CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 

MEDICAL HISTORY: - Aortic stenosis
- Hyperlipidemia
- Hypothyroidism
- Anemia
- Depression/Anxiety
- History of L carotid bruit
- Hodgkin's disease: [**2116**], s/p chemo and XRT
- Recent injury to L hand: laceration [**2-28**] power tool accident,
multiple stitches on upper flexor surface of forearm and palm,
dressing in place, stitches to be removed on Friday, on Keflex
500 [**Hospital1 **]

MEDICATION ON ADMISSION: ASA 81mg qd
Lipitor 20mg qd
Synthroid 125mcg qd
Prozac 40mg qd
Keflex 500mg qid (for stitches)
Valtrex 500mg qd
Ibuprofen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- T 98.2, HR 90, BP 120s-130s/100-107, O2sat 99% RA
General- awake and alert, lying flat in bed, NAD
HEENT- sclerae anicteric, moist MM
Neck- unable to assess JVD lying flat, systolic murmur radiating
to carotids
Lungs- CTAB anteriorly
Heart- RRR, normal S1/S2, 3/6 SEM at RUSB
Abd- mildly distended but soft, NT, NABS
Ext- no LE edema, DP pulses 2+ b/l, feet warm and well-perfused,

FAMILY HISTORY: Father with MI at 53yo and CABG in mid50s

SOCIAL HISTORY: 25 pk-yr smoking history, quit 17y ago; social EtOH
Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Congenital insufficiency of aortic valve,Other primary cardiomyopathies,Atrioventricular block, complete,Congestive heart failure, unspecified,Intermediate coronary syndrome,Other early complications of trauma,Other accidents,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Contusion of forearm,Personal history of hodgkin's disease,Anemia, unspecified,Anxiety state, unspecified,Precipitous drop in hematocrit,Unspecified essential hypertension
Crnry athrscl natve vssl,Aortic valve disorder,Cong aorta valv insuffic,Prim cardiomyopathy NEC,Atriovent block complete,CHF NOS,Intermed coronary synd,Early complic trauma NEC,Accident NEC,Late effect of radiation,Abn react-radiotherapy,Contusion of forearm,Hx-hodgkin's disease,Anemia NOS,Anxiety state NOS,Drop, hematocrit, precip,Hypertension NOS
Admission Date:  [**2143-4-29**]              Discharge Date:   [**2143-5-9**]

Date of Birth:  [**2093-2-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2143-5-3**] Two vessel coronary artery bypass grafting(LIMA to LAD,
vein graft to left PDA) and Aortic Valve Replacement utilizing a
[**Street Address(2) 66683**]. [**Male First Name (un) 923**] mechanical valve.
[**2143-5-1**] Emergent Fasciotomy of Left Upper Extremity
[**2143-4-29**] Cardiac Catheterization


Past Medical History:
- Aortic stenosis
- Hyperlipidemia
- Hypothyroidism
- Anemia
- Depression/Anxiety
- History of L carotid bruit
- Hodgkin's disease: [**2116**], s/p chemo and XRT
- Recent injury to L hand: laceration [**2-28**] power tool accident,
multiple stitches on upper flexor surface of forearm and palm,
dressing in place, stitches to be removed on Friday, on Keflex
500 [**Hospital1 **]


Social History:
25 pk-yr smoking history, quit 17y ago; social EtOH

Family History:
Father with MI at 53yo and CABG in mid50s

Physical Exam:
Vitals- T 98.2, HR 90, BP 120s-130s/100-107, O2sat 99% RA
General- awake and alert, lying flat in bed, NAD
HEENT- sclerae anicteric, moist MM
Neck- unable to assess JVD lying flat, systolic murmur radiating
to carotids
Lungs- CTAB anteriorly
Heart- RRR, normal S1/S2, 3/6 SEM at RUSB
Abd- mildly distended but soft, NT, NABS
Ext- no LE edema, DP pulses 2+ b/l, feet warm and well-perfused,

Neuro- grossly nonfocal

Pertinent Results:
[**2143-4-29**] Cath:
1. Two vessel coronary artery disease including severe (80%)
LMCA stenosis
2. Moderate aortic stenosis with a mean gradient of 20mmHg and
[**Location (un) 109**] of 0.98 cm2.
3. Hemodynamics: mildly elevated right heart filling pressure
(RVEDP 12mmHg) and moderately elevated left heart filling
pressure (LVEDP 21mmHg). Cardiac output 4.7 L/min, cardiac index
of 2.4.
4. Normal ventricular function with EF 65%.
5. Ostial RIMA stenosis, patent LIMA.

[**2143-5-9**] 07:50AM BLOOD Hct-25.7*
[**2143-5-7**] 05:50AM BLOOD WBC-8.3 RBC-3.05* Hgb-9.4* Hct-27.6*
MCV-91 MCH-30.7 MCHC-33.9 RDW-14.5 Plt Ct-379#
[**2143-4-29**] 10:40AM BLOOD WBC-5.0 RBC-3.59* Hgb-11.9* Hct-32.8*
MCV-91 MCH-33.3* MCHC-36.4* RDW-13.1 Plt Ct-351
[**2143-5-9**] 07:50AM BLOOD PT-25.4* INR(PT)-2.6*
[**2143-5-7**] 05:50AM BLOOD Glucose-94 UreaN-22* Creat-0.9 Na-134
K-4.0 Cl-96 HCO3-29 AnGap-13
[**2143-4-29**] 10:40AM BLOOD Glucose-110* UreaN-14 Creat-0.8 Na-133
K-4.4 Cl-101 HCO3-25 AnGap-11
[**2143-5-6**] 05:17AM BLOOD Calcium-8.5 Phos-3.7 Mg-1.9

Brief Hospital Course:
Mr. [**Known lastname 40962**] [**Last Name (Titles) 1834**] elective cardiac catheterization for a
positive stress test and was found to have severe left main
coronary artery disease.  He had an IABP placed after he had
chest pain post-cath.  His aortic valve was also evaluated
during cath, and he was found to have mild to moderate aortic
stenosis.  He was admitted to the CCU to await CABG-AVR.  He
remained chest pain-free for the rest of his stay in the CCU.
He was maintained on ASA and a high-dose statin.  He was also
put on a beta blocker that was titrated up for better
perioperative beta blockade.  He was also put on IV heparin for
his IABP.  He had a carotid US that showed less than 40%
stenosis of his internal carotid arteries bilaterally.  He was
scheduled to go to the OR on [**5-1**] for CABG-AVR.  However, he
began to develop a hematoma in the area of his left forearm
laceration in the early morning before his scheduled surgery.
He had severe pain in his arm and hand, and there was concern
for evolving compartment syndrome.  His IV heparin was
discontinued and Plastic Surgery was called for evaluation.
They removed the stitches on his forearm to allow drainage of
the hematoma.  However, it continued to expand and the decision
was made to take him for urgent fasciotomy to prevent
compartment syndrome.  As he would be receiving large amounts of
IV heparin on bypass, Cardiac Surgery decided to postpone his
CABG-AVR until the fasciotomy was performed and his wound was
stable.  He was taken for fasciotomy the morning of [**5-1**].  He was
kept on IV Ancef postoperatively.

On [**5-3**], Dr. [**Last Name (STitle) **] performed two vessel coronary artery
bypass grafting and an aortic valve replacment with a St. [**Male First Name (un) 923**]
mechanical valve. For further surgical details, please see
seperate dictated op note. Following the operation, he was
brought to the CSRU for invasive monitoring. Within 24 hours, he
awoke neurologically intact and was extubated. The IABP was
weaned and removed without complication. He initially required
epicardial pacing for complete heart block. The EP service was
consulted for potential pacemaker. Over several days, his native
heart rate improved and complete heart block resolved. Pacemaker
was therefore not indicated and Warfarin anticoagulation was
initiated. On postoperative day three, he transferred to the
SDU. He transiently required Heparin for a subtherapeutic INR.
Warfarin was dosed for a goal INR between 2.0 - 3.0. Low dose
beta blockade was intitated and advanced as tolerated. He
remained in a normal sinus rhythm with no further episodes of
heart block. Over several additional days, he made steady
progress with physical therapy and continued to make clinical
improvements with diuresis. The Plastic surgery team continued
to follow his wound, which remained stable. He was cleared for
discharge to home on postoperative six. Dr. [**Last Name (STitle) **] will monitor
his Warfarin as an outpatient. He will also need to follow up
with Plastic surgery as directed. His postop cardiac follow up
appointment will be arranged in approximately 4 weeks.

Medications on Admission:
ASA 81mg qd
Lipitor 20mg qd
Synthroid 125mcg qd
Prozac 40mg qd
Keflex 500mg qid (for stitches)
Valtrex 500mg qd
Ibuprofen prn

Discharge Medications:
1. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
Disp:*60 Capsule(s)* Refills:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*100 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
7. Valacyclovir 500 mg Tablet Sig: One (1) Tablet PO QD ().
Disp:*30 Tablet(s)* Refills:*2*
8. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours
as needed.
Disp:*50 Tablet(s)* Refills:*0*
9. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
10. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
Disp:*20 Tablet(s)* Refills:*0*
11. 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*
12. Warfarin 2.5 mg Tablet Sig: One (1) Tablet PO qpm: Take as
directed. Daily dose may vary according to INR. Check INR [**5-13**]
with results to Dr. [**Last Name (STitle) **] office.
Disp:*60 Tablet(s)* Refills:*2*
13. Zantac 150 mg Capsule Sig: One (1) Capsule PO twice a day.
Disp:*60 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
CAD and AS - s/p CABG and AVR, Compartment syndrome - s/p
fasciotomy, HTN, elevated cholesterol, Hodgkins Lymphoma - s/p
thoracotomy with chemotherapy and radiation, Hypothyroidism,
Herpes Simplex, History of Zoster, Depression


Discharge Condition:
Stable. Good.


Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions. Monitor Warfarin as outpatient with Dr.
[**Last Name (STitle) **]. Warfarin should be adjusted for goal INR between 2.0 -
3.0. INR should be checked with 48-72 hours after discharge.

Followup Instructions:
Cardiac surgeon, Dr. [**Last Name (STitle) **] in [**5-1**] weeks - call for appt.
Plastic surgery hand clinic in [**1-28**] weeks, call ([**Telephone/Fax (1) 57665**] for
appt or see Plastic surgeon in [**Hospital1 1474**]
Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in 1 weeks  and for INR checks- call for
appt.
Local cardiologist, Dr. [**Last Name (STitle) **] in [**3-1**] weeks - call for appt.



Completed by:[**2143-5-24**]
{"Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Congenital insufficiency of aortic valve,Other primary cardiomyopathies,Atrioventricular block, complete,Congestive heart failure, unspecified,Intermediate coronary syndrome,Other early complications of trauma,Other accidents,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Contusion of forearm,Personal history of hodgkin's disease,Anemia, unspecified,Anxiety state, unspecified,Precipitous drop in hematocrit,Unspecified essential hypertension"}


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: 

MEDICAL HISTORY: - Aortic stenosis
- Hyperlipidemia
- Hypothyroidism
- Anemia
- Depression/Anxiety
- History of L carotid bruit
- Hodgkin's disease: [**2116**], s/p chemo and XRT
- Recent injury to L hand: laceration [**2-28**] power tool accident,
multiple stitches on upper flexor surface of forearm and palm,
dressing in place, stitches to be removed on Friday, on Keflex
500 [**Hospital1 **]

MEDICATION ON ADMISSION: ASA 81mg qd
Lipitor 20mg qd
Synthroid 125mcg qd
Prozac 40mg qd
Keflex 500mg qid (for stitches)
Valtrex 500mg qd
Ibuprofen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals- T 98.2, HR 90, BP 120s-130s/100-107, O2sat 99% RA
General- awake and alert, lying flat in bed, NAD
HEENT- sclerae anicteric, moist MM
Neck- unable to assess JVD lying flat, systolic murmur radiating
to carotids
Lungs- CTAB anteriorly
Heart- RRR, normal S1/S2, 3/6 SEM at RUSB
Abd- mildly distended but soft, NT, NABS
Ext- no LE edema, DP pulses 2+ b/l, feet warm and well-perfused,

FAMILY HISTORY: Father with MI at 53yo and CABG in mid50s

SOCIAL HISTORY: 25 pk-yr smoking history, quit 17y ago; social EtOH 

### Response:
{"Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Congenital insufficiency of aortic valve,Other primary cardiomyopathies,Atrioventricular block, complete,Congestive heart failure, unspecified,Intermediate coronary syndrome,Other early complications of trauma,Other accidents,Late effect of radiation,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Contusion of forearm,Personal history of hodgkin's disease,Anemia, unspecified,Anxiety state, unspecified,Precipitous drop in hematocrit,Unspecified essential hypertension"}
