CHIEF COMPLAINT: Chest tightness

PRESENT ILLNESS: Mr. [**Known lastname **] is a 74 year old male with known coronary artery
disease. He presented to [**Hospital **] Hospital with a six week
history of chest tightness and heaviness. He underwent cardiac
catheterization which revealed 70% left main lesion including
severe three vessel coronary artery disease. He was subsequently
transferred to the [**Hospital1 18**] for cardiac surgical intervention.

MEDICAL HISTORY: Coronary Artery Disease - Prior PTCA/stenting to RCA in [**2135**]
Type II Diabetes Mellitus
Hypertension
Dyslipidemia
Benign Prostatic Hypertrophy, s/p TURP [**2131**]
Degenerative Joint Disease
Diverticular Disease
Sigmoid Resection [**2145**]
Cataract Surgery
Right Knee Operation [**2144**]

MEDICATION ON ADMISSION: Aspirin 81 qd, Enalapril 10 qd, Fexofenadine 180 qd, Levemir 23
units, Novolog sliding scale, Lopressor 50 [**Hospital1 **], Lovastatin 40
qd, Omeprazole 20 qd, Terazosin 4 qd, Viagra prn

ALLERGIES: Percocet

PHYSICAL EXAM: BP 126/69, P 62, RR 12
Ht 70 inches
Wt 80 kg
General - WDWN male in NAD
Skin - unremarkable
HEENT - oropharynx benign, EOMI, sclera anicteric
Neck - supple, no JVD
Chest - lungs CTA bilaterally
Heart - regular rate and rhythm, normal s1s2, no rub or murmur
Abdomen - benign
Ext - warm, no edema
Neuro - alert and oriented, CN 2-12 grossly intact, FROM, [**5-23**]
strength

FAMILY HISTORY: Father died of MI at age 62.

SOCIAL HISTORY: Performs office work part time. 30 pack year history of tobacco
but quit smoking in [**2122**]. Denies ETOH.
Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cervical spondylosis without myelopathy,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Acquired absence of intestine (large) (small),Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Family history of ischemic heart disease,Long-term (current) use of insulin
Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Cervical spondylosis,Esophageal reflux,Dvrtclo colon w/o hmrhg,Acquire absnce intestine,Status-post ptca,History of tobacco use,Fam hx-ischem heart dis,Long-term use of insulin
Admission Date:  [**2147-3-15**]              Discharge Date:   [**2147-3-21**]

Date of Birth:  [**2072-12-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Percocet

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

Major Surgical or Invasive Procedure:
[**2147-3-16**] Five Vessel Coronary Artery Bypass Grafting(left
internal mammary artery to left anterior descending artery with
vein grafts to the diagonal, first obtuse marginal, second
obtuse marginal, and PDA)


History of Present Illness:
Mr. [**Known lastname **] is a 74 year old male with known coronary artery
disease. He presented to [**Hospital **] Hospital with a six week
history of chest tightness and heaviness. He underwent cardiac
catheterization which revealed 70% left main lesion including
severe three vessel coronary artery disease. He was subsequently
transferred to the [**Hospital1 18**] for cardiac surgical intervention.

Past Medical History:
Coronary Artery Disease - Prior PTCA/stenting to RCA in [**2135**]
Type II Diabetes Mellitus
Hypertension
Dyslipidemia
Benign Prostatic Hypertrophy, s/p TURP [**2131**]
Degenerative Joint Disease
Diverticular Disease
Sigmoid Resection [**2145**]
Cataract Surgery
Right Knee Operation [**2144**]


Social History:
Performs office work part time. 30 pack year history of tobacco
but quit smoking in [**2122**]. Denies ETOH.

Family History:
Father died of MI at age 62.

Physical Exam:
BP 126/69, P 62, RR 12
Ht 70 inches
Wt 80 kg
General - WDWN male in NAD
Skin - unremarkable
HEENT - oropharynx benign, EOMI, sclera anicteric
Neck - supple, no JVD
Chest - lungs CTA bilaterally
Heart - regular rate and rhythm, normal s1s2, no rub or murmur
Abdomen - benign
Ext - warm, no edema
Neuro - alert and oriented, CN 2-12 grossly intact, FROM, [**5-23**]
strength

Pertinent Results:
[**2147-3-15**] 01:32PM BLOOD WBC-6.0 RBC-3.98* Hgb-12.7* Hct-35.3*
MCV-89 MCH-32.0 MCHC-36.0* RDW-13.0 Plt Ct-196
[**2147-3-15**] 01:32PM BLOOD PT-14.4* PTT-29.8 INR(PT)-1.3*
[**2147-3-15**] 01:32PM BLOOD Glucose-149* UreaN-10 Creat-0.8 Na-141
K-4.0 Cl-108 HCO3-30 AnGap-7*
[**2147-3-15**] 01:32PM BLOOD ALT-12 AST-16 LD(LDH)-131 AlkPhos-67
TotBili-0.7
[**2147-3-15**] 01:32PM BLOOD Albumin-3.9 Calcium-8.9 Phos-2.7 Mg-1.9
[**2147-3-15**] 01:32PM BLOOD %HbA1c-7.9*
[**2147-3-15**] Carotid Ultrasound
1. Mild plaque in the right internal carotid artery with less
than 40%
stenosis. 2. No stenosis in the left internal carotid artery.
This is a baseline examination at the [**Hospital1 18**].
[**2147-3-15**] Echocardiogram
The left atrium is mildly dilated. The estimated right atrial
pressure is 0-5 mmHg. Right ventricular chamber size and free
wall motion are normal. The ascending aorta is mildly dilated.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. The pulmonary
artery systolic pressure could not be determined. There is an
anterior space which most likely represents a fat pad.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the intensive care unit given his
critical coronary anatomy. He underwent routine preoperative
evaluation - please see result section for preoperative study
results. He remained pain free on medical therapy and was
cleared for surgery. The following day, Dr. [**Last Name (STitle) **] performed
coronary artery bypass grafting surgery. Please see operative
note for details. Following the operation, he was transferred to
the surgical intensive care unit for invasive monitoring. Within
24 hours, he awoke neurologically intact and was extubated
without incident. His unit course was otherwise routine and he
transferred to the step down floor on postoperative day one.
His chest tubes and epicardial wires were removed.  He was seen
in consultation by the physical therapy service.  His beta
blockade was titrated up as tolerated.  By post-operative day
five he was ready for discharge to home.

Medications on Admission:
Aspirin 81 qd, Enalapril 10 qd, Fexofenadine 180 qd, Levemir 23
units, Novolog sliding scale, Lopressor 50 [**Hospital1 **], Lovastatin 40
qd, Omeprazole 20 qd, Terazosin 4 qd, Viagra prn

Discharge Medications:
1. 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*
2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
4. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
5. Terazosin 1 mg Capsule Sig: Four (4) Capsule PO HS (at
bedtime).
Disp:*30 Capsule(s)* Refills:*2*
6. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 5
days.
Disp:*5 Tablet(s)* Refills:*2*
7. Levemir Flexpen 100 unit/mL Insulin Pen Sig: Twenty Three
(23) units Subcutaneous at bedtime.
Disp:*qs * Refills:*2*
8. Novolog Flexpen 100 unit/mL Insulin Pen Sig: see sliding
scale  Subcutaneous three times a day.
Disp:*qs * Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] Area VNA

Discharge Diagnosis:
Coronary Artery Disease - s/p CABG
Type II Diabetes Mellitus
Hypertension
Dyslipidemia
Prior PTCA/stenting to RCA in [**2135**]


Discharge Condition:
Good


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.


Followup Instructions:
Dr. [**First Name (STitle) **] [**Name (STitle) **] in [**4-23**] weeks, call for appt ([**Telephone/Fax (1) 11763**]
Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] Sanan (PCP) in [**2-21**] weeks, call for appt
([**Telephone/Fax (1) 80746**]
Dr. [**Last Name (STitle) 8579**] or Caligan (cardiology) in [**2-21**] weeks, call for appt



Completed by:[**2147-3-21**]
{'Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cervical spondylosis without myelopathy,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Acquired absence of intestine (large) (small),Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Family history of ischemic heart disease,Long-term (current) use of insulin'}


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 tightness

PRESENT ILLNESS: Mr. [**Known lastname **] is a 74 year old male with known coronary artery
disease. He presented to [**Hospital **] Hospital with a six week
history of chest tightness and heaviness. He underwent cardiac
catheterization which revealed 70% left main lesion including
severe three vessel coronary artery disease. He was subsequently
transferred to the [**Hospital1 18**] for cardiac surgical intervention.

MEDICAL HISTORY: Coronary Artery Disease - Prior PTCA/stenting to RCA in [**2135**]
Type II Diabetes Mellitus
Hypertension
Dyslipidemia
Benign Prostatic Hypertrophy, s/p TURP [**2131**]
Degenerative Joint Disease
Diverticular Disease
Sigmoid Resection [**2145**]
Cataract Surgery
Right Knee Operation [**2144**]

MEDICATION ON ADMISSION: Aspirin 81 qd, Enalapril 10 qd, Fexofenadine 180 qd, Levemir 23
units, Novolog sliding scale, Lopressor 50 [**Hospital1 **], Lovastatin 40
qd, Omeprazole 20 qd, Terazosin 4 qd, Viagra prn

ALLERGIES: Percocet

PHYSICAL EXAM: BP 126/69, P 62, RR 12
Ht 70 inches
Wt 80 kg
General - WDWN male in NAD
Skin - unremarkable
HEENT - oropharynx benign, EOMI, sclera anicteric
Neck - supple, no JVD
Chest - lungs CTA bilaterally
Heart - regular rate and rhythm, normal s1s2, no rub or murmur
Abdomen - benign
Ext - warm, no edema
Neuro - alert and oriented, CN 2-12 grossly intact, FROM, [**5-23**]
strength

FAMILY HISTORY: Father died of MI at age 62.

SOCIAL HISTORY: Performs office work part time. 30 pack year history of tobacco
but quit smoking in [**2122**]. Denies ETOH. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cervical spondylosis without myelopathy,Esophageal reflux,Diverticulosis of colon (without mention of hemorrhage),Acquired absence of intestine (large) (small),Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Family history of ischemic heart disease,Long-term (current) use of insulin'}
