CHIEF COMPLAINT: Unstable Angina

PRESENT ILLNESS: This 57 year old male has a history of a STEMI in [**2163-5-29**] and
was treated with PCI to the mid-LAD with a driver stent and
micro driver to D1. In [**2163-7-29**], he developed recurrent chest
pain with elevated cardiac enzymes. A repeat cardiac
catheterization was done which revealed a 40% LAD stenosis
distal to the previous stent, a 50% instent restenosis of the D1
and a 90% ostial thrombotic OM2 lesion. The RCA was not injected
at that time. The patient was treated with PTCA and placement of
a Xience drug eluting stent. The patient reports that since
[**Month (only) 216**], he had been doing well until a few weeks ago when he
started to experience recurrent chest pain related to activity.
The pain has occurred after going up and down stairs or walking
the dog. This went on for about a week intermittently, with each
episode resolving after 1 ntg. These symptoms have not recurred
in the last 2 weeks. The patient denies claudication, edema,
orthopnea, PND and lightheadedness.

MEDICAL HISTORY: - Coronary artery disease, s/p myoardial infarction with 2 bare
metal stents to LAD and OM1 in 6/'[**62**]
- Hypertension, diagnosed ~5 years ago
- Dyslipidemia
- Sydenham Chorea at age 12, hospitalized for 1-2 months

MEDICATION ON ADMISSION: [**Known lastname **] 75mg daily
Lisinopril 20mg daily
Toprol 150mg daily
Aspirin 325mg daily
Crestor 40mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.4 BP 115/73 HR 62 RR 20 SpO2 97%
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate, in bed rest from cardiac cath.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. However his maternal grandmother and uncle had
[**Name (NI) 5290**] in their 70s. [**Name (NI) **] father had HTN as well. No FHx of
DM.

SOCIAL HISTORY: -Tobacco history: noted on admission note as 20 pack years, but
patient reports 5 pack year smoking history (x10 years); quit 10
years ago.
-ETOH: A couple glasses of red wine per week.
-Illicit drugs: Denies.
-Patient lives at home, recently separated from wife. Reports
moderate activity level at home.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Morbid obesity,Constipation, unspecified,Cardiomegaly,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Intermed coronary synd,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS,Morbid obesity,Constipation NOS,Cardiomegaly,Status-post ptca
Admission Date:  [**2164-3-9**]              Discharge Date:   [**2164-3-16**]

Date of Birth:  [**2106-7-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Unstable Angina

Major Surgical or Invasive Procedure:
[**2164-3-12**] - Off pump coronary artery bypass grafting to two
vessels. (Left internal mammary artery->Left anterior descending
artery, Saphenous vein graft->Distal circumflex artery.)
[**2164-3-9**] Cardiac Catheterization


History of Present Illness:
This 57 year old male has a history of a STEMI in [**2163-5-29**] and
was treated with PCI to the mid-LAD with a driver stent and
micro driver to D1. In [**2163-7-29**], he developed recurrent chest
pain with elevated cardiac enzymes. A repeat cardiac
catheterization was done which revealed a 40% LAD stenosis
distal to the previous stent, a 50% instent restenosis of the D1
and a 90% ostial thrombotic OM2 lesion. The RCA was not injected
at that time. The patient was treated with PTCA and placement of
a Xience drug eluting stent. The patient reports that since
[**Month (only) 216**], he had been doing well until a few weeks ago when he
started to experience recurrent chest pain related to activity.
The pain has occurred after going up and down stairs or walking
the dog. This went on for about a week intermittently, with each
episode resolving after 1 ntg. These symptoms have not recurred
in the last 2 weeks. The patient denies claudication, edema,
orthopnea, PND and lightheadedness.

The patient was referred for a stress test done on [**2164-3-8**]. The
official report is not yet available, however according to Dr
.[**Doctor Last Name 1911**] with exercise, the patient??????s ekg revealed an IVCD
with right axis deviation and the patient developed significant
angina at 6 minutes. Nuclear imaging was significant for a large
reversible inferior wall defect. Patient presented to the
hospital this morning for elective cardiac cath to reexamine
coronary arteries.  Patient was found to have severe 2 VD. The
decision was made not to perform an intervention but to consult
CT surgery for CABG evaluation. On presentation to the floor
after cardiac catheterization, patient denies any chest pain or
shortness of breath.  He does admit to some mild back discomfort
that he attributes to positioning during cath today.


Past Medical History:
- Coronary artery disease, s/p myoardial infarction with 2 bare
metal stents to LAD and OM1 in 6/'[**62**]
- Hypertension, diagnosed ~5 years ago
- Dyslipidemia
- Sydenham Chorea at age 12, hospitalized for 1-2 months


Social History:
-Tobacco history: noted on admission note as 20 pack years, but
patient reports 5 pack year smoking history (x10 years); quit 10
years ago.
-ETOH: A couple glasses of red wine per week.
-Illicit drugs: Denies.
-Patient lives at home, recently separated from wife. Reports
moderate activity level at home.


Family History:
There is no family history of premature coronary artery disease
or sudden death. However his maternal grandmother and uncle had
[**Name (NI) 5290**] in their 70s. [**Name (NI) **] father had HTN as well. No FHx of
DM.


Physical Exam:
VS: T 98.4 BP 115/73 HR 62 RR 20 SpO2 97%
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate, in bed rest from cardiac cath.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

CV: RR, normal S1, S2. 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 heard anteriorly (posterior exam deferred as
patient is in bed rest).
Abd: +bs, Soft, NTND.
Ext: No c/c/e.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

Pertinent Results:
[**2164-3-9**] 12:30PM BLOOD WBC-6.5 RBC-4.70 Hgb-14.9 Hct-41.4 Plt
Ct-168
[**2164-3-9**] 08:20AM BLOOD PT-13.8* INR(PT)-1.2*
[**2164-3-9**] 12:30PM BLOOD Glucose-108* UreaN-18 Creat-0.9 Na-137
K-4.0 Cl-106 HCO3-23 AnGap-12
[**2164-3-9**] 12:30PM BLOOD ALT-29 AST-23 AlkPhos-38* Amylase-35
TotBili-1.2
[**2164-3-9**] 12:30PM BLOOD Albumin-4.2
[**2164-3-9**] 12:30PM BLOOD %HbA1c-6.2*

[**2164-3-9**] Cardiac Cath:
1. Selective coronary angiography of this left dominant system
revealed severe 2 vessel coronary artery disease. The LMCA was
normal. The LAD had a ostial 70% stenosis, with mild instent
narrowing distally. D1 was small with a patent stent but diffuse
mild restenosis. The LCX was a large dominant vessel; the stent
from the LCX into OM1 was patent with mild disease. There was
>90% stenosis in the main AV LCX just distal to the previous
stent. The RCA was a small nondominant vessel with a 50%
stenosis in the mid portion. 2. Limited resting hemodynamics
revealed elevated left sided filling pressures with a LVEDP of
20 mm Hg. Left ventriculography revealed preserved ejection
fraction at 62% with small segment lateral mild hypokinesis.
There was no mitral regurgitation. There was no significant
gradient across the aortic valve. There was mild systemic
arterial hypertension with a central aortic pressure of 140/84
mm Hg.

[**2164-3-10**] Echocardiogram:
The left atrium is dilated. The right atrium is moderately
dilated. There is moderate symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. Due to
suboptimal technical quality, a focal wall motion abnormality
cannot be fully excluded. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The aortic root is mildly
dilated at the sinus level. The ascending aorta is mildly
dilated. The number of aortic valve leaflets cannot be
determined. The aortic valve leaflets are mildly thickened.
There is a minimally increased gradient consistent with minimal
aortic valve stenosis. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. The pulmonary artery systolic pressure could not
be determined. There is no pericardial effusion.

[**2164-3-16**] 07:00AM BLOOD WBC-10.7 RBC-4.04* Hgb-13.0* Hct-35.8*
MCV-89 MCH-32.1* MCHC-36.3* RDW-13.5 Plt Ct-221
[**2164-3-16**] 07:00AM BLOOD Glucose-108* UreaN-16 Creat-1.1 Na-135
K-4.0 Cl-97 HCO3-31 AnGap-11
[**2164-3-9**] 12:30PM BLOOD ALT-29 AST-23 AlkPhos-38* Amylase-35
TotBili-1.2

Brief Hospital Course:
Mr. [**Known lastname 78694**] was admitted and underwent cardiac
catheterization. Coronary angiography revealed a left dominant
system and severe two vessel coronary artery disease - please
see result section for further details. Given the findings,
cardiac surgery was consulted and preoperative evaluation was
performed. Risks and benefits were discussed with the patient
regarding surgical revascularization, and he wished to proceed.
Given the patient was on [**Known lastname **], surgery was delayed for several
days to allow for washout. His preoperative course was otherwise
uneventful and he was cleared for surgery. Given his inpatient
stay was greater than 24 hours prior to surgical intervention,
Vancomycin was utilized for perioperative antibiotics.

On [**3-12**], Dr. [**First Name (STitle) **] performed off pump coronary artery
bypass grafting surgery. For surgical details, please see
operative note. Following the operation, he was brought to the
cardivascular surgical intensive care unit for invasive
monitoring. Within 24 hours, he awoke neurologically intact and
was extubated. He maintained stable hemodynamics and transferred
to the step down floor on postoperative day one.  His chest
tubes were removed and a subsequent set of chest radiographs
reveals small stable bilateral apical pneumothoraces.  His
epicardial wires were removed.  He was seen in consultation by
the physical therapy service.  On his third post-operative day
he mentioned that he occasionally felt a sternal click, but it
was unable to be elucidated by the surgical team and there was
no sternal drainage.  Sternal precautions were reviewed with Mr.
[**Known lastname 78694**].  By post-operative day four he was ready for
discharge to home.


Medications on Admission:
[**Known lastname **] 75mg daily
Lisinopril 20mg daily
Toprol 150mg daily
Aspirin 325mg daily
Crestor 40mg daily

Discharge Medications:
1. 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*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): take while taking pain medication for
constipation.
Disp:*60 Capsule(s)* Refills:*2*
3. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*2*
4. 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*
5. Rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary artery bypass grafting
Hyperlipidemia
Hypertension
Obesity


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. Gently pat the wound
dry.  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 from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.


Followup Instructions:
Please follow-up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] (cardiac surgery) in 1
month. ([**Telephone/Fax (1) 1504**]
Please follow-up with Dr. [**Last Name (STitle) 1911**] (cardiology) in 2 weeks.
Please follow-up with Dr. [**Last Name (STitle) **] (primary care provider)
in [**1-31**] weeks.

Scheduled appointments:
Provider: [**Name10 (NameIs) 1918**] [**Name11 (NameIs) **] Phone:[**Telephone/Fax (1) 11767**]
Date/Time:[**2164-5-14**] 9:40


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2164-3-16**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Morbid obesity,Constipation, unspecified,Cardiomegaly,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: Unstable Angina

PRESENT ILLNESS: This 57 year old male has a history of a STEMI in [**2163-5-29**] and
was treated with PCI to the mid-LAD with a driver stent and
micro driver to D1. In [**2163-7-29**], he developed recurrent chest
pain with elevated cardiac enzymes. A repeat cardiac
catheterization was done which revealed a 40% LAD stenosis
distal to the previous stent, a 50% instent restenosis of the D1
and a 90% ostial thrombotic OM2 lesion. The RCA was not injected
at that time. The patient was treated with PTCA and placement of
a Xience drug eluting stent. The patient reports that since
[**Month (only) 216**], he had been doing well until a few weeks ago when he
started to experience recurrent chest pain related to activity.
The pain has occurred after going up and down stairs or walking
the dog. This went on for about a week intermittently, with each
episode resolving after 1 ntg. These symptoms have not recurred
in the last 2 weeks. The patient denies claudication, edema,
orthopnea, PND and lightheadedness.

MEDICAL HISTORY: - Coronary artery disease, s/p myoardial infarction with 2 bare
metal stents to LAD and OM1 in 6/'[**62**]
- Hypertension, diagnosed ~5 years ago
- Dyslipidemia
- Sydenham Chorea at age 12, hospitalized for 1-2 months

MEDICATION ON ADMISSION: [**Known lastname **] 75mg daily
Lisinopril 20mg daily
Toprol 150mg daily
Aspirin 325mg daily
Crestor 40mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.4 BP 115/73 HR 62 RR 20 SpO2 97%
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate, in bed rest from cardiac cath.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. However his maternal grandmother and uncle had
[**Name (NI) 5290**] in their 70s. [**Name (NI) **] father had HTN as well. No FHx of
DM.

SOCIAL HISTORY: -Tobacco history: noted on admission note as 20 pack years, but
patient reports 5 pack year smoking history (x10 years); quit 10
years ago.
-ETOH: A couple glasses of red wine per week.
-Illicit drugs: Denies.
-Patient lives at home, recently separated from wife. Reports
moderate activity level at home. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Morbid obesity,Constipation, unspecified,Cardiomegaly,Percutaneous transluminal coronary angioplasty status'}
