CHIEF COMPLAINT: Exertional chest discomfort

PRESENT ILLNESS: This is a 55 year old female with multiple cardiac risk factors
and known coronary disease. She has undergone multiple
percutaneous interventions to her left anterior descending
artery in [**2116**] and [**2117**].

MEDICAL HISTORY: Coronary artery disease - s/p multiple LAD PCI/stenting,
Hypertension, Diabetes mellitus, Hyperlipidemia, GERD, Obesity,
Hepatosplenomegaly, History of pancreatitis due to elevated
triglycerides, s/p Hysterectomy, s/p Lumpectomy, s/p Hemorrhoid
surgery

MEDICATION ON ADMISSION: ASA 325 qd, Plavix 75 qd, Toprol XL 25 qd, Lopid 600 [**Hospital1 **],
Glucophage 1000 [**Hospital1 **], Imdur 30 qd, Pravachol 20 qd, Lisinopril 10
qd, Actos 45 qd, Glipizide 10 qd, Ativan prn, Omeprazole 20 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 140/74, P 75
General: Well developed, obese female in NAD
HEENT: Unremarkable
Neck: Supple, no JVD
Lungs: Clear bilaterally
Heart: RRR, normal s1s2, no murmur or rub
Abdomen: soft, nontender, nondistended, normoactive bowel sounds
Ext: warm, no edema
Pulses: 2+ distally, no carotid or femoral bruits noted
Neuro: Nonfocal, MAE

FAMILY HISTORY: Aunt diagnosed with CAD in her 60's.

SOCIAL HISTORY: Married, lives in [**Location 5110**]. She has one daughter. She is an
office manager at Building 19. Prior light smoker, quit 5 years
ago.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux
Crnry athrscl natve vssl,Intermed coronary synd,Comp-oth cardiac device,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux
Admission Date:  [**2119-8-10**]              Discharge Date:   [**2119-8-19**]

Date of Birth:  [**2064-5-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Exertional chest discomfort

Major Surgical or Invasive Procedure:
[**2119-8-15**] Two vessel coronary artery bypass grafting - left
internal mammary to left anterior descending and vein graft to
diagonal


History of Present Illness:
This is a 55 year old female with multiple cardiac risk factors
and known coronary disease. She has undergone multiple
percutaneous interventions to her left anterior descending
artery in [**2116**] and [**2117**].

She was in her USOH until the end of [**Month (only) 216**] when she began to
experience exertional chest discomfort. She admitted to
occasional rest symptoms. Her angina does respond to Nitro. She
denies claudication, orthopnea, edema, PND, syncope, presyncope
and palpitations. Given her history, she was admitted for
cardiac catheterization.

Past Medical History:
Coronary artery disease - s/p multiple LAD PCI/stenting,
Hypertension, Diabetes mellitus, Hyperlipidemia, GERD, Obesity,
Hepatosplenomegaly, History of pancreatitis due to elevated
triglycerides, s/p Hysterectomy, s/p Lumpectomy, s/p Hemorrhoid
surgery

Social History:
Married, lives in [**Location 5110**]. She has one daughter. She is an
office manager at Building 19. Prior light smoker, quit 5 years
ago.

Family History:
Aunt diagnosed with CAD in her 60's.

Physical Exam:
Vitals: BP 140/74, P 75
General: Well developed, obese female in NAD
HEENT: Unremarkable
Neck: Supple, no JVD
Lungs: Clear bilaterally
Heart: RRR, normal s1s2, no murmur or rub
Abdomen: soft, nontender, nondistended, normoactive bowel sounds
Ext: warm, no edema
Pulses: 2+ distally, no carotid or femoral bruits noted
Neuro: Nonfocal, MAE

Pertinent Results:
[**2119-8-17**] 03:24AM BLOOD WBC-7.0 RBC-2.95* Hgb-8.5* Hct-24.8*
MCV-84 MCH-28.7 MCHC-34.3 RDW-15.5 Plt Ct-212
[**2119-8-17**] 03:24AM BLOOD Glucose-152* UreaN-15 Creat-0.6 Na-139
K-3.6 Cl-102 HCO3-27 AnGap-14
[**2119-8-10**] 03:58PM BLOOD %HbA1c-7.7* [Hgb]-DONE [A1c]-DONE

Brief Hospital Course:
Mrs. [**Known lastname 1313**] was admitted and underwent cardiac catheterization.
Angiography was notable for 90% proximal and mid LAD in-stent
restenoses. The second diagonal also had a 80% lesion. The left
main, circumflex and right coronary arteries had no significant
disease. Based on the above findings, cardiac surgery was
consulted and further evaluation was performed as the patient
preferred to proceed with surgical revascularization. A carotid
ultrasound was normal. An echocardiogram revealed a LVEF of 70%
with only trivial mitral regurgitation. The ascending aorta was
mildly dilated, measuring 3.9 centimeters. The rest of her
evaluation was unremarkable and she was cleared for surgery.

On [**2119-8-15**], Dr. [**Last Name (STitle) **] performed two vessel coronary artery
bypass grafting. The operation was complicated by a mild
coagulopathy. A postoperative TEE showed normal LV function and
no mitral regurgitation. Following surgery, she was brought to
the CSRU. Her coagulopathy improved with multiple blood
products. No further intervention was required. Within 24 hours
she was extubated and awoke neurologically intact. She
maintained stable hemodynamics and remained in a normal sinus
rhythm. On POD#1, she transferred to the SDU.  Beta blockade was
resumed and advanced as tolerated. She remained fluid overloaded
and required further diuresis. She responded well to Lasix and
by discharge, had room air oxygen saturations of *******. She
made steady progress and worked daily with PT. All tubes and
wires were removed without incident. Medical therapy was
optimized and she was discharged to home on POD#4.

Medications on Admission:
ASA 325 qd, Plavix 75 qd, Toprol XL 25 qd, Lopid 600 [**Hospital1 **],
Glucophage 1000 [**Hospital1 **], Imdur 30 qd, Pravachol 20 qd, Lisinopril 10
qd, Actos 45 qd, Glipizide 10 qd, Ativan prn, Omeprazole 20 qd

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. Glipizide 10 mg Tab, Sust Release Osmotic Push Sig: One (1)
Tab, Sust Release Osmotic Push PO DAILY (Daily).
4. Pioglitazone 45 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

6. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
7. Pravastatin Sodium 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
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. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
11. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day
for 2 weeks.
13. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO once a day for 2 weeks.
14. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Coronary artery disease - s/p CABG x 2, Hypertension, Diabetes
mellitus, Hyperlipidemia, GERD, Obesity, Hepatosplenomegaly,
History of pancreatitis


Discharge Condition:
Good


Discharge Instructions:
Patient may shower. No baths. No lotions or creams to incisions.
No lifting no more than 10 lbs for 10 weeks. No driving for one
month. Monitor wounds for signs of infection.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **](PCP) in [**1-12**] weeks
Dr. [**First Name4 (NamePattern1) 122**] [**Last Name (NamePattern1) **](cardiologist) in [**1-12**] weeks



Completed by:[**2119-8-18**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux'}


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: Exertional chest discomfort

PRESENT ILLNESS: This is a 55 year old female with multiple cardiac risk factors
and known coronary disease. She has undergone multiple
percutaneous interventions to her left anterior descending
artery in [**2116**] and [**2117**].

MEDICAL HISTORY: Coronary artery disease - s/p multiple LAD PCI/stenting,
Hypertension, Diabetes mellitus, Hyperlipidemia, GERD, Obesity,
Hepatosplenomegaly, History of pancreatitis due to elevated
triglycerides, s/p Hysterectomy, s/p Lumpectomy, s/p Hemorrhoid
surgery

MEDICATION ON ADMISSION: ASA 325 qd, Plavix 75 qd, Toprol XL 25 qd, Lopid 600 [**Hospital1 **],
Glucophage 1000 [**Hospital1 **], Imdur 30 qd, Pravachol 20 qd, Lisinopril 10
qd, Actos 45 qd, Glipizide 10 qd, Ativan prn, Omeprazole 20 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 140/74, P 75
General: Well developed, obese female in NAD
HEENT: Unremarkable
Neck: Supple, no JVD
Lungs: Clear bilaterally
Heart: RRR, normal s1s2, no murmur or rub
Abdomen: soft, nontender, nondistended, normoactive bowel sounds
Ext: warm, no edema
Pulses: 2+ distally, no carotid or femoral bruits noted
Neuro: Nonfocal, MAE

FAMILY HISTORY: Aunt diagnosed with CAD in her 60's.

SOCIAL HISTORY: Married, lives in [**Location 5110**]. She has one daughter. She is an
office manager at Building 19. Prior light smoker, quit 5 years
ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux'}
