CHIEF COMPLAINT: Chest Discomfort

PRESENT ILLNESS: Mr. [**Known lastname 65584**] is a 66 year old male with significant past
medical histroy who recently saw his cardiologist complaining of
exertional chest discomfort for approximately 1 year. Also
accompanied by shortness of breath. Recent EKG showed evidence
of a prior MI. He underwent a stress echo which showed evidence
of septal inferoapical hypokinesis. Along with patient having
chest discomfort and EKG notable for ST depressions in lead 2,
3, AVF. He was thus referred for cardiac cath. Cath revealed
significant three vessel disease with mild to moderate left
ventricular dysfunction. He was then referred to cardiac
surgery.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obstructive Sleep Apnea
Gastroesophageal Reflux Disease
h/o CVA
Hemochromatosis
s/p left shoulder surgery x 2
s/p achilles tendon repair
s/p right knee surgery
s/p upper lip repair x 2 after traumatic accident

MEDICATION ON ADMISSION: 1. Metformin 1000mg [**Hospital1 **]
2. Atenolol 50mg qd
3. Lisinopril 40mg qd
4. HCTZ 40mg qd
5. Cimetidine 400mg prn
6. Aspirin 325mg qd
7. Aggrenox 25-200mg [**Hospital1 **] stopped [**3-27**]

ALLERGIES: Lipitor

PHYSICAL EXAM: 

FAMILY HISTORY: Father w/ HTN and DM, died in 70's. Mother had a CVA in her
70's.

SOCIAL HISTORY: Married and works at the FBI as a supply technician.
Quit smoking 36 years ago.
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)
Crnry athrscl natve vssl,Surg compl-heart,Intermed coronary synd,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Esophageal reflux,Obstructive sleep apnea
Admission Date:  [**2143-4-4**]              Discharge Date:   [**2143-4-11**]

Date of Birth:  [**2076-7-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lipitor

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest Discomfort

Major Surgical or Invasive Procedure:
Coronary Artery Bypass Graft x 4 (LIMA to LAD, SVG to OM1, SVG
to OM2, SVG to PDA) on [**2143-4-4**]

History of Present Illness:
Mr. [**Known lastname 65584**] is a 66 year old male with significant past
medical histroy who recently saw his cardiologist complaining of
exertional chest discomfort for approximately 1 year. Also
accompanied by shortness of breath. Recent EKG showed evidence
of a prior MI. He underwent a stress echo which showed evidence
of septal inferoapical hypokinesis. Along with patient having
chest discomfort and EKG notable for ST depressions in lead 2,
3, AVF. He was thus referred for cardiac cath. Cath revealed
significant three vessel disease with mild to moderate left
ventricular dysfunction. He was then referred to cardiac
surgery.

Past Medical History:
Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obstructive Sleep Apnea
Gastroesophageal Reflux Disease
h/o CVA
Hemochromatosis
s/p left shoulder surgery x 2
s/p achilles tendon repair
s/p right knee surgery
s/p upper lip repair x 2 after traumatic accident

Social History:
Married and works at the FBI as a supply technician.
Quit smoking 36 years ago.

Family History:
Father w/ HTN and DM, died in 70's. Mother had a CVA in her
70's.

Pertinent Results:
Echo [**4-4**]: PREBYPASS: There is mild regional left ventricular
systolic dysfunction. The aortic valve leaflets (3) are mildly
thickened. Trace aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Mild (1+) mitral regurgitation is
seen. POSTBYPASS: LV systolic function relatively unchanged
compared to prebypass LVEF~40-45%. RV systolic function remains
normal. Study otherwise unchanged from prebypass.
CXR [**4-6**]:  Tiny left apical pneumothorax following chest tube
removal.
[**Last Name (un) **] DUP EXTEXT BIL [**4-10**]: No evidence of DVT in the left lower
extremities bilaterally.
[**2143-4-4**] 04:15PM BLOOD WBC-21.9*# RBC-3.42* Hgb-11.5* Hct-31.6*
MCV-92 MCH-33.7* MCHC-36.4* RDW-12.4 Plt Ct-146*
[**2143-4-8**] 06:40AM BLOOD WBC-15.6* RBC-3.26* Hgb-10.2* Hct-30.2*
MCV-93 MCH-31.5 MCHC-33.9 RDW-14.5 Plt Ct-103*
[**2143-4-4**] 05:30PM BLOOD PT-13.4* PTT-24.5 INR(PT)-1.2*
[**2143-4-4**] 05:30PM BLOOD UreaN-14 Creat-1.1 Cl-108 HCO3-23
[**2143-4-8**] 06:40AM BLOOD Glucose-138* UreaN-22* Creat-1.0 Na-137
K-4.5 Cl-102 HCO3-23 AnGap-17
[**2143-4-7**] 02:10AM BLOOD Calcium-8.5 Phos-2.6* Mg-2.1
[**2143-4-6**] 08:20PM BLOOD K-4.3
[**2143-4-6**] 08:20PM BLOOD freeCa-1.08*

Brief Hospital Course:
Mr. [**Known lastname 65584**] was a same day admit and on [**4-4**] was brought to
the operating room where he underwent a coronary artery bypass
graft x 4. Please see op note for surgical details. He tolerated
the procedure well and was transferred to the CSRU in stable
condition on minimal Inotropic support. On post-op day one he
was weaned from sedation and awoke neurologically intact and was
extubated. Chest tubes were removed post op day two. He remained
in the CSRU for several days for Inotropic support which was
finally weaned off on post-op day three and he was transferred
to the cardiac surgery step-down unit. B blockers and diuretics
were started per protocol and he was gently diuresed towards his
pre-op weight during his post-op course. He had an episode of
rapid atrial fibrillation on post-op day two in which he was
given an Amiodarone bolus and then started on a drip with
conversion to sinus rhythm. During the rest of his hospital
course he had several more episodes of atrial fibrillation that
were treated appropriately. Eventually Amiodarone was switched
to po and at time of discharge was in sinus rhythm. Epicardial
pacing wires were removed on post-op day three. Physical therapy
worked with patient during entire post-op course for strength
and mobility. Cleared level 5 by post-op day 6. He developed
some left calf to left popliteal pain on post-op day six. U/S
was done to rule-out DVT and was negative. He continued to be
above his pre-op weight at time of discharge and was sent home
with diuretics. He appeared stable and was discharged home with
VNA services and the appropriate follow-up appointments on
post-op day five.

Medications on Admission:
1. Metformin 1000mg [**Hospital1 **]
2. Atenolol 50mg qd
3. Lisinopril 40mg qd
4. HCTZ 40mg qd
5. Cimetidine 400mg prn
6. Aspirin 325mg qd
7. Aggrenox 25-200mg [**Hospital1 **] stopped [**3-27**]

Discharge Medications:
1. 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*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. 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:*0*
4. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*1*
5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
6. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
8. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 10
days.
Disp:*40 Capsule, Sustained Release(s)* Refills:*0*
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take 400mg twice a day for 5 days. Then 400mg once a day
for 1 week. And finally 200mg once a day until stopped by
cardiologist.
Disp:*60 Tablet(s)* Refills:*1*
10. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*

Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obstructive Sleep Apnea
Gastroesophageal Reflux Disease
h/o CVA

Discharge Condition:
Good

Discharge Instructions:
[**Month (only) 116**] take shower. Wash incisions with water and gently soap.
Gently pat dry. Do not apply lotions, creams, ointments, or
powders to incisions. Do no take bath or swim.
Do not drive for 1 month.
Do not lift more than 10 pounds for 2 months.
If you develop a fever more than 101.5 or notice chest/sternal
drainage, please contact office immediately.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 11679**] in [**2-15**] weeks
Dr. [**Last Name (STitle) **] in [**2-15**] weeks


Completed by:[**2143-4-11**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)'}


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 Discomfort

PRESENT ILLNESS: Mr. [**Known lastname 65584**] is a 66 year old male with significant past
medical histroy who recently saw his cardiologist complaining of
exertional chest discomfort for approximately 1 year. Also
accompanied by shortness of breath. Recent EKG showed evidence
of a prior MI. He underwent a stress echo which showed evidence
of septal inferoapical hypokinesis. Along with patient having
chest discomfort and EKG notable for ST depressions in lead 2,
3, AVF. He was thus referred for cardiac cath. Cath revealed
significant three vessel disease with mild to moderate left
ventricular dysfunction. He was then referred to cardiac
surgery.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obstructive Sleep Apnea
Gastroesophageal Reflux Disease
h/o CVA
Hemochromatosis
s/p left shoulder surgery x 2
s/p achilles tendon repair
s/p right knee surgery
s/p upper lip repair x 2 after traumatic accident

MEDICATION ON ADMISSION: 1. Metformin 1000mg [**Hospital1 **]
2. Atenolol 50mg qd
3. Lisinopril 40mg qd
4. HCTZ 40mg qd
5. Cimetidine 400mg prn
6. Aspirin 325mg qd
7. Aggrenox 25-200mg [**Hospital1 **] stopped [**3-27**]

ALLERGIES: Lipitor

PHYSICAL EXAM: 

FAMILY HISTORY: Father w/ HTN and DM, died in 70's. Mother had a CVA in her
70's.

SOCIAL HISTORY: Married and works at the FBI as a supply technician.
Quit smoking 36 years ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)'}
