CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 58M presented to [**Hospital1 **] [**Location (un) 620**] with a three day history of chest
pain, now severe and radiating to his upper back. The patient
was hypertensive to 198/124, equal in both arms. CXR was
negative. He was given labetalol, NGT, and ASA. Troponin was
elevated to 0.268, CK-MB 51, MBI 13. CXR was negative.
Transferred to [**Hospital1 18**] for CTA to rule out dissection.
.
Patient drove up to MA a few days ago and noticed tightness in
his shoulders and back.  Played golf the next day and continued
to have upper back and upper chest pain b/l.  Denies SOB,
dizziness.  Had some nausea at first, but resolved.  Continued
to play golf.  At night used a cold pack to releive the pain and
was able to sleep.  The next day he continued to have the pain
without relief so he went to the [**Hospital1 **] at [**Location (un) 620**].
.
In the ED, the troponin was elevated to 0.4, MB 88. A CTA was
negative for acute dissection. Patient was seen by cardiology
and they recommended heparin, integrillin gtt's for possible
cath.

MEDICAL HISTORY: 1.  slipped disc durgery in [**2087**]
2.  rhinoplasty in [**2097**]

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T= 97.6  BP= 130/82   HR= 55-64 RR= 18  O2 sat= 96 % on RA
GENERAL: middle-aged male lying in bed in NAD.  Alert and
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. OP clear, MMM
NECK: Supple with JVP of 7 cm.
CARDIAC: Regular and bradycardic, normal S1, S2. No m/r/g.
LUNGS: CTAB
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e.
SKIN: no rashes

FAMILY HISTORY: His paternal grandfather had an MI at the age of 39, otherwise
non-contributory.

SOCIAL HISTORY: Patient works in the golf buisness, recently had been caddying
and walks 6 to 10 miles per day.  Lives in [**Doctor First Name 5256**], now
in [**Location (un) 7349**] for the summer; in MA on a visit to play golf.
-Tobacco history:  Patient has smoked [**1-26**] ppd for 20 years
-ETOH:  has about 4 drinks per night.  Denies having hangovers
or withdrawal symptoms.
-Illicit drugs:  hx of cocaine use in the 80's, nothing recently
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Other respiratory abnormalities
Subendo infarct, initial,Crnry athrscl natve vssl,Tobacco use disorder,Respiratory abnorm NEC
Admission Date:  [**2124-8-5**]              Discharge Date:   [**2124-8-13**]

Date of Birth:  [**2066-5-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization [**2124-8-7**]
Coronary artery bypass graft x 5 (Left internal mammary artery >
left anterior descending, Saphenous vein graft > diagonal >
obtuse marginal, saphenous vein graft > right coronary artery >
posterior descending artery) [**2124-8-9**]

History of Present Illness:
58M presented to [**Hospital1 **] [**Location (un) 620**] with a three day history of chest
pain, now severe and radiating to his upper back. The patient
was hypertensive to 198/124, equal in both arms. CXR was
negative. He was given labetalol, NGT, and ASA. Troponin was
elevated to 0.268, CK-MB 51, MBI 13. CXR was negative.
Transferred to [**Hospital1 18**] for CTA to rule out dissection.
.
Patient drove up to MA a few days ago and noticed tightness in
his shoulders and back.  Played golf the next day and continued
to have upper back and upper chest pain b/l.  Denies SOB,
dizziness.  Had some nausea at first, but resolved.  Continued
to play golf.  At night used a cold pack to releive the pain and
was able to sleep.  The next day he continued to have the pain
without relief so he went to the [**Hospital1 **] at [**Location (un) 620**].
.
In the ED, the troponin was elevated to 0.4, MB 88. A CTA was
negative for acute dissection. Patient was seen by cardiology
and they recommended heparin, integrillin gtt's for possible
cath.

Past Medical History:
1.  slipped disc durgery in [**2087**]
2.  rhinoplasty in [**2097**]

Social History:
Patient works in the golf buisness, recently had been caddying
and walks 6 to 10 miles per day.  Lives in [**Doctor First Name 5256**], now
in [**Location (un) 7349**] for the summer; in MA on a visit to play golf.
-Tobacco history:  Patient has smoked [**1-26**] ppd for 20 years
-ETOH:  has about 4 drinks per night.  Denies having hangovers
or withdrawal symptoms.
-Illicit drugs:  hx of cocaine use in the 80's, nothing recently


Family History:
His paternal grandfather had an MI at the age of 39, otherwise
non-contributory.

Physical Exam:
VS: T= 97.6  BP= 130/82   HR= 55-64 RR= 18  O2 sat= 96 % on RA
GENERAL: middle-aged male lying in bed in NAD.  Alert and
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. OP clear, MMM
NECK: Supple with JVP of 7 cm.
CARDIAC: Regular and bradycardic, normal S1, S2. No m/r/g.
LUNGS: CTAB
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e.
SKIN: no rashes

Pertinent Results:
[**8-5**] Chest CT: 1. No aortic dissection 2. Findings concerning
for right lower lobe pneumonia with slightly enlarged medistinal
nodes. 3 month followup is recommended to ensure resolution.
.
EKG:  Sinus bradycardia, T wave inversions in III, aVF, V5, and
V6 and biphasic T waves in II and V4.
.
[**8-7**] Cardiac cath: 1. Selective coronary angiography of this
right dominant system revealed three vessel disease.  The LMCA
had no significant disease.  The LAD had an 80% stenosis
involving the bifurcation at the D1.  The D1 additionally had at
the mid segment an 80% stenosis.  The OM1 was a small vessel
with 95% stenosis.  The OM2 had a 100% total occlusion with a
large proximal thrombus.  The OM2 had retrograde filling by
collaterals.  The RCA had an 80% stenosis at the proximal
segment, an 90% stenosis at the mid/distal segment.  The R-PDL
had an 80% stenosis. 2. Limited resting hemodynamic assessment
demonstrated normal systemic arterial pressure with a central
aortic pressure of 138/78 mm Hg.  The LVEDP was mildly elevated
at 22 mm Hg, which was suggestive of diastolic dysfunction.
Carefull pullback across the aortic valve showed no evidence of
aortic stenosis. 3. Left ventriculogram demonstrated normal
systolic function and normal wall motion.  There was no mitral
regurgitation.
[**8-9**] Echo: PRE-BYPASS: The left atrium is dilated. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. No atrial septal defect or patent
foramen ovale is seen by 2D, color Doppler or saline contrast
with maneuvers. There is mild symmetric left ventricular
hypertrophy with normal cavity size. There is mild regional left
ventricular systolic dysfunction with mild focal abnormalities
in the lateral wall, apex and inerior wall.. Overall left
ventricular systolic function is mildly depressed (LVEF= 45 to
50 %). Right ventricular chamber size and free wall motion are
normal. There are simple atheroma in the descending thoracic
aorta. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. The
mitral valve leaflets are mildly thickened. Mild (1+)mitral
regurgitation is seen. There is no pericardial effusion. Dr.
[**Last Name (STitle) **] was notified in person of the results on Mr. [**Known lastname 2093**], D at
10 AM on [**2124-8-9**].
Post_Bypass: Ascening aortic contour is intact. Mild MR and
there is no change from the preop. Normal RV systolic function.
Overall LVEF 50%.

[**2124-8-5**] 02:55AM BLOOD WBC-10.2 RBC-4.49* Hgb-13.7* Hct-39.7*
MCV-88 MCH-30.5 MCHC-34.5 RDW-13.6 Plt Ct-196
[**2124-8-11**] 06:40AM BLOOD WBC-9.6 RBC-3.20* Hgb-10.0* Hct-28.7*
MCV-90 MCH-31.2 MCHC-34.8 RDW-13.1 Plt Ct-184
[**2124-8-5**] 02:55AM BLOOD PT-13.2 PTT-28.6 INR(PT)-1.1
[**2124-8-10**] 01:11AM BLOOD PT-13.6* PTT-29.9 INR(PT)-1.2*
[**2124-8-5**] 02:55AM BLOOD Glucose-136* UreaN-20 Creat-0.9 Na-139
K-3.6 Cl-104 HCO3-28 AnGap-11
[**2124-8-11**] 06:40AM BLOOD Glucose-110* UreaN-22* Creat-1.2 Na-137
K-4.5 Cl-101 HCO3-28 AnGap-13
[**2124-8-11**] 06:40AM BLOOD Calcium-8.4 Phos-3.9 Mg-2.0

Brief Hospital Course:
58 yo male smoker with no PMH found to have a NSTEMI with
positive cardiac enzymes.
On [**8-7**] he underwent a cardiac cath which revealed sever three
vessel coronary artery disease. He was appropriately worked-up
for bypass surgery and on [**8-7**] he was brought to the operating
room where he underwent a coronary artery bypass graft x 5.
Please see operative report for surgical details. Following
surgery he was transferred to the CVICU for invasive monitoring
in stable condition. Later on op day he was weaned from
sedation, awoke neurologically intact and extubated. On post-op
day two beta-blockers and diuretics were started and he was
transferred to the telemetry floor for further care. Also on
this day, chest tubes were removed without incident. The
remainder of his postoperative course was uneventful and he
progressed well. He was discharged to home on POD#4 on [**8-13**].

Medications on Admission:
None

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
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:*2*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*
7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Coronary artery disease s/p Coronary artery bypass graft x 5
Myocardial Infarction
PMH: s/p Back surgery, s/p Rhinoplasty

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:
Chest CT scan in 3 months as follow up for enlarged mediastinal
lymph nodes.
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] - ([**Telephone/Fax (1) 2037**] - you have an appointment on
[**9-21**] at 1pm
Dr [**Last Name (STitle) **] in 4 weeks - please call to schedule appointment
It is recommended that you remain locally until follow up
appointment with Dr [**Last Name (STitle) **] and Dr [**Last Name (STitle) **]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Other respiratory abnormalities'}


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: 58M presented to [**Hospital1 **] [**Location (un) 620**] with a three day history of chest
pain, now severe and radiating to his upper back. The patient
was hypertensive to 198/124, equal in both arms. CXR was
negative. He was given labetalol, NGT, and ASA. Troponin was
elevated to 0.268, CK-MB 51, MBI 13. CXR was negative.
Transferred to [**Hospital1 18**] for CTA to rule out dissection.
.
Patient drove up to MA a few days ago and noticed tightness in
his shoulders and back.  Played golf the next day and continued
to have upper back and upper chest pain b/l.  Denies SOB,
dizziness.  Had some nausea at first, but resolved.  Continued
to play golf.  At night used a cold pack to releive the pain and
was able to sleep.  The next day he continued to have the pain
without relief so he went to the [**Hospital1 **] at [**Location (un) 620**].
.
In the ED, the troponin was elevated to 0.4, MB 88. A CTA was
negative for acute dissection. Patient was seen by cardiology
and they recommended heparin, integrillin gtt's for possible
cath.

MEDICAL HISTORY: 1.  slipped disc durgery in [**2087**]
2.  rhinoplasty in [**2097**]

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T= 97.6  BP= 130/82   HR= 55-64 RR= 18  O2 sat= 96 % on RA
GENERAL: middle-aged male lying in bed in NAD.  Alert and
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. OP clear, MMM
NECK: Supple with JVP of 7 cm.
CARDIAC: Regular and bradycardic, normal S1, S2. No m/r/g.
LUNGS: CTAB
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e.
SKIN: no rashes

FAMILY HISTORY: His paternal grandfather had an MI at the age of 39, otherwise
non-contributory.

SOCIAL HISTORY: Patient works in the golf buisness, recently had been caddying
and walks 6 to 10 miles per day.  Lives in [**Doctor First Name 5256**], now
in [**Location (un) 7349**] for the summer; in MA on a visit to play golf.
-Tobacco history:  Patient has smoked [**1-26**] ppd for 20 years
-ETOH:  has about 4 drinks per night.  Denies having hangovers
or withdrawal symptoms.
-Illicit drugs:  hx of cocaine use in the 80's, nothing recently 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Tobacco use disorder,Other respiratory abnormalities'}
