CHIEF COMPLAINT: Chest and bilateral arm pain.

PRESENT ILLNESS: 64 year old male with past medical history noted below who
presented to the emergency department in early [**Month (only) 359**] with
chest pressure and heaviness. He was admitted and ruled out for
a myocardial infarction. A stress test was positive and he was
cathed. Cath showed severe 3-vessel disease. He was felt to be
stable and discharged by cardiology with plan to return for
CABG. He returned on [**2178-11-6**] and underwent coronary artery
bypass graft surgery times three.

MEDICAL HISTORY: Peripheral vascular disease
Hypertension
Hyperlipidemia
Aortic stenosis
Chronic renal insufficiency
degenerative joint disease
cerebrovascular disease
S/P appendectomy
S/P aortobifemoral bypass, [**2168**]
S/P right hypogastric artery endarterectomy, [**2177**]
s/p multiple pacemaker implants
central venous thrombosis

MEDICATION ON ADMISSION: Plavix 75mg/D
Imdur 30mg/D
Metoprolol 25mg/D
Allopurinol 100mg/D
Ezetimide 10mg/D
Furosemide 40mg/G
HCTZ 25mg/D
Lisinopril 40mg/D
ASA 325mg/D
percocet prn
NTG 0.4mg sl prn

ALLERGIES: Inderal La / Lipitor

PHYSICAL EXAM: discharge:
Anxious, reasonable when talked to
Chest: lungs clear to auscultation, sternum stable
COR: regular rate, normal S1S2. II/VI systolic murmur loudest at
apex
Abdomen: numerous well healed incisions. Normoactive bowel
sounds. Soft and nontender
Extremities: warm with trace edema

FAMILY HISTORY: Family history is notable for a father who died of a heart
attack at age 53, a mother who is still living at 89 who has
diabetes and recently had a heart attack.  He has 4 brothers and
1 sister.  One brother recently died of liver cancer.  One
brother has diabetes and kidney failure.  Another brother has
diabetes and is s/p multiple bypasses and stents.

SOCIAL HISTORY: The patient retired in [**2147**] from the [**First Name8 (NamePattern2) 8314**] [**Last Name (NamePattern1) **] Corporation
and has since been a pool hussler and investor.
Social history is significant for a 60+ pack year smoking
history.
Social ETOH use now per patient.
daily narcotic use for shoulder pain
Coronary atherosclerosis of native coronary artery,Acute respiratory failure,Mechanical complication due to cardiac pacemaker (electrode),Opioid type dependence, continuous,Alcohol withdrawal,Hemorrhage complicating a procedure,Aortic valve disorders,Other convulsions,Hyperpotassemia,Chronic kidney disease, unspecified,Other and unspecified coagulation defects,Encephalopathy, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other chronic pain,Osteoarthrosis, unspecified whether generalized or localized, shoulder region,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified angina pectoris,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other and unspecified hyperlipidemia,Tobacco use disorder
Crnry athrscl natve vssl,Acute respiratry failure,Malfunc cardiac pacemake,Opioid dependence-contin,Alcohol withdrawal,Hemorrhage complic proc,Aortic valve disorder,Convulsions NEC,Hyperpotassemia,Chronic kidney dis NOS,Coagulat defect NEC/NOS,Encephalopathy NOS,Abn react-anastom/graft,Chronic pain NEC,Osteoarthros NOS-shlder,Hy kid NOS w cr kid I-IV,Angina pectoris NEC/NOS,Hx TIA/stroke w/o resid,Hyperlipidemia NEC/NOS,Tobacco use disorder
Admission Date:  [**2178-11-6**]              Discharge Date:   [**2178-11-16**]

Date of Birth:  [**2114-3-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Inderal La / Lipitor

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest and bilateral arm pain.

Major Surgical or Invasive Procedure:
Aortic valve replacement (21mm St. [**Male First Name (un) 923**] tissue), coronary artery
bypass grafts x 3 (LIMA-LAD, SVG-OM, SVG-PDA) [**11-6**]


History of Present Illness:
64 year old male with past medical history noted below who
presented to the emergency department in early [**Month (only) 359**] with
chest pressure and heaviness. He was admitted and ruled out for
a myocardial infarction. A stress test was positive and he was
cathed. Cath showed severe 3-vessel disease. He was felt to be
stable and discharged by cardiology with plan to return for
CABG. He returned on [**2178-11-6**] and underwent coronary artery
bypass graft surgery times three.

Past Medical History:
Peripheral vascular disease
Hypertension
Hyperlipidemia
Aortic stenosis
Chronic renal insufficiency
degenerative joint disease
cerebrovascular disease
S/P appendectomy
S/P aortobifemoral bypass, [**2168**]
S/P right hypogastric artery endarterectomy, [**2177**]
s/p multiple pacemaker implants
central venous thrombosis

Social History:
The patient retired in [**2147**] from the [**First Name8 (NamePattern2) 8314**] [**Last Name (NamePattern1) **] Corporation
and has since been a pool hussler and investor.
Social history is significant for a 60+ pack year smoking
history.
Social ETOH use now per patient.
daily narcotic use for shoulder pain

Family History:
Family history is notable for a father who died of a heart
attack at age 53, a mother who is still living at 89 who has
diabetes and recently had a heart attack.  He has 4 brothers and
1 sister.  One brother recently died of liver cancer.  One
brother has diabetes and kidney failure.  Another brother has
diabetes and is s/p multiple bypasses and stents.


Physical Exam:
discharge:
Anxious, reasonable when talked to
Chest: lungs clear to auscultation, sternum stable
COR: regular rate, normal S1S2. II/VI systolic murmur loudest at
apex
Abdomen: numerous well healed incisions. Normoactive bowel
sounds. Soft and nontender
Extremities: warm with trace edema


Pertinent Results:
[**2178-11-16**] 05:40AM BLOOD WBC-8.1 RBC-2.58* Hgb-7.9* Hct-23.9*
MCV-92 MCH-30.5 MCHC-33.1 RDW-15.5 Plt Ct-404
[**2178-11-11**] 03:26AM BLOOD PT-12.1 PTT-26.7 INR(PT)-1.0
[**2178-11-14**] 07:35AM BLOOD Glucose-138* UreaN-50* Creat-2.0* Na-142
K-4.3 Cl-108 HCO3-22 AnGap-16
[**Known lastname **],[**Known firstname 2922**] [**Medical Record Number 26188**] M  64  [**2114-3-24**]

Radiology Report CHEST (PORTABLE AP) Study Date of [**2178-11-11**] 9:05
AM


[**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG CSRU [**2178-11-11**] SCHED
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 26189**]
Reason: repeat CXR, eval for possible left upper ptx

[**Hospital 93**] MEDICAL CONDITION:
   64 year old man intubated, post cabg
REASON FOR THIS EXAMINATION:
   repeat CXR, eval for possible left upper ptx

Final Report
AP CHEST 9:31 A.M., [**11-11**]

HISTORY: Possible prior pneumothorax. New lines and tubes.

IMPRESSION: AP chest compared to [**11-10**] at 10:01 p.m.

Moderate left pleural effusion is slightly larger. Small right
pleural
effusion, if any. Normal post-operative cardiomediastinal
silhouette. No
pneumothorax. Nasogastric tube would need to be advanced several
centimeters
to move all the side-ports into the stomach. Other lines and
tubes in
standard placements. Feeding tube has been removed.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: WED [**2178-11-11**] 11:52 AM

  Imaging Lab



Brief Hospital Course:
This 64 year old white male has known aortic stenosis and
coronary artery disease and has been extensively worked up for
surgery. He was admitted at this time for elective cardiac
surgery. He went to the operating room on [**2178-11-6**] where surgery
was performed as noted.  See operative report for details. He
weaned from bypass easily on no pressors.  He was coagulopathic
and received extra protamine, FFP, and platelets which corrected
these and slowed postoperative bleeding.  He remained
hemodynamically stable. He had episodic severe agitation on
awakening.

He was extubated on POD1 and within one hour, complained of
pain, breathing problems and became apneic. He then had jerking
motions suggestive of seizure.  He was reintubated for acute
respiratory failure. A CT of the head was negative and EEG
showed no lateralized or epileptiform features. He was seen by
neurology. Dilantin loading was done, but no further dosing
ordered. On POD2, he was stable and on lightening sedation he
became very agiated, thrashing and hypertensive. He nodded to
questions but was not reliable.  Given his substance abuse
history and behaviors, Ativan and Methadone were recommended by
the Pain service. (Information from his brother, indicates that
the patient takes [**3-31**] Percocets a day for chronic shoulder pain
and drinks several times a week.  He also indicated that there
is central venous thrombosis from the patients 7 pacer implants
for brady arrhythmias and syncopal episode over the years.) To
ensure hemodynamic stability, he remained intubated and sedated
for several days. Tube feedings were initiated and followed
closely by the Nutrition service. Once his anti-hypertensive
regimen along with analgesic control was optimized, he was
re-exubated on POD6.

He was transferred to the step down floor on POD 7. He had
several episodes of attempting to leave the hospital late at
night. He was not combative and reqired Haldol IV on the 1st
night only. He was then placed on Haldol PO twice daily. He had
trouble with walking feeling dizzy and unsteady but insisted he
go home.

He slowly improved and on POD 10 he was cleared by physical
therapy and was alert and oriented.  He was discharged to home
in stable condition.

Medications on Admission:
Plavix 75mg/D
Imdur 30mg/D
Metoprolol 25mg/D
Allopurinol 100mg/D
Ezetimide 10mg/D
Furosemide 40mg/G
HCTZ 25mg/D
Lisinopril 40mg/D
ASA 325mg/D
percocet prn
NTG 0.4mg sl prn

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 7 days.
Disp:*14 Capsule(s)* Refills:*0*
3. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every [**3-29**]
hours as needed.
Disp:*50 Tablet(s)* Refills:*0*
6. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Ferrous Gluconate 325 mg (36 mg Iron) Tablet Sig: One (1)
Tablet PO three times a day.
Disp:*90 Tablet(s)* Refills:*2*
8. Vitamin C 500 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO twice a day.
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
9. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
10. 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*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
coronary artery disease
s/p coronary artery bypass grafts x 3 (LIMA-LAD, SVG-OM,
SVG-PDA), aortic valve replacement (21mm St. [**Male First Name (un) **] tissue) [**11-6**]
aortic stenosis
hypertension
hyperlipidemia
peripheral vascular disease
chronic renal insufficiency
cerebrovascular disease
s/p permanent dual chamber pacemeker insertion
s/p appendectomy
s/p aortobifemoral bypass graft
degenerative joint disease


Discharge Condition:
good


Discharge Instructions:
no driving for 4 weeks and off all narcotics
no lifting more than 10 pounds for 10 weeks
shower daily, no baths or swimming
no lotions, creams or powders to incisions
report any redness of, or drainage from incisions
report any fever greater than 100.5
report any weight gain greater than 2 pounds a day or 5 pounds
in a week
take all medications as directed

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
[**Hospital 409**] clinic in 2 weeks
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 20561**] in 2 weeks ([**Telephone/Fax (1) 26190**])
Please call for appointments



Completed by:[**2178-11-16**]
{'Coronary atherosclerosis of native coronary artery,Acute respiratory failure,Mechanical complication due to cardiac pacemaker (electrode),Opioid type dependence, continuous,Alcohol withdrawal,Hemorrhage complicating a procedure,Aortic valve disorders,Other convulsions,Hyperpotassemia,Chronic kidney disease, unspecified,Other and unspecified coagulation defects,Encephalopathy, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other chronic pain,Osteoarthrosis, unspecified whether generalized or localized, shoulder region,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified angina pectoris,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other and unspecified hyperlipidemia,Tobacco use disorder'}


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 and bilateral arm pain.

PRESENT ILLNESS: 64 year old male with past medical history noted below who
presented to the emergency department in early [**Month (only) 359**] with
chest pressure and heaviness. He was admitted and ruled out for
a myocardial infarction. A stress test was positive and he was
cathed. Cath showed severe 3-vessel disease. He was felt to be
stable and discharged by cardiology with plan to return for
CABG. He returned on [**2178-11-6**] and underwent coronary artery
bypass graft surgery times three.

MEDICAL HISTORY: Peripheral vascular disease
Hypertension
Hyperlipidemia
Aortic stenosis
Chronic renal insufficiency
degenerative joint disease
cerebrovascular disease
S/P appendectomy
S/P aortobifemoral bypass, [**2168**]
S/P right hypogastric artery endarterectomy, [**2177**]
s/p multiple pacemaker implants
central venous thrombosis

MEDICATION ON ADMISSION: Plavix 75mg/D
Imdur 30mg/D
Metoprolol 25mg/D
Allopurinol 100mg/D
Ezetimide 10mg/D
Furosemide 40mg/G
HCTZ 25mg/D
Lisinopril 40mg/D
ASA 325mg/D
percocet prn
NTG 0.4mg sl prn

ALLERGIES: Inderal La / Lipitor

PHYSICAL EXAM: discharge:
Anxious, reasonable when talked to
Chest: lungs clear to auscultation, sternum stable
COR: regular rate, normal S1S2. II/VI systolic murmur loudest at
apex
Abdomen: numerous well healed incisions. Normoactive bowel
sounds. Soft and nontender
Extremities: warm with trace edema

FAMILY HISTORY: Family history is notable for a father who died of a heart
attack at age 53, a mother who is still living at 89 who has
diabetes and recently had a heart attack.  He has 4 brothers and
1 sister.  One brother recently died of liver cancer.  One
brother has diabetes and kidney failure.  Another brother has
diabetes and is s/p multiple bypasses and stents.

SOCIAL HISTORY: The patient retired in [**2147**] from the [**First Name8 (NamePattern2) 8314**] [**Last Name (NamePattern1) **] Corporation
and has since been a pool hussler and investor.
Social history is significant for a 60+ pack year smoking
history.
Social ETOH use now per patient.
daily narcotic use for shoulder pain 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute respiratory failure,Mechanical complication due to cardiac pacemaker (electrode),Opioid type dependence, continuous,Alcohol withdrawal,Hemorrhage complicating a procedure,Aortic valve disorders,Other convulsions,Hyperpotassemia,Chronic kidney disease, unspecified,Other and unspecified coagulation defects,Encephalopathy, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other chronic pain,Osteoarthrosis, unspecified whether generalized or localized, shoulder region,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified angina pectoris,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other and unspecified hyperlipidemia,Tobacco use disorder'}
