CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: This 85 year old female presented to the Emergency Room with
chest pain.  She had a coronary intervention on [**2162-2-10**] with a
bare metal stent to the prox-mid LAD and mid-distal LCx/OM1 and
had been participating in reportedly rigorous cardiac rehab,
using the exercise bike and treadmill without any symptoms
including chest pain or shortness of breath.

MEDICAL HISTORY: coronary artery disease
s/p coronary intervention
Dyslipidemia
Hypertension
Hypothyroidism
Total hysterecotomy for fibroids in [**2111**]
gastroesophageal reflux
Macular Degeneration

MEDICATION ON ADMISSION: - Aspirin 325mg daily
- Plavix 75mg daily
- Atorvastatin 80mg daily
- Levothyroxine 25 mcg qod
- Ranitidine 150mg [**Hospital1 **]
- Metoprolol succinate 50 mg Extended Release daily
- Coenzyme Q10
- Nitroglycerin 0.3 mg Sublingual prn
- Lisinopril 40 mg daily
- Imdur ER 30 mg PO daily
- HCTZ 25 mg PO daily
- Sertaline 50 mg PO daily

ALLERGIES: trazodone

PHYSICAL EXAM: VS: 97.5 173/64, repeat 180/74 48 18 97%RA 63kg
GENERAL: Alert, interactive, appropriate, well appearing, HOH,
NAD.
HEENT: Sclera anicteric. Pupils equal and round. MMM.
NECK: Supple with JVP <9cm.
CARDIAC: RRR, normal S1/S2, GII systolic murmer at RUSB, GII
holosystolic murmer at LSB. No thrills, lifts. No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: WWP, no c/c, trace pitting edema b/l.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: DP 2+
Left: DP 2+

FAMILY HISTORY: Brother with CABG at 68yo, Mother with history of angina.

SOCIAL HISTORY: She lives at home by herself and performs all of her ADL's. She
has a friend near by ([**Name (NI) **]), and is close with her daughter
[**Name (NI) **], who accompanies her here today.
-Tobacco history: quit 56yrs ago
-ETOH: very rarely, a few drinks per year
-Illicit drugs: denies
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Macular degeneration (senile), unspecified,Examination of participant in clinical trial,Other specified cardiac dysrhythmias
Crnry athrscl natve vssl,Intermed coronary synd,Status-post ptca,Hyperlipidemia NEC/NOS,Hypertension NOS,Hypothyroidism NOS,Esophageal reflux,Macular degeneration NOS,Exam-clincal trial,Cardiac dysrhythmias NEC
Admission Date:  [**2162-4-19**]              Discharge Date:   [**2162-4-27**]

Date of Birth:  [**2076-10-2**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
trazodone

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
left heart catheterization, coronary angiogram [**2162-4-20**]

Coronary artery bypass graft x3 (left internal mammary artery >
left anterior descending artery, saphenous vein graft > obtuse
marginal, saphenous vein graft > diagonal) [**2162-4-22**]


History of Present Illness:
This 85 year old female presented to the Emergency Room with
chest pain.  She had a coronary intervention on [**2162-2-10**] with a
bare metal stent to the prox-mid LAD and mid-distal LCx/OM1 and
had been participating in reportedly rigorous cardiac rehab,
using the exercise bike and treadmill without any symptoms
including chest pain or shortness of breath.

However, 3 weeks prior to admission, she began experiencing
sub-sternal chest pressure and tightness which occurred both at
rest and with significant exertion (carrying heavy groceries,
vaccuming 4 rooms), which was relieved in [**2-6**] minutes with rest
and with Nitro. She was started in Isosorbide Mononitrate last
week for her chest pain and her metoprolol dose was increased
from 25mg to 50mg, with initial improvement of her symptoms.
However, her symptoms subsequently returned and became
progressively more frequent, occurring on a daily basis in the
past several days. She reports associated burning pain but
denies dyspnea, nausea, lightheadedness, arm or jaw pain. She
does report that in the past several days, she has been
experiencing "soreness" between her shoulder blades with the
onset of chest pain which does not vary with movement and is
relieved in [**2-6**] minutes with rest or Nitro when the chest pain
abates. Of note, her pre-intervention symptoms were similar in
that she experienced substernal chest pressure and tightness
also both on significant exertion and at rest and lasting [**5-11**]
minutes, but reports her symptoms at that time were associated
with dyspnea and a burning "indigestion-like pain" of a
different nature than her current symptoms. She was symptom-free
initially following the intervention and reports compliance with
all of her medications.
.
She presented to OSH after speaking with her outpatient
physician, [**Name10 (NameIs) **] reports being chest pain free since this morning
when she had an episode at the OSH and was given full dose ASA
and Nitro SL and Nitro paste with relief. Initial troponin at
OSH was negative. She was found to be bradycardic but
asymptomatic, hemodynamically stable, and was transferred to
[**Hospital1 18**] for further evaluation.
.
In the ED, initial vitals were 45 160/70 20 100% 4L NC
She remained bradycardic but chest pain free in the ED. .
On arrival to the floor, she reported an episode of chest
tightness and burning similar to her episodes at home which
occurred after straining to have a bowel movement in the
bathroom. EKG was obtained during the episode, which
self-resolved after ~5 minutes. She denied any associated
symptoms and looked comfortable at the time.

Past Medical History:
coronary artery disease
s/p coronary intervention
Dyslipidemia
Hypertension
Hypothyroidism
Total hysterecotomy for fibroids in [**2111**]
gastroesophageal reflux
Macular Degeneration


Social History:
She lives at home by herself and performs all of her ADL's. She
has a friend near by ([**Name (NI) **]), and is close with her daughter
[**Name (NI) **], who accompanies her here today.
-Tobacco history: quit 56yrs ago
-ETOH: very rarely, a few drinks per year
-Illicit drugs: denies


Family History:
Brother with CABG at 68yo, Mother with history of angina.


Physical Exam:
VS: 97.5 173/64, repeat 180/74 48 18 97%RA 63kg
GENERAL: Alert, interactive, appropriate, well appearing, HOH,
NAD.
HEENT: Sclera anicteric. Pupils equal and round. MMM.
NECK: Supple with JVP <9cm.
CARDIAC: RRR, normal S1/S2, GII systolic murmer at RUSB, GII
holosystolic murmer at LSB. No thrills, lifts. No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: WWP, no c/c, trace pitting edema b/l.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: DP 2+
Left: DP 2+


Pertinent Results:
[**2162-4-26**] 04:00AM BLOOD WBC-8.5 Hct-30.5* Plt Ct-255
[**2162-4-25**] 05:10AM BLOOD WBC-10.3 RBC-3.32* Hgb-9.8* Hct-28.9*
MCV-87 MCH-29.7 MCHC-34.0 RDW-14.7 Plt Ct-224
[**2162-4-26**] 04:00AM BLOOD UreaN-12 Creat-0.8 Na-137 K-4.1 Cl-103
HCO3-20* AnGap-18
[**2162-4-25**] 05:10AM BLOOD UreaN-14 Creat-0.7 Na-139 K-5.2* Cl-106
[**2162-4-26**] 04:00AM BLOOD Mg-2.2
[**2162-4-25**] 05:10AM BLOOD Mg-2.3

[**2162-4-22**] TEE
Conclusions
Prebypass
No spontaneous echo contrast is seen in the body of the left
atrium or left atrial appendage. No spontaneous echo contrast is
seen in the body of the right atrium. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). Tissue Doppler imaging suggests an increased left
ventricular filling pressure (PCWP>18mmHg). Right ventricular
chamber size and free wall motion are normal. 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. Mild (1+) mitral regurgitation is
seen. There is no pericardial effusion.

Postbypass
The patient is A-paced and is on no infusions. Biventricular
systolic function continues to be normal. Mitral and tricuspid
regurgitation is now mild. The thoracic aorta is intact post
decannulation.

Dr. [**Last Name (STitle) **] was notified in person of the results at the
time of the study.


Brief Hospital Course:
She was admitted on [**2162-4-19**] from the Emergency Room after
presenting with chest pain. She ruled out for a myocardial
infarction. She underwent a cardiac catheterization which
revealed in-stent restenosis and was referred for surgical
evaluation.  She underwent routine preoperative workup and on
[**4-23**] was brought to the Operating Room for coronary artery
bypass grafting tow three vessels. Please see operative note for
details. She received vancomycin and cefazolin for perioperative
antibiotics.

Post operatively she was transferred to the intensive care unit
for post operative management.  In the first twenty-four hours
she was weaned and extubated without complications.  She
continued to progress and on postoperative day one chest tubes
were removed, she was started on betablockers and diuretics and
was transferred to the step down unit for further recovery.
Pacing wires were discontinued without complication.  The
physical Therapy service was consulted for assistance with her
strength and mobility. She was gently diuresed towards her
preoperative weight. She developed atrial fibrillation which
responded to an increase in her beta blockade.  Medications were
titrated for hypertension.  Amlodipine was added, and home dose
of Lisinoopril 40mg was resumed.  Heart rate did not allow room
for additional Lopressor.  The patient should be monitored on
the current regimen for a few days, and if additional
anti-hypertensive is needed, consider resuming Imdur.  She
continued to make steady progress and was discharged to [**Doctor First Name 391**]
[**Hospital **] rehabilitation on postoperative day 5.


Medications on Admission:
- Aspirin 325mg daily
- Plavix 75mg daily
- Atorvastatin 80mg daily
- Levothyroxine 25 mcg qod
- Ranitidine 150mg [**Hospital1 **]
- Metoprolol succinate 50 mg Extended Release daily
- Coenzyme Q10
- Nitroglycerin 0.3 mg Sublingual prn
- Lisinopril 40 mg daily
- Imdur ER 30 mg PO daily
- HCTZ 25 mg PO daily
- Sertaline 50 mg PO daily

Discharge Disposition:
Extended Care

Facility:
[**Doctor First Name 391**] Bay Skilled Nursing & Rehabilitation Center - [**Hospital1 392**]

Discharge Diagnosis:
Coronary artery disease
s/p Coronary artery bypass
Dyslipidemia
Hypertension
Hypothyroidism
Gastroesophageal reflux disease
Macular Degeneration


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with assistance
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right - healing well, no erythema or drainage.
Edema -trace


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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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) **] ([**Telephone/Fax (1) 170**]) on [**2162-5-17**] at 1:45 pm
Cardiologist/PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] ([**Telephone/Fax (1) 4475**]) on [**2162-5-21**] at
1:00 pm
Wound check - [**Hospital **] Medical Building, [**Apartment Address(1) **] A ([**Telephone/Fax (1) 170**])
on [**2162-5-4**] at 11 am

**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:[**2162-4-27**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Macular degeneration (senile), unspecified,Examination of participant in clinical trial,Other specified cardiac dysrhythmias'}


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 85 year old female presented to the Emergency Room with
chest pain.  She had a coronary intervention on [**2162-2-10**] with a
bare metal stent to the prox-mid LAD and mid-distal LCx/OM1 and
had been participating in reportedly rigorous cardiac rehab,
using the exercise bike and treadmill without any symptoms
including chest pain or shortness of breath.

MEDICAL HISTORY: coronary artery disease
s/p coronary intervention
Dyslipidemia
Hypertension
Hypothyroidism
Total hysterecotomy for fibroids in [**2111**]
gastroesophageal reflux
Macular Degeneration

MEDICATION ON ADMISSION: - Aspirin 325mg daily
- Plavix 75mg daily
- Atorvastatin 80mg daily
- Levothyroxine 25 mcg qod
- Ranitidine 150mg [**Hospital1 **]
- Metoprolol succinate 50 mg Extended Release daily
- Coenzyme Q10
- Nitroglycerin 0.3 mg Sublingual prn
- Lisinopril 40 mg daily
- Imdur ER 30 mg PO daily
- HCTZ 25 mg PO daily
- Sertaline 50 mg PO daily

ALLERGIES: trazodone

PHYSICAL EXAM: VS: 97.5 173/64, repeat 180/74 48 18 97%RA 63kg
GENERAL: Alert, interactive, appropriate, well appearing, HOH,
NAD.
HEENT: Sclera anicteric. Pupils equal and round. MMM.
NECK: Supple with JVP <9cm.
CARDIAC: RRR, normal S1/S2, GII systolic murmer at RUSB, GII
holosystolic murmer at LSB. No thrills, lifts. No S3 or S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: WWP, no c/c, trace pitting edema b/l.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: DP 2+
Left: DP 2+

FAMILY HISTORY: Brother with CABG at 68yo, Mother with history of angina.

SOCIAL HISTORY: She lives at home by herself and performs all of her ADL's. She
has a friend near by ([**Name (NI) **]), and is close with her daughter
[**Name (NI) **], who accompanies her here today.
-Tobacco history: quit 56yrs ago
-ETOH: very rarely, a few drinks per year
-Illicit drugs: denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Esophageal reflux,Macular degeneration (senile), unspecified,Examination of participant in clinical trial,Other specified cardiac dysrhythmias'}
