CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Mr. [**Known lastname 88571**] is a 66 year old male has a history of
dyslipidemia and prior tobacco abuse. He reports that over the
past six to eight weeks he has noticed "heartburn" or chest
pressure type symptoms when exerting himself after a meal or
walking up and down inclines. These symptoms always resolve
quickly with rest. He has also noticed occasional dyspnea on
exertion. For this reason, he underwent non imaging stress
testing where he was noted to have 3mm ST depression in the
inferoapical/anterior leads along with a fall in blood pressure.
He was referred for left heart catheterization. He was found to
have three vessel coronary artery disease and was referred to
cardiac surgery for revascularization.

MEDICAL HISTORY: Dyslipidemia
Lower back pain with spinal stenosis
GIB in the setting of high dose ibuprofen use (approximately 5-6
years ago)
Occasional hematuria on low dose aspirin (no prior workup)
BPH
Mild arthritis
Bilateral arthroscopic knee surgery
Hernia repair bilaterally
teeth extraction in [**2-/2140**]

MEDICATION ON ADMISSION: BISOPROLOL FUMARATE 5 QHS
ASCORBIC ACID 1000 [**Hospital1 **]
ASA 81 daily
ERGOCALCIFEROL 1,000u daily
FLAXSEED 1,000 [**Hospital1 **]
VITAMIN E 400u daily

ALLERGIES: ibuprofen / Lipitor / deer tick

PHYSICAL EXAM: Pulse:59 Resp:18  O2 sat:95/RA
B/P  Right:111/66    Left:100/72
Height:5'[**39**].5"     Weight:187 lbs

FAMILY HISTORY: Mr. [**Known lastname 88572**] father had angina in his 80's.  His mother had a
pacemaker.

SOCIAL HISTORY: He lives with his wife. Mr. [**Known lastname 88571**] works four days a week in
maintenance at [**Hospital1 **]. He quit
smoking in [**2132**] and has a history of [**1-4**] cigars per week for 40
years.  He rarely drinks alcohol.
Coronary atherosclerosis of native coronary artery,Acute kidney failure with lesion of tubular necrosis,Iatrogenic pneumothorax,Urinary complications, not elsewhere classified,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Spinal stenosis, unspecified region
Crnry athrscl natve vssl,Ac kidny fail, tubr necr,Iatrogenic pneumothorax,Surg compl-urinary tract,Intermed coronary synd,Hyperlipidemia NEC/NOS,Spinal stenosis NOS
Admission Date:  [**2140-6-13**]              Discharge Date:   [**2140-6-25**]

Date of Birth:  [**2074-1-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
ibuprofen / Lipitor / deer tick

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Coronary artery bypass grafting x four (Left internal mammary
artery > left anterior descending, saphenous vein graft >
diagonal, saphenous vein graft > obtuse marginal, saphenous vein
graft > posterior descending artery) [**2140-6-13**]


History of Present Illness:
Mr. [**Known lastname 88571**] is a 66 year old male has a history of
dyslipidemia and prior tobacco abuse. He reports that over the
past six to eight weeks he has noticed "heartburn" or chest
pressure type symptoms when exerting himself after a meal or
walking up and down inclines. These symptoms always resolve
quickly with rest. He has also noticed occasional dyspnea on
exertion. For this reason, he underwent non imaging stress
testing where he was noted to have 3mm ST depression in the
inferoapical/anterior leads along with a fall in blood pressure.
He was referred for left heart catheterization. He was found to
have three vessel coronary artery disease and was referred to
cardiac surgery for revascularization.

Past Medical History:
Dyslipidemia
Lower back pain with spinal stenosis
GIB in the setting of high dose ibuprofen use (approximately 5-6
years ago)
Occasional hematuria on low dose aspirin (no prior workup)
BPH
Mild arthritis
Bilateral arthroscopic knee surgery
Hernia repair bilaterally
teeth extraction in [**2-/2140**]

Social History:
He lives with his wife. Mr. [**Known lastname 88571**] works four days a week in
maintenance at [**Hospital1 **]. He quit
smoking in [**2132**] and has a history of [**1-4**] cigars per week for 40
years.  He rarely drinks alcohol.

Family History:
Mr. [**Known lastname 88572**] father had angina in his 80's.  His mother had a
pacemaker.

Physical Exam:
Pulse:59 Resp:18  O2 sat:95/RA
B/P  Right:111/66    Left:100/72
Height:5'[**39**].5"     Weight:187 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
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] B groin hernia incisions
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right:  cath site Left: +2
DP           Right: +2  Left: +2
PT           [**Name (NI) 167**]: +2  Left: +2
Radial       Right: +2  Left: +2

Carotid Bruit        Right: 0   Left: 0
Discharge:
VS: T: 98.2  HR: 70 SR  BP: 122/80 18 Sats: 100% RA
General: 66 year-old male in no apparent distress
HEENT; normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR normal S1.S2 no murmur
Resp: clear breath sounds throught out
GI: benign
Extr: warm no edema
Incision: sternal & LLE clean, dry intact
Neuro: awake, alert, oriented walking in halls


Pertinent Results:
LEFT ATRIUM: Normal LA size.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. PFO is present.

LEFT VENTRICLE: Normal LV wall thickness and cavity size. Normal
LV wall thickness, cavity size, and global systolic function
(LVEF>55%). Normal LV wall thickness, cavity size and
regional/global systolic function (LVEF >55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal ascending, transverse and descending thoracic
aorta with no atherosclerotic plaque. Normal diameter of aorta
at the sinus, ascending and arch levels.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
MITRAL VALVE: Normal mitral valve leaflets with trivial MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.
PERICARDIUM: No pericardial effusion.
PREBYPASS:
ESSENTIALLY NORMAL exam. He has a small PFO with left to right
flow. Normal function, normal valves.
The left atrium is normal in size. A patent foramen ovale is
present. Left ventricular wall thicknesses and cavity size are
normal. Left ventricular wall thickness, cavity size, and global
systolic function are normal (LVEF>55%). Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF >55%). Right ventricular chamber size and free wall
motion are normal. The ascending, transverse and descending
thoracic aorta are normal in diameter and free of
atherosclerotic plaque . The diameters of aorta at the sinus,
ascending and arch levels are normal. The aortic valve leaflets
(3) appear structurally normal with good leaflet excursion and
no aortic stenosis or aortic regurgitation. The mitral valve
appears structurally normal with trivial mitral regurgitation.
There is no pericardial effusion.
POSTBYPASS: Unchanged. No segmental wall motion abnormalities.
LVEF 50-55%, No dissection seen after removal of aortic cannula.


[**2140-6-20**] 06:25AM BLOOD WBC-8.9 RBC-3.52* Hgb-10.4* Hct-31.4*
MCV-89 MCH-29.7 MCHC-33.3 RDW-13.1 Plt Ct-334
[**2140-6-21**] 05:50AM BLOOD Glucose-126* UreaN-76* Creat-6.7* Na-136
K-4.2 Cl-103 HCO3-22 AnGap-15
[**2140-6-23**] 08:51AM BLOOD UreaN-64* Creat-5.4*
[**2140-6-22**] 10:00PM BLOOD UreaN-70* Creat-5.9*# Na-138 K-3.7 Cl-106
[**2140-6-22**] 05:55AM BLOOD Glucose-114* UreaN-77* Creat-7.0* Na-137
K-4.4 Cl-104 HCO3-23 AnGap-14

Brief Hospital Course:
On [**6-13**] he was brought to the operating room for coronary artery
bypass graft surgery.  Please see the operative note for
details.  He received cefazolin for perioperative antibiotics
and was transferred to the intensive care unit for post
operative management.  That evening he was weaned from sedation,
awoke neurologically intact and was extubated without
complications.  On post operative day one he was started on
Lasix and beta blockers, additionally chest tubes were removed
and was noted for bilateral apical pneumothorax.  He had serial
chest xrays that revealed continued improvement over the next
few days without further intervention.  His chest xray at the
time of discharge showed stable pneumothoraces. On post
operative day two his epicardial wires were removed and
transferred to the floor.

Respiratory: aggressive incentive spirometer, ambulation and
good pain control he titrated off oxygen with room saturations
of 98%

Cardiac: hemodynamically stable sinus rhythm 80's without
ectopy.  Beta-blockers were titrated.  Blood pressure 110-130's
stable.  Statins and aspirin continued.

GI: Proton Pump Inhibitor & bowel regimen.  Tolerated a regular
diet

Renal: POD 3 developed ATN with peak Cre of 7.0 (baseline 0.9).
Furosemide and toradol was discontinued. He continued to make
adequate urine.  Electrolytes were replete as needed. He was
seen by renal who recommended chem 10 labs daily
keeping SBP>100 and dose meds for eGFR<15.  He was given 1 liter
of LR on POD 9 and 10 and his cratinine and BUN had decreased
after stopping all diuretics and IVF was given. His creatinine
had decreased to 4.1 at the time of discharge.

Endocrine: insulin sliding scale with blood sugars < 150.

Pain: Toradol discontinued with rising creatinine, Oxycodone and
acetaminophen were continued with good pain control.

Disposition: he was seen by physical therapy for strength and
mobility. He continued to make steady progress and was
discharged to home on [**2140-6-25**]. He will need his electrolytes,
BUN and Creatinine checked on [**2140-6-27**].  All follow-up
appointments were advised.


Medications on Admission:
BISOPROLOL FUMARATE 5 QHS
ASCORBIC ACID 1000 [**Hospital1 **]
ASA 81 daily
ERGOCALCIFEROL 1,000u daily
FLAXSEED 1,000 [**Hospital1 **]
VITAMIN E 400u daily

Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): hold for loose stools.
4. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for fever or pain.
Disp:*40 Tablet(s)* Refills:*0*
5. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for fever or pain.
6. rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Outpatient Lab Work
BUN/CRE Monday [**2140-6-27**] and call results to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3142**]
[**Telephone/Fax (1) 58707**]


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Coronary artery disease s/p CABG
Pneumothorax
Dyslipidemia
Lower back pain with spinal stenosis
Gastrointestinal bleeding
Hematuria
Benign prostatic hypertrophy
Mild arthritis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
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**]

**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:

Date/Time:[**2140-6-27**] BUN/creatinine check call results to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 3142**]
[**Telephone/Fax (1) 170**]

Surgeon: Dr [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] Date/Time:[**2140-7-7**] 1:30 [**Hospital Unit Name **] [**Last Name (un) 2577**] Building [**Last Name (NamePattern1) **]

Cardiologist:[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7756**]/ [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7526**] [**2140-7-18**] 1:00 pm

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) 59917**] [**Telephone/Fax (1) 21640**] in [**4-5**] weeks [**Telephone/Fax (1) 21640**]

**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:[**2140-6-25**]
{'Coronary atherosclerosis of native coronary artery,Acute kidney failure with lesion of tubular necrosis,Iatrogenic pneumothorax,Urinary complications, not elsewhere classified,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Spinal stenosis, unspecified region'}


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 88571**] is a 66 year old male has a history of
dyslipidemia and prior tobacco abuse. He reports that over the
past six to eight weeks he has noticed "heartburn" or chest
pressure type symptoms when exerting himself after a meal or
walking up and down inclines. These symptoms always resolve
quickly with rest. He has also noticed occasional dyspnea on
exertion. For this reason, he underwent non imaging stress
testing where he was noted to have 3mm ST depression in the
inferoapical/anterior leads along with a fall in blood pressure.
He was referred for left heart catheterization. He was found to
have three vessel coronary artery disease and was referred to
cardiac surgery for revascularization.

MEDICAL HISTORY: Dyslipidemia
Lower back pain with spinal stenosis
GIB in the setting of high dose ibuprofen use (approximately 5-6
years ago)
Occasional hematuria on low dose aspirin (no prior workup)
BPH
Mild arthritis
Bilateral arthroscopic knee surgery
Hernia repair bilaterally
teeth extraction in [**2-/2140**]

MEDICATION ON ADMISSION: BISOPROLOL FUMARATE 5 QHS
ASCORBIC ACID 1000 [**Hospital1 **]
ASA 81 daily
ERGOCALCIFEROL 1,000u daily
FLAXSEED 1,000 [**Hospital1 **]
VITAMIN E 400u daily

ALLERGIES: ibuprofen / Lipitor / deer tick

PHYSICAL EXAM: Pulse:59 Resp:18  O2 sat:95/RA
B/P  Right:111/66    Left:100/72
Height:5'[**39**].5"     Weight:187 lbs

FAMILY HISTORY: Mr. [**Known lastname 88572**] father had angina in his 80's.  His mother had a
pacemaker.

SOCIAL HISTORY: He lives with his wife. Mr. [**Known lastname 88571**] works four days a week in
maintenance at [**Hospital1 **]. He quit
smoking in [**2132**] and has a history of [**1-4**] cigars per week for 40
years.  He rarely drinks alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute kidney failure with lesion of tubular necrosis,Iatrogenic pneumothorax,Urinary complications, not elsewhere classified,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Spinal stenosis, unspecified region'}
