CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is a 77 y.o. female with history of HTN, HLD and CAD s/p
CABG x5 who presented as an outpatient with chest pressure. The
patient spent the winter in [**State 108**] and returned about 2 weeks
ago. Two weeks before she was to return home she experienced an
episode of nonradiating chest heaviness that resolved with NGT
and rest, although was not worse with exertion. She attributed
this to anxiety that she was feeling while planning the return
home. She has been home for 2 weeks, and had two more similar
episodes, also potentially related to anxiety. She had angina
prior to her CABG in [**2103**], but that was a heartburn sensation,
rather than the current pressure. She presented yesterday to
[**Hospital1 18**] for elective cardiac catherization, which showed 80%
stenosis at the LIMA-LAD touchdown, 80-90% distal left main
stenosis, 80% ostial LCx stenosis, RCA with diffuse disease. CT
surgery felt redo CABG was too risky due to LIMA being stuck to
the sternum. On the following day, she returned to the cath lab
and had stenting of the LIMA with a 2.5 x 12mm Xience stent,
rotablation and 2.5x15 mm Xience (postdilated to 3.5mm) stent in
LM into LCx. An Impella assist device was placed preemptively
for the procedure, but removed in the cath lab. She was admitted
to the CCU for close monitoring.

MEDICAL HISTORY: HTN
CAD s/p off pump cabg [**2103**] with a LIMA to the LAD, SVG to the
left ventricular branch, the obtuse marginal and the diagonal,
and an SVG to the acute marginal. All the SVG's reported
occluded subsequent caths in [**2104**].
HLD
GERD
Anxiety
Osteoarthritis
Sciatica
Tonsillectomy
Umbilical Hernia
Hysterectomy/BSO

MEDICATION ON ADMISSION: Imdur 30mg daily
Losartan 50mg daily
Metoprolol 50mg AM, 25mg PM
sl nitro daily
Simvastatin 40mg daily
Aspirin 81mg daily
Ca/Mg/Zn
vitamin D 800 IU daily
Glucosamine 1500mg daily
Omeprazole 20mg daily

ALLERGIES: Percodan / Percocet

PHYSICAL EXAM: VS: T 98.2 BP 118/56 HR 67 RR 16 O2sat 98% 2L
GENERAL: WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. MM slightly dry.
NECK: Supple with no JVD.
CARDIAC: RRR, normal S1, S2. 2/6 SEM at RUSB/LUSB. No rubs or
gallops.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi anteriorly.
ABDOMEN: Soft, NTND. NABS.
EXTREMITIES: Trace ankle edema. Bilat groin without hematoma,
tenderness, ecchymoses. 2+ DP and PT pulses. WWP.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: Her twin brother had CAD, he passed away in his 60??????s of lung CA.
Father died of lung CA.

SOCIAL HISTORY: Quit smoking 43 years ago (as of [**2113**]) after smoking 1 pack a
day for 10 years. Lives in [**Location 11252**] NH with her husband [**Name (NI) **].
[**Name2 (NI) **] a son [**Name (NI) **]. She is retired. She reports one glass of wine a
couple times a week. She has never had any home care services.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Sciatica,Anxiety state, unspecified,Anemia, unspecified,Family history of ischemic heart disease,Personal history of tobacco use,Acquired absence of both cervix and uterus
Crnry athrscl natve vssl,Intermed coronary synd,Hyperlipidemia NEC/NOS,Hypertension NOS,Esophageal reflux,Osteoarthros NOS-unspec,Sciatica,Anxiety state NOS,Anemia NOS,Fam hx-ischem heart dis,History of tobacco use,Acq absnce cervix/uterus
Admission Date:  [**2113-3-22**]              Discharge Date:   [**2113-3-24**]

Date of Birth:  [**2035-9-6**]             Sex:   F

Service: MEDICINE

Allergies:
Percodan / Percocet

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catherization x2
Stents x3
Impella use during cath


History of Present Illness:
This is a 77 y.o. female with history of HTN, HLD and CAD s/p
CABG x5 who presented as an outpatient with chest pressure. The
patient spent the winter in [**State 108**] and returned about 2 weeks
ago. Two weeks before she was to return home she experienced an
episode of nonradiating chest heaviness that resolved with NGT
and rest, although was not worse with exertion. She attributed
this to anxiety that she was feeling while planning the return
home. She has been home for 2 weeks, and had two more similar
episodes, also potentially related to anxiety. She had angina
prior to her CABG in [**2103**], but that was a heartburn sensation,
rather than the current pressure. She presented yesterday to
[**Hospital1 18**] for elective cardiac catherization, which showed 80%
stenosis at the LIMA-LAD touchdown, 80-90% distal left main
stenosis, 80% ostial LCx stenosis, RCA with diffuse disease. CT
surgery felt redo CABG was too risky due to LIMA being stuck to
the sternum. On the following day, she returned to the cath lab
and had stenting of the LIMA with a 2.5 x 12mm Xience stent,
rotablation and 2.5x15 mm Xience (postdilated to 3.5mm) stent in
LM into LCx. An Impella assist device was placed preemptively
for the procedure, but removed in the cath lab. She was admitted
to the CCU for close monitoring.

On review of systems, she has a chronic dry cough and occasional
blood drops at the end of a BM, but denies any prior history of
stroke, TIA, deep venous thrombosis, pulmonary embolism,
bleeding at the time of surgery, myalgias, joint pains,
hemoptysis, or black stools. She denies recent fevers, chills or
rigors. She confirms hip pain, that she relates to sciatica, but
denies exertional calf pain. All of the other review of systems
were negative.

Cardiac review of systems is notable for chest pressure as above
(none currently), longstanding intermittent lightheadedness
(stable), and absence of dyspnea on exertion, paroxysmal
nocturnal dyspnea, orthopnea, ankle edema, palpitations, or
syncope.

Past Medical History:
HTN
CAD s/p off pump cabg [**2103**] with a LIMA to the LAD, SVG to the
left ventricular branch, the obtuse marginal and the diagonal,
and an SVG to the acute marginal. All the SVG's reported
occluded subsequent caths in [**2104**].
HLD
GERD
Anxiety
Osteoarthritis
Sciatica
Tonsillectomy
Umbilical Hernia
Hysterectomy/BSO

CARDIAC HISTORY:
Prior testing/procedures include:

[**7-/2103**] OFF??????PUMP CABG with LIMA-LAD, SVG to the left ventricular
branch, the obtuse marginal and diagonal, and an SVG to the
acute marginal.

[**7-/2104**] Cardiac Cath: native 3vd present including 40-50% left
main, 60-70% LAD, 70-90% in the OM, and 70% mid RCA. The LIMA
graft was extremely small and showed competitive filling of the
distal LAD. The SVG??????s were all totally occluded.

[**9-/2104**] Cardiac Cath: Pressure wire without significant gradients
across the Left Main, the entire LAD, the entire RCA, and the
proximal to mid circumflex. Medical therapy was recommended.

[**2-/2110**] TTE: Normal LV size and reported ejection fraction of
60-65%. Trace MR. Mild to moderate TR with right ventricular
systolic pressure of 45mmhg.

[**4-/2112**] Duplex Carotid Imaging: No hemodynamically significant
stenosis in either carotid system. An incidental finding of tiny
nodules measuring 2-4mm were reported, which most likely
represented benign thyroid adenomas.

Social History:
Quit smoking 43 years ago (as of [**2113**]) after smoking 1 pack a
day for 10 years. Lives in [**Location 11252**] NH with her husband [**Name (NI) **].
[**Name2 (NI) **] a son [**Name (NI) **]. She is retired. She reports one glass of wine a
couple times a week. She has never had any home care services.

Family History:
Her twin brother had CAD, he passed away in his 60??????s of lung CA.
Father died of lung CA.

Physical Exam:
VS: T 98.2 BP 118/56 HR 67 RR 16 O2sat 98% 2L
GENERAL: WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. MM slightly dry.
NECK: Supple with no JVD.
CARDIAC: RRR, normal S1, S2. 2/6 SEM at RUSB/LUSB. No rubs or
gallops.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi anteriorly.
ABDOMEN: Soft, NTND. NABS.
EXTREMITIES: Trace ankle edema. Bilat groin without hematoma,
tenderness, ecchymoses. 2+ DP and PT pulses. WWP.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.

Pertinent Results:
[**2113-3-23**] 10:45AM BLOOD WBC-6.8 RBC-4.00* Hgb-12.4 Hct-34.5*
MCV-86 MCH-31.1 MCHC-36.1* RDW-13.4 Plt Ct-238
[**2113-3-23**] 04:15PM BLOOD WBC-5.3 RBC-3.16* Hgb-9.6* Hct-27.2*
MCV-86 MCH-30.5 MCHC-35.5* RDW-13.6 Plt Ct-158
[**2113-3-24**] 05:50AM BLOOD WBC-6.2 RBC-3.28* Hgb-10.2* Hct-28.7*
MCV-88 MCH-31.1 MCHC-35.5* RDW-13.3 Plt Ct-176
[**2113-3-23**] 10:45AM BLOOD Glucose-99 UreaN-17 Creat-1.0 Na-139
K-4.3 Cl-105 HCO3-25 AnGap-13
[**2113-3-24**] 05:50AM BLOOD CK(CPK)-56

Brief Hospital Course:
The details of the patient's elective cardiac catheterization on
[**3-22**] and PCI on [**3-23**] are described in the HPI. She was montiored
overnight in the CCU, where she remained asymptomatic and
hemodynamically stable. Her hematocrit was trended due to
moderate blood loss (quantity unclear) during the procedure;
after an initial drop, it remained stable. Her femoral puncture
sites showed no bleeding, hematoma, or bruits and distal pulses
remained intact. She was started on clopidogrel 75mg daily and
her ASA was increased from 81mg to 325mg daily for the next
month. She was continued on all of her other outpatient
medications and discharged in stable condition. Her code status
during this admission was DNR/DNI.

Medications on Admission:
Imdur 30mg daily
Losartan 50mg daily
Metoprolol 50mg AM, 25mg PM
sl nitro daily
Simvastatin 40mg daily
Aspirin 81mg daily
Ca/Mg/Zn
vitamin D 800 IU daily
Glucosamine 1500mg daily
Omeprazole 20mg daily

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
3. Losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO QAM
(once a day (in the morning)).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO QPM
(once a day (in the evening)).
6. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1)
Sublingual once a day as needed for chest pain.
7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Calcium-Magnesium-Zinc     Tablet Sig: One (1) Tablet PO
once a day.
12. Glucosamine 750 mg Capsule Sig: Two (2) Capsule PO once a
day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
CAD

Secondary:
HTN
hyperlipidemia


Discharge Condition:
stable


Discharge Instructions:
You were admitted to the hospital for a cardiac catherization.
You had a diagnostic catherization on [**2113-3-22**] showing stenosis
is several major vessels in your heart. On [**2113-3-23**] you had a
catherization to stent the narrowings. You recieved a total of 3
stents and had a procedure to evacuate part of the narrowing.

Please take all medications as prescribed, especially aspirin
and plavix. It is very important that you take plavix every day
as it prevents thrombosis in your stent. The following changes
were made to your medications:
- Please take Aspirin 325mg everyday for 1 month. Then you can
resume taking 81mg daily
- Plavix 75mg must be taken every day. Do not discontinue this
medication without first consulting your cardiologist.

You should take Aspirin 325mg for 1 month, and then take 81mg
after that every day.

Please call your doctor or return to the hospital if you have
chest pain, shortness of breath, increased pain or swelling in
your groin, lightheadedness, increased redness on your back or
chest or any other concerning symptoms.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 11250**] in the next week. Please
call her office at [**Telephone/Fax (1) 11254**] to schedule this appointment. We
have also left a message with her office to call you to schedule
the appointment.



Completed by:[**2113-3-24**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Sciatica,Anxiety state, unspecified,Anemia, unspecified,Family history of ischemic heart disease,Personal history of tobacco use,Acquired absence of both cervix and uterus'}


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 77 y.o. female with history of HTN, HLD and CAD s/p
CABG x5 who presented as an outpatient with chest pressure. The
patient spent the winter in [**State 108**] and returned about 2 weeks
ago. Two weeks before she was to return home she experienced an
episode of nonradiating chest heaviness that resolved with NGT
and rest, although was not worse with exertion. She attributed
this to anxiety that she was feeling while planning the return
home. She has been home for 2 weeks, and had two more similar
episodes, also potentially related to anxiety. She had angina
prior to her CABG in [**2103**], but that was a heartburn sensation,
rather than the current pressure. She presented yesterday to
[**Hospital1 18**] for elective cardiac catherization, which showed 80%
stenosis at the LIMA-LAD touchdown, 80-90% distal left main
stenosis, 80% ostial LCx stenosis, RCA with diffuse disease. CT
surgery felt redo CABG was too risky due to LIMA being stuck to
the sternum. On the following day, she returned to the cath lab
and had stenting of the LIMA with a 2.5 x 12mm Xience stent,
rotablation and 2.5x15 mm Xience (postdilated to 3.5mm) stent in
LM into LCx. An Impella assist device was placed preemptively
for the procedure, but removed in the cath lab. She was admitted
to the CCU for close monitoring.

MEDICAL HISTORY: HTN
CAD s/p off pump cabg [**2103**] with a LIMA to the LAD, SVG to the
left ventricular branch, the obtuse marginal and the diagonal,
and an SVG to the acute marginal. All the SVG's reported
occluded subsequent caths in [**2104**].
HLD
GERD
Anxiety
Osteoarthritis
Sciatica
Tonsillectomy
Umbilical Hernia
Hysterectomy/BSO

MEDICATION ON ADMISSION: Imdur 30mg daily
Losartan 50mg daily
Metoprolol 50mg AM, 25mg PM
sl nitro daily
Simvastatin 40mg daily
Aspirin 81mg daily
Ca/Mg/Zn
vitamin D 800 IU daily
Glucosamine 1500mg daily
Omeprazole 20mg daily

ALLERGIES: Percodan / Percocet

PHYSICAL EXAM: VS: T 98.2 BP 118/56 HR 67 RR 16 O2sat 98% 2L
GENERAL: WDWN female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. MM slightly dry.
NECK: Supple with no JVD.
CARDIAC: RRR, normal S1, S2. 2/6 SEM at RUSB/LUSB. No rubs or
gallops.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi anteriorly.
ABDOMEN: Soft, NTND. NABS.
EXTREMITIES: Trace ankle edema. Bilat groin without hematoma,
tenderness, ecchymoses. 2+ DP and PT pulses. WWP.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: Her twin brother had CAD, he passed away in his 60??????s of lung CA.
Father died of lung CA.

SOCIAL HISTORY: Quit smoking 43 years ago (as of [**2113**]) after smoking 1 pack a
day for 10 years. Lives in [**Location 11252**] NH with her husband [**Name (NI) **].
[**Name2 (NI) **] a son [**Name (NI) **]. She is retired. She reports one glass of wine a
couple times a week. She has never had any home care services. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Sciatica,Anxiety state, unspecified,Anemia, unspecified,Family history of ischemic heart disease,Personal history of tobacco use,Acquired absence of both cervix and uterus'}
