CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: The patient is a 51-year-old gentleman who presented with
unstable angina. Cardiac catheterization revealed severe 3-
vessel coronary disease with preserved left ventricular
function. The patient was therefore referred for coronary artery
bypass grafting.

MEDICAL HISTORY: 1) CAD, as above, [**2106-5-31**] exercise MIBI with fixed inferior
defect, associated hypokineses. EF reported at 57%.
2)Kidney stones
3)Colonic Polyps - s/p polypectomy

MEDICATION ON ADMISSION: ASA 81', Lipitor 80', plavix 600' (stopped [**6-7**]), metoprolol
12.5", SL NTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AFVSS

FAMILY HISTORY: Mother- died of SCD at age 62
Father- died of bladder cancer

SOCIAL HISTORY: He works as teacher in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 86**] Public School. He does not have
any smoking or drinking history.
Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Crnry athrscl natve vssl,Asthma NOS,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2106-6-16**]              Discharge Date:   [**2106-6-21**]

Date of Birth:  [**2054-7-4**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2106-6-16**] Coronary artery bypass grafting x4 left internal mammary
artery to left anterior descending coronary; reverse saphenous
vein single graft from aorta to the 1st diagonal coronary
artery; reverse saphenous vein single graft from aorta to the
1st obtuse marginal coronary artery; as well as reverse
saphenous vein single graft from aorta to the distal right
coronary artery


History of Present Illness:
The patient is a 51-year-old gentleman who presented with
unstable angina. Cardiac catheterization revealed severe 3-
vessel coronary disease with preserved left ventricular
function. The patient was therefore referred for coronary artery
bypass grafting.

Past Medical History:
1) CAD, as above, [**2106-5-31**] exercise MIBI with fixed inferior
defect, associated hypokineses. EF reported at 57%.
2)Kidney stones
3)Colonic Polyps - s/p polypectomy

Social History:
He works as teacher in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 86**] Public School. He does not have
any smoking or drinking history.


Family History:
Mother- died of SCD at age 62
Father- died of bladder cancer


Physical Exam:
AFVSS

NEURO:PERRL / [**Last Name (LF) 3899**], [**First Name3 (LF) 2995**] equally, Answers simple commands, Neg
pronator drift, Sensation intact to ST, 2 plus DTR, Neg [**Name2 (NI) **]

HEENT: NCAT, Neg lesions nares, oral pharnyx, auditory

NECK: Supple / FAROM, neg lyphandopathy, supra clavicular nodes

LUNGS: CTA b/l

CARDIAC: RRR without murmers

ABDOMEN: Soft, NTTP, ND, pos BS, neg CVA tenderness

EXT:

rle - palp fem, [**Doctor Last Name **], pt, dp

lle - palp fem, [**Doctor Last Name **], pt, dp


Pertinent Results:
  [**2106-6-16**] Intra-op TEE for CABG

PRE-BYPASS:
1. The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or  color Doppler.
2. Left ventricular wall thicknesses and cavity size are normal.
Overall left  ventricular systolic function is normal
(LVEF>55%).
3. The right ventricular cavity is mildly dilated. Right
ventricular systolic  function is normal.
4. There are simple atheroma in the aortic arch. There are
simple atheroma in  the descending thoracic aorta.
5. There are three aortic valve leaflets. There is no aortic
valve stenosis.  Trace aortic regurgitation is seen.
6. The mitral valve leaflets are structurally normal. Mild (1+)
mitral
regurgitation is seen.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive  infusions including phenylephrine.
1. Regional and global left ventricular systolic function are
normal. Right  ventricular systolic function is normal.
2. MR [**First Name (Titles) **] [**Last Name (Titles) 1506**]
3. Aorta is intact post decannulation


[**2106-6-20**] 04:00AM BLOOD WBC-6.7 RBC-2.96* Hgb-9.3* Hct-25.9*
MCV-88 MCH-31.4 MCHC-35.9* RDW-13.9 Plt Ct-208
[**2106-6-19**] 04:05AM BLOOD Glucose-107* UreaN-12 Creat-0.7 Na-140
K-4.0 Cl-103 HCO3-32 AnGap-9
[**2106-6-18**] 02:32AM BLOOD Calcium-8.1* Phos-3.2 Mg-1.9

[**2106-6-18**] Chest x-ray: Interval development of a small-to-moderate
left pleural effusion.


Brief Hospital Course:
Mr [**Known lastname 15848**],[**Known firstname 1112**]  was admitted on [**2105-6-16**] for an elective
surgery.

Pre-operatively, he was consented, prepped, and brought down to
the operating room for surgery.

He underwent the below procedure:

PROCEDURE:
1.  Coronary artery bypass grafting x4 left internal mammary
    artery to left anterior descending coronary; reverse
    saphenous vein single graft from aorta to the 1st
    diagonal coronary artery; reverse saphenous vein single
    graft from aorta to the 1st obtuse marginal coronary
    artery; as well as reverse saphenous vein single graft
    from aorta to the distal right coronary artery.
2.  Endoscopic left greater saphenous vein harvesting.

Intra-operatively, he was closely monitored and remained
hemodynamically stable. He tolerated the procedure well without
any difficulty or complication. Post-operatively, transferred to
the CSRU for further stabilization and invasive monitoring.
Within 24 hours, he awoke neurologically intact and was
extubated without any sequele. After extubation he was
transfered to the floor in stable condition. On the floor, he
remained hemodynamically stable with his pain controlled. He
remained in a normal sinus rhyth without atrial or ventricular
arrhythmias. He progressed with physical therapy to improve his
strength and mobility. He continues to make steady progress
without any incidents.  He was discharged home with services on
postoperative day five.

Medications on Admission:
ASA 81', Lipitor 80', plavix 600' (stopped [**6-7**]), metoprolol
12.5", SL NTG prn

Discharge Medications:
1. 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*
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
5. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 1 weeks.
Disp:*30 Tablet(s)* Refills:*0*
6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
7. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 7 days.
Disp:*14 Packet(s)* Refills:*0*
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain for 7 days.
Disp:*30 Tablet(s)* Refills:*0*
9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
Disp:*60 Tablet(s)* Refills:*0*
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
Disp:*60 Capsule(s)* Refills:*2*
11. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO three times a
day for 2 weeks: Take with food.
Disp:*42 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
CAD
ulcer dz w/history of UGI bleed
Asthma
HTN
dyslipidemia


Discharge Condition:
Good


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:
Call your PCP schedule an appointment for 2 weeks. [**Last Name (LF) **],[**First Name3 (LF) **]
M. [**Telephone/Fax (1) 2393**].

Provider: [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 128**] Date/Time:[**2106-6-29**]
3:00

Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) **], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2106-7-2**] 11:00

Call Dr[**Name (NI) 9379**] office and schedule an appointment for 4
weeks. ([**Telephone/Fax (1) 1504**].



Completed by:[**2106-6-22**]
{'Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: The patient is a 51-year-old gentleman who presented with
unstable angina. Cardiac catheterization revealed severe 3-
vessel coronary disease with preserved left ventricular
function. The patient was therefore referred for coronary artery
bypass grafting.

MEDICAL HISTORY: 1) CAD, as above, [**2106-5-31**] exercise MIBI with fixed inferior
defect, associated hypokineses. EF reported at 57%.
2)Kidney stones
3)Colonic Polyps - s/p polypectomy

MEDICATION ON ADMISSION: ASA 81', Lipitor 80', plavix 600' (stopped [**6-7**]), metoprolol
12.5", SL NTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: AFVSS

FAMILY HISTORY: Mother- died of SCD at age 62
Father- died of bladder cancer

SOCIAL HISTORY: He works as teacher in [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 86**] Public School. He does not have
any smoking or drinking history. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Asthma, unspecified type, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
