CHIEF COMPLAINT: Exertional chest pain

PRESENT ILLNESS: Mr. [**Known lastname 63812**] is a 68 year old male with history of CAD. He is
status post anterior MI and Cypher stent placement to LAD in
[**2150-6-26**]. For the last several months, he has complained of
exertional chest discomfort. Cardiac catheterization on [**2-24**] demonstrated a 50% distal left main lesion; an ostial 40%
circumflex stenosis; and an ostial 70% LAD lesion with a 50% mid
vessel lesion. The RCA was small, and nondominant. Subsequent
echocardiogram showed an LVEF of 40-45%. There was only trivial
MR. Based on the above results, he was referred for cardiac
surgical intervention. He underwent routine preoperative  and
was electively admitted for surgical revascularization.

MEDICAL HISTORY: Coronary artery disease
Hypertension
Diabetes Mellitus
Hypercholesterolemia
Asthma
Asbestosis
Carotid Disease

MEDICATION ON ADMISSION: Aspirin 325 qd, Plavix 75 qd, Lisinopril 10 qd, Toprol XL 100
qd, Singulair 10 qd, Pravocol 20 qd, Advair [**Hospital1 **],
Glyburide/Metformin 2.5/500 [**Hospital1 **]

ALLERGIES: Atorvastatin

PHYSICAL EXAM: Vitals: BP126/50 , HR 69, RR 17, SAT  100% on room air
General: well developed male in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Patient states mother and 2 brothers with "heart problems" but
unable to elaborate.

SOCIAL HISTORY: Patient had prior tob use, quit in [**2130**], social drinker (not
daily), currently works as Longshoreman, lives alone in [**12-28**] of a
two family home while daughter lives in other half.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Atrial fibrillation,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2151-3-5**]              Discharge Date:   [**2151-3-11**]

Date of Birth:  [**2082-8-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Atorvastatin

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Exertional chest pain

Major Surgical or Invasive Procedure:
[**2151-3-5**] Three Vessel CABG utilizing left internal mammary to
left anterior descending and vein grafts to diagonal and obtuse
marginal

History of Present Illness:
Mr. [**Known lastname 63812**] is a 68 year old male with history of CAD. He is
status post anterior MI and Cypher stent placement to LAD in
[**2150-6-26**]. For the last several months, he has complained of
exertional chest discomfort. Cardiac catheterization on [**2-24**] demonstrated a 50% distal left main lesion; an ostial 40%
circumflex stenosis; and an ostial 70% LAD lesion with a 50% mid
vessel lesion. The RCA was small, and nondominant. Subsequent
echocardiogram showed an LVEF of 40-45%. There was only trivial
MR. Based on the above results, he was referred for cardiac
surgical intervention. He underwent routine preoperative  and
was electively admitted for surgical revascularization.

Past Medical History:
Coronary artery disease
Hypertension
Diabetes Mellitus
Hypercholesterolemia
Asthma
Asbestosis
Carotid Disease

Social History:
Patient had prior tob use, quit in [**2130**], social drinker (not
daily), currently works as Longshoreman, lives alone in [**12-28**] of a
two family home while daughter lives in other half.

Family History:
Patient states mother and 2 brothers with "heart problems" but
unable to elaborate.

Physical Exam:
Vitals: BP126/50 , HR 69, RR 17, SAT  100% on room air
General: well developed male in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

Pertinent Results:
Echo [**3-5**]:Pre-CPB: There are simple atheroma in the descending
thoracic aorta. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. The mitral valve leaflets are mildly thickened.
Trivial mitral regurgitation is seen. Post CPB: Preserved
biventricular systolic function. EF 50 - 55%. Trivial MR. [**First Name (Titles) **] [**Last Name (Titles) **].
Aorta intact. Other parameters as pre-CPB.
CXR [**3-11**]: Increased left pleural effusion and probable left
basilar atelectasis. Infectious consolidation cannot be
excluded.
[**2151-3-5**] 11:30AM BLOOD WBC-14.1*# RBC-2.98* Hgb-7.4* Hct-23.1*
MCV-77* MCH-24.8* MCHC-32.1 RDW-16.9* Plt Ct-181
[**2151-3-9**] 05:30AM BLOOD WBC-13.0* RBC-3.55* Hgb-9.2* Hct-27.9*
MCV-79* MCH-25.8* MCHC-32.9 RDW-16.9* Plt Ct-266
[**2151-3-5**] 12:29PM BLOOD PT-14.5* PTT-29.3 INR(PT)-1.3*
[**2151-3-7**] 05:00AM BLOOD PT-15.3* PTT-26.2 INR(PT)-1.4*
[**2151-3-5**] 12:29PM BLOOD UreaN-17 Creat-0.9 Cl-110* HCO3-22
[**2151-3-9**] 05:30AM BLOOD Glucose-108* UreaN-21* Creat-0.9 Na-134
K-3.8 Cl-97 HCO3-26 AnGap-15
[**2151-3-11**] 05:15AM BLOOD Mg-2.1
[**2151-3-6**] 05:36AM BLOOD freeCa-1.15

Brief Hospital Course:
Mr. [**Known lastname 63812**] was admitted and taken directly to the operating
room where Dr. [**Last Name (STitle) 914**] performed three vessel coronary artery
bypass grafting. The operation was uneventful and he was brought
to the CSRU for invasive monitoring. Within 24 hours, he awoke
neurologically intact and was extubated. He was weaned from
inotropic support without difficulty. Amiodarone was started for
intermittent episodes of atrial fibrillation. PRBCs were
intermittently transfused to maintain hematocrit near 30%. He
otherwise maintained stable hemodynamics and was transferred to
the SDU on postoperative day three. He remained mostly in a
normal sinus rhythm. Amiodarone was continued and beta blockade
was advanced as tolerated. K and Mg levels were monitored
closely and repleted per protocol. Over several days, medical
therapy was optimized and he continued to make clinical
improvements with diuresis. Physical therapy worked with patient
throughout post-op course for strength and mobility. No further
atrial fibrillation was noted and he was cleared for discharge
to home with VNA services on postoperative day six.

Medications on Admission:
Aspirin 325 qd, Plavix 75 qd, Lisinopril 10 qd, Toprol XL 100
qd, Singulair 10 qd, Pravocol 20 qd, Advair [**Hospital1 **],
Glyburide/Metformin 2.5/500 [**Hospital1 **]

Discharge Medications:
1. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig:
Three (3) Tablet Sustained Release 24HR PO BID (2 times a day).
Disp:*180 Tablet Sustained Release 24HR(s)* Refills:*2*
2. 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:*2*
3. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*2*
10. Glyburide-Metformin 2.5-500 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 7 days: then drop to 200 mg (one tablet) once daily.
Disp:*60 Tablet(s)* Refills:*1*
12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 6-8 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
13. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
14. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for
1 weeks.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] Home care

Discharge Diagnosis:
Coronary artery disease s/p Coronary Artery Bypass Graft x 3
Postop Atrial Fibrillation
Hypertension
Diabetes Mellitus
Hypercholesterolemia
Asthma
Asbestosis
Carotid Disease

Discharge Condition:
Good

Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions.

Followup Instructions:
Cardiac [**Last Name (LF) 5059**], [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**] in [**3-31**] weeks.
Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 12922**] in [**1-29**] weeks.
Local cardiologist, Dr. [**Last Name (STitle) **] in [**1-29**] weeks.


Completed by:[**2151-3-26**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: Exertional chest pain

PRESENT ILLNESS: Mr. [**Known lastname 63812**] is a 68 year old male with history of CAD. He is
status post anterior MI and Cypher stent placement to LAD in
[**2150-6-26**]. For the last several months, he has complained of
exertional chest discomfort. Cardiac catheterization on [**2-24**] demonstrated a 50% distal left main lesion; an ostial 40%
circumflex stenosis; and an ostial 70% LAD lesion with a 50% mid
vessel lesion. The RCA was small, and nondominant. Subsequent
echocardiogram showed an LVEF of 40-45%. There was only trivial
MR. Based on the above results, he was referred for cardiac
surgical intervention. He underwent routine preoperative  and
was electively admitted for surgical revascularization.

MEDICAL HISTORY: Coronary artery disease
Hypertension
Diabetes Mellitus
Hypercholesterolemia
Asthma
Asbestosis
Carotid Disease

MEDICATION ON ADMISSION: Aspirin 325 qd, Plavix 75 qd, Lisinopril 10 qd, Toprol XL 100
qd, Singulair 10 qd, Pravocol 20 qd, Advair [**Hospital1 **],
Glyburide/Metformin 2.5/500 [**Hospital1 **]

ALLERGIES: Atorvastatin

PHYSICAL EXAM: Vitals: BP126/50 , HR 69, RR 17, SAT  100% on room air
General: well developed male in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Patient states mother and 2 brothers with "heart problems" but
unable to elaborate.

SOCIAL HISTORY: Patient had prior tob use, quit in [**2130**], social drinker (not
daily), currently works as Longshoreman, lives alone in [**12-28**] of a
two family home while daughter lives in other half. 

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