CHIEF COMPLAINT: 68 year old AA female with 45 minutes of acute chest pain.

PRESENT ILLNESS: 68 African American F with HTN, hyerlipidemia, DM2, p/w CP acute
onset, "felt like indigestion" lasting 45mins, radiating to back
and under L arm. Reportedly began while walking in house, no
unusual exertion. Pt experienced mild diaphoresis but no n/v,
palpitations, sob. Previously experienced similar pain a month
ago which resolved spontaneously. At baseline develops DOE after
climbing a flight of stairs, but no PND or orthopnea.
.
In ED, SBP 180-200's, received Metoprolol 5mg IV x 3,
hydralazine 20mg, SLNTG x 3, with overall resolution of chest
pain. 1st set of CE negative. EKG with ST depression in V2-V6
(no old).  Denies f/c, melena, BRBPR, HA, dizziness, weakness,
numbness, diarrhea, or constipation.

MEDICAL HISTORY: PMHx:
1. HTN
2. G6PD carrier, does not have the disease.
3. DM2- Per pt, glucose well controlled with last Hgb A1c of 6.
something.
4. CRI (baseline 2.0)
5. Hyperlipidemia

MEDICATION ON ADMISSION: 1. HCTZ 50mg qday
2. Glyburide 5mg [**Hospital1 **]
3. labetolol 400mg [**Hospital1 **]
4. Diovan 240mg qday
5. Norvasc 10mg qday
6. Lipitor 40mg qday
7. avandia 4mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.3  155/68 64-91 16 94%on RA 105 kg
Gen: Well-developed, well nourished. in bed NAD. obese pleasant
lady.
HEENT: PERRL, EOMI, anicteric, OP nlm MMM.
Neck: supple. o JVD elevation, no carotid bruit.
Chest: CTA bilat
CV: RRR with 3/5 systolic murmur best heard at R second
intercostal space. Normal s1, s2. No rubs, gallop.
Abd: obese, soft, nt, nd, nl bs.
Ext: 2+ DPs equal bilat, 2+ radial equal bilat. [**12-27**]+ pitting LLE
edema bilat.
Skin: wnl
Neuro: AOx3, CN 2-12 grossly nl. Strength 5/5, sensation intact.

FAMILY HISTORY: Sister with CAD at age 60s. Mother died of MI

SOCIAL HISTORY: Lives with daughter. [**Name (NI) **] tobacco, ETOH, or drug use.
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease
Subendo infarct, initial,Acute kidney failure NOS,Hyp kid NOS w cr kid V,CHF NOS,Hyposmolality,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Anemia in chr kidney dis
Admission Date:  [**2106-6-26**]              Discharge Date:   [**2106-7-13**]

Date of Birth:  [**2038-3-18**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
68 year old AA female with 45 minutes of acute chest pain.

Major Surgical or Invasive Procedure:
CABGx4(LIMA->LAD< SVG->RCA, OM, Ramus) [**2106-7-6**]
Cardiac cath [**2106-6-30**]


History of Present Illness:
68 African American F with HTN, hyerlipidemia, DM2, p/w CP acute
onset, "felt like indigestion" lasting 45mins, radiating to back
and under L arm. Reportedly began while walking in house, no
unusual exertion. Pt experienced mild diaphoresis but no n/v,
palpitations, sob. Previously experienced similar pain a month
ago which resolved spontaneously. At baseline develops DOE after
climbing a flight of stairs, but no PND or orthopnea.
.
In ED, SBP 180-200's, received Metoprolol 5mg IV x 3,
hydralazine 20mg, SLNTG x 3, with overall resolution of chest
pain. 1st set of CE negative. EKG with ST depression in V2-V6
(no old).  Denies f/c, melena, BRBPR, HA, dizziness, weakness,
numbness, diarrhea, or constipation.


Past Medical History:
PMHx:
1. HTN
2. G6PD carrier, does not have the disease.
3. DM2- Per pt, glucose well controlled with last Hgb A1c of 6.
something.
4. CRI (baseline 2.0)
5. Hyperlipidemia


Social History:
Lives with daughter. [**Name (NI) **] tobacco, ETOH, or drug use.

Family History:
Sister with CAD at age 60s. Mother died of MI

Physical Exam:
VS 97.3  155/68 64-91 16 94%on RA 105 kg
Gen: Well-developed, well nourished. in bed NAD. obese pleasant
lady.
HEENT: PERRL, EOMI, anicteric, OP nlm MMM.
Neck: supple. o JVD elevation, no carotid bruit.
Chest: CTA bilat
CV: RRR with 3/5 systolic murmur best heard at R second
intercostal space. Normal s1, s2. No rubs, gallop.
Abd: obese, soft, nt, nd, nl bs.
Ext: 2+ DPs equal bilat, 2+ radial equal bilat. [**12-27**]+ pitting LLE
edema bilat.
Skin: wnl
Neuro: AOx3, CN 2-12 grossly nl. Strength 5/5, sensation intact.



Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2106-7-11**] 05:00AM    12.9* 3.53* 10.2* 31.2* 88 29.0 32.9 15.2
246
  BASIC COAGULATION (PT, PTT, PLT, INR) Plt Ct
[**2106-7-11**] 05:00AM    246

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2106-7-11**] 05:00AM    64* 52* 2.1* 131* 4.4 100 21*1 14
1 NOTE UPDATED REFERENCE RANGE AS OF [**2106-6-25**]
CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron
[**2106-7-10**] 04:53AM              2.3

RADIOLOGY   Preliminary Report

CHEST (PA & LAT)  [**2106-7-12**] 11:15 AM

CHEST (PA & LAT)

Reason: r/o inf., effusion

[**Hospital 93**] MEDICAL CONDITION:
68 year old woman with CAD
REASON FOR THIS EXAMINATION:
r/o inf., effusion
EXAMINATION: PA and lateral chest.

HISTORY: Coronary artery disease. Possible pleural effusion.

IMPRESSION: PA and lateral chest compared to prior chest
radiographs since [**2106-6-26**], most recently [**2106-7-7**].

Since [**7-7**], the Swan-Ganz catheter has been removed, and
there is less mediastinal vascular engorgement. Moderate
enlargement of the cardiac silhouette is also decreased. Small
bilateral pleural effusions and mild left lower lobe atelectasis
are new. The upper lungs are clear. There is no pneumothorax.

A right PIC catheter projects over the expected course to the
SVC.

COMMENTS:
  1. Selective coronary coronary angiography revealed a right
dominant
system with three vessel coronary artery disease. The [**Month (only) **] had a
50%
distal bifurcation lesion. The LAD had 50% ostial disease with a
70%
ostial small D2 lesion. The LCX had had sequential 90%, 50%, and
70% mid
vessel lesions. The RCA had mild ostial disease
and an 80% mid vessel lesion at the origin of a large acute
marginal
branch which had sequential 90% lesions, and 70% mid to distal
disease.
  2. Limited resting hemodynamics demonstrated significantly
elevated
system pressures with moderately elevated left sided pressures
(LVEDP 28
mmHg) and no gradient upon movement of the catheter from the
ventricle
back to the aorta.
  3. Left ventriculography was deferred.

FINAL DIAGNOSIS:
1. Three vessel and moderate left main coronary artery disease.
2. Mild elevation of left ventricular diastolic pressure.

ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].
REFERRING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].
CARDIOLOGY FELLOW: [**Last Name (LF) 41687**],[**First Name3 (LF) **]
  [**Last Name (LF) **],[**First Name3 (LF) **] S.
ATTENDING STAFF: [**Last Name (LF) 2052**],[**First Name3 (LF) 2053**] J.


([**Numeric Identifier 98112**])








Brief Hospital Course:
She presented to the ER on [**6-26**] and was hypertensive in the
180s-200s.  She ruled in for an MI and was started on heparin
and Plavix.  She had a negative MRI/MRA of the chest. Hematology
saw her for the G6PD and found that she does not have it, she is
a
carrier, and she was started on ASA.
She had angina at rest and was hypertensive when this would
occur.  On [**6-30**] she underwent cardiac cath which revealed:
50%[**First Name9 (NamePattern2) **] [**Last Name (un) 2435**]., 50% ostial LAD, 70% ostial D2, 90% LCX, and 80%
mid RCA lesion.  She had an echo which showed an EF of 60-70%
and minimal AS.
Following her cath, her creatinine rose and peaked at 2.9.
Eventually it came down to 2.4 and on [**7-6**] she had a CABGx4 w/
LIMA->LAD, SVG->RCA, OM, and Ramus.  She tolerated the procedure
well and was transferred to the CSRU on Neo and Propofol in
stable condition. She was extubated on POD#1 and her urine
output dwindled on that day.  Renal was consulted and she was
given volume and Lasix and this eventually resolved.
She continued to progress and had her chest tubes out on POD#1
and epicardial pacing wires on POD#3.  She was transferred to
the floor on POD#3 and required aggressive antihypertensive
therapy.  Her creatinine came down to 2.1, and she progressed
slowly and was discharged to rehab on POD#7 in stable condition.


Medications on Admission:
1. HCTZ 50mg qday
2. Glyburide 5mg [**Hospital1 **]
3. labetolol 400mg [**Hospital1 **]
4. Diovan 240mg qday
5. Norvasc 10mg qday
6. Lipitor 40mg qday
7. avandia 4mg qday


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
4. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
5. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours) as needed.
6. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 537**]- [**Location (un) 538**]

Discharge Diagnosis:
Coronary artery disease
Chronic renal insufficiency
NIDDM
HTN
Hyperlipidemia


Discharge Condition:
Good.

Discharge Instructions:
Follow medications on discharge isntructions.
You may not drive for 4 weeks.
You may not lift more than 10 lbs. for 3 months.
You should shower, let water flow over wounds, pat dry with a
towel.
Do not use lotions, powders, or creams on wounds.
Call our office for sternal drainage, temp.>101.5

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) **] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.



Completed by:[**2106-7-13**]
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease'}


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: 68 year old AA female with 45 minutes of acute chest pain.

PRESENT ILLNESS: 68 African American F with HTN, hyerlipidemia, DM2, p/w CP acute
onset, "felt like indigestion" lasting 45mins, radiating to back
and under L arm. Reportedly began while walking in house, no
unusual exertion. Pt experienced mild diaphoresis but no n/v,
palpitations, sob. Previously experienced similar pain a month
ago which resolved spontaneously. At baseline develops DOE after
climbing a flight of stairs, but no PND or orthopnea.
.
In ED, SBP 180-200's, received Metoprolol 5mg IV x 3,
hydralazine 20mg, SLNTG x 3, with overall resolution of chest
pain. 1st set of CE negative. EKG with ST depression in V2-V6
(no old).  Denies f/c, melena, BRBPR, HA, dizziness, weakness,
numbness, diarrhea, or constipation.

MEDICAL HISTORY: PMHx:
1. HTN
2. G6PD carrier, does not have the disease.
3. DM2- Per pt, glucose well controlled with last Hgb A1c of 6.
something.
4. CRI (baseline 2.0)
5. Hyperlipidemia

MEDICATION ON ADMISSION: 1. HCTZ 50mg qday
2. Glyburide 5mg [**Hospital1 **]
3. labetolol 400mg [**Hospital1 **]
4. Diovan 240mg qday
5. Norvasc 10mg qday
6. Lipitor 40mg qday
7. avandia 4mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS 97.3  155/68 64-91 16 94%on RA 105 kg
Gen: Well-developed, well nourished. in bed NAD. obese pleasant
lady.
HEENT: PERRL, EOMI, anicteric, OP nlm MMM.
Neck: supple. o JVD elevation, no carotid bruit.
Chest: CTA bilat
CV: RRR with 3/5 systolic murmur best heard at R second
intercostal space. Normal s1, s2. No rubs, gallop.
Abd: obese, soft, nt, nd, nl bs.
Ext: 2+ DPs equal bilat, 2+ radial equal bilat. [**12-27**]+ pitting LLE
edema bilat.
Skin: wnl
Neuro: AOx3, CN 2-12 grossly nl. Strength 5/5, sensation intact.

FAMILY HISTORY: Sister with CAD at age 60s. Mother died of MI

SOCIAL HISTORY: Lives with daughter. [**Name (NI) **] tobacco, ETOH, or drug use. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Hyposmolality and/or hyponatremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia in chronic kidney disease'}
