CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 52yo man with known CAD s/p inferior MI([**2089**]) and stenting in
[**2090**] and [**2096**]. Now with recurrent chest pain over the last 2
months. Had +ETT then referred for cardiac cath. Cath revealed
multivessel disease and he was referred for surgical
revascularization.

MEDICAL HISTORY: - Coronary artery disease s/p inferior MI([**2089**]) with BMS to
distal RCA. S/p PTCA [**2090**] of distal RCA secondary to in-stent
restenosis, s/p DES of PLB([**6-/2099**])& LAD([**8-/2099**])
- Diabetes Mellitus II w/peripheral neuropathy(feet)
- Hypertension
- Hypercholesterolemia
- + tobacco use
- Tremors-primary
- MVA ([**2098**])w/concussion and rib fx

MEDICATION ON ADMISSION: Propanolol 160 mg [**Hospital1 **]
Ibuprofen 800 mg TID
Soma 350mg TID prn
Metformin 500 mg [**Hospital1 **]
Prilosec 20mg daily
MVI daily
ASA 81 mg daily
Glyburide 1.25 mg daily
Clonazepam 1 mg daily"

ALLERGIES: Tylenol / Simvastatin

PHYSICAL EXAM: Pulse: 52     Resp: 16    O2 sat: 94%-RA
B/P 120/90 Right:    Left:
Height:  73"   Weight: 224 lbs

FAMILY HISTORY: father died of MI @57yo

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:
Lives with: 2 children-Daughter 16yo, son 18yo
(divorced-exwife deceased)
Occupation:electrician
Tobacco: ongoing- 1ppd 30Pk yrs
ETOH:1 drink/wk
Coronary atherosclerosis of native coronary artery,Unspecified pleural effusion,Ostium secundum type atrial septal defect,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Pure hypercholesterolemia,Tobacco use disorder,Abnormal involuntary movements,Anemia, unspecified,Pain in limb
Crnry athrscl natve vssl,Pleural effusion NOS,Secundum atrial sept def,DMII neuro nt st uncntrl,Neuropathy in diabetes,Old myocardial infarct,Status-post ptca,Hypertension NOS,Pure hypercholesterolem,Tobacco use disorder,Abn involun movement NEC,Anemia NOS,Pain in limb
Admission Date:  [**2100-8-24**]              Discharge Date:   [**2100-8-29**]

Date of Birth:  [**2047-10-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Tylenol / Simvastatin

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

Major Surgical or Invasive Procedure:
[**2100-8-24**] Coronary Artery Bypass Graft x 3 - left internal mammary
artery to left anterior descending artery, saphenous vein grafts
to diagonal and PDA


History of Present Illness:
52yo man with known CAD s/p inferior MI([**2089**]) and stenting in
[**2090**] and [**2096**]. Now with recurrent chest pain over the last 2
months. Had +ETT then referred for cardiac cath. Cath revealed
multivessel disease and he was referred for surgical
revascularization.

Past Medical History:
- Coronary artery disease s/p inferior MI([**2089**]) with BMS to
distal RCA. S/p PTCA [**2090**] of distal RCA secondary to in-stent
restenosis, s/p DES of PLB([**6-/2099**])& LAD([**8-/2099**])
- Diabetes Mellitus II w/peripheral neuropathy(feet)
- Hypertension
- Hypercholesterolemia
- + tobacco use
- Tremors-primary
- MVA ([**2098**])w/concussion and rib fx

Social History:
Race:caucasian
Last Dental Exam:
Lives with: 2 children-Daughter 16yo, son 18yo
(divorced-exwife deceased)
Occupation:electrician
Tobacco: ongoing- 1ppd 30Pk yrs
ETOH:1 drink/wk

Family History:
father died of MI @57yo

Physical Exam:
Pulse: 52     Resp: 16    O2 sat: 94%-RA
B/P 120/90 Right:    Left:
Height:  73"   Weight: 224 lbs

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM []paresthesia/sensitivity from jaw
extending behind left ear
Chest: Lungs w/insp/exp wheezes
Heart: RRR [x]  Irregular []  Murmur-none
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Varicosities: mild []
Neuro: Grossly intact-essential tremors
Pulses:
Femoral      Right:   Left:
DP           Right:   Left:
PT           [**Name (NI) 167**]:   Left:
Radial       Right:   Left:

Carotid Bruit        Right:    Left

Pertinent Results:
Pre CPB:

No spontaneous echo contrast or thrombus is seen in the body of
the left atrium or left atrial appendage, the Left atrial
appendage ejection velocities were aproximately 20cm/s
(borderline) .

A small secundum atrial septal defect is present. There is
bidirectional flow.

Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. There is mild focal left
ventricular hypokinesis (LVEF = 40 %). There is hypokinesia of
the apical and mid portions of the inferior wall and
inferoseptal walls.

The right ventricular cavity is mildly dilated with normal free
wall contractility.

There are simple atheroma in the descending thoracic aorta.

The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation.

There is mild mitral regurgitation.

Dr. [**Last Name (STitle) **] was notified in person of the results.

Post CPB:

There is mild hypokinesis of the anteroseptal wall, otherwise
all other prebypass findings are unchanged.

Mild mitral regurgitation persists.

The aortic contours are intact post decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 1509**] [**Name8 (MD) 1510**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2100-8-24**] 12:24


Brief Hospital Course:
Mr. [**Known lastname **] was a same day admission after undergoing a
pre-operative work-up prior to admission. On [**8-24**] he was brought
directly to the operating room where he underwent a coronary
artery bypass grafting x3 with a left internal mammary artery to
left anterior descending artery and reverse saphenous vein
grafts to the posterior descending artery and the first diagonal
artery. This procedure was erformed by Dr. [**Last Name (STitle) **].  Please see the
operative report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring in critical but
stable condition. Within 24 hours he was weaned from sedation,
awoke neurologically intact and extubated.  His home propanolol
was restarted.  He was transferred to the surgical step down
floor.  His chest tubes and wires were removed.  He did develop
right calf pain and tenderness.  Ultrasound did not reveal
evidence of DVT.  The physical therapy service assessed him and
felt he would be safe for discharge to home.  By post-operative
day 5 he was ready for discharge to home.  All follow-up
appointments were advised.

Medications on Admission:
Propanolol 160 mg [**Hospital1 **]
Ibuprofen 800 mg TID
Soma 350mg TID prn
Metformin 500 mg [**Hospital1 **]
Prilosec 20mg daily
MVI daily
ASA 81 mg daily
Glyburide 1.25 mg daily
Clonazepam 1 mg daily"

Discharge Medications:
1. 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*
2. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Cyclobenzaprine 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times
a day).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) as needed for cough for 2 weeks.
Disp:*90 Capsule(s)* Refills:*0*
8. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
10. Propranolol 40 mg Tablet Sig: Four (4) Tablet PO BID (2
times a day).
11. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: [**12-5**]
Puffs Inhalation Q6H (every 6 hours) as needed for wheeze.
Disp:*1 MDI* Refills:*1*
12. Glyburide 2.5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
13. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
14. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
15. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day
for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA, [**Hospital1 1559**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft
Past medical history:
- s/p inferior MI([**2089**]) with BMS to distal RCA. S/p PTCA [**2090**] of
distal RCA secondary to in-stent restenosis, s/p DES of
PLB([**6-/2099**])& LAD([**8-/2099**])
- Diabetes Mellitus II w/peripheral neuropathy(feet)
- Hypertension
- Hypercholesterolemia
- + tobacco use
- Tremors-primary
- MVA ([**2098**])w/concussion and rib fx


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Dilaudid

Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema trace bilaterally


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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
Surgeon: Dr.[**Last Name (STitle) **] for Dr. [**Last Name (STitle) **] Thursday [**9-16**] @ 9:15 AM
@[**Hospital1 **] [**Telephone/Fax (1) 109410**]
Cardiologist: Dr. [**Last Name (STitle) 31888**] [**9-27**] @ 9:30 AM @ [**Hospital1 **]

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 54160**] [**Name (STitle) **] in [**3-8**] 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:[**2100-8-29**]
{'Coronary atherosclerosis of native coronary artery,Unspecified pleural effusion,Ostium secundum type atrial septal defect,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Pure hypercholesterolemia,Tobacco use disorder,Abnormal involuntary movements,Anemia, unspecified,Pain in limb'}


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: 52yo man with known CAD s/p inferior MI([**2089**]) and stenting in
[**2090**] and [**2096**]. Now with recurrent chest pain over the last 2
months. Had +ETT then referred for cardiac cath. Cath revealed
multivessel disease and he was referred for surgical
revascularization.

MEDICAL HISTORY: - Coronary artery disease s/p inferior MI([**2089**]) with BMS to
distal RCA. S/p PTCA [**2090**] of distal RCA secondary to in-stent
restenosis, s/p DES of PLB([**6-/2099**])& LAD([**8-/2099**])
- Diabetes Mellitus II w/peripheral neuropathy(feet)
- Hypertension
- Hypercholesterolemia
- + tobacco use
- Tremors-primary
- MVA ([**2098**])w/concussion and rib fx

MEDICATION ON ADMISSION: Propanolol 160 mg [**Hospital1 **]
Ibuprofen 800 mg TID
Soma 350mg TID prn
Metformin 500 mg [**Hospital1 **]
Prilosec 20mg daily
MVI daily
ASA 81 mg daily
Glyburide 1.25 mg daily
Clonazepam 1 mg daily"

ALLERGIES: Tylenol / Simvastatin

PHYSICAL EXAM: Pulse: 52     Resp: 16    O2 sat: 94%-RA
B/P 120/90 Right:    Left:
Height:  73"   Weight: 224 lbs

FAMILY HISTORY: father died of MI @57yo

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:
Lives with: 2 children-Daughter 16yo, son 18yo
(divorced-exwife deceased)
Occupation:electrician
Tobacco: ongoing- 1ppd 30Pk yrs
ETOH:1 drink/wk 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified pleural effusion,Ostium secundum type atrial septal defect,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Pure hypercholesterolemia,Tobacco use disorder,Abnormal involuntary movements,Anemia, unspecified,Pain in limb'}
