CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This 66 year old white female with a past medical history
signficant for NSTEMI and percutaneous interventions to the LAD
and OM1, presented [**Last Name (un) 83915**] outside ED after awaking from sleep with
angina. She had some EKG changes, although difficult they were
somewhat difficult to interpret given baseline her left bundle
branch block. She ruled out for MI by cardiac enzymes. Cardiac
catheterization showed triple vessel disease and cardiac surgery
is consulted for possible surgical revascularization.

MEDICAL HISTORY: Coronary Artery Disease
s/p Myocardial Infarction
s/p Cypher DES to mid LAD, POBA of OM1
Insulin dependent Diabetes mellitus
Hypertension
Hyperlipidemia
left bundle branch block
Peripheral neuropathy
Gastroesophageal reflux disease
s/p C-section x3
s/p cholecystectomy
s/p appendectomy
s/p hysterectomy

MEDICATION ON ADMISSION: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Codeine

PHYSICAL EXAM: Admission:

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death. Mom with hx of stroke. Leukemia in family.

SOCIAL HISTORY: Former elementry school cook manager, retired 7 yrs ago.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Polyneuropathy in diabetes,Esophageal reflux,Other left bundle branch block,Long-term (current) use of insulin,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Acquired absence of both cervix and uterus,Personal history of tobacco use,Other chronic pulmonary heart diseases
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS,DMI neuro nt st uncntrld,Neuropathy in diabetes,Esophageal reflux,Left bb block NEC,Long-term use of insulin,Status-post ptca,Acq absence of organ NEC,Acq absnce cervix/uterus,History of tobacco use,Chr pulmon heart dis NEC
Admission Date:  [**2121-3-12**]              Discharge Date:   [**2121-3-22**]

Date of Birth:  [**2054-9-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Sulfa (Sulfonamide Antibiotics) / Codeine

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

Major Surgical or Invasive Procedure:
[**3-14**]- left heart catheterization, coronary angiogram
[**3-17**]- Coronary Artery Bypass Graft x 4 (Left internal mammary to
left anterior descending, Saphenouse vein graft to obtuse
marginal, Saphenous vein graft to diagonal, Saphenous vein graft
to Ramus)


History of Present Illness:
This 66 year old white female with a past medical history
signficant for NSTEMI and percutaneous interventions to the LAD
and OM1, presented [**Last Name (un) 83915**] outside ED after awaking from sleep with
angina. She had some EKG changes, although difficult they were
somewhat difficult to interpret given baseline her left bundle
branch block. She ruled out for MI by cardiac enzymes. Cardiac
catheterization showed triple vessel disease and cardiac surgery
is consulted for possible surgical revascularization.

Past Medical History:
Coronary Artery Disease
s/p Myocardial Infarction
s/p Cypher DES to mid LAD, POBA of OM1
Insulin dependent Diabetes mellitus
Hypertension
Hyperlipidemia
left bundle branch block
Peripheral neuropathy
Gastroesophageal reflux disease
s/p C-section x3
s/p cholecystectomy
s/p appendectomy
s/p hysterectomy

Social History:
Former elementry school cook manager, retired 7 yrs ago.

Lives at home with husband, children/grandchildren in area.
-Tobacco history: quit 20 yrs ago, 19 pack year history
-ETOH: occ
-Illicit drugs: none

Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death. Mom with hx of stroke. Leukemia in family.

Physical Exam:
Admission:

Pulse:71    Resp: 17    O2 sat: 98% RA
B/P  Right:140/50       Left: 130/50
Height: 5'8"      Weight:86.2kg

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
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] RLQ and hypogastrium incision
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right:  dressing Left: +2
DP           Right: +1  Left: +1
PT           [**Name (NI) 167**]: +1  Left: +1
Radial       Right: +2 Left: +2

Carotid Bruit        Right: +    Left: -

Brief Hospital Course:
Following ruling out for an infarction she underwent
catheterization. She was referred for revascularization.  On
[**3-17**] she was taken to the Operating Room where quadruple
bypass grafting was performed.  See operative note for details.
She weaned from by pass on Propofol and Neo Synephrine
infusions.  She remained stable, weaned from pressors easily and
was extubated.  Beta blockade was begun and diuresis towards her
preoperative weight.

CTs and pacing wires wre removed according to protocols.
Physical Therapy was consulted for strength and mobility.  She
had some brief atrial fibrillation which was treated with
Amiodarone and Lopressor.  She did convert to sinus rhythm
shortly thereafter.  Lantus and humalog were titrated for blood
glucose control.  The patient did receive two units of packed
red blood cells for a hematocrit of 24%.  Hematocrit rose
appropriately.  By the time of discharge on POD 5 the patient
was ambulating freely, the wound was healing and pain was
controlled with oral analgesics.  She was discharged home in
good condition with VNA services.  All follow up instructions
were explained.  She is to keep a log of her blood sugars and
present it to her PCP this week.

Medications on Admission:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Calcium  Oral
5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
-- PT STOPPED TAKING RECENTLY
7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
9. Insulin Glargine 100 unit/mL Solution Sig: Sixteen (16)
units Subcutaneous at bedtime.
Disp:*300 units* Refills:*2*
10. Vitamin D  Oral
11. Humalog 100 unit/mL Solution Sig: One (1) unit Subcutaneous
four times a day: Please check sugars before meals and bedtime
and give humalog based on your sliding scale dosing.
Disp:*200 units* Refills:*2*
12. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. Atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day.
14. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) tab
Sublingual q5min as needed for chest pain.
Disp:*25 pills* Refills:*1*

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO Q 24H (Every 24 Hours).
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
7. Insulin Glargine 100 unit/mL Cartridge Sig: Sixteen (16)
units Subcutaneous at bedtime.
8. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
10. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain/fever.
11. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
12. Ferrous Gluconate 325 mg (37.5 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
13. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
14. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day) as needed for under abd fold .
Disp:*qs * Refills:*0*
15. Insulin Glargine 100 unit/mL Solution Sig: One (1)
Subcutaneous dinner: 25 units glargine at dinner.
Disp:*qs * Refills:*2*
16. Insulin Lispro 100 unit/mL Solution Sig: One (1)
Subcutaneous four times a day: dose according to sliding scale.
Disp:*qs * Refills:*2*
17. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
18. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO BID (2 times a
day) for 2 weeks.
Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Community VNA, [**Location (un) 8545**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Diabetes mellitus
Hypertension
Hyperlipidemia
s/p Myocardial Infarction
s/p DES to mid LAD, POBA of OM1
left bundle branch block
Peripheral neuropathy
Gastroesophageal reflux disease
s/p C-section x3
s/p cholecystectomy
s/p appendectomy
s/p hysterectomy


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating, gait steady
Sternal pain managed with ultram prn

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 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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge

Followup Instructions:
you have an appointment with:
Surgeon Dr. [**Last Name (STitle) **] on [**4-30**] at 1pm ([**Telephone/Fax (1) 170**])
Please call to schedule appointments:
Primary Care Dr. [**First Name (STitle) 333**] [**Last Name (NamePattern4) 83916**] this week- bring a log of
blood sugars ([**Telephone/Fax (1) 40076**])
Cardiologist Dr. [**Last Name (STitle) 8579**] in [**1-18**] weeks
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will schedule



Completed by:[**2121-3-22**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Polyneuropathy in diabetes,Esophageal reflux,Other left bundle branch block,Long-term (current) use of insulin,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Acquired absence of both cervix and uterus,Personal history of tobacco use,Other chronic pulmonary heart diseases'}


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 white female with a past medical history
signficant for NSTEMI and percutaneous interventions to the LAD
and OM1, presented [**Last Name (un) 83915**] outside ED after awaking from sleep with
angina. She had some EKG changes, although difficult they were
somewhat difficult to interpret given baseline her left bundle
branch block. She ruled out for MI by cardiac enzymes. Cardiac
catheterization showed triple vessel disease and cardiac surgery
is consulted for possible surgical revascularization.

MEDICAL HISTORY: Coronary Artery Disease
s/p Myocardial Infarction
s/p Cypher DES to mid LAD, POBA of OM1
Insulin dependent Diabetes mellitus
Hypertension
Hyperlipidemia
left bundle branch block
Peripheral neuropathy
Gastroesophageal reflux disease
s/p C-section x3
s/p cholecystectomy
s/p appendectomy
s/p hysterectomy

MEDICATION ON ADMISSION: 1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Codeine

PHYSICAL EXAM: Admission:

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death. Mom with hx of stroke. Leukemia in family.

SOCIAL HISTORY: Former elementry school cook manager, retired 7 yrs ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Polyneuropathy in diabetes,Esophageal reflux,Other left bundle branch block,Long-term (current) use of insulin,Percutaneous transluminal coronary angioplasty status,Other acquired absence of organ,Acquired absence of both cervix and uterus,Personal history of tobacco use,Other chronic pulmonary heart diseases'}
