CHIEF COMPLAINT: Recurrent chest pain

PRESENT ILLNESS: This is a 66 year old gentleman with a fairly extensive cardiac
history beginning in [**2094**] which has included five stents. He
underwent his most recent stent in [**2117-9-15**] which was a drug
eluting stent to his circumflex artery. He did well with this up
until the past month when he began to develop recurrent episodes
of his typical angina. He underwent a cardiac catheterization
last week whcih revealed severe two vessel disease. Given the
severity of his disease and his inset of symptoms, he has been
referred for surgical revascularization.

MEDICAL HISTORY: CAD, s/p IMI and multiple stents
CVA in [**2102**] without residual deficits
TIA in [**2102**]
Insulin dependent diabetes mellitus
Hypertension
Hyperlipidemia
Bell ??????s palsy in [**2106**]
Anemia, s/p rectal bleeding from hemorrhoids, s/p transfusions
(last episode 4 years ago)
[**Doctor Last Name 15532**]??????s esophagus
GERD
History of NSVT
Systolic murmur
Arthritis
obesity
Past Surgical History :
S/P right ankle fracture
Hemorroidectomy x 2
S/P cyst removal from elbow
S/P left knee arthroscopy
Blepharoplasty
Cataract Surgery

MEDICATION ON ADMISSION: celebrex 200 mg daily
clonidine 0.2 mg [**Hospital1 **]
plavix 75 mg daily - last dose 5 days prior to OR date
cartia XT 120 mg daily
HCTZ 25 mg daily
isosorbide mononitrate SR 120 mg daily
losartan 75 mg [**Hospital1 **]
toprol XL 100 mg daily
protonix 40 mg daily
crestor 40 mg daily
ASA 325 mg daily
regular insulin SS QACHS
Humulin N 30 units qAM, 20 units qPM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 56 SB      Resp: 16        O2 sat: 97
B/P  Right: 138/84        Left: 134/84
Height:  70"   Weight:  265#

FAMILY HISTORY: Brother died of MI at age 62.

SOCIAL HISTORY: Occupation: owns pawn shop
Last Dental Exam: Full dentures.
Lives with: wife
[**Name (NI) **]: Caucasian
Tobacco: 30pack year hx. Quit 35 years ago.
ETOH: 4 drinks per month
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Other and unspecified angina pectoris,Other and unspecified hyperlipidemia,Unspecified cerebrovascular disease,Barrett's esophagus,Undiagnosed cardiac murmurs,Arthropathy, unspecified, site unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,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
Crnry athrscl natve vssl,Surg compl-heart,Atrial fibrillation,Hypertension NOS,Status-post ptca,Old myocardial infarct,Obesity NOS,DMII wo cmp nt st uncntr,Long-term use of insulin,Angina pectoris NEC/NOS,Hyperlipidemia NEC/NOS,Cerebrovasc disease NOS,Barrett's esophagus,Cardiac murmurs NEC,Arthropathy NOS-unspec,Hx TIA/stroke w/o resid,Abn react-anastom/graft
Admission Date:  [**2118-7-26**]              Discharge Date:   [**2118-8-1**]

Date of Birth:  [**2051-9-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Recurrent chest pain

Major Surgical or Invasive Procedure:
[**2118-7-26**] Three Vessel Coronary Artery Bypass Grafting utilizing
the left internal mammary artery to left anterior descending
with vein grafts to obtuse marginal and posterior descending
artery.


History of Present Illness:
This is a 66 year old gentleman with a fairly extensive cardiac
history beginning in [**2094**] which has included five stents. He
underwent his most recent stent in [**2117-9-15**] which was a drug
eluting stent to his circumflex artery. He did well with this up
until the past month when he began to develop recurrent episodes
of his typical angina. He underwent a cardiac catheterization
last week whcih revealed severe two vessel disease. Given the
severity of his disease and his inset of symptoms, he has been
referred for surgical revascularization.

Past Medical History:
CAD, s/p IMI and multiple stents
CVA in [**2102**] without residual deficits
TIA in [**2102**]
Insulin dependent diabetes mellitus
Hypertension
Hyperlipidemia
Bell ??????s palsy in [**2106**]
Anemia, s/p rectal bleeding from hemorrhoids, s/p transfusions
(last episode 4 years ago)
[**Doctor Last Name 15532**]??????s esophagus
GERD
History of NSVT
Systolic murmur
Arthritis
obesity
Past Surgical History :
S/P right ankle fracture
Hemorroidectomy x 2
S/P cyst removal from elbow
S/P left knee arthroscopy
Blepharoplasty
Cataract Surgery


Social History:
Occupation: owns pawn shop
Last Dental Exam: Full dentures.
Lives with: wife
[**Name (NI) **]: Caucasian
Tobacco: 30pack year hx. Quit 35 years ago.
ETOH: 4 drinks per month


Family History:
Brother died of MI at age 62.


Physical Exam:
Pulse: 56 SB      Resp: 16        O2 sat: 97
B/P  Right: 138/84        Left: 134/84
Height:  70"   Weight:  265#

General: Well developed, well nourished male in NAD
Skin: Dry [X] intact [X] no C/C
HEENT: PERRLA [X] EOMI [X], anicteric sclera, OP benign
Neck:  Supple [X] Full ROM [X] no JVD
Chest: Lungs clear bilaterally [X]
Heart: RRR Nl S1-S2, No M/R/G
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X] obese. Negative [**Doctor Last Name **] sign.
Extremities: Warm [X], well-perfused [X]  Trace Edema
Varicosities: Some anterior varicosities noted. GSV appears
suitable.
Neuro: Grossly intact
Pulses:
Femoral      Right: 2  Left:2
DP           Right: 1  Left:1
PT           [**Name (NI) 167**]: 1  Left:1
Radial       Right: 2  Left:2

Carotid Bruit        Right: ?Faint   Left: None


Pertinent Results:
[**2118-7-26**] Intraop TEE:
Prebypass: No atrial septal defect is seen by 2D or color
Doppler. 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 simple atheroma in the descending thoracic aorta. The
aortic valve leaflets (3) are mildly thickened. There is mild
aortic valve stenosis (valve area 1.2-1.9cm2). Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild (1+) mitral regurgitation is seen. There is no
pericardial effusion.

Post bypass: Patient is A paced and receiving an infusion of
phenylephrine. Biventricular systolic function is unchanged.
Trivial mitral regurgitation present. Aorta is intact post
decannulation.
[**2118-7-26**] 11:37AM BLOOD WBC-11.0# RBC-2.85*# Hgb-8.6*# Hct-24.9*#
MCV-87 MCH-30.1 MCHC-34.5 RDW-15.0 Plt Ct-106*
[**2118-7-29**] 06:05AM BLOOD WBC-12.3* RBC-3.39* Hgb-9.8* Hct-29.5*
MCV-87 MCH-28.9 MCHC-33.2 RDW-15.6* Plt Ct-123*
[**2118-7-26**] 11:37AM BLOOD PT-14.8* PTT-31.1 INR(PT)-1.3*
[**2118-7-26**] 12:54PM BLOOD PT-14.3* PTT-31.2 INR(PT)-1.2*
[**2118-7-29**] 06:05AM BLOOD Glucose-174* UreaN-30* Creat-1.1 Na-140
K-4.4 Cl-101 HCO3-29 AnGap-14
[**2118-7-27**] 03:08AM BLOOD Glucose-105 UreaN-19 Creat-1.1 Na-139
K-4.7 Cl-107 HCO3-26 AnGap-11

Brief Hospital Course:
[**7-26**] Mr. [**Known lastname **] was taken to the operating room and underwent
coronary artery bypass grafting x3(Left internal Mammary Artery
grafted to the left anterior descending artery/Saphenous vein
grafted to the Obtuse Marginal artery/Posterior descending
artery) by Dr. [**Last Name (STitle) **]. Cross clamp time= 53 minutes,
Cardiopulmonary Bypass time= 71 minutes. Please see Dr[**Last Name (STitle) **]
operative note for further surgical details. He tolerated the
procedure well and was transferred to the CVICU for invasive
monitoring. Within 24 hours, he awoke neurologically intact and
was extubated without complication. All lines and drains were
discontinued in a timely fashion. Beta-blocker, aspirin, statin
and diuresis was initiated. He maintained good hemodynamics and
transferred to the step down unit on postoperative day one.
Physical therapy was consulted for evaluation.POD#2 his rhythm
went into rapid atrial fibrillation with a rate in the 150s. He
was treated with Amiodarone and increased Beta-blockade. He
converted to sinus rhythm and than over the next day went back
into rate controlled atrial fibrillation. POD#3 Anticoagulation
was started with Coumadin. Empiric antibiotics was started for
an elevated white blood cell count, urine culture was negative
and Cipro was discontinued. Mr.[**Known lastname **] failed to void and a
foley was reinserted and Flomax was started. He continued to
progress and was cleared for discharge to home with VNA by
Dr.[**Last Name (STitle) **] on POD #6. He was set up with coumadin follow-up by
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on the day of discharge. All follow up
appointments were advised.


Medications on Admission:
celebrex 200 mg daily
clonidine 0.2 mg [**Hospital1 **]
plavix 75 mg daily - last dose 5 days prior to OR date
cartia XT 120 mg daily
HCTZ 25 mg daily
isosorbide mononitrate SR 120 mg daily
losartan 75 mg [**Hospital1 **]
toprol XL 100 mg daily
protonix 40 mg daily
crestor 40 mg daily
ASA 325 mg daily
regular insulin SS QACHS
Humulin N 30 units qAM, 20 units qPM

Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO twice a day:
take 400mg (two 200mg tablets) [**Hospital1 **] for one week, then 400mg
daily for one week, and then decrease to 200mg.
Disp:*120 Tablet(s)* Refills:*2*
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. Rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. 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*
5. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*2*
6. Outpatient Lab Work
INR to be drawn on [**2118-8-3**] with results sent to the [**Company 191**]
anticoagulation office.  INR goal for Afib [**1-18**].
7. Losartan 50 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
8. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*2*
9. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
10. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Thirty
(30) units Subcutaneous QAM.
11. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Twenty
(20) units Subcutaneous QPM.
12. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
13. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 10 days.
Disp:*20 Tablet(s)* Refills:*2*
14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours) for 10 days.
Disp:*20 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*
15. Coumadin 3 mg Tablet Sig: One (1) Tablet PO once a day: INR
to be drawn on [**2118-8-3**] with results sent to the office of Dr.
[**First Name4 (NamePattern1) 3979**] [**Last Name (NamePattern1) **] at ([**Telephone/Fax (1) 52849**].  INR goal for Afib [**1-18**].
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Coronary Artery Disease, s/p CABG
Postop Atrial Fibrillation
History of Myocardial Infarction
Cerebrovascular Disease
Type I Diabetes Mellitus
Hypertension
Dyslipidemia
Anemia


Discharge Condition:
Good


Discharge Instructions:
1)No driving for one month
2)No lifting more than 10 lbs for at least 10 weeks from the
date of surgery
3)Please shower daily. Wash surgical incisions with soap and
water only.
4)Do not apply lotions, creams or ointments to any surgical
incision.
5)Please call cardiac surgeon immediately if you experience
fever, excessive weight gain and/or signs of a wound
infection(erythema, drainage, etc...). Office number is
[**Telephone/Fax (1) 170**].
6)Call with any additional questions or concerns.


Followup Instructions:
[**Hospital 409**] clinic in 2 weeks
Dr. [**Last Name (STitle) **] in [**3-20**] weeks, call for appt. #[**Telephone/Fax (1) **]
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**1-18**] weeks, call for appt
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**1-18**] weeks, call for appt.  #[**Telephone/Fax (1) **]
INR to be drawn on [**2118-8-3**] with results sent to the office of
Dr. [**First Name4 (NamePattern1) 3979**] [**Last Name (NamePattern1) **] at ([**Telephone/Fax (1) 52849**].  INR goal for Afib [**1-18**].



Completed by:[**2118-8-1**]
{"Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Other and unspecified angina pectoris,Other and unspecified hyperlipidemia,Unspecified cerebrovascular disease,Barrett's esophagus,Undiagnosed cardiac murmurs,Arthropathy, unspecified, site unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,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"}


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: Recurrent chest pain

PRESENT ILLNESS: This is a 66 year old gentleman with a fairly extensive cardiac
history beginning in [**2094**] which has included five stents. He
underwent his most recent stent in [**2117-9-15**] which was a drug
eluting stent to his circumflex artery. He did well with this up
until the past month when he began to develop recurrent episodes
of his typical angina. He underwent a cardiac catheterization
last week whcih revealed severe two vessel disease. Given the
severity of his disease and his inset of symptoms, he has been
referred for surgical revascularization.

MEDICAL HISTORY: CAD, s/p IMI and multiple stents
CVA in [**2102**] without residual deficits
TIA in [**2102**]
Insulin dependent diabetes mellitus
Hypertension
Hyperlipidemia
Bell ??????s palsy in [**2106**]
Anemia, s/p rectal bleeding from hemorrhoids, s/p transfusions
(last episode 4 years ago)
[**Doctor Last Name 15532**]??????s esophagus
GERD
History of NSVT
Systolic murmur
Arthritis
obesity
Past Surgical History :
S/P right ankle fracture
Hemorroidectomy x 2
S/P cyst removal from elbow
S/P left knee arthroscopy
Blepharoplasty
Cataract Surgery

MEDICATION ON ADMISSION: celebrex 200 mg daily
clonidine 0.2 mg [**Hospital1 **]
plavix 75 mg daily - last dose 5 days prior to OR date
cartia XT 120 mg daily
HCTZ 25 mg daily
isosorbide mononitrate SR 120 mg daily
losartan 75 mg [**Hospital1 **]
toprol XL 100 mg daily
protonix 40 mg daily
crestor 40 mg daily
ASA 325 mg daily
regular insulin SS QACHS
Humulin N 30 units qAM, 20 units qPM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 56 SB      Resp: 16        O2 sat: 97
B/P  Right: 138/84        Left: 134/84
Height:  70"   Weight:  265#

FAMILY HISTORY: Brother died of MI at age 62.

SOCIAL HISTORY: Occupation: owns pawn shop
Last Dental Exam: Full dentures.
Lives with: wife
[**Name (NI) **]: Caucasian
Tobacco: 30pack year hx. Quit 35 years ago.
ETOH: 4 drinks per month 

### Response:
{"Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Other and unspecified angina pectoris,Other and unspecified hyperlipidemia,Unspecified cerebrovascular disease,Barrett's esophagus,Undiagnosed cardiac murmurs,Arthropathy, unspecified, site unspecified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,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"}
