CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 77 y/o female with htn, hyperchol, no prior CAD with acute onset
exertional CP 16:30 yesterday with SOB/diaphoresis/nausea
lasting 20 min allev with rest. Had repeat episode later in the
evening lasting >20min at rest. Presented to ED where relieved
with O2. EKG nitally normal but next day had TWI in prox LAD
distribution, but pain free. TnT 0.06 -> 0.13. Plavix load, ASA,
BB, integrilin, heparin gtt.

MEDICAL HISTORY: htn, hyperchol, djd, uterine fibroid, psoriasis, nocturnal
cramping

MEDICATION ON ADMISSION: questran 4g qd
quinine 260 qhs
ibuprofen 600mg tid
fosamax 70mg qwk
calcium
ASA 325 qd
glucosamine
valsartan 80mg qd

ALLERGIES: Vioxx / Celebrex / Lipitor / Zestril

PHYSICAL EXAM: 97.0, 118/76, p54, 99% RA
gen: comfortable, nard
heent: mmm, op clear
lungs: mild crackles bses
Cor: s1/s2, regular, no m/r/g
vasc: nml carotid upstroke and pressure, no buit
ext: no peripheral edema, dp 2+
neuro - motor [**4-15**], sensation intact

FAMILY HISTORY: father died 80 y/o of cancer

SOCIAL HISTORY: nonsmoker, no alcohol, no illicit drugs
Subendocardial infarction, initial episode of care,Mitral valve disorders,Alkalosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, lower leg
Subendo infarct, initial,Mitral valve disorder,Alkalosis,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Osteoarthros NOS-l/leg
Admission Date:  [**2133-10-3**]              Discharge Date:   [**2133-10-14**]

Date of Birth:  [**2055-11-23**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Vioxx / Celebrex / Lipitor / Zestril

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

Major Surgical or Invasive Procedure:
CABG, MV repair


History of Present Illness:
77 y/o female with htn, hyperchol, no prior CAD with acute onset
exertional CP 16:30 yesterday with SOB/diaphoresis/nausea
lasting 20 min allev with rest. Had repeat episode later in the
evening lasting >20min at rest. Presented to ED where relieved
with O2. EKG nitally normal but next day had TWI in prox LAD
distribution, but pain free. TnT 0.06 -> 0.13. Plavix load, ASA,
BB, integrilin, heparin gtt.

Past Medical History:
htn, hyperchol, djd, uterine fibroid, psoriasis, nocturnal
cramping

Social History:
nonsmoker, no alcohol, no illicit drugs

Family History:
father died 80 y/o of cancer

Physical Exam:
97.0, 118/76, p54, 99% RA
gen: comfortable, nard
heent: mmm, op clear
lungs: mild crackles bses
Cor: s1/s2, regular, no m/r/g
vasc: nml carotid upstroke and pressure, no buit
ext: no peripheral edema, dp 2+
neuro - motor [**4-15**], sensation intact

Pertinent Results:
[**2133-10-14**] 07:05AM BLOOD WBC-8.2 RBC-3.25* Hgb-10.0* Hct-29.8*
MCV-92 MCH-30.8 MCHC-33.5 RDW-13.4 Plt Ct-414
[**2133-10-14**] 07:05AM BLOOD Glucose-98 UreaN-17 Creat-0.6 Na-141
K-3.8 Cl-105 HCO3-25 AnGap-15

Brief Hospital Course:
77 y/o female with multiple cardiac risk factors but no known
prior CAD admitted with for NSTEMI with EKG findings worrisome
for LAD lesion supplying large territory.  She ruled in by
cardiac biomarkers, history, and EKG findings.  She was started
on integrilin, heparin, ASA, plavix for ACS and underwent left
heart catheterization which demonstrated 3 vessel disease with a
95% midLAD stenosis.

She was taken to the OR on [**10-8**], and underwent a CABG X 4 (LIMA
> LAD, SVG > RCA, SVG>OM1, SVG > OM2, and mitral valve repair
(26 mm [**Doctor Last Name 405**] ring).  Post-op she was transferred to the CSRU
on epinephrine, neosynephrine, and propofol gtts.  She was
extubated the day of surgery.
POD # 1 neo was weaned off, PA catheter was removed, diuresis
was started
POD # 2 she was transferred out of the ICU, chest tubes were
removed
POD # 3 she c/o fatigue, was slow to ambulate, had significant
peripheral edema, continued with diuresis
POD # 4 received Diamox for slight metabolic alkalosis, and
continued need for diuresis.
POD #5 remained slow to progress with ambulation, diuresis
continues, chest x-ray showed small right effusion, moderat left
effusion (both somewhat decreased from prev. x-ray), also, she
ahd no further oxygen requirement.
POD # 6, still c/o fatigue, denies pain or dyspnea, ready for
transfer to rehab.

Medications on Admission:
questran 4g qd
quinine 260 qhs
ibuprofen 600mg tid
fosamax 70mg qwk
calcium
ASA 325 qd
glucosamine
valsartan 80mg qd

Discharge Medications:
1. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every six (6) hours as needed for pain.
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days: then re-assess need for diuresis please.
9. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
10. FOSAMAX 70 mg Tablet Sig: One (1) Tablet PO once a week.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Coronary artery disease
Mitral regurgitation
Hypertension


Discharge Condition:
good

Discharge Instructions:
no lifting > 10# or driving for 1 month
no creams, lotions or ointments to incisions
may shower, no bathing for 1 month

Followup Instructions:
with Dr. [**Last Name (STitle) **] in [**1-13**] weeks
with Dr. [**Last Name (STitle) 73**] in [**1-13**] weeks
with Dr. [**Last Name (STitle) **] in 4 weeks



Completed by:[**2133-10-14**]
{'Subendocardial infarction, initial episode of care,Mitral valve disorders,Alkalosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, lower leg'}


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: 77 y/o female with htn, hyperchol, no prior CAD with acute onset
exertional CP 16:30 yesterday with SOB/diaphoresis/nausea
lasting 20 min allev with rest. Had repeat episode later in the
evening lasting >20min at rest. Presented to ED where relieved
with O2. EKG nitally normal but next day had TWI in prox LAD
distribution, but pain free. TnT 0.06 -> 0.13. Plavix load, ASA,
BB, integrilin, heparin gtt.

MEDICAL HISTORY: htn, hyperchol, djd, uterine fibroid, psoriasis, nocturnal
cramping

MEDICATION ON ADMISSION: questran 4g qd
quinine 260 qhs
ibuprofen 600mg tid
fosamax 70mg qwk
calcium
ASA 325 qd
glucosamine
valsartan 80mg qd

ALLERGIES: Vioxx / Celebrex / Lipitor / Zestril

PHYSICAL EXAM: 97.0, 118/76, p54, 99% RA
gen: comfortable, nard
heent: mmm, op clear
lungs: mild crackles bses
Cor: s1/s2, regular, no m/r/g
vasc: nml carotid upstroke and pressure, no buit
ext: no peripheral edema, dp 2+
neuro - motor [**4-15**], sensation intact

FAMILY HISTORY: father died 80 y/o of cancer

SOCIAL HISTORY: nonsmoker, no alcohol, no illicit drugs 

### Response:
{'Subendocardial infarction, initial episode of care,Mitral valve disorders,Alkalosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, lower leg'}
