CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: Mrs. [**Known lastname 4223**] is a 65 year old female who underwent bare metal
stenting to her diagonal artery in [**2172-4-9**], presented to [**Hospital1 9191**] with complaints of chest pain and shortness of breath.
She ruled out for myocardial infarction. Subsequent stress
testing revealed 2mm ST depressions. She was stabilized on
medical therapy and transferred to the [**Hospital1 18**] for further
evaluation and treatment.

MEDICAL HISTORY: Coronary artery disease s/p bare metal stent to diagonal [**4-16**],
Hypertension, Dyslipidemia, Thoracic outlet syndrome s/p
bilateral removal of 1st rib, s/p Hysterectomy and bladder
resuspension, s/p left knee surgery, s/p Tonsillectomy, s/p TMJ
surgery, s/p Appendectomy

MEDICATION ON ADMISSION: Transfer meds: Aspirin 81 qd, Plavix 75 qd, Lipitor 20 qd,
Lopressor 25 tid, Protonix 40 qd, Advair, Ativan prn

ALLERGIES: Demerol / Corn

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: 97.6, 107/65, 77, 18, 98% RA
GENERAL: WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Two brothers with coronary disease, s/p PCI in their 50s

SOCIAL HISTORY: Denies tobacco history. Admits to occasional ETOH. She is [**Name Initial (MD) **]
retired RN.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified essential hypertension,Anemia, unspecified,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Examination of participant in clinical trial
Crnry athrscl natve vssl,Intermed coronary synd,Comp-oth cardiac device,Abn react-artif implant,Hypertension NOS,Anemia NOS,Status-post ptca,Hyperlipidemia NEC/NOS,Exam-clincal trial
Admission Date:  [**2172-10-20**]              Discharge Date:   [**2172-10-30**]

Date of Birth:  [**2107-9-15**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Demerol / Corn

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

Major Surgical or Invasive Procedure:
[**2172-10-26**] Two Vessel Coronary Artery Bypass Grafting utilizing
the left internal mammary artery to left anterior descending and
vein graft to diagonal artery.
[**2172-10-21**] Cardiac Catheterization

History of Present Illness:
Mrs. [**Known lastname 4223**] is a 65 year old female who underwent bare metal
stenting to her diagonal artery in [**2172-4-9**], presented to [**Hospital1 9191**] with complaints of chest pain and shortness of breath.
She ruled out for myocardial infarction. Subsequent stress
testing revealed 2mm ST depressions. She was stabilized on
medical therapy and transferred to the [**Hospital1 18**] for further
evaluation and treatment.

Past Medical History:
Coronary artery disease s/p bare metal stent to diagonal [**4-16**],
Hypertension, Dyslipidemia, Thoracic outlet syndrome s/p
bilateral removal of 1st rib, s/p Hysterectomy and bladder
resuspension, s/p left knee surgery, s/p Tonsillectomy, s/p TMJ
surgery, s/p Appendectomy

Social History:
Denies tobacco history. Admits to occasional ETOH. She is [**Name Initial (MD) **]
retired RN.

Family History:
Two brothers with coronary disease, s/p PCI in their 50s

Physical Exam:
PHYSICAL EXAMINATION:
VS: 97.6, 107/65, 77, 18, 98% RA
GENERAL: WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP low sitting upright.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ DP 2+ PT 2+

Pertinent Results:
[**2172-10-21**] Cardiac Cath: Selective coronary angiography of this
right dominant system revealed single vessel disease. The LMCA
was a small vessel but free of significant stenoses. The LAD had
a complex 90% in-stent restenosis of the diagonal branch and a
90% long LAD stenosis after D1. The LCx and RCA had mild luminal
irregularities but no angiographically significant stenoses.
[**2172-10-21**] Carotid Ultrasound: Normal carotid study
[**2172-10-26**] Intraop TEE: PRE BYPASS: No spontaneous echo contrast
is seen in the body of the left atrium or left atrial appendage.
No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thicknesses and cavity size are normal. There
is mild regional left ventricular systolic dysfunction with mild
septal and apical hypokinesis. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. There are complex (>4mm)
atheroma in the aortic arch. There are simple atheroma in the
descending thoracic aorta. The aortic valve leaflets (3) are
mildly thickened. Trace aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. There is mild to moderate tricuspid regurgitation.
There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in
person of the results in the operating room at the time of the
study.
POST BYPASS:Normal right ventricular systolic function. The left
ventricle now displays moderate to severe hypokinesis of the mid
and distal septal, inferoseptal, anteroseptal and apical walls.
The overall EF is about 50%. The mitral regurgitation is
slightly worse, now bordering on mild to moderate. The tricuspid
regurgitation is also worsened, now at least moderate. The
thoracic aorta appears intact.
[**10-30**] CXR: Right pleural effusion is small, left pleural
effusion is small to moderate. There is mild fluid overload.
There are bibasilar atelectasis.

[**2172-10-21**] 05:55AM BLOOD WBC-5.1 RBC-4.49 Hgb-12.4 Hct-35.2*
MCV-79* MCH-27.6 MCHC-35.2* RDW-13.4 Plt Ct-230
[**2172-10-29**] 05:15AM BLOOD WBC-7.2 RBC-3.32* Hgb-10.0* Hct-27.2*
MCV-82 MCH-30.0 MCHC-36.6* RDW-15.2 Plt Ct-133*
[**2172-10-21**] 05:55AM BLOOD PT-13.0 PTT-27.2 INR(PT)-1.1
[**2172-10-26**] 05:09PM BLOOD PT-14.1* PTT-35.2* INR(PT)-1.2*
[**2172-10-21**] 05:55AM BLOOD Glucose-98 UreaN-19 Creat-0.8 Na-140
K-4.4 Cl-105 HCO3-27 AnGap-12
[**2172-10-29**] 05:15AM BLOOD Glucose-97 UreaN-13 Creat-0.9 Na-141
K-3.6 Cl-106 HCO3-29 AnGap-10
[**2172-10-21**] 05:55AM BLOOD Calcium-9.2 Phos-4.2 Mg-2.2 Cholest-152
[**2172-10-26**] 06:25AM BLOOD Calcium-9.4 Phos-4.2 Mg-2.3
[**2172-10-21**] 05:55AM BLOOD Triglyc-215* HDL-36 CHOL/HD-4.2
LDLcalc-73

Brief Hospital Course:
Mrs. [**Known lastname 4223**] was admitted under cardiology. The following day
she underwent cardiac catheterization which revealed severe
single vessel coronary artery disease. Given the complex
in-stent restenosis involving the left anterior descending
artery and diagonal branch, cardiac surgery was consulted for
revascularization surgery. She remained stable on medical
therapy. Plavix was stopped and she was maintained on a heparin
drip given history of bare metal stent in [**2172-4-9**]. Workup was
essentially unremarkable and she was eventually cleared for
surgery.
On [**10-26**], Dr. [**Last Name (STitle) **] performed coronary artery bypass
grafting surgery. For surgical details, please see separate
dictated operative note. Following the operation, she was
brought to the CVICU for invasive monitoring. Within 24 hours,
she awoke neurologically intact and was extubated without
incident. Her postop hematocrit was noted to be 21% for which
she received two units of packed red blood cells. Her CVICU
course was otherwise uneventful and she transferred to the SDU
on postoperative day two. Chest tubes and epicardial pacing
wires were removed per protocol. She continued to recover
without any post-op complication and worked with physical
therapy for strength and mobility. On post-op day four she was
discharged home with VNA services and the appropriate follow-up
appointments.

Medications on Admission:
Transfer meds: Aspirin 81 qd, Plavix 75 qd, Lipitor 20 qd,
Lopressor 25 tid, Protonix 40 qd, Advair, Ativan prn

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
2. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*1*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
4. Meclizine 12.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*1*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
1 months.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
7. 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:*1*
8. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
9. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
tba

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass x 2
Postop Anemia
PMH: s/p Bare metal stent to Diagonal [**4-16**], Hypertension,
Dyslipidemia, Thoracic outlet syndrome s/p bilateral removal of
1st rib, s/p Hysterectomy and bladder resuspension, s/p left
knee surgery, s/p Tonsillectomy, s/p TMJ surgery, s/p
Appendectomy

Discharge Condition:
Good

Discharge Instructions:
Please shower daily , no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 100.5
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 one month and off [**Doctor Last Name **] narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns: [**Telephone/Fax (1) 170**]

Followup Instructions:
Dr. [**Last Name (STitle) **] in [**3-14**] weeks, call for appt
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 8098**] in [**1-12**] weeks, call for appt
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2093**] in [**12-12**] weeks, call for appt
Please follow-up with neurologist regarding vertigo


Completed by:[**2172-10-30**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified essential hypertension,Anemia, unspecified,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Examination of participant in clinical trial'}


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: Mrs. [**Known lastname 4223**] is a 65 year old female who underwent bare metal
stenting to her diagonal artery in [**2172-4-9**], presented to [**Hospital1 9191**] with complaints of chest pain and shortness of breath.
She ruled out for myocardial infarction. Subsequent stress
testing revealed 2mm ST depressions. She was stabilized on
medical therapy and transferred to the [**Hospital1 18**] for further
evaluation and treatment.

MEDICAL HISTORY: Coronary artery disease s/p bare metal stent to diagonal [**4-16**],
Hypertension, Dyslipidemia, Thoracic outlet syndrome s/p
bilateral removal of 1st rib, s/p Hysterectomy and bladder
resuspension, s/p left knee surgery, s/p Tonsillectomy, s/p TMJ
surgery, s/p Appendectomy

MEDICATION ON ADMISSION: Transfer meds: Aspirin 81 qd, Plavix 75 qd, Lipitor 20 qd,
Lopressor 25 tid, Protonix 40 qd, Advair, Ativan prn

ALLERGIES: Demerol / Corn

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: 97.6, 107/65, 77, 18, 98% RA
GENERAL: WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Two brothers with coronary disease, s/p PCI in their 50s

SOCIAL HISTORY: Denies tobacco history. Admits to occasional ETOH. She is [**Name Initial (MD) **]
retired RN. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Unspecified essential hypertension,Anemia, unspecified,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Examination of participant in clinical trial'}
