CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 61F w/ significant cardiac history with multiple stents, last to
LCx in [**10-9**], was in her USOF when she developed chest tightness
after dinner. Patient went to her bedroom and experienced [**10-11**]
crushing chest pressure at rest that radiated to the LEFT
axilla, was nonpositional, was associated with SOB, and lasted
for roughly 1 hour. No syncope or lightheadeness. No back pain.
No leg pain. No palpitations. No pnd. Has noted increase leg
swelling for 1 month. PCP doubled lasix dose and checked TTE
which showed unchagned EF. Pt thinks she has been gaining weight
but is unsure how much because she does not check. Does report
cough x 2 days but nonproductive and without fevers. She took 3
sub lingual nitroglycerines without relief. After calling EMS,
she experienced some relief with SL nitro spray. Patient reports
she has experiencecd chest tightness in the past as her anginal
equivalent, but reports this was more painful.

MEDICAL HISTORY: CAD (see below)
Diabetes Type I
HTN
Dyslipidemia
Rheumatoid arthritis
Hypercholesterolemia
Depression
GERD
Cataracts
.
Cardiac History:
CAD s/p MI [**22**] yrs ago
s/p stent to RCA [**2111**]
s/p DES to LCx/OM1 [**2-9**]
s/p DES to LAD [**3-9**]
s/p DES to Lcx [**10-9**]
.
[**2119-12-25**]: s/p fall with compound fracture of her left fingers
S/P humerus fracture about 4 yrs ago
s/p C sx
S/p Tonsillectomy
Cardiac Risk Factors: + Diabetes, + Dyslipidemia, + Hypertension

MEDICATION ON ADMISSION: AMLODIPINE - 5 mg Tablet - 1 Tablet(s) by mouth at bedtime
ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth one tab qam in
place of the metoprolol
ATORVASTATIN [LIPITOR] - 80 mg Tablet - 1 Tablet(s) by mouth
once
a day
CILOSTAZOL [PLETAL] - 100 mg Tablet - 1 Tablet(s) by mouth twice

ALLERGIES: Ticlid / Zocor / Zestril

PHYSICAL EXAM: VS - T 97.7, BP 140/66, HR 71, RR 22, Sat 94% on 4L
Gen: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, No JVD appreciated. No carotid bruits apprecaited.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. One sister with breast cancer and one sister
with [**Name2 (NI) **]. Mother died of liver cancer. Father died of unknown
causes.

SOCIAL HISTORY: She lives alone in [**Location (un) **]. Denies smoking, alcohol, and drugs.
Former teacher's aid in [**Location (un) 38**] but now retired 5 years.
Widowed 5 years ago.
Significant for the absence of current tobacco use. There is no
history of alcohol abuse. She is single, and lives alone yet
close to her daughter. She is a retired as a teacher??????s aide. One
sister with breast cancer. Another sister with colorectal
cancer.
Subendocardial infarction, initial episode of care,Acute diastolic heart failure,Other complications due to other cardiac device, implant, and graft,Diabetes with unspecified complication, type I [juvenile type], uncontrolled,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Rheumatoid arthritis,Old myocardial infarction
Subendo infarct, initial,Ac diastolic hrt failure,Comp-oth cardiac device,DMI unspf uncntrld,Crnry athrscl natve vssl,Atrial fibrillation,Anemia NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Abn react-cardiac cath,Rheumatoid arthritis,Old myocardial infarct
Admission Date:  [**2121-2-9**]              Discharge Date:   [**2121-2-19**]

Date of Birth:  [**2059-10-31**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ticlid / Zocor / Zestril

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

Major Surgical or Invasive Procedure:
s/p coronary artery bypass grafting x3(Lima-LAD/SVG->OM/PDA)


History of Present Illness:
61F w/ significant cardiac history with multiple stents, last to
LCx in [**10-9**], was in her USOF when she developed chest tightness
after dinner. Patient went to her bedroom and experienced [**10-11**]
crushing chest pressure at rest that radiated to the LEFT
axilla, was nonpositional, was associated with SOB, and lasted
for roughly 1 hour. No syncope or lightheadeness. No back pain.
No leg pain. No palpitations. No pnd. Has noted increase leg
swelling for 1 month. PCP doubled lasix dose and checked TTE
which showed unchagned EF. Pt thinks she has been gaining weight
but is unsure how much because she does not check. Does report
cough x 2 days but nonproductive and without fevers. She took 3
sub lingual nitroglycerines without relief. After calling EMS,
she experienced some relief with SL nitro spray. Patient reports
she has experiencecd chest tightness in the past as her anginal
equivalent, but reports this was more painful.


Past Medical History:
CAD (see below)
Diabetes Type I
HTN
Dyslipidemia
Rheumatoid arthritis
Hypercholesterolemia
Depression
GERD
Cataracts
.
Cardiac History:
CAD s/p MI [**22**] yrs ago
s/p stent to RCA [**2111**]
s/p DES to LCx/OM1 [**2-9**]
s/p DES to LAD [**3-9**]
s/p DES to Lcx [**10-9**]
.
[**2119-12-25**]: s/p fall with compound fracture of her left fingers
S/P humerus fracture about 4 yrs ago
s/p C sx
S/p Tonsillectomy
Cardiac Risk Factors: + Diabetes, + Dyslipidemia, + Hypertension



Social History:
She lives alone in [**Location (un) **]. Denies smoking, alcohol, and drugs.
Former teacher's aid in [**Location (un) 38**] but now retired 5 years.
Widowed 5 years ago.
Significant for the absence of current tobacco use. There is no
history of alcohol abuse. She is single, and lives alone yet
close to her daughter. She is a retired as a teacher??????s aide. One
sister with breast cancer. Another sister with colorectal
cancer.


Family History:
There is no family history of premature coronary artery disease
or sudden death. One sister with breast cancer and one sister
with [**Name2 (NI) **]. Mother died of liver cancer. Father died of unknown
causes.

Physical Exam:
VS - T 97.7, BP 140/66, HR 71, RR 22, Sat 94% on 4L
Gen: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, No JVD appreciated. No carotid bruits apprecaited.

CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Crackles bilaterally
with faint end expiratory wheezes bilaterally. Resonant to
percussion in all lung fields.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c. No femoral bruits. 1+ tight LE edema to knees
bilaterally.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
[**2121-2-18**] 06:30AM BLOOD WBC-7.1 RBC-2.88* Hgb-8.7* Hct-25.4*
MCV-88 MCH-30.1 MCHC-34.0 RDW-16.9* Plt Ct-190
[**2121-2-19**] 06:15AM BLOOD Glucose-113* UreaN-17 Creat-0.7 Na-133
K-4.3 Cl-100 HCO3-26 AnGap-11
[**2121-2-19**] 06:15AM BLOOD Mg-2.0

[**2121-2-9**] 02:50AM BLOOD WBC-6.7 RBC-3.29* Hgb-9.5* Hct-28.1*
MCV-85 MCH-28.8 MCHC-33.7 RDW-18.6* Plt Ct-282
[**2121-2-17**] 06:20AM BLOOD Hct-28.0*
[**2121-2-14**] 12:43PM BLOOD PT-14.4* PTT-36.1* INR(PT)-1.3*
[**2121-2-9**] 02:50AM BLOOD PT-14.1* PTT-127.7* INR(PT)-1.2*
[**2121-2-17**] 06:20AM BLOOD K-4.5
[**2121-2-16**] 01:03PM BLOOD Glucose-293* UreaN-20 Creat-1.0 Na-134
K-5.3* Cl-103 HCO3-22 AnGap-14
[**2121-2-9**] 02:50AM BLOOD Glucose-199* UreaN-22* Creat-1.0 Na-136
K-4.5 Cl-103 HCO3-24 AnGap-14


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 110051**] (Complete)
Done [**2121-2-14**] at 10:57:35 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2059-10-31**]
Age (years): 61 F  Hgt (in): 64
BP (mm Hg): 120/60  Wgt (lb): 170
HR (bpm): 60  BSA (m2): 1.83 m2
Indication: Intraop CABG
ICD-9 Codes: 424.0
Test Information
Date/Time: [**2121-2-14**] at 10:57    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW1-: Machine: aw5
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.1 cm  <= 5.6 cm
Left Ventricle - Peak Resting LVOT gradient:  4 mm Hg  <= 10 mm
Hg
Left Ventricle - Septal Peak E':  *0.05 m/s  > 0.08 m/s
Left Ventricle - Ratio E/E':  *18  < 15
Aorta - Annulus:  2.0 cm  <= 3.0 cm
Aorta - Sinus Level:  3.1 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.8 cm  <= 3.0 cm
Aorta - Ascending:  3.1 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.2 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  6 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  3 mm Hg
Aortic Valve - Valve Area:  *2.5 cm2  >= 3.0 cm2
Mitral Valve - Peak Velocity:  1.1 m/sec
Mitral Valve - Mean Gradient:  2 mm Hg
Mitral Valve - Pressure Half Time:  110 ms
Mitral Valve - MVA (P [**1-3**] T):  2.2 cm2
Mitral Valve - E Wave:  0.9 m/sec
Mitral Valve - A Wave:  0.8 m/sec
Mitral Valve - E/A ratio:  1.13
Mitral Valve - E Wave deceleration time:  *275 ms  140-250 ms

Findings
LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal
interatrial septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Normal regional LV systolic function. Overall normal LVEF
(>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. The MR
vena contracta is <0.3cm. Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

PERICARDIUM: No pericardial effusion.
Conclusions
Pre Bypass: Left ventricular wall thicknesses are normal. The
left ventricular cavity size is normal. Regional left
ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve leaflets
are mildly thickened, primarily at leaflet tips. Mild (1+)
mitral regurgitation is seen.

Post bypass: Preserved biventricular function, LVEF >55%. MR
remains trace/mild. Aortic contours intact. Remaining exam is
unchanged. All findings discussed with surgeons at the time of
the exam.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician
    [**Known lastname **],[**Known firstname **] [**Medical Record Number 110052**] F  61  [**2059-10-31**]

Radiology Report CHEST (PORTABLE AP) Study Date of [**2121-2-17**]
11:25 AM


[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2121-2-17**] 11:25 AM
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 110053**]
Reason: PTX



[**Hospital 93**] MEDICAL CONDITION:
   61 year old woman s/p CABG x3
REASON FOR THIS EXAMINATION:
   PTX



Final Report
CHEST SINGLE VIEW ON [**2-17**]

HISTORY: Status post CABG.

REFERENCE EXAM: [**2-14**].

FINDINGS: There has been interval removal of the tubes and
drains. There is
mild cardiomegaly and mild volume loss in both lower lobes but
no definite
infiltrate or effusion.

DR. [**First Name (STitle) **] [**Doctor Last Name **]
Approved: MON [**2121-2-17**] 12:57 PM

  Imaging Lab




?????? [**2115**] CareGroup IS. All rights reserved.


Brief Hospital Course:
[**2-14**] Ms.[**Known lastname 67888**] was taken to the operating room and underwent
Coronary artery bypass grafting x 3 (left internal mammary
artery grafted to left anterior descending artery/Saphenous vein
graft to Obtuse Marginal/Posterior descending artery). Please
refer to Dr[**Last Name (STitle) 5305**] operative report for further details. She
tolerated the procedure well and was transferred in stable but
critical condition to the CVICU.  She awoke neurologically
intact and was extubated that evening. All lines and drains were
discontinued in a timely fashion. On POD#1 Ms.[**Known lastname 67888**] was
transferred to the step down unit for further monitoring and
progression. [**Last Name (un) **] Diabetes Center was consulted for glucose
control. During the evening hours of POD#2, Ms.[**Known lastname 110054**] rhythm
went into atrial fibrillation. She was hemodynamically stable,
treated with Amiodarone bolus and converted to oral dosing.
Beta-blocker was optimized and she  converted to Normal sinus
rhythm. The remainder of her postoperative course was
essentially uneventful and she continued to progress. On POD 5
she was ready for discharge to home with visiting nurse
arrangements. All follow up appointments were advised.


Medications on Admission:
AMLODIPINE - 5 mg Tablet - 1 Tablet(s) by mouth at bedtime
ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth one tab qam in
place of the metoprolol
ATORVASTATIN [LIPITOR] - 80 mg Tablet - 1 Tablet(s) by mouth
once
a day
CILOSTAZOL [PLETAL] - 100 mg Tablet - 1 Tablet(s) by mouth twice

a day
CITALOPRAM [CELEXA] - 20 mg Tablet - 1 Tablet(s) by mouth qam
CLOPIDOGREL [PLAVIX] - 75 mg Tablet - 1 Tablet(s) by mouth daily

do not stop unless directed by Dr [**Last Name (STitle) **]
CYANOCOBALAMIN - (Prescribed by Other Provider: [**Name10 (NameIs) **] [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 10088**]) - 1,000 mcg/mL Solution - Inject 1 cc per month
(1000mcg)
ENALAPRIL MALEATE - (Prescribed by Other Provider) - 20 mg
Tablet - 1 Tablet(s) by mouth twice a day - No Substitution
FLUOCINONIDE - 0.05 % Ointment - apply [**Hospital1 **] to scalp for up to 14

days per month avoid face-folds-genitals
FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth once a day
FUROSEMIDE - 20 mg Tablet - 0.5 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] - 100 unit/mL Solution - 24units at
bedtime
INSULIN LISPRO [HUMALOG] - (Prescribed by Other Provider) - 100

unit/mL Solution - use sliding scale four times a day based on
Blood Sugar value [**First Name8 (NamePattern2) **] [**Name8 (MD) **] M.D.
ISOSORBIDE DINITRATE [ISORDIL] - (Prescribed by Other Provider)

- 30 mg po daily
LORAZEPAM - 0.5 mg Tablet - 1 Tablet(s) by mouth at bedtime as
needed for insomnia
METHOTREXATE SODIUM [METHOTREXATE (ANTI-RHEUMATIC)] - 2.5 mg
Tablets, Dose Pack - 10 Tablets(s) by mouth once per week
NITROGLYCERIN - 0.4 mg Tablet, Sublingual - one Tablet(s)
sublingually once a day
PANTOPRAZOLE [PROTONIX] - 40 mg Tablet, Delayed Release (E.C.) -

1 Tablet(s) by mouth once a day

Medications - OTC
ASPIRIN - 325 mg Tablet - 1 Tablet(s) by mouth once a day


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
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:*0*
3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
5. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Cilostazol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
10. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*0*
11. Valacyclovir 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every
8 hours) for 7 days.
Disp:*40 Tablet(s)* Refills:*0*
12. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg 2x/day for 7 days, then 200mg 2x/day for 7 days,
then 200mg/day until further instructed.
Disp:*120 Tablet(s)* Refills:*2*
13. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
14. Furosemide 20 mg Tablet Sig: .5 Tablet PO once a day: begin
this dose (10mg/day) when 40mg/day for 1 week is complete.
Disp:*30 Tablet(s)* Refills:*0*
15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily).
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
16. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
17. Insulin Glargine 100 unit/mL Solution Sig: Thirty Six (36)
units Subcutaneous at bedtime.
Disp:*qs units* Refills:*2*
18. Insulin Needles (Disposable)     Needle Sig: One (1)
Miscellaneous four times a day.
Disp:*qs * Refills:*2*
19. Insulin Syringe 1 mL 28 X 1  Syringe Sig: One (1)
Miscellaneous four times a day.
Disp:*qs * Refills:*2*
20. Insulin Lispro 100 unit/mL Solution Sig: One (1)
Subcutaneous four times a day: see sliding scale.
Disp:*qs * Refills:*2*
21. glucose test strips
glucose test strips
QID and prn
22. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for anxiety.
Disp:*30 Tablet(s)* Refills:*0*
23. Methotrexate Sodium 2.5 mg Tablet Sig: Ten (10) Tablet PO
once a week: saturday.
Disp:*20 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
s/p coronary artery bypass x3(Lima-LAD/SVG->OM/PDA)-[**2121-2-14**]
diabetes mellitus-Type 1
hypertension
hyperlipidemia
myocardial infarction '[**08**] with TPA
coronary artery disease s/p multiple PCIs/BMS x3(RCA/DES x2
LAD)/DES x3 LCx-most recent [**10-9**]
gastroesophageal reflux disease
Anemia; baseline HCT:27-30
rheumatoid arthritis
Depression
Herpes
Cataracts
s/p (R) Humerus Fx/C-section/tonsillectomy


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**]


Followup Instructions:
Dr [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**Last Name (STitle) **] in 1 week :please call for appointment ([**Telephone/Fax (1) 250**])
Dr [**Last Name (STitle) **] in [**2-4**] weeks: please call for appointment
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2121-2-19**]
{'Subendocardial infarction, initial episode of care,Acute diastolic heart failure,Other complications due to other cardiac device, implant, and graft,Diabetes with unspecified complication, type I [juvenile type], uncontrolled,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Rheumatoid arthritis,Old myocardial infarction'}


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

PRESENT ILLNESS: 61F w/ significant cardiac history with multiple stents, last to
LCx in [**10-9**], was in her USOF when she developed chest tightness
after dinner. Patient went to her bedroom and experienced [**10-11**]
crushing chest pressure at rest that radiated to the LEFT
axilla, was nonpositional, was associated with SOB, and lasted
for roughly 1 hour. No syncope or lightheadeness. No back pain.
No leg pain. No palpitations. No pnd. Has noted increase leg
swelling for 1 month. PCP doubled lasix dose and checked TTE
which showed unchagned EF. Pt thinks she has been gaining weight
but is unsure how much because she does not check. Does report
cough x 2 days but nonproductive and without fevers. She took 3
sub lingual nitroglycerines without relief. After calling EMS,
she experienced some relief with SL nitro spray. Patient reports
she has experiencecd chest tightness in the past as her anginal
equivalent, but reports this was more painful.

MEDICAL HISTORY: CAD (see below)
Diabetes Type I
HTN
Dyslipidemia
Rheumatoid arthritis
Hypercholesterolemia
Depression
GERD
Cataracts
.
Cardiac History:
CAD s/p MI [**22**] yrs ago
s/p stent to RCA [**2111**]
s/p DES to LCx/OM1 [**2-9**]
s/p DES to LAD [**3-9**]
s/p DES to Lcx [**10-9**]
.
[**2119-12-25**]: s/p fall with compound fracture of her left fingers
S/P humerus fracture about 4 yrs ago
s/p C sx
S/p Tonsillectomy
Cardiac Risk Factors: + Diabetes, + Dyslipidemia, + Hypertension

MEDICATION ON ADMISSION: AMLODIPINE - 5 mg Tablet - 1 Tablet(s) by mouth at bedtime
ATENOLOL - 50 mg Tablet - 1 Tablet(s) by mouth one tab qam in
place of the metoprolol
ATORVASTATIN [LIPITOR] - 80 mg Tablet - 1 Tablet(s) by mouth
once
a day
CILOSTAZOL [PLETAL] - 100 mg Tablet - 1 Tablet(s) by mouth twice

ALLERGIES: Ticlid / Zocor / Zestril

PHYSICAL EXAM: VS - T 97.7, BP 140/66, HR 71, RR 22, Sat 94% on 4L
Gen: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, No JVD appreciated. No carotid bruits apprecaited.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death. One sister with breast cancer and one sister
with [**Name2 (NI) **]. Mother died of liver cancer. Father died of unknown
causes.

SOCIAL HISTORY: She lives alone in [**Location (un) **]. Denies smoking, alcohol, and drugs.
Former teacher's aid in [**Location (un) 38**] but now retired 5 years.
Widowed 5 years ago.
Significant for the absence of current tobacco use. There is no
history of alcohol abuse. She is single, and lives alone yet
close to her daughter. She is a retired as a teacher??????s aide. One
sister with breast cancer. Another sister with colorectal
cancer. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute diastolic heart failure,Other complications due to other cardiac device, implant, and graft,Diabetes with unspecified complication, type I [juvenile type], uncontrolled,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Anemia, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Rheumatoid arthritis,Old myocardial infarction'}
