CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 55 yr old pt with hyperlipidemia, smoking and HIV on antivirals
and lipitor at home, smoker (1 pk/d since age 11 and daily
marijuana) who developed rest chest and left arm discomfort
overnight associated with nausea nd cold feeling all over
especially in feet. No documented fever. Presented to [**Hospital1 2436**]
ER this AM and vitals were stable with HR 70-80, BP
109-140/60-80's, sat 98% 2 L NC. ECGs hyperacute T and ST
elevation with biphasic T waves in V1-2.  Treated with ASA
325mg,
1 inch Nitropaste. His cardiac enzymes were elevated (Trop 0.41
and myloglobin 274 -they do not do CPK). He was transferred
directly to [**Hospital1 18**] cath lab and found to have 3 vessel disease:
 - LMCA tapers.
 - LAD: 50% ostial, 2 other serial lesions at mLAD (70% each)

MEDICAL HISTORY: MI
HIV
Hyperlipidemia
Lung nodules
Emphysema
peptic Ulcer Disease
HPV
Depression
peripheral neuropathy

MEDICATION ON ADMISSION: Lipitor 80 mg daily
Aspirin
fosamprenovir 1400 mg [**Hospital1 **]
emtricitabine-tenovir 200-300 mg daily
protonix 40 mg daily
celexa 20 mg daily
lopressor 25 mg [**Hospital1 **]
colace daily

ALLERGIES: Bactrim

PHYSICAL EXAM: Blood pressure was 118/69 mm Hg while seated.  Pulse was 82
beats/min and regular, respiratory rate was 20 breaths/min. Tmax
was 98.4 Generally the patient was well developed, well
nourished
and well groomed. The patient was oriented to person, place and
time. The patient's mood and affect were not inappropriate.

FAMILY HISTORY: His family history includes father with emphysema, and his
mother
had lung cancer.  He has a brother with skin cancer.

SOCIAL HISTORY: On social history, he is not currently working.  He lives with a
close friend and former partner.  [**Name (NI) **] is actively smoking [**12-4**]
pack
per day which is cut down from 1-2 packs in the past.  He also
smokes occasional marijuana.  He denies any travel to the
Midwest
but did live in [**State 2690**] for 10 years and otherwise has been in the
Northeast.
Subendocardial infarction, initial episode of care,Other emphysema,Coronary atherosclerosis of native coronary artery,Asymptomatic human immunodeficiency virus [HIV] infection status,Other and unspecified hyperlipidemia,Tobacco use disorder
Subendo infarct, initial,Emphysema NEC,Crnry athrscl natve vssl,Asymp hiv infectn status,Hyperlipidemia NEC/NOS,Tobacco use disorder
Admission Date:  [**2137-1-8**]              Discharge Date:   [**2137-1-15**]

Date of Birth:  [**2081-5-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Bactrim

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


Major Surgical or Invasive Procedure:
[**2137-1-11**] - CABGx4
[**2137-1-8**] - Cardiac Catheterization


History of Present Illness:
55 yr old pt with hyperlipidemia, smoking and HIV on antivirals
and lipitor at home, smoker (1 pk/d since age 11 and daily
marijuana) who developed rest chest and left arm discomfort
overnight associated with nausea nd cold feeling all over
especially in feet. No documented fever. Presented to [**Hospital1 2436**]
ER this AM and vitals were stable with HR 70-80, BP
109-140/60-80's, sat 98% 2 L NC. ECGs hyperacute T and ST
elevation with biphasic T waves in V1-2.  Treated with ASA
325mg,
1 inch Nitropaste. His cardiac enzymes were elevated (Trop 0.41
and myloglobin 274 -they do not do CPK). He was transferred
directly to [**Hospital1 18**] cath lab and found to have 3 vessel disease:
 - LMCA tapers.
 - LAD: 50% ostial, 2 other serial lesions at mLAD (70% each)

and large D1 80%
 - LCX: 70% ostial. OM1 70% and 2 more LCX lesions: one 70% at
ostium of OM1 and 2nd lesion 70% post OM1 takeoff.
 - RCA 80% mid at PDA.
 - EF 35-40% with Akinetic apex on LV gram.


Past Medical History:
MI
HIV
Hyperlipidemia
Lung nodules
Emphysema
peptic Ulcer Disease
HPV
Depression
peripheral neuropathy

Social History:
On social history, he is not currently working.  He lives with a
close friend and former partner.  [**Name (NI) **] is actively smoking [**12-4**]
pack
per day which is cut down from 1-2 packs in the past.  He also
smokes occasional marijuana.  He denies any travel to the
Midwest
but did live in [**State 2690**] for 10 years and otherwise has been in the
Northeast.


Family History:
His family history includes father with emphysema, and his
mother
had lung cancer.  He has a brother with skin cancer.


Physical Exam:
Blood pressure was 118/69 mm Hg while seated.  Pulse was 82
beats/min and regular, respiratory rate was 20 breaths/min. Tmax
was 98.4 Generally the patient was well developed, well
nourished
and well groomed. The patient was oriented to person, place and
time. The patient's mood and affect were not inappropriate.

There was no xanthalesma and conjunctiva were pink with no
pallor
or cyanosis of the oral mucosa.  The neck was supple without
JVD.
The carotid waveform was normal.  There was no thyromegaly. The
were no chest wall deformities, scoliosis or kyphosis.  The
respirations were not labored and there were no use of accessory
muscles. The lungs were clear to auscultation bilaterally with
normal breath sounds and no adventitial sounds or rubs.

Palpation of the heart revealed the PMI to be located in the 5th
intercostal space, mid clavicular line.  There were no thrills,
lifts or palpable S3 or S4.  The heart sounds revealed a normal
S1 and the S2 was normal. There were no rubs, murmurs, clicks or
gallops.

The abdominal aorta was not enlarged by palpation. There was no
hepatosplenomegaly or tenderness. The abdomen was soft nontender
and nondistended. The extremities had no pallor, cyanosis,
clubbing or edema. There were no abdominal, femoral or carotid
bruits. Inspection and/or palpation of skin and subcutaneous
tissue showed no stasis dermatitis, ulcers, scars, or xanthomas.

Pulses:
Right: Carotid 2+  Femoral 2+  Popliteal 2+  DP 2+   PT 2+
Left:  Carotid 2+  Femoral 2+  Popliteal 2+  DP 2+   PT 2+


Pertinent Results:
[**2137-1-8**] 02:30PM   PT-12.8 PTT-30.8 INR(PT)-1.1
[**2137-1-8**] 02:30PM   PLT COUNT-220
[**2137-1-8**] 02:30PM   WBC-6.5 RBC-3.76* HGB-11.8* HCT-34.1* MCV-91
MCH-31.3 MCHC-34.6 RDW-13.6
[**2137-1-8**] 02:30PM   %HbA1c-5.9 [Hgb]-DONE [A1c]-DONE
[**2137-1-8**] 02:30PM   ALT(SGPT)-17 AST(SGOT)-37 CK(CPK)-385* ALK
PHOS-59 AMYLASE-73 TOT BILI-0.3
[**2137-1-8**] 02:30PM   GLUCOSE-105 UREA N-9 CREAT-0.7 SODIUM-133
POTASSIUM-3.9 CHLORIDE-102 TOTAL CO2-25 ANION GAP-10
[**2137-1-8**] 06:18PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG

WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2137-1-15**] 06:00AM    7.7 2.75* 8.5* 24.8* 90 31.0 34.3 13.5
PND
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2137-1-15**] 06:00AM        PND
BASIC COAGULATION (FIBRINOGEN, DD, TT, REPTILASE, BT) Fibrino
[**2137-1-11**] 11:05AM    253

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2137-1-15**] 06:00AM    98 12 0.8 130* 3.7 94* 27 13


[**2137-1-8**] Cardiac Catheterization
1.  Selective coronary angiography of this right dominant system
reveals
severe three veseel coronary artery disease.  The LMCA tapers
distally
into ostial 50% LAD lesiona and ostial 70% LCx lesion.  The mLAD
has a
70% stenosis, D1 has a 80% stenosis at its origin and D2 has a
70%
stenosis.  The OM1 has a 70% ostial lesion and the mLCx has a
70% lesion
after the take-off the OM1.  The mRCA has a 80% lesion and the
mPDA has
an 80% lesion.
2.  Limited resting hemodynamic measurement reveals normal
central
aortic pressure with mildly elevated LV filling pressure (LVEDP
15mmHg).
3.  Left ventriculography demonstrates moderately depressed LV
function
with a calculated ejection fraction of 38%.  The anterior
lateral wall
was akinetic and the apex were hypokinetic.  The rest of LV wall
motion
was normal.

[**2137-1-9**] ECHO
The left atrium is normal in size. The estimated right atrial
pressure is 5-10 mmHg. Left ventricular wall thicknesses and
cavity size are normal. There is mild to moderate regional left
ventricular systolic dysfunction with focal severe hypokinesis
of the distal half of the anterior wall and distal inferior and
lateral walls. The apex is mildly aneurysmal and akinetic. There
is normal systolic function of the remaining segments. No masses
or thrombi are seen in the left ventricle. Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. Trace aortic regurgitation is seen. The mitral valve
leaflets are structurally normal. Mild (1+) mitral regurgitation
is seen. The pulmonary artery systolic pressure could not be
determined. There is no pericardial effusion.

[**2137-1-9**] Carotid Ultrasound
Minimal plaque with bilateral less than 40% carotid stenosis.

Cardiology Report ECHO Study Date of [**2137-1-11**]


*** Report not finalized ***
PRELIMINARY REPORT

PATIENT/TEST INFORMATION:
Indication: cabg
Status: Inpatient
Date/Time: [**2137-1-11**] at 09:55
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW2-:
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name (STitle) **] [**Name (STitle) **]

MEASUREMENTS:
Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 5.2 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: 30% to 35% (nl >=55%)
Aorta - Ascending: 3.0 cm (nl <= 3.4 cm)
Aortic Valve - LVOT Diam: 2.2 cm

INTERPRETATION:

Findings:

LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

LV WALL MOTION: Regional LV wall motion abnormalities include:
mid anterior -
hypo; mid anteroseptal - hypo; mid inferoseptal - hypo; mid
inferior - hypo;
mid inferolateral - hypo; mid anterolateral - hypo; anterior
apex - hypo;
septal apex - hypo; inferior apex - hypo; lateral apex - hypo;
apex - hypo;
remaining LV segments contract normally.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal ascending aorta diameter. Normal descending aorta
diameter.
Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve
leaflets. Trace AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. Mild
[1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify
I was present in compliance with HCFA regulations. No TEE
related
complications. The TEE probe was passed with assistance from the

anesthesioology staff using a laryngoscope. The patient was
under general
anesthesia throughout the procedure.

Conclusions:
Pre-CPB: No spontaneous echo contrast is seen in the left atrial
appendage.
Apex is akinetic. Mid- and distal segments of the anterior,
inferior, AS and
IL segments are hypokinetic. The remaining left ventricular
segments contract
normally. Right ventricular chamber size and free wall motion
are normal.
There are simple atheroma in the descending thoracic aorta.
There are three
aortic valve leaflets. The aortic valve leaflets are mildly
thickened. Trace
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened.
Mild (1+) mitral regurgitation is seen. The tricuspid valve
leaflets are
mildly thickened. There is no pericardial effusion.
[**Location (un) **] PHYSICIAN:



([**Numeric Identifier 48424**])





Brief Hospital Course:
Mr. [**Known lastname 48425**] was admitted to the [**Hospital1 18**] on [**2137-1-8**] for further
management of his chest pain. He ruled in for a myocardial
infarction with an elevated troponin. A cardiac catheterization
was performed which revealed severe three vessel disease. Given
the severity of his disease, the cardiac surgical service was
consulted for surgical management. Mr. [**Known lastname 48425**] was worked-up in
the usual preoperative manner including a carotid duplex
ultrasound which showed no significant internal carotid artery
stenosis. On [**2137-1-11**], Mr. [**Known lastname 48425**] was taken to the operating room
where he underwent coronary artery bypass grafting to four
vessels. Postoperatively he was taken to the cardiac surgical
intensive care unit for monitoring. On postoperative Mr. [**Known lastname 48425**] [**Last Name (Titles) **]e neurologically intact and was extubated. He was then
transferred to the step down unit for further recovery. He was
gently diuresed towards his preoperative weight. The physical
therapy service was consulted for assistance with his
postoperative strength and mobility. Beta blockade, aspirin and
a statin were started. Made good progress and cleared for
discharge to home with services on POD #4. Pt. to make all
follow-up appts. as per discharge instructions.

Medications on Admission:
Lipitor 80 mg daily
Aspirin
fosamprenovir 1400 mg [**Hospital1 **]
emtricitabine-tenovir 200-300 mg daily
protonix 40 mg daily
celexa 20 mg daily
lopressor 25 mg [**Hospital1 **]
colace daily


Discharge Medications:
1. 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*
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:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
4. Fosamprenavir 700 mg Tablet Sig: Two (2) Tablet PO Q12H
(every 12 hours).
Disp:*120 Tablet(s)* Refills:*1*
5. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
10. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
14. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
15. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
One (1) Capsule, Sustained Release PO once a day for 7 days.
Disp:*7 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Caregroup VNA

Discharge Diagnosis:
CAD s/p CABGx4
Hypercholesterolemia
Lung Nodules
Emphysema
HPV
HIV
Depression
Peptic ulcers
MI


Discharge Condition:
Stable


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
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. 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.


Followup Instructions:
Follow-up with Dr. [**First Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with Dr. [**Last Name (STitle) **] in 2 weeks. [**Telephone/Fax (1) 2393**]
Follow up with Dr. [**Last Name (STitle) **] in [**1-5**] weeks


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

Completed by:[**2137-1-15**]
{'Subendocardial infarction, initial episode of care,Other emphysema,Coronary atherosclerosis of native coronary artery,Asymptomatic human immunodeficiency virus [HIV] infection status,Other and unspecified hyperlipidemia,Tobacco use disorder'}


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: 55 yr old pt with hyperlipidemia, smoking and HIV on antivirals
and lipitor at home, smoker (1 pk/d since age 11 and daily
marijuana) who developed rest chest and left arm discomfort
overnight associated with nausea nd cold feeling all over
especially in feet. No documented fever. Presented to [**Hospital1 2436**]
ER this AM and vitals were stable with HR 70-80, BP
109-140/60-80's, sat 98% 2 L NC. ECGs hyperacute T and ST
elevation with biphasic T waves in V1-2.  Treated with ASA
325mg,
1 inch Nitropaste. His cardiac enzymes were elevated (Trop 0.41
and myloglobin 274 -they do not do CPK). He was transferred
directly to [**Hospital1 18**] cath lab and found to have 3 vessel disease:
 - LMCA tapers.
 - LAD: 50% ostial, 2 other serial lesions at mLAD (70% each)

MEDICAL HISTORY: MI
HIV
Hyperlipidemia
Lung nodules
Emphysema
peptic Ulcer Disease
HPV
Depression
peripheral neuropathy

MEDICATION ON ADMISSION: Lipitor 80 mg daily
Aspirin
fosamprenovir 1400 mg [**Hospital1 **]
emtricitabine-tenovir 200-300 mg daily
protonix 40 mg daily
celexa 20 mg daily
lopressor 25 mg [**Hospital1 **]
colace daily

ALLERGIES: Bactrim

PHYSICAL EXAM: Blood pressure was 118/69 mm Hg while seated.  Pulse was 82
beats/min and regular, respiratory rate was 20 breaths/min. Tmax
was 98.4 Generally the patient was well developed, well
nourished
and well groomed. The patient was oriented to person, place and
time. The patient's mood and affect were not inappropriate.

FAMILY HISTORY: His family history includes father with emphysema, and his
mother
had lung cancer.  He has a brother with skin cancer.

SOCIAL HISTORY: On social history, he is not currently working.  He lives with a
close friend and former partner.  [**Name (NI) **] is actively smoking [**12-4**]
pack
per day which is cut down from 1-2 packs in the past.  He also
smokes occasional marijuana.  He denies any travel to the
Midwest
but did live in [**State 2690**] for 10 years and otherwise has been in the
Northeast. 

### Response:
{'Subendocardial infarction, initial episode of care,Other emphysema,Coronary atherosclerosis of native coronary artery,Asymptomatic human immunodeficiency virus [HIV] infection status,Other and unspecified hyperlipidemia,Tobacco use disorder'}
