CHIEF COMPLAINT: Positive stress test

PRESENT ILLNESS: 71 year old male with multiple CAD risk factors who has had
"routine" stress tests for several years. A stress-echo in [**Month (only) 547**]
of [**2145**] was markedly positive and he was brought to the cath lab
where it was found that he had severe 3-vessel disease. Patient
was discharged to home to decide on if he wanted surgery or not
and was lost to follow up. His cardiologist finally convinced
him that he needed re-evaluation and he was cathed on [**2146-10-11**]
that showed worsening of his CAD.

MEDICAL HISTORY: CAD s/p MI
Diabetes type 2
Hypertension
High cholesterol
Osteoarthritis

MEDICATION ON ADMISSION: Glyburide 5 MG PO daily
Ketorolac 0.4% drops to left eye twice daily
Lisinopril 10MG PO daily
Claritin-D 120/5 daily
Metformin 1000mg PO twice daily
Metoprolol 50 MG PO twice daily
TNG sl 0.3 PRN chest pain
Zocor 40 MG po daily
ASA 81 mg po daily
Multivitamin

ALLERGIES: Lipitor / Pravachol / Isosorbide

PHYSICAL EXAM: Admission:
145/79  HR 65  Height: 5'4"  Weight 164lbs
General: pleasant to speak with. Answers questions appropriately
Chest: Lungs clear to auscultation bilaterally
COR: Nl s1s2. No murmurs, rubs, gallops appreciated.
Abdomen: soft, nontender without rebound or guarding.
Normoactive bowel sounds.
Extremities: warm without edema. 1+ distal pulses
Labs: wbc 4.6, hct 31.5, plts 119.  Cr 1.3.
EKG: sinus bradycardia @ 57BPM, RBBB, inverted T waves
II/III/AVF

FAMILY HISTORY: His father had heart problems in his 50s.  His mother died of
CHF in her mid to late 80s.

SOCIAL HISTORY: Patient is a retried electrician.  He has only a remote history
of tobacco as a teenager.  He has no history of alcohol abuse
but does admit to social alcohol consumption.  He is currently
married and lives in [**Location 4288**] with his wife.
Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Old myocardial infarction,Iron deficiency anemia, unspecified,Other and unspecified angina pectoris,Other iatrogenic hypotension,Family history of ischemic heart disease
Crnry athrscl natve vssl,Cardiac dysrhythmias NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Osteoarthros NOS-unspec,Old myocardial infarct,Iron defic anemia NOS,Angina pectoris NEC/NOS,Iatrogenc hypotnsion NEC,Fam hx-ischem heart dis
Admission Date:  [**2146-10-11**]              Discharge Date:   [**2146-10-17**]

Date of Birth:  [**2075-7-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lipitor / Pravachol / Isosorbide

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Positive stress test

Major Surgical or Invasive Procedure:
Cardiac catheterization [**2146-10-11**]
CABGx3(LIMA-LAD, SVG-OM,SVG-PDA) [**2146-10-12**]


History of Present Illness:
71 year old male with multiple CAD risk factors who has had
"routine" stress tests for several years. A stress-echo in [**Month (only) 547**]
of [**2145**] was markedly positive and he was brought to the cath lab
where it was found that he had severe 3-vessel disease. Patient
was discharged to home to decide on if he wanted surgery or not
and was lost to follow up. His cardiologist finally convinced
him that he needed re-evaluation and he was cathed on [**2146-10-11**]
that showed worsening of his CAD.

Past Medical History:
CAD s/p MI
Diabetes type 2
Hypertension
High cholesterol
Osteoarthritis

Social History:
Patient is a retried electrician.  He has only a remote history
of tobacco as a teenager.  He has no history of alcohol abuse
but does admit to social alcohol consumption.  He is currently
married and lives in [**Location 4288**] with his wife.


Family History:
His father had heart problems in his 50s.  His mother died of
CHF in her mid to late 80s.


Physical Exam:
Admission:
145/79  HR 65  Height: 5'4"  Weight 164lbs
General: pleasant to speak with. Answers questions appropriately
Chest: Lungs clear to auscultation bilaterally
COR: Nl s1s2. No murmurs, rubs, gallops appreciated.
Abdomen: soft, nontender without rebound or guarding.
Normoactive bowel sounds.
Extremities: warm without edema. 1+ distal pulses
Labs: wbc 4.6, hct 31.5, plts 119.  Cr 1.3.
EKG: sinus bradycardia @ 57BPM, RBBB, inverted T waves
II/III/AVF

Pertinent Results:
[**2146-10-11**] 09:15AM   WBC-4.6 RBC-3.53* HGB-11.0* HCT-31.5* MCV-89
MCH-31.3 MCHC-35.0 RDW-12.3
[**2146-10-11**] 09:15AM   ALT(SGPT)-10 AST(SGOT)-13 ALK PHOS-51
AMYLASE-64 TOT BILI-0.2
[**2146-10-11**] 04:00PM   ALT(SGPT)-14 AST(SGOT)-15 LD(LDH)-133 ALK
PHOS-62 TOT BILI-0.4
[**2146-10-11**] 04:00PM   GLUCOSE-189* UREA N-21* CREAT-1.1 SODIUM-141
POTASSIUM-4.8 CHLORIDE-104 TOTAL CO2-30 ANION GAP-12

[**2146-10-11**] Cardiac Cath
1.  Selective coronary angiography of this right-dominant system

revealed three-vessel coronary artery disease.  The LMCA was
without
significant stenoses.  The LAD had a 90% stenosis after D1.  The
LCX was
totally occluded proximally.  A large OM branch and smaller
distal OM
branches were filled from collaterals.  The RCA had a long
mid-vessel
90% stenosis with a distal total occlusion before its
bifurcation, with
distal filling of the PDA and PL branches from the LAD.
2.  Limited resting hemodynamics revealed normal aortic
pressures


Brief Hospital Course:
Patient was admitted on [**2146-10-11**] for a diagnostic cath that
revealed severe 3-vessel disease (90% LAD, 100% prox LCX with
collaterals filling marginals, 90% mid RCA, distally occluded
RCA with PDA and PLS filling via collaterals).  [**10-12**] he was taken
to the OR where he underwent CABG x3 (Lima->LAD, SVG->OM/PDA).
Please refer to Dr[**Last Name (STitle) **] operative report for further
details. He was transferred to the CVICU where he woke up
neurologically intact and was extubated without difficulty. All
lines and drains were discontinued in a timely fashion. He was
transferred to the SDU on POD# 2. He continued to progress and
did well postoperatively. On POD# 3 it was felt he was ready for
discharge to home with VNA. All followup appointments were
discussed with Mr.[**Known lastname **] and he was advised that he might call
[**Hospital Ward Name 121**] 6 anytime with questions or concerns he may have.

Medications on Admission:
Glyburide 5 MG PO daily
Ketorolac 0.4% drops to left eye twice daily
Lisinopril 10MG PO daily
Claritin-D 120/5 daily
Metformin 1000mg PO twice daily
Metoprolol 50 MG PO twice daily
TNG sl 0.3 PRN chest pain
Zocor 40 MG po daily
ASA 81 mg po daily
Multivitamin

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
3. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 5 days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
6. 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*
7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*0*
10. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
11. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary Artery Disease
Diabetes
Osteoarthritis
Hypertension
hyperlididemia


Discharge Condition:
Good


Discharge Instructions:
No lifting more than 10 pounds for 10 weeks
No creams, lotions or powders to incisions
Shower daily, no baths or swimming
No driving for 4 weeks and off narcotics
Report any wound drainage/redness or fever more than 101
Take all medications as directed

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 20**] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 3070**]
Date/Time:[**2146-11-22**] 10:15
Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) in 4 weeks
Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 120**] in [**3-13**] weeks



Completed by:[**2146-10-15**]

Name:  [**Known lastname **],[**Known firstname 33**]                  Unit No:   [**Numeric Identifier 18045**]

Admission Date:  [**2146-10-11**]              Discharge Date:   [**2146-10-17**]

Date of Birth:  [**2075-7-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lipitor / Pravachol / Isosorbide

Attending:[**First Name3 (LF) 741**]
Addendum:
Sinus tachycardia developed and he was observed for 48 hours. He
remained in a sinus rhythm susequently and was discharged home
[**Female First Name (un) **] higher dose of lopressor.

Chief Complaint:
CAD

Major Surgical or Invasive Procedure:
Cardiac catheterization [**2146-10-11**]
CABGx3(LIMA-LAD, SVG-OM,SVG-PDA) [**2146-10-12**]


Past Medical History:
CAD s/p MI
Diabetes type 2
Hypertension
High cholesterol
Osteoarthritis

Pertinent Results:
[**2146-10-11**] 04:00PM   GLUCOSE-189* UREA N-21* CREAT-1.1 SODIUM-141
POTASSIUM-4.8 CHLORIDE-104 TOTAL CO2-30 ANION GAP-12

Brief Hospital Course:
On POD #3 ( [**10-15**]) he developed a sinus tachycardia and was kept
in the hospital for another 48 hours.  He remained stable and
was discharged on post operative day 5.

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
3. 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*
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*2*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
9. Potassium Chloride 20 mEq Packet Sig: One (1)  PO once a day
for 7 days.
Disp:*7 7* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 136**] Homecare

Discharge Diagnosis:
Coronary Artery Disease
Diabetes
Osteoarthritis
Hypertension
hyperlididemia


Discharge Condition:
Good


Discharge Instructions:
No lifting more than 10 pounds for 10 weeks
No creams, lotions or powders to incisions
Shower daily, no baths or swimming
No driving for 4 weeks and off of all narcotics
Report any wound drainage/redness or fever more than 101
Take all medications as directed
report any weight gain of greater than 3 pounds

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 14618**]
Date/Time:[**2146-11-22**] 10:15
Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 1477**]) in 4 weeks
Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 2124**] in [**3-13**] weeks


                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2146-10-17**]
{'Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Old myocardial infarction,Iron deficiency anemia, unspecified,Other and unspecified angina pectoris,Other iatrogenic hypotension,Family history of ischemic heart disease'}


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: Positive stress test

PRESENT ILLNESS: 71 year old male with multiple CAD risk factors who has had
"routine" stress tests for several years. A stress-echo in [**Month (only) 547**]
of [**2145**] was markedly positive and he was brought to the cath lab
where it was found that he had severe 3-vessel disease. Patient
was discharged to home to decide on if he wanted surgery or not
and was lost to follow up. His cardiologist finally convinced
him that he needed re-evaluation and he was cathed on [**2146-10-11**]
that showed worsening of his CAD.

MEDICAL HISTORY: CAD s/p MI
Diabetes type 2
Hypertension
High cholesterol
Osteoarthritis

MEDICATION ON ADMISSION: Glyburide 5 MG PO daily
Ketorolac 0.4% drops to left eye twice daily
Lisinopril 10MG PO daily
Claritin-D 120/5 daily
Metformin 1000mg PO twice daily
Metoprolol 50 MG PO twice daily
TNG sl 0.3 PRN chest pain
Zocor 40 MG po daily
ASA 81 mg po daily
Multivitamin

ALLERGIES: Lipitor / Pravachol / Isosorbide

PHYSICAL EXAM: Admission:
145/79  HR 65  Height: 5'4"  Weight 164lbs
General: pleasant to speak with. Answers questions appropriately
Chest: Lungs clear to auscultation bilaterally
COR: Nl s1s2. No murmurs, rubs, gallops appreciated.
Abdomen: soft, nontender without rebound or guarding.
Normoactive bowel sounds.
Extremities: warm without edema. 1+ distal pulses
Labs: wbc 4.6, hct 31.5, plts 119.  Cr 1.3.
EKG: sinus bradycardia @ 57BPM, RBBB, inverted T waves
II/III/AVF

FAMILY HISTORY: His father had heart problems in his 50s.  His mother died of
CHF in her mid to late 80s.

SOCIAL HISTORY: Patient is a retried electrician.  He has only a remote history
of tobacco as a teenager.  He has no history of alcohol abuse
but does admit to social alcohol consumption.  He is currently
married and lives in [**Location 4288**] with his wife. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Old myocardial infarction,Iron deficiency anemia, unspecified,Other and unspecified angina pectoris,Other iatrogenic hypotension,Family history of ischemic heart disease'}
