CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: Pt is 78 y/o F with h/o CAD s/p stenting and HTN who was
transferred from OSH for a finding of focal right carotid
dissection on CT scan.  Pt initially presented to OSH last night
after developing chest pain that was minimally relieved by 3
doses of sublingual nitro.  On the day prior to admission, pt
did
have an episode of chest pain that was relieved by one dose of
sublingual nitro.  Pt states that pain felt like pressure and
radiated across her chest.  Pt denies shortness of breath.  Pt
states that she also has had episodes of right neck pain over
the past few days.  She states that she has had chronic neck
pain since she developed a tooth abscess a year and a half ago
and
needed a root canal but the neck pain was worse over the past
few days.  Pt also has had complaints of numbness and tingling
in her left hand over the past several weeks.  She denies focal
weakness or vision changes.  No fevers, chills, lightheadedness,
dizziness, cough, abd pain, nausea/vomiting, or dysuria.

MEDICAL HISTORY: CAD s/p stent
htn
hyperlipidemia
anxiety

MEDICATION ON ADMISSION: asa 81
zetia 10 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: T 97.8  P 56  BP 162/65  R 18  SaO2 100%
Gen: nad
Neck: supple
Heent: non-icteric
Lungs: clear
heart: RRR
Abd: soft, nontender, nondistended, no pulsatile mass
Extrem: palpable femoral, popliteal, and DP/PT pulses
bilaterally

FAMILY HISTORY: Parents had CHF, DM, and CAD

SOCIAL HISTORY: Smoked 2 ppd for 18 years, quit smoking 40 years ago, no etoh.
Chest pain, unspecified,Cervicalgia,Constipation, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Percutaneous transluminal coronary angioplasty status
Chest pain NOS,Cervicalgia,Constipation NOS,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Anxiety state NOS,Status-post ptca
Admission Date:  [**2129-3-3**]              Discharge Date:   [**2129-3-5**]

Date of Birth:  [**2050-7-7**]             Sex:   F

Service: SURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2777**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Pt is 78 y/o F with h/o CAD s/p stenting and HTN who was
transferred from OSH for a finding of focal right carotid
dissection on CT scan.  Pt initially presented to OSH last night
after developing chest pain that was minimally relieved by 3
doses of sublingual nitro.  On the day prior to admission, pt
did
have an episode of chest pain that was relieved by one dose of
sublingual nitro.  Pt states that pain felt like pressure and
radiated across her chest.  Pt denies shortness of breath.  Pt
states that she also has had episodes of right neck pain over
the past few days.  She states that she has had chronic neck
pain since she developed a tooth abscess a year and a half ago
and
needed a root canal but the neck pain was worse over the past
few days.  Pt also has had complaints of numbness and tingling
in her left hand over the past several weeks.  She denies focal
weakness or vision changes.  No fevers, chills, lightheadedness,
dizziness, cough, abd pain, nausea/vomiting, or dysuria.


Past Medical History:
CAD s/p stent
htn
hyperlipidemia
anxiety


Social History:
Smoked 2 ppd for 18 years, quit smoking 40 years ago, no etoh.

Family History:
Parents had CHF, DM, and CAD

Physical Exam:
T 97.8  P 56  BP 162/65  R 18  SaO2 100%
Gen: nad
Neck: supple
Heent: non-icteric
Lungs: clear
heart: RRR
Abd: soft, nontender, nondistended, no pulsatile mass
Extrem: palpable femoral, popliteal, and DP/PT pulses
bilaterally


Pertinent Results:
Labs on admission:
[**2129-3-3**] 11:55PM BLOOD WBC-8.8 RBC-4.06* Hgb-12.4 Hct-37.3
MCV-92 MCH-30.6 MCHC-33.3 RDW-13.6 Plt Ct-300
[**2129-3-3**] 11:55PM BLOOD PT-14.5* PTT-122.7* INR(PT)-1.3*
[**2129-3-3**] 11:55PM BLOOD Glucose-133* UreaN-14 Creat-0.8 Na-138
K-4.2 Cl-104 HCO3-25 AnGap-13
[**2129-3-3**] 11:55PM BLOOD Calcium-9.3 Phos-4.0 Mg-2.5
Labs prior to discharge:
[**2129-3-4**] 07:46AM BLOOD PT-13.7* PTT-60.1* INR(PT)-1.2*
[**2129-3-4**] 07:46AM BLOOD Glucose-130* UreaN-15 Creat-0.8 Na-137
K-4.2 Cl-103 HCO3-24 AnGap-14

Imaging:
CAROTID SERIES COMPLETE PORT Study Date of [**2129-3-4**] 10:44 AM
Right ICA stenosis <40%.
Left ICA stenosis <40%.
KUB: Non-obstructive bowel gas pattern

Brief Hospital Course:
78 y/o F with CAD who now presents with chest pain and question
of focal right carotid dissection on OSH CT scan.  Scans
reviewed and we concluded that she did not have any evidence
suggestive of a right or left carotid dissection.  Her symptoms
are most consistent with typical angina and not a carotid
dissection.  Carotid ultrasound showed unimpressive bilateral
carotid stenoses.   Patient remained asymptomatic without chest
pain or neuro symptoms during her hospital stay.  Patient was
afebrile with stable vital signs.  Labs unremarkable.  Patient
is scheduled for an outpatient stress test.  She will follow up
with her PCP and cardiologist.  Discharged home today in good
condition tolerating POs and ambulating well.

Medications on Admission:
asa 81
zetia 10 mg daily


Discharge Medications:
1. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
2. Zetia 10 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Chest pain


Discharge Condition:
Good


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting,
diarrhea or other reasons.
* Signs of dehydration include dry mouth, rapid heartbeat or
feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your skin, or the whites of your eyes become yellow.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Do not drive or operate heavy machinery while taking any
narcotic pain medication.  You may have constipation when taking
narcotic pain medications (oxycodone, percocet, vicodin,
hydrocodone, dilaudid, etc.); you should continue drinking
fluids, you may take stool softeners, and should eat foods that
are high in fiber.
* Continue to ambulate several times per day.
* No heavy ([**9-1**]  lbs) until your follow up appointment.


Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] in 2 weeks.

Please follow up with your cardiologist and primary care
physician this week.

Have your outpatient stress test as scheduled.



Completed by:[**2129-3-5**]
{'Chest pain, unspecified,Cervicalgia,Constipation, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Percutaneous transluminal coronary angioplasty status'}


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: Pt is 78 y/o F with h/o CAD s/p stenting and HTN who was
transferred from OSH for a finding of focal right carotid
dissection on CT scan.  Pt initially presented to OSH last night
after developing chest pain that was minimally relieved by 3
doses of sublingual nitro.  On the day prior to admission, pt
did
have an episode of chest pain that was relieved by one dose of
sublingual nitro.  Pt states that pain felt like pressure and
radiated across her chest.  Pt denies shortness of breath.  Pt
states that she also has had episodes of right neck pain over
the past few days.  She states that she has had chronic neck
pain since she developed a tooth abscess a year and a half ago
and
needed a root canal but the neck pain was worse over the past
few days.  Pt also has had complaints of numbness and tingling
in her left hand over the past several weeks.  She denies focal
weakness or vision changes.  No fevers, chills, lightheadedness,
dizziness, cough, abd pain, nausea/vomiting, or dysuria.

MEDICAL HISTORY: CAD s/p stent
htn
hyperlipidemia
anxiety

MEDICATION ON ADMISSION: asa 81
zetia 10 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: T 97.8  P 56  BP 162/65  R 18  SaO2 100%
Gen: nad
Neck: supple
Heent: non-icteric
Lungs: clear
heart: RRR
Abd: soft, nontender, nondistended, no pulsatile mass
Extrem: palpable femoral, popliteal, and DP/PT pulses
bilaterally

FAMILY HISTORY: Parents had CHF, DM, and CAD

SOCIAL HISTORY: Smoked 2 ppd for 18 years, quit smoking 40 years ago, no etoh. 

### Response:
{'Chest pain, unspecified,Cervicalgia,Constipation, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anxiety state, unspecified,Percutaneous transluminal coronary angioplasty status'}
