CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: This 66 year old patient with a
history of hypertension, elevated cholesterol and type 2
diabetes
has been feeling intermittent chest pain and exertional dyspnea
with activity and at rest for the past 2 and a half years. At a
routine follow up appointment with his cardiologist for his
hypertension he mentioned that he has chest pain that lasts a
few
minutes when he exercises on the treadmill. He was then referred
for a stress test on [**2151-11-10**]. The patient  exercised for 4
minutes and 3 seconds [**First Name8 (NamePattern2) **] [**Doctor First Name **] protocol at 89% of predicted
max.
The patient had 2/10 chest pain. There was marked 2-[**Street Address(2) 2051**]
depression at inferior leads V4 - V6, as well as frequent PVC's
and couplets. In the MIBI portion there was a postive
inferoapical defect. LVEF is 45% with inferior hypokinesis.
Presently the patient continues to have exertional chest pain
and
dyspnea and also reports feeling occasional claudication
symptoms, but otherwise denies palpitations, edema, orthopnea,
PND, lightheadedness. His cath today revealed two vessel CAD.

MEDICAL HISTORY: Carotid Stenosis
Hypertension
Elevated cholesterol
Diabetes
Arthritis
Alcohol abuse, none for 27 years

MEDICATION ON ADMISSION: CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth once every morning
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth once ever morning
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once every morning
PIOGLITAZONE [ACTOS] -  (Prescribed by Other Provider) - 30 mg
Tablet - 1 Tablet(s) by mouth once every morning
PRAMIPEXOLE -  (Prescribed by Other Provider) - 0.25 mg Tablet -
1 Tablet(s) by mouth once every evening
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
Tablet(s) by mouth once every evening
VERAPAMIL -  (Prescribed by Other Provider) - 180 mg Cap,24 hr
Sust Release Pellets - 1 Cap(s) by mouth once every morning

ALLERGIES: Cortisone

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: His brother and sister have hypertension, an older brother is a
diabetic

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:edentulous
Lives with:lives alone
Occupation:retired, does volunteer work
Tobacco: quit smoking 15 years ago
ETOH:none recent
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr
Admission Date:  [**2151-11-26**]              Discharge Date:   [**2151-11-30**]

Date of Birth:  [**2084-11-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Cortisone

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
chest pain


Major Surgical or Invasive Procedure:
Coronary artery bypass grafting x2 (with a left internal mammary
artery to the left anterior descending artery and reverse
saphenous vein graft to the obtuse marginal artery)on [**2151-11-26**]


History of Present Illness:
This 66 year old patient with a
history of hypertension, elevated cholesterol and type 2
diabetes
has been feeling intermittent chest pain and exertional dyspnea
with activity and at rest for the past 2 and a half years. At a
routine follow up appointment with his cardiologist for his
hypertension he mentioned that he has chest pain that lasts a
few
minutes when he exercises on the treadmill. He was then referred
for a stress test on [**2151-11-10**]. The patient  exercised for 4
minutes and 3 seconds [**First Name8 (NamePattern2) **] [**Doctor First Name **] protocol at 89% of predicted
max.
The patient had 2/10 chest pain. There was marked 2-[**Street Address(2) 2051**]
depression at inferior leads V4 - V6, as well as frequent PVC's
and couplets. In the MIBI portion there was a postive
inferoapical defect. LVEF is 45% with inferior hypokinesis.
Presently the patient continues to have exertional chest pain
and
dyspnea and also reports feeling occasional claudication
symptoms, but otherwise denies palpitations, edema, orthopnea,
PND, lightheadedness. His cath today revealed two vessel CAD.


Past Medical History:
Carotid Stenosis
Hypertension
Elevated cholesterol
Diabetes
Arthritis
Alcohol abuse, none for 27 years


Social History:
Race:caucasian
Last Dental Exam:edentulous
Lives with:lives alone
Occupation:retired, does volunteer work
Tobacco: quit smoking 15 years ago
ETOH:none recent

Family History:
His brother and sister have hypertension, an older brother is a
diabetic

Physical Exam:
Admission Physical Exam

Pulse: 89 Resp:  O2 sat: 97%
B/P  135/80
Height: 5 feet 11 inches    Weight:228 pounds

General:
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 []  Murmur
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**]:1+   Left:1+
Radial       Right:2+   Left:2+

Carotid Bruit        Right:-    Left:-


Pertinent Results:
[**2151-11-28**] 04:45AM BLOOD WBC-9.9 RBC-3.60* Hgb-10.8* Hct-30.9*
MCV-86 MCH-30.0 MCHC-35.0 RDW-14.0 Plt Ct-175
[**2151-11-26**] 03:00PM BLOOD WBC-14.1*# RBC-3.07*# Hgb-9.2* Hct-26.4*
MCV-86 MCH-29.9 MCHC-34.6 RDW-13.8 Plt Ct-240
[**2151-11-27**] 04:07AM BLOOD PT-13.4 PTT-23.1 INR(PT)-1.1
[**2151-11-26**] 03:00PM BLOOD PT-14.6* PTT-24.2 INR(PT)-1.3*
[**2151-11-28**] 04:45AM BLOOD Glucose-122* UreaN-23* Creat-1.1 Na-138
K-5.0 Cl-101 HCO3-32 AnGap-10
[**2151-11-26**] 04:11PM BLOOD UreaN-17 Creat-1.0 Na-136 K-4.6 Cl-105
HCO3-28 AnGap-8


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Last Name (LF) **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 87156**]
(Complete) Done [**2151-11-26**] at 1:37:00 PM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]
[**Last Name (NamePattern4) 18**] - Department of Cardiac S
[**Last Name (NamePattern1) 439**], 2A
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2084-11-20**]
Age (years): 67 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Chest pain. Left ventricular function. Preoperative
assessment.
ICD-9 Codes: 424.0
Test Information
Date/Time: [**2151-11-26**] at 13:37    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 168**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW5-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Aorta - Annulus:  2.4 cm  <= 3.0 cm
Aorta - Sinus Level:  *3.9 cm  <= 3.6 cm
Aorta - Ascending:  3.3 cm  <= 3.4 cm

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Normal regional LV systolic function. Overall normal LVEF
(>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal ascending aorta diameter. Complex (>4mm) atheroma
in the descending thoracic aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AR.


MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) PR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PREBYPASS
No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thicknesses are normal. The left ventricular
cavity size is normal. 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 complex (>4mm) atheroma in the descending
thoracic aorta. The aortic valve leaflets (3) are mildly
thickened. No aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Mild (1+) mitral regurgitation is
seen.

POSTBYPASS Normal biventricular systolic function. Mild mitral
regurgitation is unchnaged. Thoracic aorta appears intact after
decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting
physician


?????? [**2144**] CareGroup IS. All rights reserved.


Brief Hospital Course:
On [**2151-11-26**] Mr.[**Known lastname 4143**] was taken to the operating room and
underwent Coronary artery bypass grafting x2 (with a left
internal mammary artery to the left anterior descending artery
and reverse saphenous vein graft to the obtuse marginal artery)
with Dr.[**Last Name (STitle) **]. Please refer to operative report for further
deatils. He tolerated the procedure well and was transferred to
the CVICU intubated and sedated in critical but stable
condition. He awoke neurologically intact and was extubated
without difficulty. All lines and drains were discontinued [**Female First Name (un) **]
timely fashion. he was weaned off all drips and started on
Beta-blocker/Statin/ASA and diuresis. On POD#1 he was
transferred to the step down unit for further monitoring.
Physical therapy was consulted for evaluation of strength and
mobility. The remainder of his hospital course was essentially
uneventful. On POD#4 he was cleared by Dr.[**Last Name (STitle) **] for discharge to
[**Hospital **] Rehabilitation in [**Location (un) **]. All follow up appointments
were advised.

Medications on Admission:
CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth once every morning
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth once ever morning
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once every morning
PIOGLITAZONE [ACTOS] -  (Prescribed by Other Provider) - 30 mg
Tablet - 1 Tablet(s) by mouth once every morning
PRAMIPEXOLE -  (Prescribed by Other Provider) - 0.25 mg Tablet -
1 Tablet(s) by mouth once every evening
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
Tablet(s) by mouth once every evening
VERAPAMIL -  (Prescribed by Other Provider) - 180 mg Cap,24 hr
Sust Release Pellets - 1 Cap(s) by mouth once every morning

Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 325 mg Tablet - 1
Tablet(s) by mouth once every morning
MULTIVITAMIN -  (Prescribed by Other Provider) - Dosage
uncertain

Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours).

6. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain/temp.
7. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
8. pioglitazone 15 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
9. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
10. metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
11. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day.
12. insulin regular human 100 unit/mL (3 mL) Insulin Pen Sig:
One (1)  Subcutaneous ACHS: per RISS.


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location (un) 5165**]

Discharge Diagnosis:
Coronary artery disease
s/p CABG x2-10/15/10

Carotid Stenosis
Hypertension
Elevated cholesterol
Diabetes
Arthritis
Alcohol abuse, none for 27 years


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema



Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon:Dr.[**Last Name (STitle) **] #[**Telephone/Fax (1) 170**], an appointment was arranged for
Wed, [**2151-12-15**] at 1:15
Cardiologist:Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on  [**12-20**] at 1:30

Please call to schedule appointments with your
Primary Care Dr.[**Last Name (STitle) 87157**] [**Name (STitle) 17996**]  in [**2-13**] 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**



Completed by:[**2151-11-30**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: This 66 year old patient with a
history of hypertension, elevated cholesterol and type 2
diabetes
has been feeling intermittent chest pain and exertional dyspnea
with activity and at rest for the past 2 and a half years. At a
routine follow up appointment with his cardiologist for his
hypertension he mentioned that he has chest pain that lasts a
few
minutes when he exercises on the treadmill. He was then referred
for a stress test on [**2151-11-10**]. The patient  exercised for 4
minutes and 3 seconds [**First Name8 (NamePattern2) **] [**Doctor First Name **] protocol at 89% of predicted
max.
The patient had 2/10 chest pain. There was marked 2-[**Street Address(2) 2051**]
depression at inferior leads V4 - V6, as well as frequent PVC's
and couplets. In the MIBI portion there was a postive
inferoapical defect. LVEF is 45% with inferior hypokinesis.
Presently the patient continues to have exertional chest pain
and
dyspnea and also reports feeling occasional claudication
symptoms, but otherwise denies palpitations, edema, orthopnea,
PND, lightheadedness. His cath today revealed two vessel CAD.

MEDICAL HISTORY: Carotid Stenosis
Hypertension
Elevated cholesterol
Diabetes
Arthritis
Alcohol abuse, none for 27 years

MEDICATION ON ADMISSION: CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth once every morning
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth once ever morning
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once every morning
PIOGLITAZONE [ACTOS] -  (Prescribed by Other Provider) - 30 mg
Tablet - 1 Tablet(s) by mouth once every morning
PRAMIPEXOLE -  (Prescribed by Other Provider) - 0.25 mg Tablet -
1 Tablet(s) by mouth once every evening
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
Tablet(s) by mouth once every evening
VERAPAMIL -  (Prescribed by Other Provider) - 180 mg Cap,24 hr
Sust Release Pellets - 1 Cap(s) by mouth once every morning

ALLERGIES: Cortisone

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: His brother and sister have hypertension, an older brother is a
diabetic

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:edentulous
Lives with:lives alone
Occupation:retired, does volunteer work
Tobacco: quit smoking 15 years ago
ETOH:none recent 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
