CHIEF COMPLAINT: Chest pain radiating to the back

PRESENT ILLNESS: Mr. [**Known lastname 74177**] is a 47 yo male with history of MI x 2 most recently
in [**6-/2142**] with cath showing severe 3 vessel disease with bare
metal stents x2 to LCX and plan for CABG in 1-2months, who woke
up this am at 5:30 and went to use restroom, noticed substernal
chest pain, radiating to his back [**8-10**] in severity. The pain
persisted and he went to OSH around 11am.  BP 156/89, HR 59  He
was given NTG x 3 with no effect, Maalox with some relief,
followed by 1mg of morphine with complete resolution of chest
pain. Was transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: Coronary Artery Disease
History of MI [**2137**] and NSTEMI/IMI in [**2142-6-1**]
Prior PCI and bare metal stents to circumflex artery
Hypertension
Hypercholesterolemia
Insulin Dependent Diabetes Mellitus
Obesity
Osteoarthritis - chronic low back, hip and knee pain
History of Retroperitoneal Bleed(s/p cardiac cath)
Pilonoidal Cyst Surgery
Ankle Surgery

MEDICATION ON ADMISSION: Aspirin 325 qd
Metoprolol 100 am/50 pm
Lipitor 80 qd
Lisinopril 5 qd
Plavix 75 qd
Heparin gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T97.6 , BP 138/79R 137/69L , HR 52=7 , RR 12, O2 98% RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, no JVD
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.  BS+
Ext: No c/c/e.
Skin: No ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; 2+ DP, no femoral bruit
Left: Carotid 2+ without bruit; 2+ DP, no femoral bruit

FAMILY HISTORY: Father history CAD, HTN CABG at 74 yo
Mother with hx HTN, died from cerebral hemorrhage at 54 yo.

SOCIAL HISTORY: Denies any hx tobacco, etoh use.  Works as truck driver.  Lives
at home with wife and 11 year old twins.  Does not exercise
regularly
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Old myocardial infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Cardiac dysrhythmias NEC,Old myocardial infarct,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Obesity NOS,Osteoarthros NOS-unspec,Long-term use of insulin
Admission Date:  [**2142-8-5**]              Discharge Date:   [**2142-8-13**]

Date of Birth:  [**2095-3-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest pain radiating to the back

Major Surgical or Invasive Procedure:
[**2142-8-7**] Four Vessel Coronary Artery Bypass Grafting(left internal
mammary artery to left anterior descending, vein grafts to
diagonal, obtuse marginal, and PDA)

History of Present Illness:
Mr. [**Known lastname 74177**] is a 47 yo male with history of MI x 2 most recently
in [**6-/2142**] with cath showing severe 3 vessel disease with bare
metal stents x2 to LCX and plan for CABG in 1-2months, who woke
up this am at 5:30 and went to use restroom, noticed substernal
chest pain, radiating to his back [**8-10**] in severity. The pain
persisted and he went to OSH around 11am.  BP 156/89, HR 59  He
was given NTG x 3 with no effect, Maalox with some relief,
followed by 1mg of morphine with complete resolution of chest
pain. Was transferred to [**Hospital1 18**] for further care.

Past Medical History:
Coronary Artery Disease
History of MI [**2137**] and NSTEMI/IMI in [**2142-6-1**]
Prior PCI and bare metal stents to circumflex artery
Hypertension
Hypercholesterolemia
Insulin Dependent Diabetes Mellitus
Obesity
Osteoarthritis - chronic low back, hip and knee pain
History of Retroperitoneal Bleed(s/p cardiac cath)
Pilonoidal Cyst Surgery
Ankle Surgery

Social History:
Denies any hx tobacco, etoh use.  Works as truck driver.  Lives
at home with wife and 11 year old twins.  Does not exercise
regularly

Family History:
Father history CAD, HTN CABG at 74 yo
Mother with hx HTN, died from cerebral hemorrhage at 54 yo.

Physical Exam:
VS: T97.6 , BP 138/79R 137/69L , HR 52=7 , RR 12, O2 98% RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, no JVD
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.  BS+
Ext: No c/c/e.
Skin: No ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; 2+ DP, no femoral bruit
Left: Carotid 2+ without bruit; 2+ DP, no femoral bruit

Pertinent Results:
[**8-7**] Echo: Prebypass: 1.No atrial septal defect is seen by 2D or
color Doppler. 2. There is mild to moderate regional left
ventricular systolic dysfunction of the apex, apical portions of
the anterior, septal and inferior walls . The mid septal and
inferior walls are also hypokinetic. 3. Right ventricular
chamber size and free wall motion are normal. 4. There are
simple atheroma in the descending thoracic aorta. 5. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. Trace aortic regurgitation is seen. 6. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. Post Bypass:
1. Biventricular systolic function remains unchanged. 2. Mild 1+
mitral regurgitation is unchanged. 4. Ascending aorta is intact
post-decannulation. 5. At one point there was severe hypotension
associated with Supraventricular tachycardia when LV function
was severely depressed. Post cardioversion the cardiac function
recovered to baseline.
[**8-13**] CXR: The cardiomediastinal contour is widened compared to
preoperative films but appears stable on the postoperative
period. Median sternotomy wires are again. The left-sided
pleural effusion appears worse compared to the prior study.
Right lower lobe atelectasis posteriorly is also worse compared
to the prior film.

[**2142-8-5**] 02:40PM BLOOD WBC-7.0 RBC-4.34* Hgb-13.3* Hct-38.5*
MCV-89 MCH-30.7 MCHC-34.6 RDW-15.8* Plt Ct-164
[**2142-8-8**] 09:37AM BLOOD WBC-8.6 RBC-3.57* Hgb-11.0* Hct-31.7*
MCV-89 MCH-30.9 MCHC-34.8 RDW-15.8* Plt Ct-177#
[**2142-8-13**] 09:05AM BLOOD WBC-4.7 RBC-3.03* Hgb-9.3* Hct-27.3*
MCV-90 MCH-30.8 MCHC-34.2 RDW-15.5 Plt Ct-227#
[**2142-8-5**] 02:40PM BLOOD PT-12.3 PTT-26.9 INR(PT)-1.1
[**2142-8-7**] 09:05PM BLOOD PT-15.3* PTT-68.2* INR(PT)-1.4*
[**2142-8-5**] 02:40PM BLOOD Glucose-135* UreaN-22* Creat-1.1 Na-138
K-4.3 Cl-104 HCO3-26 AnGap-12
[**2142-8-13**] 09:05AM BLOOD Glucose-99 UreaN-22* Creat-1.3* Na-136
K-4.1 Cl-100 HCO3-29 AnGap-11

Brief Hospital Course:
Mr. [**Known lastname 74177**] was admitted to the cardiology service and remained
pain free on medical therapy which included intravenous Heparin.
There was no evidence of active ischemia. He was well known to
the cardiac surgical service and surgical revascularization was
planned for the near future. Given his angina, and his known
coronary artery disease, he was taken to the operating room on
[**8-7**] and underwent coronary artery bypass grafting surgery
by Dr. [**First Name (STitle) **]. Operative course was notable for supraventricular
tachycardia. Amiodarone was initiated, and cardioversion was
successfully performed. For additional surgical details, please
see separate 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 without
incident. He remained on Amiodarone without further occurrence
of atrial or ventricular arrhythmias. He gradually weaned from
inotropic support and tolerated resumption of beta blockade. His
CSRU course was otherwise uneventful and he transferred to the
SDU on postoperative day two. Epicardial pacing wires were
removed on post-op day three. He remained stable over the next
several days while receiving physical therapy for strength and
mobility. On post-op day 6 he was doing well and ready for
discharge home with VNA services and the appropriate follow-up
appointments.

Medications on Admission:
Aspirin 325 qd
Metoprolol 100 am/50 pm
Lipitor 80 qd
Lisinopril 5 qd
Plavix 75 qd
Heparin gtt

Discharge Medications:
1. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Insulin Glargine 100 unit/mL Solution Sig: Thirty Eight (38)
UNITS Subcutaneous once a day: SubCutaneously at bedtime.
Disp:*qs qs* Refills:*2*
4. Insulin Lispro 100 unit/mL Solution Sig: 2-20 UNITS
Subcutaneous four times a day: Use As Directed by sliding scale.
Disp:*qs qs* Refills:*2*
5. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
Please take 400mg once a day for 7 days then decrease to 200mg
daily and follow up with Dr [**Last Name (STitle) **] .
Disp:*60 Tablet(s)* Refills:*0*
6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*0*
7. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
9. 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*
10. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day
for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
11. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO once a day for 2 weeks.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Bayada Nurses Inc

Discharge Diagnosis:
Coronary Artery Disease - s/p Coronary Artery Bypass Graft x 4
Intraoperative Supraventricular Tachycardia
PMH: History of MI [**2137**] and IMI [**6-/2142**], Prior PCI and bare metal
stents to LCX, Hypertension, Hypercholesterolemia, Insulin
Dependent Diabetes Mellitus, Obesity, Osteoarthritis

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, 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 [**Telephone/Fax (1) 170**]
Blood glucose please continue to follow sliding scale and lantus
as prior to admission, please call [**Last Name (un) 387**] if bg > 200 x2


Followup Instructions:
Please call to schedule appointments
Dr. [**First Name (STitle) **] in [**4-5**] weeks, [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) **] in [**2-3**] weeks [**Telephone/Fax (1) 74178**]
Dr. [**Last Name (STitle) **] in [**2-3**] weeks [**0-0-**]
Wound check appointment please schedule with RN [**Telephone/Fax (1) 3633**]
Dr. [**Last Name (STitle) **] on [**2142-8-23**] @ 01:40pm - please call to confirm appt
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2142-10-9**] 9:00
Provider: [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 128**] Date/Time:[**2142-10-9**]
10:00


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

Completed by:[**2142-8-13**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Old myocardial infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin'}


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 radiating to the back

PRESENT ILLNESS: Mr. [**Known lastname 74177**] is a 47 yo male with history of MI x 2 most recently
in [**6-/2142**] with cath showing severe 3 vessel disease with bare
metal stents x2 to LCX and plan for CABG in 1-2months, who woke
up this am at 5:30 and went to use restroom, noticed substernal
chest pain, radiating to his back [**8-10**] in severity. The pain
persisted and he went to OSH around 11am.  BP 156/89, HR 59  He
was given NTG x 3 with no effect, Maalox with some relief,
followed by 1mg of morphine with complete resolution of chest
pain. Was transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: Coronary Artery Disease
History of MI [**2137**] and NSTEMI/IMI in [**2142-6-1**]
Prior PCI and bare metal stents to circumflex artery
Hypertension
Hypercholesterolemia
Insulin Dependent Diabetes Mellitus
Obesity
Osteoarthritis - chronic low back, hip and knee pain
History of Retroperitoneal Bleed(s/p cardiac cath)
Pilonoidal Cyst Surgery
Ankle Surgery

MEDICATION ON ADMISSION: Aspirin 325 qd
Metoprolol 100 am/50 pm
Lipitor 80 qd
Lisinopril 5 qd
Plavix 75 qd
Heparin gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T97.6 , BP 138/79R 137/69L , HR 52=7 , RR 12, O2 98% RA
Gen: WDWN middle aged male in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate. Pleasant.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, no JVD
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.  BS+
Ext: No c/c/e.
Skin: No ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; 2+ DP, no femoral bruit
Left: Carotid 2+ without bruit; 2+ DP, no femoral bruit

FAMILY HISTORY: Father history CAD, HTN CABG at 74 yo
Mother with hx HTN, died from cerebral hemorrhage at 54 yo.

SOCIAL HISTORY: Denies any hx tobacco, etoh use.  Works as truck driver.  Lives
at home with wife and 11 year old twins.  Does not exercise
regularly 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Old myocardial infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obesity, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin'}
