CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 73 y/o female with several months of exertional chest
discomfort. Was admitted to OSH in [**8-22**] but was ruled out for
myocardial infarction and had a negative stress test. Since then
she was been noticing increasing frequency of chest pain.
Admitted to OSH where she underwent cardiac cath which showed
severe three vessel coronary artery disease.

MEDICAL HISTORY: Hypertension, Hypothyroidism, Obstructive airway disease

MEDICATION ON ADMISSION: Lopressor 50mg [**Hospital1 **], Prilosec 20mg qd, Levothyroxine 100mcg qd,
Symbicort 160/4.5 2 puffs [**Hospital1 **], MVI, Lasix 20mg qd, Diovan 160mg
qd, Pravachol 20mg qd, Aspirin 81mg qd, Isosorbide 10mg [**Hospital1 **]

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: At discharge:
VS: 98.8, 125/60, 73SR, 18, 95%RA
Gen: NAD
Skin: no rash
Chest: crackles bilateral bases, o/w clear
Heart: RRR, no murmur or rub
Abd: NABS, soft, non-tender, non-distended
Ext: trace edema
Neuro: grossly in-tact
Incisions:  [**Doctor Last Name **]- c/d/i, no erythema or drainage, LEVH- minor
erythema about the edges, no drainage, wound well approximated

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired nurse. Denies tobacco and ETOH use.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Other diseases of respiratory system, not elsewhere classified,Swelling, mass, or lump in head and neck,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Other iatrogenic hypotension,Atrial fibrillation,Unspecified erythematous condition,Obstructive sleep apnea (adult)(pediatric)
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Hypothyroidism NOS,Resp system disease NEC,Swelling in head & neck,Adv eff antinfct NEC/NOS,Iatrogenc hypotnsion NEC,Atrial fibrillation,Erythematous cond NOS,Obstructive sleep apnea
Name:  [**Known lastname **] [**Known lastname 13138**],[**Known firstname 13139**] M             Unit No:   [**Numeric Identifier 13140**]

Admission Date:  [**2103-10-15**]              Discharge Date:   [**2103-10-24**]

Date of Birth:  [**2030-3-7**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ciprofloxacin

Attending:[**First Name3 (LF) 741**]
Addendum:
The patient was also discharged on Keflex 500 QID for 1 week for
sternal and leg redness.

Discharge Disposition:
Home

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2103-10-24**]

Admission Date:  [**2103-10-15**]              Discharge Date:   [**2103-10-24**]

Date of Birth:  [**2030-3-7**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ciprofloxacin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2103-10-17**] Coronary Artery Bypass Graft x 4 (Left internal mammary
artery to left anterior descending, Saphenous vein graft to
Diagonal, Saphenous vein graft to Obtuse marginal, Saphenous
vein graft to Posterior descending artery)

History of Present Illness:
73 y/o female with several months of exertional chest
discomfort. Was admitted to OSH in [**8-22**] but was ruled out for
myocardial infarction and had a negative stress test. Since then
she was been noticing increasing frequency of chest pain.
Admitted to OSH where she underwent cardiac cath which showed
severe three vessel coronary artery disease.

Past Medical History:
Hypertension, Hypothyroidism, Obstructive airway disease

Social History:
Retired nurse. Denies tobacco and ETOH use.

Family History:
Non-contributory

Physical Exam:
At discharge:
VS: 98.8, 125/60, 73SR, 18, 95%RA
Gen: NAD
Skin: no rash
Chest: crackles bilateral bases, o/w clear
Heart: RRR, no murmur or rub
Abd: NABS, soft, non-tender, non-distended
Ext: trace edema
Neuro: grossly in-tact
Incisions:  [**Doctor Last Name **]- c/d/i, no erythema or drainage, LEVH- minor
erythema about the edges, no drainage, wound well approximated

Pertinent Results:
[**2103-10-16**] CT: 1. Elevation of right hemidiaphragm secondary to
eventration, without evidence of pleural tumor or hepatic tumor.
2. Single kidney identified on the right. This is likely due to
embryologic variant, although left-sided pelvic kidney is not
excluded (as the pelvis was
not scanned on this examination). 3. Ascending aortic arch
appears essentially void of vascular calcifications; however,
mild vascular calcifications are seen along the entire course of
the descending thoracic and abdominal aortic. 4. Marked vascular
calcifications, particularly involving the coronary arteries.
[**2103-10-16**] Carotid U/S: 1. Less than 40% stenosis in the right
internal carotid artery. 2. 40-59% stenosis in the left internal
carotid artery.
[**2103-10-17**] Echo: Prebypass: 1. No atrial septal defect is seen by
2D or color Doppler. 2. Left ventricular wall thicknesses are
normal. Regional left ventricular wall motion is normal. Overall
left ventricular systolic function is normal (LVEF>55%). 3.
Right ventricular chamber size and free wall motion are normal.
4. There are simple atheroma in the descending thoracic aorta.
5. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. 6. The
mitral valve leaflets are mildly thickened. Moderate (2+) mitral
regurgitation is seen. 7. Dr. [**Last Name (STitle) **] was notified in person of
the results on [**2103-10-17**] at 1030 am. POSTBYPASS: 1. The patient
is on phenylephrine and epinephrine infusions. 2. The left
ventricular function remains good, EF 65%. 3. The mitral
regurgitation immediately after bypass appeared moderate to
severe (3+) but improved to prebypass levels of moderate MR. 4.
Aortic contours are smooth after decannulation.

Brief Hospital Course:
As mentioned in the HPI, Mrs. [**Known lastname **] [**Known lastname 52014**] was transferred from
OSH for surgical revascularization. She was worked-up in the
appropriate manner and brought to the operating room on [**10-17**]
where she underwent a coronary artery bypass graft x 4. Please
see operative report for surgical details. Following surgery she
was transferred to the CVICU for invasive monitoring in stable
condition. Within 24 hours she was weaned from sedation, awoke
neurologically intact and extubated. On post-op day one she was
started on beta-blockers and diuretics and gently diuresed
towards her pre-op weight.  The patient was transferred to the
step-down unit where she made good progress.  Chest tubes and
pacing wires were discontinued without complication.  Hematocrit
was 24 on POD 5 and the patient was feeling weak.  She was
transfused two units of packed red blood cells with improvement
in her symptoms.  Hematocrit rose to 30.  A short course of
keflex was given for sternal drainage which promptly cleared.
Hospital course was otherwise uneventful and the patient was
discharged home on POD 7.

Medications on Admission:
Lopressor 50mg [**Hospital1 **], Prilosec 20mg qd, Levothyroxine 100mcg qd,
Symbicort 160/4.5 2 puffs [**Hospital1 **], MVI, Lasix 20mg qd, Diovan 160mg
qd, Pravachol 20mg qd, Aspirin 81mg qd, Isosorbide 10mg [**Hospital1 **]

Discharge Medications:
1. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
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:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
8. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*0*
9. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
11. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
PMH: Hypertension, Hypothyroidism, Obstructive airway disease

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month or while taking narcotics for pain.
7) Take lasix and potassium for 1 week and then stop.
8) Call with any questions or concerns.

Followup Instructions:
Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] in 4 weeks
Dr. [**Last Name (STitle) 5017**] [**Telephone/Fax (1) 5424**] in [**12-17**] weeks
Dr. [**Last Name (STitle) 12593**] [**Telephone/Fax (1) 12597**] in [**11-15**] weeks
Please call all providers to schedule appointments.



Completed by:[**2103-10-24**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Other diseases of respiratory system, not elsewhere classified,Swelling, mass, or lump in head and neck,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Other iatrogenic hypotension,Atrial fibrillation,Unspecified erythematous condition,Obstructive sleep apnea (adult)(pediatric)'}


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: 73 y/o female with several months of exertional chest
discomfort. Was admitted to OSH in [**8-22**] but was ruled out for
myocardial infarction and had a negative stress test. Since then
she was been noticing increasing frequency of chest pain.
Admitted to OSH where she underwent cardiac cath which showed
severe three vessel coronary artery disease.

MEDICAL HISTORY: Hypertension, Hypothyroidism, Obstructive airway disease

MEDICATION ON ADMISSION: Lopressor 50mg [**Hospital1 **], Prilosec 20mg qd, Levothyroxine 100mcg qd,
Symbicort 160/4.5 2 puffs [**Hospital1 **], MVI, Lasix 20mg qd, Diovan 160mg
qd, Pravachol 20mg qd, Aspirin 81mg qd, Isosorbide 10mg [**Hospital1 **]

ALLERGIES: Ciprofloxacin

PHYSICAL EXAM: At discharge:
VS: 98.8, 125/60, 73SR, 18, 95%RA
Gen: NAD
Skin: no rash
Chest: crackles bilateral bases, o/w clear
Heart: RRR, no murmur or rub
Abd: NABS, soft, non-tender, non-distended
Ext: trace edema
Neuro: grossly in-tact
Incisions:  [**Doctor Last Name **]- c/d/i, no erythema or drainage, LEVH- minor
erythema about the edges, no drainage, wound well approximated

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired nurse. Denies tobacco and ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Other diseases of respiratory system, not elsewhere classified,Swelling, mass, or lump in head and neck,Other and unspecified anti-infectives causing adverse effects in therapeutic use,Other iatrogenic hypotension,Atrial fibrillation,Unspecified erythematous condition,Obstructive sleep apnea (adult)(pediatric)'}
