CHIEF COMPLAINT: chest pain, dyspnea on exertion

PRESENT ILLNESS: 49 yo Mwith exertional dyspnea and
chest pressure starting about 2-3 months ago, relieved with
rest.
Pt had abnormal stress test on [**2142-7-4**] and was referred for
cardiac cath to further evaluate.  Cardiac cath reveals coronary
artery disease.
The patient is referred for surgical revascularization.

MEDICAL HISTORY: Type I DM
Retinopathy
Hyperlipidemia
HTN
Stage I kidney disease
Neuropathy

MEDICATION ON ADMISSION: Enalapril Maleate 20mg by mouth daily
Humalog sliding scale injection four times a day
Lantus 18 units injection at bedtime
Simvastatin 20mg by mouth daily
Aspirin 81mg by mouth daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History: (parents/children/siblings CAD < 55 y/o): denies

SOCIAL HISTORY: Lives with: [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **]:Caucasian
Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic kidney disease, Stage I,Other and unspecified angina pectoris,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified
Crnry athrscl natve vssl,Atrial fibrillation,Abn react-anastom/graft,Chro kidney dis stage I,Angina pectoris NEC/NOS,DMI ophth nt st uncntrld,Diabetic retinopathy NOS,Hyperlipidemia NEC/NOS,Neuropathy in diabetes,Hy kid NOS w cr kid I-IV
Admission Date:  [**2142-7-25**]              Discharge Date:   [**2142-7-28**]

Date of Birth:  [**2093-5-4**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
chest pain, dyspnea on exertion

Major Surgical or Invasive Procedure:
coronary artery bypass x 3 (SVG-Dx2, SVG-OM, SVG-PDA) [**2142-7-25**]


History of Present Illness:
49 yo Mwith exertional dyspnea and
chest pressure starting about 2-3 months ago, relieved with
rest.
Pt had abnormal stress test on [**2142-7-4**] and was referred for
cardiac cath to further evaluate.  Cardiac cath reveals coronary
artery disease.
The patient is referred for surgical revascularization.

Past Medical History:
Type I DM
Retinopathy
Hyperlipidemia
HTN
Stage I kidney disease
Neuropathy


Social History:
Lives with: [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **]:Caucasian

Tobacco:QUIT [**4-/2141**], 1-1.5 PPD X30YRS
ETOH:DENIES
ILLICIT DRUG: DENIES
Occupation:PAROLE OFFICER FOR [**State **]
Last Dental Exam: >1 year


Family History:
Family History: (parents/children/siblings CAD < 55 y/o): denies


Physical Exam:
Physical Exam

Pulse:86 Resp:16  O2 sat:98 % RA
B/P  Right:144/96    Left:149/71
Height:5'4"     Weight:136 LBS

General:Awake & alert. Oriented x 3
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X], U/dentures
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X]  Irregular []  Murmur None,
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  Edema Varicosities:
None [X]
Neuro: Grossly intact
Pulses:
Femoral      Right:+2   Left:+2
DP           Right:+1   Left:+1
PT           [**Name (NI) 167**]:+1   Left:+1
Radial       Right:+2   Left:+2    Pos Allens test

Carotid Bruit        Right:NO    Left:NO


Pertinent Results:
[**2142-7-26**] 02:24AM BLOOD WBC-14.1* RBC-2.52* Hgb-8.1* Hct-22.4*
MCV-89 MCH-32.1* MCHC-36.1* RDW-13.3 Plt Ct-170
[**2142-7-25**] 01:41PM BLOOD PT-12.3 PTT-35.9* INR(PT)-1.0
[**2142-7-26**] 02:24AM BLOOD UreaN-18 Creat-0.8 Na-140 Cl-109* HCO3-22
[**2142-7-26**] 02:24AM BLOOD Phos-4.0 Mg-2.3

PRE-BYPASS:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. A patent foramen ovale is
present.
There is mild symmetric left ventricular hypertrophy with normal
cavity size and regional/global systolic function (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The ascending, transverse and descending thoracic aorta are
normal in diameter and free of atherosclerotic plaque to XX cm
from the incisors.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Trace aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is no pericardial effusion.
Dr.[**First Name (STitle) **] was notified in person of the results on [**Known lastname 32521**]
before surgical incision.

Post_Bypass:

Biventricular systolic function. LVEF 55%.
Trivial MR< TR, AI
Thoracic aorta is intact


Brief Hospital Course:
The patient was admitted and brought to the operating room on
[**2142-7-25**] where he underwent CABGx3 as detailed in the operative
note.  Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in critical but
stable condition for observation and recovery.  POD 1 found the
patient extubated, alert and oriented and breathing comfortably.
 He was neurologically intact and hemodynamically stable.  He
was found suitable for transfer to telemetry.  Chest tubes and
pacing wires were discontinued without complication.
Beta-blocker was started and the patient was diuresed toward his
preop weight.  Physical therapy was consulted for post-op
strength and mobility.  The patient did have a brief episode of
rapid atrial fibrillation for which he received IV amiodarone,
and beta-blocker was titrated accordingly.  He did convert to
sinus rhythm.  He was cleared for discharge to home by Dr.
[**First Name (STitle) **] on POD 3.  Appropriate follow up was advised.

Medications on Admission:
Enalapril Maleate 20mg by mouth daily
Humalog sliding scale injection four times a day
Lantus 18 units injection at bedtime
Simvastatin 20mg by mouth daily
Aspirin 81mg by mouth daily


Discharge Medications:
1. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
2. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*135 Tablet(s)* Refills:*2*
7. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO twice a day:
400mg 2x/day for 1 week, then 200mg 2x/day for 1 week, then
200mg/day until further instructed.
Disp:*60 Tablet(s)* Refills:*2*
8. Insulin Glargine 100 unit/mL Solution Sig: One (1)
Subcutaneous at bedtime: 10 units glargine at bedtime, and
humalog sliding scale as usual until further instructed by
[**Last Name (un) 387**].
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 1
weeks.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
coronary artery disease


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, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr. [**First Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**First Name (STitle) **],[**First Name3 (LF) 275**] M. [**Telephone/Fax (1) 2378**] in 1 week
[**Last Name (un) **] Diabetes- make appt. within 1 week, keep a log of blood
sugars
Dr. [**Last Name (STitle) **] in [**2-27**] weeks
Please call for appointments
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])


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

Completed by:[**2142-7-28**]
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic kidney disease, Stage I,Other and unspecified angina pectoris,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}


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, dyspnea on exertion

PRESENT ILLNESS: 49 yo Mwith exertional dyspnea and
chest pressure starting about 2-3 months ago, relieved with
rest.
Pt had abnormal stress test on [**2142-7-4**] and was referred for
cardiac cath to further evaluate.  Cardiac cath reveals coronary
artery disease.
The patient is referred for surgical revascularization.

MEDICAL HISTORY: Type I DM
Retinopathy
Hyperlipidemia
HTN
Stage I kidney disease
Neuropathy

MEDICATION ON ADMISSION: Enalapril Maleate 20mg by mouth daily
Humalog sliding scale injection four times a day
Lantus 18 units injection at bedtime
Simvastatin 20mg by mouth daily
Aspirin 81mg by mouth daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History: (parents/children/siblings CAD < 55 y/o): denies

SOCIAL HISTORY: Lives with: [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **]:Caucasian 

### Response:
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Chronic kidney disease, Stage I,Other and unspecified angina pectoris,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Other and unspecified hyperlipidemia,Polyneuropathy in diabetes,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}
