CHIEF COMPLAINT: Excertional Chest Pain

PRESENT ILLNESS: Mr. [**Known lastname 95516**] is a 48 y/o Spanish speaking male with a
h/o of HTN, DM2, hyperlipidemia, tobacco abuse, CAD, recently
diagnosed lung cancer who presented with chest pain over the
last several weeks, described as pressure with radiation to both
arms and associated with SOB, associated wqith excertion but
also occuring at rest. It is not associated with diaphoresis,
nausea, or vomiting. Last chest pain was this morning. Currently
he is chest pain free.
He underwent ETT on day of admission during which he developed
SSCP and dyspnea after 2.5 min which was [**6-29**] and progressed to
[**10-29**] and then resolved with oxygen after 6 minutes. Rhythm
remained sinus without ectopy. 0.5mm downsloping ST depressions
were noted on lead II, aVF at 5.5 minutes exercise that
resaolved 2 min into recovery stage. Hemodyanmic response to
limited exercise was appropriate.  Nuclear report showed
moderate to severe reversible perfusion defects in the septum
and anterior wall extending to the apex with associated
hypokinesis consistent with a proximal LAD lesion, LVEF 45%.
He had a cardiac cath at [**Hospital1 18**] in [**2-23**] which showed 1 vessel CAD
with a distal LM stenosis of 30%, LAD 50% proximal disease, LCx
40% proximal disease. RCA was small, non-dominant, and without
lesions. LVEDP measured at 25 mmHg, EF 54%.
After stress results patient underwent cath which showed 2
vessel disease with 60-70% LM disease, 70% pLAD, and 70% pLCx.
He had no intervention.

MEDICAL HISTORY: Hypertension
Diabetes
Hyperlipidemia
CAD
Non-small-cell Lung Ca, diagnosed in past 1-2 weeks; T3 N2
disease making him stage IIIa lung cancer.
Low back pain, multiple herniated disks

MEDICATION ON ADMISSION: Allergies: NKDA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Lying in bed, comfortable but tearfull
T 98.5  BP 146/93  HR 96  RR 20  SAT 98% on RA
HEENT: sclera anicteric, mm moist
Neck: good carotid pulses, no bruits
Chest: Lungs clear
Heart: RRR. No m/g/r.
Abd: +bs, soft, NT, ND
Ext: Warm, well perfused, equal femoral pulses without bruits,
2+ popliteal pulses, 1+ DP pulses

FAMILY HISTORY: not elicited

SOCIAL HISTORY: From prior note. Lives in [**Location 86**] with his wife. [**Name (NI) **] three
children. Prior tobacco abuse of [**2-22**] ppd x 34 years; currently
smoking one to [**1-21**] pack cigarettes/day. Originally from [**Country **]
[**Country **], moved to US in [**2122**]. Previously worked at a paper
recycling factory but stopped approximately 10 years ago after a
work related injury. Denies etoh and recreational drug use.
Coronary atherosclerosis of native coronary artery,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other and unspecified angina pectoris,Delirium due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Displacement of lumbar intervertebral disc without myelopathy,Tobacco use disorder
Crnry athrscl natve vssl,Mal neo upper lobe lung,Mal neo lymph-intrathor,Angina pectoris NEC/NOS,Delirium d/t other cond,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Lumbar disc displacement,Tobacco use disorder
Admission Date:  [**2137-1-29**]              Discharge Date:   [**2137-2-7**]

Date of Birth:  [**2088-4-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Excertional Chest Pain


Major Surgical or Invasive Procedure:
CABGx2(LIMA->LAD, SVG->OM) [**2137-1-31**]
Lymph node biopsy of LUL [**2137-1-31**]


History of Present Illness:
Mr. [**Known lastname 95516**] is a 48 y/o Spanish speaking male with a
h/o of HTN, DM2, hyperlipidemia, tobacco abuse, CAD, recently
diagnosed lung cancer who presented with chest pain over the
last several weeks, described as pressure with radiation to both
arms and associated with SOB, associated wqith excertion but
also occuring at rest. It is not associated with diaphoresis,
nausea, or vomiting. Last chest pain was this morning. Currently
he is chest pain free.
He underwent ETT on day of admission during which he developed
SSCP and dyspnea after 2.5 min which was [**6-29**] and progressed to
[**10-29**] and then resolved with oxygen after 6 minutes. Rhythm
remained sinus without ectopy. 0.5mm downsloping ST depressions
were noted on lead II, aVF at 5.5 minutes exercise that
resaolved 2 min into recovery stage. Hemodyanmic response to
limited exercise was appropriate.  Nuclear report showed
moderate to severe reversible perfusion defects in the septum
and anterior wall extending to the apex with associated
hypokinesis consistent with a proximal LAD lesion, LVEF 45%.
He had a cardiac cath at [**Hospital1 18**] in [**2-23**] which showed 1 vessel CAD
with a distal LM stenosis of 30%, LAD 50% proximal disease, LCx
40% proximal disease. RCA was small, non-dominant, and without
lesions. LVEDP measured at 25 mmHg, EF 54%.
After stress results patient underwent cath which showed 2
vessel disease with 60-70% LM disease, 70% pLAD, and 70% pLCx.
He had no intervention.


Past Medical History:
Hypertension
Diabetes
Hyperlipidemia
CAD
Non-small-cell Lung Ca, diagnosed in past 1-2 weeks; T3 N2
disease making him stage IIIa lung cancer.
Low back pain, multiple herniated disks


Social History:
From prior note. Lives in [**Location 86**] with his wife. [**Name (NI) **] three
children. Prior tobacco abuse of [**2-22**] ppd x 34 years; currently
smoking one to [**1-21**] pack cigarettes/day. Originally from [**Country **]
[**Country **], moved to US in [**2122**]. Previously worked at a paper
recycling factory but stopped approximately 10 years ago after a
work related injury. Denies etoh and recreational drug use.


Family History:
not elicited


Physical Exam:
Lying in bed, comfortable but tearfull
T 98.5  BP 146/93  HR 96  RR 20  SAT 98% on RA
HEENT: sclera anicteric, mm moist
Neck: good carotid pulses, no bruits
Chest: Lungs clear
Heart: RRR. No m/g/r.
Abd: +bs, soft, NT, ND
Ext: Warm, well perfused, equal femoral pulses without bruits,
2+ popliteal pulses, 1+ DP pulses


Pertinent Results:
[**2137-1-29**] 05:26PM   GLUCOSE-133* UREA N-9 CREAT-0.7 SODIUM-138
POTASSIUM-3.1* CHLORIDE-101 TOTAL CO2-27 ANION GAP-13
[**2137-1-29**] 05:26PM   ALT(SGPT)-19 AST(SGOT)-17 AMYLASE-34 TOT
BILI-0.3
[**2137-1-29**] 05:26PM   ALBUMIN-4.1
[**2137-1-29**] 05:26PM   %HbA1c-6.9* [Hgb]-DONE [A1c]-DONE
[**2137-1-29**] 05:26PM   WBC-11.4* RBC-4.57* HGB-13.9* HCT-38.6*
MCV-85 MCH-30.3 MCHC-35.9* RDW-14.8
[**2137-1-29**] 05:26PM   PT-12.4 PTT-23.5 INR(PT)-1.0
[**2137-1-29**] 05:26PM   PLT COUNT-333
[**2137-2-5**] 04:45AM BLOOD WBC-7.7 RBC-3.41* Hgb-10.1* Hct-29.1*
MCV-85 MCH-29.5 MCHC-34.6 RDW-14.9 Plt Ct-367#
[**2137-2-5**] 04:45AM BLOOD Plt Ct-367#
[**2137-2-5**] 04:45AM BLOOD Glucose-117* UreaN-10 Creat-0.7 Na-141
K-4.1 Cl-102 HCO3-25 AnGap-18

[**2137-1-29**] Cardiac Catheterization
1. Two vessel coronary artery disease.
2. Significant left main stenosis.

[**2137-1-29**] Exercising MIBI
Moderate to severe reversible perfusion defects in the septum
and
anterior wall extending to the apex with associated hypokinesis
consistent with a proximal LAD lesion. Left ventricular cavity
size is slightly larger on exercise images consistent with
transient ischemic dilatation.

[**2137-1-30**] Head MRI
Nearly uninterpretable study due to gross patient motion.
Possible left frontal developmental venous anomaly. Perhaps the
patient would be better able to tolerate a CT scan of the brain
with resultant less image degradation due to motion artifacts.

[**2137-1-31**] ECHO
he left atrium is normal in size. No mass/thrombus is seen in
the left atrium or left atrial appendage and the right atrium or
the right atrial appendage. No atrial septal defect is seen by
2D or color Doppler. There is mild symmetric left ventricular
hypertrophy with normal cavity size. There is mild regional left
ventricular systolic dysfunction. Overall left ventricular
systolic function is mildly depressed. Resting regional wall
motion abnormalities include mild hypokinesis in the apical
anteroseptal and anterior walls. Right ventricular chamber size
and free wall motion are normal. There are simple atheroma in
the descending thoracic aorta. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is no
pericardial effusion.

[**2137-2-5**] Head CT
No evidence of intracranial hemorrhage or acute territorial
infarction.

[**2137-2-4**] CXR
Left apical lung mass and pneumothorax are relatively unchanged
when compared to [**2137-2-2**]. Patient is again noted to be status
post CABG. Bibasilar atelectasis is slightly worse on the left
when compared to the previous study. Shift of the trachea from
the midline to the right is unchanged from the previous exam.

[**2137-1-31**] Mediastinal Lymph Node Biopsy
I. Lymph node, mediastinal level five (A):

Mediational poorly differentiated carcinoma with squamous
features, present within one lymph node (+[**1-20**]).

II. Lymph node, mediastinal level six (B):

One lymph node, no malignancy identified (0/1).


Brief Hospital Course:
Mr. [**Known lastname 95516**] was admitted to the [**Hospital1 18**] on [**2137-1-29**] following an
exercise tolerance test for a cardiac catheterization. This
revealed a 70% stenosed left main, a 70% stenosed left anterior
descending artery and a 70% stenosed left circumflex artery.
Heparin was started for anticoagulation. Given the severity of
his disease, the cardiac surgical service was consulted. Mr.
[**Known lastname 95516**] was worked-up in the usual preoperative manner. Given
his history of lung cancer, the thoracic surgery service was
consulted for a mediastinal lymph node biopsy at the time of his
surgery. A head MRI was performed to rule out metastatic disease
which was not interpretable due to motion artifact. On [**2137-1-31**],
Mr. [**Known lastname 95516**] was taken to the operating room where he underwent
coronary artery bypass grafting to two vessels as well as a
mediastinal lymph node dissection. Postoperatively he was taken
to the cardiac surgical intensive care unit for monitoring. On
postoperative day one, Mr. [**Known lastname 95516**] [**Last Name (Titles) 5058**] and was extubated.
Beta blockade and aspirin were resumed. As he was experiencing
significant pain, the pain service was consulted who started a
dilaudid PCA pump. He was then transferred to the cardiac
surgical intensive care unit for further recovery. He was gently
diuresed towards his preoperative weight. The physical therapy
service was consulted for assistance with his postoperative
strength and mobility. On [**2137-2-3**], Mr. [**Known lastname 95516**] became somewhat
agitated and anxious. Clonopin was given with good effect and a
psychiatry consult was obtained. Haldol was recommended as
needed and a head CT was obtained. This revealed no evidence of
intracranial hemorrhage or acute territorial infarction. His
narcotics were discontinued with subsequent stabilization of his
delirium. Vancomycin was started for mild sternal serous
drainage. The pathology results of Mr. [**Known lastname 95517**] mediastinal
lymph node biopsy revealed mediational poorly differentiated
carcinoma with squamous features, present within one lymph node
(+[**1-20**]). Mr. [**Known lastname 95516**] continued to make steady progress and was
discharged home on postoperative day seven. He will follow-up
with Dr. [**Last Name (STitle) **], hiss cardiologist, Dr. [**Last Name (STitle) 95518**] of the
thoracic surgery service and his primary care physician as an
outpatient.

Medications on Admission:
Allergies: NKDA

Meds:
Motrin 800 mg po TID
Atenolol 50 mg po daily
HCTZ 25 mg po daily
ASA 81 mg po daily
Gemfibrozil 600 mg po BID
Elavil 50 mg po daily
Actos 15 mg po daily
Zantac 150 mg po BID
Albuterol 2 puffs [**Hospital1 **]
Fioricet prn
Flexeril 10 mg po prn
Percocet 1-2 tabs Q8h prn


Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days.
Disp:*28 Capsule, Sustained Release(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. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Pioglitazone 15 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4-6H (every
4 to 6 hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
7. Lopressor 50 mg Tablet Sig: 1.5 Tablets PO three times a day.
Disp:*135 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary artery disease


Discharge Condition:
Good


Discharge Instructions:
Follow medications on discharge instructions.
You may not lift more than 10 lbs. for 3 months.
You may not drive for 4 weeks.
You should shower daily, let water flow over wounds, pat dry
with a towel.
Do not use powders, lotions, or creams on wounds.
Call our office for sternal drainage, temp>101

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in four weeks [**Telephone/Fax (1) 170**]
Follow up with Dr. [**Last Name (STitle) **] for Tues. [**2137-2-12**], [**Telephone/Fax (1) 170**]
Follow up with Dr. [**Last Name (STitle) **] for 1-2 weeks



Completed by:[**2137-2-7**]
{'Coronary atherosclerosis of native coronary artery,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other and unspecified angina pectoris,Delirium due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Displacement of lumbar intervertebral disc without myelopathy,Tobacco use disorder'}


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: Excertional Chest Pain

PRESENT ILLNESS: Mr. [**Known lastname 95516**] is a 48 y/o Spanish speaking male with a
h/o of HTN, DM2, hyperlipidemia, tobacco abuse, CAD, recently
diagnosed lung cancer who presented with chest pain over the
last several weeks, described as pressure with radiation to both
arms and associated with SOB, associated wqith excertion but
also occuring at rest. It is not associated with diaphoresis,
nausea, or vomiting. Last chest pain was this morning. Currently
he is chest pain free.
He underwent ETT on day of admission during which he developed
SSCP and dyspnea after 2.5 min which was [**6-29**] and progressed to
[**10-29**] and then resolved with oxygen after 6 minutes. Rhythm
remained sinus without ectopy. 0.5mm downsloping ST depressions
were noted on lead II, aVF at 5.5 minutes exercise that
resaolved 2 min into recovery stage. Hemodyanmic response to
limited exercise was appropriate.  Nuclear report showed
moderate to severe reversible perfusion defects in the septum
and anterior wall extending to the apex with associated
hypokinesis consistent with a proximal LAD lesion, LVEF 45%.
He had a cardiac cath at [**Hospital1 18**] in [**2-23**] which showed 1 vessel CAD
with a distal LM stenosis of 30%, LAD 50% proximal disease, LCx
40% proximal disease. RCA was small, non-dominant, and without
lesions. LVEDP measured at 25 mmHg, EF 54%.
After stress results patient underwent cath which showed 2
vessel disease with 60-70% LM disease, 70% pLAD, and 70% pLCx.
He had no intervention.

MEDICAL HISTORY: Hypertension
Diabetes
Hyperlipidemia
CAD
Non-small-cell Lung Ca, diagnosed in past 1-2 weeks; T3 N2
disease making him stage IIIa lung cancer.
Low back pain, multiple herniated disks

MEDICATION ON ADMISSION: Allergies: NKDA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Lying in bed, comfortable but tearfull
T 98.5  BP 146/93  HR 96  RR 20  SAT 98% on RA
HEENT: sclera anicteric, mm moist
Neck: good carotid pulses, no bruits
Chest: Lungs clear
Heart: RRR. No m/g/r.
Abd: +bs, soft, NT, ND
Ext: Warm, well perfused, equal femoral pulses without bruits,
2+ popliteal pulses, 1+ DP pulses

FAMILY HISTORY: not elicited

SOCIAL HISTORY: From prior note. Lives in [**Location 86**] with his wife. [**Name (NI) **] three
children. Prior tobacco abuse of [**2-22**] ppd x 34 years; currently
smoking one to [**1-21**] pack cigarettes/day. Originally from [**Country **]
[**Country **], moved to US in [**2122**]. Previously worked at a paper
recycling factory but stopped approximately 10 years ago after a
work related injury. Denies etoh and recreational drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Malignant neoplasm of upper lobe, bronchus or lung,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other and unspecified angina pectoris,Delirium due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Displacement of lumbar intervertebral disc without myelopathy,Tobacco use disorder'}
