CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 73 y/o male with exertional chest pain. Had an abnormal stress
test and then underwent a cardiac cath. Cath revealed three
vessel disease and he was referred for surgical intervention.

MEDICAL HISTORY: Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy,
Emphysema, s/p Hemmorrhoidectomy

MEDICATION ON ADMISSION: Aspirin 81mg qd, Pepcid 20mg qd, Flomax

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 64 18 127/64 170cm 150#
General: NAD
Skin: w/d, intact
HEENT: EOMI, PERRL, OP benign
Neck: Supple, FROM -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: RRR, -c/r/m/g
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -c/c/e, -varicosities, 2+ pulses
throughout
Neuro: MAE, non-focal, A&O x 3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking 10 yrs ago. Denies ETOH use.
Coronary atherosclerosis of native coronary artery,Other emphysema,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Crnry athrscl natve vssl,Emphysema NEC,Hypertension NOS,Pure hypercholesterolem,BPH w/o urinary obs/LUTS
Admission Date:  [**2119-3-23**]              Discharge Date:   [**2119-3-28**]

Date of Birth:  [**2045-8-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
s/p CABGx3(LIMA->LAD< SVG->OM, dRCA) [**2119-3-23**]

History of Present Illness:
73 y/o male with exertional chest pain. Had an abnormal stress
test and then underwent a cardiac cath. Cath revealed three
vessel disease and he was referred for surgical intervention.

Past Medical History:
Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy,
Emphysema, s/p Hemmorrhoidectomy

Social History:
Quit smoking 10 yrs ago. Denies ETOH use.

Family History:
Non-contributory

Physical Exam:
VS: 64 18 127/64 170cm 150#
General: NAD
Skin: w/d, intact
HEENT: EOMI, PERRL, OP benign
Neck: Supple, FROM -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: RRR, -c/r/m/g
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -c/c/e, -varicosities, 2+ pulses
throughout
Neuro: MAE, non-focal, A&O x 3

Pertinent Results:
[**3-23**] Echo: PRE-BYPASS: Overall left ventricular systolic
function is normal (LVEF>55%). Regional left ventricular wall
motion is normal. Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (3) are mildly
thickened. There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. Physiologic mitral regurgitation is seen
(within normal limits). No spontaneous echo contrast is seen in
the left atrial appendage. No thrombus is seen in the left
atrial appendage. No atrial septal defect is seen by 2D or color
Doppler. There are simple atheroma in the aortic arch. The
descending thoracic aorta is mildly dilated. There are simple
atheroma in the descending thoracic aorta. There is no
pericardial effusion. POST-BYPASS: Preserved [**Hospital1 **]-ventricular
systolic function. No evidence of aortic dissection post
de-canulation. Rest of study is unchanged from pre-bypass.
[**3-25**] Echo: The left atrium is normal in size. Left ventricular
wall thickness, cavity size, and systolic function are normal
(LVEF>55%). There is post-op septal motion. Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. Right ventricular chamber size and free wall
motion are normal. The aortic valve is not well seen. There is
no aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. No mitral
regurgitation is seen. There is a small pericardial effusion.
Compared with the prior study (images reviewed) of [**2118-10-28**],
biventricular systolic function is similar (post-op septal
motion is new). A small pericardial effusion is now noted.
[**3-27**] CXR: Right internal jugular vascular sheath has been
removed with no pneumothorax. Bilateral upper lobe fibronodular
opacities with adjacent bullous emphysema and apical thickening
are unchanged. Cardiac and mediastinal contours are stable in
the postoperative period. Bibasilar reticular opacities are
again demonstrated likely due to chronic lung disease.
Superimposed acute basilar atelectatic changes have nearly
resolved. Small pleural effusions are seen bilaterally.

[**2119-3-23**] 12:29PM BLOOD WBC-13.0*# RBC-2.94*# Hgb-9.3*#
Hct-27.6*# MCV-94 MCH-31.7 MCHC-33.8 RDW-13.9 Plt Ct-133*#
[**2119-3-28**] 07:25AM BLOOD WBC-9.2 RBC-3.73* Hgb-11.9* Hct-35.4*
MCV-95 MCH-32.0 MCHC-33.6 RDW-14.6 Plt Ct-347#
[**2119-3-23**] 12:29PM BLOOD PT-15.4* PTT-40.7* INR(PT)-1.4*
[**2119-3-26**] 07:00AM BLOOD PT-11.8 PTT-26.0 INR(PT)-1.0
[**2119-3-23**] 01:53PM BLOOD UreaN-12 Creat-0.6 Cl-116* HCO3-23
[**2119-3-28**] 07:25AM BLOOD Glucose-114* UreaN-22* Creat-1.0 Na-135
K-3.8 Cl-95* HCO3-29 AnGap-15
[**2119-3-28**] 07:25AM BLOOD Calcium-9.0 Phos-3.2 Mg-2.7*

Brief Hospital Course:
Mr. [**Known lastname **] was a same day admit after undergoing all pre-operative
work-up as an outpatient. On day of admission he was brought to
the operating room where he underwent a coronary artery bypass
graft x 3. Please see operative report for details. Following
surgery he was transferred to the CSRU for invasive monitoring
in stable condition. Later on op day he was weaned from
sedation, awoke neurologically intact and extubated. On post-op
day one beta blockers and diuretics were started and he was
gently diuresed towards his pre-op weight. He was then
transferred to the telemetry floor for further care. On post-op
day two chest tubes and epicardial pacing wires were removed.
Also on this day he was experiencing some chest pain and an echo
was performed which showed no changes from prior except a small
pericardial effusion. Over the next couple of days Mr. [**Known lastname **]
continued to improve and worked with physical therapy for
strength and mobility. On post-op day five he was discharged
home with VNA services and the appropriate follow-up
appointments.

Medications on Admission:
Aspirin 81mg qd, Pepcid 20mg qd, Flomax

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
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:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0*
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*0*
6. Pepcid 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
7. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Coronary artery disease s/p Coronary Artery Bypass Graft x 3
PMH: Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy,
Emphysema, s/p Hemmorrhoidectomy

Discharge Condition:
Good

Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs. for 2 months.
Shower daily, let water flow over wounds, pat dry with a towel.
Do not use lotions, powders, or creams on wounds.
Call our office for temp>101.5, sternal drainage.

Followup Instructions:
Make an appointment with Dr. [**First Name (STitle) **] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) **] for 2-3 weeks.
Make an appointment with Dr. [**Last Name (STitle) 914**] for 4 weeks.


Completed by:[**2119-3-28**]
{'Coronary atherosclerosis of native coronary artery,Other emphysema,Unspecified essential hypertension,Pure hypercholesterolemia,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: 73 y/o male with exertional chest pain. Had an abnormal stress
test and then underwent a cardiac cath. Cath revealed three
vessel disease and he was referred for surgical intervention.

MEDICAL HISTORY: Hypertension, Hyperlipidemia, Benign Prostatic Hypertrophy,
Emphysema, s/p Hemmorrhoidectomy

MEDICATION ON ADMISSION: Aspirin 81mg qd, Pepcid 20mg qd, Flomax

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 64 18 127/64 170cm 150#
General: NAD
Skin: w/d, intact
HEENT: EOMI, PERRL, OP benign
Neck: Supple, FROM -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: RRR, -c/r/m/g
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -c/c/e, -varicosities, 2+ pulses
throughout
Neuro: MAE, non-focal, A&O x 3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking 10 yrs ago. Denies ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other emphysema,Unspecified essential hypertension,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
