CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This 66 year old female complains of chest pain over the last
few months,relieved with nitroglycerin and accompanied with
shortness of breath at rest and exercise. She underwent a stress
test which was inconclusive. Therefore she had a cardiac
catheterization which revealed severe three vessel coronary
artery disease. She was referred for surgical intervention.

MEDICAL HISTORY: emphysema
Hypothyroidism
Rheumatoid Arthritis
Depression/Anxiety

MEDICATION ON ADMISSION: Advair, Levoxyl, Toprol XL, HCTZ, Protonix, Potassium, Aspirin,
Nitro prn, Vitamin B, Albuterol HFA

ALLERGIES: Penicillins / Erythromycin / Clindamycin / Codeine / Ampicillin
/ Amoxicillin / Adhesive Tape / Novocain / Ciprofloxacin

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Brother with CAD at 66

SOCIAL HISTORY: Occupation:
Last Dental Exam:
Lives with: alone
Race:caucasian
Tobacco:> 40 pack years, stopped 5-6 years ago
ETOH:denies
Coronary atherosclerosis of native coronary artery,Chronic obstructive asthma, unspecified,Intermediate coronary syndrome,Other iatrogenic hypotension,Unspecified acquired hypothyroidism,Rheumatoid arthritis,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Anxiety state, unspecified,Other acute pain,Personal history of tobacco use,Backache, unspecified
Crnry athrscl natve vssl,Chronic obst asthma NOS,Intermed coronary synd,Iatrogenc hypotnsion NEC,Hypothyroidism NOS,Rheumatoid arthritis,Osteoarthros NOS-pelvis,Anxiety state NOS,Acute pain NEC,History of tobacco use,Backache NOS
Admission Date:  [**2121-10-10**]              Discharge Date:   [**2121-10-20**]

Date of Birth:  [**2055-7-26**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Erythromycin / Clindamycin / Codeine / Ampicillin
/ Amoxicillin / Adhesive Tape / Novocain / Ciprofloxacin

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2121-10-13**] - CABGx4 (left internal mammary artery->Left anterior
descending artery, Saphenous vein graft (SVG)->Diagonal artery,
SVG->Obtuse marginal artery, SVG->Posterior descending artery).


History of Present Illness:
This 66 year old female complains of chest pain over the last
few months,relieved with nitroglycerin and accompanied with
shortness of breath at rest and exercise. She underwent a stress
test which was inconclusive. Therefore she had a cardiac
catheterization which revealed severe three vessel coronary
artery disease. She was referred for surgical intervention.


Past Medical History:
emphysema
Hypothyroidism
Rheumatoid Arthritis
Depression/Anxiety


Social History:
Occupation:
Last Dental Exam:
Lives with: alone
Race:caucasian
Tobacco:> 40 pack years, stopped 5-6 years ago
ETOH:denies


Family History:
Brother with CAD at 66


Physical Exam:
Admission:

Pulse: Resp:  O2 sat:
B/P  Right:    Left:
Height:     Weight:

General:
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 OCCASSIONAL PREMATURE BEATS
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  Edema Varicosities
BILATERALLY: None []
Neuro: Grossly intact
Pulses:
Femoral      Right: +2  Left: +2
DP           Right: +1  Left: +1
PT           [**Name (NI) 167**]:  +1 Left: +1
Radial       Right: +2 Left: +2

Carotid Bruit        Right:NONE    Left:NONE


Pertinent Results:
[**2121-10-10**] Carotid Duplex Ultrasound
Right ICA with no stenosis.
Left ICA with no stenosis.

[**2121-10-13**] ECHO
PRE-BYPASS: The left atrium is normal in size. No spontaneous
echo contrast or thrombus is seen in the body of the left atrium
or left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler. Overall left ventricular systolic function is
mildly depressed (LVEF= XX %). Right ventricular chamber size
and free wall motion are normal. There are complex (>4mm)
atheroma in the descending thoracic aorta. There are three
aortic valve leaflets. There is no valvular aortic stenosis. The
increased transaortic velocity is likely related to high cardiac
output. Trace aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Trivial mitral regurgitation is
seen. There is no pericardial effusion.

POST. CPB:
1. Globally improved LV systolic function EF = 55%
2. Preserved RV systolci function.
3. No other change in valve structure and function

[**2121-10-19**] 05:30AM BLOOD WBC-6.3 RBC-3.26* Hgb-9.4* Hct-28.3*
MCV-87 MCH-28.7 MCHC-33.1 RDW-16.5* Plt Ct-375
[**2121-10-19**] 05:30AM BLOOD Glucose-87 UreaN-13 Creat-0.7 Na-142
K-3.9 Cl-113* HCO3-18* AnGap-15

Brief Hospital Course:
Ms. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2121-10-10**] for surgical
management of her coronary artery disease. Plavix was allowed to
clear over the next several days. She was worked-up in the usual
preoperative manner including a carotid duplex ultrasound which
showed no significant internal carotid artery disease. On
[**2121-10-13**], Ms. [**Known lastname **] was taken to the operating room where she
underwent coronary artery bypass grafting to four vessels.
(Please see operative note for details.) She weaned from bypass
on Neosynephrine and Propofol.  Postoperatively she was taken to
the intensive care unit for monitoring. Over the next 24 hours
she awoke neurologically intact and was extubated.

She was stable, requiring pressors for several days.  This was
weaned off by POD 3 and low dose Lopressor was resumed. She was
then transferred to the step down unit for further recovery.

The physical therapy service was consulted for assistance with
her postoperative strength and mobility. She was gently diuresed
towards her preoperative weight. Socila services was visited her
to discuss social and personal issue due to her depression and
anxiety.  She became ambulatory, her hemodynamics remained
stable and she was ready for discharge.  A transfer to a
rehabilitation facility was initiated to allow further recovery
before discharge to an independent situation.

Follow up,restrictions and medications were as noted in the
sumary elsewhere.

STOP [**10-20**]


Medications on Admission:
Advair, Levoxyl, Toprol XL, HCTZ, Protonix, Potassium, Aspirin,
Nitro prn, Vitamin B, Albuterol HFA


Discharge Medications:
1. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation DAILY (Daily).
2. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY  ().
3. Aspirin Low Dose 81 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO once a day.
4. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO every four (4)
hours as needed for pain for 2 weeks.
6. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO once a
day.
7. Skelaxin 800 mg Tablet Sig: One (1) Tablet PO four times a
day.
8. Topamax 25 mg Capsule, Sprinkle Sig: Five (5) Capsule,
Sprinkle PO three times a day.
9. Lopressor 50 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Piroxicam 20 mg Capsule Sig: One (1) Capsule PO once a day.

11. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO at bedtime.

12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
13. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for anxiety.
14. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
15. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for fever or pain.
16. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
tba

Discharge Diagnosis:
coronary artery disease
s/p coronary artery bypass grafts
emphysema
Hypothyroidism
Rheumatoid Arthritis
Depression/Anxiety


Discharge Condition:
Good


Discharge Instructions:
Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
Report any temperature greater then 100.5.
Report any weight gain of 2 pounds in 24 hours or 5 pounds in 1
week.
Shower daily. Wash incisions with soap and water.no swimming or
baths.
No lotions, creams or powders to incisions for 6 weeks.
No driving for 1 month andtaking narcotics.
No lifting greater then 10 pounds for 10 weeks from date of
surgery.
Take all medications as directed.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 170**])
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 83585**]) in [**12-31**] weeks.
Dr. [**First Name8 (NamePattern2) 1154**] [**Last Name (NamePattern1) 10302**] ([**Telephone/Fax (1) 83586**]in [**12-31**] weeks.
Please call all providers for appointments.



Completed by:[**2121-10-20**]
{'Coronary atherosclerosis of native coronary artery,Chronic obstructive asthma, unspecified,Intermediate coronary syndrome,Other iatrogenic hypotension,Unspecified acquired hypothyroidism,Rheumatoid arthritis,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Anxiety state, unspecified,Other acute pain,Personal history of tobacco use,Backache, unspecified'}


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: This 66 year old female complains of chest pain over the last
few months,relieved with nitroglycerin and accompanied with
shortness of breath at rest and exercise. She underwent a stress
test which was inconclusive. Therefore she had a cardiac
catheterization which revealed severe three vessel coronary
artery disease. She was referred for surgical intervention.

MEDICAL HISTORY: emphysema
Hypothyroidism
Rheumatoid Arthritis
Depression/Anxiety

MEDICATION ON ADMISSION: Advair, Levoxyl, Toprol XL, HCTZ, Protonix, Potassium, Aspirin,
Nitro prn, Vitamin B, Albuterol HFA

ALLERGIES: Penicillins / Erythromycin / Clindamycin / Codeine / Ampicillin
/ Amoxicillin / Adhesive Tape / Novocain / Ciprofloxacin

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Brother with CAD at 66

SOCIAL HISTORY: Occupation:
Last Dental Exam:
Lives with: alone
Race:caucasian
Tobacco:> 40 pack years, stopped 5-6 years ago
ETOH:denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic obstructive asthma, unspecified,Intermediate coronary syndrome,Other iatrogenic hypotension,Unspecified acquired hypothyroidism,Rheumatoid arthritis,Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh,Anxiety state, unspecified,Other acute pain,Personal history of tobacco use,Backache, unspecified'}
