CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is an 85 yr old male with CRI (baseline creat 1.8-2.3) who
was admitted to [**Hospital 46**] Hosp with a NSTEMI last month (medically
managed) and was then readmitted to [**Hospital 46**] Hosp with chest pain
on [**2128-4-26**]. He had squeezing sub-sternal CP intermittently for 2
weeks (both at rest and with exertion). The CP was associated
with SOB. He ruled in again for MI with trop reportedly 0.15,
ck??????s were negative. ETT reportedly revealed a reversible
inferior posterior defect. He is on coumadin for hx of DVT,
which has been on hold, and INR on [**2128-4-29**] was 1.5. He was pain
free at rest but has had chest pain when getting oob to the BR,
which has resolved with ntg SL and oxygen at [**Hospital 46**] Hosp.
Creatinine was up to 2.3. He was hydrated just prior to transfer
to the [**Hospital1 18**] for cardiac catheterization and further management
of his coronary artery disease. On admission, he was pain free.

MEDICAL HISTORY: Coronary artery disease with Recent MI
Chronic Renal Insuffiency
History of Deep Vein Thrombosis
Atrial Fibrillation
Hypertension
Hyperlipidemia

MEDICATION ON ADMISSION: CURRENT MEDICATIONS (on transfer):
Asa 81mg qd
Ntg paste 1 inch
Imdur 60mg qd
Lopressor 100mg [**Hospital1 **]
Protonix 40mg qd
Lipitor 5mg qd
MVI qd
Glucosamine 2000mg qd
HCTZ 12.5mg qd, recently held due to rising creatinine
Ambien 5mg qhs prn

ALLERGIES: Adhesive Tape

PHYSICAL EXAM: VS: T 97.8 BP 119/73 HR 73 RR 18 O2 96% RA
Gen: 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: Brother in 50's with CAD.

SOCIAL HISTORY: Significant for the absence of current tobacco use. There is no
history of alcohol abuse.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Peripheral vascular complications, not elsewhere classified,Other specified intestinal obstruction,Acute kidney failure with lesion of tubular necrosis,Subendocardial infarction, subsequent episode of care,Atrial flutter,Chronic airway obstruction, not elsewhere classified,Hyperosmolality and/or hypernatremia,Aneurysm of artery of lower extremity,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Unspecified disorder of kidney and ureter,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,Surg comp-peri vasc syst,Intestinal obstruct NEC,Ac kidny fail, tubr necr,Subendo infarct, subseq,Atrial flutter,Chr airway obstruct NEC,Hyperosmolality,Lower extremity aneurysm,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hx-ven thrombosis/embols,Renal & ureteral dis NOS,Hypertension NOS
Admission Date:  [**2128-4-30**]              Discharge Date:   [**2128-5-23**]


Service: CARDIOTHORACIC

Allergies:
Adhesive Tape

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2128-4-30**] Cardiac Catheterization
[**2128-5-4**] Thrombin Injection of Right Groin Pseudoaneurysm
[**2128-5-5**] 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
[**2128-5-17**] Cardioversion


History of Present Illness:
This is an 85 yr old male with CRI (baseline creat 1.8-2.3) who
was admitted to [**Hospital 46**] Hosp with a NSTEMI last month (medically
managed) and was then readmitted to [**Hospital 46**] Hosp with chest pain
on [**2128-4-26**]. He had squeezing sub-sternal CP intermittently for 2
weeks (both at rest and with exertion). The CP was associated
with SOB. He ruled in again for MI with trop reportedly 0.15,
ck??????s were negative. ETT reportedly revealed a reversible
inferior posterior defect. He is on coumadin for hx of DVT,
which has been on hold, and INR on [**2128-4-29**] was 1.5. He was pain
free at rest but has had chest pain when getting oob to the BR,
which has resolved with ntg SL and oxygen at [**Hospital 46**] Hosp.
Creatinine was up to 2.3. He was hydrated just prior to transfer
to the [**Hospital1 18**] for cardiac catheterization and further management
of his coronary artery disease. On admission, he was pain free.

Past Medical History:
Coronary artery disease with Recent MI
Chronic Renal Insuffiency
History of Deep Vein Thrombosis
Atrial Fibrillation
Hypertension
Hyperlipidemia


Social History:
Significant for the absence of current tobacco use. There is no
history of alcohol abuse.

Family History:
Brother in 50's with CAD.

Physical Exam:
VS: T 97.8 BP 119/73 HR 73 RR 18 O2 96% RA
Gen: 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 6cm.
CV: PMI located in 5th intercostal space, midclavicular line.
Very distant heart sounds, irregular. No m/r/g. No thrills,
lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi anteriorly.
Abd: Soft,nt, obse, +BS. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
Ext: 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:
[**2128-4-30**] 01:56PM BLOOD WBC-7.4 RBC-4.16* Hgb-13.9* Hct-40.4
MCV-97 MCH-33.4* MCHC-34.4 RDW-13.7 Plt Ct-149*
[**2128-4-30**] 01:56PM BLOOD PT-16.4* INR(PT)-1.5*
[**2128-5-5**] 01:18PM BLOOD Fibrino-332
[**2128-4-30**] 01:56PM BLOOD Glucose-141* UreaN-30* Creat-1.6* Na-136
K-4.4 Cl-104 HCO3-25 AnGap-11
[**2128-4-30**] 01:56PM BLOOD ALT-17 AST-21 AlkPhos-46 TotBili-0.7
[**2128-4-30**] 01:56PM BLOOD %HbA1c-5.8
[**2128-5-2**] 06:50AM BLOOD CK-MB-3

[**2128-4-30**] Cardiac catheterization: Selective coronary angiography
of this right dominant system revealed three vessel disease. The
LMCA had a distal 30% lesion. The LAD was moderately calcified
with a 30% ostial stenosis and an 80% lesion in the mid-vessel
just after the take off of a major D2 branch, which had diffuse
plaquing. The D1 branch had a proximal 80% stenosis. The LCx had
a 90% lesion in the proximal AV groove and a 40% lesion
distally. The was a major OM3 branch with a proximal 70%
stenosis. The RCA was diffusely diseased throughout with a 50%
mid-vessel stenosis and 60-70% stenosis in the PDA. There was a
major AM branch with a 60% lesion. Moderate diastolic left
ventricular dysfunction.

[**2128-5-3**] TTE: Preserved global left ventricular systolic
function(LVEF approximately 55%). Right ventricular cavity
enlargement but with good free wall function.  No AI. Trivial
MR. [**First Name (Titles) **] [**Last Name (Titles) **].

[**2128-5-4**] Carotid Ultrasound: Less than 40% stenosis involving the
internal carotid arteries bilaterally.

[**2128-5-4**] Groin Ultrasound: Right groin pseudoaneurysm measuring
up to 2.8 cm at site of previous right femoral puncture.

[**2128-5-15**] Abdominal CT Scan: Findings consistent with colonic
ileus. Short segment of narrowed ileum with mild wall
thickening. The appearance raises concern for a neoplastic
process, for which further evaluation is recommended. Multiple
bilateral cystic lesions in the kidneys, not fully characterized
here. Although these most likely represents simple cysts, this
appearance could be evaluated by ultrasound if clinically
indicated.


Brief Hospital Course:
On admission, Mr. [**Known lastname **] [**Last Name (Titles) 1834**] cardiac catheterization
which revealed severe three vessel coronary artery disease. He
was pretreated with Plavix. Given his chronic renal
insufficiency, LV gram was deferred and echocardiogram was
obtained which showed preserved global left ventricular systolic
function. In anticipation for cardiac surgical intervention,
Plavix was discontinued. Additional workup included cartoid
ultrasond which found minimal disease of the internal carotid
arteries. Cardiac catheterization was complicated by a right
common femoral artery pseudoaneurysm which was successfully
treated with thrombin injection on [**5-4**]. He otherwise
remained pain free on medical therapy. He had bouts of
paroxsymal atrial fibrillation preoperatively for which he was
maintained on Amiodarone and Heparin.

On [**5-5**], Dr. [**Last Name (STitle) **] performed coronary artery bypass
grafting surgery. For surgical details, please see seperate
dictated operative note. Following the operation, he was brought
to the CSRU for invasive monitoring. Within 24 hours, he awoke
neurologically intact and was extubated. He continued to
experience periods of atrial fibrillation/flutter which was
initially treated with beta blockade and Amiodarone. Given
persistent atrial arrhythmias associated with hypotension, the
EP service was consulted. Amiodarone was continued while
Metoprolol was temporarily discontinued in hopes to improve
hemodynamics. Warfarin was also resumed with a temporary Heparin
bridge. Successful cardioversion was performed on [**5-17**], but
he returned to atrial fibillation within several days. A second
electrical cardioversion was attempted, but was also
unsuccessful.  It was recommended that he remain on Amiodarone
at discharge with anticoagulation indefinitely.

His renal function declined in the early postoperative period.
His creatinine peaked to 3.8 on postoperative day ten. He did
not experience oliguria. The renal service was consulted and
attributed his acute on chronic renal failure to acute tubular
necrosis secondary to hypotension. Despite significant rise in
creatinine, there was no indication for dialysis. Over the
remaineder of his hospital stay, his renal function slowly
improved. He also experienced some hypernatremia which was
treated with free water.

His postoperative course was also complicated by an
ileus/colonic pseudobstruction. He was temporarily made NPO and
required placement of nasogastric and rectal tubes. With the
above measures and aggressive bowel regimen, his
pseudobstruction gradually resolved. His diet was slowly
advanced and by discharge, he was tolerating a regular diet.

He was also noted to have a sternal click associated with
sternal drainage. He was placed on strict sternal precautions
with close observation of his sternal incision. At discharge,
his sternal drainage had resolved although he continued to have
a click.

By post-operative day seventeen he was ready for discharge to a
rehabilitation facility.

Medications on Admission:
CURRENT MEDICATIONS (on transfer):
Asa 81mg qd
Ntg paste 1 inch
Imdur 60mg qd
Lopressor 100mg [**Hospital1 **]
Protonix 40mg qd
Lipitor 5mg qd
MVI qd
Glucosamine 2000mg qd
HCTZ 12.5mg qd, recently held due to rising creatinine
Ambien 5mg qhs prn

MEDS (home, [**Last Name (un) 5487**] doses):
HCTZ
Metoprolol
Coumadin
Glucosamine


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
5. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
9. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
10. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital 169**] Center - [**Location (un) 3320**]

Discharge Diagnosis:
Coronary artery disease - s/p CABG
Acute MI
Postop Colonic Pseudo-obstruction(Olgilvie's syndrome)
Postop Sternal Drainage
Postop Acute on Chronic Renal Insuffiency
Right Groin Pseudoaneurysm - s/p Thrombin Injection
History of Deep Vein Thrombosis
Atrial Fibrillation/Flutter - s/p Cardioversion
Hypertension
Hyperlipidemia


Discharge Condition:
Good


Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions.  Warfarin should be monitored closely and
adjusted for goal INR between 2.0 - 3.0.  Pre-admission his
coumadin was followed by his cardiologist, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in
[**Location (un) 3320**], Mass ([**Telephone/Fax (1) 73314**].

Followup Instructions:
Dr. [**Last Name (STitle) **] in [**4-15**] weeks, call for appt ([**Telephone/Fax (1) 11763**]
Dr. [**Last Name (STitle) 5310**] in [**2-14**] weeks, call for appt ([**Telephone/Fax (1) 73315**]
Dr. [**Last Name (STitle) 12246**] in [**2-14**] weeks, call for appt ([**Telephone/Fax (1) 73316**]
Dr. [**Last Name (STitle) **] from electrophysiology in 1 month, call for an
appointment ([**Telephone/Fax (1) 22784**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Peripheral vascular complications, not elsewhere classified,Other specified intestinal obstruction,Acute kidney failure with lesion of tubular necrosis,Subendocardial infarction, subsequent episode of care,Atrial flutter,Chronic airway obstruction, not elsewhere classified,Hyperosmolality and/or hypernatremia,Aneurysm of artery of lower extremity,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Unspecified disorder of kidney and ureter,Unspecified essential hypertension'}


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: This is an 85 yr old male with CRI (baseline creat 1.8-2.3) who
was admitted to [**Hospital 46**] Hosp with a NSTEMI last month (medically
managed) and was then readmitted to [**Hospital 46**] Hosp with chest pain
on [**2128-4-26**]. He had squeezing sub-sternal CP intermittently for 2
weeks (both at rest and with exertion). The CP was associated
with SOB. He ruled in again for MI with trop reportedly 0.15,
ck??????s were negative. ETT reportedly revealed a reversible
inferior posterior defect. He is on coumadin for hx of DVT,
which has been on hold, and INR on [**2128-4-29**] was 1.5. He was pain
free at rest but has had chest pain when getting oob to the BR,
which has resolved with ntg SL and oxygen at [**Hospital 46**] Hosp.
Creatinine was up to 2.3. He was hydrated just prior to transfer
to the [**Hospital1 18**] for cardiac catheterization and further management
of his coronary artery disease. On admission, he was pain free.

MEDICAL HISTORY: Coronary artery disease with Recent MI
Chronic Renal Insuffiency
History of Deep Vein Thrombosis
Atrial Fibrillation
Hypertension
Hyperlipidemia

MEDICATION ON ADMISSION: CURRENT MEDICATIONS (on transfer):
Asa 81mg qd
Ntg paste 1 inch
Imdur 60mg qd
Lopressor 100mg [**Hospital1 **]
Protonix 40mg qd
Lipitor 5mg qd
MVI qd
Glucosamine 2000mg qd
HCTZ 12.5mg qd, recently held due to rising creatinine
Ambien 5mg qhs prn

ALLERGIES: Adhesive Tape

PHYSICAL EXAM: VS: T 97.8 BP 119/73 HR 73 RR 18 O2 96% RA
Gen: 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: Brother in 50's with CAD.

SOCIAL HISTORY: Significant for the absence of current tobacco use. There is no
history of alcohol abuse. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Peripheral vascular complications, not elsewhere classified,Other specified intestinal obstruction,Acute kidney failure with lesion of tubular necrosis,Subendocardial infarction, subsequent episode of care,Atrial flutter,Chronic airway obstruction, not elsewhere classified,Hyperosmolality and/or hypernatremia,Aneurysm of artery of lower extremity,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Personal history of venous thrombosis and embolism,Unspecified disorder of kidney and ureter,Unspecified essential hypertension'}
