CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 49 year old man with history of coronary artery disease s/p
STEMI in [**1-13**], 2BMS to LAD at [**Hospital1 2177**], ischemic cardiomyopathy (EF
40-45%), hypertension, diabetes mellitus recent hospitilization
on [**2179-4-25**] for chest pain, at the time ruled out.
Today patient presents with chest pain, non radiation. left
side. + SOB, no n/v, pain similar to previous MI. took 2 SL NTG
at home without good effect. Pain started after dinner, he was
not exerting him self. states pain relieved once he was started
on nitro gtt. +SOb last several days.
.
ED Course: Vitals 98.1 BP 128/87 Hr 81, 99% RA.
ruled in for MI with trop 0.18 given ASA 325, Metoprol,
morphine, Nitroglycerin and started on heparin and nitro gtt.
Admitted for cardiac cath and further work-up.

MEDICAL HISTORY: ? Parkinson's Disease
HTN
Cardiomyopathy (EF 40-45%)
CAD s/p MI
Diabetes Mellitus
Back pain after car accident

MEDICATION ON ADMISSION: atenelol 50mg daily
zanaflex 2mg [**Hospital1 **]
percocet prn
metformin 500 daily
glipizide 5mg daily
simvastatin 80 daily
lisinopril 10 mg daily
plavix 75 daily
asprin 325 daily
seroquel 100mg qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.7 BP 110/58 Hr 80 RR 16 O2 99%RA
.
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,
unable to see JVP.
The carotid waveform was normal. There was no thyromegaly. The
were no chest wall deformities, scoliosis or kyphosis.
The patient had moderate pain with palpation over the site of
his chest pain.
The respirations were not labored and there were no use of
accessory muscles. The lungs were clear to ascultation
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. There is slightly increased edema on R as compared to
L, which is chronic according to the patient. There were no
abdominal, femoral or carotid bruits. Inspection and/or
palpation of skin and subcutaneous tissue showed mild stasis
changes on the R leg.

FAMILY HISTORY: no CAD, otherwise NC

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. There is no family
history of premature coronary artery disease or sudden death.
The patient lives alone, has VNA and several women from his
church who help with daily activities. Using walker and cane for
ambulation
Subendocardial infarction, initial episode of care,Other complications due to other cardiac device, implant, and graft,Combined systolic and diastolic heart failure, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in unspecified place,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Paralysis agitans,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]
Subendo infarct, initial,Comp-oth cardiac device,Syst/diast hrt fail NOS,Urin tract infection NOS,Crnry athrscl natve vssl,Abn react-cardiac cath,Accident in place NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Paralysis agitans,Enterococcus group d
Admission Date:  [**2179-5-9**]              Discharge Date:   [**2179-5-23**]

Date of Birth:  [**2129-3-31**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2179-5-13**] - Coronary artery bypass grafting times 3
with left internal mammary artery graft to left anterior
descending, reverse saphenous vein graft to marginal branch
and the posterior descending artery.
[**2179-5-9**] - Cardiac Catheterization

History of Present Illness:
49 year old man with history of coronary artery disease s/p
STEMI in [**1-13**], 2BMS to LAD at [**Hospital1 2177**], ischemic cardiomyopathy (EF
40-45%), hypertension, diabetes mellitus recent hospitilization
on [**2179-4-25**] for chest pain, at the time ruled out.
Today patient presents with chest pain, non radiation. left
side. + SOB, no n/v, pain similar to previous MI. took 2 SL NTG
at home without good effect. Pain started after dinner, he was
not exerting him self. states pain relieved once he was started
on nitro gtt. +SOb last several days.
.
ED Course: Vitals 98.1 BP 128/87 Hr 81, 99% RA.
ruled in for MI with trop 0.18 given ASA 325, Metoprol,
morphine, Nitroglycerin and started on heparin and nitro gtt.
Admitted for cardiac cath and further work-up.

Past Medical History:
? Parkinson's Disease
HTN
Cardiomyopathy (EF 40-45%)
CAD s/p MI
Diabetes Mellitus
Back pain after car accident

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. There is no family
history of premature coronary artery disease or sudden death.
The patient lives alone, has VNA and several women from his
church who help with daily activities. Using walker and cane for
ambulation

Family History:
no CAD, otherwise NC

Physical Exam:
97.7 BP 110/58 Hr 80 RR 16 O2 99%RA
.
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,
unable to see JVP.
The carotid waveform was normal. There was no thyromegaly. The
were no chest wall deformities, scoliosis or kyphosis.
The patient had moderate pain with palpation over the site of
his chest pain.
The respirations were not labored and there were no use of
accessory muscles. The lungs were clear to ascultation
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. There is slightly increased edema on R as compared to
L, which is chronic according to the patient. There were no
abdominal, femoral or carotid bruits. Inspection and/or
palpation of skin and subcutaneous tissue showed mild stasis
changes on the R leg.

Pertinent Results:
[**2179-5-18**] 06:25AM BLOOD WBC-9.0 RBC-3.42* Hgb-9.4* Hct-27.5*
MCV-81* MCH-27.6 MCHC-34.3 RDW-14.2 Plt Ct-219
[**2179-5-16**] 02:43AM BLOOD PT-14.2* PTT-31.5 INR(PT)-1.3*
[**2179-5-18**] 06:25AM BLOOD Glucose-131* UreaN-13 Creat-1.2 Na-139
K-3.9 Cl-103 HCO3-27 AnGap-13
[**2179-5-17**] 06:40AM BLOOD Calcium-8.7 Phos-3.7 Mg-2.0

IMAGING:
[**2179-5-18**] CXR: There is moderate enlargement of cardiac
silhouette. There is a small amount of left-sided pleural
effusion. Retrocardiac opacity is noted, most likely due to
atelectasis/consolidation. Right-sided CV line tip is projecting
within the right atrium. The patient is status post CABG.
IMPRESSION: 1. A small left-sided pleural effusion is unchanged.
2. Left retrocardiac opacity is noted. This suggests presence of
atelectasis/consolidation, underlying pneumonia cannot be
excluded. This process is unchanged compared to prior study.
[**2179-5-9**] CARDIAC CATH: 1. Selective coronary angiography of this
right dominant system demonstrated 3 vessel coronary artery
disease. The LMCA was patent. The LAD had 90% ISRS in the
previous stent with TIMI II flow. The D1 at the lesion has a 90%
origin lesion. The distal LAD had minimal disease. The LCX had
mid-segment 50% stenosis. The RCA had an anomalous origin from
the L coronary cusp. The proximal vessel had a 90% stenosis with
a crux 70% lesion. The PDA and PLB were large though short
vessels. 2. Resting hemodynamics were performed. The right sided
filling pressures were mildly elevated (mean RA pressure was
10mmHg and RVEDP was 8mmHg). The pulmonary artery pressures were
elevated measuring 39/22mmHg. The left sided filling pressures
were mildly elevated (mean PCW pressure was 12mmHg). The
systemic arterial pressures were within normal range. The
cardiac index was within normal range. FINAL DIAGNOSIS: 1. 3
vessel coronary artery disease. 2. Mildly elevated left and
right sided filling pressures. 3. Normal cardiac index.
[**2179-5-10**] ECHO: The left atrium is mildly dilated. No atrial septal
defect is seen by 2D or color Doppler. There is mild symmetric
left ventricular hypertrophy. The left ventricular cavity size
is normal. There is mild to moderate regional left ventricular
systolic dysfunction with with mid to distal
anterior/septal/apical hypokinesis. No masses or thrombi are
seen in the left ventricle. There is no ventricular septal
defect. Right ventricular chamber size is normal. Right
ventricular systolic function is borderline normal. The aortic
arch is mildly dilated. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild to moderate ([**2-9**]+) mitral regurgitation is seen.
The tricuspid valve leaflets are mildly thickened. The estimated
pulmonary artery systolic pressure is normal. The end-diastolic
pulmonic regurgitation velocity is increased suggesting
pulmonary artery diastolic hypertension. There is no pericardial
effusion.
[**2179-5-22**] 04:40AM BLOOD WBC-10.8 RBC-3.53* Hgb-9.4* Hct-28.7*
MCV-81* MCH-26.7* MCHC-32.9 RDW-14.5 Plt Ct-571*
[**2179-5-22**] 04:40AM BLOOD Plt Ct-571*
[**2179-5-22**] 04:40AM BLOOD Glucose-113* UreaN-11 Creat-1.0 Na-136
K-4.4 Cl-103 HCO3-23 AnGap-14
[**2179-5-12**] 11:39AM BLOOD %HbA1c-6.5* [Hgb]-DONE [A1c]-DONE

Brief Hospital Course:
Mr. [**Known lastname 1968**] was admitted to the [**Hospital1 18**] on [**2179-5-9**] for further
management of his myocardial infarction. Plavix and Integrilin
were started. He was taken to the cardiac catheterization lab
where he was found to have severe three vessel coronary artery
disease. Given the severity of his disease, the cardiac surgical
service was consulted for surgical management. Mr. [**Known lastname 1968**] was
worked-up in the usual preoperative manner. Given Mr. [**Known lastname 10881**]
increased irritability and inappropriateness, the psychiatry
service was consulted for assistance in his care. Seroquel and
Ativan were used with good effect. After several days of Plavix
washout, Mr. [**Known lastname 1968**] was taken to the operating room where he
underwent coronary artery bypass grafting to three vessels.
Please see operative not for detail. Postoperatively he was
taken to the intensive care unit for monitoring. He was
transfused with red blood cells for postoperative anemia.

On postoperative day one, Mr. [**Known lastname 1968**] [**Last Name (Titles) 5058**] neurologically intact
and was extubated.  Vancomycin was started for a urine culture
positive for enterococcus. On post-operative day three, Mr.
[**Known lastname 1968**] was 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. His
white blood cell count began to trend upward, his chest x-ray
showed left lower lobe consolidation with possible pneumonia,
and he had low grade temperatures.  He was placed on
levofloxacin, which he refused.  He was then placed on unasyn,
which he also refused initially, and then accepted. Pt. then
delayed his discharge several days with c/o back pain, and
repeat CXR showed left basilar atelectasis. Cleared for
discharge to home with VNA services on POD #10. Pt. is to make
all follow-up appts. as per discharge instructions.

Medications on Admission:
atenelol 50mg daily
zanaflex 2mg [**Hospital1 **]
percocet prn
metformin 500 daily
glipizide 5mg daily
simvastatin 80 daily
lisinopril 10 mg daily
plavix 75 daily
asprin 325 daily
seroquel 100mg qhs


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(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. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Metformin 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Glipizide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*0*
6. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
Disp:*270 Tablet(s)* Refills:*1*
9. Quetiapine 100 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
Disp:*30 Tablet(s)* Refills:*0*
10. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3
PMH: Hyperlipidemia, Hypertension, s/p PTCA/Stenting, Ischemic
Cardiomyopathy, ?Parkinsons Disease, Diabetes Mellitus Type II

Discharge Condition:
AMA - patient may have pneumonia, patient aware of risk of
leaving AMA


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:
Please follow-up with Cardiac Surgeon Dr. [**Last Name (STitle) **] in 1 month.
([**Telephone/Fax (1) 1504**]
Please follow-up with cardiologist in 2 weeks.
Please follow-up with primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 105380**] in [**3-14**]
weeks. [**Telephone/Fax (1) 96093**]


Completed by:[**2179-5-26**]
{'Subendocardial infarction, initial episode of care,Other complications due to other cardiac device, implant, and graft,Combined systolic and diastolic heart failure, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in unspecified place,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Paralysis agitans,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]'}


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: 49 year old man with history of coronary artery disease s/p
STEMI in [**1-13**], 2BMS to LAD at [**Hospital1 2177**], ischemic cardiomyopathy (EF
40-45%), hypertension, diabetes mellitus recent hospitilization
on [**2179-4-25**] for chest pain, at the time ruled out.
Today patient presents with chest pain, non radiation. left
side. + SOB, no n/v, pain similar to previous MI. took 2 SL NTG
at home without good effect. Pain started after dinner, he was
not exerting him self. states pain relieved once he was started
on nitro gtt. +SOb last several days.
.
ED Course: Vitals 98.1 BP 128/87 Hr 81, 99% RA.
ruled in for MI with trop 0.18 given ASA 325, Metoprol,
morphine, Nitroglycerin and started on heparin and nitro gtt.
Admitted for cardiac cath and further work-up.

MEDICAL HISTORY: ? Parkinson's Disease
HTN
Cardiomyopathy (EF 40-45%)
CAD s/p MI
Diabetes Mellitus
Back pain after car accident

MEDICATION ON ADMISSION: atenelol 50mg daily
zanaflex 2mg [**Hospital1 **]
percocet prn
metformin 500 daily
glipizide 5mg daily
simvastatin 80 daily
lisinopril 10 mg daily
plavix 75 daily
asprin 325 daily
seroquel 100mg qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.7 BP 110/58 Hr 80 RR 16 O2 99%RA
.
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,
unable to see JVP.
The carotid waveform was normal. There was no thyromegaly. The
were no chest wall deformities, scoliosis or kyphosis.
The patient had moderate pain with palpation over the site of
his chest pain.
The respirations were not labored and there were no use of
accessory muscles. The lungs were clear to ascultation
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. There is slightly increased edema on R as compared to
L, which is chronic according to the patient. There were no
abdominal, femoral or carotid bruits. Inspection and/or
palpation of skin and subcutaneous tissue showed mild stasis
changes on the R leg.

FAMILY HISTORY: no CAD, otherwise NC

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. There is no family
history of premature coronary artery disease or sudden death.
The patient lives alone, has VNA and several women from his
church who help with daily activities. Using walker and cane for
ambulation 

### Response:
{'Subendocardial infarction, initial episode of care,Other complications due to other cardiac device, implant, and graft,Combined systolic and diastolic heart failure, unspecified,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in unspecified place,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Paralysis agitans,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus]'}
