in 2 weeks-nurses to schedule appointment before
discharge


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2198-3-20**]
{'Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Gout, unspecified,Personal history of malignant neoplasm of testis,Other postprocedural status'}


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: 64 yo M with complaints of chest burning while shoveling with
+ETT today, sent directly for cardiac catheterization. Admitted
for CABG

MEDICAL HISTORY: Hyperlipidemia
Asthma
GERD
Gout
testicular CA

MEDICATION ON ADMISSION: 1. Albuterol Sulfate 1-2 Puffs Q6H/PRN for wheezing.
2. Allopurinol 100 mg DAILY
3. Doxazosin 1 mg QHS
4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk  [**Hospital1 **]
5. Metoprolol Tartrate 12.5 mg [**Hospital1 **]
6. Nitroglycerin 0.3 mg (1)PRN for chest pain:
7. Simvastatin 10 mg DAILY
8. Aspirin 325 mg DAILY

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse: Resp:  O2 sat:
B/P  Right:167/99    Left:165/101
Height:180 lbs     Weight:5'5"

FAMILY HISTORY: - Father CAD age 62.
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: -Born and lives in [**Location 3146**], MA
-Occupation: Telecommunications technician
-Tobacco history: Quit cigars >10 years ago
-ETOH: Infrequent
-Illicit drugs: None 

### Response:
{'Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Esophageal reflux,Gout, unspecified,Personal history of malignant neoplasm of testis,Other postprocedural status'}
