CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: Pt is 64M with h/o DM, CAD s/p LAD stent at [**Hospital1 2025**], being worked up
for THR and had a + myocardial perfusion scan showing evidence
on anterior ischemia.   Two days after scan, pt was presented to
[**Hospital1 **] with complains of angina on exertion on [**4-14**].

MEDICAL HISTORY: Primary diagnosis:
Angina
Mitral Regurgitation
Coronary artery disease

MEDICATION ON ADMISSION: Humalog three times daily before meals
Levemir 90 units HS
fluoxetine HCL 20 mg capsule four times a day
Focalin XR 30 mg Daily
Diovan 320 mg daily
fenofibrate micronized 200 mg daily
bupropion 300 mg extended release daily
aspirin 81 mg daily
Cialis 20 mg p.r.n.
omega-3 one capsule [**Hospital1 **]
multivitamins 1 tablet daily
cinnamon extract 1 capsule daily
glucosamine chondroitin twice daily
fiber tabs
Valerian 450mg [**12-23**] capsules HS PRN

ALLERGIES: Ace Inhibitors / Nickel

PHYSICAL EXAM: Admission physical exam:
VS: 98.5 145/96, 86, 16, 97% RA
GENERAL: Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Cancer in a maternal uncle, bladder cancer, aunt
with pancreatic cancer.  Father with diabetes, heart disease in
brother and mother.  Seborrhea twin brother, mother and twin
brother have diverticulitis.

SOCIAL HISTORY: Retired.  He has ten cigarettes pack year
history, quit 27 years ago, one to two drinks per week.
Married.
Other complications due to other cardiac device, implant, and graft,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Hemorrhage complicating a procedure,Other digestive system complications,Paralytic ileus,Alkalosis,Acute posthemorrhagic anemia,Delirium due to conditions classified elsewhere,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Osteoarthrosis, localized, not specified whether primary or secondary, pelvic region and thigh,Attention deficit disorder with hyperactivity,Obesity, unspecified,Obsessive-compulsive disorders,Impotence of organic origin,Body Mass Index 28.0-28.9, adult,Cervical spondylosis without myelopathy,Depressive disorder, not elsewhere classified,Examination of participant in clinical trial,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Long-term (current) use of insulin,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Comp-oth cardiac device,Mitral valve disorder,Crnry athrscl natve vssl,Intermed coronary synd,Hemorrhage complic proc,Oth digestv system comp,Paralytic ileus,Alkalosis,Ac posthemorrhag anemia,Delirium d/t other cond,Thrombocytopenia NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Obstructive sleep apnea,Hyperlipidemia NEC/NOS,Loc osteoarth NOS-pelvis,Attn deficit w hyperact,Obesity NOS,Obsessive-compulsive dis,Impotence, organic orign,BMI 28.0-28.9,adult,Cervical spondylosis,Depressive disorder NEC,Exam-clincal trial,History of tobacco use,Status-post ptca,Acq absence of organ NEC,Long-term use of insulin,Abn react-artif implant
Admission Date:  [**2136-4-16**]              Discharge Date:   [**2136-4-29**]

Date of Birth:  [**2071-5-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ace Inhibitors / Nickel

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


Major Surgical or Invasive Procedure:
[**2136-4-20**]
1. Coronary artery bypass grafting x2; left internal
    mammary artery graft to left anterior descending,
    reverse saphenous vein graft to diagonal branch.
2. Mitral valve repair with a 28 mm Physio II annuloplasty
    ring.


History of Present Illness:
Pt is 64M with h/o DM, CAD s/p LAD stent at [**Hospital1 2025**], being worked up
for THR and had a + myocardial perfusion scan showing evidence
on anterior ischemia.   Two days after scan, pt was presented to
[**Hospital1 **] with complains of angina on exertion on [**4-14**].

At OSH, he was started on plavix, continued on aspirin 81 mg.
EKG without any significant ST segment depressions or elevations
and no TWI, his cardiac enzymes were flat.  He was not started
on a heparin drip.  Pt remained chest pain free while in
hospital but did not feel comfortable going home for outpt cath.


Transferred to [**Hospital1 18**] for cardiac catheterization.


Past Medical History:
Primary diagnosis:
Angina
Mitral Regurgitation
Coronary artery disease

Secondary diagnosis:
Insulin dependent diabetes mellitus
Chronic kidney disease
Hypertension
Anxiety/depression


Social History:
Retired.  He has ten cigarettes pack year
history, quit 27 years ago, one to two drinks per week.
Married.


Family History:
Cancer in a maternal uncle, bladder cancer, aunt
with pancreatic cancer.  Father with diabetes, heart disease in
brother and mother.  Seborrhea twin brother, mother and twin
brother have diverticulitis.


Physical Exam:
Admission physical exam:
VS: 98.5 145/96, 86, 16, 97% RA
GENERAL: Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVD flat.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
NEURO: CN II-XII tested and intact, strength 5/5 throughout,
sensation grossly normal. Gait not tested.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

Discharge physical exam:


Pertinent Results:
IMAGING:
[**2136-4-17**] TTE:
The left atrium is elongated. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). Right ventricular chamber size and free wall motion
are normal. The ascending aorta is mildly dilated. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis or aortic regurgitation. The
mitral valve leaflets are structurally normal. There is no
mitral valve prolapse. Mild (1+) mitral regurgitation is seen.
The pulmonary artery systolic pressure could not be determined.
There is no pericardial effusion.
IMPRESSION: Normal global and regional biventricular systolic
function. Mild mitral regurgitation in a structurally normal
valve. Mild ascending aorta dilation.

[**2136-4-17**] Cardiac catheterization:
COMMENTS:
1. Selective coronary angiography in this right dominant system
demonstrated severe single vessel disease.   The LMCA was
patent.  The LAD had a 90% in stent restenosis and a 90% ostial
diagonal lesion prior to the previous stent.   The LCx was
patent.  The RCA was patent.
2.  Limited resting hemodynamics revealed a normal systemic
arterial blood pressure with a central aortic pressure of 108/68
mmHg.

FINAL DIAGNOSIS:
1. Severe single vessel coronary artery disease.
2. Normal systemic arterial blood pressure.

[**2136-4-18**] Chest X-ray PA and Lateral:
Heart size is normal.  Mediastinum is normal.  Lungs are
essentially clear.  There is no pleural effusion or
pneumothorax.
IMPRESSION: No evidence of acute cardiopulmonary process.



Brief Hospital Course:
Mr. [**Known lastname 91961**] is a 64 year old man with a past medical history of
diabetes mellitus, coronary artery disease s/p drug eluting
stent times two in the diagonal and left anterior descending
artery at [**Hospital3 2576**] [**Hospital3 **] in [**2131**], presents from an
outside hospital with epigastric pain taken to cath [**2136-4-17**]
where an in-stent restonosis of his left anterior descending
artery stent of 85-90% and lesion in the diagonal artery
proximal to the stent of 90% was noted with plans for coronary
artery bypass grafting.
The patient was brought to the operating room on [**2136-4-20**] where
the patient underwent a coronary artery bypass grafting times
two and mitral valve repair.  Overall the patient tolerated the
procedure well and post-operatively was transferred to the CVICU
in stable condition for recovery and invasive monitoring. His
pressure was labile and a few hours out of the operating room he
had increased chest tube output and dropped his hematocrit. He
returned to the operating room for reexploration of surgical
bleeding. See intraoperative notes for further details. He
returned to the unit in stable condition on pressors. His
pressors were weaned off over 24-48hrs. He extubated on
post-operative day one. He  was somewhat confused and mildly
agitated for the first two days after surgery. On post-operative
day three he developed abdominal distension and pain. Both a KUB
and CT scan of the abdomen indicated possible early small bowel
obstruction, therefore he was made NPO, an nasal gastric tube
was placed and he was seen by general surgery. The patient was
transferred to the telemetry floor for further recovery. By
post-operative day six his abdominal exam was improved and nasal
gastric tube was discontinued and diet advanced.
He continued to progress. He remained neurologically intact and
hemodynamically stable. He was gently diuresed towards pre-op
weight. His chest tubes and pacing wires were discontinued
without complication.  The patient was evaluated by the physical
therapy service for assistance with strength and mobility.  By
the time of discharge on post-operative day nine the patient was
ambulating freely, the wound was healing and pain was controlled
with oral analgesics.  The patient was discharged home in good
condition with appropriate follow up instructions.

Medications on Admission:
Humalog three times daily before meals
Levemir 90 units HS
fluoxetine HCL 20 mg capsule four times a day
Focalin XR 30 mg Daily
Diovan 320 mg daily
fenofibrate micronized 200 mg daily
bupropion 300 mg extended release daily
aspirin 81 mg daily
Cialis 20 mg p.r.n.
omega-3 one capsule [**Hospital1 **]
multivitamins 1 tablet daily
cinnamon extract 1 capsule daily
glucosamine chondroitin twice daily
fiber tabs
Valerian 450mg [**12-23**] capsules HS PRN

Discharge Medications:


1. Levemir 100 unit/mL Solution Sig: Ninety (90) units
Subcutaneous once a day.
2. Humalog 100 unit/mL Solution Sig: Per home instructions units
Subcutaneous three times a day: Prior to meals .
3. Focalin XR 15 mg Capsule, ER Multiphase 50-50 Sig: One (1)
Capsule, ER Multiphase 50-50 PO twice a day.
4. fenofibrate micronized 200 mg Capsule Sig: One (1) Capsule PO
once a day.
5. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Omega 3 350-400 mg Capsule Sig: One (1) Capsule PO once a
day.
7. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
8. Cinnamon 500 mg Capsule Oral
9. Glucosamine  Oral
10. Fiber-Tabs  Oral
11. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 5
days.
Disp:*5 Tablet(s)* Refills:*2*
12. Wellbutrin 100 mg Tablet Sig: Three (3) Tablet PO once a
day.
13. fluoxetine 20 mg Capsule Sig: Four (4) Capsule PO DAILY
(Daily).
14. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
15. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
16. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain, fever.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Primary diagnosis:
Angina
Mitral Regurgitation
Coronary artery disease

Secondary diagnosis:
Insulin dependent diabetes mellitus
Chronic kidney disease
Hypertension
Anxiety/depression


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
Trace edema


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to 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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
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:
Wound Check at Cardiac Surgery Office [**Telephone/Fax (1) 170**], [**2136-5-3**]
10:15
Surgeon Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] [**2136-5-30**] at 1:15p
Cardiologist Dr. [**Last Name (STitle) 7526**] [**2136-5-10**] at 11:30

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] F. [**Telephone/Fax (1) 21640**] in [**2-23**] 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**



Completed by:[**2136-4-29**]
{'Other complications due to other cardiac device, implant, and graft,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Hemorrhage complicating a procedure,Other digestive system complications,Paralytic ileus,Alkalosis,Acute posthemorrhagic anemia,Delirium due to conditions classified elsewhere,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Osteoarthrosis, localized, not specified whether primary or secondary, pelvic region and thigh,Attention deficit disorder with hyperactivity,Obesity, unspecified,Obsessive-compulsive disorders,Impotence of organic origin,Body Mass Index 28.0-28.9, adult,Cervical spondylosis without myelopathy,Depressive disorder, not elsewhere classified,Examination of participant in clinical trial,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Long-term (current) use of insulin,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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: Pt is 64M with h/o DM, CAD s/p LAD stent at [**Hospital1 2025**], being worked up
for THR and had a + myocardial perfusion scan showing evidence
on anterior ischemia.   Two days after scan, pt was presented to
[**Hospital1 **] with complains of angina on exertion on [**4-14**].

MEDICAL HISTORY: Primary diagnosis:
Angina
Mitral Regurgitation
Coronary artery disease

MEDICATION ON ADMISSION: Humalog three times daily before meals
Levemir 90 units HS
fluoxetine HCL 20 mg capsule four times a day
Focalin XR 30 mg Daily
Diovan 320 mg daily
fenofibrate micronized 200 mg daily
bupropion 300 mg extended release daily
aspirin 81 mg daily
Cialis 20 mg p.r.n.
omega-3 one capsule [**Hospital1 **]
multivitamins 1 tablet daily
cinnamon extract 1 capsule daily
glucosamine chondroitin twice daily
fiber tabs
Valerian 450mg [**12-23**] capsules HS PRN

ALLERGIES: Ace Inhibitors / Nickel

PHYSICAL EXAM: Admission physical exam:
VS: 98.5 145/96, 86, 16, 97% RA
GENERAL: Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Cancer in a maternal uncle, bladder cancer, aunt
with pancreatic cancer.  Father with diabetes, heart disease in
brother and mother.  Seborrhea twin brother, mother and twin
brother have diverticulitis.

SOCIAL HISTORY: Retired.  He has ten cigarettes pack year
history, quit 27 years ago, one to two drinks per week.
Married. 

### Response:
{'Other complications due to other cardiac device, implant, and graft,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Hemorrhage complicating a procedure,Other digestive system complications,Paralytic ileus,Alkalosis,Acute posthemorrhagic anemia,Delirium due to conditions classified elsewhere,Thrombocytopenia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Obstructive sleep apnea (adult)(pediatric),Other and unspecified hyperlipidemia,Osteoarthrosis, localized, not specified whether primary or secondary, pelvic region and thigh,Attention deficit disorder with hyperactivity,Obesity, unspecified,Obsessive-compulsive disorders,Impotence of organic origin,Body Mass Index 28.0-28.9, adult,Cervical spondylosis without myelopathy,Depressive disorder, not elsewhere classified,Examination of participant in clinical trial,Personal history of tobacco use,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Long-term (current) use of insulin,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
