CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Mr. [**Known lastname 16585**] is a 77 yo man with 3 vessel CAD s/p CABG [**5-7**] and
s/p LAD stenting [**4-7**] who presents with crescendo chest
discomfort over the last week.
.
He had done well since his last stent placement in [**4-7**], with no
need for nitroglycerin until two weeks prior to admission. He
developed chest discomfort with light activity such as climbing
one flight of stairs or carrying packages. The chest discomfort
was sternal in location, sometimes radiating to his bilateral
shoulders, arms, and jaw, [**4-10**] in intensity, and relieved at
first within minutes of one nitroglycerin. It felt like his
prior angina. He had some associated diaphoresis and nausea,
without dyspnea or palpitations. His chest discomfort was not
pleuritic in character nor did it feel like heartburn. His
nitroglycerin requirement increased over the weeek to the point
where he was taking 4 nitroglycerin per episode, leading him to
seek medical attention.
.
In the ED, his vitals were T 97.3, P 52, BP 151/61, RR 16, O2
99% RA. He was given ASA 325mg. He was taken to the cath lab
where he was found to have 80% stenosis of the LAD at D1 origin
with patent proximal LAD stent, and 70% stenosis of the mid RCA.
The procedure was complicated by dissection of the LAD,
necessitating placement of DESx2 to the LAD. His D1 was occluded
post stenting.
.
Upon arrival to the floor, the patient initially complained of
[**5-11**] chest discomfort that improved with lopressor and IV
morphine.
.
Review of systems is positive for prior stroke, claudications,
and night time leg cramps. He denies any history of deep venous
thrombosis, pulmonary embolism, bleeding at the time of surgery,
cough, black stools or red stools. He denies recent fevers,
chills or rigors. He does have chronic constipation and urinary
frequency. All of the other review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
syncope or presyncope.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Systolic CHF (EF 45%; [**5-7**])
CAD
--STEMI [**5-7**]
--CABG [**5-7**] (SVG->OM)
--s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) **] to LMCA/LAD, PTCA of D2 and mid LAD [**4-7**]
[**2138**] CVA
Carotid artery disease, s/p right CEA in [**2144**]
PVD (known bruit over right groin) with claudication
Gout
GERD
Lower back pain s/p L4-5 laminectomy
Nasal fractures, s/p surgical correction
Tonsillectomy

MEDICATION ON ADMISSION: Aspir-81 81 mg--1 tablet(s) by mouth qam
LISINOPRIL 10 mg--1 tablet(s) by mouth once a day
METOPROLOL TARTRATE 50 mg--1 tablet(s) by mouth twice a day
NITROGLYCERIN 0.4 mg prn
OMEPRAZOLE 20 mg--1 capsule(s) by mouth once a day
PLAVIX 75 mg--1 tablet(s) by mouth qam
SIMVASTATIN 40 mg--1 tablet(s) by mouth once a day
DIPHENHYDRAMINE HCL 25 mg--1 tablet(s) by mouth at bedtime
QUININE SULFATE 324 mg--1 capsule(s) by mouth hs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: CCU exam
VS: T 96.0F P54 BP 113/44 RR 12 O2 100% on 3L NC
General: Pale appearing elderly man lying in bed appearing
somewhat uncomfortable
Neck: Sclera white, conjunctiva pale. MMM. JVP measurement
limited as patient lying flat post-sheath removal. No carotid
bruits appreciated. Carotid upstrokes brisk 2+ bilaterally.
+scar R neck post CEA. No thyromegally.
CV: Regular rate S1 S2 no m/r/g. PMI nondisplaced.
Pulm: Lungs clear bilaterally on anterior exam without rales,
wheezes, or rhonchi
Chest: Midline sternotomy scar, well healed
Abd: Soft, +BS, nontender, no masses or organomegally, +L renal
bruit and R femoral bruit. R and L groin sites bandaged C/D/I
Extrem: Warm and well perfused, no edema, 2+ distal pulses
Neuro: Alert and interactive, moving all extremities
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Decreased hair on lower extremities.

FAMILY HISTORY: Brother with ??????heart problems??????, died in his 40??????s.

SOCIAL HISTORY: 100-pack-year history of smoking,and discontinued in [**2136**]. Wife
smokes.
Social beer drinking (about 8-10 beers/week). Married with four
children. Former truck driver.
Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia
Subendo infarct, initial,Systolic hrt failure NOS,Accidental op laceration,Chronic kidney dis NOS,Crnry athrscl natve vssl,Hy kid NOS w cr kid I-IV,Pure hypercholesterolem
Admission Date:  [**2149-8-22**]              Discharge Date:   [**2149-8-25**]

Date of Birth:  [**2072-3-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 7223**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
Mr. [**Known lastname 16585**] is a 77 yo man with 3 vessel CAD s/p CABG [**5-7**] and
s/p LAD stenting [**4-7**] who presents with crescendo chest
discomfort over the last week.
.
He had done well since his last stent placement in [**4-7**], with no
need for nitroglycerin until two weeks prior to admission. He
developed chest discomfort with light activity such as climbing
one flight of stairs or carrying packages. The chest discomfort
was sternal in location, sometimes radiating to his bilateral
shoulders, arms, and jaw, [**4-10**] in intensity, and relieved at
first within minutes of one nitroglycerin. It felt like his
prior angina. He had some associated diaphoresis and nausea,
without dyspnea or palpitations. His chest discomfort was not
pleuritic in character nor did it feel like heartburn. His
nitroglycerin requirement increased over the weeek to the point
where he was taking 4 nitroglycerin per episode, leading him to
seek medical attention.
.
In the ED, his vitals were T 97.3, P 52, BP 151/61, RR 16, O2
99% RA. He was given ASA 325mg. He was taken to the cath lab
where he was found to have 80% stenosis of the LAD at D1 origin
with patent proximal LAD stent, and 70% stenosis of the mid RCA.
The procedure was complicated by dissection of the LAD,
necessitating placement of DESx2 to the LAD. His D1 was occluded
post stenting.
.
Upon arrival to the floor, the patient initially complained of
[**5-11**] chest discomfort that improved with lopressor and IV
morphine.
.
Review of systems is positive for prior stroke, claudications,
and night time leg cramps. He denies any history of deep venous
thrombosis, pulmonary embolism, bleeding at the time of surgery,
cough, black stools or red stools. He denies recent fevers,
chills or rigors. He does have chronic constipation and urinary
frequency. All of the other review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
syncope or presyncope.

Past Medical History:
Hypertension
Hyperlipidemia
Systolic CHF (EF 45%; [**5-7**])
CAD
--STEMI [**5-7**]
--CABG [**5-7**] (SVG->OM)
--s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) **] to LMCA/LAD, PTCA of D2 and mid LAD [**4-7**]
[**2138**] CVA
Carotid artery disease, s/p right CEA in [**2144**]
PVD (known bruit over right groin) with claudication
Gout
GERD
Lower back pain s/p L4-5 laminectomy
Nasal fractures, s/p surgical correction
Tonsillectomy

Social History:
100-pack-year history of smoking,and discontinued in [**2136**]. Wife
smokes.
Social beer drinking (about 8-10 beers/week). Married with four
children. Former truck driver.


Family History:
Brother with ??????heart problems??????, died in his 40??????s.

Physical Exam:
CCU exam
VS: T 96.0F P54 BP 113/44 RR 12 O2 100% on 3L NC
General: Pale appearing elderly man lying in bed appearing
somewhat uncomfortable
Neck: Sclera white, conjunctiva pale. MMM. JVP measurement
limited as patient lying flat post-sheath removal. No carotid
bruits appreciated. Carotid upstrokes brisk 2+ bilaterally.
+scar R neck post CEA. No thyromegally.
CV: Regular rate S1 S2 no m/r/g. PMI nondisplaced.
Pulm: Lungs clear bilaterally on anterior exam without rales,
wheezes, or rhonchi
Chest: Midline sternotomy scar, well healed
Abd: Soft, +BS, nontender, no masses or organomegally, +L renal
bruit and R femoral bruit. R and L groin sites bandaged C/D/I
Extrem: Warm and well perfused, no edema, 2+ distal pulses
Neuro: Alert and interactive, moving all extremities
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Decreased hair on lower extremities.

Pertinent Results:
[**2149-8-22**] 10:47AM   WBC-5.8 RBC-4.65 HGB-13.4* HCT-39.5* MCV-85
MCH-28.8 MCHC-33.9 RDW-13.9
[**2149-8-22**] 10:47AM   PLT COUNT-214
[**2149-8-22**] 10:47AM   NEUTS-60.5 LYMPHS-30.6 MONOS-4.9 EOS-3.2
BASOS-0.9
[**2149-8-22**] 10:47AM   PT-10.9 PTT-23.2 INR(PT)-0.9
[**2149-8-22**] 10:47AM   CK(CPK)-96
[**2149-8-22**] 10:47AM   CK-MB-NotDone
[**2149-8-22**] 10:47AM   cTropnT-<0.01

[**2149-8-22**] 10:47AM   GLUCOSE-100 UREA N-29* CREAT-1.3* SODIUM-142
POTASSIUM-4.5 CHLORIDE-106 TOTAL CO2-29 ANION GAP-12
[**8-23**] 8am CK 832, CK-MB 13.9 (Tropn 0.3 [**7-23**] 3am)
.
[**8-22**] CXR
The patient is status post median sternotomy. There is
calcification of the thoracic aorta. There is no focal
consolidation or overt pulmonary edema.
.
[**8-22**] EKG
10am, ED: sinus bradycardia 51bpm, normal axis and intervals,
normal R wave progression, inv T in III, no signs acute ischemia
.
[**8-23**] TTE
.

Brief Hospital Course:
Unstable Angina: He underwent a cardiac cath which was
complicated by a dissection of LAD, now s/p LAD stenting which
in turn was compliated by a block of D1.  He was temporarily on
a balloon pump in the cath lab to enhance coronary perfusion.
The balloon removed in the CCU.  His ACEI and beta blocker were
titrated up during this hospitalization.  He was also continued
on his ASA/plavix/statin.
.
CHF: TTE with severe apical hypokinesis, EF 30%; clinically
euvolemic with no signs of HF.  He was treated with betablocker
and ACE.
.
Anemia:  On admission with hct 39-->33.  Guaiac negative, no
evidence of acute bleed.  Hemodynamically stable.
.
Chronic renal insufficiency:  With baseline Cr 1.1-1.2.  On
discharge with Cr 1.4 in setting of contrast load with cardiac
catheterization.  Received post cath IVF with bicarb.


Medications on Admission:
Aspir-81 81 mg--1 tablet(s) by mouth qam
LISINOPRIL 10 mg--1 tablet(s) by mouth once a day
METOPROLOL TARTRATE 50 mg--1 tablet(s) by mouth twice a day
NITROGLYCERIN 0.4 mg prn
OMEPRAZOLE 20 mg--1 capsule(s) by mouth once a day
PLAVIX 75 mg--1 tablet(s) by mouth qam
SIMVASTATIN 40 mg--1 tablet(s) by mouth once a day
DIPHENHYDRAMINE HCL 25 mg--1 tablet(s) by mouth at bedtime
QUININE SULFATE 324 mg--1 capsule(s) by mouth hs

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
[**Month/Year (2) **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
[**Month/Year (2) **]:*30 Tablet(s)* Refills:*2*
4. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
[**Month/Year (2) **]:*30 Tablet(s)* Refills:*2*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
7. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1)
Sublingual x3.
8. Benadryl 25 mg Tablet Sig: One (1) Tablet PO qhs prn.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary
Unstable Angina
Secondary
Coronary artery disease


Discharge Condition:
Stable



Completed by:[**2149-9-18**]
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia'}


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: Mr. [**Known lastname 16585**] is a 77 yo man with 3 vessel CAD s/p CABG [**5-7**] and
s/p LAD stenting [**4-7**] who presents with crescendo chest
discomfort over the last week.
.
He had done well since his last stent placement in [**4-7**], with no
need for nitroglycerin until two weeks prior to admission. He
developed chest discomfort with light activity such as climbing
one flight of stairs or carrying packages. The chest discomfort
was sternal in location, sometimes radiating to his bilateral
shoulders, arms, and jaw, [**4-10**] in intensity, and relieved at
first within minutes of one nitroglycerin. It felt like his
prior angina. He had some associated diaphoresis and nausea,
without dyspnea or palpitations. His chest discomfort was not
pleuritic in character nor did it feel like heartburn. His
nitroglycerin requirement increased over the weeek to the point
where he was taking 4 nitroglycerin per episode, leading him to
seek medical attention.
.
In the ED, his vitals were T 97.3, P 52, BP 151/61, RR 16, O2
99% RA. He was given ASA 325mg. He was taken to the cath lab
where he was found to have 80% stenosis of the LAD at D1 origin
with patent proximal LAD stent, and 70% stenosis of the mid RCA.
The procedure was complicated by dissection of the LAD,
necessitating placement of DESx2 to the LAD. His D1 was occluded
post stenting.
.
Upon arrival to the floor, the patient initially complained of
[**5-11**] chest discomfort that improved with lopressor and IV
morphine.
.
Review of systems is positive for prior stroke, claudications,
and night time leg cramps. He denies any history of deep venous
thrombosis, pulmonary embolism, bleeding at the time of surgery,
cough, black stools or red stools. He denies recent fevers,
chills or rigors. He does have chronic constipation and urinary
frequency. All of the other review of systems were negative.
.
Cardiac review of systems is notable for absence of dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
syncope or presyncope.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Systolic CHF (EF 45%; [**5-7**])
CAD
--STEMI [**5-7**]
--CABG [**5-7**] (SVG->OM)
--s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Last Name (Prefixes) **] to LMCA/LAD, PTCA of D2 and mid LAD [**4-7**]
[**2138**] CVA
Carotid artery disease, s/p right CEA in [**2144**]
PVD (known bruit over right groin) with claudication
Gout
GERD
Lower back pain s/p L4-5 laminectomy
Nasal fractures, s/p surgical correction
Tonsillectomy

MEDICATION ON ADMISSION: Aspir-81 81 mg--1 tablet(s) by mouth qam
LISINOPRIL 10 mg--1 tablet(s) by mouth once a day
METOPROLOL TARTRATE 50 mg--1 tablet(s) by mouth twice a day
NITROGLYCERIN 0.4 mg prn
OMEPRAZOLE 20 mg--1 capsule(s) by mouth once a day
PLAVIX 75 mg--1 tablet(s) by mouth qam
SIMVASTATIN 40 mg--1 tablet(s) by mouth once a day
DIPHENHYDRAMINE HCL 25 mg--1 tablet(s) by mouth at bedtime
QUININE SULFATE 324 mg--1 capsule(s) by mouth hs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: CCU exam
VS: T 96.0F P54 BP 113/44 RR 12 O2 100% on 3L NC
General: Pale appearing elderly man lying in bed appearing
somewhat uncomfortable
Neck: Sclera white, conjunctiva pale. MMM. JVP measurement
limited as patient lying flat post-sheath removal. No carotid
bruits appreciated. Carotid upstrokes brisk 2+ bilaterally.
+scar R neck post CEA. No thyromegally.
CV: Regular rate S1 S2 no m/r/g. PMI nondisplaced.
Pulm: Lungs clear bilaterally on anterior exam without rales,
wheezes, or rhonchi
Chest: Midline sternotomy scar, well healed
Abd: Soft, +BS, nontender, no masses or organomegally, +L renal
bruit and R femoral bruit. R and L groin sites bandaged C/D/I
Extrem: Warm and well perfused, no edema, 2+ distal pulses
Neuro: Alert and interactive, moving all extremities
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Decreased hair on lower extremities.

FAMILY HISTORY: Brother with ??????heart problems??????, died in his 40??????s.

SOCIAL HISTORY: 100-pack-year history of smoking,and discontinued in [**2136**]. Wife
smokes.
Social beer drinking (about 8-10 beers/week). Married with four
children. Former truck driver. 

### Response:
{'Subendocardial infarction, initial episode of care,Systolic heart failure, unspecified,Accidental puncture or laceration during a procedure, not elsewhere classified,Chronic kidney disease, unspecified,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia'}
