CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Mr. [**Known lastname 69850**] is a 66 year old male who developed fatigue/chest
pain this past [**Month (only) **]/[**Month (only) 205**] while playing tennis. The symptoms were
similiar to those he experienced in [**2112**] prior to receiving an
left anterior descending artery stent. His symptoms resolved
with rest however he has noticed a progressive decline in his
aerobic capacity. A stress echocardiogram was obtained which was
positive for ischemia. A cardiac catheterization was
subsequently performed
which showed severe left main and single vessel disease. Given
the severity of his disease, he has been referred for surgical
management.

MEDICAL HISTORY: - Coronary artery disease
- Hypertension
- Hyperlipidemia
- Diverticulitis
- Arthritis
- GERD
- PCI/Stent to LAD [**2112**]
- Achilles tendon rupture with repair [**2106**]
- Right rotator cuff surgery in [**2122**] and [**2123**], right
- Arthroscopy of knee, left

MEDICATION ON ADMISSION: Coreg 3.15mg twice daily
Lipitor 80mg daily
Diovan 80mg daily
Aspirin 81mg daily
Prevacid 30mg daily
Multivitamins
Fish oil

ALLERGIES: Vioxx

PHYSICAL EXAM: Pulse: 85 Resp: 16 O2 sat: 97%
B/P  Right: 134/77   Left: 118/81
Height: 5'7"    Weight: 207lbs

FAMILY HISTORY: Mr. [**Known lastname 69851**] brother has coronary artery disease and diabetes.

SOCIAL HISTORY: Mr. [**Known lastname 69850**] is a high school guidance counselor.  He smoked
1-1.5 packs per day for ten years, quiting in his 20s.  He
reports drinking less than one alcoholic beverage per week.
Coronary atherosclerosis of native coronary artery,Atrial flutter,Other and unspecified angina pectoris,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Esophageal reflux,Long-term (current) use of aspirin,Arthropathy, unspecified, site unspecified,Fever, unspecified
Crnry athrscl natve vssl,Atrial flutter,Angina pectoris NEC/NOS,Status-post ptca,Hypertension NOS,Hyperlipidemia NEC/NOS,Dvrtclo colon w/o hmrhg,Esophageal reflux,Long-term use of aspirin,Arthropathy NOS-unspec,Fever NOS
Admission Date:  [**2126-9-17**]              Discharge Date:   [**2126-9-23**]

Date of Birth:  [**2060-5-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Vioxx

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
Coronary artery bypass grafting times three (left internal
mammary to left anterior descending, saphenous vein graft to
diagonal, saphenous vein graft to obtuse marginal) on [**2126-9-17**]


History of Present Illness:
Mr. [**Known lastname 69850**] is a 66 year old male who developed fatigue/chest
pain this past [**Month (only) **]/[**Month (only) 205**] while playing tennis. The symptoms were
similiar to those he experienced in [**2112**] prior to receiving an
left anterior descending artery stent. His symptoms resolved
with rest however he has noticed a progressive decline in his
aerobic capacity. A stress echocardiogram was obtained which was
positive for ischemia. A cardiac catheterization was
subsequently performed
which showed severe left main and single vessel disease. Given
the severity of his disease, he has been referred for surgical
management.

Past Medical History:
- Coronary artery disease
- Hypertension
- Hyperlipidemia
- Diverticulitis
- Arthritis
- GERD
- PCI/Stent to LAD [**2112**]
- Achilles tendon rupture with repair [**2106**]
- Right rotator cuff surgery in [**2122**] and [**2123**], right
- Arthroscopy of knee, left


Social History:
Mr. [**Known lastname 69850**] is a high school guidance counselor.  He smoked
1-1.5 packs per day for ten years, quiting in his 20s.  He
reports drinking less than one alcoholic beverage per week.


Family History:
Mr. [**Known lastname 69851**] brother has coronary artery disease and diabetes.


Physical Exam:
Pulse: 85 Resp: 16 O2 sat: 97%
B/P  Right: 134/77   Left: 118/81
Height: 5'7"    Weight: 207lbs

General: Well-developed male in no acute distress
Skin: Warm [X] Dry [X] intact [X]
HEENT: NCAT [X] 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
+
[X]
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: -   Left: -


Pertinent Results:
Intra-op TEE [**2126-9-17**]:
Conclusions
Pre-Bypass:
The left atrium is normal in size. No spontaneous echo contrast
or thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage.
Left ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%).
Right ventricular chamber size and free wall motion are normal.
The ascending, transverse and descending thoracic aorta are
normal in diameter with minimal atherosclerotic plaque. The
diameters of aorta at the sinus, ascending and arch levels are
normal.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis or aortic
regurgitation.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen.

Post-Bypass:
The patient is A-Paced on a phenylephrine infusion s/p 3 vessel
CABG
Left ventricular function is preserved with EF-55%. No WMA.
Normal functioning aortic valve and trivial MR remain.
There is a small right pleural effusion.
There is no echocardiographic evidence of a aortic dissection
post de-cannulation.
.


[**2126-9-23**] 06:10AM BLOOD Hct-27.0*
[**2126-9-22**] 05:40AM BLOOD WBC-6.3 RBC-2.69* Hgb-8.8* Hct-26.2*
MCV-97 MCH-32.7* MCHC-33.7 RDW-13.6 Plt Ct-236
[**2126-9-21**] 04:54AM BLOOD WBC-7.2 RBC-2.50* Hgb-8.5* Hct-24.1*
MCV-97 MCH-33.9* MCHC-35.2* RDW-13.5 Plt Ct-165
[**2126-9-20**] 02:55PM BLOOD Hct-23.0*
[**2126-9-20**] 10:19AM BLOOD WBC-7.8 RBC-2.67* Hgb-8.8* Hct-25.9*
MCV-97 MCH-33.1* MCHC-34.1 RDW-12.8 Plt Ct-145*
[**2126-9-23**] 06:10AM BLOOD PT-20.0* INR(PT)-1.9*
[**2126-9-22**] 05:40AM BLOOD PT-13.1* INR(PT)-1.2*
[**2126-9-21**] 04:54AM BLOOD PT-12.0 INR(PT)-1.1
[**2126-9-22**] 05:40AM BLOOD Glucose-144* UreaN-19 Creat-0.8 Na-139
K-4.6 Cl-104 HCO3-29 AnGap-11
[**2126-9-21**] 04:54AM BLOOD Glucose-103* UreaN-23* Creat-0.9 Na-142
K-3.8 Cl-105 HCO3-31 AnGap-10
[**2126-9-20**] 10:19AM BLOOD Glucose-136* UreaN-22* Creat-0.9 Na-140
K-4.0 Cl-103 HCO3-34* AnGap-7*

Brief Hospital Course:
Mr. [**Known lastname 69850**] was brought to the Operating Room on [**2126-9-17**] where he
underwent coronary artery bypass grafting times three (left
internal mammary to left anterior descending, saphenous vein
graft to diagonal, saphenous vein graft to obtuse marginal).
Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.
Post-operative day one found the patient extubated, alert and
oriented and breathing comfortably.  The patient was
neurologically intact and hemodynamically stable, weaned from
inotropic and vasopressor support.  Beta blocker was initiated
and the patient was gently diuresed toward the preoperative
weight.  The patient was transferred to the telemetry floor for
further recovery.  He experienced atrial fibrillation, which
converted to sinus rhythm with amiodarone. AFib returned and he
was started on coumadin.  He remained in AFib/Flutter at
discharge.  He received blood for a hct of 22%.  The patient
developed a fever and blood was discontinued.  Hematocrit rose
appropriately and remained stable.  Stool guaiac was negative.
Chest tubes and pacing wires were discontinued without
complication.  The patient was evaluated by the physical therapy
service for assistance with strength and mobility.  By the time
of discharge on post-operative day 6 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  The patient was discharged to home in good
condition with appropriate follow up instructions.

Medications on Admission:
Coreg 3.15mg twice daily
Lipitor 80mg daily
Diovan 80mg daily
Aspirin 81mg daily
Prevacid 30mg daily
Multivitamins
Fish oil


Discharge Medications:
1. Aspirin 81 mg PO DAILY
2. Atorvastatin 80 mg PO DAILY
3. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY
4. Amiodarone 400 mg PO BID
400mg [**Hospital1 **] x 1 week, then 400mg daily x 1 week, then 200mg daily

RX *amiodarone 200 mg 2 tablet(s) by mouth twice a day Disp #*56
Tablet Refills:*0
5. Docusate Sodium 100 mg PO BID
RX *docusate sodium [Col-Rite] 100 mg 1 capsule(s) by mouth
twice a day Disp #*60 Capsule Refills:*0
6. Furosemide 20 mg PO DAILY Duration: 5 Days
RX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*5 Tablet
Refills:*0
7. Potassium Chloride 20 mEq PO DAILY Duration: 5 Days
Hold for K+ > 4.5
RX *potassium chloride [Klor-Con] 20 mEq 1 packet by mouth daily
Disp #*5 Packet Refills:*0
8. HYDROmorphone (Dilaudid) 2-4 mg PO Q3H:PRN pain
RX *hydromorphone 2 mg [**1-14**] tablet(s) by mouth q3h Disp #*60
Tablet Refills:*0
9. Ondansetron 4 mg PO Q8H:PRN nausea
RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours
Disp #*30 Tablet Refills:*0
10. Polyethylene Glycol 17 g PO DAILY:PRN constipation
11. Metoprolol Tartrate 12.5 mg PO BID
RX *metoprolol tartrate 25 mg 0.5 (One half) tablet(s) by mouth
twice a day Disp #*60 Tablet Refills:*0
12. Tamsulosin 0.4 mg PO HS
RX *tamsulosin 0.4 mg 1 capsule(s) by mouth daily Disp #*30
Capsule Refills:*0
13. Warfarin 2 mg PO DAILY16 Duration: 1 Doses
dose to change per Dr. [**First Name (STitle) 4223**] for goal INR 2-2.5
RX *warfarin [Coumadin] 2 mg 1 tablet(s) by mouth daily Disp
#*30 Tablet Refills:*0


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
coronary artery disease
PMH:
- Hypertension
- Hyperlipidemia
- Diverticulitis
- Arthritis
- GERD
Past Surgical History:
- PCI/Stent to LAD [**2112**]
- Achilles tendon rupture with repair [**2106**]
- Right rotator cuff surgery in [**2122**] and [**2123**], right
- Arthroscopy of knee, left


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


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:
Wound Check at Cardiac Surgery Office [**Telephone/Fax (1) 170**] [**2126-9-26**]
10:45p
Surgeon Dr. [**Last Name (STitle) **] [**2126-10-16**] at 1:00p [**Telephone/Fax (1) 170**]
Cardiologist Dr. [**Last Name (STitle) 6254**] [**2126-10-10**] at 11:20am
Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) 69852**] [**Name (STitle) 4223**] ([**Telephone/Fax (1) 69853**] in [**4-18**] 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**

Labs: PT/INR
Coumadin for AFib
Goal INR 2-2.5
First draw [**2126-9-24**]
Then please do INR checks Monday, Wednesday, and Friday for 2
weeks then decrease as directed by Dr. [**First Name (STitle) 4223**]
Results to phone [**Telephone/Fax (1) 69854**], fax [**Telephone/Fax (1) 69855**]



Completed by:[**2126-9-23**]
{'Coronary atherosclerosis of native coronary artery,Atrial flutter,Other and unspecified angina pectoris,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Esophageal reflux,Long-term (current) use of aspirin,Arthropathy, unspecified, site unspecified,Fever, unspecified'}


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: Mr. [**Known lastname 69850**] is a 66 year old male who developed fatigue/chest
pain this past [**Month (only) **]/[**Month (only) 205**] while playing tennis. The symptoms were
similiar to those he experienced in [**2112**] prior to receiving an
left anterior descending artery stent. His symptoms resolved
with rest however he has noticed a progressive decline in his
aerobic capacity. A stress echocardiogram was obtained which was
positive for ischemia. A cardiac catheterization was
subsequently performed
which showed severe left main and single vessel disease. Given
the severity of his disease, he has been referred for surgical
management.

MEDICAL HISTORY: - Coronary artery disease
- Hypertension
- Hyperlipidemia
- Diverticulitis
- Arthritis
- GERD
- PCI/Stent to LAD [**2112**]
- Achilles tendon rupture with repair [**2106**]
- Right rotator cuff surgery in [**2122**] and [**2123**], right
- Arthroscopy of knee, left

MEDICATION ON ADMISSION: Coreg 3.15mg twice daily
Lipitor 80mg daily
Diovan 80mg daily
Aspirin 81mg daily
Prevacid 30mg daily
Multivitamins
Fish oil

ALLERGIES: Vioxx

PHYSICAL EXAM: Pulse: 85 Resp: 16 O2 sat: 97%
B/P  Right: 134/77   Left: 118/81
Height: 5'7"    Weight: 207lbs

FAMILY HISTORY: Mr. [**Known lastname 69851**] brother has coronary artery disease and diabetes.

SOCIAL HISTORY: Mr. [**Known lastname 69850**] is a high school guidance counselor.  He smoked
1-1.5 packs per day for ten years, quiting in his 20s.  He
reports drinking less than one alcoholic beverage per week. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Atrial flutter,Other and unspecified angina pectoris,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diverticulosis of colon (without mention of hemorrhage),Esophageal reflux,Long-term (current) use of aspirin,Arthropathy, unspecified, site unspecified,Fever, unspecified'}
