CHIEF COMPLAINT: Recurrent angina

PRESENT ILLNESS: Mr. [**Known lastname 1968**] is a 56 year old male with known coronary disease,
suffering a non ST myocardial infarction in [**2182**]. Angioplasty
with a bare metal stent was accomplished then. He has anomolous
origin of the right coronary from the left cusp and recently
developed recurrent pain. A stress test was positive for pain
without perfusion defects. He was admitted for catheterization
which revealed in stent stenosis which was not ammenable to
percutaneous intervention.

MEDICAL HISTORY: Coronary artery disease/Myocardial Infarction s/p RCA stent
Degenerative joint disease
Noninsulin dependent diabetes mellitus
Anxiety disorder
Hyperlipidemia
Hypertension
s/p Bilateral total knee replacements
s/p Appendectomy in his teens

MEDICATION ON ADMISSION: Byetta 5mcg [**Hospital1 **], Actos 45mg, Morphine SR 100 [**Hospital1 **], IR 15mg PRN,
Aspirin 81mg qd, Lipitor 80mg, Metoprolol 25mg [**Hospital1 **], Lisinopril
40mg, Colace, Ibuprofen 800mg PRN, Metformin 850 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: There is no family history of premature coronary artery disease.

SOCIAL HISTORY: Tobacco history: None
ETOH: None
Illicit drugs: None
Lives by himself, unemployed secondary to disability
Other complications due to other cardiac device, implant, and graft,Coronary artery anomaly,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,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Old myocardial infarction,Other and unspecified angina pectoris,Atrial fibrillation,Percutaneous transluminal coronary angioplasty status
Comp-oth cardiac device,Coronary artery anomaly,Crnry athrscl natve vssl,Abn react-cardiac cath,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Old myocardial infarct,Angina pectoris NEC/NOS,Atrial fibrillation,Status-post ptca
Admission Date:  [**2185-5-25**]              Discharge Date:   [**2185-5-31**]

Date of Birth:  [**2128-11-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Recurrent angina

Major Surgical or Invasive Procedure:
left heart catheterization, coronary angiography [**2185-5-25**]
coronary artery bypass grafts x 1 (SVG-dRCA) [**2185-5-27**]

History of Present Illness:
Mr. [**Known lastname 1968**] is a 56 year old male with known coronary disease,
suffering a non ST myocardial infarction in [**2182**]. Angioplasty
with a bare metal stent was accomplished then. He has anomolous
origin of the right coronary from the left cusp and recently
developed recurrent pain. A stress test was positive for pain
without perfusion defects. He was admitted for catheterization
which revealed in stent stenosis which was not ammenable to
percutaneous intervention.

Past Medical History:
Coronary artery disease/Myocardial Infarction s/p RCA stent
Degenerative joint disease
Noninsulin dependent diabetes mellitus
Anxiety disorder
Hyperlipidemia
Hypertension
s/p Bilateral total knee replacements
s/p Appendectomy in his teens

Social History:
Tobacco history: None
ETOH: None
Illicit drugs: None
Lives by himself, unemployed secondary to disability

Family History:
There is no family history of premature coronary artery disease.


Physical Exam:
Admission:

VS: T 98.3 105/60 85 19 97% RA FS 102
.
GENERAL: Well appearing man in no distress. 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 not elevated
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

Pertinent Results:
[**2185-5-25**] Cath: 1. Selective coronary angiography of this
right-dominant ystem revealed single vessel coronary artery
disease. The LMCA had no ignificant stenoses. The LAD had a 30%
ostial stenosis. The LCX had a 30%ostial stenosis. The RCA arose
from the left coronary cusp and had 60-70%instent restenosis;
the vessel was best cannulated with an AL3 catheter. 2. Limited
resting hemodynamics demonstrated elevated left ventricular
filling pressures with an LVEDP of 28 mmHg.  No gradient was
seen across the aortic valve.
[**2185-5-27**] Echo: The left atrium is mildly dilated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal for the patient's body size. Overall left
ventricular systolic function is low normal (LVEF 50-55%).
Tissue Doppler imaging suggests a normal left ventricular
filling pressure (PCWP<12mmHg). Transmitral Doppler velocity is
consistent with impaired ventricular relaxation. The right
ventricular cavity is mildly dilated with borderline normal free
wall function. The ascending, transverse and descending thoracic
aorta are normal in diameter and free of atherosclerotic plaque.
The diameters of aorta at the sinus, ascending and arch levels
are normal. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
The prosthetic mitral valve leaflets are thickened. Mild (1+)
mitral regurgitation is seen. There is no pericardial effusion.
Pulmonary Artery Catheter is seen in PA. POST CPB: Good
Biventricular Function. No changes in valve function. Aortic
contours intact. Remaining exam unchanged. All findings
discussed with surgeons at the time of the exam.

[**2185-5-24**] 11:25PM BLOOD WBC-6.2 RBC-3.92* Hgb-11.4* Hct-35.0*
MCV-89 MCH-29.2 MCHC-32.7 RDW-13.8 Plt Ct-306
[**2185-5-31**] 05:15AM BLOOD WBC-5.4 RBC-3.23* Hgb-9.6* Hct-29.2*
MCV-90 MCH-29.8 MCHC-33.0 RDW-13.7 Plt Ct-288
[**2185-5-25**] 05:45AM BLOOD PT-12.3 PTT-29.4 INR(PT)-1.0
[**2185-5-27**] 11:40AM BLOOD PT-13.9* PTT-32.5 INR(PT)-1.2*
[**2185-5-24**] 11:25PM BLOOD Glucose-96 UreaN-24* Creat-1.0 Na-140
K-4.7 Cl-105 HCO3-26 AnGap-14
[**2185-5-31**] 05:15AM BLOOD Glucose-121* UreaN-16 Creat-0.7 Na-137
K-4.5 Cl-103 HCO3-26 AnGap-13
[**2185-5-26**] 04:45AM BLOOD ALT-17 AST-18 LD(LDH)-171 AlkPhos-75
TotBili-0.3
[**2185-5-27**] 05:15AM BLOOD Calcium-9.1 Phos-3.7 Mg-2.0
[**2185-5-25**] 05:45AM BLOOD %HbA1c-6.5*

Brief Hospital Course:
Following cardiac catheterization he was admitted receiving
medical management and remained chest pain free. Catheterization
revealed in-stent disease and intervention in the lab was not
feasible due to anatomy. He was referred for surgical
intervention. He underwent usual pre-operative work-up and on
[**5-27**] he was taken to the operating room where a single vein
graft was placed to the right coronary artery. Please see
operative report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring in stable
condition. Later on op day he was weaned from sedation, awoke
neurologically intact and extubated. His chest tubes and
epicardial pacing wires were removed according to protocols. He
was transferred to the floor on post-op day one. Beta blockers
and diuretics were initiated and he was titrated towards pre-op
weight. Physical therapy worked with the patient for mobility
and strengthening. On post-op day two he had several bouts of
atrial fibrillation which was converted back to sinus rhythm
with Amiodarone and Lopressor. The rest of his post-op course
was uneventful and he was discharged to rehab for additional PT
with the appropriate medications and follow-up appointments.

Medications on Admission:
Byetta 5mcg [**Hospital1 **], Actos 45mg, Morphine SR 100 [**Hospital1 **], IR 15mg PRN,
Aspirin 81mg qd, Lipitor 80mg, Metoprolol 25mg [**Hospital1 **], Lisinopril
40mg, Colace, Ibuprofen 800mg PRN, Metformin 850 mg daily

Discharge Medications:
1. Byetta 5 mcg/0.02 mL Pen Injector Sig: One (1)  Subcutaneous
twice a day.
2. Actos 45 mg Tablet Sig: One (1) Tablet PO once a day.
3. Morphine 100 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
6. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Docusate Sodium 100 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
8. Ibuprofen 800 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
9. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
10. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
12. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 5 days. Then, 200mg [**Hospital1 **] x 7 days. Then 200mg
QD until stopped by Cardiologist.
13. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 5 days.
14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours) for 5 days.
15. Metformin 850 mg Tablet Sig: One (1) Tablet PO once a day.

Discharge Disposition:
Extended Care

Facility:
TBA

Discharge Diagnosis:
Coronary artery disease s/p coronary artery bypass graft x 1
Degenerative joint disease
Noninsulin dependent diabetes mellitus
Anxiety disorder
Hyperlipidemia
Hypertension
s/p Bilateral total knee replacements
s/p Appendectomy in his teens

Discharge Condition:
good

Discharge Instructions:
shower daily, no baths or swimming
no lotions, creams or powders to incisions
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
report any redness of, or drainage from incisions
report any fever greater than 100.5
report any weight gain greater than 2 pounds a day or 5 pounds a
week
take all medications as directed

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
[**Hospital Ward Name 121**] 6 wound clinic in 2 weeks
Dr. [**First Name11 (Name Pattern1) 2270**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] in [**12-10**] weeks ([**Telephone/Fax (1) 3581**])
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in 2 weeks
please call for appointments


Completed by:[**2185-5-31**]
{'Other complications due to other cardiac device, implant, and graft,Coronary artery anomaly,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,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Old myocardial infarction,Other and unspecified angina pectoris,Atrial fibrillation,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: Recurrent angina

PRESENT ILLNESS: Mr. [**Known lastname 1968**] is a 56 year old male with known coronary disease,
suffering a non ST myocardial infarction in [**2182**]. Angioplasty
with a bare metal stent was accomplished then. He has anomolous
origin of the right coronary from the left cusp and recently
developed recurrent pain. A stress test was positive for pain
without perfusion defects. He was admitted for catheterization
which revealed in stent stenosis which was not ammenable to
percutaneous intervention.

MEDICAL HISTORY: Coronary artery disease/Myocardial Infarction s/p RCA stent
Degenerative joint disease
Noninsulin dependent diabetes mellitus
Anxiety disorder
Hyperlipidemia
Hypertension
s/p Bilateral total knee replacements
s/p Appendectomy in his teens

MEDICATION ON ADMISSION: Byetta 5mcg [**Hospital1 **], Actos 45mg, Morphine SR 100 [**Hospital1 **], IR 15mg PRN,
Aspirin 81mg qd, Lipitor 80mg, Metoprolol 25mg [**Hospital1 **], Lisinopril
40mg, Colace, Ibuprofen 800mg PRN, Metformin 850 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: There is no family history of premature coronary artery disease.

SOCIAL HISTORY: Tobacco history: None
ETOH: None
Illicit drugs: None
Lives by himself, unemployed secondary to disability 

### Response:
{'Other complications due to other cardiac device, implant, and graft,Coronary artery anomaly,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,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Old myocardial infarction,Other and unspecified angina pectoris,Atrial fibrillation,Percutaneous transluminal coronary angioplasty status'}
