CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: Mrs. [**Known lastname **]. [**Known lastname **] is a -52-year-old female with hepatitis C and
child A cirrhosis who was known to have peripheral vascular
disease and underwent cardiac
catheterization for anginal symptoms that showed severe 3-vessel
disease, presenting for coronary revascularization. I decided to
perform the operation off-pump on a beating heart given early
cirrhosis to try and avoid causing further liver decompensation
from cardiopulmonary bypass.

MEDICAL HISTORY: CAD s/p CABGx4
Hepatitis C
Diabetes mellitus Type II
HTN
Asthma
GERD
Depression/Anxiety
Rheumatic Fever

MEDICATION ON ADMISSION: Prevacid (no substitute) 15mg daily
Zestril (no substitute:sun sensitive with Lisinopril)  20mg
daily
Prozac 40mg and 60mg alternating daily doses
Aspirin 81mg daily
Lorazepam PRN as needed for anxiety

ALLERGIES: Codeine

PHYSICAL EXAM: Ht: 5 feet   inches
Wt: 150 lbs
GENERAL:  Alert and well, no acute distress.
HEENT: Sclera anicteric, oropharynx clear.
NECK: Supple, no thyromegaly.
CVS: S1-S2, no added sounds, murmurs or thrills.
CHEST: Lungs clear to auscultation and percussion bilaterally.
ABDOMEN: RUQ and LLQ tender on deep palpation, no guarding. No
hepato- or splenomegaly.  BS normal.
LYMPH NODES: No cervical, supraclavicular, axillary,
epitrochlear, or inguinal lymphadenopathy.
NEURO: grossly intact.
EXTREMITIES: No edema, clubbing or cyanosis.  Peripheries well
perfused.
SKIN: Dry and intact.  No jaundice or pallor.  No rashes noted.

FAMILY HISTORY: Mother with CAD in her 30's.

SOCIAL HISTORY: Unemployed on disability. Occassional ETOH. Never smoked. Lives
with significant other.
Coronary atherosclerosis of native coronary artery,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Dysthymic disorder,Esophageal reflux,Asthma, unspecified type, unspecified
Crnry athrscl natve vssl,Chrnc hpt C wo hpat coma,Cirrhosis of liver NOS,Chr blood loss anemia,DMII wo cmp nt st uncntr,Hypertension NOS,Dysthymic disorder,Esophageal reflux,Asthma NOS
Admission Date:  [**2190-7-6**]              Discharge Date:   [**2190-7-13**]

Date of Birth:  [**2137-10-18**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2190-7-9**] - Off-pump coronary artery bypass grafting x4 with left
internal mammary artery grafted to the left anterior descending,
reverse saphenous vein graft to the marginal branch, diagonal
branch and the posterior descending artery.
[**2190-7-6**] - Cardiac Catheterization


History of Present Illness:
Mrs. [**Known lastname **]. [**Known lastname **] is a -52-year-old female with hepatitis C and
child A cirrhosis who was known to have peripheral vascular
disease and underwent cardiac
catheterization for anginal symptoms that showed severe 3-vessel
disease, presenting for coronary revascularization. I decided to
perform the operation off-pump on a beating heart given early
cirrhosis to try and avoid causing further liver decompensation
from cardiopulmonary bypass.


Past Medical History:
CAD s/p CABGx4
Hepatitis C
Diabetes mellitus Type II
HTN
Asthma
GERD
Depression/Anxiety
Rheumatic Fever

Social History:
Unemployed on disability. Occassional ETOH. Never smoked. Lives
with significant other.

Family History:
Mother with CAD in her 30's.

Physical Exam:
Ht: 5 feet   inches
Wt: 150 lbs
GENERAL:  Alert and well, no acute distress.
HEENT: Sclera anicteric, oropharynx clear.
NECK: Supple, no thyromegaly.
CVS: S1-S2, no added sounds, murmurs or thrills.
CHEST: Lungs clear to auscultation and percussion bilaterally.
ABDOMEN: RUQ and LLQ tender on deep palpation, no guarding. No
hepato- or splenomegaly.  BS normal.
LYMPH NODES: No cervical, supraclavicular, axillary,
epitrochlear, or inguinal lymphadenopathy.
NEURO: grossly intact.
EXTREMITIES: No edema, clubbing or cyanosis.  Peripheries well
perfused.
SKIN: Dry and intact.  No jaundice or pallor.  No rashes noted.


Pertinent Results:
[**2190-7-6**] 09:14AM   WBC-3.1* RBC-4.44 HGB-10.9* HCT-34.0* MCV-77*
MCH-24.5* MCHC-32.0 RDW-15.0
[**2190-7-6**] 09:14AM   ALT(SGPT)-37 AST(SGOT)-47* ALK PHOS-71 TOT
BILI-0.3
[**2190-7-6**] 09:14AM   GLUCOSE-178* UREA N-12 CREAT-0.7 SODIUM-135
POTASSIUM-4.0 CHLORIDE-104 TOTAL CO2-24 ANION GAP-11
[**2190-7-6**] 11:10AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-NEG

[**2190-7-6**] Cardiac Catheterization
1. Selective coronary angiography of this right dominant system
demonstrated three (3) vessel coronary artery disease.
Specifically the
left main was calcified with no flow limiting lesions.  The left

anterior descending artery was diffusely diseased with a long
complex
90% lesion in the proximal portion of the vessel that extended
into the
first diagaonal.  The left circumflex was a small caliber vessel
with a
90% lesion in the obtuse marginal.  The right coronary artery
was also a
small caliber vessel with diffuse disease throughtout the
vessel.
2. LV ventriculography demonstrated a preserved left ventricular

function with an ejection fraction of approximately 65%.  The
mitral
valve did not demonstrate any evidence of any valvular
regurgitation.
There was no significant pressure gradient across the aortic
valve upon
pullback from the left ventricle to the aorta.
3. Limited resting hemodynamics demonstrated moderate systemic
hypertension.

[**2190-7-9**] ECHO:
PREGRAFTING
No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thickness, cavity size, and systolic function
are normal (LVEF>55%). Right ventricular chamber size and free
wall motion are normal. There are simple atheroma in the
descending thoracic aorta. The aortic valve leaflets (3) are
mildly thickened. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. Thjere is mild to moderate TR.

POSTGRAFTING
Preserved biventricular systolic function. Study unchanged from
baseline.

[**2190-7-8**] Ultrasound
Mild heterogeneity within the liver. No ascites. No additional
pathology seen.


Brief Hospital Course:
Ms. [**Known lastname **]. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2190-7-6**] for further
evaluation of her chest pain. She underwent a cardiac
catheterization which revealed three vessel disease. Given the
severity of her disease, the cardiac surgical servive was
consulted for surgical evaluation. She was worked-up in the
usual preoperative manner. The hepatology service was consulted
for evaluation of surgical risk given her hepatitis. She was
classified as a Child's score A cirrhotic and cleared for
surgery. The hematology service was consulted given her
leukocytopenia however it was felt that this was mild,
longstanding and related to her hepatitis. On [**2190-7-9**], Ms. [**Known lastname **].
[**Known lastname **] was taken to the operating room where she underwent off
pump coronary artery bypass grafting to four vessels. Please see
operative note for details. Postoperatively she was taken to the
CSRU for monitoring. She latera awoke neurologically intact and
was extubated. On postoperative day one, Ms. [**Known lastname **]. [**Known lastname **] was
transferred to the step down unit for further recovery. She was
gently diuresed towards her preoperative weight. The physical
therapy service was consulted for assistance with her
postoperative strength and mobility.  She has remained
hemodynamically stable and is now ready for discharge.

Medications on Admission:
Prevacid (no substitute) 15mg daily
Zestril (no substitute:sun sensitive with Lisinopril)  20mg
daily
Prozac 40mg and 60mg alternating daily doses
Aspirin 81mg daily
Lorazepam PRN as needed for anxiety


Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
2. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
3. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
4. 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*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
6. Prevacid 15 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
7. Prozac 20 mg Capsule Sig: Two (2) Capsule PO once a day:
Alternate 40 mg with 60 mg every other day as before your
surgery.
Disp:*75 Capsule(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
CAD s/p CABGx4
Hepatitis C
Diabetes mellitus Type II
HTN
Asthma
GERD
Depression/Anxiety
Rheumatic Fever


Discharge Condition:
Stable


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
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. Please shower daily.
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) Call with any questions or concerns.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with cardiologist Dr. [**Last Name (STitle) **] in 2 weeks. [**Telephone/Fax (1) 57005**]
Follow-up with Dr. [**Last Name (STitle) **] in [**2-6**] weeks. [**Telephone/Fax (1) 6803**]



Completed by:[**2190-7-13**]
{'Coronary atherosclerosis of native coronary artery,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Dysthymic disorder,Esophageal reflux,Asthma, unspecified type, 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: Mrs. [**Known lastname **]. [**Known lastname **] is a -52-year-old female with hepatitis C and
child A cirrhosis who was known to have peripheral vascular
disease and underwent cardiac
catheterization for anginal symptoms that showed severe 3-vessel
disease, presenting for coronary revascularization. I decided to
perform the operation off-pump on a beating heart given early
cirrhosis to try and avoid causing further liver decompensation
from cardiopulmonary bypass.

MEDICAL HISTORY: CAD s/p CABGx4
Hepatitis C
Diabetes mellitus Type II
HTN
Asthma
GERD
Depression/Anxiety
Rheumatic Fever

MEDICATION ON ADMISSION: Prevacid (no substitute) 15mg daily
Zestril (no substitute:sun sensitive with Lisinopril)  20mg
daily
Prozac 40mg and 60mg alternating daily doses
Aspirin 81mg daily
Lorazepam PRN as needed for anxiety

ALLERGIES: Codeine

PHYSICAL EXAM: Ht: 5 feet   inches
Wt: 150 lbs
GENERAL:  Alert and well, no acute distress.
HEENT: Sclera anicteric, oropharynx clear.
NECK: Supple, no thyromegaly.
CVS: S1-S2, no added sounds, murmurs or thrills.
CHEST: Lungs clear to auscultation and percussion bilaterally.
ABDOMEN: RUQ and LLQ tender on deep palpation, no guarding. No
hepato- or splenomegaly.  BS normal.
LYMPH NODES: No cervical, supraclavicular, axillary,
epitrochlear, or inguinal lymphadenopathy.
NEURO: grossly intact.
EXTREMITIES: No edema, clubbing or cyanosis.  Peripheries well
perfused.
SKIN: Dry and intact.  No jaundice or pallor.  No rashes noted.

FAMILY HISTORY: Mother with CAD in her 30's.

SOCIAL HISTORY: Unemployed on disability. Occassional ETOH. Never smoked. Lives
with significant other. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic hepatitis C without mention of hepatic coma,Cirrhosis of liver without mention of alcohol,Iron deficiency anemia secondary to blood loss (chronic),Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Dysthymic disorder,Esophageal reflux,Asthma, unspecified type, unspecified'}
