CHIEF COMPLAINT: coronary artery disease

PRESENT ILLNESS: This 61 year old male has a history of an NSTEMI in [**2133**] with
stenting of the LAD lesion at [**Hospital6 **]. About
one month ago he began to notice that after he walks for [**10-14**]
minutes, particularly when going uphill or when walking rapidly,
he feels a dull substernal pressure associated with some
shortness of breath, sometimes with nausea. With relaxation, his
symptoms will resolve. He has not had any symptoms at rest.
Recent stress testing has revealed an anteroseptal and
inferoseptal perfusion defect with a small amount of
reversibility. He was referred for cardiac catheterization to
further evaluate. He was found to have in stent restenosis and
three vessel disease. He is now being admitted to cardiac
surgery for revascularization.

MEDICAL HISTORY: [**2-/2134**]: non ST elevation MI, s/p LAD stenting
Hypertension
Hyperlipidemia
Diabetes
Neuropathy
Hx of non healing right foot ulcers s/p surgery [**2145**]
Osteomyelitis of right foot s/p I&[**Initials (NamePattern4) **] [**2147-5-31**]
History of anemia
Prior mention of bipolar disorder in OMR (patient disagrees with
diagnosis)
Depression
Prostate cancer, followed by Dr. [**Last Name (STitle) 27078**] currently under
observation only, scheduled for another biopsy in [**2148-4-30**],
1st biopsy was [**2147-4-30**]
GERD

MEDICATION ON ADMISSION: LISINOPRIL 10 mg daily
METFORMIN 850 mg TID
METOPROLOL TARTRATE 75 mg [**Hospital1 **]
NITROGLYCERIN 0.3 mg Tablet, Sublingual - 1 Tablet sublingually
every 5 minutes to the maximum of three as needed for chest pain
CRESTOR 20 mg daily
ASPIRIN 325 mg daily
MULTIVITAMIN 1 Tablet daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:74 Resp:14  O2 sat:100/RA
B/P  Right:157/94    Left:129/93
Height:5'1"     Weight:89 kgs

FAMILY HISTORY: Premature coronary artery disease- Mother had CHF,died at 86

SOCIAL HISTORY: Race:African american
Last Dental Exam:2 months ago
Lives with: wife
Contact:[**Name (NI) 98087**] (wife cell) [**Telephone/Fax (1) 98088**]
[**Name2 (NI) 27057**]tion:Retired- previously worked as a communication
director
for the [**State 1558**]
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: < 1 drink/week [x]  [**2-6**] drinks/week [] >8 drinks/week []
Illicit drug use:denies
Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Acute posthemorrhagic anemia,Other pneumothorax,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Bipolar disorder, unspecified,Esophageal reflux,Old myocardial infarction,Mononeuritis of unspecified site,Malignant neoplasm of prostate,Examination of participant in clinical trial
Crnry athrscl natve vssl,DMII neuro uncntrld,Neuropathy in diabetes,Ac posthemorrhag anemia,Other pneumothorax,Status-post ptca,Hypertension NOS,Bipolar disorder NOS,Esophageal reflux,Old myocardial infarct,Mononeuritis NOS,Malign neopl prostate,Exam-clincal trial
Admission Date:  [**2148-2-27**]              Discharge Date:   [**2148-3-3**]

Date of Birth:  [**2086-12-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
coronary artery disease

Major Surgical or Invasive Procedure:
[**2148-2-27**] - Coronary artery bypass grafting x5 with a left
internal mammary artery to left anterior descending artery and
reverse saphenous vein graft to the distal right coronary
artery, first obtuse marginal artery, first and second diagonal
artery.


History of Present Illness:
This 61 year old male has a history of an NSTEMI in [**2133**] with
stenting of the LAD lesion at [**Hospital6 **]. About
one month ago he began to notice that after he walks for [**10-14**]
minutes, particularly when going uphill or when walking rapidly,
he feels a dull substernal pressure associated with some
shortness of breath, sometimes with nausea. With relaxation, his
symptoms will resolve. He has not had any symptoms at rest.
Recent stress testing has revealed an anteroseptal and
inferoseptal perfusion defect with a small amount of
reversibility. He was referred for cardiac catheterization to
further evaluate. He was found to have in stent restenosis and
three vessel disease. He is now being admitted to cardiac
surgery for revascularization.


Past Medical History:
[**2-/2134**]: non ST elevation MI, s/p LAD stenting
Hypertension
Hyperlipidemia
Diabetes
Neuropathy
Hx of non healing right foot ulcers s/p surgery [**2145**]
Osteomyelitis of right foot s/p I&[**Initials (NamePattern4) **] [**2147-5-31**]
History of anemia
Prior mention of bipolar disorder in OMR (patient disagrees with
diagnosis)
Depression
Prostate cancer, followed by Dr. [**Last Name (STitle) 27078**] currently under
observation only, scheduled for another biopsy in [**2148-4-30**],
1st biopsy was [**2147-4-30**]
GERD


Social History:
Race:African american
Last Dental Exam:2 months ago
Lives with: wife
Contact:[**Name (NI) 98087**] (wife cell) [**Telephone/Fax (1) 98088**]
[**Name2 (NI) 27057**]tion:Retired- previously worked as a communication
director
for the [**State 1558**]
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: < 1 drink/week [x]  [**2-6**] drinks/week [] >8 drinks/week []
Illicit drug use:denies


Family History:
Premature coronary artery disease- Mother had CHF,died at 86


Physical Exam:
Pulse:74 Resp:14  O2 sat:100/RA
B/P  Right:157/94    Left:129/93
Height:5'1"     Weight:89 kgs

General: awake, alert, NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema [] _none_
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: palp   Left: palp
DP           Right: palp   Left: palp
PT           [**Name (NI) 167**]: palp   Left: palp
Radial       Right: palp   Left: palp
R radial art puncture c/d/i, no bleed/hematoma

Carotid Bruit        Right: none    Left: none


Pertinent Results:
[**2148-2-27**] ECHO
PRE-CPB:
No thrombus is seen in the left atrial appendage. No atrial
septal defect is seen by 2D or color Doppler.
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is low normal (LVEF 50-55%). Right ventricular
chamber size and free wall motion are normal.
No thoracic aortic dissection is seen. The aortic valve leaflets
(3) appear structurally normal with good leaflet excursion and
no aortic stenosis.
The mitral valve appears structurally normal with trivial mitral
regurgitation.

[**2148-3-1**] 05:35AM BLOOD
WBC-9.7 RBC-3.33* Hgb-10.1* Hct-29.2* MCV-87 MCH-30.2 MCHC-34.6
RDW-12.6 Plt Ct-180
[**2148-2-27**] 01:01PM BLOOD
WBC-10.3 RBC-3.25* Hgb-9.8* Hct-27.7* MCV-85 MCH-30.1 MCHC-35.3*
RDW-12.7 Plt Ct-133*
[**2148-3-1**] 05:35AM BLOOD
Glucose-152* UreaN-22* Creat-1.4* Na-138 K-4.0 Cl-103 HCO3-26
AnGap-13
[**2148-2-27**] 02:15PM BLOOD
UreaN-16 Creat-1.1 Na-137 K-4.1 Cl-108 HCO3-23 AnGap-10
[**2148-2-29**] 02:15AM BLOOD
ALT-7 AST-28 LD(LDH)-165 AlkPhos-37* Amylase-24 TotBili-0.3
[**2148-3-3**] 05:30AM BLOOD WBC-6.4 RBC-3.24* Hgb-9.7* Hct-27.3*
MCV-84 MCH-29.9 MCHC-35.5* RDW-12.5 Plt Ct-233
[**2148-3-1**] 05:35AM BLOOD WBC-9.7 RBC-3.33* Hgb-10.1* Hct-29.2*
MCV-87 MCH-30.2 MCHC-34.6 RDW-12.6 Plt Ct-180
[**2148-3-3**] 05:30AM BLOOD Glucose-182* UreaN-18 Creat-1.3* Na-138
K-4.0 Cl-100 HCO3-32 AnGap-10
[**2148-3-2**] 05:30AM BLOOD UreaN-21* Creat-1.2 Na-140 K-3.8 Cl-103
[**2148-3-1**] 05:35AM BLOOD Glucose-152* UreaN-22* Creat-1.4* Na-138
K-4.0 Cl-103 HCO3-26 AnGap-13
[**2148-2-29**] 02:15AM BLOOD Glucose-99 UreaN-15 Creat-1.3* Na-137
K-4.7 Cl-105 HCO3-23 AnGap-14

Brief Hospital Course:
As a same day admit he was taken to the Operating room where
underwent coronary artery bypass grafting x5 with a left
internal mammary artery to left anterior descending artery and
reverse saphenous vein graft to the distal right coronary
artery, first obtuse marginal artery, first and second diagonal
artery. See operative note for details. He weaned from bypass
easily on NeoSynephrine and Propofol. POD 1 found the patient
awake and alert, extubated without incidence.  He required
pressors until the second postoperative day when it was weaned
to off. He then transferred to the floor on POD #2 in stable
condition. Lopressor was started and titrated up for blood
pressure control. Oral hyperglycemic agents were added back and
titrated for blood sugar control. Chest tubes were removed per
cardiac surgery protocol. He had a small left apical
pneumothorax after chest tube pull which was stable at the time
of discharge. Pacing wires were removed on POD 3 per protocol.
Physical Therapy evaluated him for strength and mobility and he
was cleared for home. He was nauseated on POD 4 and discharge
was held. He was started on Reglan and had a bowel movement with
resolution of nausea the following day. On POD 5 he was
ambulating in the halls with assistance, tolerating a full oral
diet and incisions were healing well. It was thought that he was
safe for discharge at this time. All follow up appointments were
advised and instructions for medications and activity were
discussed.

Medications on Admission:
LISINOPRIL 10 mg daily
METFORMIN 850 mg TID
METOPROLOL TARTRATE 75 mg [**Hospital1 **]
NITROGLYCERIN 0.3 mg Tablet, Sublingual - 1 Tablet sublingually
every 5 minutes to the maximum of three as needed for chest pain
CRESTOR 20 mg daily
ASPIRIN 325 mg daily
MULTIVITAMIN 1 Tablet daily


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
4. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever or pain. Tablet(s)
6. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
7. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain for 4 weeks.
Disp:*50 Tablet(s)* Refills:*0*
8. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*0*
9. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO Q12H (every 12 hours) for 7 days.
Disp:*14 Tablet Extended Release(s)* Refills:*0*
10. metformin 1,000 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
11. Amaryl 1 mg Tablet Sig: One (1) Tablet PO daily ().
Disp:*30 Tablet(s)* Refills:*0*
12. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*0*
13. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
Disp:*30 Capsule(s)* Refills:*0*
14. senna 8.6 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
Disp:*30 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
right atrial mass
s/p excision of right atrial mass
coronary artery disease
s/p LAD stenting
Hypertension
Hyperlipidemia
noninsulin dependent Diabetes  mellitus
Neuropathy
h/o nonhealing right foot ulcers -s/p surgery [**2145**]
h/o anemia
bipolar disorder
Depression
Prostate cancer
gastroesophageal reflux


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
Leg Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
1) 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.
2) Please NO lotions, cream, powder, or ointments to incisions.
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart provided.
4) No driving for approximately one month and while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon when you will likely be cleared to drive.
5) No lifting more than 10 pounds for 10 weeks
6) Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**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 [**2148-3-28**] at 1:30pm
Cardiologist:Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**] on [**2148-3-13**] at 10:40am
Office will call patient with wound check appointment

Please call to schedule appointments with:
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 7976**]in [**4-4**] 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**

VNA to CHECK BUN/CREA/K on [**2148-3-5**] and call results to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 3142**] at [**Telephone/Fax (1) 170**]



Completed by:[**2148-3-3**]
{'Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Acute posthemorrhagic anemia,Other pneumothorax,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Bipolar disorder, unspecified,Esophageal reflux,Old myocardial infarction,Mononeuritis of unspecified site,Malignant neoplasm of prostate,Examination of participant in clinical trial'}


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: coronary artery disease

PRESENT ILLNESS: This 61 year old male has a history of an NSTEMI in [**2133**] with
stenting of the LAD lesion at [**Hospital6 **]. About
one month ago he began to notice that after he walks for [**10-14**]
minutes, particularly when going uphill or when walking rapidly,
he feels a dull substernal pressure associated with some
shortness of breath, sometimes with nausea. With relaxation, his
symptoms will resolve. He has not had any symptoms at rest.
Recent stress testing has revealed an anteroseptal and
inferoseptal perfusion defect with a small amount of
reversibility. He was referred for cardiac catheterization to
further evaluate. He was found to have in stent restenosis and
three vessel disease. He is now being admitted to cardiac
surgery for revascularization.

MEDICAL HISTORY: [**2-/2134**]: non ST elevation MI, s/p LAD stenting
Hypertension
Hyperlipidemia
Diabetes
Neuropathy
Hx of non healing right foot ulcers s/p surgery [**2145**]
Osteomyelitis of right foot s/p I&[**Initials (NamePattern4) **] [**2147-5-31**]
History of anemia
Prior mention of bipolar disorder in OMR (patient disagrees with
diagnosis)
Depression
Prostate cancer, followed by Dr. [**Last Name (STitle) 27078**] currently under
observation only, scheduled for another biopsy in [**2148-4-30**],
1st biopsy was [**2147-4-30**]
GERD

MEDICATION ON ADMISSION: LISINOPRIL 10 mg daily
METFORMIN 850 mg TID
METOPROLOL TARTRATE 75 mg [**Hospital1 **]
NITROGLYCERIN 0.3 mg Tablet, Sublingual - 1 Tablet sublingually
every 5 minutes to the maximum of three as needed for chest pain
CRESTOR 20 mg daily
ASPIRIN 325 mg daily
MULTIVITAMIN 1 Tablet daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:74 Resp:14  O2 sat:100/RA
B/P  Right:157/94    Left:129/93
Height:5'1"     Weight:89 kgs

FAMILY HISTORY: Premature coronary artery disease- Mother had CHF,died at 86

SOCIAL HISTORY: Race:African american
Last Dental Exam:2 months ago
Lives with: wife
Contact:[**Name (NI) 98087**] (wife cell) [**Telephone/Fax (1) 98088**]
[**Name2 (NI) 27057**]tion:Retired- previously worked as a communication
director
for the [**State 1558**]
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: < 1 drink/week [x]  [**2-6**] drinks/week [] >8 drinks/week []
Illicit drug use:denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, uncontrolled,Polyneuropathy in diabetes,Acute posthemorrhagic anemia,Other pneumothorax,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Bipolar disorder, unspecified,Esophageal reflux,Old myocardial infarction,Mononeuritis of unspecified site,Malignant neoplasm of prostate,Examination of participant in clinical trial'}
