CHIEF COMPLAINT: Exertional chest pain

PRESENT ILLNESS: 67yo male w/ diabetes, HTN, and dyslipidemia presented with 2-3
month h/o of substernal chest pressure w/ garden work, last
episode one week ago w/ pain [**5-9**].  He denies shortness of
breath, radiating pain, palpitations or diaphoresis and is not
experiencing any chest pain at this time.  His symptoms improve
with rest.  Otherwise pt feels well, denies PND or orthopnea or
palpitations.  He explains that he stopped all medications
(including lisinopril, glyburide, niacin, rosiglitazone) [**2-1**]
various side effects including chest discomfort, diarrhea and
rhinorrhea. He is willing to take medications at this time and
is ammenable to surgery and post-op meds.

MEDICAL HISTORY: DM
HTN
dyslipidemia
gout
Rheumatic fever as child

MEDICATION ON ADMISSION: Aspirin 325mg daily
Allopurinol 300mg daily

ALLERGIES: Avandia / Metformin / Penicillins

PHYSICAL EXAM: VS: T97.8 BP 142/68 HR62 RR16 O2 97% RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa.
Neck: Supple with JVP of 5 cm.
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts.
Chest: No chest wall deformities, Resp were unlabored, no
accessory muscle use. CTAB, no crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness.
Ext: No c/c/e. No femoral bruits.
Pulses:
Right: Carotid 2+ DP 1+ PT not palpable
Left: Carotid 2+ DP 1+ PT not palpable

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: 20 pack-year hx smoking, quit >35 years ago, drinks "[**3-3**]
highballs" a night but denies alcohol drinking has ever been a
problem or interfered with his life; widowed, lives in duplex
next to daughter [**Name (NI) **].
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Gout, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,DMII wo cmp nt st uncntr,Ocl crtd art wo infrct,Gout NOS,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2193-7-11**]              Discharge Date:   [**2193-7-20**]

Date of Birth:  [**2125-11-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Avandia / Metformin / Penicillins

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

Major Surgical or Invasive Procedure:
s/p CABG x4(LIMA-LAD,SVG-PDA,SVG-OM,SVG-Diag)7/16
[**7-11**] Cardiac Catherization


History of Present Illness:
67yo male w/ diabetes, HTN, and dyslipidemia presented with 2-3
month h/o of substernal chest pressure w/ garden work, last
episode one week ago w/ pain [**5-9**].  He denies shortness of
breath, radiating pain, palpitations or diaphoresis and is not
experiencing any chest pain at this time.  His symptoms improve
with rest.  Otherwise pt feels well, denies PND or orthopnea or
palpitations.  He explains that he stopped all medications
(including lisinopril, glyburide, niacin, rosiglitazone) [**2-1**]
various side effects including chest discomfort, diarrhea and
rhinorrhea. He is willing to take medications at this time and
is ammenable to surgery and post-op meds.


Past Medical History:
DM
HTN
dyslipidemia
gout
Rheumatic fever as child


Social History:
20 pack-year hx smoking, quit >35 years ago, drinks "[**3-3**]
highballs" a night but denies alcohol drinking has ever been a
problem or interfered with his life; widowed, lives in duplex
next to daughter [**Name (NI) **].

Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
VS: T97.8 BP 142/68 HR62 RR16 O2 97% RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa.
Neck: Supple with JVP of 5 cm.
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts.
Chest: No chest wall deformities, Resp were unlabored, no
accessory muscle use. CTAB, no crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness.
Ext: No c/c/e. No femoral bruits.
Pulses:
Right: Carotid 2+ DP 1+ PT not palpable
Left: Carotid 2+ DP 1+ PT not palpable


Pertinent Results:
[**2193-7-19**] 05:10PM BLOOD

WBC-6.9 RBC-2.53* Hgb-8.3* Hct-24.8* MCV-98 MCH-32.7* MCHC-33.2
RDW-13.8 Plt Ct-231

[**2193-7-16**] 03:26AM BLOOD

PT-11.9 PTT-23.4 INR(PT)-1.0

[**2193-7-18**] 05:11PM BLOOD

Glucose-132* UreaN-19 Creat-1.1 Na-134 K-3.9 Cl-95* HCO3-30
AnGap-13

[**2193-7-18**] 05:11PM BLOOD

Calcium-8.9 Phos-3.0 Mg-2.2

Brief Hospital Course:
This 67WM was admitted for elective cardiac catherization, which
revealed 90% LMCA stenosis, 60% LAD, 70% proximal D1, diffuse
disease of LCX, and a 70% ostial RCA lesion with an LVEF of 65%.
 Dr, [**Name (NI) **] was consulted and the pt. was recommended for CABG.
 On [**7-15**] he underwent Coronary artery bypass graft, please see
operative report for further details.  He tolerated the
procedure well and was transferred to the CSRU in stable
condition on Neosynephrine and Propofol.  He was extubated on
the morning of POD#1 and was transferred to the floor.  His
chest tubes and wires were removed on POD#2. He continues to
progress and was discharged to home in stable condition on POD#
5.

Medications on Admission:
Aspirin 325mg daily
Allopurinol 300mg daily


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(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. 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*
4. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
5. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
Disp:*60 Tablet(s)* Refills:*0*
6. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
s/p CABG x4(LIMA-LAD,SVG-PDA,SVG-OM,SVG-Diag)[**7-15**]
PMH: HTN,^lipids,DM2,Gout,Nephrolithisis,Rheumatic fever


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 appointments with:
Dr [**First Name (STitle) **] [**Name (STitle) **] in [**1-1**] weeks [**Telephone/Fax (1) 3183**]
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**2-2**] weeks [**Telephone/Fax (1) 3183**]
Dr [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Wound check appointment [**Hospital Ward Name 121**] 2 please schedule with RN
[**Telephone/Fax (1) 3633**]



Completed by:[**2193-7-20**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Gout, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}


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: Exertional chest pain

PRESENT ILLNESS: 67yo male w/ diabetes, HTN, and dyslipidemia presented with 2-3
month h/o of substernal chest pressure w/ garden work, last
episode one week ago w/ pain [**5-9**].  He denies shortness of
breath, radiating pain, palpitations or diaphoresis and is not
experiencing any chest pain at this time.  His symptoms improve
with rest.  Otherwise pt feels well, denies PND or orthopnea or
palpitations.  He explains that he stopped all medications
(including lisinopril, glyburide, niacin, rosiglitazone) [**2-1**]
various side effects including chest discomfort, diarrhea and
rhinorrhea. He is willing to take medications at this time and
is ammenable to surgery and post-op meds.

MEDICAL HISTORY: DM
HTN
dyslipidemia
gout
Rheumatic fever as child

MEDICATION ON ADMISSION: Aspirin 325mg daily
Allopurinol 300mg daily

ALLERGIES: Avandia / Metformin / Penicillins

PHYSICAL EXAM: VS: T97.8 BP 142/68 HR62 RR16 O2 97% RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa.
Neck: Supple with JVP of 5 cm.
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts.
Chest: No chest wall deformities, Resp were unlabored, no
accessory muscle use. CTAB, no crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness.
Ext: No c/c/e. No femoral bruits.
Pulses:
Right: Carotid 2+ DP 1+ PT not palpable
Left: Carotid 2+ DP 1+ PT not palpable

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: 20 pack-year hx smoking, quit >35 years ago, drinks "[**3-3**]
highballs" a night but denies alcohol drinking has ever been a
problem or interfered with his life; widowed, lives in duplex
next to daughter [**Name (NI) **]. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Gout, unspecified,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
