CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 62 y/o male with 2 week h/o inermittent chest pain and shortness
of breath. Presented to MWMC via ambulance with normal EKG and
elevated troponin I (initial 0.7 and rose to 0.9). Underwent
cardiac cath which revealed multi-vessel coronary artery
disease. Transferred to [**Hospital1 18**] for surgical managament.

MEDICAL HISTORY: Hypertension, Benign Prostatic Hypertrophy, Prostatitis, s/p R.
achilles tendon repair, s/p R. knee [**Doctor First Name **]., s/p T&A

MEDICATION ON ADMISSION: At home: Lisinopril 20mg qAM, 10mg qPM

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Gen: WD/WN male
HEENT: PERRL, EOMI, NC/AT
Neck: Supple, FROM, -JVD
Lungs: CTAB -w/r/r
Cardiac: RRR -c/r/g/m
Abd: Soft, NT/ND +BS
Ext: -c/c/e, -varicosities, left ankle puncture sore
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Father had an MI at age 49.

SOCIAL HISTORY: Denies Tobacco use. ETOH 1 glass wine/day.
Coronary atherosclerosis of native coronary artery,Acquired cardiac septal defect,Pulmonary collapse,Intermediate coronary syndrome,Hypotension, unspecified,Retention of urine, unspecified,Anemia, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Crnry athrscl natve vssl,Acq cardiac septl defect,Pulmonary collapse,Intermed coronary synd,Hypotension NOS,Retention urine NOS,Anemia NOS,Hypertension NOS,BPH w/o urinary obs/LUTS
Admission Date:  [**2139-4-16**]              Discharge Date:   [**2139-4-22**]

Date of Birth:  [**2076-10-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides)

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

Major Surgical or Invasive Procedure:
[**2139-4-16**] Coronary Artery Bypass Graft x 5 (LIMA to LAD, SVG to
Diag1, SVG to Diag2, SVG to OM, SVG PDA), ASD closure

History of Present Illness:
62 y/o male with 2 week h/o inermittent chest pain and shortness
of breath. Presented to MWMC via ambulance with normal EKG and
elevated troponin I (initial 0.7 and rose to 0.9). Underwent
cardiac cath which revealed multi-vessel coronary artery
disease. Transferred to [**Hospital1 18**] for surgical managament.

Past Medical History:
Hypertension, Benign Prostatic Hypertrophy, Prostatitis, s/p R.
achilles tendon repair, s/p R. knee [**Doctor First Name **]., s/p T&A

Social History:
Denies Tobacco use. ETOH 1 glass wine/day.

Family History:
Father had an MI at age 49.

Physical Exam:
Gen: WD/WN male
HEENT: PERRL, EOMI, NC/AT
Neck: Supple, FROM, -JVD
Lungs: CTAB -w/r/r
Cardiac: RRR -c/r/g/m
Abd: Soft, NT/ND +BS
Ext: -c/c/e, -varicosities, left ankle puncture sore
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2139-4-16**] Echo: PRE-CPB: 1. No thrombus is seen in the left atrial
appendage. The interatrial septum is aneurysmal. A secundum type
atrial septal defect is present. 2. Overall left ventricular
systolic function is mildly depressed. LVEF = 40%. There is
moderately severe apical,anteroapical and inferoapical
hypokinesis. 3. Right ventricular chamber size and free wall
motion are normal. 4. There are simple atheroma in the ascending
aorta. There are simple atheroma in the aortic arch. There are
simple atheroma in the descending thoracic aorta. 5. There are
three aortic valve leaflets. The aortic valve leaflets are
mildly thickened. Trace aortic regurgitation is seen. 6. The
mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. 7. The tricuspid valve leaflets are
mildly thickened. POST-CPB: On infusions of epinephrine and
phenylephrine 1. Left ventricular function is improved. Apex
appears normal. 2. Trace flow across the site of the repaired
ASD by color flow 3. Aorta is intact post decannulation 4. Other
findings are unchanged
[**2139-4-20**] CXR: Left lower lobe collapse is stable.
Cardiomediastinal silhouette has a normal postoperative
appearance. Small right and moderate left pneumothorax have
decreased slightly in size. Small bilateral pleural effusions
are stable on the right and increased on the left. Intestinal
distention noted in the upper abdomen following decompression of
the stomach.

[**2139-4-16**] 02:35PM BLOOD WBC-7.7 RBC-4.29* Hgb-13.6* Hct-38.2*
MCV-89 MCH-31.8 MCHC-35.7* RDW-13.1 Plt Ct-231
[**2139-4-21**] 08:55AM BLOOD WBC-10.1 RBC-3.18* Hgb-9.9* Hct-28.3*
MCV-89 MCH-31.1 MCHC-34.9 RDW-13.0 Plt Ct-400#
[**2139-4-16**] 02:35PM BLOOD PT-13.4* PTT-47.3* INR(PT)-1.2*
[**2139-4-20**] 06:25AM BLOOD PT-13.1 PTT-29.2 INR(PT)-1.1
[**2139-4-16**] 02:35PM BLOOD Glucose-105 UreaN-15 Creat-0.8 Na-138
K-4.5 Cl-103 HCO3-28 AnGap-12
[**2139-4-20**] 06:25AM BLOOD Glucose-86 UreaN-32* Creat-0.9 Na-138
K-5.0 Cl-105 HCO3-29 AnGap-9
[**2139-4-20**] 06:25AM BLOOD Calcium-8.5 Phos-4.0 Mg-2.2

Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname 24642**] was transferred to [**Hospital1 18**]
for surgical management. He continued to have chest pain
post-cath despite receiving Nitroglycerin and Morphine. Because
of this and due to the severity of his coronary disease he was
brought emergently to the operating room. He underwent a
coronary artery bypass x 5 and a ASD closure. Please see
operative report for surgical details. Following surgery she was
transferred to the CSRU for invasive monitoring in stable
condition. Within 24 hours he was weaned from sedation, awoke
neurologically intact and was extubated. During initial post-op
days he required a blood transfusion secondary to having a low
HCT and being hypotensive. He remained on Neo-Synephrine until
post-op day three when beta blockers and diuretics were started.
He was gently diuresed towards his pre-op weight. On post-op day
three his chest tubes were removed and he was transferred to the
telemetry floor. On post-op day four his epicardial pacing wires
were removed. During his post-op course he worked with PT for
strength and mobility. He continued to improve clinically and
was discharged home on post-op five with the appropriate meds
and follow-up appointments.

Medications on Admission:
At home: Lisinopril 20mg qAM, 10mg qPM

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
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:*1*
3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*1*
6. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
7. Metoclopramide 5 mg Tablet Sig: One (1) Tablet PO before
meals  for 3 days.
Disp:*30 Tablet(s)* Refills:*0*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
10. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*0*
11. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
Disp:*180 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Last Name (un) 2646**]

Discharge Diagnosis:
Coronary Artery Disease s/p Emergent Coronary Artery Bypass
Graft x 5
PMH: Hypertension, Benign Prostatic Hypertrophy, Prostatitis,
s/p R. achilles tendon repair, s/p R. knee [**Doctor First Name **]., s/p T&A

Discharge Condition:
Good

Discharge Instructions:
[**Month (only) 116**] shower, no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns

Followup Instructions:
Dr. [**First Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] - call to schedule appt
Dr. [**Last Name (STitle) 656**] in 1 week [**Telephone/Fax (1) 42422**] - call to schedule appt
Dr [**Last Name (STitle) 32255**] in [**1-17**] week - call to schedule appt
Please call MWHC to schedule wound check appt with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
for next week [**Telephone/Fax (1) 6256**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2139-4-23**]
{'Coronary atherosclerosis of native coronary artery,Acquired cardiac septal defect,Pulmonary collapse,Intermediate coronary syndrome,Hypotension, unspecified,Retention of urine, unspecified,Anemia, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: 62 y/o male with 2 week h/o inermittent chest pain and shortness
of breath. Presented to MWMC via ambulance with normal EKG and
elevated troponin I (initial 0.7 and rose to 0.9). Underwent
cardiac cath which revealed multi-vessel coronary artery
disease. Transferred to [**Hospital1 18**] for surgical managament.

MEDICAL HISTORY: Hypertension, Benign Prostatic Hypertrophy, Prostatitis, s/p R.
achilles tendon repair, s/p R. knee [**Doctor First Name **]., s/p T&A

MEDICATION ON ADMISSION: At home: Lisinopril 20mg qAM, 10mg qPM

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Gen: WD/WN male
HEENT: PERRL, EOMI, NC/AT
Neck: Supple, FROM, -JVD
Lungs: CTAB -w/r/r
Cardiac: RRR -c/r/g/m
Abd: Soft, NT/ND +BS
Ext: -c/c/e, -varicosities, left ankle puncture sore
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Father had an MI at age 49.

SOCIAL HISTORY: Denies Tobacco use. ETOH 1 glass wine/day. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acquired cardiac septal defect,Pulmonary collapse,Intermediate coronary syndrome,Hypotension, unspecified,Retention of urine, unspecified,Anemia, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
