CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 62 yo F with known 2VCAD s/p DES to
mid RCA [**5-22**] who presented to OSH with chest pain with rest and
exertion. EKG was normal and she ruled out for MI. She was
transferred to [**Hospital1 18**] for cardiac cath.

MEDICAL HISTORY: coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-22**]
Chronic back pain/Head ache on narcotics
Herpes Simplex

MEDICATION ON ADMISSION: ASA 325mg po daily
Plavix 75mg po daily
Atorvastatin 10mg po daily
Amlodipine 10mg po daily
Lisinopril 10mg po daily
Metoprolol Succinate 100mg po daily
Imdur 60mg po daily
Sertraline 150mg po daily
Tizanidine 2mg po TID
Bupropion 300mg po daily
Minocin 100mg po PRN
Acyclovir PRN
Ultram PRN
Vitamins

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:69 Resp:12  O2 sat:97%RA
B/P  Right:88/50    Left:108/62
Height:5'0"     Weight:44.5kg (98lbs)

FAMILY HISTORY: Father died of MI age 50, mother with MI age 65

SOCIAL HISTORY: Lives with:alone
Occupation:financial planner
Tobacco:quit age 32
ETOH:6 glasses/week
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Atherosclerosis of native arteries of the extremities, unspecified,Stricture of artery,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Ocl crtd art wo infrct,Athscl extrm ntv art NOS,Stricture of artery,Status-post ptca
Admission Date:  [**2173-9-8**]              Discharge Date:   [**2173-9-12**]

Date of Birth:  [**2110-12-10**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2173-9-8**] coronary artery bypass x 3 (SVG to DIAG with prox "Y" to
free LIMA to LAD, SVG to PDA)

History of Present Illness:
62 yo F with known 2VCAD s/p DES to
mid RCA [**5-22**] who presented to OSH with chest pain with rest and
exertion. EKG was normal and she ruled out for MI. She was
transferred to [**Hospital1 18**] for cardiac cath.

Past Medical History:
coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-22**]
Chronic back pain/Head ache on narcotics
Herpes Simplex


Social History:
Lives with:alone
Occupation:financial planner
Tobacco:quit age 32
ETOH:6 glasses/week


Family History:
Father died of MI age 50, mother with MI age 65


Physical Exam:
Pulse:69 Resp:12  O2 sat:97%RA
B/P  Right:88/50    Left:108/62
Height:5'0"     Weight:44.5kg (98lbs)

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] RLQ incision
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact
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: 0   Left: 0


Pertinent Results:
PRE BYPASS The left atrium is mildly dilated. No spontaneous
echo contrast or thrombus is seen in the body of the left
atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. No atrial septal defect is seen
by 2D or color Doppler. Left ventricular wall thickness, cavity
size, and global systolic function are normal (LVEF = 75%).
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 simple 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. Trivial mitral regurgitation is seen. Dr.
[**Last Name (STitle) **] was notified in person of the results in the
operating room at the time of the study.

POST BYPASS Normal biventricular systolic function. Thoracic
aorta intact post decannulation. No significant changes from the
pre-bypass study.
  Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2173-9-8**] 15:49


Brief Hospital Course:
Admitted [**9-8**] and underwent surgery with Dr. [**First Name (STitle) **]. Transferred
to the CVICU in stable condition on titrated phenylephrine and
propofol drips. Extubated that evening and transferred to the
floor on POD #1 to begin increasing her activity level. She was
gently diuresed toward her preop weight and beta blockade was
titrated. She was maintained on a statin and ASA. She was
cleared for discharge to home on POD#4 by Dr. [**Last Name (STitle) **].

Medications on Admission:
ASA 325mg po daily
Plavix 75mg po daily
Atorvastatin 10mg po daily
Amlodipine 10mg po daily
Lisinopril 10mg po daily
Metoprolol Succinate 100mg po daily
Imdur 60mg po daily
Sertraline 150mg po daily
Tizanidine 2mg po TID
Bupropion 300mg po daily
Minocin 100mg po PRN
Acyclovir PRN
Ultram PRN
Vitamins

Plavix - last dose:[**2173-8-19**]


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/fever.
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
4. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Tizanidine 2 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Bupropion HCl 150 mg Tablet Sustained Release Sig: Two (2)
Tablet Sustained Release PO QAM (once a day (in the morning)).
9. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
10. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for severe pain.
Disp:*45 Tablet(s)* Refills:*0*
11. 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*
12. Psyllium     Packet Sig: One (1) Packet PO TID (3 times a
day) as needed for constipation.
13. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO TID
(3 times a day).
14. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*120 Tablet(s)* Refills:*0*
15. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours): for oral lesion.
16. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-22**]
Chronic back pain/Head ache on narcotics
Herpes Simplex


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - clean and dry. Healing.
bilat leg incisions- clean and dry w/ intact steristrips
edema-no edema


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**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge

Followup Instructions:
Plaese call your Surgeon Dr. [**First Name (STitle) **] [**Telephone/Fax (1) 170**] and schedule an
appointment to seen in 4 weeks.

[**Name6 (MD) **] [**Last Name (NamePattern4) 6559**], MD Phone:[**Telephone/Fax (1) 62**] Date/Time:[**2173-9-24**]
10:40
Please call to schedule appointments
Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] W. [**Telephone/Fax (1) 3329**]  in [**2-13**] 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**
Provider: [**Name Initial (NameIs) 703**] (H3) [**Doctor Last Name 5034**] THYROID RADIOLOGY Phone:[**Telephone/Fax (1) 327**]
Date/Time:[**2174-1-12**] 8:00
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 1803**] Date/Time:[**2174-1-18**]
9:20


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

Completed by:[**2173-9-12**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Atherosclerosis of native arteries of the extremities, unspecified,Stricture of artery,Percutaneous transluminal coronary angioplasty 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: 62 yo F with known 2VCAD s/p DES to
mid RCA [**5-22**] who presented to OSH with chest pain with rest and
exertion. EKG was normal and she ruled out for MI. She was
transferred to [**Hospital1 18**] for cardiac cath.

MEDICAL HISTORY: coronary artery disease, s/p coronary artery bypass [**2173-9-8**]
PMH:
Hypertension
hyperlipidemia
Peripheral Arterial Disease
Carotid Artery Disease
Bilateral subclavian stenosis s/p L stent [**5-22**]
Chronic back pain/Head ache on narcotics
Herpes Simplex

MEDICATION ON ADMISSION: ASA 325mg po daily
Plavix 75mg po daily
Atorvastatin 10mg po daily
Amlodipine 10mg po daily
Lisinopril 10mg po daily
Metoprolol Succinate 100mg po daily
Imdur 60mg po daily
Sertraline 150mg po daily
Tizanidine 2mg po TID
Bupropion 300mg po daily
Minocin 100mg po PRN
Acyclovir PRN
Ultram PRN
Vitamins

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:69 Resp:12  O2 sat:97%RA
B/P  Right:88/50    Left:108/62
Height:5'0"     Weight:44.5kg (98lbs)

FAMILY HISTORY: Father died of MI age 50, mother with MI age 65

SOCIAL HISTORY: Lives with:alone
Occupation:financial planner
Tobacco:quit age 32
ETOH:6 glasses/week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Atherosclerosis of native arteries of the extremities, unspecified,Stricture of artery,Percutaneous transluminal coronary angioplasty status'}
