CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: Ms. [**Known lastname **] is a 53 female s/p stenting of the proximal LAD and
s/p V.fib arrest in 11/[**2182**]. She who presented today with
substernal chest pain.  The patient reports that the pain began
at 8:30PM when she stood up in her kitchen. the pain was [**6-20**]
with radiation to the left arm, mild nausea and diaphoresis. She
took a SL NTG with minimal relief.  She called EMS and received
another Nitro SL in transit.

MEDICAL HISTORY: noninsulin dependent diabetes mellitus
Dyslipidemia
hypertension
S/p Cardiac Arrest [**10/2183**]

MEDICATION ON ADMISSION: aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
metoprolol succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.

ALLERGIES: Lisinopril / Ampicillin

PHYSICAL EXAM: On Admission:
VS: 97.3 127/85 80 18 9%RA
General: Appears well and in NAD. Lying in bed.
HEENT: PERRLA, EOMI, anicteric, MMM, OP clear
CV: RRR, S1 and S2, no m/r/g
Lung: CTAB, no w/r/r
Abdomen: Soft, NT/ND, BSx4
Ext: No gross deformity or edema
Neuro: Awake, alert and oriented. CN II-XII intact. Moving all
extremeties.

FAMILY HISTORY: Mother: Died of heart failure at age of 52 secondary to a
"virus". No history of arrythmias, syncope, or sudden death in
the family.

SOCIAL HISTORY: 4th grade teacher, remote smoking history. Quit 25 years ago,
smoking [**12-14**] ppd for 5-10 years. Drinks [**12-14**] glasses of wine per
week. Denies drug use.
Coronary atherosclerosis of native coronary artery,Personal history of sudden cardiac arrest,Intermediate coronary syndrome,Acute posthemorrhagic anemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Long-term (current) use of aspirin
Crnry athrscl natve vssl,Hx sudden cardiac arrest,Intermed coronary synd,Ac posthemorrhag anemia,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Depressive disorder NEC,Anxiety state NOS,Status-post ptca,History of tobacco use,Long-term use of aspirin
Admission Date:  [**2184-9-22**]              Discharge Date:   [**2184-10-1**]

Date of Birth:  [**2130-12-14**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Lisinopril / Ampicillin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
left heart catheterization, coronary angiogram
Coronary Artery Bipass Graft x1(LIMA-LAD)

History of Present Illness:
Ms. [**Known lastname **] is a 53 female s/p stenting of the proximal LAD and
s/p V.fib arrest in 11/[**2182**]. She who presented today with
substernal chest pain.  The patient reports that the pain began
at 8:30PM when she stood up in her kitchen. the pain was [**6-20**]
with radiation to the left arm, mild nausea and diaphoresis. She
took a SL NTG with minimal relief.  She called EMS and received
another Nitro SL in transit.

In [**Hospital1 18**] ED, initial vital signs were 98.6, 80, 110/63, 16
and100%on RA. She was given an additional two NTG and Morphine
IV which resolved the pain. EKG shows new TWI in lead V2, no
other changes. Troponins (-).  Placed in observation and
underwent nuclear scan that showed a reversible distal anterior
wall and apical perfusion defect.

Given the findings on the nuclear study, the patient underwent
catheterization that revealed an osteal lesion not amenable to
intervention. CT surgery was contact[**Name (NI) **] regarding surgical
intervention.

Past Medical History:
noninsulin dependent diabetes mellitus
Dyslipidemia
hypertension
S/p Cardiac Arrest [**10/2183**]


Social History:
4th grade teacher, remote smoking history. Quit 25 years ago,
smoking [**12-14**] ppd for 5-10 years. Drinks [**12-14**] glasses of wine per
week. Denies drug use.


Family History:
Mother: Died of heart failure at age of 52 secondary to a
"virus". No history of arrythmias, syncope, or sudden death in
the family.

Physical Exam:
On Admission:
VS: 97.3 127/85 80 18 9%RA
General: Appears well and in NAD. Lying in bed.
HEENT: PERRLA, EOMI, anicteric, MMM, OP clear
CV: RRR, S1 and S2, no m/r/g
Lung: CTAB, no w/r/r
Abdomen: Soft, NT/ND, BSx4
Ext: No gross deformity or edema
Neuro: Awake, alert and oriented. CN II-XII intact. Moving all
extremeties.

Pertinent Results:
[**2184-9-23**] Nuclear Perfusion Study - IMPRESSION: 1. Reversible
distal anterior wall and apical perfusion defect. 2. Normal wall
motion with an ejection fraction of 67%.

[**2184-9-23**] Cardiac Cath - COMMENTS: 1.  Single vessel coronary
artery disease 2.  Ostial 80% stenosis involving the left
anterior descending coronary artery proximal to the previously
deployed stent 3. Withhold clopidogrel. 4. Cardiac surgery
consultation  FINAL DIAGNOSIS:
1. One vessel coronary artery disease. 2. Ostial 80% stenosis of
the LAD proximal to the previously deployed stent.

[**2184-9-30**] 03:11AM BLOOD WBC-9.5 RBC-3.24* Hgb-10.2* Hct-29.2*
MCV-90 MCH-31.5 MCHC-34.9 RDW-11.8 Plt Ct-159
[**2184-9-22**] 09:50PM BLOOD WBC-7.3 RBC-4.36 Hgb-13.8 Hct-37.5 MCV-86
MCH-31.8 MCHC-36.9* RDW-11.9 Plt Ct-220
[**2184-9-30**] 03:11AM BLOOD Glucose-115* UreaN-7 Creat-0.6 Na-141
K-3.9 Cl-104 HCO3-29 AnGap-12
[**2184-9-22**] 09:50PM BLOOD Glucose-93 UreaN-15 Creat-0.9 Na-143
K-3.7 Cl-109* HCO3-24 AnGap-14

Intra-op TEE [**9-27**]
Conclusions
PREBYPASS: NORMAL LV SYSTOLIC FUNCTION, LVEF . 55%, NO SWMA. The
left atrium is normal in size. Left ventricular wall thicknesses
and cavity size are normal. Right ventricular chamber size and
free wall motion are normal. The ascending, transverse and
descending thoracic aorta are normal in diameter and free of
atherosclerotic plaque to XX cm from the incisors. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis or aortic regurgitation. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no pericardial effusion.
POST BYPASS: unchanged. Normal EF, no dissection seen after
cannula removed.
  Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 16164**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2184-9-27**] 18:16


Brief Hospital Course:
She was admitted to the floor. On [**2184-9-23**], the patient
underwent cardiac catheterization that showed an 80% stenosed
LAD ostial lesion. Plavix was held and the patient underwent
Plavix washout.

On [**9-27**] she was taken to the operating Room where single vessel
grafting was performed. She was stable, weaned from Neo
Synephrine, awoke intact and was extubated.  Beta blocker was
resumed and she was diuresed towrds her preoperative weight.
Blood pressure would not tolerate resuming Diovan.  This should
be addressed as an outpatient.  Physical Therapy worked with her
for strength and mobility.

CTs and wires were removed without incident.  Arranagements were
made for out patient follow up. Wounds were clean and healing
well at discharge on POD 4 to home.

Medications on Admission:
aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
metoprolol succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.

Discharge Medications:
1. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain, fever.
3. Aspir-81 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
7. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
8. oxycodone-acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
Disp:*qs 1 month ML(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
coronary artery disease
s/p coronary artery bypass grafts x1 [**2184-9-27**]
s/p coronary stenting
anxiety/depression
s/p appendectomy


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage

Edema- none


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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 call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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
Surgeon:Dr.[**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]) on [**2184-11-3**] 1:00
Cardiologist: Dr.[**Name (NI) 13892**] office will call you with an appt.

Please call to schedule appointments with:
Primary Care Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 47598**] ([**Telephone/Fax (1) 9386**]in [**3-16**] 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:[**2184-10-1**]
{'Coronary atherosclerosis of native coronary artery,Personal history of sudden cardiac arrest,Intermediate coronary syndrome,Acute posthemorrhagic anemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Long-term (current) use of aspirin'}


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: Ms. [**Known lastname **] is a 53 female s/p stenting of the proximal LAD and
s/p V.fib arrest in 11/[**2182**]. She who presented today with
substernal chest pain.  The patient reports that the pain began
at 8:30PM when she stood up in her kitchen. the pain was [**6-20**]
with radiation to the left arm, mild nausea and diaphoresis. She
took a SL NTG with minimal relief.  She called EMS and received
another Nitro SL in transit.

MEDICAL HISTORY: noninsulin dependent diabetes mellitus
Dyslipidemia
hypertension
S/p Cardiac Arrest [**10/2183**]

MEDICATION ON ADMISSION: aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
metoprolol succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.

ALLERGIES: Lisinopril / Ampicillin

PHYSICAL EXAM: On Admission:
VS: 97.3 127/85 80 18 9%RA
General: Appears well and in NAD. Lying in bed.
HEENT: PERRLA, EOMI, anicteric, MMM, OP clear
CV: RRR, S1 and S2, no m/r/g
Lung: CTAB, no w/r/r
Abdomen: Soft, NT/ND, BSx4
Ext: No gross deformity or edema
Neuro: Awake, alert and oriented. CN II-XII intact. Moving all
extremeties.

FAMILY HISTORY: Mother: Died of heart failure at age of 52 secondary to a
"virus". No history of arrythmias, syncope, or sudden death in
the family.

SOCIAL HISTORY: 4th grade teacher, remote smoking history. Quit 25 years ago,
smoking [**12-14**] ppd for 5-10 years. Drinks [**12-14**] glasses of wine per
week. Denies drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Personal history of sudden cardiac arrest,Intermediate coronary syndrome,Acute posthemorrhagic anemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Anxiety state, unspecified,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Long-term (current) use of aspirin'}
