CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 62 year old female transferred from [**Hospital3 **] Hospital with chest
pain and ECG changes for cardiac catheterization.
Patient has h/o HTN, diabetes and strong FH of CAD reports
intermittent exertional chest pressure over past few weeks. This
morning while driving to work had c/o "[**11-18**]" mid sternal chest
pressure radiating to neck, shoulders and throat associated with
nausea and shortness of breath. Denies c/o PND,
orthopnea, diaphoresis, lightheadedness, edema or palpatations.
Usually sleeps with 1 pillow. ECG reportedly showed ST
depression inferiorly and TWI anteriorly (no ECG available).
Patient reports chest pressure relieved after SL NTG. Started on
NTG gtt, heparin and integrellin gtt at OSH. CK 284, MB negative
4.8. Transferred for cardiac cath. Pain free on arrival to
holding area.

MEDICAL HISTORY: HTN
Type I Diabetes
Peripheral neuropathy
s/p Cholecystectomy [**2135**]
s/p C-section [**2145**]

MEDICATION ON ADMISSION: Aspirin 81 mg daily
Univasc 15 mg daily (reports noncompliance/ took approx 3X/WK)
HCTZ 25 mg daily (reports noncompliance/ took approx 3X/WK)
Protonix 40 mg daily
Vitamin E 4400 IU daily
Multivitamin daily
Caltrate 600 mg daily
Avandia 4 mg daily
Insulin 70/30  40 units [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Arrived to holding area in NAD, pain free.
Overweight female, skin warm and dry.
Ht:5'7", Wt:223 lbs.
VSS 145/70-72(SR)
Neck: carotids 2+, no bruits
Heart: S1,S2, no murmurs/gallops or rubs noted
Lungs clear
Abdomen large soft and nontender, +BS, no bruits
Pulses:   R         L
Femoral   1+        1+ no bruits
DP        2+        2+
PT        1+        1+
Extremities: no edema noted, good CSM to feet.

FAMILY HISTORY: Strong FH of CAD-->mother with MI at age 45, father died of MI
at age 61.

SOCIAL HISTORY: Lives with husband, 2 children ages 38 and 20 yrs. Works as
bookkeeper and at [**Hospital3 12678**] College. Nonsmoker. Denies
alcohol use.
Subendocardial infarction, initial episode of care,Phlebitis and thrombophlebitis of upper extremities, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Esophageal reflux,Unspecified hereditary and idiopathic peripheral neuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Family history of ischemic heart disease,Long-term (current) use of insulin
Subendo infarct, initial,Phlbts vn NOS up extrm,Crnry athrscl natve vssl,Atrial fibrillation,Esophageal reflux,Idio periph neurpthy NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Fam hx-ischem heart dis,Long-term use of insulin
Admission Date:  [**2165-11-19**]              Discharge Date:   [**2165-11-27**]

Date of Birth:  [**2103-3-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2165-11-22**] CABGx3(LIMA->LAD,SVG->D1,SVG->D2)


History of Present Illness:
62 year old female transferred from [**Hospital3 **] Hospital with chest
pain and ECG changes for cardiac catheterization.
Patient has h/o HTN, diabetes and strong FH of CAD reports
intermittent exertional chest pressure over past few weeks. This
morning while driving to work had c/o "[**11-18**]" mid sternal chest
pressure radiating to neck, shoulders and throat associated with
nausea and shortness of breath. Denies c/o PND,
orthopnea, diaphoresis, lightheadedness, edema or palpatations.
Usually sleeps with 1 pillow. ECG reportedly showed ST
depression inferiorly and TWI anteriorly (no ECG available).
Patient reports chest pressure relieved after SL NTG. Started on
NTG gtt, heparin and integrellin gtt at OSH. CK 284, MB negative
4.8. Transferred for cardiac cath. Pain free on arrival to
holding area.


Past Medical History:
HTN
Type I Diabetes
Peripheral neuropathy
s/p Cholecystectomy [**2135**]
s/p C-section [**2145**]


Social History:
Lives with husband, 2 children ages 38 and 20 yrs. Works as
bookkeeper and at [**Hospital3 12678**] College. Nonsmoker. Denies
alcohol use.


Family History:
Strong FH of CAD-->mother with MI at age 45, father died of MI
at age 61.


Physical Exam:
Arrived to holding area in NAD, pain free.
Overweight female, skin warm and dry.
Ht:5'7", Wt:223 lbs.
VSS 145/70-72(SR)
Neck: carotids 2+, no bruits
Heart: S1,S2, no murmurs/gallops or rubs noted
Lungs clear
Abdomen large soft and nontender, +BS, no bruits
Pulses:   R         L
Femoral   1+        1+ no bruits
DP        2+        2+
PT        1+        1+
Extremities: no edema noted, good CSM to feet.


Pertinent Results:
[**2165-11-27**] 07:53AM BLOOD WBC-10.6 RBC-2.83* Hgb-9.2* Hct-26.1*
MCV-92 MCH-32.4* MCHC-35.2* RDW-13.9 Plt Ct-282
[**2165-11-19**] 04:10PM BLOOD WBC-9.2 RBC-4.50 Hgb-13.7 Hct-39.5 MCV-88
MCH-30.6 MCHC-34.8 RDW-12.9 Plt Ct-273
[**2165-11-27**] 07:53AM BLOOD Glucose-114* UreaN-18 Creat-0.8 Na-138
K-4.2 Cl-103 HCO3-27 AnGap-12
[**2165-11-19**] 04:10PM BLOOD Glucose-99 UreaN-14 Creat-0.8 Na-137
K-3.8 Cl-103 HCO3-24 AnGap-14
[**2165-11-27**] 07:53AM BLOOD Calcium-7.9* Phos-2.5* Mg-2.0
[**2165-11-21**] 09:25PM BLOOD %HbA1c-7.0* [Hgb]-DONE [A1c]-DONE

Brief Hospital Course:
Mrs. [**Known lastname 63272**] is a 62 year-old lady who was having worsening
anginal symptoms and underwent cardiac catheterization that
showed a complex proximal left anterior
descending stenosis involving the first diagonal branch and
disease in another diagonal branch. She has some mild to
moderate disease in the circumflex system with no significant
marginal branches. The right coronary was preserved. She
underwent an uncomplicated CABG x 3 on [**2165-11-22**]. Please see OP
report for details. Post-operatively she was cared for in the
CSRU, where she was weened off of all pressors and extubated
without incident. She was intermittently transfused to maintain
hematocrit near 30%. Her chest tubes were removed on POD #2.
She did have episodes of atrial fibrillation that required
Amiodarone, and she successfully converted back to a normal
sinus rhythm.  She did well and was able to be transferred to
the floor on POD #3. She remained in a normal sinus rhythm - no
further atrial arrhythmias were noted. She was noted to have a
left forearm phlebitis and a leukocytosis that improved with
antibiotics. Her white count peaked to 19K. By discharge, her
white count improved to 10K. Over several days medical therapy
was optimized. She responded well to diuresis and continued to
make clinical improvments. Physical therapy worked with her
aggressively and she was able to be discharged home on POD #5.
She will remain on Amiodarone until follow up with Dr. [**Last Name (STitle) **]
or local cardiologist.

Medications on Admission:
Aspirin 81 mg daily
Univasc 15 mg daily (reports noncompliance/ took approx 3X/WK)
HCTZ 25 mg daily (reports noncompliance/ took approx 3X/WK)
Protonix 40 mg daily
Vitamin E 4400 IU daily
Multivitamin daily
Caltrate 600 mg daily
Avandia 4 mg daily
Insulin 70/30  40 units [**Hospital1 **]


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. 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*
4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Rosiglitazone 4 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take 2 twice a day for 3 days, then take 2 once a day
for 7 days, then take 1 once a day ongoing.
Disp:*120 Tablet(s)* Refills:*0*
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
10. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for
7 days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
11. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
12. Insulin 70/30 70-30 unit/mL Suspension Sig: Forty (40) units
Subcutaneous twice a day.
Disp:*qs * Refills:*2*
13. Caltrate [**Telephone/Fax (3) 41616**]-25 mg-unit-mg Tablet Sig: One (1)
Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
CAD
HTN
DM
Hepatitis A
GERD
Phlebitis


Discharge Condition:
good.


Discharge Instructions:
Patient may shower. No baths. No lotions or creams to incisions.
No driving for 4-6 weeks. No lifting more than 10 lbs for at
least 10 weeks.
Please call for fever, redness or drainage at incision, or
weight gain greater than 2 lbs in 1 day or 5 lbs in 1 week.

Followup Instructions:
Please follow-up with Dr [**Last Name (STitle) **] in 1 month, call to schedule an
appointment.
Please follow-up with Dr [**Last Name (STitle) 5193**] in 2 weeks.



Completed by:[**2165-12-16**]
{'Subendocardial infarction, initial episode of care,Phlebitis and thrombophlebitis of upper extremities, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Esophageal reflux,Unspecified hereditary and idiopathic peripheral neuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Family history of ischemic heart disease,Long-term (current) use of insulin'}


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 year old female transferred from [**Hospital3 **] Hospital with chest
pain and ECG changes for cardiac catheterization.
Patient has h/o HTN, diabetes and strong FH of CAD reports
intermittent exertional chest pressure over past few weeks. This
morning while driving to work had c/o "[**11-18**]" mid sternal chest
pressure radiating to neck, shoulders and throat associated with
nausea and shortness of breath. Denies c/o PND,
orthopnea, diaphoresis, lightheadedness, edema or palpatations.
Usually sleeps with 1 pillow. ECG reportedly showed ST
depression inferiorly and TWI anteriorly (no ECG available).
Patient reports chest pressure relieved after SL NTG. Started on
NTG gtt, heparin and integrellin gtt at OSH. CK 284, MB negative
4.8. Transferred for cardiac cath. Pain free on arrival to
holding area.

MEDICAL HISTORY: HTN
Type I Diabetes
Peripheral neuropathy
s/p Cholecystectomy [**2135**]
s/p C-section [**2145**]

MEDICATION ON ADMISSION: Aspirin 81 mg daily
Univasc 15 mg daily (reports noncompliance/ took approx 3X/WK)
HCTZ 25 mg daily (reports noncompliance/ took approx 3X/WK)
Protonix 40 mg daily
Vitamin E 4400 IU daily
Multivitamin daily
Caltrate 600 mg daily
Avandia 4 mg daily
Insulin 70/30  40 units [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Arrived to holding area in NAD, pain free.
Overweight female, skin warm and dry.
Ht:5'7", Wt:223 lbs.
VSS 145/70-72(SR)
Neck: carotids 2+, no bruits
Heart: S1,S2, no murmurs/gallops or rubs noted
Lungs clear
Abdomen large soft and nontender, +BS, no bruits
Pulses:   R         L
Femoral   1+        1+ no bruits
DP        2+        2+
PT        1+        1+
Extremities: no edema noted, good CSM to feet.

FAMILY HISTORY: Strong FH of CAD-->mother with MI at age 45, father died of MI
at age 61.

SOCIAL HISTORY: Lives with husband, 2 children ages 38 and 20 yrs. Works as
bookkeeper and at [**Hospital3 12678**] College. Nonsmoker. Denies
alcohol use. 

### Response:
{'Subendocardial infarction, initial episode of care,Phlebitis and thrombophlebitis of upper extremities, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Esophageal reflux,Unspecified hereditary and idiopathic peripheral neuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Family history of ischemic heart disease,Long-term (current) use of insulin'}
