CHIEF COMPLAINT: Dyspnea and Chest pain

PRESENT ILLNESS: 46 year old male with type 1 diabetes on an insulin pump,
hypertension, and hypercholesterolemia, with admission to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] on [**11-2**] with chest pain and mild dyspnea. The chest
pain initially started on Sunday radiating across chest and
under axilla. This persisted all night and by Monday it was
radiating to his left collar bone and down left arm with left
5th digit numbness.
Ruled out for MI. Gated study revealed LVEF of 41% with global
hypokinesis with no areas of ischemia or infarct. It was
initially thought that his CP was non-cardiac and he was sent
home on percocet, but when he tried to return to work, he became
very short of breath and diaphoretic. He then contact[**Name (NI) **] her
primary MD who sent him to see Dr. [**Last Name (STitle) 77919**].  He was sent to
the [**Hospital1 **] where he had a cardiac cath that showed multivessel
disease and was referred for surgical evaluation

MEDICAL HISTORY: Type I DM diagnosed on [**2140-8-16**], on insulin pump
HTN
Hypercholesterolemia
Seizure as a child in the setting of fevers only
Past Surgical History
S/p Lap Cholecystectomy [**2148**]

MEDICATION ON ADMISSION: INSULIN ASPART [NOVOLOG] -  (Prescribed by Other Provider) - 100
unit/mL Solution - insulin pump  12 0.925 units per hour, 3am
1.4
unit hr, 5am 0.65 units, 7a 0.6 units her hour, 12pm 0.4 units
per hour, 6pm 0.65 units per, 8pm 0.8 units her hour.
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
(One) Tablet(s) by mouth once a day
OXYCODONE-ACETAMINOPHEN -  (Prescribed by Other Provider) - 5
mg-325 mg Tablet - 1 Tablet(s) by mouth every four hours as
needed for chest pain
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
(One) Tablet(s) by mouth once a day
Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 (One) Tablet(s) by mouth once a day

ALLERGIES: General Anesthesia  / phenobarbital / Pentobarbital

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Father with CABG at age 58.
Paternal grandfather died of MI at age 52.
Maternal grandfather died of HF at age 79.
Maternal uncle died of Ventricular Fibrillation at age 49.
Another maternal uncle died during valve replacement surgery in
his mid 50's.

SOCIAL HISTORY: He is married and lives with his wife in [**Name (NI) 20935**] MA.
He has four children ages [**9-25**].
He works full time as an operator at sewage treatment center.
Denied any tobacco and alcohol
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Anemia, unspecified,Long-term (current) use of insulin
Crnry athrscl natve vssl,Intermed coronary synd,DMI wo cmp nt st uncntrl,Status cardiac pacemaker,Hyperlipidemia NEC/NOS,Iatrogenc hypotnsion NEC,Anemia NOS,Long-term use of insulin
Admission Date:  [**2150-11-11**]              Discharge Date:   [**2150-11-16**]

Date of Birth:  [**2104-10-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
General Anesthesia  / phenobarbital / Pentobarbital

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea and Chest pain


Major Surgical or Invasive Procedure:
[**2150-11-12**]: Coronary artery bypass grafting x3: Left internal
mammary artery graft to left anterior descending, reverse
saphenous vein graft to the first marginal branch and diagonal
branch.


History of Present Illness:
46 year old male with type 1 diabetes on an insulin pump,
hypertension, and hypercholesterolemia, with admission to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] on [**11-2**] with chest pain and mild dyspnea. The chest
pain initially started on Sunday radiating across chest and
under axilla. This persisted all night and by Monday it was
radiating to his left collar bone and down left arm with left
5th digit numbness.
Ruled out for MI. Gated study revealed LVEF of 41% with global
hypokinesis with no areas of ischemia or infarct. It was
initially thought that his CP was non-cardiac and he was sent
home on percocet, but when he tried to return to work, he became
very short of breath and diaphoretic. He then contact[**Name (NI) **] her
primary MD who sent him to see Dr. [**Last Name (STitle) 77919**].  He was sent to
the [**Hospital1 **] where he had a cardiac cath that showed multivessel
disease and was referred for surgical evaluation

However, he and his wife have been anxious at home and over the
past day, he notes slightly more dyspnea at rest.  He also has
had continuous CP since his d/c.  He contact[**Name (NI) **] cardiac surgery
who asked that he come to the ED.

In the ED, his HR and bp were well controlled, and his pain
improved from [**5-15**] to [**3-15**] with SL nitro. He was still slightly
dyspneic at rest.
Denies PND, edema, leg swelling, h/o DVTs or PEs. ROS otw neg in
detail.

Past Medical History:
Type I DM diagnosed on [**2140-8-16**], on insulin pump
HTN
Hypercholesterolemia
Seizure as a child in the setting of fevers only
Past Surgical History
S/p Lap Cholecystectomy [**2148**]


Social History:
He is married and lives with his wife in [**Name (NI) 20935**] MA.
He has four children ages [**9-25**].
He works full time as an operator at sewage treatment center.
Denied any tobacco and alcohol


Family History:
Father with CABG at age 58.
Paternal grandfather died of MI at age 52.
Maternal grandfather died of HF at age 79.
Maternal uncle died of Ventricular Fibrillation at age 49.
Another maternal uncle died during valve replacement surgery in
his mid 50's.


Physical Exam:
Physical Exam

Pulse: 67 Resp:18  O2 sat:100
B/P  Right:107/60   Left:
Height:5 feet   9.5 inches     Weight: 201   pounds
General:
Skin: Dry and intact
HEENT: PERRLA, EOMI.
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally
Heart: JVP < 5 cm. PMI focal. Nl S1, S2. No S4. No m.
Abdomen: Soft, non-distended and non-tender.
Extremities:No edema. Warm and well perfused.
Neuro: Grossly intact
Psych: Anxious but otherwise appropriate
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:1+   Left:1+
PT           [**Name (NI) 167**]:1+   Left:1+
Radial       Right:2+  Left:2+

Pertinent Results:
[**2150-11-10**]; CTA CHEST: The aorta is normal in caliber without
acute pathology. The  pulmonary arterial tree is well opacified
to the subsegmental level, demonstrating no filling defects to
suggest pulmonary embolism. The heart is normal in size without
pericardial effusion. Multivessel coronary arterial
calcifications are present. There is no mediastinal, hilar, or
axillary adenopathy by size criteria.
The lungs are clear with the exception of bibasilar dependent
atelectasis.  Central airways are patent.
BONE WINDOW: No focal concerning lesion.
Limited subdiaphragmatic evaluation demonstrates a 12-mm
interpolar exophytic left renal cyst. The spleen is mildly
enlarged to 14 cm.
IMPRESSION:
1. No acute aortic pathology or pulmonary embolism.
2. Borderline splenomegaly to 13-14 cm, clinical significance
unclear.

[**2150-11-15**] 05:49AM BLOOD WBC-6.6 RBC-3.32* Hgb-9.8* Hct-28.1*
MCV-85 MCH-29.5 MCHC-34.8 RDW-12.4 Plt Ct-132*
[**2150-11-14**] 05:06AM BLOOD WBC-6.7 RBC-3.40* Hgb-10.0* Hct-27.8*
MCV-82 MCH-29.3 MCHC-35.8* RDW-12.2 Plt Ct-125*
[**2150-11-15**] 05:49AM BLOOD Glucose-173* UreaN-14 Creat-1.1 Na-136
K-4.0 Cl-101 HCO3-31 AnGap-8
[**2150-11-14**] 03:00PM BLOOD Glucose-237* UreaN-19 Creat-1.2 Na-135
K-4.0 Cl-100 HCO3-30 AnGap-9
[**2150-11-14**] 05:06AM BLOOD Glucose-123* UreaN-20 Creat-1.3* Na-133
K-4.4 Cl-101 HCO3-28 AnGap-8

Brief Hospital Course:
Mr. [**Known lastname **] is a 46 year-old male with type I DM with left main
equivalent CAD was admitted with acute chest pain and and marked
dyspnea at rest. His chest pain was somewhat atypical given his
essentially normal EKG and prev neg troponins however given his
coronary anatomy and improvement of his chest pain and dyspnea
on Nitro he was admitted to the MICU for presumed subendocardial
ischemia.  He was followed by [**Hospital **] Clinic for his type I
Diabetes and insulin pump. On [**2150-11-12**] he was taken to the
operating room with cardiac surgery for Coronary Artery Bypass
Graft surgery.  See operative report for further details.
Overall the he tolerated the procedure well and post-operatively
was transferred to the CVICU in stable condition for recovery
and invasive monitoring. He was extubated on post operative
night, alert, oriented and breathing comfortably.  The patient
was neurologically intact and hemodynamically stable, weaned
from inotropic and vasopressor support on POD 1. Beta blocker
was initiated and the patient was gently diuresed toward the
preoperative weight. His insulin pump was restarted which he
managed himself. He transferred to the telemetry floor for
further recovery. 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 POD four he was ambulating freely, the
wound was healing and pain was controlled with oral analgesics.
The he was discharged home with services in good condition with
appropriate follow up instructions

Medications on Admission:
INSULIN ASPART [NOVOLOG] -  (Prescribed by Other Provider) - 100
unit/mL Solution - insulin pump  12 0.925 units per hour, 3am
1.4
unit hr, 5am 0.65 units, 7a 0.6 units her hour, 12pm 0.4 units
per hour, 6pm 0.65 units per, 8pm 0.8 units her hour.
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
(One) Tablet(s) by mouth once a day
OXYCODONE-ACETAMINOPHEN -  (Prescribed by Other Provider) - 5
mg-325 mg Tablet - 1 Tablet(s) by mouth every four hours as
needed for chest pain
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
(One) Tablet(s) by mouth once a day
Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 (One) Tablet(s) by mouth once a day


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
2. 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:*1*
3. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*1*
4. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*
5. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day for 7 days.
Disp:*7 Tablet, ER Particles/Crystals(s)* Refills:*0*
6. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
7. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*1*
8. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
9. insulin pump


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Coronary Artery Disease s/p CABG
Diabetes Mellitus Type I on insulin pump
Hypertension
Hypercholesterolemia


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with Percocet
Sternal Incision - healing well, no erythema or drainage
Left leg EVH no erythema or drainage
Edema +1 bilateral lower extremities


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 follow up with outpatient endocrinology for blood glucose
management goal 100-130

**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**]
Tuesday [**11-24**] at 10:30 am

Surgeon Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**]  Date/Time:[**2150-12-16**] 1:00
Location: [**Hospital Unit Name **] [**Last Name (NamePattern1) **] [**Hospital Unit Name **]

Cardiologist Dr. [**Last Name (STitle) 92599**] [**Telephone/Fax (1) 65733**] - Wednesday [**12-23**]
at 2pm

Please call to schedule the following:
Primary Care Dr. [**First Name (STitle) 1661**] [**Telephone/Fax (1) 79522**] in [**3-10**] 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**



Completed by:[**2150-11-16**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Anemia, unspecified,Long-term (current) use of insulin'}


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: Dyspnea and Chest pain

PRESENT ILLNESS: 46 year old male with type 1 diabetes on an insulin pump,
hypertension, and hypercholesterolemia, with admission to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] on [**11-2**] with chest pain and mild dyspnea. The chest
pain initially started on Sunday radiating across chest and
under axilla. This persisted all night and by Monday it was
radiating to his left collar bone and down left arm with left
5th digit numbness.
Ruled out for MI. Gated study revealed LVEF of 41% with global
hypokinesis with no areas of ischemia or infarct. It was
initially thought that his CP was non-cardiac and he was sent
home on percocet, but when he tried to return to work, he became
very short of breath and diaphoretic. He then contact[**Name (NI) **] her
primary MD who sent him to see Dr. [**Last Name (STitle) 77919**].  He was sent to
the [**Hospital1 **] where he had a cardiac cath that showed multivessel
disease and was referred for surgical evaluation

MEDICAL HISTORY: Type I DM diagnosed on [**2140-8-16**], on insulin pump
HTN
Hypercholesterolemia
Seizure as a child in the setting of fevers only
Past Surgical History
S/p Lap Cholecystectomy [**2148**]

MEDICATION ON ADMISSION: INSULIN ASPART [NOVOLOG] -  (Prescribed by Other Provider) - 100
unit/mL Solution - insulin pump  12 0.925 units per hour, 3am
1.4
unit hr, 5am 0.65 units, 7a 0.6 units her hour, 12pm 0.4 units
per hour, 6pm 0.65 units per, 8pm 0.8 units her hour.
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
(One) Tablet(s) by mouth once a day
OXYCODONE-ACETAMINOPHEN -  (Prescribed by Other Provider) - 5
mg-325 mg Tablet - 1 Tablet(s) by mouth every four hours as
needed for chest pain
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
(One) Tablet(s) by mouth once a day
Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 (One) Tablet(s) by mouth once a day

ALLERGIES: General Anesthesia  / phenobarbital / Pentobarbital

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Father with CABG at age 58.
Paternal grandfather died of MI at age 52.
Maternal grandfather died of HF at age 79.
Maternal uncle died of Ventricular Fibrillation at age 49.
Another maternal uncle died during valve replacement surgery in
his mid 50's.

SOCIAL HISTORY: He is married and lives with his wife in [**Name (NI) 20935**] MA.
He has four children ages [**9-25**].
He works full time as an operator at sewage treatment center.
Denied any tobacco and alcohol 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Cardiac pacemaker in situ,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Anemia, unspecified,Long-term (current) use of insulin'}
