CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 75 y/o female with extensive past medical history who developed
acute onset chest pain and dyspnea at the end of [**Month (only) 321**]. The
symptoms progressively worsened and EMS brought patient to
outside hospital. Underwent cardiac cath which revealed severe
three vessel coronary artery disease and was transferred to
[**Hospital1 18**] for surgical revascularization.

MEDICAL HISTORY: Diabetes Mellitus, Hypertension, Hypercholesterolemia,
Congestive Heart Failure, Diabetic Retinopathy, Hypothyroidism,
Carpal tunnel syndrome s/p bilateral surgery, s/p Hysterectomy,
Obesity, Recurrent Urinary Tract Infections, s/p Appendectomy,
s/p Tonsillectomy, s/p bilateral cataract surgery, s/p
Thyroidectomy

MEDICATION ON ADMISSION: Carvedilol 12.5mg [**Hospital1 **], Lasix 40mg qd, KCL, Aspirin 325mg qd,
Lisinopril 2.5mg qd, Amlodipine 10mg qd, Levothyroxine 125mg qd,
Simvastatin 80mg qd, Insulin

ALLERGIES: Codeine / Trazamine / Percocet / Vicodin

PHYSICAL EXAM: At discharge:
VS: 99.2  97BPM  96/51  20  96% 4L NC
Gen: Pleasant, answers questions appropriately
HEENT: PERRLA
Neck: supple, tender to palpation along sternocleidomastoid,
worse when coughing
Chest: Decreased lung sounds at left base. Serous drainage from
distal pole of sternal incision. Sternum stable with cough.
Heart: Bradycardic rate, distant heart sounds with normal S1S2
Abd: obese, normoactive bowel sounds. Soft and nontender without
rebound/guarding
Ext: warm with 1+ edema to mid shins
Neuro: intact

FAMILY HISTORY: Positive for [**Name (NI) 2320**], mother died of CAD

SOCIAL HISTORY: Patient lives with her son, smoked 1ppd for 20 years before
quitting 30 years ago, drinks socially, no illicit/IVDU.
Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Examination of participant in clinical trial,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other postprocedural status,Other primary cardiomyopathies
Crnry athrscl natve vssl,Diastolc hrt failure NOS,DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Cardiac dysrhythmias NEC,Hypertension NOS,Pure hypercholesterolem,Hypothyroidism NOS,Exam-clincal trial,Ocl crtd art wo infrct,Post-proc states NEC,Prim cardiomyopathy NEC
Admission Date:  [**2163-1-5**]              Discharge Date:   [**2163-1-11**]

Date of Birth:  [**2087-9-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Trazamine / Percocet / Vicodin

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2163-1-6**] Coronary Artery Bypass Graft x 5 (Left internal mammary
artery to Left anterior descending, Saphenous vein graft to
Diagonal,  Saphenous vein graft to Ramus, Saphenous vein graft
to Obtuse Marginal, Saphenous vein graft to Right coronary
artery)

History of Present Illness:
75 y/o female with extensive past medical history who developed
acute onset chest pain and dyspnea at the end of [**Month (only) 321**]. The
symptoms progressively worsened and EMS brought patient to
outside hospital. Underwent cardiac cath which revealed severe
three vessel coronary artery disease and was transferred to
[**Hospital1 18**] for surgical revascularization.

Past Medical History:
Diabetes Mellitus, Hypertension, Hypercholesterolemia,
Congestive Heart Failure, Diabetic Retinopathy, Hypothyroidism,
Carpal tunnel syndrome s/p bilateral surgery, s/p Hysterectomy,
Obesity, Recurrent Urinary Tract Infections, s/p Appendectomy,
s/p Tonsillectomy, s/p bilateral cataract surgery, s/p
Thyroidectomy

Social History:
Patient lives with her son, smoked 1ppd for 20 years before
quitting 30 years ago, drinks socially, no illicit/IVDU.

Family History:
Positive for [**Name (NI) 2320**], mother died of CAD

Physical Exam:
At discharge:
VS: 99.2  97BPM  96/51  20  96% 4L NC
Gen: Pleasant, answers questions appropriately
HEENT: PERRLA
Neck: supple, tender to palpation along sternocleidomastoid,
worse when coughing
Chest: Decreased lung sounds at left base. Serous drainage from
distal pole of sternal incision. Sternum stable with cough.
Heart: Bradycardic rate, distant heart sounds with normal S1S2
Abd: obese, normoactive bowel sounds. Soft and nontender without
rebound/guarding
Ext: warm with 1+ edema to mid shins
Neuro: intact

Pertinent Results:
[**1-5**] ChestCT: 1. Mild calcifications of the aortic annulus and
anterior ascending aorta extending to the level of the right
pulmonary artery. 2. Pulmonary arterial hypertension. 3.
Mediastinal lymph nodes likely reactive.
[**1-6**] Echo: The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF 60-70%). Tissue Doppler imaging
suggests an increased left ventricular filling pressure
(PCWP>18mmHg). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
ascending aorta is mildly dilated. The aortic valve leaflets (3)
are mildly thickened and display slightly reduced systolic
excusion. However, frank aortic stenosis is NOT present. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Mild (1+)
mitral regurgitation is seen. There is mild pulmonary artery
systolic hypertension. There is no pericardial effusion.
Compared with the findings of the prior study (images reviewed)
of [**2162-4-29**], no major change is evident.
[**2163-1-6**] Carotid U/S: 1. 40-59% stenosis of the right internal
carotid artery. 2. Less than 40% stenosis of the left internal
carotid artery.
[**2163-1-9**] 06:45AM BLOOD WBC-8.7 RBC-3.10* Hgb-9.2* Hct-25.5*
MCV-82 MCH-29.6 MCHC-36.1* RDW-15.4 Plt Ct-120*
[**2163-1-5**] 07:24PM BLOOD WBC-8.0 RBC-4.26 Hgb-12.0 Hct-34.4*
MCV-81* MCH-28.1 MCHC-34.8 RDW-15.0 Plt Ct-219
[**2163-1-6**] 06:57PM BLOOD PT-14.9* PTT-34.8 INR(PT)-1.3*
[**2163-1-5**] 07:24PM BLOOD PT-13.6* PTT-24.6 INR(PT)-1.2*
[**2163-1-10**] 05:19AM BLOOD Glucose-130* UreaN-37* Creat-1.6* Na-135
K-5.1 Cl-101 HCO3-26 AnGap-13
[**2163-1-9**] 06:45AM BLOOD Glucose-118* UreaN-33* Creat-1.3* Na-136
K-4.3 Cl-102 HCO3-21* AnGap-17
[**2163-1-8**] 06:03AM BLOOD Glucose-111* UreaN-26* Creat-1.2* Na-136
K-4.5 Cl-103 HCO3-24 AnGap-14
[**2163-1-5**] 07:24PM BLOOD Glucose-255* UreaN-20 Creat-0.9 Na-138
K-3.9 Cl-102 HCO3-28 AnGap-12
[**2163-1-9**] 06:45AM BLOOD Mg-2.5
[**2163-1-7**] 02:00AM BLOOD Mg-2.3
[**2163-1-5**] 07:24PM BLOOD %HbA1c-7.4*

Brief Hospital Course:
As mentioned in the HPI, Mrs. [**Known lastname 4886**] was transferred from OSH
for cardiac surgery. She was appropriately worked-up and brought
to the operating room on [**1-6**] where she underwent a coronary
artery bypass graft x 5. Please see operative report for
surgical details. Following surgery she was transferred to the
CVICU for invasive monitoring in stable condition. Within 24
hours she was weaned from sedation, awoke neurologically intact
and extubated.

She was gently diuresed with IV lasix towards her pre-operative
weight. On POD 4 she had a slight increase in her BUN/CR and her
lasix was changed to [**Hospital1 **]. Physical therapy was consulted to work
on strength and balance and felt that she would be best served
by a short stay at a rehab facility.  There was serous drainage
from the distal pole of her sternal incision and she was started
on a 5 day course of Keflex.

On POD 4 she was screened and received a bed and was discharged
to rehab.

Medications on Admission:
Carvedilol 12.5mg [**Hospital1 **], Lasix 40mg qd, KCL, Aspirin 325mg qd,
Lisinopril 2.5mg qd, Amlodipine 10mg qd, Levothyroxine 125mg qd,
Simvastatin 80mg qd, Insulin

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day): Hold for SBP < 90, HR < 50.
Disp:*30 Tablet(s)* Refills:*0*
2. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 5 days.
Disp:*5 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
5. 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:*0*
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
Disp:*qs Tablet(s)* Refills:*0*
7. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
Disp:*qs ML(s)* Refills:*0*
8. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
Disp:*5 Suppository(s)* Refills:*0*
9. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day): until patient is ambulatory and
out of bed on a consistent basis.
Disp:*qs qs* Refills:*2*
10. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
11. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
12. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
Disp:*30 Tablet(s)* Refills:*0*
13. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
14. Insulin Lispro Protam & Lispro 100 unit/mL (75-25) Insulin
Pen Sig: One (1)  Subcutaneous three times a day: Patient to
receive 20 units at breakfast, 10 units at lunch, and 25 units
at dinner.
Disp:*qs qs* Refills:*2*
15. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q8H
(every 8 hours) as needed.
Disp:*qs ML(s)* Refills:*0*
16. Cephalexin 250 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours) for 5 days.
Disp:*30 Capsule(s)* Refills:*0*
17. Furosemide 40 mg IV BID
18. Ondansetron 4 mg IV Q8H:PRN


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 5
PMH: Diabetes Mellitus, Hypertension, Hypercholesterolemia,
Congestive Heart Failure, Diabetic Retinopathy, Hypothyroidism,
Carpal tunnel syndrome s/p bilateral surgery, s/p Hysterectomy,
Obesity, Recurrent Urinary Tract Infections, s/p Appendectomy,
s/p Tonsillectomy, s/p bilateral cataract surgery, s/p
Thyroidectomy

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, 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 [**Telephone/Fax (1) 170**]

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks
Dr. [**Last Name (STitle) 5717**] in [**2-3**] weeks
Dr. [**First Name (STitle) **] in [**3-7**] weeks


Completed by:[**2163-1-10**]

Name:  [**Known lastname 2601**],[**Known firstname 6310**] M                Unit No:   [**Numeric Identifier 15824**]

Admission Date:  [**2163-1-5**]              Discharge Date:   [**2163-1-11**]

Date of Birth:  [**2087-9-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Trazamine / Percocet / Vicodin

Attending:[**First Name3 (LF) 1543**]
Addendum:
Patient will be on Metoclopramide 10MG IV q6 hours for 24 hours.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 49**] - [**Location (un) 50**]

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2163-1-10**]

Name:  [**Known lastname 2601**],[**Known firstname 6310**] M                Unit No:   [**Numeric Identifier 15824**]

Admission Date:  [**2163-1-5**]              Discharge Date:   [**2163-1-11**]

Date of Birth:  [**2087-9-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Trazamine / Percocet / Vicodin

Attending:[**First Name3 (LF) 1543**]
Addendum:
[**2163-1-11**] Addendum:
Minimal Serous drainage noted from the sternal inferior pole.
Sternum stable. No [**Doctor Last Name **]/click. Afebrile, WBC ct 9.7
As discussed with Dr.[**Last Name (STitle) **]: Betadine swabs/DSD b.id/prn.
Keflex x 7day course. Wound check scheduled at clinic in 1 week:
[**1-19**] coming from rehab.

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 49**] - [**Location (un) 50**]

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2163-1-11**]
{'Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Examination of participant in clinical trial,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other postprocedural status,Other primary cardiomyopathies'}


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: 75 y/o female with extensive past medical history who developed
acute onset chest pain and dyspnea at the end of [**Month (only) 321**]. The
symptoms progressively worsened and EMS brought patient to
outside hospital. Underwent cardiac cath which revealed severe
three vessel coronary artery disease and was transferred to
[**Hospital1 18**] for surgical revascularization.

MEDICAL HISTORY: Diabetes Mellitus, Hypertension, Hypercholesterolemia,
Congestive Heart Failure, Diabetic Retinopathy, Hypothyroidism,
Carpal tunnel syndrome s/p bilateral surgery, s/p Hysterectomy,
Obesity, Recurrent Urinary Tract Infections, s/p Appendectomy,
s/p Tonsillectomy, s/p bilateral cataract surgery, s/p
Thyroidectomy

MEDICATION ON ADMISSION: Carvedilol 12.5mg [**Hospital1 **], Lasix 40mg qd, KCL, Aspirin 325mg qd,
Lisinopril 2.5mg qd, Amlodipine 10mg qd, Levothyroxine 125mg qd,
Simvastatin 80mg qd, Insulin

ALLERGIES: Codeine / Trazamine / Percocet / Vicodin

PHYSICAL EXAM: At discharge:
VS: 99.2  97BPM  96/51  20  96% 4L NC
Gen: Pleasant, answers questions appropriately
HEENT: PERRLA
Neck: supple, tender to palpation along sternocleidomastoid,
worse when coughing
Chest: Decreased lung sounds at left base. Serous drainage from
distal pole of sternal incision. Sternum stable with cough.
Heart: Bradycardic rate, distant heart sounds with normal S1S2
Abd: obese, normoactive bowel sounds. Soft and nontender without
rebound/guarding
Ext: warm with 1+ edema to mid shins
Neuro: intact

FAMILY HISTORY: Positive for [**Name (NI) 2320**], mother died of CAD

SOCIAL HISTORY: Patient lives with her son, smoked 1ppd for 20 years before
quitting 30 years ago, drinks socially, no illicit/IVDU. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Diastolic heart failure, unspecified,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Examination of participant in clinical trial,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other postprocedural status,Other primary cardiomyopathies'}
