CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 50 year old man who had four days of chest and
left arm pain and was admitted to [**Hospital6 3105**]
after a subsequent cardiac catheterization revealed multi-vessel
coronary artery disease. He was transferred to [**Hospital1 18**] for
surgical evaluation.

MEDICAL HISTORY: Hypertension
Diabetes Mellitus
Depression
Anxiety
Benign prostatic hypertrophy
Skin lesion removal of right infraorbital area
s/p TURP

MEDICATION ON ADMISSION: lisinopril 20mg daily, lantus 50 units at bedtime, aspirin 81mg
daily, remeron 45mg daily, zocor 80mg daily, relafen 750mg [**Hospital1 **]
PRN, colace 100mg [**Hospital1 **], metformin 1000mg [**Hospital1 **]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:50  Resp:16  O2 sat:100%RA
B/P  L:147/81
Height:5"3     Weight:151 lbs

FAMILY HISTORY: No Premature coronary artery disease

SOCIAL HISTORY: Race:hispanic
Last Dental Exam:> 1 year
Lives with:wife
Contact:  [**Name (NI) **] [**Last Name (NamePattern1) 91012**]          Phone #([**Telephone/Fax (1) 92458**]
Occupation:disability due to depression
Cigarettes: Smoked no [x] yes [] last cigarette [**2172**] Hx:
1.5ppd times 25 years
ETOH: < 1 drink/week [x]  [**2-3**] drinks/week [] >8 drinks/week []
Illicit drug use - no
Coronary atherosclerosis of native coronary artery,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Other iatrogenic hypotension,Unspecified essential hypertension,Precordial pain,Long-term (current) use of insulin,Personal history of tobacco use
Crnry athrscl natve vssl,Pleural effusion NOS,Hyposmolality,DMII wo cmp nt st uncntr,Anemia NOS,Idio periph neurpthy NOS,Iatrogenc hypotnsion NEC,Hypertension NOS,Precordial pain,Long-term use of insulin,History of tobacco use
Admission Date:  [**2189-1-17**]              Discharge Date:   [**2189-1-25**]

Date of Birth:  [**2138-6-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2189-1-19**] Coronary artery bypass graft x4 -- left internal mammary
artery to left anterior descending artery and saphenous vein
grafts to diagonal, obtuse marginal 1, and obtuse marginal 2

History of Present Illness:
Mr. [**Known lastname **] is a 50 year old man who had four days of chest and
left arm pain and was admitted to [**Hospital6 3105**]
after a subsequent cardiac catheterization revealed multi-vessel
coronary artery disease. He was transferred to [**Hospital1 18**] for
surgical evaluation.

Past Medical History:
Hypertension
Diabetes Mellitus
Depression
Anxiety
Benign prostatic hypertrophy
Skin lesion removal of right infraorbital area
s/p TURP

Social History:
Race:hispanic
Last Dental Exam:> 1 year
Lives with:wife
Contact:  [**Name (NI) **] [**Last Name (NamePattern1) 91012**]          Phone #([**Telephone/Fax (1) 92458**]
Occupation:disability due to depression
Cigarettes: Smoked no [x] yes [] last cigarette [**2172**] Hx:
1.5ppd times 25 years
ETOH: < 1 drink/week [x]  [**2-3**] drinks/week [] >8 drinks/week []
Illicit drug use - no

Family History:
No Premature coronary artery disease

Physical Exam:
Pulse:50  Resp:16  O2 sat:100%RA
B/P  L:147/81
Height:5"3     Weight:151 lbs

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 [x] grade I/VI diastolic
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact [x]
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:-    Left:-

Pertinent Results:
CT [**2189-1-18**]: No intrathoracic, intra-abdominal, or intrapelvic
pathology
identified.
.
Echo: [**2189-1-19**]: PRE-BYPASS:
The left atrium is dilated. No spontaneous echo contrast or
thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler. 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 mildly thickened. No mitral regurgitation is seen.
There is no pericardial effusion. Dr.[**First Name (STitle) **] was notified in
person of the results before surgical incision.
Postbypass: Preserved biventricular systolic function. LVEF 55%.
Intact thoracic aorta. No new valvular findings.

Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname **] was transferred from
outside hospital after cardiac cath revealed severe coronary
artery disease. Upon admission he was medically managed and
underwent pre-operative work-up. On [**1-20**] he was brought to the
operating room where he underwent a coronary arterty bypass
graft x 4. Please see operative note for details. Following
surgery he was transferred to the CVICU for invasive monitoring
in stable condition. His awoke from sedation hemodynamically
stable and was weaned from the ventilator and extubated. He was
started on betablockers, lasix, ASA and statin therapy. CT and
temporary pacing wires were removed per protocol. He was
evaluated by physical tehrpay for strnegth and conditioning. On
3 separate occasions when he was walking on the stairs he became
hypotensive w/ SBP 70's-80's and diaphoretic. His medications
were adjusted and he was given 2 UPRBC for post-op anemia( HCT
22) with stabilization of his hemodynamics. An ECHO was done
without evidence of pericardial effusion. CXR revealed a
moderate left effusion which has responded to diuresis. On POD#
6 he was cleared for dischrge to home and all follow up
instructions and appointments were advised.

Medications on Admission:
lisinopril 20mg daily, lantus 50 units at bedtime, aspirin 81mg
daily, remeron 45mg daily, zocor 80mg daily, relafen 750mg [**Hospital1 **]
PRN, colace 100mg [**Hospital1 **], metformin 1000mg [**Hospital1 **]

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. 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*
3. mirtazapine 15 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
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. metoprolol tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
6. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
8. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 5 days.
Disp:*5 Tablet(s)* Refills:*1*
9. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day for 5 days.
Disp:*10 Tablet Extended Release(s)* Refills:*1*
10. glargine
take only 10 units of lantus at bedtime and check you
fingerstick before meals and at bedtime


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Coronary artery disease s/p Coronary artery bypass graft x 4
Past medical history:
Hypertension
Diabetes Mellitus
Depression
Anxiety
Benign prostatic hypertrophy
Skin lesion removal of right infraorbital area
s/p TURP

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema- none


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**]

**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. [**First Name (STitle) **] on [**2189-3-3**] at 1:00pm in the [**Hospital **] medical
office building, [**Hospital Unit Name **]
Cardiologist: Dr. [**Last Name (STitle) 66588**] on [**2189-2-25**] at 10:45am
Wound check: [**Hospital Unit Name **], [**Hospital Unit Name **] on [**2189-1-29**] at 11:00am

Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 696**] in [**4-2**] 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:[**2189-1-25**]
{'Coronary atherosclerosis of native coronary artery,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Other iatrogenic hypotension,Unspecified essential hypertension,Precordial pain,Long-term (current) use of insulin,Personal history of tobacco use'}


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: Mr. [**Known lastname **] is a 50 year old man who had four days of chest and
left arm pain and was admitted to [**Hospital6 3105**]
after a subsequent cardiac catheterization revealed multi-vessel
coronary artery disease. He was transferred to [**Hospital1 18**] for
surgical evaluation.

MEDICAL HISTORY: Hypertension
Diabetes Mellitus
Depression
Anxiety
Benign prostatic hypertrophy
Skin lesion removal of right infraorbital area
s/p TURP

MEDICATION ON ADMISSION: lisinopril 20mg daily, lantus 50 units at bedtime, aspirin 81mg
daily, remeron 45mg daily, zocor 80mg daily, relafen 750mg [**Hospital1 **]
PRN, colace 100mg [**Hospital1 **], metformin 1000mg [**Hospital1 **]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:50  Resp:16  O2 sat:100%RA
B/P  L:147/81
Height:5"3     Weight:151 lbs

FAMILY HISTORY: No Premature coronary artery disease

SOCIAL HISTORY: Race:hispanic
Last Dental Exam:> 1 year
Lives with:wife
Contact:  [**Name (NI) **] [**Last Name (NamePattern1) 91012**]          Phone #([**Telephone/Fax (1) 92458**]
Occupation:disability due to depression
Cigarettes: Smoked no [x] yes [] last cigarette [**2172**] Hx:
1.5ppd times 25 years
ETOH: < 1 drink/week [x]  [**2-3**] drinks/week [] >8 drinks/week []
Illicit drug use - no 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified pleural effusion,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Other iatrogenic hypotension,Unspecified essential hypertension,Precordial pain,Long-term (current) use of insulin,Personal history of tobacco use'}
