CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 70 y/o russian speaking Male w/ PMH of HTN, hyperlipidemia,
recent episodes of angina, with concern for unstable angina, and
3vd transferred from [**Hospital1 3278**] not on heparin or plavix. Chest pain
w/ exertion and DOE that began on Friday. Relieved by nitro. He
is transferred from [**Hospital1 3278**] to us for medical management over the
w/e and then tentative CABG with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on Tueday morning.
Trops neg x3. No ST-TW changes on EKG. CD of angiogram here with
him. Nuclear stress was done> large sized moderately severe
infarct in the inferior wall w/ ischemia  in the inferior
lateral wall and hypokinesis of the inferior lateral walls.
During an initial ETT, pt lost consciousness  which was presumed
to be vagal. Cathed yesterday and found to have  normal LM, 65%
LAD (FFR 0.68), 20% D1, 80% proximal Cx, RCA with mid 80%
diffuse disease, distal occlusion. LVEF 60% w/ no aortic
stenosis. No chest pain, no drips, no plavix.
Going under [**Hospital1 1516**] attending (Dr. [**Last Name (STitle) 73**] - further f/u with
Dr. [**Last Name (STitle) 171**] in the office. Transfer to [**Hospital Ward Name 121**] 3 for anticipated CT
surgery next week. Copy of cath film with patient.
.
ROS:
Denies any prior history of stroke, TIA, deep venous thrombosis,
pulmonary embolism, bleeding at the time of surgery, myalgias,
joint pains, cough, hemoptysis, black stools or red stools.
Denies recent fevers, chills or rigors. Denies exertional
buttock or calf pain. Otherwise negative.

MEDICAL HISTORY: Coronary Artery Disease
PMH:
-HTN
-HLD
-LLE cellulitis (?)-pt unaware

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Aspirin 81 mg PO DAILY
2. Doxazosin 4 mg PO HS
3. lisinopril-hydrochlorothiazide *NF* 10-12.5 mg Oral QD
4. Atenolol 50 mg PO BID
hold for SBP<100, HR<60
5. Atorvastatin 80 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMIT:
VS: 98.2   70   130/80   18   98  RA
GENERAL: NAD, AxOx3.
HEENT:  JVP not appreciable. Sclera anicteric. EOMI. MMM
CARDIAC: RRR, normal S1, S2. No m/r/g.
LUNGS: CTAB, no crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: pretibial edema none.

FAMILY HISTORY: mom w/ MI ~age 70.

SOCIAL HISTORY: He is originally from [**Country 532**]. 30 pack year smoking hx. Quit 6
yrs ago. occasional ETOH, denies illicit drugs. He works in
assembly of dice and various dice-related products
Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Intermediate coronary syndrome,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Crnry athrscl natve vssl,Atrial fibrillation,Intermed coronary synd,Iatrogenc hypotnsion NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,BPH w/o urinary obs/LUTS
Admission Date:  [**2146-10-7**]              Discharge Date:   [**2146-10-15**]

Date of Birth:  [**2076-4-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
[**2146-10-11**]
Coronary artery bypass grafting x3,
with the left internal mammary artery to left anterior
descending artery and reverse saphenous vein graft to the
posterior descending artery and the obtuse marginal artery.


History of Present Illness:
70 y/o russian speaking Male w/ PMH of HTN, hyperlipidemia,
recent episodes of angina, with concern for unstable angina, and
3vd transferred from [**Hospital1 3278**] not on heparin or plavix. Chest pain
w/ exertion and DOE that began on Friday. Relieved by nitro. He
is transferred from [**Hospital1 3278**] to us for medical management over the
w/e and then tentative CABG with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on Tueday morning.
Trops neg x3. No ST-TW changes on EKG. CD of angiogram here with
him. Nuclear stress was done> large sized moderately severe
infarct in the inferior wall w/ ischemia  in the inferior
lateral wall and hypokinesis of the inferior lateral walls.
During an initial ETT, pt lost consciousness  which was presumed
to be vagal. Cathed yesterday and found to have  normal LM, 65%
LAD (FFR 0.68), 20% D1, 80% proximal Cx, RCA with mid 80%
diffuse disease, distal occlusion. LVEF 60% w/ no aortic
stenosis. No chest pain, no drips, no plavix.
Going under [**Hospital1 1516**] attending (Dr. [**Last Name (STitle) 73**] - further f/u with
Dr. [**Last Name (STitle) 171**] in the office. Transfer to [**Hospital Ward Name 121**] 3 for anticipated CT
surgery next week. Copy of cath film with patient.
.
ROS:
Denies any prior history of stroke, TIA, deep venous thrombosis,
pulmonary embolism, bleeding at the time of surgery, myalgias,
joint pains, cough, hemoptysis, black stools or red stools.
Denies recent fevers, chills or rigors. Denies exertional
buttock or calf pain. Otherwise negative.

Cardiac review of systems is notable for absence of paroxysmal
nocturnal dyspnea, orthopnea, ankle edema, palpitations.

Past Medical History:
Coronary Artery Disease
PMH:
-HTN
-HLD
-LLE cellulitis (?)-pt unaware

Past Surgical History: none


Social History:
He is originally from [**Country 532**]. 30 pack year smoking hx. Quit 6
yrs ago. occasional ETOH, denies illicit drugs. He works in
assembly of dice and various dice-related products

Family History:
mom w/ MI ~age 70.

Physical Exam:
ADMIT:
VS: 98.2   70   130/80   18   98  RA
GENERAL: NAD, AxOx3.
HEENT:  JVP not appreciable. Sclera anicteric. EOMI. MMM
CARDIAC: RRR, normal S1, S2. No m/r/g.
LUNGS: CTAB, no crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: pretibial edema none.

Pertinent Results:
[**2146-10-11**] Intra-op TEE
Conclusions
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.
Left ventricular wall thicknesses and cavity size are normal.
LVEF-55%. There is mild regional left ventricular systolic
dysfunction with mild hypokinesis in the mid inferior septal
region.
Right ventricular chamber size and free wall motion are normal.
The aortic root is mildly dilated at the sinus level. The
ascending aorta and aortic arch are mildly dilated. There are
simple atheroma throughout the aorta.
There are three aortic valve leaflets. There is no aortic valve
stenosis. Mild (1+) aortic regurgitation is seen. The aortic
regurgitation jet is eccentric, directed toward the anterior
mitral leaflet.
The mitral valve leaflets are mildly thickened. Mild mitral
regurgitation is seen.

Post-Bypass
Post-bypass the patient is A-paced and on a phenylephrine
infusion.
LVEF-55%.
1+AR remains. Mild MR [**First Name (Titles) **] [**Last Name (Titles) 1506**].
There is no echocardiographic evidence of aortic dissection post
decannulation.
.

[**2146-10-15**] 05:45AM BLOOD WBC-9.5 RBC-2.84* Hgb-9.2* Hct-26.5*
MCV-93 MCH-32.5* MCHC-34.9 RDW-13.1 Plt Ct-226
[**2146-10-14**] 05:55AM BLOOD WBC-10.6 RBC-2.89* Hgb-9.2* Hct-26.9*
MCV-93 MCH-32.0 MCHC-34.3 RDW-12.8 Plt Ct-166
[**2146-10-15**] 05:45AM BLOOD Glucose-97 UreaN-13 Creat-0.7 Na-136
K-4.2 Cl-100 HCO3-29 AnGap-11
[**2146-10-14**] 05:55AM BLOOD UreaN-12 Creat-0.7 Na-139 K-4.3 Cl-101
[**2146-10-15**] 05:45AM BLOOD Calcium-8.1* Phos-2.7 Mg-2.2

Brief Hospital Course:
MEDICINE COURSE:
70 y/o russian speaking Male w/ PMH of HTN, HLD, recent episodes
of angina, with concern for unstable angina, and 3VD on cath.
.
# 3-Vessel CAD/Crescendo angina: hx concerning for unstable
angina, enzymes negative, and EKG without ST/TW/Q changes.
Patient was treated with ASA, beta blocker, lipitor, and no
heparin or plavix and transferred to cardiac surgery for CABG.
.
# HTN:  continued HCTZ/ACEi
.
# HLD:  continued statin
.
# BPH: continued doxasozin.
SURGICAL COURSE:
The patient was brought to the Operating Room on [**2146-10-11**] where
the patient underwent CABG x 3 with Dr. [**Last Name (STitle) **].  Overall the
patient tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  The patient
was transferred to the telemetry floor for further recovery.
Chest tubes and pacing wires were discontinued without
complication.  He did have a brief bout of AFib and converted to
Sinus Rhythm with Amiodarone and titration of Beta Blocker.  The
patient was evaluated by the physical therapy service for
assistance with strength and mobility.  By the time of discharge
on POD 4 the patient was ambulating freely, the wound was
healing and pain was controlled with oral analgesics.  The
patient was discharged to the [**Hospital3 2558**] in [**Location (un) **] in
good condition with appropriate follow up instructions.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Aspirin 81 mg PO DAILY
2. Doxazosin 4 mg PO HS
3. lisinopril-hydrochlorothiazide *NF* 10-12.5 mg Oral QD
4. Atenolol 50 mg PO BID
hold for SBP<100, HR<60
5. Atorvastatin 80 mg PO DAILY


Discharge Medications:
1. Aspirin 81 mg PO DAILY
2. Atorvastatin 80 mg PO DAILY
3. Acetaminophen 650 mg PO Q4H:PRN pain/fever
4. Amiodarone 400 mg PO BID
400mg [**Hospital1 **] x 1 week, then 400mg daily x 1 week then 200mg daily
5. Bisacodyl 10 mg PR DAILY:PRN constipation
6. Docusate Sodium 100 mg PO BID
7. Furosemide 40 mg PO DAILY Duration: 1 Weeks
8. Metoprolol Tartrate 25 mg PO TID
Hold for HR < 55 or SBP < 90 and call medical provider.
9. Oxycodone-Acetaminophen (5mg-325mg) [**2-7**] TAB PO Q4H:PRN pain
RX *oxycodone-acetaminophen [Endocet] 5 mg-325 mg [**2-7**] tablet(s)
by mouth every four (4) hours Disp #*40 Tablet Refills:*0
10. Potassium Chloride 20 mEq PO DAILY Duration: 1 Weeks
Hold for K+ > 4.5
11. Ranitidine 150 mg PO BID
12. Doxazosin 4 mg PO HS


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Coronary Artery Disease
PMH:
-HTN
-HLD
-LLE cellulitis (?)-pt unaware

Past Surgical History: none


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, deconditioned
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
Trace lower extremity 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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
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**


Followup Instructions:
You are scheduled for the following appointments:
Surgeon Dr. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8583**], MD Phone:[**Telephone/Fax (1) 170**], [**2146-11-3**] 1:30,
 [**Telephone/Fax (1) 170**]
Cardiologist Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2146-10-31**] 12:20

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) 32246**],[**First Name3 (LF) **] [**Telephone/Fax (1) 32247**] in [**5-12**] 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**



Completed by:[**2146-10-15**]
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Intermediate coronary syndrome,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: 70 y/o russian speaking Male w/ PMH of HTN, hyperlipidemia,
recent episodes of angina, with concern for unstable angina, and
3vd transferred from [**Hospital1 3278**] not on heparin or plavix. Chest pain
w/ exertion and DOE that began on Friday. Relieved by nitro. He
is transferred from [**Hospital1 3278**] to us for medical management over the
w/e and then tentative CABG with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on Tueday morning.
Trops neg x3. No ST-TW changes on EKG. CD of angiogram here with
him. Nuclear stress was done> large sized moderately severe
infarct in the inferior wall w/ ischemia  in the inferior
lateral wall and hypokinesis of the inferior lateral walls.
During an initial ETT, pt lost consciousness  which was presumed
to be vagal. Cathed yesterday and found to have  normal LM, 65%
LAD (FFR 0.68), 20% D1, 80% proximal Cx, RCA with mid 80%
diffuse disease, distal occlusion. LVEF 60% w/ no aortic
stenosis. No chest pain, no drips, no plavix.
Going under [**Hospital1 1516**] attending (Dr. [**Last Name (STitle) 73**] - further f/u with
Dr. [**Last Name (STitle) 171**] in the office. Transfer to [**Hospital Ward Name 121**] 3 for anticipated CT
surgery next week. Copy of cath film with patient.
.
ROS:
Denies any prior history of stroke, TIA, deep venous thrombosis,
pulmonary embolism, bleeding at the time of surgery, myalgias,
joint pains, cough, hemoptysis, black stools or red stools.
Denies recent fevers, chills or rigors. Denies exertional
buttock or calf pain. Otherwise negative.

MEDICAL HISTORY: Coronary Artery Disease
PMH:
-HTN
-HLD
-LLE cellulitis (?)-pt unaware

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Aspirin 81 mg PO DAILY
2. Doxazosin 4 mg PO HS
3. lisinopril-hydrochlorothiazide *NF* 10-12.5 mg Oral QD
4. Atenolol 50 mg PO BID
hold for SBP<100, HR<60
5. Atorvastatin 80 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMIT:
VS: 98.2   70   130/80   18   98  RA
GENERAL: NAD, AxOx3.
HEENT:  JVP not appreciable. Sclera anicteric. EOMI. MMM
CARDIAC: RRR, normal S1, S2. No m/r/g.
LUNGS: CTAB, no crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: pretibial edema none.

FAMILY HISTORY: mom w/ MI ~age 70.

SOCIAL HISTORY: He is originally from [**Country 532**]. 30 pack year smoking hx. Quit 6
yrs ago. occasional ETOH, denies illicit drugs. He works in
assembly of dice and various dice-related products 

### Response:
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Intermediate coronary syndrome,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
