CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 86 year old male with right sided chest pain about 2-3 weeks ago
while working in the yard.  At this time, he attributed the pain
to an upper respiratory infection.  Over the weekend of [**7-30**] he
noticed that when walking uphill he developed substernal chest
pain without radiation after about 50 feet.  With cessation of
exercise, the pain dissipated after 4-5 minutes.  This was
reproducible.  He rested at home with very little physical
activity for 2 days and was free of symptoms until [**8-1**] when he
attempted to be more active.  At this time he spoke with his
physician who instructed him to come to the ED by ambulance.

MEDICAL HISTORY: Hypertension
Malaria
Spinal Stenosis
Arthritis
Rotator Cuff Dz
Mild Neuropathy
TMJ
Hx GI Bleed w/NSAID use (naproxen)
CCY
Appy
Lumbar post discectomy/fusion
R TKA
B cataracts
B rotator cuff repairs

MEDICATION ON ADMISSION: quinapril 20 mg daily
HCTZ 12.5 mg daily
ASA 81 mg daily
Primidone 50 mg daily

ALLERGIES: Gentamicin / Polysporin / Bacitracin / Doxercalciferol /
Meloxicam

PHYSICAL EXAM: Pulse: 77 Resp: 18 O2 sat: 98% RA
B/P  Right: 132/79   Left: 141/83
Height:     Weight:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: retired
Lives with wife
[**Name (NI) 1139**]: none for 20yrs ~40pkyr hx
ETOH: none for 7 years
Congestive heart failure, unspecified,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Unspecified essential hypertension,Other specified retention of urine,Unspecified hereditary and idiopathic peripheral neuropathy,Spinal stenosis, unspecified region,Knee joint replacement,Personal history of malaria
CHF NOS,Aortic valve disorder,Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Atrial fibrillation,Hypertension NOS,Oth spcf retention urine,Idio periph neurpthy NOS,Spinal stenosis NOS,Joint replaced knee,Personal histry malaria
Admission Date:  [**2101-8-3**]              Discharge Date:   [**2101-8-13**]


Service: CARDIOTHORACIC

Allergies:
Gentamicin / Polysporin / Bacitracin / Doxercalciferol /
Meloxicam

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

Major Surgical or Invasive Procedure:
[**2101-8-8**] Coronary artery bypass graft (left internal mammary
artery > left anterior descending, saphenous vein graft > obtuse
marginal)  Aortic valve replacement (23 mm [**Company **] porcine)


History of Present Illness:
86 year old male with right sided chest pain about 2-3 weeks ago
while working in the yard.  At this time, he attributed the pain
to an upper respiratory infection.  Over the weekend of [**7-30**] he
noticed that when walking uphill he developed substernal chest
pain without radiation after about 50 feet.  With cessation of
exercise, the pain dissipated after 4-5 minutes.  This was
reproducible.  He rested at home with very little physical
activity for 2 days and was free of symptoms until [**8-1**] when he
attempted to be more active.  At this time he spoke with his
physician who instructed him to come to the ED by ambulance.

At [**Hospital **] hospital, he had a normal ECG and cardiac enzymes
were
negative.  An echocardiogram showed moderate aortic stenosis and
normal ventricular function.  Coronary angiography revealed a
90% distal Left main
stenosis and a 70% mid LAD stenosis.  He was transferred for
surgical evaluation.

Past Medical History:
Hypertension
Malaria
Spinal Stenosis
Arthritis
Rotator Cuff Dz
Mild Neuropathy
TMJ
Hx GI Bleed w/NSAID use (naproxen)
CCY
Appy
Lumbar post discectomy/fusion
R TKA
B cataracts
B rotator cuff repairs

Social History:
Occupation: retired
Lives with wife
[**Name (NI) 1139**]: none for 20yrs ~40pkyr hx
ETOH: none for 7 years


Family History:
noncontributory

Physical Exam:
Pulse: 77 Resp: 18 O2 sat: 98% RA
B/P  Right: 132/79   Left: 141/83
Height:     Weight:

General:
Skin: Dry [x] [**Name (NI) 5235**] [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur SEM
Abdomen: Soft [x] non-distended [x] non-tender [x]x  bowel
sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly [**Name (NI) 5235**]
Pulses:
Femoral      Right: 2+  Left:2+
DP           Right:2+   Left:2+
PT           [**Name (NI) 167**]:2+   Left:2+
Radial       Right:2+   Left:2+

Carotid Bruit        Right: none    Left:soft


Pertinent Results:
[**2101-8-5**] ECHO
Pre-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is mildly depressed
(LVEF= 40 -= 45%), with mild global free wall hypokinesis.
There are simple atheroma in the descending thoracic [**Month/Day/Year 5236**].
There are three aortic valve leaflets. The aortic valve leaflets
are severely thickened/deformed.
There is critical aortic valve stenosis (valve area <0.8cm2).
Trace aortic regurgitation is seen.
The mitral valve leaflets are moderately thickened. Mild (1+)
mitral regurgitation is seen.
There is no pericardial effusion.

Post-CPB:
Patient is in SR, on low dose NTG infusion.
There is a prosthetic AVR with residual mean gradient 14 mmHg.
No leak, no AI.
Improved biventricular systolic fxn.
Trace MR.
[**First Name (Titles) **] [**Last Name (Titles) 5235**]. Other parameters as pre-bypass.

[**2101-8-4**] Carotids
Impression: Right ICA stenosis <40%.
Left ICA stenosis 40-59%.

[**2101-8-5**] Chest CT
1. Aortic valve calcification.
2. Mild thoracic aortic calcification mostly involving the
distal aortic
arch, as above.
3. Severe coronary artery calcifications.
4. Evidence of prior asbestos exposure, including multiple
calcified pleural plaques. No pleural effusion.
5. Likely history of previous granulomatous exposure, including
a calcified granuloma and a few calcified subcarinal lymph
nodes.
6. Borderline mediastinal adenopathy, as above.
7. Evidence of prior cholecystectomy.
8. Minimal splenic diverticulosis without evidence of
diverticulitis.

[**2101-8-10**] 06:05AM BLOOD WBC-10.8 RBC-3.41* Hgb-10.1* Hct-30.5*
MCV-90 MCH-29.5 MCHC-33.0 RDW-14.0 Plt Ct-125*
[**2101-8-9**] 03:02AM BLOOD PT-15.2* PTT-38.8* INR(PT)-1.3*
[**2101-8-10**] 06:05AM BLOOD Glucose-113* UreaN-13 Creat-0.8 Na-137
K-4.0 Cl-101 HCO3-27 AnGap-13
[**2101-8-11**] 05:25AM BLOOD Mg-2.4
[**2101-8-4**] 01:15PM BLOOD %HbA1c-6.2*

Brief Hospital Course:
Mr. [**Known lastname 7086**] was transferred in from outside hospital and
underwent preoperative workup including a carotid ultrasound and
an echocardiogram.  He was ready for surgery and was taken to
the operating [****] and underwent coronary artery bypass
graft and aortic valve replacement surgery.  See operative
report for further details.  He received vancomycin for
perioperative antibiotics since he was in the hospital
preoperatively.  He was transfered to the intensive care unit
for hemodynamic management.  Within 24 hours he awoke
neurologically [**Month/Year (2) 5235**] and was extubated.  Chest tubes and pacing
wires were discontinued without complication.  The patient was
transferred to the telemetry unit for further recovery.  He did
experience a brief episode (approximately 2 hours) of rate
controlled atrial fibrillation.  Beta blocker was titrated
accordingly and the patient returned to sinus rhythm.  The
physical therapy service was consulted for post-operative
strength and mobility.  Post-operative course was uneventful and
the patient was discharged to rehab on POD 4.

Medications on Admission:
quinapril 20 mg daily
HCTZ 12.5 mg daily
ASA 81 mg daily
Primidone 50 mg daily


Discharge Medications:
1. 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*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(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. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Primidone 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
8. Haloperidol 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
9. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*90 Capsule(s)* Refills:*0*
10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 931**] House Nursing & Rehabilitation Center - [**Location (un) 932**]

Discharge Diagnosis:
Coronary artery disease s/p CABG
Aortic stenosis s/p AVR
Hypertension
Arthritis
Neuropathy
GI bleed previously with NSAID use
Rotator cuff repair
Spinal stenosis
Malaria


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:
Dr [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) 33667**] in 1 week ([**Telephone/Fax (1) 81613**]) please call for
appointment
Dr [**First Name8 (NamePattern2) 518**] [**Last Name (NamePattern1) 8579**] in [**3-1**] weeks - please call for appointment



Completed by:[**2101-8-13**]
{'Congestive heart failure, unspecified,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Unspecified essential hypertension,Other specified retention of urine,Unspecified hereditary and idiopathic peripheral neuropathy,Spinal stenosis, unspecified region,Knee joint replacement,Personal history of malaria'}


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: 86 year old male with right sided chest pain about 2-3 weeks ago
while working in the yard.  At this time, he attributed the pain
to an upper respiratory infection.  Over the weekend of [**7-30**] he
noticed that when walking uphill he developed substernal chest
pain without radiation after about 50 feet.  With cessation of
exercise, the pain dissipated after 4-5 minutes.  This was
reproducible.  He rested at home with very little physical
activity for 2 days and was free of symptoms until [**8-1**] when he
attempted to be more active.  At this time he spoke with his
physician who instructed him to come to the ED by ambulance.

MEDICAL HISTORY: Hypertension
Malaria
Spinal Stenosis
Arthritis
Rotator Cuff Dz
Mild Neuropathy
TMJ
Hx GI Bleed w/NSAID use (naproxen)
CCY
Appy
Lumbar post discectomy/fusion
R TKA
B cataracts
B rotator cuff repairs

MEDICATION ON ADMISSION: quinapril 20 mg daily
HCTZ 12.5 mg daily
ASA 81 mg daily
Primidone 50 mg daily

ALLERGIES: Gentamicin / Polysporin / Bacitracin / Doxercalciferol /
Meloxicam

PHYSICAL EXAM: Pulse: 77 Resp: 18 O2 sat: 98% RA
B/P  Right: 132/79   Left: 141/83
Height:     Weight:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: retired
Lives with wife
[**Name (NI) 1139**]: none for 20yrs ~40pkyr hx
ETOH: none for 7 years 

### Response:
{'Congestive heart failure, unspecified,Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Unspecified essential hypertension,Other specified retention of urine,Unspecified hereditary and idiopathic peripheral neuropathy,Spinal stenosis, unspecified region,Knee joint replacement,Personal history of malaria'}
