CHIEF COMPLAINT: Chest discomfort

PRESENT ILLNESS: This is a 59 year old male with strong family history of
coronary artery disease. He recently [**Month/Day/Year 1834**] stressing testing
due to complaints of exertional chest discomfort. The stress
test was positive for ischemia, and he was subsequently admitted
to the [**Hospital1 18**] for cardiac catheterization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
GERD
Benign Prostatic Hypertrophy
Prior Neck Surgery

MEDICATION ON ADMISSION: Lisinopril 10 [**Hospital1 **], Zocor 40 qd, Aciphex 40 qd, Doxasozin 1 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 180/82, HR 65, RR 19
General: WDWN male in no acute distress, bed rest [**2-10**] cath
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, normal s1s2, no murmur or rub
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Father died of an MI at age 60.

SOCIAL HISTORY: Quit tobacco over 15 years ago. Admits to only rare ETOH.
Employed as an engineer. He is married.
Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Intermediate coronary syndrome,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Family history of ischemic heart disease
Crnry athrscl natve vssl,Anemia NOS,Intermed coronary synd,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,BPH w/o urinary obs/LUTS,Fam hx-ischem heart dis
Admission Date:  [**2136-8-23**]              Discharge Date:   [**2136-8-28**]

Date of Birth:  [**2077-1-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2136-8-23**] Cardiac Catheterization
[**2136-8-23**] Four Vessel Coronary Artery Bypass Grafting utilizing
left internal mammary artery to left anterior descending, vein
grafts to ramus and right coronary artery

History of Present Illness:
This is a 59 year old male with strong family history of
coronary artery disease. He recently [**Month/Day/Year 1834**] stressing testing
due to complaints of exertional chest discomfort. The stress
test was positive for ischemia, and he was subsequently admitted
to the [**Hospital1 18**] for cardiac catheterization.

Past Medical History:
Hypertension
Hyperlipidemia
GERD
Benign Prostatic Hypertrophy
Prior Neck Surgery

Social History:
Quit tobacco over 15 years ago. Admits to only rare ETOH.
Employed as an engineer. He is married.

Family History:
Father died of an MI at age 60.

Physical Exam:
Vitals: BP 180/82, HR 65, RR 19
General: WDWN male in no acute distress, bed rest [**2-10**] cath
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, normal s1s2, no murmur or rub
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

Pertinent Results:
[**2136-8-23**] Cath: Coronary angiography in this right dominant system
demonstrated one vessel disease. The LMCA had a 80% distal
stenosis. The LAD had moderate diffuse disease. The left
circumflex artery had mild luminal irregularities. The RCA had
60% stenosis in the mid section.
[**2136-8-23**] Echo: PRE-BYPASS: 1. The left atrium is moderately
dilated. No mass/thrombus is seen in the left atrium or left
atrial appendage. No thrombus is seen in the left atrial
appendage. 2. No atrial septal defect is seen by 2D or color
Doppler. 3. Overall left ventricular systolic function is low
normal (LVEF 50-55%). 4. The right ventricular cavity is mildly
dilated. 5. There are simple atheroma in the descending thoracic
aorta. 6. There are three aortic valve leaflets. The aortic
valve leaflets are mildly thickened. Trace aortic regurgitation
is seen. 7. The mitral valve leaflets are mildly thickened.
Trivial mitral regurgitation is seen. The tricuspid valve
leaflets are mildly thickened. 8. The pulmonic valve leaflets
are thickened. 9. There is no pericardial effusion. Post-bypass:
On infusion of phenylephrine. Improved biventricular systolic
function. LVEF now 60%. Mild MR. [**First Name (Titles) **] [**Last Name (Titles) **], TR, PI. Aortic
contour is normal postdecannulation.
[**2136-8-26**] CXR: Widening of left cardiomediastinal contour is
stable in appearance compared to previous postoperative
radiographs. Right internal jugular vascular catheter has been
removed with no evidence of pneumothorax. Unusual lucency is
identified within the left retrocardiac region on only the PA
view without comparable finding on lateral view. Left lower lobe
atelectasis shows interval improvement. Small pleural effusions
are present bilaterally. Within the imaged portion of the upper
abdomen, mildly distended loops of bowel are present, possibly
due to postoperative ileus but incompletely evaluated on this
study.

[**2136-8-23**] 09:40AM BLOOD WBC-7.0 RBC-4.58* Hgb-15.1 Hct-42.1
MCV-92 MCH-32.9* MCHC-35.7* RDW-13.3 Plt Ct-215
[**2136-8-25**] 02:55AM BLOOD WBC-13.4* RBC-2.58*# Hgb-8.4*# Hct-23.9*#
MCV-93 MCH-32.7* MCHC-35.3* RDW-13.6 Plt Ct-138*
[**2136-8-27**] 06:20AM BLOOD WBC-7.1 RBC-3.31* Hgb-10.4* Hct-30.0*
MCV-91 MCH-31.4 MCHC-34.6 RDW-14.1 Plt Ct-146*
[**2136-8-23**] 09:40AM BLOOD PT-12.4 INR(PT)-1.1
[**2136-8-25**] 02:55AM BLOOD PT-14.7* PTT-28.4 INR(PT)-1.3*
[**2136-8-23**] 09:40AM BLOOD Glucose-110* UreaN-17 Creat-1.2 Na-141
K-4.9 Cl-105 HCO3-27 AnGap-14
[**2136-8-27**] 06:20AM BLOOD Glucose-105 UreaN-18 Creat-1.2 Na-139
K-4.1 Cl-103 HCO3-28 AnGap-12
[**2136-8-27**] 06:20AM BLOOD Calcium-8.1* Phos-2.2* Mg-2.2

Brief Hospital Course:
Mr. [**Known lastname 36546**] [**Last Name (Titles) 1834**] cardiac catheterization which revealed
a severe 80% left main lesion. Given his critical coronary
anatomy, he was urgently taken to the operating room where
coronary artery bypass grafting was performed by Dr. [**Last Name (STitle) **].
For surgical details, please see separate dictated operative
note. Following the operation, he was brought to the CSRU for
invasive monitoring. Within 24 hours, he awoke neurologically
intact and was extubated. He maintained stable hemodynamics and
weaned from intravenous therapy without difficulty. His CSRU
course was otherwise uneventful and he transferred to the SDU on
postoperative day one. He tolerated beta blockade and remained
in a normal sinus rhythm. He was given several units of packed
red blood cells for a postoperative anemia. Over several days,
beta blockade was advanced as tolerated and he continued to make
clinical improvements with diuresis. He was eventually cleared
for discharge to home on postoperative day five with VNA
services and the appropriate follow-up appointments.

Medications on Admission:
Lisinopril 10 [**Hospital1 **], Zocor 40 qd, Aciphex 40 qd, Doxasozin 1 qd

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
4. 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:*0*
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Doxazosin 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*0*
7. Aciphex 20 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
10 days.
Disp:*10 Tablet(s)* Refills:*0*
9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO once a day for 10 days.
Disp:*20 Capsule, Sustained Release(s)* Refills:*0*
10. preop meds
Please do not take your lisinopril until instructed by your
cardiologist

Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary Artery Disease - s/p Coronary Artery Bypass Graft
Postoperative Anemia
PMH: Hypertension, Hyperlipidemia, Gastroesophageal Reflux
Disease, Benign Prostatic Hypertrophy

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, 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 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Please call to schedule all appointments
Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) **] in [**2-11**] weeks
Dr. [**Last Name (STitle) 2472**] in 1 weeks [**Telephone/Fax (1) 133**]
Please schedule wound check with RN [**Telephone/Fax (1) 3633**]


Completed by:[**2136-8-28**]
{'Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Intermediate coronary syndrome,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Family history of ischemic heart disease'}


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 discomfort

PRESENT ILLNESS: This is a 59 year old male with strong family history of
coronary artery disease. He recently [**Month/Day/Year 1834**] stressing testing
due to complaints of exertional chest discomfort. The stress
test was positive for ischemia, and he was subsequently admitted
to the [**Hospital1 18**] for cardiac catheterization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
GERD
Benign Prostatic Hypertrophy
Prior Neck Surgery

MEDICATION ON ADMISSION: Lisinopril 10 [**Hospital1 **], Zocor 40 qd, Aciphex 40 qd, Doxasozin 1 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 180/82, HR 65, RR 19
General: WDWN male in no acute distress, bed rest [**2-10**] cath
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm, normal s1s2, no murmur or rub
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Father died of an MI at age 60.

SOCIAL HISTORY: Quit tobacco over 15 years ago. Admits to only rare ETOH.
Employed as an engineer. He is married. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Intermediate coronary syndrome,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Family history of ischemic heart disease'}
