CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 70 year old male with no PMH who presented to OSH with confusion
in setting of NSTEMI. All head imaging negative. Transferred for
cardiac cath.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: ASA 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:79     Resp:13  O2 sat: 98% RA
B/P  Right:144/75    Left:140/68
Height:5'[**11**]"    Weight:188 LBS

FAMILY HISTORY: 1 brother and 1 sister/14 siblings with CAD s/p stenting

SOCIAL HISTORY: Occupation: Former professional baseball player.  Works in
sporting goods store.
Last Dental Exam:>1 yr ago
Lives with:sister and nephew
[**Name (NI) **]:Caucasian
Tobacco:Denies
ETOH:4 drinks/week
Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Transient global amnesia,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery
Subendo infarct, initial,Surg comp-peri vasc syst,Delirium d/t other cond,Hypertension NOS,Transient global amnesia,Abn react-cardiac cath,Crnry athrscl natve vssl
Admission Date:  [**2110-7-11**]              Discharge Date:   [**2110-7-22**]

Date of Birth:  [**2039-10-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**7-18**] Coronary artery bypass grafting x3 with left internal
mammary artery to the left anterior descending artery; reverse
saphenous vein single graft from the aorta to the posterior
descending artery; as well as reverse saphenous vein graft from
the aorta to obtuse marginal 1, Repair of aortovenous fistula in
the right groin by vascular (this will be dictated by vascular
surgery

History of Present Illness:
70 year old male with no PMH who presented to OSH with confusion
in setting of NSTEMI. All head imaging negative. Transferred for
cardiac cath.


Past Medical History:
none

Social History:
Occupation: Former professional baseball player.  Works in
sporting goods store.
Last Dental Exam:>1 yr ago
Lives with:sister and nephew
[**Name (NI) **]:Caucasian
Tobacco:Denies
ETOH:4 drinks/week

Family History:
1 brother and 1 sister/14 siblings with CAD s/p stenting

Physical Exam:
Pulse:79     Resp:13  O2 sat: 98% RA
B/P  Right:144/75    Left:140/68
Height:5'[**11**]"    Weight:188 LBS

General:ALert & oriented x 3
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X]
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X]  Irregular []  No Murmur or gallops.
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:+2   Left:+2
PT           [**Name (NI) 167**]:+2   Left:+2
Radial       Right:+2   Left:+2

Carotid Bruit        Right: None    Left: None

Pertinent Results:
[**7-14**] Cardiac cath: 1. Coronary angiography in this right
dominant system demonstrated three vessel disease. The LMCA had
a distal 60% stenosis. The LAD was diffusely disease with a 20%
stenosis proximally and 80% stenosis in the mid vessel. The
diagonals were small and diffusely diseased. The Cx had a 90%
stenosis at the origin with a thrombotic subtotal occlusion at
the mid Cx where the OM1 came off. The RCA was diffusely
diseased with a 90% stenosis in the proximal vessel. The mid RCA
had a 60% stenosis. The distal vessels of the RCA fill via left
to right collaterals. 2. Central aortic pressure was 130/70
mmHg.
[**7-18**] Echo: PREBYPASS: 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. The aortic valve leaflets (3) are mildly thickened. There
is sclerosis of the aortic valve with decreased mobility of the
non-coronary cusp. ([**Location (un) 109**]~ 2.1 cm2) No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. Trivial
mitral regurgitation is seen. POSTBYPASS: There is preserved
biventricular systolic function. The exam is unchanged from
prebypass
[**7-16**] Femoral U/S: Grayscale and color Doppler son[**Name (NI) 1417**] were
performed in the right groin at the puncture site. Color flow is
identified within both the common femoral artery and vein.
Proximal to the puncture site in the common femoral vein, there
are elevated velocities of approximately 260 cm/sec. This
waveform demonstrated pulsatility and turbulence. There is a
normal arterial waveform in the adjacent femoral artery. Distal
to the puncture site in the common femoral vein, there were
appropriate waveforms with a velocity of approximately 20
cm/sec. Surrounding small hematoma was identified. A fistulous
connection between the common femoral artery and common femoral
vein is possibly seen.

[**2110-7-11**] 09:15PM BLOOD WBC-8.6 RBC-4.97 Hgb-15.3 Hct-44.6 MCV-90
MCH-30.9 MCHC-34.3 RDW-13.9 Plt Ct-283
[**2110-7-21**] 05:10AM BLOOD WBC-14.7* RBC-2.88* Hgb-9.1* Hct-26.3*
MCV-91 MCH-31.5 MCHC-34.6 RDW-13.9 Plt Ct-248
[**2110-7-11**] 09:15PM BLOOD PT-12.7 PTT-25.2 INR(PT)-1.1
[**2110-7-19**] 03:50PM BLOOD PT-15.1* PTT-30.2 INR(PT)-1.3*
[**2110-7-11**] 09:15PM BLOOD Glucose-102 UreaN-24* Creat-0.9 Na-140
K-4.0 Cl-105 HCO3-26 AnGap-13
[**2110-7-21**] 05:10AM BLOOD Glucose-128* UreaN-29* Creat-0.9 Na-135
K-4.7 Cl-100 HCO3-29 AnGap-11
[**2110-7-18**] 06:10AM BLOOD ALT-33 AST-26 AlkPhos-70 TotBili-1.1

Brief Hospital Course:
Mr. [**Known lastname 82924**] was transferred from OSH with a myocardial
infarction. Upon admission he underwent a cardiac cath which
revealed severe three vessel and 60% left main disease. After
cath he was admitted for cardiac surgery work-up and Plavix
washout. On [**7-18**] he was brought to the operating room where he
underwent a coronary artery bypass graft x 3(Left internal
Mammary Artery grafted to Left Anterior Descending/Saphenous
Vein Grafted to Obtuse Marginal/Posterior Descending Artery) and
repair of Right Groin aortovenous fistula.Cross Clamp Time= 90
minutes. Cardiopulmonary Bypass Time=111 minutes. Please see
Dr[**Last Name (STitle) 5305**] operative report for further details. He tolerated
the procedure well and was transferred in critical but stable
condition to the CVICU. He weaned from sedation, awoke
neurologically intact and extubated on POD#1. All lines and
drains were discontinued when criteria was met.Chest tubes
remained in to POD#3 due to drainage/Plavix preop. Beta-Blocker,
Plavix, and diuresis was initiated when tolerated. He continued
to progress and was transferred to the step down Floor for
further monitoring. Physical Therapy was consulted for
evaluation/mobility. POD#3 on exam, bloody sternal drainage was
noted and antibiotics were initiated. CXR was reviewed by
DR.[**Last Name (STitle) 914**] and DR.[**Last Name (STitle) **] from radiology.  The remainder of his
postoperative course was essentially uneventful. He continued to
progress and was cleared by Dr.[**Last Name (STitle) 914**] for discharge to home
with VNA on POD#4. All follow up appointments were advised.


Medications on Admission:
ASA 81 mg daily

Discharge Medications:
1. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
2. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
Please take 400mg (two 200mg pills)daily for one week, then
decrease to 200mg daily for one week.
Disp:*60 Tablet(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*60 Tablet, Chewable(s)* Refills:*2*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for poor targets.
Disp:*60 Tablet(s)* Refills:*2*
9. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 14
days.
Disp:*28 Tablet(s)* Refills:*0*
10. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 10 days.
Disp:*40 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3
Myocardial Infarction

Discharge Condition:
Good

Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain. In the event that you have drainage
from your sternal wound, please contact the [**Name2 (NI) 5059**] at ([**Telephone/Fax (1) 4044**].
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry. Please shower daily. No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.

Followup Instructions:
[**Hospital Ward Name 121**] 6 for wound check in 1 week, call for appointment
[**Telephone/Fax (1) 3071**]
Dr. [**Last Name (STitle) 914**] in 4 weeks, [**Telephone/Fax (1) **], please call for
appointment
Dr. [**Last Name (STitle) 12167**] in [**1-28**] weeks
PCP [**Last Name (NamePattern4) **] [**12-27**] weeks


Completed by:[**2110-7-22**]
{'Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Transient global amnesia,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery'}


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: 70 year old male with no PMH who presented to OSH with confusion
in setting of NSTEMI. All head imaging negative. Transferred for
cardiac cath.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: ASA 81 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:79     Resp:13  O2 sat: 98% RA
B/P  Right:144/75    Left:140/68
Height:5'[**11**]"    Weight:188 LBS

FAMILY HISTORY: 1 brother and 1 sister/14 siblings with CAD s/p stenting

SOCIAL HISTORY: Occupation: Former professional baseball player.  Works in
sporting goods store.
Last Dental Exam:>1 yr ago
Lives with:sister and nephew
[**Name (NI) **]:Caucasian
Tobacco:Denies
ETOH:4 drinks/week 

### Response:
{'Subendocardial infarction, initial episode of care,Peripheral vascular complications, not elsewhere classified,Delirium due to conditions classified elsewhere,Unspecified essential hypertension,Transient global amnesia,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Coronary atherosclerosis of native coronary artery'}
