CHIEF COMPLAINT: Chest Pain and DOE

PRESENT ILLNESS: 57 y/o male s/p MI in '[**53**] and stents x2 in [**6-30**] after c/o onging
c/p and DOE. Since that time pt. continued to have worsening of
symptoms and is now seeking surgical treatment vs. medical.

MEDICAL HISTORY: CAD, s/p MI '[**53**], s/p stents x 2 on [**6-30**]
HTN
^Chol
DM2
BPH
s/p ORIF L. ankle '[**46**]
s/p cyst removal on back

MEDICATION ON ADMISSION: 1. Imdur qd
2. Natrilix SR 0.5 mg qd
3. Coversyl 8 mg qd
4. Lopressor 75 mg [**Hospital1 **]
5. Plavix 75 mg qd
6. Vastarel 20 mg tid
7. Glucophage 500 mg [**Hospital1 **]
8. NPH Insulin 30 units qAM, 20 qHS
9. Humalog SS w/ meals
10. ASA 152 mg qd
11. Mono-tildiem SR 200 mg qd
12. MVI qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Ht: 5'6" Wt: 193 lbs BP: 139/71
General: walked into office in NAD
Skin: warm, dry
HEENT: EOMI, PERRLA
Neck: supple, - carotid bruit
Chest: CTAB
Heart: RRR (bradycardic), +S1/S2, -c/r/m/g
Abd: soft, round, NT/ND, +BS
Ext: warm, well-perfused, -c/c/e, - varicosities
Neuro: A&O x 3, appropriate
Pulses: BDP 1+, BPT 1+, BRadial 1+

FAMILY HISTORY: +FH for CAD - Father died of MI at 67 (first in 50s), Mother
died of MI at 76. Brothers (two) had MI at 50

SOCIAL HISTORY: Live in [**Country 22390**] with wife, Social drinker and quit smoking 1.5
years ago after <50yr pk hx. Denies recreational drug use.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Old myocardial infarct,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Status-post ptca
Admission Date:  [**2166-1-29**]              Discharge Date:   [**2166-2-4**]

Date of Birth:  [**2108-6-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest Pain and DOE

Major Surgical or Invasive Procedure:
CABGx4(LIMA->Diag, SVG->LAD, Ramus, OM) [**2166-1-29**]

History of Present Illness:
57 y/o male s/p MI in '[**53**] and stents x2 in [**6-30**] after c/o onging
c/p and DOE. Since that time pt. continued to have worsening of
symptoms and is now seeking surgical treatment vs. medical.

Past Medical History:
CAD, s/p MI '[**53**], s/p stents x 2 on [**6-30**]
HTN
^Chol
DM2
BPH
s/p ORIF L. ankle '[**46**]
s/p cyst removal on back

Social History:
Live in [**Country 22390**] with wife, Social drinker and quit smoking 1.5
years ago after <50yr pk hx. Denies recreational drug use.

Family History:
+FH for CAD - Father died of MI at 67 (first in 50s), Mother
died of MI at 76. Brothers (two) had MI at 50

Physical Exam:
Ht: 5'6" Wt: 193 lbs BP: 139/71
General: walked into office in NAD
Skin: warm, dry
HEENT: EOMI, PERRLA
Neck: supple, - carotid bruit
Chest: CTAB
Heart: RRR (bradycardic), +S1/S2, -c/r/m/g
Abd: soft, round, NT/ND, +BS
Ext: warm, well-perfused, -c/c/e, - varicosities
Neuro: A&O x 3, appropriate
Pulses: BDP 1+, BPT 1+, BRadial 1+

Pertinent Results:
Pre-op CXR: Small nodular opacities in the right lung, probably
representing calcified granuloma.
Pre-op EKG: Sinus bradycardia at 47. A-V conduction delay. Left
atrial abnormality.
Pre-op Labs: WBC/RBC/Hct/Hgb/Platelets: 5.8/4.63/13.4/39.5/330
PT/PTT/INR: 12.5/23/1
Glucose/BUN/Creat/NA/K/Cl/HCO3: 188/16/0.9/136/4.1/94/33
AST/ALT/Alk Phos/TotBili: 32/28/122/0.3
HgbA1C: 12.6
Pre-op UA negative
[**2166-2-2**] 06:30AM BLOOD WBC-8.5 RBC-3.62* Hgb-10.5* Hct-31.8*
MCV-88 MCH-29.1 MCHC-33.1 RDW-13.7 Plt Ct-306
[**2166-2-2**] 06:30AM BLOOD PT-13.1 INR(PT)-1.1
[**2166-2-2**] 06:30AM BLOOD Glucose-122* UreaN-17 Creat-0.9 K-4.3
[**2166-2-4**] 07:15AM BLOOD K-5.0

Brief Hospital Course:
Pt. was a direct admit and brought to the operating room on
[**2166-1-29**] where a coronary artery bypass graft x 4 procedure was
performed. Please see operative not for full details. Pt.
tolerated the procedure well with a CPB time of 93min and XCT of
84min. Pt. was transferred to [**Date Range 58879**] in stable condition with a
MAP of 68, CVP 12, PAD 14, [**Doctor First Name 1052**] 19, HR 80 A-paced and on Neo,
Propofol, and Insulin. In the [**Name (NI) 58879**], pt. required a bronchoscopy
to evaluate a collapsed RUL. A mucous plug was removed. Later
that day propofol was weaned, pt. became alert and was extubated
and breathing on his own. H was also neurologically intact
POD #1 - Neo was weaned off. Pt. had rhonchorous bs bilat. Pt.
was stable and transferred to [**Name (NI) 58879**]. B-blocker, lasix, plavix
started
POD #2 - Pt. had elevated glucose. Plan was to increase Insulin
to pre-op dose. Remove chest tubes, pacing wires, and foley.
POD #3 - Pt. has congested, productive cough. Plan pulm. toilet
and increase mobility. VS stable.
POD #5 - Pt. doing well, but cont. to have same resp.
congestion, but improved with neb rx. MDIs prn and OOB with
increased mobility
POD #6 - Pt. had good post-op course with some resp. congestion.
D/C home/hotel today. Labs stable. Post-op PE:
T 100 P 87 BP 106/64 RR 20
Neuro: alert, oriented, non-focal
Pulm: CTAB
Cardiac: RRR
Sternum: -drainage/erythema
Abd: soft, NT/ND, +BS
Ext: Warm, incision c/d

Medications on Admission:
1. Imdur qd
2. Natrilix SR 0.5 mg qd
3. Coversyl 8 mg qd
4. Lopressor 75 mg [**Hospital1 **]
5. Plavix 75 mg qd
6. Vastarel 20 mg tid
7. Glucophage 500 mg [**Hospital1 **]
8. NPH Insulin 30 units qAM, 20 qHS
9. Humalog SS w/ meals
10. ASA 152 mg qd
11. Mono-tildiem SR 200 mg qd
12. MVI qd

Discharge Medications:
1. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 7 days.
Disp:*14 Packet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. 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*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
6. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 3 months.
Disp:*30 Tablet(s)* Refills:*2*
7. Metformin HCl 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Thirty
(30) Units Subcutaneous once a day: 30 U Q am, 20 U Q pm.
Disp:*1 vial* Refills:*2*
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. Dextromethorphan-Guaifenesin 10-100 mg/5 mL Syrup Sig: Five
(5) ML PO Q6H (every 6 hours) as needed.
Disp:*qs ML(s)* Refills:*0*
11. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
12. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-29**]
Puffs Inhalation Q6H (every 6 hours) as needed.
Disp:*1 MDI* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
CAD (MI '[**53**]), CABGx4(LIMA->Diag, SVG->LAD, Ramus, OM) [**2166-1-29**]
s/p stents x 2 on [**6-30**]
HTN
^Chol
DM2
BPH
s/p ORIF L. ankle '[**46**]
s/p cyst removal on back

Discharge Condition:
good

Discharge Instructions:
no lifting > 10# or driving for 1 month
may shower, no bathing for 1 month
no creams or lotions to incisions

Followup Instructions:
with Dr. [**Last Name (STitle) **] in 3 weeks
with primary care physician upon return home



Completed by:[**2166-3-3**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status'}


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 and DOE

PRESENT ILLNESS: 57 y/o male s/p MI in '[**53**] and stents x2 in [**6-30**] after c/o onging
c/p and DOE. Since that time pt. continued to have worsening of
symptoms and is now seeking surgical treatment vs. medical.

MEDICAL HISTORY: CAD, s/p MI '[**53**], s/p stents x 2 on [**6-30**]
HTN
^Chol
DM2
BPH
s/p ORIF L. ankle '[**46**]
s/p cyst removal on back

MEDICATION ON ADMISSION: 1. Imdur qd
2. Natrilix SR 0.5 mg qd
3. Coversyl 8 mg qd
4. Lopressor 75 mg [**Hospital1 **]
5. Plavix 75 mg qd
6. Vastarel 20 mg tid
7. Glucophage 500 mg [**Hospital1 **]
8. NPH Insulin 30 units qAM, 20 qHS
9. Humalog SS w/ meals
10. ASA 152 mg qd
11. Mono-tildiem SR 200 mg qd
12. MVI qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Ht: 5'6" Wt: 193 lbs BP: 139/71
General: walked into office in NAD
Skin: warm, dry
HEENT: EOMI, PERRLA
Neck: supple, - carotid bruit
Chest: CTAB
Heart: RRR (bradycardic), +S1/S2, -c/r/m/g
Abd: soft, round, NT/ND, +BS
Ext: warm, well-perfused, -c/c/e, - varicosities
Neuro: A&O x 3, appropriate
Pulses: BDP 1+, BPT 1+, BRadial 1+

FAMILY HISTORY: +FH for CAD - Father died of MI at 67 (first in 50s), Mother
died of MI at 76. Brothers (two) had MI at 50

SOCIAL HISTORY: Live in [**Country 22390**] with wife, Social drinker and quit smoking 1.5
years ago after <50yr pk hx. Denies recreational drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status'}
