CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This 76 year old Russian speaking male presented to the ER after
awakening from sleep with chest pain. He ruled out for an
infarction. Catheterization showed severe left main and triple
vessel disease and Cardiac Surgery was consulted for surgical
revascularization.

MEDICAL HISTORY: Insulin dependent diabetes mellitus
Hypercholesterolemia
Hypertension
chronic kidney disease
coronary artery disease
Celiac sprue
s/p pericardial tamponade [**7-24**]
s/p coronary angioplasty

MEDICATION ON ADMISSION: Aspirin 325 po daily
Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for SOB,
cough.
Fluticasone 50 mcg/Actuation Spray, Suspension Sig: 2sprays
Nasal
TID
Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: 1
puff [**Hospital1 **]
Polysaccharide Iron Complex 150 mg po TID
Metoprolol Tartrate 25 po daily
Sevelamer HCl 400 mg po TID
Montelukast 10 mg po daily
Tamsulosin 0.8 po q HS
Clopidogrel 75 mg po daily
Simvastatin 40 mg po daily
Amiodarone 200 po 3X/WEEK (MO,WE,FR).
Amlodipine 5 mg po daily
B Complex-Vitamin C-Folic Acid 1 mg po daily
Lantus 8 units SC q AM
Humalog 100 unit/mL Solution Sig: take [**First Name8 (NamePattern2) **] [**Last Name (un) **] sliding
scale  Subcutaneous qachs.
Calcitriol 0.25 mcg po daily
Loratadine 10 mg po daily

ALLERGIES: Gluten

PHYSICAL EXAM: Admission:

FAMILY HISTORY: [**Name (NI) 1094**] mother died in what was thought to be an MI in the
holocaust.

SOCIAL HISTORY: Born in [**Country 532**], moved to US in [**2150**]. Lives with his wife and
son. Former organic chemistry professor. He has never smoked. He
does not
consume alcohol on a regular basis (1 drink every 2-3 months).
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Ostium secundum type atrial septal defect,Hyposmolality and/or hyponatremia,Chronic kidney disease, Stage IV (severe),Unspecified nasal polyp,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Celiac disease,Chronic obstructive asthma, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Nontoxic uninodular goiter,Atrial fibrillation,Old myocardial infarction,Anemia in chronic kidney disease
Crnry athrscl natve vssl,Intermed coronary synd,Pleural effusion NOS,Secundum atrial sept def,Hyposmolality,Chr kidney dis stage IV,Nasal polyp NOS,DMII wo cmp uncntrld,Long-term use of insulin,Pure hypercholesterolem,Hy kid NOS w cr kid I-IV,Celiac disease,Chronic obst asthma NOS,BPH w/o urinary obs/LUTS,Nontox uninodular goiter,Atrial fibrillation,Old myocardial infarct,Anemia in chr kidney dis
Admission Date:  [**2165-12-15**]              Discharge Date:   [**2165-12-23**]

Date of Birth:  [**2089-7-2**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Gluten

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

Major Surgical or Invasive Procedure:
[**2165-12-16**] -left heart Catheterization,coronary angiogram
[**2165-12-17**] - CABGx4 (Left internal mammary artery->Left anterior
descending artery, Saphenous vein graft (SVG)->Posterior
descending artery, SVG->Diagonal artery, SVG->Obtuse marginal
artery.)


History of Present Illness:
This 76 year old Russian speaking male presented to the ER after
awakening from sleep with chest pain. He ruled out for an
infarction. Catheterization showed severe left main and triple
vessel disease and Cardiac Surgery was consulted for surgical
revascularization.


Past Medical History:
Insulin dependent diabetes mellitus
Hypercholesterolemia
Hypertension
chronic kidney disease
coronary artery disease
Celiac sprue
s/p pericardial tamponade [**7-24**]
s/p coronary angioplasty


Social History:
Born in [**Country 532**], moved to US in [**2150**]. Lives with his wife and
son. Former organic chemistry professor. He has never smoked. He
does not
consume alcohol on a regular basis (1 drink every 2-3 months).


Family History:
[**Name (NI) 1094**] mother died in what was thought to be an MI in the
holocaust.

Physical Exam:
Admission:

Pulse:53 Resp:12  O2 sat:95%RA
B/P  Right:150/69    Left:149/64
Height: 5'2"    Weight:130 LBS

General: comfortable
Skin: Dry [x] intact [x]
HEENT: PERRLA [] EOMI [x]
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur: No
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [-]
Neuro: Grossly intact. mobes 4 ext. follows commands, R handed
Pulses:
Femoral      Right:palp   Left:palp
DP           Right:dop    Left:palp
[**Doctor Last Name **]          Right: palp  Left:palp
Radial       Right:palp   Left:palp

Carotid Bruit        Right: -   Left:-


Pertinent Results:
[**2165-12-17**] ECHO
PRE-BYPASS:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage.
A patent foramen ovale is present. A left-to-right shunt across
the interatrial septum is seen at rest.
There is mild symmetric left ventricular hypertrophy with normal
cavity size and regional/global systolic function (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are focal calcifications in the aortic arch. There are
simple atheroma in the descending thoracic aorta. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is no pericardial effusion. Dr. [**Last Name (STitle) **]
was notified in person of the results before surgical incision.
POST-BYPASS:
Normal biventricular systolic function. LVEF 55%.

[**2165-12-23**] 06:55AM BLOOD WBC-9.0 RBC-3.06* Hgb-9.5* Hct-29.1*
MCV-95 MCH-31.1 MCHC-32.8 RDW-15.3 Plt Ct-192
[**2165-12-22**] 07:00AM BLOOD WBC-8.0 RBC-2.98* Hgb-9.3* Hct-27.6*
MCV-92 MCH-31.2 MCHC-33.8 RDW-15.5 Plt Ct-146*
[**2165-12-23**] 06:55AM BLOOD Glucose-215* UreaN-40* Creat-2.5* Na-132*
K-4.5 Cl-95* HCO3-28 AnGap-14
[**2165-12-22**] 07:00AM BLOOD Glucose-284* UreaN-42* Creat-2.6* Na-132*
K-4.9 Cl-95* HCO3-27 AnGap-15

Brief Hospital Course:
Mr. [**Known lastname 8133**] was admitted to the [**Hospital1 18**] on [**2165-12-15**] for
management of his chest pain. He ruled out for a myocardial
infarction. He was started on Plavix, nitroglycerin and Heparin.
A cardiac catheterization was performed which revealed severe
left main and three vessel disease. Given the severity of his
disease, the cardiac surgical service was consulted for surgical
management. He was worked-up in the usual preoperative manner
and was ready for surgery.

On [**2165-12-17**] he was to the Operating Room where he underwent
coronary artery bypass grafting to four vessels. Please see
operative note for details. Postoperatively he was taken to the
intensive care unit for monitoring. Over the next 24 hours, he
awoke neurologically intact and was extubated. He required low
dose pressors for a couple of days and a baseline random
Cortisol was 25.  Midodrine and Florinef were begun. The pressor
was weaned off and he transferred to the floor on POD 3. Beta
blockade, aspirin and a statin were resumed. Later on
postoperative day one, he was transferred to the step down unit
for further recovery. He was gently diuresed towards his
preoperative weight. The Physical Therapy service was consulted
for assistance with his postoperative strength and mobility.

Immediately after transfer he was found to have a glucose of
400.  He transferred back to the ICU for an insulin infusion.
This weaned off, steroids were stopped and he was stable.  .He
was begun on Lantus with sliding scale coverage and he
transferred back to the floor.  His glucose control was
improving, however, he was still hyperglycemic to 260 and Lantus
was increased to 15 U with SSI coverage.  He has unsteady on his
feet and unable to safely be sent home.  Rehabilitation was
discussed with him and his family and they agreed to a transfer
to such a facility for further recovery prior to discharge.  He
did occasionally drop his BP to the 80s upon standing, although
he was asymptomatic and it rose quickly to the 100s.

Arrangements were made for follow up after discharge. Wounds
were clean and healing well.

Restrictions, precautions and medications were discussed with he
and the family prior to discharge.  Arrangements for follow up
were made as well.


Medications on Admission:
Aspirin 325 po daily
Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for SOB,
cough.
Fluticasone 50 mcg/Actuation Spray, Suspension Sig: 2sprays
Nasal
TID
Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: 1
puff [**Hospital1 **]
Polysaccharide Iron Complex 150 mg po TID
Metoprolol Tartrate 25 po daily
Sevelamer HCl 400 mg po TID
Montelukast 10 mg po daily
Tamsulosin 0.8 po q HS
Clopidogrel 75 mg po daily
Simvastatin 40 mg po daily
Amiodarone 200 po 3X/WEEK (MO,WE,FR).
Amlodipine 5 mg po daily
B Complex-Vitamin C-Folic Acid 1 mg po daily
Lantus 8 units SC q AM
Humalog 100 unit/mL Solution Sig: take [**First Name8 (NamePattern2) **] [**Last Name (un) **] sliding
scale  Subcutaneous qachs.
Calcitriol 0.25 mcg po daily
Loratadine 10 mg po daily


Discharge Medications:
1. Epoetin Alfa 10,000 unit/mL Solution Sig: One (1) inj
Injection once a month.
2. Toprol XL 25 mg Tablet Sustained Release 24 hr Sig: 0.5
Tablet Sustained Release 24 hr PO once a day.
Disp:*15 Tablet Sustained Release 24 hr(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
5. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain for 4 weeks.
Disp:*50 Tablet(s)* Refills:*0*
6. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Sevelamer HCl 400 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
8. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for sleep. Tablet(s)
9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 4 weeks.
Disp:*30 Tablet(s)* Refills:*0*
10. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 4 weeks.
Disp:*30 Tablet(s)* Refills:*0*
11. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal TID (3 times a day).
12. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
13. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY
(Daily). Capsule(s)
14. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
15. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
16. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
17. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
2-4 Puffs Inhalation Q4H (every 4 hours) as needed for wheeze.
Disp:*1 * Refills:*2*
18. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: Two (2)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
19. Lantus 100 unit/mL Cartridge Sig: 15 units  Subcutaneous
once a day.
20. Humalog 100 unit/mL Cartridge Sig: see sliding scale below
Subcutaneous ac and HS: 120-160:4units SQ
161-200:6units SQ
201-240:8units SQ
241-280:10units SQ
281-320:12units SQ
Begin HS coverage at 161.
21. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO three times a day.
22. Bisacodyl 10 mg Suppository Sig: One (1)  Rectal once a day.



Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Coronary artery disease
s/p coronary artery bypass grafts
Unstable angina
s/p coronary angioplasty
Type I diabetes mellitis
Nasal polyps


Discharge Condition:
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Activity Status:Ambulatory - Independent


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your 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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr. [**Last Name (STitle) **] in 1 month ([**Telephone/Fax (1) 170**]) [**2166-1-22**] at 1:00 PM
Provider: [**First Name11 (Name Pattern1) 4283**] [**Last Name (NamePattern4) 4284**], M.D. ([**Telephone/Fax (1) 250**]):[**2165-12-31**] 8:50am
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.([**Telephone/Fax (1) 62**]):[**2166-1-16**] 10:00am



Completed by:[**2165-12-23**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Ostium secundum type atrial septal defect,Hyposmolality and/or hyponatremia,Chronic kidney disease, Stage IV (severe),Unspecified nasal polyp,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Celiac disease,Chronic obstructive asthma, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Nontoxic uninodular goiter,Atrial fibrillation,Old myocardial infarction,Anemia in chronic kidney disease'}


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 76 year old Russian speaking male presented to the ER after
awakening from sleep with chest pain. He ruled out for an
infarction. Catheterization showed severe left main and triple
vessel disease and Cardiac Surgery was consulted for surgical
revascularization.

MEDICAL HISTORY: Insulin dependent diabetes mellitus
Hypercholesterolemia
Hypertension
chronic kidney disease
coronary artery disease
Celiac sprue
s/p pericardial tamponade [**7-24**]
s/p coronary angioplasty

MEDICATION ON ADMISSION: Aspirin 325 po daily
Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for SOB,
cough.
Fluticasone 50 mcg/Actuation Spray, Suspension Sig: 2sprays
Nasal
TID
Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: 1
puff [**Hospital1 **]
Polysaccharide Iron Complex 150 mg po TID
Metoprolol Tartrate 25 po daily
Sevelamer HCl 400 mg po TID
Montelukast 10 mg po daily
Tamsulosin 0.8 po q HS
Clopidogrel 75 mg po daily
Simvastatin 40 mg po daily
Amiodarone 200 po 3X/WEEK (MO,WE,FR).
Amlodipine 5 mg po daily
B Complex-Vitamin C-Folic Acid 1 mg po daily
Lantus 8 units SC q AM
Humalog 100 unit/mL Solution Sig: take [**First Name8 (NamePattern2) **] [**Last Name (un) **] sliding
scale  Subcutaneous qachs.
Calcitriol 0.25 mcg po daily
Loratadine 10 mg po daily

ALLERGIES: Gluten

PHYSICAL EXAM: Admission:

FAMILY HISTORY: [**Name (NI) 1094**] mother died in what was thought to be an MI in the
holocaust.

SOCIAL HISTORY: Born in [**Country 532**], moved to US in [**2150**]. Lives with his wife and
son. Former organic chemistry professor. He has never smoked. He
does not
consume alcohol on a regular basis (1 drink every 2-3 months). 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Ostium secundum type atrial septal defect,Hyposmolality and/or hyponatremia,Chronic kidney disease, Stage IV (severe),Unspecified nasal polyp,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Celiac disease,Chronic obstructive asthma, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Nontoxic uninodular goiter,Atrial fibrillation,Old myocardial infarction,Anemia in chronic kidney disease'}
