CHIEF COMPLAINT: Exertional angina

PRESENT ILLNESS: 65 year old male with history of
hypertension and severe hyperlipidemia, intolerant to some
statins, presented to his cardiologist last week with 2 week
history of chest tightness that was occurring with exertion.  It
was relieved with rest - denied any rest pain, radiation to jaw
or arm, associated disphoresis, dyspnea, nausea.  He was
referred
for a stress test where he went 6 minutes 12 sec on a standard
[**Doctor First Name **] protocol which was stopped due to dyspnea and chest
tightness.  He had extensive ischemic EKG changes and > [**Street Address(2) 2051**]
depressions in the inferior and lateral leads with ST elevation
in AVR and slight ST elevation in AVL.  He was referred to a
cardiac cath, which revealed LM, LAD, and RCA dz. Transferred to
[**Hospital1 18**] for CABG. Currently CP free.

MEDICAL HISTORY: Coronary Artery Disease
Exertional angina
Severe Hyperlipidemia - can tolerate Lipitor - last lipid panel
[**2170-4-17**] LDL 208 prior to initiation of Lipitor
Hypertension
Past Surgical History:
Appendectomy
Polypectomy

MEDICATION ON ADMISSION: HCTZ 25 mg daily
ASA 81 daily
Coenzyme Q
Flonase Inhaler
Vitamin D
Lipitor 10 mg every other day
Atenolol 25 mg daily - started [**6-12**]
NTG PRN  - started [**6-12**]

ALLERGIES: sulfa

PHYSICAL EXAM: Pulse:55 Resp:18  O2 sat: 98%
B/P  Right: 133/88   Left: 140/80
Height: 5ft 6"    Weight:160lbs

FAMILY HISTORY: Father AAA but is 90         Mother died of CVA in her 70's

SOCIAL HISTORY: Lives with:wife
Contact: Wife               Phone #[**Pager number 111854**]
[**Name2 (NI) **]ion:works for gas company
Cigarettes: Smoked no [x] yes [] last cigarette _____ Hx:
Other Tobacco use:
ETOH: Drink [**1-29**] beer a night
Illicit drug use: none
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified angina pectoris,Other specified cardiac dysrhythmias
Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Angina pectoris NEC/NOS,Cardiac dysrhythmias NEC
Admission Date:  [**2170-6-14**]              Discharge Date:   [**2170-6-19**]

Date of Birth:  [**2104-12-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
sulfa

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Exertional angina


Major Surgical or Invasive Procedure:
Coronary Artery Bypass x 4 (LIMA-LAD, SVG-DIAG, SVG-RI,SVG-RCA)
[**2170-6-15**]


History of Present Illness:
65 year old male with history of
hypertension and severe hyperlipidemia, intolerant to some
statins, presented to his cardiologist last week with 2 week
history of chest tightness that was occurring with exertion.  It
was relieved with rest - denied any rest pain, radiation to jaw
or arm, associated disphoresis, dyspnea, nausea.  He was
referred
for a stress test where he went 6 minutes 12 sec on a standard
[**Doctor First Name **] protocol which was stopped due to dyspnea and chest
tightness.  He had extensive ischemic EKG changes and > [**Street Address(2) 2051**]
depressions in the inferior and lateral leads with ST elevation
in AVR and slight ST elevation in AVL.  He was referred to a
cardiac cath, which revealed LM, LAD, and RCA dz. Transferred to
[**Hospital1 18**] for CABG. Currently CP free.

Past Medical History:
Coronary Artery Disease
Exertional angina
Severe Hyperlipidemia - can tolerate Lipitor - last lipid panel
[**2170-4-17**] LDL 208 prior to initiation of Lipitor
Hypertension
Past Surgical History:
Appendectomy
Polypectomy


Social History:
Lives with:wife
Contact: Wife               Phone #[**Pager number 111854**]
[**Name2 (NI) **]ion:works for gas company
Cigarettes: Smoked no [x] yes [] last cigarette _____ Hx:
Other Tobacco use:
ETOH: Drink [**1-29**] beer a night
Illicit drug use: none


Family History:
Father AAA but is 90         Mother died of CVA in her 70's


Physical Exam:
Pulse:55 Resp:18  O2 sat: 98%
B/P  Right: 133/88   Left: 140/80
Height: 5ft 6"    Weight:160lbs

Five Meter Walk Test #1_______ #2 _________  #3_________

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 [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+
[]
Extremities: Warm [x], well-perfused [x]  Edema [] _____
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: +2  Left:+2
DP           Right:+2   Left:+2
PT           [**Name (NI) 167**]: +2  Left:+2
Radial       Right: +2  Left:+2

Carotid Bruit        Right: None   Left:None


Pertinent Results:
[**2170-6-14**] Intra-op Echo
Conclusions
The left atrium is moderately dilated. Left ventricular wall
thickness, cavity size and regional/global systolic function are
normal (LVEF 65%). Tissue Doppler imaging suggests a normal left
ventricular filling pressure (PCWP<12mmHg). Right ventricular
chamber size and free wall motion are normal. The ascending
aorta is mildly dilated. The aortic arch is mildly dilated. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. Mild (1+) mitral regurgitation is seen. The
estimated pulmonary artery systolic pressure is normal. There is
no pericardial effusion.
.

[**2170-6-18**] 04:36AM BLOOD Hct-33.1*
[**2170-6-17**] 05:48AM BLOOD WBC-7.8 RBC-3.95* Hgb-11.3* Hct-35.3*
MCV-89 MCH-28.7 MCHC-32.1 RDW-14.0 Plt Ct-190
[**2170-6-14**] 03:55PM BLOOD WBC-6.4 RBC-5.03 Hgb-14.2 Hct-44.7 MCV-89
MCH-28.3 MCHC-31.9 RDW-14.4 Plt Ct-247
[**2170-6-15**] 02:13PM BLOOD PT-12.9* PTT-27.1 INR(PT)-1.2*
[**2170-6-14**] 03:55PM BLOOD PT-11.6 PTT-28.1 INR(PT)-1.1
[**2170-6-18**] 04:36AM BLOOD UreaN-19 Creat-0.9 Na-139 K-4.9 Cl-103
[**2170-6-14**] 03:55PM BLOOD Glucose-86 UreaN-19 Creat-0.9 Na-141
K-3.9 Cl-107 HCO3-25 AnGap-13

Brief Hospital Course:
Mr.[**Known lastname 12184**] was brought to the Operating Room on [**2170-6-15**] where
he  underwent CABG x 3:left internal mammary artery graft to
left anterior descending, reverse saphenous vein graft to the
ramus intermedius branch right coronary artery and diagonal
branch with Dr. [**Last Name (STitle) **].  Overall the patient tolerated the
procedure well and post-operatively was transferred to the CVICU
in stable condition for recovery and invasive monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  He awoke neurologically intact and was
extubated without incident. He was hemodynamically stable,
weaned from inotropic and vasopressor support.  Beta blocker was
initiated and the patient was gently diuresed towards his
preoperative weight.  The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued without complication. The remainder of
his hospital course was essentially uneventful. Mr.[**Known lastname **] was
evaluated by the physical therapy service for assistance with
strength and mobility.  By the time of discharge on POD# 4 the
patient was ambulating freely, the wound was healing and pain
was controlled with oral analgesics.  He was discharged to home
with VNA services in good condition with appropriate follow up
instructions.

Medications on Admission:
HCTZ 25 mg daily
ASA 81 daily
Coenzyme Q
Flonase Inhaler
Vitamin D
Lipitor 10 mg every other day
Atenolol 25 mg daily - started [**6-12**]
NTG PRN  - started [**6-12**]


Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily) as needed for constipation.
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. fluticasone 50 mcg/actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
Disp:*qs * Refills:*2*
6. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO EVERY OTHER
DAY (Every Other Day).
Disp:*60 Tablet(s)* Refills:*2*
7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
9. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
10. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
11. potassium chloride 10 mEq Capsule, Extended Release Sig: Two
(2) Capsule, Extended Release PO BID (2 times a day) for 5 days.
Disp:*20 Capsule, Extended Release(s)* Refills:*0*
12. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
13. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
Coronary Artery Disease
Exertional angina
Severe Hyperlipidemia - can tolerate Lipitor - last lipid panel
[**2170-4-17**] LDL 208 prior to initiation of Lipitor
Hypertension
Past Surgical History:
Appendectomy
Polypectomy


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
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 [**2170-7-25**] at 1:00p
Cardiologist:[**Doctor First Name **] Tabaee [**2170-7-12**] at 1:30p
[**Hospital3 **]CARDIOLOGY
[**Location (un) 16993**], [**Location (un) **],[**Numeric Identifier 43858**]
[**Telephone/Fax (1) 16995**]
Wound Check at Cardiac Surgery Office [**Telephone/Fax (1) 170**] on [**2170-6-26**]
at 10:00a
Please call to schedule the following:

Primary Care Dr. [**Last Name (STitle) 88127**] in [**5-3**] weeks

**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:[**2170-6-19**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified angina pectoris,Other specified cardiac dysrhythmias'}


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 angina

PRESENT ILLNESS: 65 year old male with history of
hypertension and severe hyperlipidemia, intolerant to some
statins, presented to his cardiologist last week with 2 week
history of chest tightness that was occurring with exertion.  It
was relieved with rest - denied any rest pain, radiation to jaw
or arm, associated disphoresis, dyspnea, nausea.  He was
referred
for a stress test where he went 6 minutes 12 sec on a standard
[**Doctor First Name **] protocol which was stopped due to dyspnea and chest
tightness.  He had extensive ischemic EKG changes and > [**Street Address(2) 2051**]
depressions in the inferior and lateral leads with ST elevation
in AVR and slight ST elevation in AVL.  He was referred to a
cardiac cath, which revealed LM, LAD, and RCA dz. Transferred to
[**Hospital1 18**] for CABG. Currently CP free.

MEDICAL HISTORY: Coronary Artery Disease
Exertional angina
Severe Hyperlipidemia - can tolerate Lipitor - last lipid panel
[**2170-4-17**] LDL 208 prior to initiation of Lipitor
Hypertension
Past Surgical History:
Appendectomy
Polypectomy

MEDICATION ON ADMISSION: HCTZ 25 mg daily
ASA 81 daily
Coenzyme Q
Flonase Inhaler
Vitamin D
Lipitor 10 mg every other day
Atenolol 25 mg daily - started [**6-12**]
NTG PRN  - started [**6-12**]

ALLERGIES: sulfa

PHYSICAL EXAM: Pulse:55 Resp:18  O2 sat: 98%
B/P  Right: 133/88   Left: 140/80
Height: 5ft 6"    Weight:160lbs

FAMILY HISTORY: Father AAA but is 90         Mother died of CVA in her 70's

SOCIAL HISTORY: Lives with:wife
Contact: Wife               Phone #[**Pager number 111854**]
[**Name2 (NI) **]ion:works for gas company
Cigarettes: Smoked no [x] yes [] last cigarette _____ Hx:
Other Tobacco use:
ETOH: Drink [**1-29**] beer a night
Illicit drug use: none 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified angina pectoris,Other specified cardiac dysrhythmias'}
