CHIEF COMPLAINT: Jaw pain

PRESENT ILLNESS: 66 year old male who presented after having episode of jaw pain
lasted 2 minutes.  He underwent nuclear stress test that was
positive and referred for cardiac catheterization which revealed
thre vessel coronary disease. Ultimately referred for surgical
revascularization.

MEDICAL HISTORY: Hypertension
Chronic obstructive pulmonary disease
Asthma
Myocardial infarction [**2182**]
Gastric esophageal reflux disease

MEDICATION ON ADMISSION: Advair 50/50 twice a day
Aspirin 81 mg daily
HCTZ 25 mg daily
Metoprolol 25 mg daily
MVI daily
Nitroglycerin SL prn
Omeprazole 20 mg daily
pro neb 3.05mg/3ml prn
quinapril 40 mg daily
simvastatin 80 mg daily
Spiriva 18 mcg daily
Zetia 10 mg daily

ALLERGIES: Vancomycin

PHYSICAL EXAM: General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [] EOMI []
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x] anterior
Heart: RRR [x]  Irregular []  distant no murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] no palpable masses
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: alert and oriented x3 non focal
Pulses:
Femoral      Right: cath site   Left: - right groin mynx closure

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Lives with: spouse
Occupation: retired carpenter
Tobacco: 60 pack history
ETOH: none
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Old myocardial infarction,Chronic obstructive asthma, unspecified,Esophageal reflux,Other iatrogenic hypotension
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Old myocardial infarct,Chronic obst asthma NOS,Esophageal reflux,Iatrogenc hypotnsion NEC
Admission Date:  [**2196-4-20**]              Discharge Date:   [**2196-4-25**]

Date of Birth:  [**2129-8-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Vancomycin

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

Major Surgical or Invasive Procedure:
[**2196-4-21**] Coronary Artery Bypass Graft x 3 with left internal
mammary artery to the left anterior descending artery and
reverse saphenous vein graft to the posterior descending artery
and the distal left circumflex artery

History of Present Illness:
66 year old male who presented after having episode of jaw pain
lasted 2 minutes.  He underwent nuclear stress test that was
positive and referred for cardiac catheterization which revealed
thre vessel coronary disease. Ultimately referred for surgical
revascularization.

Past Medical History:
Hypertension
Chronic obstructive pulmonary disease
Asthma
Myocardial infarction [**2182**]
Gastric esophageal reflux disease

Social History:
Lives with: spouse
Occupation: retired carpenter
Tobacco: 60 pack history
ETOH: none

Family History:
non contributory

Physical Exam:
General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [] EOMI []
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x] anterior
Heart: RRR [x]  Irregular []  distant no murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] no palpable masses
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: alert and oriented x3 non focal
Pulses:
Femoral      Right: cath site   Left: - right groin mynx closure

DP           Right: +1  Left: +1
PT           [**Name (NI) 167**]: +1  Left: +1
Radial       Right: +2  Left: +2

Carotid Bruit        Right: no bruit     Left: no bruit

Pertinent Results:
[**2196-4-24**] 06:25AM BLOOD WBC-13.4* RBC-3.48* Hgb-9.8* Hct-30.1*
MCV-87 MCH-28.2 MCHC-32.7 RDW-12.8 Plt Ct-169
[**2196-4-24**] 06:25AM BLOOD Glucose-90 UreaN-14 Creat-0.7 Na-138
K-3.5 Cl-98 HCO3-33* AnGap-11
[**2196-4-25**] 06:20AM BLOOD UreaN-17 Creat-0.8 K-3.7

Echo [**2196-4-25**]
The left ventricle is not well seen. The left ventricular cavity
size is normal. Overall left ventricular systolic function
cannot be reliably assessed. However, the apex appears
hypokinetic and the rest of the left ventricle appears to
contract somewhat more vigorously. The right ventricular cavity
is dilated with depressed free wall contractility.

A pericardial effusion may be present, but could not be
quantitated due to the technically suboptimal nature of this
study. There are no echocardiographic signs of cardiac tamponade
present.

Brief Hospital Course:
The patient was admitted to the hospital on [**2101-4-20**] for
pre-ooperative workup and brought to the operating room on
[**2196-4-21**] where the patient underwent urgent coronary artery
bypass x 3.  Overall the patient tolerated the procedure well
and post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.  Cefazolin was
used for surgical antibiotic prophylaxis, as he experienced
urticaria with vancomycin.  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 discharged home in good condition
with appropriate follow up instructions.

Medications on Admission:
Advair 50/50 twice a day
Aspirin 81 mg daily
HCTZ 25 mg daily
Metoprolol 25 mg daily
MVI daily
Nitroglycerin SL prn
Omeprazole 20 mg daily
pro neb 3.05mg/3ml prn
quinapril 40 mg daily
simvastatin 80 mg daily
Spiriva 18 mcg daily
Zetia 10 mg daily

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
3. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temp/pain.
7. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
8. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
9. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
Disp:*30 Tablet(s)* Refills:*2*
10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO
three times a day.
Disp:*90 Tablet(s)* Refills:*2*
11. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] Area VNA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3
Past medical history:
Hypertension
Chronic obstructive pulmonary disease
Asthma
Myocardial infarction [**2182**]
Gastric esophageal reflux disease

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with percocet prn

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 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**]

Followup Instructions:
Please call to schedule appointments
Surgeon Dr. [**Last Name (STitle) **] [**5-25**] @ 1:00 PM [**Telephone/Fax (1) 170**]
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 32496**] in [**2-13**] weeks
Cardiologist Dr. [**Last Name (STitle) 8579**] in [**2-13**] weeks



Completed by:[**2196-4-25**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Old myocardial infarction,Chronic obstructive asthma, unspecified,Esophageal reflux,Other iatrogenic hypotension'}


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: Jaw pain

PRESENT ILLNESS: 66 year old male who presented after having episode of jaw pain
lasted 2 minutes.  He underwent nuclear stress test that was
positive and referred for cardiac catheterization which revealed
thre vessel coronary disease. Ultimately referred for surgical
revascularization.

MEDICAL HISTORY: Hypertension
Chronic obstructive pulmonary disease
Asthma
Myocardial infarction [**2182**]
Gastric esophageal reflux disease

MEDICATION ON ADMISSION: Advair 50/50 twice a day
Aspirin 81 mg daily
HCTZ 25 mg daily
Metoprolol 25 mg daily
MVI daily
Nitroglycerin SL prn
Omeprazole 20 mg daily
pro neb 3.05mg/3ml prn
quinapril 40 mg daily
simvastatin 80 mg daily
Spiriva 18 mcg daily
Zetia 10 mg daily

ALLERGIES: Vancomycin

PHYSICAL EXAM: General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [] EOMI []
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x] anterior
Heart: RRR [x]  Irregular []  distant no murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] no palpable masses
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: alert and oriented x3 non focal
Pulses:
Femoral      Right: cath site   Left: - right groin mynx closure

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Lives with: spouse
Occupation: retired carpenter
Tobacco: 60 pack history
ETOH: none 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Old myocardial infarction,Chronic obstructive asthma, unspecified,Esophageal reflux,Other iatrogenic hypotension'}
