CHIEF COMPLAINT: Burning across chest

PRESENT ILLNESS: 63F with history htn and hyperlipidemia p/t OSH ED c/o chest
burning while mowing the lawn. She was admitted to [**Hospital **]
Hospital on [**11-6**] and had a NSTEMI with a peak troponin of 1.45.
Workup included cardiac cath which revealed three vessel
disease.
She also had an elevated creatinine when she presented (1.6)
which was new for her.  A CXR revealed a 6-7 cm pulmonary nodule
in the RUL.  She is transferred for surgical consideration.

MEDICAL HISTORY: Past Medical History:
hypertension
h/o hypertensive urgency [**2097**]- stress echo was negative for
ischemia at this time
hyperlipidemia
anxiety
s/p NSTEMI [**2100-11-6**]
Past Surgical History: s/p C section

MEDICATION ON ADMISSION: triamterene/HCTZ 37.5/25mg daily
lopressor 100mg daily
simvastatin 40mg hs
diltiazem CD 240mg daily
Diovan 80mg daily
alprazolam 0.25mg hs
lisinopril recently discontinued

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 65 Resp:18  O2 sat: 97% on RA
B/P  Right: 136/77   Left:
Height: 65"    Weight: 153lb

FAMILY HISTORY: mother with a-fib
sister with a-fib

SOCIAL HISTORY: Lives with: husband
Occupation: retired
Tobacco: 1 1/2 packs per week
ETOH: denies
Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery
Subendo infarct, initial,Parox ventric tachycard,Hyperlipidemia NEC/NOS,Anxiety state NOS,Hypertension NOS,Crnry athrscl natve vssl
Admission Date:  [**2100-11-9**]              Discharge Date:   [**2100-11-14**]

Date of Birth:  [**2037-1-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Burning across chest


Major Surgical or Invasive Procedure:
[**2100-11-10**]
1. Emergency coronary artery bypass graft x4:  Left
    internal mammary artery to left anterior descending
    artery and saphenous vein graft to ramus intermedius and
    a saphenous vein sequential graft to obtuse marginal 1
    and 2.
2. Endoscopic harvesting of the long saphenous vein.


History of Present Illness:
63F with history htn and hyperlipidemia p/t OSH ED c/o chest
burning while mowing the lawn. She was admitted to [**Hospital **]
Hospital on [**11-6**] and had a NSTEMI with a peak troponin of 1.45.
Workup included cardiac cath which revealed three vessel
disease.
She also had an elevated creatinine when she presented (1.6)
which was new for her.  A CXR revealed a 6-7 cm pulmonary nodule
in the RUL.  She is transferred for surgical consideration.

Past Medical History:
Past Medical History:
hypertension
h/o hypertensive urgency [**2097**]- stress echo was negative for
ischemia at this time
hyperlipidemia
anxiety
s/p NSTEMI [**2100-11-6**]
Past Surgical History: s/p C section


Social History:
Lives with: husband
Occupation: retired
Tobacco: 1 1/2 packs per week
ETOH: denies


Family History:
mother with a-fib
sister with a-fib


Physical Exam:
Pulse: 65 Resp:18  O2 sat: 97% on RA
B/P  Right: 136/77   Left:
Height: 65"    Weight: 153lb

General:
Skin: Warm[x] Dry [x] intact [x]
HEENT: NCAT[x] PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused []  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+

Carotid Bruit        Right: no   Left: no


Pertinent Results:
[**2100-11-13**] 04:56AM BLOOD WBC-9.1 RBC-3.42* Hgb-10.3* Hct-28.8*
MCV-84 MCH-30.3 MCHC-35.9* RDW-14.4 Plt Ct-101*
[**2100-11-12**] 03:59AM BLOOD PT-14.3* PTT-26.9 INR(PT)-1.2*
[**2100-11-13**] 04:56AM BLOOD Glucose-120* UreaN-18 Creat-1.0 Na-140
K-4.0 Cl-106 HCO3-23 AnGap-15

[**2100-11-10**] Intra-op TEE
PRE-BYPASS No spontaneous echo contrast is seen in the body of
the left atrium. No atrial septal defect is seen by 2D or color
Doppler. Regional left ventricular wall motion is 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 aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. No aortic regurgitation is seen. The mitral valve
leaflets are moderately thickened. There is mild mitral valve
prolapse. Physiologic mitral regurgitation is seen (within
normal limits). The intra-aortic balloon tip is about 6 cm below
the distal aortic arch. Dr. [**Last Name (STitle) **] was notified in person
of the results in the operating room at the time of the study.

POST-BYPASS The patient is atrially paced. There is normal
biventricular systolic function. The thoracic aorta appears
intact after decannulation. No other significant changes from
the pre-bypass study

Brief Hospital Course:
The patient was transferred from an outside hospital where she
ruled in for NSTEMI on [**2100-11-6**].  She had ongoing chest pain,
received a balloon pump and was brought to the operating room on
[**2100-11-10**] where the patient underwent emergent CABG x 4 with Dr.
[**First Name (STitle) **].  Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.  POD 1 found the
patient extubated, alert and oriented and breathing comfortably.
 The patient was neurologically intact and hemodynamically
stable, weaned from inotropic and vasopressor support.  Beta
blocker was initiated and the patient was gently diuresed toward
the preoperative weight.  The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued without complication.  Hydralazine was
started for hypertension and beta blocker titrated as tolerated.
 The patient was evaluated by the physical therapy service for
assistance with strength and mobility.  ACE inhibitor was not
started, as it was felt more important to titrate her beta
blocker for tachycardia.  This can be initiated outpatient by
her cardiologist when appropriate.  By the time of discharge on
POD 4 the patient was ambulating freely, the wound was healing
and pain was controlled with oral analgesics.  The patient was
discharged to home in good condition with appropriate follow up
instructions.

Medications on Admission:
triamterene/HCTZ 37.5/25mg daily
lopressor 100mg daily
simvastatin 40mg hs
diltiazem CD 240mg daily
Diovan 80mg daily
alprazolam 0.25mg hs
lisinopril recently discontinued

Plavix - last dose: she received: [**11-7**]: 300 mg, [**11-8**]: 225 mg,
[**11-9**]: 75 mg


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO three
times a day.
Disp:*90 Tablet(s)* Refills:*2*
4. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
5. alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)) as needed for anxiety.
Disp:*20 Tablet(s)* Refills:*0*
6. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
7. 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
PMH:
hypertension
h/o hypertensive urgency [**2097**]- stress echo was negative for
ischemia at this time
hyperlipidemia
anxiety
s/p NSTEMI [**2100-11-6**]


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
Edema: 1+ edema bilateral LEs


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge


Followup Instructions:
You are scheduled for the following appointments:
Surgeon Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2100-12-6**] 1:00
Cardiologist Dr [**Last Name (STitle) 8579**] [**Telephone/Fax (1) 23882**] on [**12-7**] at 10:30am

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) 1575**] S. [**Telephone/Fax (1) 13350**] in [**3-29**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


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

Completed by:[**2100-11-14**]
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Unspecified essential hypertension,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: Burning across chest

PRESENT ILLNESS: 63F with history htn and hyperlipidemia p/t OSH ED c/o chest
burning while mowing the lawn. She was admitted to [**Hospital **]
Hospital on [**11-6**] and had a NSTEMI with a peak troponin of 1.45.
Workup included cardiac cath which revealed three vessel
disease.
She also had an elevated creatinine when she presented (1.6)
which was new for her.  A CXR revealed a 6-7 cm pulmonary nodule
in the RUL.  She is transferred for surgical consideration.

MEDICAL HISTORY: Past Medical History:
hypertension
h/o hypertensive urgency [**2097**]- stress echo was negative for
ischemia at this time
hyperlipidemia
anxiety
s/p NSTEMI [**2100-11-6**]
Past Surgical History: s/p C section

MEDICATION ON ADMISSION: triamterene/HCTZ 37.5/25mg daily
lopressor 100mg daily
simvastatin 40mg hs
diltiazem CD 240mg daily
Diovan 80mg daily
alprazolam 0.25mg hs
lisinopril recently discontinued

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 65 Resp:18  O2 sat: 97% on RA
B/P  Right: 136/77   Left:
Height: 65"    Weight: 153lb

FAMILY HISTORY: mother with a-fib
sister with a-fib

SOCIAL HISTORY: Lives with: husband
Occupation: retired
Tobacco: 1 1/2 packs per week
ETOH: denies 

### Response:
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}
