CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is a 71 yo M w h/o HTN, CAD s/p multiple stents, asthma and
type 2 diabetes presents with CP 3 days after cardiac cath.
Patient states that he developed sharp pain in the center of his
chest, occurring at rest starting last night. He took 10 SL
nitro, and achieved relief of his pain after each dose, but
recurred again. He was able to go to sleep that night. He denied
any radiation of the pain to his neck or arms, or any associated
nausea, diaphoresis, or SOB associated with this chest pain. He
denies any positional component to his pain. He has no fevers,
chills, or productive sputum, but has had a dry cough recently.
He states that this is different from both his asthma and his
GERD, and is also unlike the shortness of breath and jaw
tightness he develops when going up stairs. He does not remember
whether this is his anginal equivalent. He was most recently
seen by his cardiologist for continuing anginal symptoms and at
that time was referred for a cath. This was performed 3 days
ago, and showed 3 vessel disease (LMCA w/80% distal stenosis,
LAD w/ 60% stenosis,  distal LCx w/70% stenosis, first OM w/60%
stenosis, RCA 70% distal stenosis), and patient was scheduled
for CABG. In the ED, he received nitro SL and morphine IV with
relief of his pain. A first set of cardiac enzymes were
negative. His EKG showed minimal ST elevations <1mm in V3/V4,
and he was placed on a Heparin gtt and given BB, ASA, and
subsequently admitted for surgical revascularization.

MEDICAL HISTORY: Coronary artery disease, History of MI, History of PCI/stenting
to LAD in [**2161**], Hypertension, Hypercholesterolemia, Diabetes
Mellitus Type II, Asthma, Peripheral Neuropathy, Benign
Prostatic Hypertrophy - s/p TURP, Chronic Back pain - s/p
Laminectomy, Cervical Myelopathy, Penile Implant [**2158**]

MEDICATION ON ADMISSION: Lovastatin 80 mg qD
Metformin 500 mg [**Hospital1 **]
Advair
Ranitidine 250 mg qD
Sulindac 200 mg qD
Toprol-XL 50 mg qD
Neurontin 400 mg [**Hospital1 **]
Plavix 75 mg qD
Roxicet 5/325 mg qD
Zetia 10 mg qDay
Lisinopril 10 mg qD
Imdur 30mg qD

ALLERGIES: Codeine

PHYSICAL EXAM: VS: 98.0 BP 106/64 HR 48 RR 18 O2sat 97% 3L.
Gen: well appearing in NAD. Able to speak in full sentences.
heent: MMM. No oral ulcers. JVD flat.
neck: No carotid bruits.
cvs: RRR. No MRG.
chest: Diminished breath sounds. Expiratory wheezing bilaterally
in upper lobes.
abd: Soft, obese. Normoactive BS.
ext: No CCE. 2+DP/PT/radial pulses.

FAMILY HISTORY: Mother died by suicide, Father with leg tumor; one sib with
cirrhosis, another with history of closed head injury; other
sibs with ethanol and tobacco use history. Had 3 brothers all
deceased, 1 brother that died from asthma, 1 from stroke and 1
died in an MVA.

SOCIAL HISTORY: Mr. [**Known lastname 14502**] is originally from [**Male First Name (un) 1056**].  He emigrated to the
US in [**2116**]. urrently retired security officer at [**Location (un) 19930**]Hospital. Lives with second wife; no tobacco or alcohol; travels
to residence in [**Male First Name (un) 1056**] several times each year, last in
[**7-25**]; no ethanol since [**2159**]; no tobacco since [**2139**]. Incurred
injury to neck and back from job-related fall.  He is currently
on disability. He has 6 children, 3 grandchildren and 1
great-grandchild.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Old myocardial infarction,Esophageal reflux,Asthma, unspecified type, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Unspecified disorder of kidney and ureter,Cervical spondylosis with myelopathy,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Old myocardial infarct,Esophageal reflux,Asthma NOS,Idio periph neurpthy NOS,Renal & ureteral dis NOS,Cerv spondyl w myelopath,Status-post ptca
Admission Date:  [**2164-12-13**]              Discharge Date:   [**2164-12-22**]

Date of Birth:  [**2093-7-31**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Codeine

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

Major Surgical or Invasive Procedure:
[**2164-12-17**] Three Vessel Coronary ARtery Bypass Grafting utilizing
left internal mammary artery to left anterior descending, and
vein grafts to obtuse marginal and posterior descending artery


History of Present Illness:
This is a 71 yo M w h/o HTN, CAD s/p multiple stents, asthma and
type 2 diabetes presents with CP 3 days after cardiac cath.
Patient states that he developed sharp pain in the center of his
chest, occurring at rest starting last night. He took 10 SL
nitro, and achieved relief of his pain after each dose, but
recurred again. He was able to go to sleep that night. He denied
any radiation of the pain to his neck or arms, or any associated
nausea, diaphoresis, or SOB associated with this chest pain. He
denies any positional component to his pain. He has no fevers,
chills, or productive sputum, but has had a dry cough recently.
He states that this is different from both his asthma and his
GERD, and is also unlike the shortness of breath and jaw
tightness he develops when going up stairs. He does not remember
whether this is his anginal equivalent. He was most recently
seen by his cardiologist for continuing anginal symptoms and at
that time was referred for a cath. This was performed 3 days
ago, and showed 3 vessel disease (LMCA w/80% distal stenosis,
LAD w/ 60% stenosis,  distal LCx w/70% stenosis, first OM w/60%
stenosis, RCA 70% distal stenosis), and patient was scheduled
for CABG. In the ED, he received nitro SL and morphine IV with
relief of his pain. A first set of cardiac enzymes were
negative. His EKG showed minimal ST elevations <1mm in V3/V4,
and he was placed on a Heparin gtt and given BB, ASA, and
subsequently admitted for surgical revascularization.

Past Medical History:
Coronary artery disease, History of MI, History of PCI/stenting
to LAD in [**2161**], Hypertension, Hypercholesterolemia, Diabetes
Mellitus Type II, Asthma, Peripheral Neuropathy, Benign
Prostatic Hypertrophy - s/p TURP, Chronic Back pain - s/p
Laminectomy, Cervical Myelopathy, Penile Implant [**2158**]

Social History:
Mr. [**Known lastname 14502**] is originally from [**Male First Name (un) 1056**].  He emigrated to the
US in [**2116**]. urrently retired security officer at [**Location (un) 19930**]Hospital. Lives with second wife; no tobacco or alcohol; travels
to residence in [**Male First Name (un) 1056**] several times each year, last in
[**7-25**]; no ethanol since [**2159**]; no tobacco since [**2139**]. Incurred
injury to neck and back from job-related fall.  He is currently
on disability. He has 6 children, 3 grandchildren and 1
great-grandchild.


Family History:
Mother died by suicide, Father with leg tumor; one sib with
cirrhosis, another with history of closed head injury; other
sibs with ethanol and tobacco use history. Had 3 brothers all
deceased, 1 brother that died from asthma, 1 from stroke and 1
died in an MVA.

Physical Exam:
VS: 98.0 BP 106/64 HR 48 RR 18 O2sat 97% 3L.
Gen: well appearing in NAD. Able to speak in full sentences.
heent: MMM. No oral ulcers. JVD flat.
neck: No carotid bruits.
cvs: RRR. No MRG.
chest: Diminished breath sounds. Expiratory wheezing bilaterally
in upper lobes.
abd: Soft, obese. Normoactive BS.
ext: No CCE. 2+DP/PT/radial pulses.

Discharge
VS temp 97.3 HR 93 SR B/P 105/81  RR 18 O2 Sat 98% 2lNC at rest
RA Sat 90 with Ambulation wt 84.9kg
Neuro Alert and oriented x3 nonfocal
Pulmonary: lungs clear to auscultation ant/post
Cardiac RRR no murmur/rub/gallop
Sternal inc midline healing scant amt serous drainage distal
end, no erythema, sternum stable
Leg: left EVH steristrips no erythema, no drainage
Ext warm pulses palpable, edema LE +1 L>R
Abd soft, nontender, nondistended


Pertinent Results:
[**2164-12-22**] 05:55AM BLOOD WBC-11.1* RBC-2.86* Hgb-9.0* Hct-25.9*
MCV-91 MCH-31.4 MCHC-34.7 RDW-12.8 Plt Ct-242
[**2164-12-19**] 02:46AM BLOOD WBC-24.5*# RBC-3.23* Hgb-10.1* Hct-29.4*
MCV-91 MCH-31.3 MCHC-34.4 RDW-13.0 Plt Ct-162
[**2164-12-13**] 02:50PM BLOOD WBC-9.9 RBC-4.14* Hgb-12.9* Hct-37.2*
MCV-90 MCH-31.2 MCHC-34.7 RDW-12.8 Plt Ct-227
[**2164-12-19**] 07:08PM BLOOD Neuts-85* Bands-0 Lymphs-8* Monos-4 Eos-2
Baso-1 Atyps-0 Metas-0 Myelos-0
[**2164-12-13**] 02:50PM BLOOD Neuts-55.1 Lymphs-31.1 Monos-7.5 Eos-5.4*
Baso-0.9
[**2164-12-22**] 05:55AM BLOOD Plt Ct-242
[**2164-12-20**] 09:55AM BLOOD PT-13.1 PTT-28.9 INR(PT)-1.1
[**2164-12-13**] 02:50PM BLOOD Plt Ct-227
[**2164-12-14**] 05:55AM BLOOD PT-13.2* PTT-51.8* INR(PT)-1.2*
[**2164-12-22**] 05:55AM BLOOD Glucose-131* UreaN-26* Creat-1.4* Na-137
K-5.2* Cl-100 HCO3-30 AnGap-12
[**2164-12-19**] 07:08PM BLOOD Glucose-127* UreaN-23* Creat-1.6* Na-135
K-4.4 Cl-100 HCO3-26 AnGap-13
[**2164-12-13**] 02:50PM BLOOD Glucose-92 UreaN-25* Creat-1.3* Na-136
K-4.8 Cl-103 HCO3-26 AnGap-12
[**2164-12-19**] 02:46AM BLOOD ALT-25 AST-49* AlkPhos-70 Amylase-31
TotBili-1.0

Reason: evaluate for pneumonia

[**Hospital 93**] MEDICAL CONDITION:
71 year old man s/p cabg now with temps
REASON FOR THIS EXAMINATION:
evaluate for pneumonia
CHEST

HISTORY: CABG, fever, evaluate for pneumonia.

Two views. Comparison with the previous study of [**2164-12-19**]. There
is streaky density at the lung bases and in the left upper lobe
consistent with subsegmental atelectasis, as before. Blunting of
the posterior costophrenic sulci probably represents very small
pleural effusions. The patient is status post median sternotomy
and CABG. Mediastinal structures are unchanged. The bony thorax
is grossly intact.

IMPRESSION: Bilateral subsegmental atelectasis and possible
small bilateral pleural effusions. Status post median
sternotomy. No significant interval change.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify
I was present in compliance with HCFA regulations. The patient
was under
general anesthesia throughout the procedure.

Conclusions:
PRE-BYPASS: The left atrium is normal in size. No spontaneous
echo contrast or
thrombus is seen in the body of the left atrium or left atrial
appendage. No
atrial septal defect is seen by 2D or color Doppler. There is
severe regional
left ventricular systolic dysfunction with akinesis of the
anterior septum and
anterior wall.. The remaining left ventricular segments contract
normally.
Right ventricular chamber size and free wall motion are normal.
There are
simple atheroma in the descending thoracic aorta. There are
three aortic valve
leaflets. The aortic valve leaflets (3) are mildly thickened.
There is no
aortic valve stenosis. Trace aortic regurgitation is seen. The
mitral valve
leaflets are mildly thickened. Trivial mitral regurgitation is
seen. There is
no pericardial effusion.

POST CPB: LV systolic function globally improved on inotropic
support
(epinephrine). LVEF now 40 %. Akinetic anteroseptal mid and
apical segments.
Tivial MR [**First Name (Titles) **] [**Last Name (Titles) **] as described. TR is mild. The aortic contour is
intact post
decannulation.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD on [**2164-12-17**] 16:45.

[**Location (un) **] PHYSICIAN:


Brief Hospital Course:
Mr. [**Known lastname 14502**] was admitted to cardiology service. Cardiac enzymes
remained flat. Due to persistent chest pain at rest, he was
maintained on intravenous Heparin and Nitroglycerin. Plavix was
held in anticipation of surgery. His preoperative course was
otherwise unremarkable and he was cleared for surgery. On
[**12-17**], Dr. [**Last Name (STitle) **] performed coronary artery bypass
grafting. For additional 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 on postoperative day
one. He experienced bouts of atrial fibrillation which was
initially treated with intravenous Amiodarone. He remained
mostly in a normal sinus rhythm and continued to maintain stable
hemodynamics. On postoperative day two, he transferred to the
SDU. Beta blockade was advanced as tolerated. Plavix and Aspirin
were resumed. He remained in a normal sinus rhythm - no further
atrial arrhythmias. Patient was pan-cultured for postop fevers.
Workup revealed no growth to date. His postop course was
otherwise uneventful. He continued to make clinical improvements
and was eventually cleared for discharge to rehab on
postoperative day 5.


Medications on Admission:
Lovastatin 80 mg qD
Metformin 500 mg [**Hospital1 **]
Advair
Ranitidine 250 mg qD
Sulindac 200 mg qD
Toprol-XL 50 mg qD
Neurontin 400 mg [**Hospital1 **]
Plavix 75 mg qD
Roxicet 5/325 mg qD
Zetia 10 mg qDay
Lisinopril 10 mg qD
Imdur 30mg qD


Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
10 days. Tablet(s)
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO once a day for 10 days.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Insulin Glargine 100 unit/mL Solution Sig: Six (6) units
Subcutaneous at bedtime.
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours) for 10 days.
8. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
10. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
11. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
12. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1186**] - [**Location (un) 538**]

Discharge Diagnosis:
Coronary artery disease - s/p CABG, Postop Paroxysmal Atrial
Fibrillation, Postop Fevers, History of MI, History of
PCI/stenting in [**2161**], Hypertension, Hypercholesterolemia,
Diabetes Mellitus Type II, Peripheral Neuropathy, Benign
Prostatic Hypertrophy - s/p TURP, Chronic Back pain - s/p
Laminectomy, Penile Implant [**2158**]


Discharge Condition:
Good


Discharge Instructions:
[**Month (only) 116**] shower, no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns


Followup Instructions:
Dr. [**Last Name (STitle) **] in [**4-25**] weeks - call for appt
Dr. [**Last Name (STitle) **] in [**2-24**] weeks - call for appt
Dr. [**Last Name (STitle) 13965**] in [**2-24**] weeks - call for appt



Completed by:[**2164-12-22**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Old myocardial infarction,Esophageal reflux,Asthma, unspecified type, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Unspecified disorder of kidney and ureter,Cervical spondylosis with myelopathy,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

PRESENT ILLNESS: This is a 71 yo M w h/o HTN, CAD s/p multiple stents, asthma and
type 2 diabetes presents with CP 3 days after cardiac cath.
Patient states that he developed sharp pain in the center of his
chest, occurring at rest starting last night. He took 10 SL
nitro, and achieved relief of his pain after each dose, but
recurred again. He was able to go to sleep that night. He denied
any radiation of the pain to his neck or arms, or any associated
nausea, diaphoresis, or SOB associated with this chest pain. He
denies any positional component to his pain. He has no fevers,
chills, or productive sputum, but has had a dry cough recently.
He states that this is different from both his asthma and his
GERD, and is also unlike the shortness of breath and jaw
tightness he develops when going up stairs. He does not remember
whether this is his anginal equivalent. He was most recently
seen by his cardiologist for continuing anginal symptoms and at
that time was referred for a cath. This was performed 3 days
ago, and showed 3 vessel disease (LMCA w/80% distal stenosis,
LAD w/ 60% stenosis,  distal LCx w/70% stenosis, first OM w/60%
stenosis, RCA 70% distal stenosis), and patient was scheduled
for CABG. In the ED, he received nitro SL and morphine IV with
relief of his pain. A first set of cardiac enzymes were
negative. His EKG showed minimal ST elevations <1mm in V3/V4,
and he was placed on a Heparin gtt and given BB, ASA, and
subsequently admitted for surgical revascularization.

MEDICAL HISTORY: Coronary artery disease, History of MI, History of PCI/stenting
to LAD in [**2161**], Hypertension, Hypercholesterolemia, Diabetes
Mellitus Type II, Asthma, Peripheral Neuropathy, Benign
Prostatic Hypertrophy - s/p TURP, Chronic Back pain - s/p
Laminectomy, Cervical Myelopathy, Penile Implant [**2158**]

MEDICATION ON ADMISSION: Lovastatin 80 mg qD
Metformin 500 mg [**Hospital1 **]
Advair
Ranitidine 250 mg qD
Sulindac 200 mg qD
Toprol-XL 50 mg qD
Neurontin 400 mg [**Hospital1 **]
Plavix 75 mg qD
Roxicet 5/325 mg qD
Zetia 10 mg qDay
Lisinopril 10 mg qD
Imdur 30mg qD

ALLERGIES: Codeine

PHYSICAL EXAM: VS: 98.0 BP 106/64 HR 48 RR 18 O2sat 97% 3L.
Gen: well appearing in NAD. Able to speak in full sentences.
heent: MMM. No oral ulcers. JVD flat.
neck: No carotid bruits.
cvs: RRR. No MRG.
chest: Diminished breath sounds. Expiratory wheezing bilaterally
in upper lobes.
abd: Soft, obese. Normoactive BS.
ext: No CCE. 2+DP/PT/radial pulses.

FAMILY HISTORY: Mother died by suicide, Father with leg tumor; one sib with
cirrhosis, another with history of closed head injury; other
sibs with ethanol and tobacco use history. Had 3 brothers all
deceased, 1 brother that died from asthma, 1 from stroke and 1
died in an MVA.

SOCIAL HISTORY: Mr. [**Known lastname 14502**] is originally from [**Male First Name (un) 1056**].  He emigrated to the
US in [**2116**]. urrently retired security officer at [**Location (un) 19930**]Hospital. Lives with second wife; no tobacco or alcohol; travels
to residence in [**Male First Name (un) 1056**] several times each year, last in
[**7-25**]; no ethanol since [**2159**]; no tobacco since [**2139**]. Incurred
injury to neck and back from job-related fall.  He is currently
on disability. He has 6 children, 3 grandchildren and 1
great-grandchild. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Old myocardial infarction,Esophageal reflux,Asthma, unspecified type, unspecified,Unspecified hereditary and idiopathic peripheral neuropathy,Unspecified disorder of kidney and ureter,Cervical spondylosis with myelopathy,Percutaneous transluminal coronary angioplasty status'}
