CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: The patient is a 60 year old man with a history of
Hyperlipidemia, Obstructive sleep apnea on CPAP, and strong
family history or coronary artery disease who presented to the
[**Location (un) 620**] emergency department with 5 days of chest pain. He was
transferred to [**Hospital1 18**] for possible catheterization given
worsening chest pain and elevated troponin.

MEDICAL HISTORY: Hyperlipidemia, Obstructive sleep apnea, Nephrolithiasis,
Osteoarthritis, Rhinitis, s/p Tonsillectomy, s/p rhinoplasty,
s/p Bilateral cataract removal

MEDICATION ON ADMISSION: Heparin gtt, Nitro prn, Aspirin, Lopressor 12.5mg [**Hospital1 **],
Simvastatin 80mg qd, Plavix 75mg qd, Fluticasone nasal spray

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VS: 69 20 108/77 5'[**67**]", 102kg
Gen: Well-developed, well-nourished male in no acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, Full range of motion
Chest: Decreased breath sounds bilateral bases
Heart: Regular rate and rhythm, -murmur
Abd: Soft, Non-tender, Non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: Grossly intact, Alert and oriented x 3

FAMILY HISTORY: 1 brother with MI at 37. 1 brother multiple [**Name2 (NI) **] before 50.
Mother MI at 50, died of CAD. Father died after multiple [**Name2 (NI) **],
CVAs.

SOCIAL HISTORY: Denies Tobacco use. Admits to social ETOH use. Denies Illicit
drug use.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Acute post-thoracotomy pain,Osteoarthrosis, localized, not specified whether primary or secondary, hand,Mitral valve disorders,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Right bundle branch block,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Subendo infarct, initial,Crnry athrscl natve vssl,Atrial fibrillation,Acute post-thoracot pain,Loc osteoarth NOS-hand,Mitral valve disorder,Hyperlipidemia NEC/NOS,Obstructive sleep apnea,Rt bundle branch block,Abn react-anastom/graft
Admission Date:  [**2165-10-31**]              Discharge Date:   [**2165-11-10**]

Date of Birth:  [**2105-3-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2165-11-6**] - Coronary artery bypass grafting to four vessels. Left
internal mammary->Left anterior descending artery, Saphenous
vein graft->Diagonal artery, Saphenous vein graft->Ramus artery,
Saphenous vein graft->Obtuse marginal)
[**2165-11-1**] - Cardiac Catheterization

History of Present Illness:
The patient is a 60 year old man with a history of
Hyperlipidemia, Obstructive sleep apnea on CPAP, and strong
family history or coronary artery disease who presented to the
[**Location (un) 620**] emergency department with 5 days of chest pain. He was
transferred to [**Hospital1 18**] for possible catheterization given
worsening chest pain and elevated troponin.

Past Medical History:
Hyperlipidemia, Obstructive sleep apnea, Nephrolithiasis,
Osteoarthritis, Rhinitis, s/p Tonsillectomy, s/p rhinoplasty,
s/p Bilateral cataract removal

Social History:
Denies Tobacco use. Admits to social ETOH use. Denies Illicit
drug use.

Family History:
1 brother with MI at 37. 1 brother multiple [**Name2 (NI) **] before 50.
Mother MI at 50, died of CAD. Father died after multiple [**Name2 (NI) **],
CVAs.

Physical Exam:
VS: 69 20 108/77 5'[**67**]", 102kg
Gen: Well-developed, well-nourished male in no acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, Full range of motion
Chest: Decreased breath sounds bilateral bases
Heart: Regular rate and rhythm, -murmur
Abd: Soft, Non-tender, Non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: Grossly intact, Alert and oriented x 3

Pertinent Results:
[**11-1**] Cath:  1. Coronary angiography revealed LMCA and one
vessel coronary artery disease. The LMCA had an ostial 60%
eccentric lesion. This was interrogated with pressure wire with
lowest FFR of 0.86 with adenosine infusion. There was an
occluded D1 with severely diseased branch at the site of the
occlusion. There was a 50% LAD stenosis just after the D1;
otherwise minor disease. The LCx and RCA had minimal disease. 2.
Limited resting hemodynamics revealed moderately elevated left
sided filling pressures with LVEDP of 29 mmHg. There was mild
systemic arterial hypertension with SBP of 133 mmHg and DBP of
74 mmHg. 3. Left ventriculography revealed no mitral
regurgitation. The LVEF was calculated to be 56% with lateral
akinesis and otherwise normal motion. 4. Succesful right femoral
artery closure with Mynx device.
[**11-3**] Chest CTA: 1. No pulmonary embolus. 2. Mild dilatation of
the aortic root measuring up to 4.4 cm in transverse dimension.
Otherwise unremarkable aorta.
[**11-6**] Echo: Prebypass: 1. No atrial septal defect is seen by 2D
or color Doppler. 2. Left ventricular wall thicknesses are
normal. Regional left ventricular wall motion is normal. Overall
left ventricular systolic function is normal (LVEF>55%). 3.
Right ventricular chamber size and free wall motion are normal.
4. The aortic root is mildly dilated at the sinus level. The
ascending aorta is mildly dilated. There are simple atheroma in
the descending thoracic aorta. 5. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic stenosis. Mild (1+) aortic regurgitation is seen. 6. The
mitral valve leaflets are structurally normal. Mild (1+) mitral
regurgitation is seen. 7. Dr. [**Last Name (STitle) 914**] was notified in person of
the results on [**2165-11-6**] at 1000am. Post bypass: 1. Patient is
in sinus rhythm. 2. Biventricular systolic function is
unchanged. 3. 2+ mitral regurgitation present. 4. Aorta intact
post decannulation.
[**2165-11-10**] 08:30AM BLOOD WBC-9.0 RBC-2.70* Hgb-8.4* Hct-24.7*
MCV-92 MCH-30.9 MCHC-33.8 RDW-13.4 Plt Ct-364
[**2165-11-9**] 07:50AM BLOOD WBC-8.9 RBC-2.73* Hgb-8.5* Hct-24.3*
MCV-89 MCH-31.1 MCHC-34.8 RDW-13.1 Plt Ct-267
[**2165-10-31**] 09:15PM BLOOD WBC-6.8# RBC-4.12* Hgb-13.0* Hct-36.2*
MCV-88# MCH-31.5 MCHC-35.9*# RDW-12.7 Plt Ct-246
[**2165-11-9**] 07:50AM BLOOD Glucose-112* UreaN-19 Creat-1.2 Na-137
K-4.4 Cl-103 HCO3-22 AnGap-16
[**2165-10-31**] 09:15PM BLOOD Glucose-103 UreaN-14 Creat-1.1 Na-140
K-3.7 Cl-104 HCO3-25 AnGap-15

Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname 23**] was transferred to [**Hospital1 18**]
and underwent cardiac cath on [**11-1**]. Cath revealed 60% left main
coronary artery lesion. Following cath he received appropriate
work-up prior to surgery and waited several days for Plavix to
wash-out. On [**11-6**] he was brought to the operating room where he
underwent coronary artery bypass graft x 4. Please see operative
report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring in stable
condition. On post-op day one he was started on beta-blockers
and diuretics and gently diuresed towards his pre-op weight.
Also on this day his chest tubes were removed and he was
transferred to the telemetry floor for further care. On post-op
day two he had episode of rapid atrial fibrillation and was
started on amiodarone with increase dosage of beta-blockers. And
converted back to sinus rhythm. Epicardial pacing wires were
removed on post-op day three.  He continued to improve and was
cleared by physical therapy and discharged to home on POD 4.

Medications on Admission:
Heparin gtt, Nitro prn, Aspirin, Lopressor 12.5mg [**Hospital1 **],
Simvastatin 80mg qd, Plavix 75mg qd, Fluticasone nasal spray

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Zocor 80 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*0*
3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
4. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take 2 tablets twice daily for one week, then one tablet
twice daily for one week, then one tablet once daily for one
week, then stop.
Disp:*120 Tablet(s)* Refills:*0*
5. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
5 days.
Disp:*5 Tablet(s)* Refills:*0*
6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for 5
days.
Disp:*5 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
8. 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*


Discharge Disposition:
Home With Service

Facility:
.will be set up by [**Company 21944**] Insurance

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Myocardial Infarction
PMH: Hyperlipidemia, Obstructive sleep apnea, Nephrolithiasis,
Osteoarthritis, Rhinitis, s/p Tonsillectomy, s/p rhinoplasty,
s/p Bilateral cataract removal

Discharge Condition:
Stable

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.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks
Dr. [**Last Name (STitle) 73**] in [**1-20**] weeks
Dr. [**Last Name (STitle) **] in [**12-19**] weeks


Completed by:[**2165-11-10**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Acute post-thoracotomy pain,Osteoarthrosis, localized, not specified whether primary or secondary, hand,Mitral valve disorders,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Right bundle branch block,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: The patient is a 60 year old man with a history of
Hyperlipidemia, Obstructive sleep apnea on CPAP, and strong
family history or coronary artery disease who presented to the
[**Location (un) 620**] emergency department with 5 days of chest pain. He was
transferred to [**Hospital1 18**] for possible catheterization given
worsening chest pain and elevated troponin.

MEDICAL HISTORY: Hyperlipidemia, Obstructive sleep apnea, Nephrolithiasis,
Osteoarthritis, Rhinitis, s/p Tonsillectomy, s/p rhinoplasty,
s/p Bilateral cataract removal

MEDICATION ON ADMISSION: Heparin gtt, Nitro prn, Aspirin, Lopressor 12.5mg [**Hospital1 **],
Simvastatin 80mg qd, Plavix 75mg qd, Fluticasone nasal spray

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VS: 69 20 108/77 5'[**67**]", 102kg
Gen: Well-developed, well-nourished male in no acute distress
Skin: Unremarkable
HEENT: Unremarkable
Neck: Supple, Full range of motion
Chest: Decreased breath sounds bilateral bases
Heart: Regular rate and rhythm, -murmur
Abd: Soft, Non-tender, Non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: Grossly intact, Alert and oriented x 3

FAMILY HISTORY: 1 brother with MI at 37. 1 brother multiple [**Name2 (NI) **] before 50.
Mother MI at 50, died of CAD. Father died after multiple [**Name2 (NI) **],
CVAs.

SOCIAL HISTORY: Denies Tobacco use. Admits to social ETOH use. Denies Illicit
drug use. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Acute post-thoracotomy pain,Osteoarthrosis, localized, not specified whether primary or secondary, hand,Mitral valve disorders,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Right bundle branch block,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
