CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This 58 year old white male has a history of hypertension,
hperlipidemia, and CAD.  He had drug eluting stents to the
proximal and distal RCA in [**2-4**] and has had intermittent chest
heaviness with emotional stress and exertion since [**10-10**] which
responds to SL NTG.  His most recent ETT was done in [**2126-9-25**] and
was negative for perfusion defects with normal LV funtion.  He
underwent cardiac cath today and is now referred for surgery.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: -Diabetes, +Dyslipidemia,
+Hypertension
2. CARDIAC HISTORY:
-CABG: n/a
-PERCUTANEOUS CORONARY INTERVENTIONS: stent to RCA [**2122**]
-PACING/ICD: n/a
3. OTHER PAST MEDICAL HISTORY:
Hypercholesterolemia
hypertriglyceridemia
low HDL
overweight
hypertension
glaucoma

MEDICATION ON ADMISSION: BRIMONIDINE 0.15 % Drops - 1 drop(s) each eye [**Hospital1 **],
EZETIMIBE-SIMVASTATIN 10 mg-80 mg HS, FENOFIBRATE
NANOCRYSTALLIZED 48 mg QPM, ISOSORBIDE MONONITRATE SR 30 mg
daily, LORAZEPAM 1 mg HS PRN, LOSARTAN 50 mg daily, TOPROL 50 mg
daily, NITROGLYCERIN 0.4 mg PRN, PAROXETINE HCL 40 mg daily,
ASPIRIN 325 mg daily, OMEGA-3 FATTY ACIDS 1,000 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:60S Resp:18  O2 sat: 95% RA
B/P  Right: 92/55   Left:
Height: 5'6"    Weight: 86.2 kg

FAMILY HISTORY: Strong family history of HTN and CAD.

SOCIAL HISTORY: Works as regional supervisor for pharmacies.
-Tobacco history: smokes 0.5-1 packs/day since age 35
-ETOH: denies
-Illicit drugs: denies
Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Paralytic ileus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Unspecified glaucoma,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified
Crnry athrscl natve vssl,Mitral/aortic val insuff,Paralytic ileus,DMII wo cmp nt st uncntr,Atrial fibrillation,Status-post ptca,Hypertension NOS,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Glaucoma NOS,Abn react-anastom/graft,Anemia NOS
Admission Date:  [**2128-1-9**]              Discharge Date:   [**2128-1-17**]

Date of Birth:  [**2069-3-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2128-1-9**] - Coronary artery bypass graft x4--left internal
mammary artery to left anterior descending artery and saphenous
vein grafts to diagonal, obtuse marginal, and right coronary
arteries.


History of Present Illness:
This 58 year old white male has a history of hypertension,
hperlipidemia, and CAD.  He had drug eluting stents to the
proximal and distal RCA in [**2-4**] and has had intermittent chest
heaviness with emotional stress and exertion since [**10-10**] which
responds to SL NTG.  His most recent ETT was done in [**2126-9-25**] and
was negative for perfusion defects with normal LV funtion.  He
underwent cardiac cath today and is now referred for surgery.


Past Medical History:
1. CARDIAC RISK FACTORS:: -Diabetes, +Dyslipidemia,
+Hypertension
2. CARDIAC HISTORY:
-CABG: n/a
-PERCUTANEOUS CORONARY INTERVENTIONS: stent to RCA [**2122**]
-PACING/ICD: n/a
3. OTHER PAST MEDICAL HISTORY:
Hypercholesterolemia
hypertriglyceridemia
low HDL
overweight
hypertension
glaucoma

Social History:
Works as regional supervisor for pharmacies.
-Tobacco history: smokes 0.5-1 packs/day since age 35
-ETOH: denies
-Illicit drugs: denies


Family History:
Strong family history of HTN and CAD.

Physical Exam:
Pulse:60S Resp:18  O2 sat: 95% RA
B/P  Right: 92/55   Left:
Height: 5'6"    Weight: 86.2 kg

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
Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds
+
[x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 1+  Left: 1+
Radial       Right: cath site  Left: 2+

Carotid Bruit        Right: no   Left: no


Pertinent Results:
[**2128-1-9**] ECHO
Pre CPB:
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. Left
ventricular wall thicknesses are normal.
The left ventricular cavity is mildly dilated. Overall left
ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The aortic root is mildly dilated at the sinus level. There are
simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. There is no aortic valve
stenosis. Mild (1+) aortic regurgitation is seen.
There is no mitral valve prolapse. Mild to moderate ([**2-1**]+)
mitral regurgitation is seen.
Dr. [**Last Name (STitle) **] was notified in person of the results.

Post CPB:
The patient is A-Paced, on no inotropes.
Preserved biventricular systolic fxn.
MR [**First Name (Titles) **] [**Last Name (Titles) **] are unchanged.
Aorta intact.

[**2128-1-13**] CT scan
1. Dilated small bowel, most likely due to postoperative ileus;
however, the collapsed distal loops of ileum are atypical, this
could alternatively
represent an early small-bowel obstruction and clinical
correlation is
advised.
2. Bilateral lower lobe atelectasis.
3. Bilateral fat-containing inguinal hernias.
4. Exophytic cyst in the upper pole of the left kidney. Small
low-attenuation lesion, too small to characterize in the mid
pole of the left kidney.
5. Calcification of the aorta is noted without aneurysmal
dilatation.


Brief Hospital Course:
Mr. [**Known lastname 27996**] was admitted to the [**Hospital1 18**] on [**2128-1-9**] for surgical
management of his coronary artery disease. He was taken to the
operating room where he underwent coronary artery bypass
grafting to four vessels. Please see operative note for details.
Postoperatively he was taken to the intensive care unit for
monitoring. Over the next several hours, he awoke neurologically
intact and was extubated. On postoperative day one, he was
transferred to the step down unit for further recovery. He was
gently diuresed towards his preoperative weight. the physical
therapy service was consulted for assistance with his
postoperative strength and mobility. [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] diabetes consult
was obtained for an elevated hemoglobin A1c and blood sugars.
Metformin 500mg daily was ultimately started and Dr. [**Last Name (STitle) 1007**] will
follow-up on his diabetes care. He developed atrial fibrillation
which converted with amiodarone. As he had a couple of
paroxysmal episodes, coumadin was started. Amiodarone was
eventually stopped due to bradycardia and he was continued on
lopressor. He developed abdominal distension and decreased bowel
sounds. A general surgery consult was obtained and a CT scan was
performed with results consistent with a postoperative ileus. He
was moved back to the intensive care unit for 2 days. A
nasogastric tube was placed with large amounts of bilious
drainage. Over the next 2 days, his abdominal symptoms improved
and clear liquids were started with no issue. His diet was
slowly advance and he began to move his bowels. Antibiotics,
which were started prophylactically, were stopped. He was
transferred back to the step down unit. He continued to make
steady progress and was discharged home on [**2128-1-17**]. Dr. [**Last Name (STitle) 1007**]
will follow his coumadin for a goal INR of 2.0-2.5. His first
blood draw will be [**2128-1-19**] and he will take 2mg on [**2128-1-18**]. He
will follow-up with Dr. [**First Name (STitle) **], Dr. [**Last Name (STitle) 911**] and Dr. [**Last Name (STitle) 1007**] as an
outpatient.

Medications on Admission:
BRIMONIDINE 0.15 % Drops - 1 drop(s) each eye [**Hospital1 **],
EZETIMIBE-SIMVASTATIN 10 mg-80 mg HS, FENOFIBRATE
NANOCRYSTALLIZED 48 mg QPM, ISOSORBIDE MONONITRATE SR 30 mg
daily, LORAZEPAM 1 mg HS PRN, LOSARTAN 50 mg daily, TOPROL 50 mg
daily, NITROGLYCERIN 0.4 mg PRN, PAROXETINE HCL 40 mg daily,
ASPIRIN 325 mg daily, OMEGA-3 FATTY ACIDS 1,000 mg daily

Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Paxil 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
Disp:*1 Dropper* Refills:*2*
5. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*0*
6. 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*
7. fenofibrate nanocrystallized 48 mg Tablet Sig: One (1) Tablet
PO once a day: Take in the evening.
Disp:*30 Tablet(s)* Refills:*2*
8. Vicodin 5-500 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
10. Vytorin [**10/2097**] 10-80 mg Tablet Sig: One (1) Tablet PO once a
day: Take in the evening.
Disp:*30 Tablet(s)* Refills:*2*
11. Coumadin 1 mg Tablet Sig: As instructed by Dr. [**Last Name (STitle) 1007**] Tablet
PO once a day: Goal INR 2.0-2.5. Your first dose will be 2mg on
[**2128-1-18**] and then as instructed by Dr. [**Last Name (STitle) 1007**].
Disp:*30 Tablet(s)* Refills:*2*
12. metformin 500 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Hypertension
Type 2 diabetes
Hyperlipidemia
CAD s/p RCA stenting in [**2122**]
Glaucoma
Hx of remote hepatitis A
Depression


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with percocet
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
1) Please shower daily including washing incisions gently with
mild soap, no baths or swimming until cleared by surgeon. Look
at your incisions daily for redness or drainage.
2) Please NO lotions, cream, powder, or ointments to incisions.
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart provided.
4) No driving for approximately one month and while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon when you will likely be cleared to drive.
5) No lifting more than 10 pounds for 10 weeks
6) Take lasix 40mg once daily with potassium 20mEq for 7 days
then stop. Monitor your weight daily and report any gain of
weight or worsening swelling in your lower extremities.
7) Coumadin is for atrial fibrillation. Please take daily or as
instructed by Dr. [**Last Name (STitle) 1007**]. Goal INR is 2.0-2.5. Your discharge
dose is 2mg daily. Please note that your dose may change based
on your blood levels. You will need to have your blood drawn
Monday [**2128-1-19**] by either VNA or at Dr. [**Last Name (STitle) 25817**] lab. You will
then be called and instructed on what dose to take.
8) Please check fingersticks (blood sugar) as instructed. You
will start metformin 500mg once daily.
9)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**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: [**Doctor First Name **] [**2127-2-16**] 1:00PM ([**Telephone/Fax (1) 1504**]

Please call to schedule appointments with your
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1007**] in [**4-3**] weeks  [**Telephone/Fax (1) 10492**]
Cardiologist: Dr. [**Last Name (STitle) 911**]. Please call to schedule an for
appointment for 4 weeks. ([**Telephone/Fax (1) 7236**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication: Atrial fibrillation
Goal INR 2.0-2.5
First draw [**2128-1-19**]
Results to phone ([**Telephone/Fax (1) 21461**] fax ([**Telephone/Fax (1) 27997**] Dr. [**Last Name (STitle) 1007**]


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

Completed by:[**2128-1-17**]
{'Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Paralytic ileus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Unspecified glaucoma,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified'}


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: This 58 year old white male has a history of hypertension,
hperlipidemia, and CAD.  He had drug eluting stents to the
proximal and distal RCA in [**2-4**] and has had intermittent chest
heaviness with emotional stress and exertion since [**10-10**] which
responds to SL NTG.  His most recent ETT was done in [**2126-9-25**] and
was negative for perfusion defects with normal LV funtion.  He
underwent cardiac cath today and is now referred for surgery.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS:: -Diabetes, +Dyslipidemia,
+Hypertension
2. CARDIAC HISTORY:
-CABG: n/a
-PERCUTANEOUS CORONARY INTERVENTIONS: stent to RCA [**2122**]
-PACING/ICD: n/a
3. OTHER PAST MEDICAL HISTORY:
Hypercholesterolemia
hypertriglyceridemia
low HDL
overweight
hypertension
glaucoma

MEDICATION ON ADMISSION: BRIMONIDINE 0.15 % Drops - 1 drop(s) each eye [**Hospital1 **],
EZETIMIBE-SIMVASTATIN 10 mg-80 mg HS, FENOFIBRATE
NANOCRYSTALLIZED 48 mg QPM, ISOSORBIDE MONONITRATE SR 30 mg
daily, LORAZEPAM 1 mg HS PRN, LOSARTAN 50 mg daily, TOPROL 50 mg
daily, NITROGLYCERIN 0.4 mg PRN, PAROXETINE HCL 40 mg daily,
ASPIRIN 325 mg daily, OMEGA-3 FATTY ACIDS 1,000 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:60S Resp:18  O2 sat: 95% RA
B/P  Right: 92/55   Left:
Height: 5'6"    Weight: 86.2 kg

FAMILY HISTORY: Strong family history of HTN and CAD.

SOCIAL HISTORY: Works as regional supervisor for pharmacies.
-Tobacco history: smokes 0.5-1 packs/day since age 35
-ETOH: denies
-Illicit drugs: denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Paralytic ileus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Unspecified glaucoma,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified'}
