CHIEF COMPLAINT: Jaw and arm pain

PRESENT ILLNESS: 62 year old male with a history of jaw and left arm pain at
routine physical. Had a carotid ultrasound which showed 70-79%
right and 80-99% left carotid stenosis. He was seen by Dr [**Last Name (STitle) 3407**]
as part of a preop workup for carotid endarterectomy. He also
had a stress test on [**2176-7-8**] which showed ischemic changes with
2D echocardiographic evidence of ischemia at 3 minutes. He was
scheduled for cardiac catheterization to evaluate coronary
arteries prior to scheduled CEA. Following +ETT was loaded with
Plavix 600 mg [**2176-7-8**] now 75mg QD.  Cath results showed 3V
CAD.Csurg was consulted to evaluate for CABG/+?CEA.

MEDICAL HISTORY: noninsulin dependent diabetes mellitus
hyperlipidemia
obesity
hypertension
sleep apnea
h/o bladder cancer
Gastroesophageal reflux disease
gout
recurrent urinary tract infections

MEDICATION ON ADMISSION: cimetidine 400 mg [**Hospital1 **]
HCTZ 12.5 mg daily
indomethacin 50 mg TID ( held for 2 weeks)
simvastatin 80 mg daily
imdur 30 mg daily
toprol XL 25 mg daily
metformin 500 mg [**Hospital1 **]
viagra 100 mg prn
ASA 81 mg daily
augmentin 875 mg [**Hospital1 **] (7 day course for UTI to finish [**7-22**] PM)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: Resp:20  O2 sat: 96%
B/P  Right: 149/91 Left: 148/52
Height:5'9"     Weight:233#

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives with:Wife-[**Name (NI) **]
Occupation:Salesman
Tobacco:smokes half pack of cigarettes per day x40yrs,quit 1
week
ago
ETOH:3 drinks per week
Coronary atherosclerosis of native coronary artery,Urinary tract infection, site not specified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified sleep apnea,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Gout, unspecified,Esophageal reflux,Personal history of malignant neoplasm of bladder
Crnry athrscl natve vssl,Urin tract infection NOS,Ocl crtd art wo infrct,Sleep apnea NOS,Obesity NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Gout NOS,Esophageal reflux,Hx of bladder malignancy
Admission Date:  [**2176-7-18**]              Discharge Date:   [**2176-7-22**]

Date of Birth:  [**2114-7-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Jaw and arm pain

Major Surgical or Invasive Procedure:
[**2176-7-18**] -  Coronary artery bypass grafting x4 with left internal
mammary artery to the left anterior descending artery, and
reverse saphenous vein graft to the posterior descending artery,
the left posterior lateral branch artery and the first obtuse
marginal artery.


History of Present Illness:
62 year old male with a history of jaw and left arm pain at
routine physical. Had a carotid ultrasound which showed 70-79%
right and 80-99% left carotid stenosis. He was seen by Dr [**Last Name (STitle) 3407**]
as part of a preop workup for carotid endarterectomy. He also
had a stress test on [**2176-7-8**] which showed ischemic changes with
2D echocardiographic evidence of ischemia at 3 minutes. He was
scheduled for cardiac catheterization to evaluate coronary
arteries prior to scheduled CEA. Following +ETT was loaded with
Plavix 600 mg [**2176-7-8**] now 75mg QD.  Cath results showed 3V
CAD.Csurg was consulted to evaluate for CABG/+?CEA.


Past Medical History:
noninsulin dependent diabetes mellitus
hyperlipidemia
obesity
hypertension
sleep apnea
h/o bladder cancer
Gastroesophageal reflux disease
gout
recurrent urinary tract infections

Social History:
Lives with:Wife-[**Name (NI) **]
Occupation:Salesman
Tobacco:smokes half pack of cigarettes per day x40yrs,quit 1
week
ago
ETOH:3 drinks per week


Family History:
noncontributory


Physical Exam:
Pulse: Resp:20  O2 sat: 96%
B/P  Right: 149/91 Left: 148/52
Height:5'9"     Weight:233#

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Obese- Soft [x] non-distended [x] non-tender [x]  bowel
sounds + [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Varicosities: None [x]
Neuro: Grossly intact, nonfocal exam
Pulses:
Femoral      Right:cath site   Left: 2+
DP           Right: 2+  Left:2+
PT           [**Name (NI) 167**]: 2+  Left:2+
Radial       Right: 2+  Left:2+

Carotid Bruit: bilaterally


Pertinent Results:
[**2176-7-21**] Chest X-ray:
Cardiomegaly and postoperative mediastinal widening is stable.
Bibasilar
atelectasis left greater than right and bilateral pleural
effusions are
unchanged. There is no pneumothorax. There are no new lung
abnormalities.
Sternal wires are aligned.

[**2176-7-18**] Intraop TEE:
The left atrium is normal in size. Right ventricular chamber
size and free wall motion are normal. There are simple atheroma
in the aortic root. There are simple atheroma in the ascending
aorta. There are simple atheroma in the aortic arch. 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 structurally normal. Mild to moderate ([**12-23**]+) mitral
regurgitation is seen. There is no pericardial effusion.No PFO
Post CPB:
S/P 4 CABGX4, now on a neosynephrine drip @.8 mcg/kg/min
LV Function is preserved at >55%
No dissection flaps seen in asending aorta
There is still [**12-23**]+ Mitral regurgitation

[**2176-7-19**] WBC-8.5 RBC-3.47* Hgb-10.7* Hct-31.0*  RDW-14.5 Plt
Ct-187
[**2176-7-20**] WBC-11.3* RBC-3.55* Hgb-10.7* Hct-31.5*  RDW-14.5 Plt
Ct-183
[**2176-7-21**] WBC-10.4 RBC-3.79* Hgb-11.3* Hct-33.8*  RDW-14.5 Plt
Ct-266
[**2176-7-19**] Glucose-124* UreaN-17 Creat-1.1 Na-143 K-4.4 Cl-112*
HCO3-23
[**2176-7-20**] Glucose-117* UreaN-17 Creat-1.2 Na-137 K-3.7 Cl-100
HCO3-28
[**2176-7-21**] UreaN-14 Creat-1.2 Na-137 K-4.5 Cl-98
[**2176-7-21**] Mg-2.3

Brief Hospital Course:
Mr. [**Known lastname 15719**] was admitted to the [**Hospital1 18**] on [**2176-7-18**] for elective
surgical management of his coronary artery disease. On
admission, he was taken directly to the operating room where he
underwent coronary artery bypass grafting to four vessels.
Please see operative note for details. Postoperatively he was
taken to the intensive care unit for invasive monitoring. Over
the next 24 hours, he awoke neurologically intact and was
extubated. Beta blockade, aspirin and a statin were resumed.  On
postoperative day one, he was transferred to the step down unit
for further recovery. He was gently diuresed towards his
preoperative weight. Beta blockade was advanced as tolerated. He
remained in a normal sinus rhythm. Chest tubes and pacing wires
were removed without complication. Over several days, he
continued to make clinical improvements and was medically
cleared for discharge to home on postoperative day four. He will
follow up with Dr. [**Last Name (STitle) **] in approximately one month and will see
Dr. [**Last Name (STitle) **] as an outpatient for carotid endarterectomy.

Medications on Admission:
cimetidine 400 mg [**Hospital1 **]
HCTZ 12.5 mg daily
indomethacin 50 mg TID ( held for 2 weeks)
simvastatin 80 mg daily
imdur 30 mg daily
toprol XL 25 mg daily
metformin 500 mg [**Hospital1 **]
viagra 100 mg prn
ASA 81 mg daily
augmentin 875 mg [**Hospital1 **] (7 day course for UTI to finish [**7-22**] PM)

Discharge Medications:
1. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*90 Tablet(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
5. Metoprolol Tartrate 25 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
6. 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*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
7 days: Take daily for seven days with Potassium.
Disp:*7 Tablet(s)* Refills:*0*
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days:
Take daily for seven days with Furosemide.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Coronary artery disease
s/p coronary artery bypass grafting [**2176-7-18**]
Noninsulin dependent diabetes mellitus
Obesity
Cerebrovascular disease
Severe Left ICA stenosis, Moderate right ICA stenosis
Hypertension
Gastroesophageal reflux
Hyperlipidemia
History of bladder cancer


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with Percoets
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema 1+ edema bilaterally


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments:
Surgeon: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) on Wed., [**8-14**] @ 1:45 pm in [**Hospital Ward Name **]
2A

Please call to schedule appointments with your:
Primary Care Dr.[**First Name (STitle) **] [**Last Name (NamePattern4) 15720**] in [**12-23**] weeks ([**Telephone/Fax (1) 4775**])
Cardiologist Dr.[**Last Name (STitle) **] in [**1-24**] weeks
Vascular Surgeon Dr. [**Last Name (STitle) **] for carotid
endarterectomy([**Telephone/Fax (1) 1241**])

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2176-7-22**]
{'Coronary atherosclerosis of native coronary artery,Urinary tract infection, site not specified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified sleep apnea,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Gout, unspecified,Esophageal reflux,Personal history of malignant neoplasm of bladder'}


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: Jaw and arm pain

PRESENT ILLNESS: 62 year old male with a history of jaw and left arm pain at
routine physical. Had a carotid ultrasound which showed 70-79%
right and 80-99% left carotid stenosis. He was seen by Dr [**Last Name (STitle) 3407**]
as part of a preop workup for carotid endarterectomy. He also
had a stress test on [**2176-7-8**] which showed ischemic changes with
2D echocardiographic evidence of ischemia at 3 minutes. He was
scheduled for cardiac catheterization to evaluate coronary
arteries prior to scheduled CEA. Following +ETT was loaded with
Plavix 600 mg [**2176-7-8**] now 75mg QD.  Cath results showed 3V
CAD.Csurg was consulted to evaluate for CABG/+?CEA.

MEDICAL HISTORY: noninsulin dependent diabetes mellitus
hyperlipidemia
obesity
hypertension
sleep apnea
h/o bladder cancer
Gastroesophageal reflux disease
gout
recurrent urinary tract infections

MEDICATION ON ADMISSION: cimetidine 400 mg [**Hospital1 **]
HCTZ 12.5 mg daily
indomethacin 50 mg TID ( held for 2 weeks)
simvastatin 80 mg daily
imdur 30 mg daily
toprol XL 25 mg daily
metformin 500 mg [**Hospital1 **]
viagra 100 mg prn
ASA 81 mg daily
augmentin 875 mg [**Hospital1 **] (7 day course for UTI to finish [**7-22**] PM)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: Resp:20  O2 sat: 96%
B/P  Right: 149/91 Left: 148/52
Height:5'9"     Weight:233#

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives with:Wife-[**Name (NI) **]
Occupation:Salesman
Tobacco:smokes half pack of cigarettes per day x40yrs,quit 1
week
ago
ETOH:3 drinks per week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Urinary tract infection, site not specified,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified sleep apnea,Obesity, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Gout, unspecified,Esophageal reflux,Personal history of malignant neoplasm of bladder'}
