CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Mr. [**Known lastname 11762**] is a 51 year old gentleman with a history of atrial
fibrillation who recently presented to the emergency department
with chest pain.  A subsequent cardiac catheterization reveal
multi-vessel coronary artery disease and he was therefore
referred for surgical evaluation.

MEDICAL HISTORY: Cardiac History:
Atrial fibrillation. Diagnosed ~[**2166**], initially in paroxysmal
a-fib, occuring with exercise, more recently contstant afib for
~8 years. Rate controlled wiht metoprolol, blood pressure at
baseline 120's / 80's. No other risk factors so not
anticoagulated. Had TEEs in the past to evaluate for clot, most
recently [**2173**], negative for clot and otherwise normal.
Cardiac history negative for hypertension, hyperlipidemia, or
diabetes.

MEDICATION ON ADMISSION: toprol XL 100mg
aspirin 325mg
multivitamin
plavix 75mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At the time of discharge, Mr. [**Known lastname 11762**] was awake, alert, and
oriented.  His heart was of regular rate and rhythm with a rub.
His lungs were clear to ausculation bilaterally.  His abdomen
was soft, non-tender, and non-distended.  His medistinal
incision was clean, dry, and intact.  His sternum was stable.
His vein harvest site was clean dry and intact.  Trace edema was
noted in his upper extremities.

FAMILY HISTORY: The patient's sister has atrial fibrillation, is s/p TIA and on
Coumadin.  His mother has osteoporosis, glaucoma, and late onset
coronary artery disease. His father had atrial fibrillation,
coronary artery disease s/p CABG in his 50's, died of testicular
cancer at age 72.  His father's 2 siblings also have atrial
fibrillation.

SOCIAL HISTORY: Mr. [**Known lastname 11762**] is married and has two teenage children.  He works
as a sales engineer and exercises by rowing regularly. Other
social history is significant for the absence of current or past
tobacco use.  He drinks socially and has no history of alcohol
abuse.
Coronary atherosclerosis of native coronary artery,Mixed acid-base balance disorder,Other postoperative infection,Cellulitis and abscess of leg, except foot,Atrial fibrillation,Unspecified congenital anomaly of heart,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Acute myocardial infarction of other specified sites, subsequent episode of care,Abnormal coagulation profile
Crnry athrscl natve vssl,Mixed acid-base bal dis,Other postop infection,Cellulitis of leg,Atrial fibrillation,Cong heart anomaly NOS,Abn react-anastom/graft,Accid in resident instit,AMI NEC, subsequent,Abnrml coagultion prfile
Admission Date:  [**2176-6-24**]              Discharge Date:   [**2176-6-28**]

Date of Birth:  [**2124-11-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 922**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
[**6-24**] Coronary artery bypass graft times 5/MAZE/Ligation of left
atrial appendage


History of Present Illness:
Mr. [**Known lastname 11762**] is a 51 year old gentleman with a history of atrial
fibrillation who recently presented to the emergency department
with chest pain.  A subsequent cardiac catheterization reveal
multi-vessel coronary artery disease and he was therefore
referred for surgical evaluation.

Past Medical History:
Cardiac History:
Atrial fibrillation. Diagnosed ~[**2166**], initially in paroxysmal
a-fib, occuring with exercise, more recently contstant afib for
~8 years. Rate controlled wiht metoprolol, blood pressure at
baseline 120's / 80's. No other risk factors so not
anticoagulated. Had TEEs in the past to evaluate for clot, most
recently [**2173**], negative for clot and otherwise normal.
Cardiac history negative for hypertension, hyperlipidemia, or
diabetes.

Other Past History:
allergies
actinic keratosis.


Social History:
Mr. [**Known lastname 11762**] is married and has two teenage children.  He works
as a sales engineer and exercises by rowing regularly. Other
social history is significant for the absence of current or past
tobacco use.  He drinks socially and has no history of alcohol
abuse.


Family History:
The patient's sister has atrial fibrillation, is s/p TIA and on
Coumadin.  His mother has osteoporosis, glaucoma, and late onset
coronary artery disease. His father had atrial fibrillation,
coronary artery disease s/p CABG in his 50's, died of testicular
cancer at age 72.  His father's 2 siblings also have atrial
fibrillation.

Physical Exam:
At the time of discharge, Mr. [**Known lastname 11762**] was awake, alert, and
oriented.  His heart was of regular rate and rhythm with a rub.
His lungs were clear to ausculation bilaterally.  His abdomen
was soft, non-tender, and non-distended.  His medistinal
incision was clean, dry, and intact.  His sternum was stable.
His vein harvest site was clean dry and intact.  Trace edema was
noted in his upper extremities.

Pertinent Results:
[**2176-6-28**] 05:40AM BLOOD WBC-8.5 RBC-2.98*# Hgb-9.9*# Hct-26.7*
MCV-89 MCH-33.2* MCHC-37.1* RDW-14.7 Plt Ct-154
[**2176-6-28**] 05:40AM BLOOD Plt Ct-154
[**2176-6-28**] 05:40AM BLOOD PT-21.8* INR(PT)-2.1*
[**2176-6-28**] 05:40AM BLOOD Glucose-104 UreaN-12 Creat-0.8 Na-138
K-4.2 Cl-100 HCO3-32 AnGap-10

Brief Hospital Course:
Mr. [**Known lastname 11762**] [**Last Name (Titles) 1834**] a coronary artery bypass grafting times
five (LIMA to LAD, SVG to DIAG1, SVG to DIAG2, SVG to Ramus, SVG
to RCA)/MAZE/Ligation of left atrial appendage on [**2176-6-24**].  This
procedure was performed by Dr. [**Known firstname **] [**Last Name (NamePattern1) 914**].  He tolerated the
procedure well and was transfered in critical but stable
condition to the surgical intensive care unit.  On
post-operative day one he was extubated and his vasoactive drips
were weaned.  On the following day he was transferred to the
surgical step-down floor.  His wires were removed and he was
gently diuresed.  He was seen in consultation by the physical
therapy service.  His chest tubes were removed.  Coumadin was
started.  The patient did remain in sinus rhythm throughout the
hospital course.  He was discharged in stable condition to home
on POD#4.  By the time of discharge, the patient was ambulating
freely, the wound was healing and pain was controlled by oral
analgesics.  He was given extensive instructions regarding wound
care, diet restrictions and necessary follow up.

Medications on Admission:
toprol XL 100mg
aspirin 325mg
multivitamin
plavix 75mg

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:*0*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(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. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
6. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
7. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO once a day: dose
may change daily for goal INR [**12-17**], Dr. [**Last Name (STitle) 3306**] to dose.
Disp:*60 Tablet(s)* Refills:*2*
8. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7
days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
coronary artery disease
atrial fibrillation


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.
Please see Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (cardiologist) in [**11-15**] weeks.
Please call for appointment.
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3306**] (PCP) in [**11-15**] weeks  ([**Telephone/Fax (1) 4775**]).  Please
call for appointment.
coumadin f/u: spoke [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5638**] at Dr. [**Last Name (STitle) 3306**]' office-- they
will follow.  vna to draw on [**6-29**]- fax to [**Telephone/Fax (1) **], or call
(after 12pm) [**Telephone/Fax (1) 3308**] for [**Name8 (MD) 11582**] MD
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2176-6-28**]

Admission Date:  [**2176-7-1**]              Discharge Date:   [**2176-7-5**]

Date of Birth:  [**2124-11-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 922**]
Chief Complaint:
Redness of left lower extremity

Major Surgical or Invasive Procedure:
None


History of Present Illness:
51 year old male s/p CABG x5, MAZE, LAA ligation on [**6-24**]
with endovascular vein harvest of the left leg. Patient stated
he started to develop a red streak on left lower leg at
endoscopic vein harvest site that progressively increased during
the day.  Denied fever, chills. Patient stated he had one
episode of shakes saturday prior to admission that he related to
anxiety.

Past Medical History:
Cardiac History:
Atrial fibrillation. Diagnosed ~[**2166**], initially in paroxysmal
a-fib, occuring with exercise, more recently contstant afib for
~8 years. Rate controlled wiht metoprolol, blood pressure at
baseline 120's / 80's. No other risk factors so not
anticoagulated. Had TEEs in the past to evaluate for clot, most
recently [**2173**], negative for clot and otherwise normal.
Cardiac history negative for hypertension, hyperlipidemia, or
diabetes.

Other Past History:
allergies
actinic keratosis.


Social History:
Mr. [**Known lastname 11762**] is married and has two teenage children.  He works
as a sales engineer and exercises by rowing regularly. Other
social history is significant for the absence of current or past
tobacco use.  He drinks socially and has no history of alcohol
abuse.


Family History:
The patient's sister has atrial fibrillation, is s/p TIA and on
Coumadin.  His mother has osteoporosis, glaucoma, and late onset
coronary artery disease. His father had atrial fibrillation,
coronary artery disease s/p CABG in his 50's, died of testicular
cancer at age 72.  His father's 2 siblings also have atrial
fibrillation.

Physical Exam:
Neuro: alert, oriented, nonfocal
Pulmonary: lungs clear to auscultation bilaterally
Cardiac: Irregular rhythm. No murmurs or rubs appreciated.
Sternum stable with no erythema
Abdomen: soft and nontender, positive bowel sounds
Extremities: warm without edema. Left lower extremity cellulitis
improving.
Left leg incisions clean and dry.

Pertinent Results:
[**2176-7-1**] 07:05PM BLOOD WBC-11.1* RBC-3.29* Hgb-10.6* Hct-29.9*
MCV-91 MCH-32.3* MCHC-35.5* RDW-15.4 Plt Ct-377#
[**2176-7-1**] 07:05PM BLOOD PT-31.8* PTT-34.4 INR(PT)-3.3*
[**2176-7-1**] 07:05PM BLOOD Glucose-104 UreaN-11 Creat-0.9 Na-133
K-4.6 Cl-95* HCO3-29 AnGap-14
[**2176-7-1**] 07:05PM BLOOD ALT-125* AST-107* LD(LDH)-387*
AlkPhos-170* Amylase-144* TotBili-0.8
[**2176-7-1**] 07:05PM BLOOD Lipase-113*
[**2176-7-1**] 07:05PM BLOOD CRP-61.4*
[**2176-7-1**] 06:57PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG
[**2176-7-1**] Chest x-ray: 1. Interval decrease in bilateral apical
pneumothoraces.  2. Small bilateral pleural effusions with
associated basilar atelectasis


Brief Hospital Course:
Mr. [**Known lastname 11762**] was admitted for intravenous antibiotics for left
lower extremity cellulitis. He was started on intravenous
Unasyn. Shortly after admission, patient was noted to be in and
out of atrial fibrillation/flutter with a ventricular response
of up to 140 BPM. Dr [**Last Name (STitle) **] is the patients cardiologist and
decided to treat with IV Lopressor for rate control, with
specific request for no amiodarone. His PO Lopressor was up
titrated to 75 mg PO BID with better control of his ventricular
response.
On hospital day 3 he was put back on his home dose of Toprol XL
100 mg po daily.  His INR was elevated on admission to 3.3. It
was held for several days, being given 0.5 mg PO on HD3 when he
had an INR of 2.6.
The left lower extremity cellulitis showed significant
improvement on HD3 and Dr [**Last Name (STitle) 914**] felt patient would do well
with one more day of intravenous Unasyn and then discharge home
on Keflex PO for 7-10 days.
Also of note, patient's LFT's were found to be elevated so his
Lipitor and Tylenol were discontinued. After discontinuation,
LFT's trended towards normal. An ultrasound of his gallbladder
revealed sludge but no acute cholecystitis.
A loop monitor was placed by Dr.[**Name (NI) 1565**] service to monitor
his heart rate. A GI follow-up was recommended to his PCP for
further following of his elevated liver enzymes. Dr. [**Last Name (STitle) 3306**]
will manage his coumadin for a goal INR of 2.0-2.5. Her office
was notified on day of discharge and VNA will draw a PT/INR on
Saturday and Monday and then as instructed by Dr. [**Last Name (STitle) 3306**].
The discharged dose was reduced to 2mg.

Medications on Admission:
1. Toprol XL 100 MG PO daily
2. ASA 325 MG PO daily
3. MVI PO daily
4. Coumadin 4 MG PO daily
5. Lipitor 20 MG PO daily
6. Plavix 75 MG PO daily

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*4*
2. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed.
Disp:*30 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO twice a day.
Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*1*
6. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 1 months: For one month after surgery.
Disp:*90 Tablet(s)* Refills:*0*
7. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 10 days: For left lower extremity cellulitis.
Disp:*40 Capsule(s)* Refills:*0*
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours): Pt
noted history of GI upset with sustained NSAID use.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
9. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily):
Take 2mg daily or as directed by Dr [**Last Name (STitle) 3306**]. INR to be drawn
over weekend and then [**7-8**]. Goal INR 2.0-2.5.
Disp:*60 Tablet(s)* Refills:*0*
10. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Left lower extremity cellulitis


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. Gently pat the wound
dry.  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) Coumadin for atrial fibrillation with Goal INR 2.0-2.5. Dr.
[**Last Name (STitle) 3306**] to manage coumadin as an outpatient. Discharge dose
will be 2mg daily. VNA may draw PT/INR over weekend.
8) Please follow-up with a GI specialist through Dr. [**Last Name (STitle) 3306**]
regarding your elevated LFT's and gall bladder sludge. Dr.
[**Last Name (STitle) **] has spoken to your PCP regarding this.
9) You will be discharged home on a loop moitor followed by Dr.
[**Last Name (STitle) **] for atrial flutter.
10) 10 days of keflex for wound infection
11) Call with any questions or concerns.

Followup Instructions:
- Dr [**Last Name (STitle) 914**] in [**11-15**] weeks.
- Keep other appointments as directed by previous discharge
instructions.
- Take Coumadin 2mg daily or as directed by Dr [**Last Name (STitle) 3306**]. INR
to be drawn on Monday [**7-8**]. Plan confirmed with Dr
[**Last Name (STitle) 11844**]. Results may be faxed to [**Telephone/Fax (1) **], or call (after

- Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2176-9-3**] 1:40 or as instructed.
You will go home on a loop monitor which will be followed by Dr.
[**Last Name (STitle) **].



Completed by:[**2176-7-5**]
{'Coronary atherosclerosis of native coronary artery,Mixed acid-base balance disorder,Other postoperative infection,Cellulitis and abscess of leg, except foot,Atrial fibrillation,Unspecified congenital anomaly of heart,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Acute myocardial infarction of other specified sites, subsequent episode of care,Abnormal coagulation profile'}


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 11762**] is a 51 year old gentleman with a history of atrial
fibrillation who recently presented to the emergency department
with chest pain.  A subsequent cardiac catheterization reveal
multi-vessel coronary artery disease and he was therefore
referred for surgical evaluation.

MEDICAL HISTORY: Cardiac History:
Atrial fibrillation. Diagnosed ~[**2166**], initially in paroxysmal
a-fib, occuring with exercise, more recently contstant afib for
~8 years. Rate controlled wiht metoprolol, blood pressure at
baseline 120's / 80's. No other risk factors so not
anticoagulated. Had TEEs in the past to evaluate for clot, most
recently [**2173**], negative for clot and otherwise normal.
Cardiac history negative for hypertension, hyperlipidemia, or
diabetes.

MEDICATION ON ADMISSION: toprol XL 100mg
aspirin 325mg
multivitamin
plavix 75mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: At the time of discharge, Mr. [**Known lastname 11762**] was awake, alert, and
oriented.  His heart was of regular rate and rhythm with a rub.
His lungs were clear to ausculation bilaterally.  His abdomen
was soft, non-tender, and non-distended.  His medistinal
incision was clean, dry, and intact.  His sternum was stable.
His vein harvest site was clean dry and intact.  Trace edema was
noted in his upper extremities.

FAMILY HISTORY: The patient's sister has atrial fibrillation, is s/p TIA and on
Coumadin.  His mother has osteoporosis, glaucoma, and late onset
coronary artery disease. His father had atrial fibrillation,
coronary artery disease s/p CABG in his 50's, died of testicular
cancer at age 72.  His father's 2 siblings also have atrial
fibrillation.

SOCIAL HISTORY: Mr. [**Known lastname 11762**] is married and has two teenage children.  He works
as a sales engineer and exercises by rowing regularly. Other
social history is significant for the absence of current or past
tobacco use.  He drinks socially and has no history of alcohol
abuse. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Mixed acid-base balance disorder,Other postoperative infection,Cellulitis and abscess of leg, except foot,Atrial fibrillation,Unspecified congenital anomaly of heart,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution,Acute myocardial infarction of other specified sites, subsequent episode of care,Abnormal coagulation profile'}
