CHIEF COMPLAINT: Burping/LUQ Pain w/ Positive stress test

PRESENT ILLNESS: The pt is a 58 yo M with a h/o HTN, hypercholesterolemia who
presented to this hospital as a transfer from [**Hospital3 19345**] for cardiac cath. Pt had visited his PCP last week, [**Name Initial (PRE) **]/o
frequent eructation and nausea x 2 weeks along with LUQ
pressure. He also previously had a postitve ETT and was referred
for a cardiac cath. Cath done on [**2113-1-13**] revealed 3 vessel
disease. He was then referred for CABG.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Diabetes Mellitus
Hearing loss
h/o Benign Prostatic Hypertrophy
s/p T&A
s/p Kidney Contusion

MEDICATION ON ADMISSION: 1. MVI
2. Lisinopril 10mg qd
3. Zantac
Started after ETT:
4. ASA 81mg qd
5. Lipitor 20mg qd
6. Toprol XL 50mg qd
7. Plavix 75mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: Pleasant man in NAD, lying supine on stretcher in cath
recovery
VS: Afebrile 63 18 161/83 100 2L nc
HEENT: PERRL, EOMI, nl sclera
Cor: s1s2 RRR no m/r/g
Lungs: CTAB anteriorly, laterally
Abd: NABS, soft, NT/ND
GU: Foley to gravity
Ext: Minimal eccymosis at R groin, no hematoma, no thrill; DP
palpable, PT by doppler (baseline)
Skin: Pink, warm, dry
Neuro: A&O x 3, CN grossly intact

FAMILY HISTORY: Father deceased MI @ 49
Mother ?cardiac

SOCIAL HISTORY: Occ EtOH (approx 4 drinks/wk)
Remote tobacco (smoked pipe for approx 6 years, quit >25 yrs
ago)
Works as delivery man
Lives with wife
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Acute gastritis, without mention of hemorrhage,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other nonspecific abnormal results of function study of cardiovascular system,Unspecified hearing loss,Nonspecific (abnormal) findings on radiological and other examination of biliary tract
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Acute gastrtis w/o hmrhg,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Abn cardiovasc study NEC,Hearing loss NOS,Nonsp abn fd-bilry tract
Admission Date:  [**2113-1-13**]              Discharge Date:   [**2113-1-25**]

Date of Birth:  [**2054-2-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Burping/LUQ Pain w/ Positive stress test

Major Surgical or Invasive Procedure:
[**2113-1-19**] Coronary Artery Bypass Graft x 4 (LIMA to LAD, SVG to
[**Last Name (LF) **], [**First Name3 (LF) **], PDA)
[**2113-1-13**] Cardiac Catheterization

History of Present Illness:
The pt is a 58 yo M with a h/o HTN, hypercholesterolemia who
presented to this hospital as a transfer from [**Hospital3 19345**] for cardiac cath. Pt had visited his PCP last week, [**Name Initial (PRE) **]/o
frequent eructation and nausea x 2 weeks along with LUQ
pressure. He also previously had a postitve ETT and was referred
for a cardiac cath. Cath done on [**2113-1-13**] revealed 3 vessel
disease. He was then referred for CABG.

Past Medical History:
Hypertension
Hypercholesterolemia
Diabetes Mellitus
Hearing loss
h/o Benign Prostatic Hypertrophy
s/p T&A
s/p Kidney Contusion

Social History:
Occ EtOH (approx 4 drinks/wk)
Remote tobacco (smoked pipe for approx 6 years, quit >25 yrs
ago)
Works as delivery man
Lives with wife


Family History:
Father deceased MI @ 49
Mother ?cardiac

Physical Exam:
Gen: Pleasant man in NAD, lying supine on stretcher in cath
recovery
VS: Afebrile 63 18 161/83 100 2L nc
HEENT: PERRL, EOMI, nl sclera
Cor: s1s2 RRR no m/r/g
Lungs: CTAB anteriorly, laterally
Abd: NABS, soft, NT/ND
GU: Foley to gravity
Ext: Minimal eccymosis at R groin, no hematoma, no thrill; DP
palpable, PT by doppler (baseline)
Skin: Pink, warm, dry
Neuro: A&O x 3, CN grossly intact

Pertinent Results:
Cath [**1-13**]: Selective coronary angiography of this right dominant
system revealed three vessel coronary artery disease. The LMCA
had no angiographically apparent disease. The LAD had 70%
proximal, 80% mid, and 90% proximal D1 stenoses. The LCX had 80%
diffuse proximal stenosis with total occlusion of OM2. The RCA
had ostial occlusion with extensive left coronary collaterals to
distal vessel. Limited hemodynamics demonstrated elevated LVEDP
(23mmHg) and systemic pressures. Calculated ejection fraction
was 63%.
TTE [**1-13**]: The left ventricular cavity size is normal. Overall
left ventricular systolic function is normal (LVEF>55%). No
regional wall motion abnormality is seen.
GB U/S /13: The gallbladder again contains extensive sludge.
There is some gallbladder wall thickening to approximately 4 mm.
No pericholecystic fluid is identified, but there is some mild
edema seen There is no intra-or extra-hepatic biliary
dilatation. The findings are nonspecific. While not definitive
for acute cholecystitis, the findings are at least somewhat
suspicious. Given the patient's upcoming bypass surgery,
consideration towards cholecystectomy should be made. Again,
HIDA scan may be useful to aid diagnostic certainty
HIDA [**1-18**]: Normal study. No evidence of cholecystitis.
[**2113-1-13**] 11:30AM BLOOD WBC-5.9 RBC-4.39* Hgb-13.5* Hct-37.2*
MCV-85 MCH-30.7 MCHC-36.3* RDW-12.1 Plt Ct-272
[**2113-1-20**] 02:09AM BLOOD WBC-14.6* RBC-3.22* Hgb-10.2* Hct-27.7*
MCV-86 MCH-31.7 MCHC-36.8* RDW-12.3 Plt Ct-310
[**2113-1-23**] 06:10AM BLOOD WBC-8.4 RBC-3.63* Hgb-10.9* Hct-30.9*
MCV-85 MCH-30.1 MCHC-35.3* RDW-13.7 Plt Ct-268
[**2113-1-22**] 02:16AM BLOOD PT-13.3* PTT-30.2 INR(PT)-1.2*
[**2113-1-13**] 11:30AM BLOOD Glucose-153* UreaN-23* Creat-1.2 Na-135
K-3.8 Cl-104 HCO3-22 AnGap-13
[**2113-1-23**] 06:10AM BLOOD Glucose-89 UreaN-18 Creat-1.1 Na-138
K-3.9 Cl-99 HCO3-29 AnGap-14
[**2113-1-23**] 06:10AM BLOOD Calcium-8.2* Phos-3.5 Mg-2.0
[**2113-1-13**] 11:30AM BLOOD %HbA1c-5.7 [Hgb]-DONE [A1c]-DONE
[**2113-1-13**] 11:45AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG

Brief Hospital Course:
The patient was admitted s/p positive cath, consulted by CT [**Doctor First Name **]
and scheduled for CABG. He underwent the usual pre-operative
work-up for CABG, but continued to complain of intermittent
eructation/discomfort in abd. GI was consulted and pt had a RUQ
U/S which showed sludge but this study was post-prandial and
repeated after being NPO. LFTs WNL. The repeat U/S was again
concerning for possible cholecystitis. GI was consulted and an
EGD was performed which revealed gastritis. A HIDA scan was
performed which revealed no evidence for cholecystitis.
Following entire GI work-up, Mr. [**Known lastname 4281**] seemed suitable/stable
for bypass surgery and on hosptital day seven, [**2113-1-19**], he was
brought to the operating room where he underwent coronary artery
bypass surgery x 4. He tolerated the procedure well with no
complications. Please see operative note for surgical details.
Afterward he was transferred to the Cardiac surgery recovery
unit in stable condition and awakened neurologically intake.
He was weaned from ventilator support, extubated, and pressors
were weaned.  On POD 2 he was then transferred to the Stepdown
unit for further recovery.  His chest tubes were removed without
complication.  He was gently diuresed to his preoperative
weight, beta blockade and aspirin therapy were resumed, and
physical therapy service was consulted to assist with his
postoperative strength and mobility. Electrolytes were repleted
as needed.  On POD 3 his epicardial pacing wires were removed
without complication, he continued to improve his ability to
ambulate including climbing stairs without respiratory distress
or chest pain.  On POD 4 there was some evidence of sternal
drainage that was nonpurulent.  IV vancomycin was empirically
started.  Mr. [**Known lastname 4281**] was slow to progress in his ability to
ambulate and was complaining of musculoskeletal chest pain
frequently.  Serial ecg's and telemetry did not reveal any ST
changes.  His pain was relieved with narcotics. On POD 5 Mr.
[**Name13 (STitle) **] was 5kg his preop weight with good exercise
tolerance, no SOB, or Chest pain.  His blood pressure was
stable.  His sternotomy and leg incision were clean, minimal
serosanguinous drainage present at his sternotomy, and intact
without evidence of infection.  He was discharged home on POD 6
with services in good condition, cardiac diet, sternal
precautions, and instructed to follow up with his
PCP/cardiologist in [**12-5**] weeks.  He will come to [**Hospital Ward Name 121**] 2 for a
wound check in three days.  He will follow up with Dr. [**Last Name (STitle) **]
in four weeks.

Medications on Admission:
1. MVI
2. Lisinopril 10mg qd
3. Zantac
Started after ETT:
4. ASA 81mg qd
5. Lipitor 20mg qd
6. Toprol XL 50mg qd
7. Plavix 75mg qd


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:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*0*
6. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 10
days.
Disp:*40 Capsule, Sustained Release(s)* Refills:*0*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*20 Tablet(s)* Refills:*0*
9. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
10. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] vna

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Hypercholesterolemia
Hypertension
Diabetes Mellitus
Gastritis

Discharge Condition:
Good

Discharge Instructions:
[**Month (only) 116**] take shower. Wash incisions with water and gentle soap.
Gently pat dry. Do not take bath. Do not apply lotions, creams,
ointments or powders to incisions.
Do not drive for 1 month.
Do not lift more than 10 pounds for 2 months.
Please contact office immediately with any chest/sternal
drainage or if you experience a fever more than 101.5.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks.
Dr. [**Last Name (STitle) **](PCP) in [**12-5**] weeks.
Dr. [**Last Name (STitle) **](Cardiologist) in [**1-6**] weeks.


Completed by:[**2113-1-25**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Acute gastritis, without mention of hemorrhage,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other nonspecific abnormal results of function study of cardiovascular system,Unspecified hearing loss,Nonspecific (abnormal) findings on radiological and other examination of biliary tract'}


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: Burping/LUQ Pain w/ Positive stress test

PRESENT ILLNESS: The pt is a 58 yo M with a h/o HTN, hypercholesterolemia who
presented to this hospital as a transfer from [**Hospital3 19345**] for cardiac cath. Pt had visited his PCP last week, [**Name Initial (PRE) **]/o
frequent eructation and nausea x 2 weeks along with LUQ
pressure. He also previously had a postitve ETT and was referred
for a cardiac cath. Cath done on [**2113-1-13**] revealed 3 vessel
disease. He was then referred for CABG.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Diabetes Mellitus
Hearing loss
h/o Benign Prostatic Hypertrophy
s/p T&A
s/p Kidney Contusion

MEDICATION ON ADMISSION: 1. MVI
2. Lisinopril 10mg qd
3. Zantac
Started after ETT:
4. ASA 81mg qd
5. Lipitor 20mg qd
6. Toprol XL 50mg qd
7. Plavix 75mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: Pleasant man in NAD, lying supine on stretcher in cath
recovery
VS: Afebrile 63 18 161/83 100 2L nc
HEENT: PERRL, EOMI, nl sclera
Cor: s1s2 RRR no m/r/g
Lungs: CTAB anteriorly, laterally
Abd: NABS, soft, NT/ND
GU: Foley to gravity
Ext: Minimal eccymosis at R groin, no hematoma, no thrill; DP
palpable, PT by doppler (baseline)
Skin: Pink, warm, dry
Neuro: A&O x 3, CN grossly intact

FAMILY HISTORY: Father deceased MI @ 49
Mother ?cardiac

SOCIAL HISTORY: Occ EtOH (approx 4 drinks/wk)
Remote tobacco (smoked pipe for approx 6 years, quit >25 yrs
ago)
Works as delivery man
Lives with wife 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Acute gastritis, without mention of hemorrhage,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other nonspecific abnormal results of function study of cardiovascular system,Unspecified hearing loss,Nonspecific (abnormal) findings on radiological and other examination of biliary tract'}
