CHIEF COMPLAINT: Chest discomfort

PRESENT ILLNESS: 78M hx CAD s/p CABG (RIMA to RCA) [**2129**], DM2, in [**2145-11-23**]
developed chest pain and cath showed LAD disease not amenable to
intervention.  Also showed disease in the distal RIMA prior to
touchdown and DES was paced.  He was discharged on
ASA/plavix/atenolol/statin.  According to the patient he was
doing well until over the past few days he has had epigastric
buring that occurs with rest. Denies other associated symptoms.
His cath today revealed signifcant Left main disease.

MEDICAL HISTORY: - Coronarary artery disease
- Diabetes
- Hypertension
- hx of vocal chord tumor

MEDICATION ON ADMISSION: 1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission exam:
VS: T 98.0 BP 120/54 HR 66 RR 15 SpO2 96/RA  Weight: 229  Kg
103.8 kg
GENERAL: WDWN male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother - died of "old age" in 90s
Father - died of "massive MI" in his 60s

SOCIAL HISTORY: Married and lives with his wife in [**Name (NI) 2624**], insurance [**Doctor Last Name 360**] and
still works part time.
-Tobacco history: quit 45 years prior, approx [**7-31**] pack-year
history.
-ETOH: None
Coronary atherosclerosis of native coronary artery,Other fluid overload,Atrial fibrillation,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Hemorrhage complicating a procedure,Pulmonary collapse,Acute posthemorrhagic anemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Atherosclerosis of native arteries of the extremities with intermittent claudication,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Long-term (current) use of anticoagulants
Crnry athrscl natve vssl,Fluid overload NEC,Atrial fibrillation,Intermed coronary synd,Surg compl-heart,Hemorrhage complic proc,Pulmonary collapse,Ac posthemorrhag anemia,Ocl crtd art wo infrct,Ath ext ntv at w claudct,Hypertension NOS,DMII wo cmp nt st uncntr,Status-post ptca,Abn react-anastom/graft,Iatrogenc hypotnsion NEC,Hyperlipidemia NEC/NOS,Long-term use anticoagul
Admission Date:  [**2146-4-29**]              Discharge Date:   [**2146-5-8**]

Date of Birth:  [**2067-9-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2146-5-3**] - Redosternotomy, Coronary artery bypass grafting to two
vessels (Left internal mammary artery->Left anterior descending
artery, saphenous vein graft->obtuse mraginal artery)


History of Present Illness:
78M hx CAD s/p CABG (RIMA to RCA) [**2129**], DM2, in [**2145-11-23**]
developed chest pain and cath showed LAD disease not amenable to
intervention.  Also showed disease in the distal RIMA prior to
touchdown and DES was paced.  He was discharged on
ASA/plavix/atenolol/statin.  According to the patient he was
doing well until over the past few days he has had epigastric
buring that occurs with rest. Denies other associated symptoms.
His cath today revealed signifcant Left main disease.


Past Medical History:
- Coronarary artery disease
- Diabetes
- Hypertension
- hx of vocal chord tumor

Social History:
Married and lives with his wife in [**Name (NI) 2624**], insurance [**Doctor Last Name 360**] and
still works part time.
-Tobacco history: quit 45 years prior, approx [**7-31**] pack-year
history.
-ETOH: None

Family History:
Mother - died of "old age" in 90s
Father - died of "massive MI" in his 60s

Physical Exam:
Admission exam:
VS: T 98.0 BP 120/54 HR 66 RR 15 SpO2 96/RA  Weight: 229  Kg
103.8 kg
GENERAL: WDWN male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of [**6-30**] cm H2O
CARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3
or S4.
LUNGS: CTAB in anterior lung fields (pt on bedrest after cath),
no crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND, obese.
EXTREMITIES: No c/c/e. TR band in place on right wrist,
sensation intact in fingers and cap refill <2 sec. Right groin
access site has some oozing of blood, no tenderness or hematoma.

PULSES:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP 2+ PT 2+

Discharge:
VS: T: 98.0  HR: 50-60's SR  BP: 100-120's/60's  Sats: 93% 3L
Weight: 107.7 kg
General: 78 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR normal S1,S2 no murmur
Resp: decreased breath sounds on left 1/4 up otherwise clear
GI: benign
Extr: warm bilateral with 1+ edema
Incision: sternal clean dry intact no erythema or sternal click.
Left lower extremity vasoview site clean dry intact no erythema
Neuro: awake, alert oriented.

Pertinent Results:
Admission labs:
[**2146-4-29**] WBC-4.4 RBC-3.73* Hgb-10.7* Hct-33.0* MCV-89 MCH-28.7
MCHC-32.4 RDW-14.0 Plt Ct-189
[**2146-4-29**] PT-12.2 PTT-91.4* INR(PT)-1.1
[**2146-4-29**] Glucose-81 UreaN-12 Creat-0.1* Na-143 K-4.2 Cl-110*
HCO3-23
[**2146-4-29**] Albumin-3.4*
[**2146-4-29**] %HbA1c-6.4* eAG-137*
[**2146-4-29**] ALT-20 AST-7 AlkPhos-81 TotBili-0.3

Discharge labs:
[**2146-5-8**] WBC-9.8 RBC-3.08* Hgb-9.3* Hct-29.1* MCV-95 MCH-30.1
MCHC-31.8 RDW-15.1 Plt Ct-289
[**2146-5-8**] Glucose-189* UreaN-29* Creat-1.1 Na-141 K-4.0 Cl-102
HCO3-31
[**2146-5-6**] Mg-2.3

Imaging:
-CXR ([**2146-4-30**]): No acute cardiopulmonary radiographic
abnormality.
-CXR ([**2146-5-6**]): There is no evident pneumothorax. There are low
lung volumes with increasing bibasilar atelectasis, larger on
the left side. If any, there is a small left pleural effusion.
Right IJ catheter tip is in the lower SVC. There are no other
interval changes.

-TEE ([**2146-5-3**]):
PRE BYPASS The left atrium is dilated. No spontaneous echo
contrast or thrombus is seen in the body of the left atrium/left
atrial appendage or the body of the right atrium/right atrial
appendage. A patent foramen ovale is present. A left-to-right
shunt across the interatrial septum is seen at rest. There is
mild symmetric left ventricular hypertrophy. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. There are three
aortic valve leaflets. The aortic valve leaflets are moderately
thickened. There is no aortic valve stenosis. Trace to mild
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Mild to moderate ([**1-24**]+) mitral regurgitation
is seen. There is no pericardial effusion. Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) **]
were notified in person at the time of the study.

POST BYPASS The patient is atrially paced. There is normal
biventricular systolic function. Valvular functiojn is
unchanged. The thoracic aorta is intact after decannulation.

-Carotid US ([**5-2**]/ Right ICA 60-69% stenosis. Left ICA 40-59%
stenosis.

-Cardiac CAth [**2146-4-29**]:
1. Selective coronary angiography showed LMCA disease. The LMCA
had a
90% distal stenosis. THe LAD had mild luminal irregularities.
The LCX
had mild luminal irregularities. The RCA is known occluded.
2. Limited hemodynamics showed mild hypertension with central
pressure
of 142/61/75 mmHg.
3. Arterial conduit angiography showed via nonselective imaging
the RIMA
was widely patent with patent distal stent. The RIMA was unable
to be
engaged selective via the right radial approach (using many
differnt
catheters) or via the femoral approach using an [**Female First Name (un) 899**] guide.


Brief Hospital Course:
Mr. [**Known lastname 24393**] was admitted to the [**Hospital1 18**] on [**2146-4-29**] for further
management of his chest pain. He underwent a cardiac
catheterization and was found to have a 90% stenosed left main
coronary artery. Given the severity of his disease, the cardiac
surgery service was consulted for surgical management. Plavix
was continued given his drug eluting stent from [**2145-11-23**].
He was worked-up in the usual preoperative manner including a
carotid duplex ultrasound which showed right internal carotid
artery of 60-69% stenosed and a left internal carotid artery
40-59% stenosed. He complained of thigh claudication, mostly in
his right thigh, which is reporoducible with walking 100-200
yards and relieved by rest. His non-invasive vascuilar studies
were normal however. On [**2146-5-2**], Mr. [**Known lastname 24393**] was taken to the
operating room where he underwent a redo sterontomy with
coronary artery bypass grafting to two vessels. Please see
operative note for details. Postoperatively he was taken to the
intensive care unit for monitoring. On postoperative day one, he
awoke neurologically intact and was extubated. He was gently
diuresed towards his preoperative weight. He developed
post-operative atrial fibrillation and converted to sinus rhythm
with amiodarone. Beta-blockers were continued. Aggressive
pulmonary toilet continued.  His oxygenation improved but still
required supplemental oxygen via nasal cannula.  His glyburide
was restarted with blood sugars 69-170's. Insulin sliding scale
continued. He was seen by physical therapy service for
assistance with his postoperative strength and mobility. He was
discharged to the [**Hospital 19771**] Rehab [**Telephone/Fax (1) 24394**] on POD5. He will
follow-up as an outpatient.

Medications on Admission:
1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a

day).
5. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).


Discharge Medications:
1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): for cardiac stents.
2. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every six
(6) hours as needed for fever, pain.
5. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily)
for 7 days: then 200 mg daily starting [**5-15**].
9. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. potassium chloride 10 mEq Capsule, Extended Release Sig: Two
(2) Capsule, Extended Release PO DAILY (Daily).
11. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
13. tramadol 50 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
Hellenic - [**Location (un) 2624**]

Discharge Diagnosis:
- Coronarary artery disease
- Diabetes
- Hypertension
- hx of vocal chord tumor


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema 1+


Discharge Instructions:
1) 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.
2) Please NO lotions, cream, powder, or ointments to incisions.
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart provided.
4) No driving for approximately one month and while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon when you will likely be cleared to drive.
5) No lifting more than 10 pounds for 10 weeks
6) Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**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. [**Last Name (STitle) **], [**Telephone/Fax (1) 170**] Date/Time:[**2146-6-8**] 2:45 in
the [**Last Name (un) 2577**] Building [**Last Name (NamePattern1) **] [**Hospital Unit Name **]

Cardiologist: [**Doctor Last Name **] [**2146-5-16**] at 2:00p ([**Apartment Address(1) 24395**], [**Location (un) **],MA)

Please call to schedule appointments with your

Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] [**Telephone/Fax (1) 24396**] in [**4-28**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**




Completed by:[**2146-5-8**]
{'Coronary atherosclerosis of native coronary artery,Other fluid overload,Atrial fibrillation,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Hemorrhage complicating a procedure,Pulmonary collapse,Acute posthemorrhagic anemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Atherosclerosis of native arteries of the extremities with intermittent claudication,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Long-term (current) use of anticoagulants'}


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 discomfort

PRESENT ILLNESS: 78M hx CAD s/p CABG (RIMA to RCA) [**2129**], DM2, in [**2145-11-23**]
developed chest pain and cath showed LAD disease not amenable to
intervention.  Also showed disease in the distal RIMA prior to
touchdown and DES was paced.  He was discharged on
ASA/plavix/atenolol/statin.  According to the patient he was
doing well until over the past few days he has had epigastric
buring that occurs with rest. Denies other associated symptoms.
His cath today revealed signifcant Left main disease.

MEDICAL HISTORY: - Coronarary artery disease
- Diabetes
- Hypertension
- hx of vocal chord tumor

MEDICATION ON ADMISSION: 1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission exam:
VS: T 98.0 BP 120/54 HR 66 RR 15 SpO2 96/RA  Weight: 229  Kg
103.8 kg
GENERAL: WDWN male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother - died of "old age" in 90s
Father - died of "massive MI" in his 60s

SOCIAL HISTORY: Married and lives with his wife in [**Name (NI) 2624**], insurance [**Doctor Last Name 360**] and
still works part time.
-Tobacco history: quit 45 years prior, approx [**7-31**] pack-year
history.
-ETOH: None 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other fluid overload,Atrial fibrillation,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Hemorrhage complicating a procedure,Pulmonary collapse,Acute posthemorrhagic anemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Atherosclerosis of native arteries of the extremities with intermittent claudication,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other iatrogenic hypotension,Other and unspecified hyperlipidemia,Long-term (current) use of anticoagulants'}
