CHIEF COMPLAINT: Chest pain, shortness of breath

PRESENT ILLNESS: This is a 60-year-old woman who has a past medical history of
known CAD s/p MI in [**2153-3-10**] with a stent to her LAD at that
time.  She underwent a repeat catheterization in [**2153-8-10**]
for recurrent chest discomfort and had two stents placed in her
mid LCx. In [**2153-10-10**] she was admitted to [**Hospital 1514**] hospital
for recurrent chest discomfort similar to her prior
presentations.  She ruled out for an MI and underwent a
persantine stress test, which was positive for chest pain.
Nuclear imaging demonstrated severe apical non-reversing defect
consistent with a prior apical infarction, anteroseptal defect
with minor reversibility and a moderate sized, mild intensity
inferoposterior defect without significant reversibility.
Subsequently she underwent another cardiac catheterization that
revealed a 100% stenosis just after OM1 stent and a decrease in
his EF to 31% (EF in [**3-/2152**] 50-56%).  PCI was not attempted and
adjustments were made to her medications. Since that time she
continues to experiencing chest pain 3-4 times per week.  It is
non-radiating and is typically relieved with rest.  She states
that she gets extremely short of breath with minimal activity.
She states that she is wearing her home O2 with increasing
frequency.  She further reports that she get lightheaded when
going from a sitting to a standing position.  She is now
referred for a cardiac catheterization with possible
revascularization.

MEDICAL HISTORY: Coronary Artery Disease, Prior PCI, History of Myocardial
Infarction, Obesity, Hypertension, Hypercholesterolemia, GERD,
Depression, Tonsillectomy, Appendectomy, Cholecystectomy,
Hysterectomy, Chronic Headaches, Chronic Knee Pain, History of
MVA complicated by cerebral hematoma and coma, Prior Colon
Surgery

MEDICATION ON ADMISSION: Lisinopril 20 qd, Plavix 75 qd, lasix 40 qd, Oxycodone prn,
Aspirin 325 qd, Ambien 10 qd, Lipitor 80 qd, Coreg 18.75 [**Hospital1 **]

ALLERGIES: Compazine / Hydromorphone Hcl / Morphine

PHYSICAL EXAM: Vitals: BP 160-170/82, HR 91, RR 18, SAT 92% on room air
General: obese female in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: obese, some RLQ and LUQ tenderness, normoactive bowel
sounds
Ext: warm, no edema,
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Mother underwent CABG at age 78. Father and brother had
hypertension. Father died from a pulmonary embolism.

SOCIAL HISTORY: Quit tobacco 30 years ago. Admits to 10 pack year history. She
denies ETOH and recreational drugs. She is divorced, no
children. She is a retired chiropractor.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,Old myocardial infarct,Hyperlipidemia NEC/NOS,Esophageal reflux,Hypertension NOS
Admission Date:  [**2154-1-2**]              Discharge Date:   [**2154-1-11**]

Date of Birth:  [**2093-8-19**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Compazine / Hydromorphone Hcl / Morphine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain, shortness of breath

Major Surgical or Invasive Procedure:
[**2154-1-2**] Cardiac Catheterization
[**2154-1-3**] Three Vessel CABG(LIMA to LAD, vein grafts to diagonal
and PLB).


History of Present Illness:
This is a 60-year-old woman who has a past medical history of
known CAD s/p MI in [**2153-3-10**] with a stent to her LAD at that
time.  She underwent a repeat catheterization in [**2153-8-10**]
for recurrent chest discomfort and had two stents placed in her
mid LCx. In [**2153-10-10**] she was admitted to [**Hospital 1514**] hospital
for recurrent chest discomfort similar to her prior
presentations.  She ruled out for an MI and underwent a
persantine stress test, which was positive for chest pain.
Nuclear imaging demonstrated severe apical non-reversing defect
consistent with a prior apical infarction, anteroseptal defect
with minor reversibility and a moderate sized, mild intensity
inferoposterior defect without significant reversibility.
Subsequently she underwent another cardiac catheterization that
revealed a 100% stenosis just after OM1 stent and a decrease in
his EF to 31% (EF in [**3-/2152**] 50-56%).  PCI was not attempted and
adjustments were made to her medications. Since that time she
continues to experiencing chest pain 3-4 times per week.  It is
non-radiating and is typically relieved with rest.  She states
that she gets extremely short of breath with minimal activity.
She states that she is wearing her home O2 with increasing
frequency.  She further reports that she get lightheaded when
going from a sitting to a standing position.  She is now
referred for a cardiac catheterization with possible
revascularization.


Past Medical History:
Coronary Artery Disease, Prior PCI, History of Myocardial
Infarction, Obesity, Hypertension, Hypercholesterolemia, GERD,
Depression, Tonsillectomy, Appendectomy, Cholecystectomy,
Hysterectomy, Chronic Headaches, Chronic Knee Pain, History of
MVA complicated by cerebral hematoma and coma, Prior Colon
Surgery

Social History:
Quit tobacco 30 years ago. Admits to 10 pack year history. She
denies ETOH and recreational drugs. She is divorced, no
children. She is a retired chiropractor.

Family History:
Mother underwent CABG at age 78. Father and brother had
hypertension. Father died from a pulmonary embolism.

Physical Exam:
Vitals: BP 160-170/82, HR 91, RR 18, SAT 92% on room air
General: obese female in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: obese, some RLQ and LUQ tenderness, normoactive bowel
sounds
Ext: warm, no edema,
Pulses: 1+ distally
Neuro: nonfocal


Pertinent Results:
[**2154-1-2**] Cardiac Cath: This right dominant anatomy revealed a
significnat LMCA lesion with three vessel disease. The LMCA was
long with a large ulcer at the end. At this point the LMCA had a
> 50% narrowing. The LAD proxmally had a 60% lesion proxmal to
the stent. The LCX was occluded in the stent shortly after the
origin. This vessel was a short vessel. The RCA was larger . The
PL is bifurcating and prior to the bifurcation, there was a long
60% lesion.

[**2154-1-2**] Abdominal CTA: No CT evidence to suggest mesenteric
ischemia. Anterior abdominal wall hernia above the umbilicus,
containing a normal loop of small bowel and fat. No evidence of
obstruction.

[**2154-1-2**] 11:46AM BLOOD WBC-6.9 RBC-3.68* Hgb-11.2* Hct-32.0*
MCV-87 MCH-30.5 MCHC-35.1* RDW-13.7 Plt Ct-271
[**2154-1-2**] 11:46AM BLOOD PT-13.0 PTT-117.8* INR(PT)-1.1
[**2154-1-2**] 09:22PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2154-1-2**] 11:46AM BLOOD Albumin-3.7 Calcium-9.1 Cholest-194
[**2154-1-2**] 11:46AM BLOOD %HbA1c-6.3* [Hgb]-DONE [A1c]-DONE
[**2154-1-11**] 06:45AM BLOOD WBC-8.6 RBC-2.98* Hgb-9.2* Hct-26.7*
MCV-89 MCH-30.7 MCHC-34.3 RDW-14.9 Plt Ct-364
[**2154-1-10**] 07:00AM BLOOD WBC-8.8 RBC-3.22* Hgb-9.6* Hct-29.3*
MCV-91 MCH-29.7 MCHC-32.7 RDW-14.7 Plt Ct-454*
[**2154-1-11**] 06:45AM BLOOD Plt Ct-364
[**2154-1-10**] 07:00AM BLOOD Plt Ct-454*
[**2154-1-6**] 03:00AM BLOOD PT-12.7 PTT-26.3 INR(PT)-1.1
[**2154-1-11**] 06:45AM BLOOD UreaN-26* Creat-1.2* K-4.6
[**2154-1-10**] 07:00AM BLOOD UreaN-27* Creat-1.5* K-4.9
[**2154-1-9**] 06:25AM BLOOD Glucose-98 UreaN-25* Creat-1.3* Na-135
K-4.7 Cl-97 HCO3-30 AnGap-13
[**2154-1-7**] 06:15AM BLOOD Glucose-109* UreaN-24* Creat-1.0 Na-132*
K-4.5 Cl-96 HCO3-30 AnGap-11

Brief Hospital Course:
Mrs. [**Known lastname 174**] was admitted to under cardiology, ruled out for
myocardial infarction, and underwent cardiac catheterization.
This was notable for a 50% lesion in the mid left main coronary
artery with a 60% proximal LAD lesion, occluded LCx and 60%
lesion in the RCA. IVUS revealed an underexpanded LAD stent,
diffuse disease of LAD, and a distal ulcer in the left main
coronary artery. Given left main and multivessel disease,
cardiac surgery was consulted and furthr evaluation was
performed. Given her complaints of abdominal pain, abdominal CTA
was performed which ruled out mesenteric ischemia. There was no
evidence of colitis. Workup was otherwise unremarkable and she
was cleared for surgery. On [**1-3**], Dr. [**Last Name (STitle) **] performed
three vessel coronary artery bypass grafting. For surgical
details, please see seperate dictated operative note. Following
the operation, she was brought to the CSRU for invasive
monitoring. Within 24 hours, she awoke neurologically intact and
was extubated without incident. She weaned from pressor support
and maintained stable hemodynamics as beta blockade was resumed.
Over several days, her anti-hypertensive regimen was titrated.
She made steady progress and eventually transferred to the SDU
on postoperative day three. She continued to make clinical
improvements with diuresis and remained in a normal sinus
rhythm. As she had significant incisional pain and given her
preoperative use of narcotics, the pain service was consulted
for assistance. Oxycontin, oxycodone and toradol were given with
good effect. Mrs. [**Known lastname 174**] continued to make steady progress and
was discharged on postoperative day 8.

Medications on Admission:
Lisinopril 20 qd, Plavix 75 qd, lasix 40 qd, Oxycodone prn,
Aspirin 325 qd, Ambien 10 qd, Lipitor 80 qd, Coreg 18.75 [**Hospital1 **]

Discharge Medications:
1. 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*
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q3-4H as needed.
Disp:*50 Tablet(s)* Refills:*0*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
6. Topiramate 25 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
Disp:*60 Tablet(s)* Refills:*0*
7. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
10. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
Disp:*180 Tablet(s)* Refills:*0*
11. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*90 Capsule(s)* Refills:*0*
12. Oxycodone 40 mg Tablet Sustained Release 12HR Sig: Two (2)
Tablet Sustained Release 12HR PO Q12H (every 12 hours).
13. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 11252**] Center

Discharge Diagnosis:
Coronary artery disease - s/p CABG, History of MI, Hypertension,
Hypercholesterolemia, GERD, Obesity, Depression


Discharge Condition:
Good


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
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. 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.
7)Use support bra/Surgical bra at all times until wound has
healed.
8)Take lasix and potassium for 7 days then stop. Monitor
electrolytes and replete as needed while on lasix.

Followup Instructions:
Cardiac surgeon, Dr. [**Last Name (STitle) **] in [**3-14**] weeks. ([**Telephone/Fax (1) 1504**]
Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 71537**] in [**1-12**] weeks.
Local cardiologist, Dr. [**Last Name (STitle) 11250**] in 2 weeks. ([**Telephone/Fax (1) 59543**]
Please call all providers for appointments.



Completed by:[**2154-1-11**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified essential hypertension'}


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, shortness of breath

PRESENT ILLNESS: This is a 60-year-old woman who has a past medical history of
known CAD s/p MI in [**2153-3-10**] with a stent to her LAD at that
time.  She underwent a repeat catheterization in [**2153-8-10**]
for recurrent chest discomfort and had two stents placed in her
mid LCx. In [**2153-10-10**] she was admitted to [**Hospital 1514**] hospital
for recurrent chest discomfort similar to her prior
presentations.  She ruled out for an MI and underwent a
persantine stress test, which was positive for chest pain.
Nuclear imaging demonstrated severe apical non-reversing defect
consistent with a prior apical infarction, anteroseptal defect
with minor reversibility and a moderate sized, mild intensity
inferoposterior defect without significant reversibility.
Subsequently she underwent another cardiac catheterization that
revealed a 100% stenosis just after OM1 stent and a decrease in
his EF to 31% (EF in [**3-/2152**] 50-56%).  PCI was not attempted and
adjustments were made to her medications. Since that time she
continues to experiencing chest pain 3-4 times per week.  It is
non-radiating and is typically relieved with rest.  She states
that she gets extremely short of breath with minimal activity.
She states that she is wearing her home O2 with increasing
frequency.  She further reports that she get lightheaded when
going from a sitting to a standing position.  She is now
referred for a cardiac catheterization with possible
revascularization.

MEDICAL HISTORY: Coronary Artery Disease, Prior PCI, History of Myocardial
Infarction, Obesity, Hypertension, Hypercholesterolemia, GERD,
Depression, Tonsillectomy, Appendectomy, Cholecystectomy,
Hysterectomy, Chronic Headaches, Chronic Knee Pain, History of
MVA complicated by cerebral hematoma and coma, Prior Colon
Surgery

MEDICATION ON ADMISSION: Lisinopril 20 qd, Plavix 75 qd, lasix 40 qd, Oxycodone prn,
Aspirin 325 qd, Ambien 10 qd, Lipitor 80 qd, Coreg 18.75 [**Hospital1 **]

ALLERGIES: Compazine / Hydromorphone Hcl / Morphine

PHYSICAL EXAM: Vitals: BP 160-170/82, HR 91, RR 18, SAT 92% on room air
General: obese female in no acute distress
HEENT: oropharynx benign, EOMI, PERRL
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: obese, some RLQ and LUQ tenderness, normoactive bowel
sounds
Ext: warm, no edema,
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Mother underwent CABG at age 78. Father and brother had
hypertension. Father died from a pulmonary embolism.

SOCIAL HISTORY: Quit tobacco 30 years ago. Admits to 10 pack year history. She
denies ETOH and recreational drugs. She is divorced, no
children. She is a retired chiropractor. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Other and unspecified hyperlipidemia,Esophageal reflux,Unspecified essential hypertension'}
