CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 63 y/o male with exertional chest pressure who underwenta cath
on [**9-29**] which revealed native three vessel disease and diseased
vein grafts from prior surgery.

MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4,
Hypertension, h/o Myocardial Infarction, obstructive sleep
apnea, Diabetes Mellitus, Peripheral Vascular Disease,
Hypercholesterolemia, s/p Appendectomy

MEDICATION ON ADMISSION: Lipitor 40mg qd, Aspirin 81mg qd, Lisinopril 5mg qd, Atenolol
25mg qd, Avandia 8mg qd, Prozac 40mg qd, Protonix 40mg qd,
Insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD 65NSR
CTAB -w/r/r, MSI well-healed
RRR -c/r/m/g
Obese, soft NT/ND +BS
Well-healed above the knee SVG BLE

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: +Smoker (1ppd), Denies ETOH.
Coronary atherosclerosis of autologous vein bypass graft,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Acidosis,Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Atherosclerosis of native arteries of the extremities with intermittent claudication,Tobacco use disorder,Pure hypercholesterolemia
Crn ath atlg vn bps grft,Ocl crtd art wo infrct,Acidosis,DMII circ uncntrld,Obstructive sleep apnea,Hypertension NOS,Ath ext ntv at w claudct,Tobacco use disorder,Pure hypercholesterolem
Admission Date:  [**2168-9-29**]              Discharge Date:   [**2168-10-10**]

Date of Birth:  [**2105-2-23**]             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:
[**2168-9-30**] Re-do Coronary Artery Bypass Graft X 4 (SVG to Diag, SVG
to OM, SVG to PLV, SVG to PDA)

History of Present Illness:
63 y/o male with exertional chest pressure who underwenta cath
on [**9-29**] which revealed native three vessel disease and diseased
vein grafts from prior surgery.

Past Medical History:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4,
Hypertension, h/o Myocardial Infarction, obstructive sleep
apnea, Diabetes Mellitus, Peripheral Vascular Disease,
Hypercholesterolemia, s/p Appendectomy

Social History:
+Smoker (1ppd), Denies ETOH.

Family History:
Non-contributory

Physical Exam:
NAD 65NSR
CTAB -w/r/r, MSI well-healed
RRR -c/r/m/g
Obese, soft NT/ND +BS
Well-healed above the knee SVG BLE

Pertinent Results:
[**9-29**] CNIS: 60-69% ICA stenoses bilaterally.
[**9-30**] Echo: PRE-BYPASS: The left atrium is moderately dilated. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium or left atrial appendage. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
and cavity size are normal. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. There are simple atheroma in
the descending thoracic aorta. There are three aortic valve
leaflets. The aortic valve leaflets are mildly thickened. There
is no aortic valve stenosis. No aortic regurgitation is seen.
The mitral valve leaflets are moderately thickened. Mild (1+)
mitral regurgitation is seen. There is no pericardial effusion.
POST CPB #1:Preserved biventricular systolic function initially,
followed by a progressive worsening lateral wall motion
abnormality with the lateral wall becoming akinetic over [**6-5**]
minutes. Cardiopulmonary bypass was re-nistituted for the second
time. POST CPB#2:Lateral wall is mildly hypokinetic with
inotrpoic support. No change in valve structuire and function.
[**10-8**] CXR: Median sternotomy wires are seen. There is persistent
cardiomegaly. Since the previous study, there has been marked
improvement of the diffuse airspace opacities since the prior
study. This likely represents improvement of the pulmonary
edema. There remains some interstitial prominence without focal
consolidation.
[**2168-9-29**] 05:10PM BLOOD WBC-9.0 RBC-4.88 Hgb-13.3* Hct-39.2*
MCV-80* MCH-27.2 MCHC-33.9 RDW-16.3* Plt Ct-353#
[**2168-10-10**] 06:10AM BLOOD WBC-18.7* RBC-3.63* Hgb-10.4* Hct-30.5*
MCV-84 MCH-28.6 MCHC-34.0 RDW-15.5 Plt Ct-742*
[**2168-9-29**] 05:10PM BLOOD PT-12.1 PTT-30.8 INR(PT)-1.0
[**2168-10-7**] 03:37AM BLOOD PT-11.9 PTT-29.7 INR(PT)-1.0
[**2168-9-29**] 05:10PM BLOOD Glucose-114* UreaN-21* Creat-1.1 Na-137
K-4.2 Cl-101 HCO3-26 AnGap-14
[**2168-10-10**] 06:10AM BLOOD Glucose-103 UreaN-28* Creat-1.3* Na-136
K-5.1 Cl-103 HCO3-23 AnGap-15
[**2168-10-7**] 03:37AM BLOOD Calcium-8.8 Phos-4.1 Mg-2.2

Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname 20473**] [**Last Name (Titles) 1834**] a cardiac cath
which revealed severe disease. He was thus admitted for surgery.
He [**Last Name (Titles) 1834**] all pre-operative work-up and was brought to the
operating room on [**9-30**] where he [**Month/Year (2) 1834**] a redo-sternotomy,
coronary artery bypass graft x 4. Please see operative report
for surgical details. Following surgery he was transferred to
the CSRU for invasive monitoring. Mr. [**Known lastname 20473**] required multiple
blood transfusions post-operatively. He remained on several
inotropes for a few days which were slowly weaned. He also
remained intubated until post-op day four d/t poor oxygenation.
Chest tubes were removed on post-op day two. Diuretics were
started post-operatively and he was gently diuresed towards his
pre-op weight. Beta blockers were eventually started and
low-dose heparin was initiated d/t pt being immobile. Epicardial
pacing wires were removed per protocol. He remained in the CSRU
until post-op day seven when he was transferred to the SDU for
further management. [**Last Name (un) **] was consulted for improved diabetes
management. He remained stable over the next several days and
worked with physical therapy during his post-op course for
strength and mobility. On post-op day 10 he appeared to be doing
well and was discharged home with the appropriate meds and
follow-up appointments.

Medications on Admission:
Lipitor 40mg qd, Aspirin 81mg qd, Lisinopril 5mg qd, Atenolol
25mg qd, Avandia 8mg qd, Prozac 40mg qd, Protonix 40mg qd,
Insulin

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
Disp:*270 Tablet(s)* Refills:*2*
2. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 2 weeks.
Disp:*28 Packet(s)* Refills:*0*
3. 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*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
Disp:*60 Capsule(s)* Refills:*2*
9. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
10. Insulin Glargine 100 unit/mL Solution Sig: Fifty (50) Units
Subcutaneous once a day.
Disp:*1 Vial* Refills:*2*
11. Insulin Lispro 100 unit/mL Solution Sig: as directed Units
Subcutaneous four times a day: as per printed sliding scale
coverage.
Disp:*1 vial* Refills:*2*
12. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 7 days: for erythema at EVH site.
Disp:*7 Tablet(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Coronary Artery Disease s/p Redo-Sternotomy, Coronary Arterty
Bypass Graft x 4
PMH: s/p Coronary Artery Bypass Graft x 4, Hypertension, h/o
Myocardial Infarction, obstructive sleep apnea, Diabetes
Mellitus, Peripheral Vascular Disease, Hypercholesterolemia, s/p
Appendectomy

Discharge Condition:
good

Discharge Instructions:
may shower, no bathing or swimming for 1 month
no creams, lotions or powders to any incisions
no driving for 1 month
no lifting > 10# for 10 weeks

Followup Instructions:
with Dr. [**Last Name (STitle) 36897**] in [**1-19**] weeks for diabetes management
with Dr. [**First Name (STitle) **] in 4 weeks
with Dr. [**Last Name (STitle) **] in [**2-20**] weeks

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

Completed by:[**2168-10-11**]
{'Coronary atherosclerosis of autologous vein bypass graft,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Acidosis,Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Atherosclerosis of native arteries of the extremities with intermittent claudication,Tobacco use disorder,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: 63 y/o male with exertional chest pressure who underwenta cath
on [**9-29**] which revealed native three vessel disease and diseased
vein grafts from prior surgery.

MEDICAL HISTORY: Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4,
Hypertension, h/o Myocardial Infarction, obstructive sleep
apnea, Diabetes Mellitus, Peripheral Vascular Disease,
Hypercholesterolemia, s/p Appendectomy

MEDICATION ON ADMISSION: Lipitor 40mg qd, Aspirin 81mg qd, Lisinopril 5mg qd, Atenolol
25mg qd, Avandia 8mg qd, Prozac 40mg qd, Protonix 40mg qd,
Insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD 65NSR
CTAB -w/r/r, MSI well-healed
RRR -c/r/m/g
Obese, soft NT/ND +BS
Well-healed above the knee SVG BLE

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: +Smoker (1ppd), Denies ETOH. 

### Response:
{'Coronary atherosclerosis of autologous vein bypass graft,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Acidosis,Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Atherosclerosis of native arteries of the extremities with intermittent claudication,Tobacco use disorder,Pure hypercholesterolemia'}
