CHIEF COMPLAINT: Chest pain and h/o MI

PRESENT ILLNESS: 55 y/o male who c/o chest pain and sustained MI on [**3-23**]. She had
an acute occlusion of the RCA noted on cath at that time and the
vessel dissection during angioplasty. Underwent 6 DES to the
RCA. Now presents for surgical revascularization.

MEDICAL HISTORY: Coronary Artery Disease s/p Angioplasty and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 6 to RCA [**3-23**],
Hyperlipidemia, Hypertension, Gout, h/o Myocardial Infarction,
Nephrolithiasis s/p stone removal

MEDICATION ON ADMISSION: Aspirin 325mg qd, Lipitor 75mg qd, Lipitor 80mg qd, Lisinopril
5mg qd, Lopressor 100mg [**Hospital1 **], Plavix 75mg qd, Protonix 40mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 61 18 161/84 67" 175#
General: WDWN male in NAD
Skin: W/D -lesions
HEENT: NC/AT, EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: MAE, A & O x 3, non-focal

FAMILY HISTORY: Mother died of MI at age 52.

SOCIAL HISTORY: Denies tobacco use. Rare ETOH use.
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Gout, unspecified,Acute myocardial infarction of unspecified site, subsequent episode of care,Other and unspecified hyperlipidemia,Personal history of urinary calculi,Long-term (current) use of aspirin,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Hypertension NOS,Gout NOS,AMI NOS, subsequent,Hyperlipidemia NEC/NOS,Prsnl hst urnr dsrd calc,Long-term use of aspirin,Status-post ptca
Admission Date:  [**2157-5-31**]              Discharge Date:   [**2157-6-4**]

Date of Birth:  [**2102-4-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Chest pain and h/o MI

Major Surgical or Invasive Procedure:
[**2157-5-31**] Coronary Artery Bypass Graft x 4 (LIMA to LAD, SVG to
Diag, SVG to OM, SVG to PDA)

History of Present Illness:
55 y/o male who c/o chest pain and sustained MI on [**3-23**]. She had
an acute occlusion of the RCA noted on cath at that time and the
vessel dissection during angioplasty. Underwent 6 DES to the
RCA. Now presents for surgical revascularization.

Past Medical History:
Coronary Artery Disease s/p Angioplasty and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 6 to RCA [**3-23**],
Hyperlipidemia, Hypertension, Gout, h/o Myocardial Infarction,
Nephrolithiasis s/p stone removal

Social History:
Denies tobacco use. Rare ETOH use.

Family History:
Mother died of MI at age 52.

Physical Exam:
VS: 61 18 161/84 67" 175#
General: WDWN male in NAD
Skin: W/D -lesions
HEENT: NC/AT, EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: MAE, A & O x 3, non-focal

Pertinent Results:
Echo [**5-31**]: PRE-BYPASS: The left atrium is moderately dilated. No
atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thicknesses and cavity size are 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) appear structurally normal with good leaflet
excursion. The aortic valve leaflets are mildly thickened. There
is no aortic valve stenosis. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. The degree of mitral regurgitation did
not increse with Trendelenberg positioning nor with pharmocolgic
increse of systolic blood pressure to 170 mm Hg. There is a
trivial/physiologic pericardial effusion. POST-BYPASS: Normal
biventricular systolic function. No significant changes from pre
bypass findings.
[**2157-5-31**] 11:43AM BLOOD WBC-7.3# RBC-2.43*# Hgb-7.6*# Hct-21.5*#
MCV-89 MCH-31.5 MCHC-35.6* RDW-13.4 Plt Ct-96*
[**2157-6-2**] 06:45AM BLOOD WBC-7.8 RBC-3.63* Hgb-11.2* Hct-32.8*
MCV-90 MCH-30.8 MCHC-34.0 RDW-13.7 Plt Ct-139*
[**2157-5-31**] 11:43AM BLOOD PT-18.9* PTT-53.6* INR(PT)-1.8*
[**2157-6-2**] 06:45AM BLOOD PT-13.9* PTT-31.9 INR(PT)-1.2*
[**2157-6-2**] 06:45AM BLOOD Glucose-127* UreaN-17 Creat-1.0 Na-137
K-4.3 Cl-100 HCO3-29 AnGap-12
[**2157-6-2**] 06:45AM BLOOD Calcium-9.0 Phos-3.3 Mg-1.9
   RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2157-6-2**] 3:16 PM

CHEST (PA & LAT)

Reason: eval for pneumo s/p chest tube removal

[**Hospital 93**] MEDICAL CONDITION:
55 year old man s/p CABG
REASON FOR THIS EXAMINATION:
eval for pneumo s/p chest tube removal
CHEST, PA AND LATERAL

HISTORY: CABG, evaluate for pneumothorax post chest tube
removal.

Two views. Comparison with [**2157-3-31**]. A left chest tube has been
removed. No pneumothorax is identified. There is streaky
bilateral density consistent with subsegmental atelectasis. This
is new on the right. The patient is status post median
sternotomy and CABG as before. Mediastinal structures are
unchanged. An endotracheal tube, nasogastric tube, mediastinal
drains, and right internal jugular line have been removed.

IMPRESSION: Subsegmental atelectasis. No pneumothorax is
identified.

DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4392**]
Approved: [**Doctor First Name **] [**2157-6-2**] 8:45 PM





Brief Hospital Course:
Mr. [**Known lastname 4154**] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On day of admission he
was brought to the operating room where he underwent a coronary
artery bypass graft x 4. Please see op note for surgical
details. Following surgery she was brought to the CSRU for
invasive monitoring in stable condition. Later on op day he was
weaned from sedation, awoke neurologically intact and extubated.
On post-op day one he was started on beta blockers and
diuretics. He was gently weaned towards his pre-op weight. On
this day he was transferred to the telemetry floor for further
care. On post-op day 2 his chest tubes were removed. He
continued to improve while working with PT for strength and
mobility. On post-op day 4 he was discharged home with VNA
services and the appropriate follow-up appointments.

Medications on Admission:
Aspirin 325mg qd, Lipitor 75mg qd, Lipitor 80mg qd, Lisinopril
5mg qd, Lopressor 100mg [**Hospital1 **], Plavix 75mg qd, Protonix 40mg qd

Discharge Medications:
1. Aspirin 325 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:*1*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
5. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*1*
6. 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*
7. 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:*1*


Discharge Disposition:
Home With Service

Facility:
[**Last Name (un) 2646**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
PMH: s/p Angioplasty and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 6 to RCA [**3-23**], Hyperlipidemia,
Hypertension, Gout, h/o Myocardial Infarction, Nephrolithiasis
s/p stone removal

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
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. Please shower daily.
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.
7)  Call with any questions or concerns.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) 6254**] in [**2-19**] weeks
Dr. [**Last Name (STitle) 71779**] in [**1-18**] weeks


Completed by:[**2157-6-6**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Gout, unspecified,Acute myocardial infarction of unspecified site, subsequent episode of care,Other and unspecified hyperlipidemia,Personal history of urinary calculi,Long-term (current) use of aspirin,Percutaneous transluminal coronary angioplasty status'}


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 and h/o MI

PRESENT ILLNESS: 55 y/o male who c/o chest pain and sustained MI on [**3-23**]. She had
an acute occlusion of the RCA noted on cath at that time and the
vessel dissection during angioplasty. Underwent 6 DES to the
RCA. Now presents for surgical revascularization.

MEDICAL HISTORY: Coronary Artery Disease s/p Angioplasty and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] 6 to RCA [**3-23**],
Hyperlipidemia, Hypertension, Gout, h/o Myocardial Infarction,
Nephrolithiasis s/p stone removal

MEDICATION ON ADMISSION: Aspirin 325mg qd, Lipitor 75mg qd, Lipitor 80mg qd, Lisinopril
5mg qd, Lopressor 100mg [**Hospital1 **], Plavix 75mg qd, Protonix 40mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 61 18 161/84 67" 175#
General: WDWN male in NAD
Skin: W/D -lesions
HEENT: NC/AT, EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: MAE, A & O x 3, non-focal

FAMILY HISTORY: Mother died of MI at age 52.

SOCIAL HISTORY: Denies tobacco use. Rare ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Gout, unspecified,Acute myocardial infarction of unspecified site, subsequent episode of care,Other and unspecified hyperlipidemia,Personal history of urinary calculi,Long-term (current) use of aspirin,Percutaneous transluminal coronary angioplasty status'}
