CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 71 year old male with new onset chest pain.  He was awoken from
sleep at approximately 2AM with chest "burning" in the left
parasternal area, that radiated to his left jaw, relieved with
SL NTG at [**Hospital3 **] and then reoccured. Was transferred
for further cardiac management. He denied SOB or diaphoresis,
but did admit to some mild nausea with his chest pain.  He
denies any prior history of chest pain or chest pressure in the
past.  He does admit to some mild SOB while walking up stairs as
well as calf pain when walking distances.

MEDICAL HISTORY: - Type II DM
- HTN
- Hypothyroidism
- Hyperlipidemia
- Depression
- GERD
- TIAs
- s/p Right carotid endarterectomy [**9-28**]
- s/p hip replacement
- s/p left mastectomy 3 years ago for breast cancer (breast
cancer diagnosed after patient noted bleeding from left nipple)

MEDICATION ON ADMISSION: Celexa 20mg PO daily
Ritalin 10mg PO BID
Glyburide 5mg PO BID
Synthroid 175mcg PO daily
Trazadone 100mg PO daily
Guaifenesin 600mg PO BID
Insulin NPH 20 units QAM/25 units QPM
Insulin Regular 5 units QAM/ 10 units QPM
Lisinopril 20mg PO daily
Terazosin 5mg PO QHS
Rosigilitazone 4 mg PO daily
Lovastatin 20mg PO daily
Prilosec 20mg PO daily
Hyoscyamine 0.375 PO daily
Aspirin 325mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals T 97.7, BP 132/51, HR 77, RR 18, O2 sat 99% on 4L
Gnl: NAD, Alert and oriented x 3
HEENT: PERRLA, Anicteric, MMM, JVP to angle of jaw; Well healed
right carotid endarterectomy scar along right neck
CV: RRR, Normal S1 + S2, No murmurs, rubs or gallops
Chest: Left mastectomy scar, well healed
Resp: Clear to auscultation bilaterally, No wheezes or crackles
Abd: Soft, Nontender, NABS, No hepatosplenomegaly
Extremities: No cyanosis, or clubbing; 1+ LE edema on shins;
DT/PT intact, feet warm, hairless lower legs
skin/nails: no rashes/no jaundice/no splinters
Neuro: AAOx3

FAMILY HISTORY: Father- MI at age 63
Mother- MI at age 80

SOCIAL HISTORY: Patient lives with his wife in southern [**Name (NI) 3914**]. Formerly
operated a bed and breakfast.
- Quit smoking 50 years ago, smoke 1 ppd x 6-8 years
- Occasional EtOH use, 1-2 times/month
- No recreational drug use
Subendocardial infarction, initial episode of care,Chronic kidney disease, unspecified,Diastolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Subendo infarct, initial,Chronic kidney dis NOS,Diastolc hrt failure NOS,Crnry athrscl natve vssl,Hy kid NOS w cr kid I-IV,Esophageal reflux,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2114-11-25**]              Discharge Date:   [**2114-12-2**]

Date of Birth:  [**2043-9-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
Cardiac Catherization [**2114-11-26**]
Coronary Artery Bypass Graft x3 (saphenous vein graft -> left
anterior descending, saphenous vein graft -> right coronary
artery, saphenous vein graft->posterior lateral branch)[**2114-11-27**]

History of Present Illness:
71 year old male with new onset chest pain.  He was awoken from
sleep at approximately 2AM with chest "burning" in the left
parasternal area, that radiated to his left jaw, relieved with
SL NTG at [**Hospital3 **] and then reoccured. Was transferred
for further cardiac management. He denied SOB or diaphoresis,
but did admit to some mild nausea with his chest pain.  He
denies any prior history of chest pain or chest pressure in the
past.  He does admit to some mild SOB while walking up stairs as
well as calf pain when walking distances.

Past Medical History:
- Type II DM
- HTN
- Hypothyroidism
- Hyperlipidemia
- Depression
- GERD
- TIAs
- s/p Right carotid endarterectomy [**9-28**]
- s/p hip replacement
- s/p left mastectomy 3 years ago for breast cancer (breast
cancer diagnosed after patient noted bleeding from left nipple)


Social History:
Patient lives with his wife in southern [**Name (NI) 3914**]. Formerly
operated a bed and breakfast.
- Quit smoking 50 years ago, smoke 1 ppd x 6-8 years
- Occasional EtOH use, 1-2 times/month
- No recreational drug use


Family History:
Father- MI at age 63
Mother- MI at age 80


Physical Exam:
Vitals T 97.7, BP 132/51, HR 77, RR 18, O2 sat 99% on 4L
Gnl: NAD, Alert and oriented x 3
HEENT: PERRLA, Anicteric, MMM, JVP to angle of jaw; Well healed
right carotid endarterectomy scar along right neck
CV: RRR, Normal S1 + S2, No murmurs, rubs or gallops
Chest: Left mastectomy scar, well healed
Resp: Clear to auscultation bilaterally, No wheezes or crackles
Abd: Soft, Nontender, NABS, No hepatosplenomegaly
Extremities: No cyanosis, or clubbing; 1+ LE edema on shins;
DT/PT intact, feet warm, hairless lower legs
skin/nails: no rashes/no jaundice/no splinters
Neuro: AAOx3

Discharge
Vitals 98.1, 70 sr, 130/70, 20, 99% RA
Gen A/Ox3 NAD
Cards RRR
Lungs CTAB
Abd +BS
Inc sternum stable
Ext no edema


Pertinent Results:
CXR [**11-28**]
Lung volumes are preserved following extubation. Mild
enlargement of the postoperative cardiomediastinal silhouette is
comparable. Lungs are clear and there is no pleural effusion or
pneumothorax.

TEE [**11-27**]
PRE-CPB No atrial septal defect is seen by 2D or color Doppler.
There is mild
symmetric left ventricular hypertrophy. Regional left
ventricular wall motion
is normal. Overall left ventricular systolic function is normal
(LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are
simple atheroma in the aortic arch. There are complex (>4mm)
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. Mild (1+) mitral
regurgitation is
seen. There is a trivial/physiologic pericardial effusion.

POST-CPB Normal biventricular systolic function. No other
changes from pre-CPB
findings. Thoracic aorta appears intact.

[**2114-12-2**] 04:28AM BLOOD WBC-10.6 RBC-2.62* Hgb-7.9* Hct-22.4*
MCV-86 MCH-30.0 MCHC-35.1* RDW-15.0 Plt Ct-246
[**2114-11-25**] 10:00AM BLOOD WBC-9.2 RBC-3.70* Hgb-11.0* Hct-32.4*
MCV-88 MCH-29.8 MCHC-34.1 RDW-14.0 Plt Ct-180
[**2114-12-2**] 04:28AM BLOOD Plt Ct-246
[**2114-11-28**] 02:34AM BLOOD PT-13.0 PTT-24.9 INR(PT)-1.1
[**2114-11-25**] 10:00AM BLOOD Plt Ct-180
[**2114-11-25**] 10:00AM BLOOD PT-15.3* PTT-70.7* INR(PT)-1.4*
[**2114-12-2**] 04:28AM BLOOD Glucose-118* UreaN-37* Creat-1.6* Na-136
K-4.5 Cl-101 HCO3-25 AnGap-15
[**2114-11-25**] 10:00AM BLOOD Glucose-195* UreaN-32* Creat-1.4* Na-140
K-4.9 Cl-107 HCO3-21* AnGap-17
[**2114-11-26**] 12:01PM BLOOD ALT-15 AST-32 AlkPhos-41 Amylase-39
TotBili-0.4

Brief Hospital Course:
Presented to [**Location (un) 620**] [**Hospital1 18**] with chest pain and then transferred
to [**Hospital1 18**] for cardiac management.  He ruled in for STEMI [**11-25**] and
then underwent cardiac catherization [**11-26**] which revealed 3
vessel coronary artery disease.  He underwent cardiac surgery
preoperative workup and [**11-27**] went to the operating room for
coronary artery bypass graft surgery.  Please see operative
report for further details.  He was transferred to the cardiac
surgery unit on insulin, propofol, and neosynephrine.  In the
first 24 hours he awoke neurologically intact, extubated without
difficulty, and weaned off vasopressors.  He continued to
progress and was transferred to [**Hospital Ward Name **] 2 on post operative day 1.
He continued to progress except for elevated blood sugars and
returned to the cardiac surgery recovery unit for blood glucose
management and insulin drip.  He was transitioned back to NPH
and regular insulin sliding scale with controlled blood sugars.
He was transferred to [**Hospital Ward Name **] 2 were he continued to progress and
was ready for discharge with VNA services on postoperative day
5.  Plan for continued glucose monitoring and follow up with Dr
[**Last Name (STitle) 11694**].


Medications on Admission:
Celexa 20mg PO daily
Ritalin 10mg PO BID
Glyburide 5mg PO BID
Synthroid 175mcg PO daily
Trazadone 100mg PO daily
Guaifenesin 600mg PO BID
Insulin NPH 20 units QAM/25 units QPM
Insulin Regular 5 units QAM/ 10 units QPM
Lisinopril 20mg PO daily
Terazosin 5mg PO QHS
Rosigilitazone 4 mg PO daily
Lovastatin 20mg PO daily
Prilosec 20mg PO daily
Hyoscyamine 0.375 PO daily
Aspirin 325mg PO daily

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
for 5 days
2. 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*
3. Levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*175 Tablet(s)* Refills:*2*
4. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Methylphenidate 10 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
8. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
NPH insulin resume home dosing varying scale
Regular insulin continue with sliding scale as prior to
admission
Trazadone 100mg once daily
Guaifenisin 600mg twice a day
Hytrin 5mg once daily
Rosiglitazone 4mg twice a day
Zocor 20mg once daily
Prilosec 20mg daily
Hyoscyamine 0.375mg once daily


Discharge Disposition:
Home With Service

Facility:
VNA Alliance NH and [**State 3914**]

Discharge Diagnosis:
Cardiac Catherization [**2114-11-26**]
Coronary Artery Bypass Graft x3 (saphenous vein graft -> left
anterior descending, saphenous vein graft -> right coronary
artery, saphenous vein graft->posterior lateral branch)[**2114-11-27**]

Discharge Condition:
Good


Discharge Instructions:
[**Month (only) 116**] shower, 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 poiunds in 24 hours or
5 pounds in one week
No creams, lotions, powders, or ointments to incisions
No driving for one month
No heavy lifting (10 pounds) for 10 week
Call with any questions or concerns

Followup Instructions:
Dr. [**Last Name (STitle) **] in CT surgery clinic in 4 weeks.  Please call
[**Telephone/Fax (1) 170**] for an appointment.

Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])



Completed by:[**2114-12-3**]
{'Subendocardial infarction, initial episode of care,Chronic kidney disease, unspecified,Diastolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 71 year old male with new onset chest pain.  He was awoken from
sleep at approximately 2AM with chest "burning" in the left
parasternal area, that radiated to his left jaw, relieved with
SL NTG at [**Hospital3 **] and then reoccured. Was transferred
for further cardiac management. He denied SOB or diaphoresis,
but did admit to some mild nausea with his chest pain.  He
denies any prior history of chest pain or chest pressure in the
past.  He does admit to some mild SOB while walking up stairs as
well as calf pain when walking distances.

MEDICAL HISTORY: - Type II DM
- HTN
- Hypothyroidism
- Hyperlipidemia
- Depression
- GERD
- TIAs
- s/p Right carotid endarterectomy [**9-28**]
- s/p hip replacement
- s/p left mastectomy 3 years ago for breast cancer (breast
cancer diagnosed after patient noted bleeding from left nipple)

MEDICATION ON ADMISSION: Celexa 20mg PO daily
Ritalin 10mg PO BID
Glyburide 5mg PO BID
Synthroid 175mcg PO daily
Trazadone 100mg PO daily
Guaifenesin 600mg PO BID
Insulin NPH 20 units QAM/25 units QPM
Insulin Regular 5 units QAM/ 10 units QPM
Lisinopril 20mg PO daily
Terazosin 5mg PO QHS
Rosigilitazone 4 mg PO daily
Lovastatin 20mg PO daily
Prilosec 20mg PO daily
Hyoscyamine 0.375 PO daily
Aspirin 325mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals T 97.7, BP 132/51, HR 77, RR 18, O2 sat 99% on 4L
Gnl: NAD, Alert and oriented x 3
HEENT: PERRLA, Anicteric, MMM, JVP to angle of jaw; Well healed
right carotid endarterectomy scar along right neck
CV: RRR, Normal S1 + S2, No murmurs, rubs or gallops
Chest: Left mastectomy scar, well healed
Resp: Clear to auscultation bilaterally, No wheezes or crackles
Abd: Soft, Nontender, NABS, No hepatosplenomegaly
Extremities: No cyanosis, or clubbing; 1+ LE edema on shins;
DT/PT intact, feet warm, hairless lower legs
skin/nails: no rashes/no jaundice/no splinters
Neuro: AAOx3

FAMILY HISTORY: Father- MI at age 63
Mother- MI at age 80

SOCIAL HISTORY: Patient lives with his wife in southern [**Name (NI) 3914**]. Formerly
operated a bed and breakfast.
- Quit smoking 50 years ago, smoke 1 ppd x 6-8 years
- Occasional EtOH use, 1-2 times/month
- No recreational drug use 

### Response:
{'Subendocardial infarction, initial episode of care,Chronic kidney disease, unspecified,Diastolic heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
