CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is a 51 year old male with CAD s/p PCI at [**Hospital1 112**] in [**2170**].
Recently presented with a few months of chest pain, slowly
getting worse. Catheterization on [**11-12**] revealed an
occluded RCA, significant stenoses proximal and distal to a
previously placed proximal LAD stent and moderate disease
otherwise. He underwent preoperative evaluation and was cleared
for surgery.

MEDICAL HISTORY: Coronary Artery Disease s/p stents [**2170**]
Hyperlipidemia
Hypertension

MEDICATION ON ADMISSION: Aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: NAD, WGWN, appears stated age
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]
Edema- none
Varicosities: None [x]
Neuro: Grossly intact x
Pulses:
Femoral      Right: cath site  Left: 2+
DP           Right: 2+  Left: 1+
PT           [**Name (NI) 167**]:  2+ Left: NP
Radial       Right:  2+ Left: 2+

FAMILY HISTORY: He states his father died at the age of 54 of an MI. Denies any
other family history.

SOCIAL HISTORY: He workes in the deli department at the Stop and Shop.
-Tobacco history: denies any smoking.
-ETOH: denies any alcohol use.
-Illicit drugs: denies any drug use.
Coronary atherosclerosis of native coronary artery,Alcohol withdrawal delirium,Acute posthemorrhagic anemia,Percutaneous transluminal coronary angioplasty status,Other and unspecified alcohol dependence, unspecified,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Examination of participant in clinical trial
Crnry athrscl natve vssl,Delirium tremens,Ac posthemorrhag anemia,Status-post ptca,Alcoh dep NEC/NOS-unspec,Iatrogenc hypotnsion NEC,Hyperlipidemia NEC/NOS,Hypertension NOS,Exam-clincal trial
Admission Date:  [**2178-11-19**]              Discharge Date:   [**2178-11-26**]

Date of Birth:  [**2127-2-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2178-11-19**] Coronary artery bypass grafting times three(left
internal mammary to left anterior descending with vein grafts to
diagonal and PDA)


History of Present Illness:
This is a 51 year old male with CAD s/p PCI at [**Hospital1 112**] in [**2170**].
Recently presented with a few months of chest pain, slowly
getting worse. Catheterization on [**11-12**] revealed an
occluded RCA, significant stenoses proximal and distal to a
previously placed proximal LAD stent and moderate disease
otherwise. He underwent preoperative evaluation and was cleared
for surgery.

Past Medical History:
Coronary Artery Disease s/p stents [**2170**]
Hyperlipidemia
Hypertension

Social History:
He workes in the deli department at the Stop and Shop.
-Tobacco history: denies any smoking.
-ETOH: denies any alcohol use.
-Illicit drugs: denies any drug use.


Family History:
He states his father died at the age of 54 of an MI. Denies any
other family history.


Physical Exam:
General: NAD, WGWN, appears stated age
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]
Edema- none
Varicosities: None [x]
Neuro: Grossly intact x
Pulses:
Femoral      Right: cath site  Left: 2+
DP           Right: 2+  Left: 1+
PT           [**Name (NI) 167**]:  2+ Left: NP
Radial       Right:  2+ Left: 2+

Carotid Bruit: none


Pertinent Results:
[**2178-11-19**] Intraop TEE:
PREBYPASS
No atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy. The left
ventricular cavity is mildly dilated. Overall left ventricular
systolic function is low normal (LVEF 50-55%). Right ventricular
chamber size and free wall motion are normal. The ascending
aorta is mildly dilated. The descending thoracic aorta is mildly
dilated. There are simple atheroma in the descending thoracic
aorta. The aortic valve leaflets (3) are mildly thickened. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Mild (1+) mitral regurgitation is seen.

POSTBYPASS
LV systolic function is normal EF-55%. RV systolic function
remains normal. The study is otherwise unchanged from the
prebypass period.

Brief Hospital Course:
Admitted and underwent coronary artery bypass grafting surgery
by Dr. [**First Name (STitle) **]. For surgical details, please see operative note.
Following the operation, he was brought to the CVICU for
invasive monitoring. Within 24 hours, he awoke neurologically
intact and was extubated. On postoperative day one, he showed
signs of ETOH withdrawal. He became increasingly tachypneic,
tachycardic and hypertensive. He concomitantly became more
impulsive and confused/agitated requiring Ativan and Haldol prn.
Due to delirium tremens and agitation, he was reintubated for
safety on postoperative day three. On postoperative day four,
patient self extubated. His mental status seemed improved on
Valium three times daily. On postoperative day five, he
transferred to the cardiac SDU. Valium was titrated down
accordingly. Mental status and signs of ETOH withdrawal improved
dramatically. He remained in a normal sinus rhythm. Beta
blockade was advanced as tolerated and ACEI was added for
hypertension. Over several days, he continued to make clinical
improvements and was eventually cleared for discharge to [**Hospital1 38437**] for the Aged - MACU

Medications on Admission:
Aspirin

Discharge Medications:
1. Zantac 150 mg Tablet Sig: One (1) Tablet PO once a day.
2. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
3. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 5
days.
4. potassium chloride 10 mEq Capsule, Sustained Release Sig: One
(1) Capsule, Sustained Release PO once a day for 5 days.
5. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
6. aspirin, buffered 81 mg Tablet Sig: One (1) Tablet PO once a
day.
7. clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1)  Transdermal
qsunday .
8. Lopressor 100 mg Tablet Sig: One (1) Tablet PO three times a
day.
9. Plavix 75 mg Tablet Sig: One (1) Tablet PO once a day.
10. Wellbutrin SR 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO once a day.
11. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a
day.
12. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
13. Lipitor 20 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Coronary artery disease, s/p CABG
Postop ETOH Withdrawal, Altered Mental Status
Hyperlipidemia
Hypertension


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain well controlled
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right - healing well, no erythema or drainage
Edema trace


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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 Name8 (NamePattern2) **] [**Name (STitle) **] [**2178-12-21**] @ 1 PM
Cardiologist: Dr. [**First Name (STitle) **] [**Name (STitle) **] [**2178-12-15**] @ 140 PM
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1726**] on [**2178-12-1**] @ 145 PM

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2178-11-26**]
{'Coronary atherosclerosis of native coronary artery,Alcohol withdrawal delirium,Acute posthemorrhagic anemia,Percutaneous transluminal coronary angioplasty status,Other and unspecified alcohol dependence, unspecified,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension,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: This is a 51 year old male with CAD s/p PCI at [**Hospital1 112**] in [**2170**].
Recently presented with a few months of chest pain, slowly
getting worse. Catheterization on [**11-12**] revealed an
occluded RCA, significant stenoses proximal and distal to a
previously placed proximal LAD stent and moderate disease
otherwise. He underwent preoperative evaluation and was cleared
for surgery.

MEDICAL HISTORY: Coronary Artery Disease s/p stents [**2170**]
Hyperlipidemia
Hypertension

MEDICATION ON ADMISSION: Aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: NAD, WGWN, appears stated age
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]
Edema- none
Varicosities: None [x]
Neuro: Grossly intact x
Pulses:
Femoral      Right: cath site  Left: 2+
DP           Right: 2+  Left: 1+
PT           [**Name (NI) 167**]:  2+ Left: NP
Radial       Right:  2+ Left: 2+

FAMILY HISTORY: He states his father died at the age of 54 of an MI. Denies any
other family history.

SOCIAL HISTORY: He workes in the deli department at the Stop and Shop.
-Tobacco history: denies any smoking.
-ETOH: denies any alcohol use.
-Illicit drugs: denies any drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Alcohol withdrawal delirium,Acute posthemorrhagic anemia,Percutaneous transluminal coronary angioplasty status,Other and unspecified alcohol dependence, unspecified,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Examination of participant in clinical trial'}
