CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: This 65 year old patient has had approximately five years of
intermittent exertional chest discomfort. He has a history of
hypertension and hyperlipidemia.He reports that several stress
tests through the years have been
normal. More recently these episodes have been occurring with
increased frequency and with less and less exertion. Last
Tuesday he had an episode of substernal chest pain that occurred
after climbing one flight of stairs. His symptoms did not
resolve for at least a half hour. He denies any resting
discomfort, shortness of breath or increased fatigue. He
underwent cardiac cath at [**Hospital1 18**] which revealed 3 vessel disease.
 He is now admitted for CABG.

MEDICAL HISTORY: HTN, hyperlipidemia, renal calculi-s/p laser therapy and surgery
gout,arthritis,diverticulitis, eczema, hemmorhoids
s/p appy, s/p vasectomy,s/p renal stone surgery

MEDICATION ON ADMISSION: Norvasc 10 mg PO daily, Atenolol 100 mg PO daily,Diprolene cream
0.05% PRN eczema, Fluocinolone cream 0.025% cream PRN eczema,
Zocor 40 mg PO daily
 Prednisone PRN for gout,ASA 81 mg PO daily,Diovan 160 mg PO
daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission

FAMILY HISTORY: + CAD sister had an MI in her 50s

SOCIAL HISTORY: Lives with: wife
Occupation: [**Name2 (NI) 85101**] engineer
Tobacco: never
ETOH: 3 drinks per year
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Arthropathy, unspecified, site unspecified,Personal history of urinary calculi
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Hyperlipidemia NEC/NOS,Arthropathy NOS-unspec,Prsnl hst urnr dsrd calc
Admission Date:  [**2105-5-29**]              Discharge Date:   [**2105-6-5**]

Date of Birth:  [**2039-12-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 922**]
Chief Complaint:
Chest pain.


Major Surgical or Invasive Procedure:
Coronary artery bypass grafting x4 with left internal mammary
artery to left anterior descending coronary artery; reverse
saphenous vein single graft from the aorta to the second
diagonal coronary artery; reverse saphenous vein single graft
from the aorta to the first obtuse marginal coronary artery; as
well as reverse saphenous vein single graft from aorta to the
posterior descending coronary artery.


History of Present Illness:
This 65 year old patient has had approximately five years of
intermittent exertional chest discomfort. He has a history of
hypertension and hyperlipidemia.He reports that several stress
tests through the years have been
normal. More recently these episodes have been occurring with
increased frequency and with less and less exertion. Last
Tuesday he had an episode of substernal chest pain that occurred
after climbing one flight of stairs. His symptoms did not
resolve for at least a half hour. He denies any resting
discomfort, shortness of breath or increased fatigue. He
underwent cardiac cath at [**Hospital1 18**] which revealed 3 vessel disease.
 He is now admitted for CABG.


Past Medical History:
HTN, hyperlipidemia, renal calculi-s/p laser therapy and surgery
gout,arthritis,diverticulitis, eczema, hemmorhoids
s/p appy, s/p vasectomy,s/p renal stone surgery

Social History:
Lives with: wife
Occupation: [**Name2 (NI) 85101**] engineer
Tobacco: never
ETOH: 3 drinks per year


Family History:
+ CAD sister had an MI in her 50s


Physical Exam:
On Admission

Pulse:57 Resp:14  O2 sat: 98% on 2 liters NC
B/P  Right: 160/82   Left:
Height: 68"    Weight: 99.5 kgs

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**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right: no   Left: no


Pertinent Results:
[**2105-6-4**] 04:40AM BLOOD WBC-11.6* RBC-3.70* Hgb-10.8* Hct-33.0*
MCV-89 MCH-29.2 MCHC-32.7 RDW-14.0 Plt Ct-148*
[**2105-5-30**] 05:00AM BLOOD WBC-9.0 RBC-4.71 Hgb-14.0 Hct-42.2 MCV-90
MCH-29.8 MCHC-33.2 RDW-14.2 Plt Ct-194
[**2105-6-1**] 02:01PM BLOOD PT-14.4* PTT-31.3 INR(PT)-1.2*
[**2105-5-30**] 05:00AM BLOOD PT-13.6* PTT-27.0 INR(PT)-1.2*
[**2105-6-4**] 04:40AM BLOOD UreaN-20 Creat-1.2 Na-134 K-4.2 Cl-99
[**2105-5-30**] 05:00AM BLOOD Glucose-94 Creat-1.2 Na-138 K-4.2 Cl-102
HCO3-28 AnGap-12
[**2105-6-3**] 04:05AM BLOOD ALT-16 AST-21 LD(LDH)-169 AlkPhos-40
Amylase-30 TotBili-0.4


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 85102**], [**Known firstname 177**]       [**Hospital1 18**] [**Numeric Identifier 85103**] (Complete)
Done [**2105-6-1**] at 9:18:57 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**Known firstname 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2039-12-18**]
Age (years): 65 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Intraoperative TEE for CABG
ICD-9 Codes: 424.1, 424.0, 424.3
Test Information
Date/Time: [**2105-6-1**] at 09:18    Interpret MD: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Name Initial (MD) **] [**Name8 (MD) 4901**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW1-: Machine: AW2
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  3.4 cm  <= 4.0 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.1 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Sinus Level:  3.5 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.9 cm  <= 3.0 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aorta - Descending Thoracic:  1.9 cm  <= 2.5 cm
Aortic Valve - LVOT diam:  2.2 cm

Findings
LEFT ATRIUM: Normal LA size. No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.
Mild spontaneous echo contrast in the LAA. Good (>20 cm/s) LAA
ejection velocity. All four pulmonary veins identified and enter
the left atrium.

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

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness, cavity size,
and global systolic function (LVEF>55%).

RIGHT VENTRICLE: Dilated RV cavity. Normal RV systolic function.


AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root. Normal ascending aorta diameter.
Focal calcifications in ascending aorta. Normal descending aorta
diameter. Simple atheroma in descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Mild (1+) AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. [**Male First Name (un) **] of the
mitral chordae (normal variant). No resting LVOT gradient. Mild
(1+) MR.

TRICUSPID VALVE: Tricuspid valve not well visualized.
Physiologic TR.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
Mild 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. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient.
Conclusions
PRE BYPASS The left atrium is normal in size. No mass/thrombus
is seen in the left atrium or left atrial appendage. Mild
spontaneous echo contrast is present in the left atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler. Left ventricular wall thickness, cavity size, and
global systolic function are normal (LVEF>55%). The right
ventricular cavity is dilated with normal free wall
contractility. There are simple atheroma in the descending
thoracic aorta. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild (1+) mitral regurgitation is seen. Dr. [**Last Name (STitle) 914**]
was notified in person of the results in the operating room at
the time of the study.

POST BYPASS Normal biventricular systolic function. Thoracic
aorta intact. No significant change from pre-bypass study
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting physician
[**Last Name (NamePattern4) **] [**2105-6-1**] 12:59


?????? [**2097**] CareGroup IS. All rights reserved.


Brief Hospital Course:
The patient was admitted to the hospital and brought to the
operating room on [**2105-6-1**] where the patient underwent CABG X4
(LIMA-LAD, SVG to OM, SVG to diag, SVG to RCA).  Overall the
patient tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring.  Vancomycin was used for surgical
antibiotic prophylaxis duue to in hospital prior to surgery.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable on no inotropic or 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.
The patient was evaluated by the physical therapy service for
assistance with strength and mobility.  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 cleared by DR. [**Last Name (STitle) 914**] and discharged to home in
good condition with appropriate follow up instructions.

Medications on Admission:
Norvasc 10 mg PO daily, Atenolol 100 mg PO daily,Diprolene cream
0.05% PRN eczema, Fluocinolone cream 0.025% cream PRN eczema,
Zocor 40 mg PO daily
 Prednisone PRN for gout,ASA 81 mg PO daily,Diovan 160 mg PO
daily


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
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. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
Disp:*30 Tablet(s)* Refills:*2*
6. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 doses.
Disp:*10 Tablet(s)* Refills:*0*
7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 5 days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
coronary artery disease
s/p
HTN
hyperlipidemia
renal calculi
-s/p laser therapy and surgery
-gout
-arthritis
-diverticulitis and homorrhoids
-eczema
Past Surgical History: s/p appy
                       s/p vasectomy
                       s/p renal stone surgery

Discharge Condition:
Alert and oriented x3, nonfocal.
Ambulating with  steady gait.

Incisional pain managed with percocet

Incisions:
Sternal - healing well, no erythema or drainage

right and Leg Left - healing well, no erythema or drainage.
Edema: minimal


Discharge Instructions:
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.

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, until follow up with
surgeon.
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.**






Followup Instructions:
You are scheduled for the following appointments

Surgeon: Dr. [**Last Name (STitle) 914**] on [**2105-7-14**] 1:15pm  [**Telephone/Fax (1) 170**]

Please call to schedule appointments with your

Primary Care:  Dr. [**Last Name (STitle) 85104**] [**Telephone/Fax (1) 17663**] in [**12-27**] weeks
Cardiologist:    Dr. [**Last Name (STitle) 23705**] in [**12-27**] 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:[**2105-6-5**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Arthropathy, unspecified, site unspecified,Personal history of urinary calculi'}


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 65 year old patient has had approximately five years of
intermittent exertional chest discomfort. He has a history of
hypertension and hyperlipidemia.He reports that several stress
tests through the years have been
normal. More recently these episodes have been occurring with
increased frequency and with less and less exertion. Last
Tuesday he had an episode of substernal chest pain that occurred
after climbing one flight of stairs. His symptoms did not
resolve for at least a half hour. He denies any resting
discomfort, shortness of breath or increased fatigue. He
underwent cardiac cath at [**Hospital1 18**] which revealed 3 vessel disease.
 He is now admitted for CABG.

MEDICAL HISTORY: HTN, hyperlipidemia, renal calculi-s/p laser therapy and surgery
gout,arthritis,diverticulitis, eczema, hemmorhoids
s/p appy, s/p vasectomy,s/p renal stone surgery

MEDICATION ON ADMISSION: Norvasc 10 mg PO daily, Atenolol 100 mg PO daily,Diprolene cream
0.05% PRN eczema, Fluocinolone cream 0.025% cream PRN eczema,
Zocor 40 mg PO daily
 Prednisone PRN for gout,ASA 81 mg PO daily,Diovan 160 mg PO
daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission

FAMILY HISTORY: + CAD sister had an MI in her 50s

SOCIAL HISTORY: Lives with: wife
Occupation: [**Name2 (NI) 85101**] engineer
Tobacco: never
ETOH: 3 drinks per year 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Arthropathy, unspecified, site unspecified,Personal history of urinary calculi'}
