CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 64 yo M with severe CAD (s/p 4v CABG '[**75**], 6 stents '[**83**]), DM,
hyperchol, HTN with baseline stable angina treated by NTG SL has
been having CP at rest.  At baseline pt needs to take NTG with
mod activity (>1 flight of stairs) or sex.  His symptoms have
been getting worse over the past 2 weeks.  The night of
admission he began to have pain while walking short distances
and after an argument.  He then began to have pain, diaphoresis,
and palpitations while sitting during a play and called an
ambulance.
   Found to have BP 300/150 in field and brought to [**Hospital1 18**] ED.
Here found to have BP 229/87 and given O2, morphine, nitropaste,
metoprolol, ASA, ativan, and heparin gtt.   Denied SOB, F/C, abd
pain, leg swelling, pnd, orthopnea, HA, VA changes.  Of note,
the pt had been on ASA and plavix since his stents in '[**83**] but
had stopped since [**8-20**] when he had a prostate procedure.

MEDICAL HISTORY: 1) CAD - as above in PMH (most recent cath and stenting was [**2-16**]
and done at [**Hospital1 18**])
2) Prostate Ca - s/p seed implants [**8-20**]
3) HTN
4) High Cholesterol
5) DM x 5 years
6) Gout
7) Pagets - dx on bone scan for prostate ca work up, no symptoms
or further treatment
8)GERD
9) Tongue Cancer - '[**72**] s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **],XRT, chemo

MEDICATION ON ADMISSION: Metoprolol 25mg [**Hospital1 **]
Isosorbide 60mg qam/30mg qpm
Glucatrol XL 10mg [**Hospital1 **]
Avandia 4mg qday
Allopurinol 50mg qday
Lisinopril 40mg qday
Lipitor 20mg qday
Flomax 0.4mg qday
ASA/Plavix stopped [**8-20**]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.3 BP 229/87 -> 148/79  P 97 R 15 O2 100 on 2L NC
Wt 210 lbs
Gen - A+O x 3 NAD
HEENT - EOMI, pupils (L 4->3 mm, R 3->2mm) ERRL, OP clear
Neck - supple, no JVD, scar from tongue ca [**Doctor First Name **] on R
Cor - RRR no murmur
Chest - CTA b
Abd - S/NT/ND +BS, GUIAC - per ED
Ext - no c/c/e, Bruit over R femoral artery

FAMILY HISTORY: Cancer

SOCIAL HISTORY: No tobacco use
1 scotch per day
lives with wife and [**Name2 (NI) **]
retired consultant
Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Retention of urine, unspecified,Coronary atherosclerosis of autologous vein bypass graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Malignant neoplasm of prostate,Gout, unspecified,Esophageal reflux,Personal history of malignant neoplasm of tongue,Intermediate coronary syndrome
Acute kidney failure NOS,Hyp kid NOS w cr kid V,Retention urine NOS,Crn ath atlg vn bps grft,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Malign neopl prostate,Gout NOS,Esophageal reflux,Hx of tongue malignancy,Intermed coronary synd
Admission Date:  [**2185-11-17**]              Discharge Date:   [**2185-11-21**]

Date of Birth:  [**2123-5-9**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 9554**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
Cardiac Catheterization with stenting


History of Present Illness:
64 yo M with severe CAD (s/p 4v CABG '[**75**], 6 stents '[**83**]), DM,
hyperchol, HTN with baseline stable angina treated by NTG SL has
been having CP at rest.  At baseline pt needs to take NTG with
mod activity (>1 flight of stairs) or sex.  His symptoms have
been getting worse over the past 2 weeks.  The night of
admission he began to have pain while walking short distances
and after an argument.  He then began to have pain, diaphoresis,
and palpitations while sitting during a play and called an
ambulance.
   Found to have BP 300/150 in field and brought to [**Hospital1 18**] ED.
Here found to have BP 229/87 and given O2, morphine, nitropaste,
metoprolol, ASA, ativan, and heparin gtt.   Denied SOB, F/C, abd
pain, leg swelling, pnd, orthopnea, HA, VA changes.  Of note,
the pt had been on ASA and plavix since his stents in '[**83**] but
had stopped since [**8-20**] when he had a prostate procedure.


Past Medical History:
1) CAD - as above in PMH (most recent cath and stenting was [**2-16**]
and done at [**Hospital1 18**])
2) Prostate Ca - s/p seed implants [**8-20**]
3) HTN
4) High Cholesterol
5) DM x 5 years
6) Gout
7) Pagets - dx on bone scan for prostate ca work up, no symptoms
or further treatment
8)GERD
9) Tongue Cancer - '[**72**] s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **],XRT, chemo

Social History:
No tobacco use
1 scotch per day
lives with wife and [**Name2 (NI) **]
retired consultant

Family History:
Cancer

Physical Exam:
T 97.3 BP 229/87 -> 148/79  P 97 R 15 O2 100 on 2L NC
Wt 210 lbs
Gen - A+O x 3 NAD
HEENT - EOMI, pupils (L 4->3 mm, R 3->2mm) ERRL, OP clear
Neck - supple, no JVD, scar from tongue ca [**Doctor First Name **] on R
Cor - RRR no murmur
Chest - CTA b
Abd - S/NT/ND +BS, GUIAC - per ED
Ext - no c/c/e, Bruit over R femoral artery


Pertinent Results:
[**2185-11-17**] 04:34AM   GLUCOSE-101 UREA N-22* CREAT-1.4* SODIUM-141
POTASSIUM-3.6 CHLORIDE-108 TOTAL CO2-23 ANION GAP-14
[**2185-11-17**] 04:34AM   CK(CPK)-129
[**2185-11-17**] 04:34AM   CK-MB-4 cTropnT-0.04*
[**2185-11-17**] 04:34AM   CALCIUM-9.2 PHOSPHATE-3.7 MAGNESIUM-1.9
[**2185-11-17**] 04:34AM   WBC-6.9 RBC-4.48* HGB-13.6* HCT-40.7 MCV-91
MCH-30.3 MCHC-33.3 RDW-13.7
[**2185-11-17**] 04:34AM   PLT COUNT-229

[**2185-11-16**] 10:30PM   CK(CPK)-150
[**2185-11-16**] 10:30PM   cTropnT-0.03*

EKG - sinus tach, nl axis, nl int
      Q in III, aVF

Cardiac Cath [**2185-11-17**]
1. Three vessel coronary artery disease.
2. Successful stenting of the distal and the proximal LAD with
two Drug
ELuting Stents.
3. Unsuccessful attempt for PCI of the OM/Ramus due to inability
to
cross the lesion despite using several wires.

Echo [**2185-11-18**]
1. The left atrium is moderately dilated.
2. There is mild symmetric left ventricular hypertrophy with
normal cavity
size and systolic function (LVEF>55%). Regional left ventricular
wall motion
is normal.
3. The aortic valve leaflets (3) are mildly thickened.
4. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral
regurgitation is seen.


Brief Hospital Course:
64 yo M with severe CAD (s/p 4v CABG '[**75**], 6 stents '[**83**]), DM,
hyperchol, HTN with baseline stable angina treated by NTG SL has
been having CP at rest.

1) CAD/HTN - Pt was taken to cath and found to have lesions in
the OM/ramus and LAD.  The LAD was stented however the OM could
not be stented.  In the lab he became hypertensive to the 190's
which was controlled with labetalol and nitro drips.  He was
transferred to the CCU.  Stable BP since however had 1 episode
of CP when taken off of the nitro gtt.  This resolved upon
restarting his imdur.
   Echo revealed normal EF, mild dys dysfunction, and mod LA
enlargement.  ACE held b/c pt was having increasing Cr in
setting of dye load.  Since then restarted on his oral anti
hypertensives and has been stable.  CK/MB has been trending down
since cath.  Trop has been increasing however this is likely due
to his CRF.  He was sent out on an increased dose of metoprolol
(50mg [**Hospital1 **]).  He was instructed to watch for s/s of low BP.

2) CRF - The pt came in at his baseline Cr of 1.3.  With the
cath dye load he increased to 1.7 but has remained stable at
1.6.  ACE has been held throughout his admission due to this
rise.   Sent out without ACE.  Will f/u with outpt cardiologist.
 If Cr improves then can consider restarting ace.

3) DM - Pt's glucose well controled on oral agents with an
insulin sliding scale.  (Oral agents were stopped when he was
NPO)


Medications on Admission:
Metoprolol 25mg [**Hospital1 **]
Isosorbide 60mg qam/30mg qpm
Glucatrol XL 10mg [**Hospital1 **]
Avandia 4mg qday
Allopurinol 50mg qday
Lisinopril 40mg qday
Lipitor 20mg qday
Flomax 0.4mg qday
ASA/Plavix stopped [**8-20**]

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO QAM (once a day
(in the morning)).
5. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO QPM (once a day
(in the evening)).
6. Tamsulosin HCl 0.4 mg Capsule, Sust. Release 24HR Sig: One
(1) Capsule, Sust. Release 24HR PO HS (at bedtime).
7. Allopurinol 100 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
8. Glipizide 10 mg Tab, Sust Release Osmotic Push Sig: One (1)
Tab, Sust Release Osmotic Push PO BID (2 times a day).
9. Rosiglitazone Maleate 4 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO
twice a day.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Unstable Angina
Severe CAD
Prostate Cancer
HTN
Hypercholesterolemia
Diabetes Type II
Gout
GERD

Discharge Condition:
Stable

Discharge Instructions:
Please take all of your medications as indicated on the
discharge paper work.

If you have chest pain at rest (especially if it does not
respond to nitroglycerine) please call your physician or go to
the emergency room.  Also if you experience shortness of breath,
fevers, chills, or dizziness call your physician.

Also we have increased your metoprolol to 50mg twice a day.
Please call your cardialogist if you have any dizziness or
fainting.

Please watch your cath site(Right groin) if a lump develops or
there is redness and warmth please inform your physician.

Followup Instructions:
Please follow up with your cardiologist in 1 week (Dr.
[**Last Name (STitle) 31241**]).  Have your Creatinine rechecked.  If stable or
decreasing, should restart lisinopril.

                             [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2139**]
{'Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Retention of urine, unspecified,Coronary atherosclerosis of autologous vein bypass graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Malignant neoplasm of prostate,Gout, unspecified,Esophageal reflux,Personal history of malignant neoplasm of tongue,Intermediate coronary syndrome'}


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: 64 yo M with severe CAD (s/p 4v CABG '[**75**], 6 stents '[**83**]), DM,
hyperchol, HTN with baseline stable angina treated by NTG SL has
been having CP at rest.  At baseline pt needs to take NTG with
mod activity (>1 flight of stairs) or sex.  His symptoms have
been getting worse over the past 2 weeks.  The night of
admission he began to have pain while walking short distances
and after an argument.  He then began to have pain, diaphoresis,
and palpitations while sitting during a play and called an
ambulance.
   Found to have BP 300/150 in field and brought to [**Hospital1 18**] ED.
Here found to have BP 229/87 and given O2, morphine, nitropaste,
metoprolol, ASA, ativan, and heparin gtt.   Denied SOB, F/C, abd
pain, leg swelling, pnd, orthopnea, HA, VA changes.  Of note,
the pt had been on ASA and plavix since his stents in '[**83**] but
had stopped since [**8-20**] when he had a prostate procedure.

MEDICAL HISTORY: 1) CAD - as above in PMH (most recent cath and stenting was [**2-16**]
and done at [**Hospital1 18**])
2) Prostate Ca - s/p seed implants [**8-20**]
3) HTN
4) High Cholesterol
5) DM x 5 years
6) Gout
7) Pagets - dx on bone scan for prostate ca work up, no symptoms
or further treatment
8)GERD
9) Tongue Cancer - '[**72**] s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **],XRT, chemo

MEDICATION ON ADMISSION: Metoprolol 25mg [**Hospital1 **]
Isosorbide 60mg qam/30mg qpm
Glucatrol XL 10mg [**Hospital1 **]
Avandia 4mg qday
Allopurinol 50mg qday
Lisinopril 40mg qday
Lipitor 20mg qday
Flomax 0.4mg qday
ASA/Plavix stopped [**8-20**]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.3 BP 229/87 -> 148/79  P 97 R 15 O2 100 on 2L NC
Wt 210 lbs
Gen - A+O x 3 NAD
HEENT - EOMI, pupils (L 4->3 mm, R 3->2mm) ERRL, OP clear
Neck - supple, no JVD, scar from tongue ca [**Doctor First Name **] on R
Cor - RRR no murmur
Chest - CTA b
Abd - S/NT/ND +BS, GUIAC - per ED
Ext - no c/c/e, Bruit over R femoral artery

FAMILY HISTORY: Cancer

SOCIAL HISTORY: No tobacco use
1 scotch per day
lives with wife and [**Name2 (NI) **]
retired consultant 

### Response:
{'Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Retention of urine, unspecified,Coronary atherosclerosis of autologous vein bypass graft,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Malignant neoplasm of prostate,Gout, unspecified,Esophageal reflux,Personal history of malignant neoplasm of tongue,Intermediate coronary syndrome'}
