CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: The patient is a 63 year-old male with mutliple cardiac risk
factors who has been experiencing increasing angina. He
underwent a stress test which was stopped d/t fatigue and chest
discomfort. It was positve for ST segment depression in the
inferolateral leads and nuclear imaging revealed moderate
reversible inferoapical defect with global hypokinesis. He then
underwent a cardiac catheterization which revealed left main and
3 vessel disease but preserved left ventricular function. He was
subsequently referred for cardiac surgery.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obesity
Gout
Benign Prostatic Hypertrophy
Hearing Impairment
Rheumatic fever as a child
Prior moderate-heavy ETOH use, non recent
Back pain, cervical spondylosis, radiculopathy
s/p hand surgery

MEDICATION ON ADMISSION: Avandamet 4/1000mg [**Hospital1 **], Glyset 100mg [**Hospital1 **], Glipizide 10mg qd,
Lipitor 80mg qd, Benazepril 20mg qd, Flomax 0.4mg qd, Xenical
120mg qd, Coreg 6.25mg [**Hospital1 **], Aspirin 81mg qd, Vitamin D 400bid,
Slow Mg 64mg [**Hospital1 **]

ALLERGIES: Penicillins / Ether

PHYSICAL EXAM: VS: 60 15 140/70 97% 72" 240#
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, -JVD
Lungs: CTAB -w/r/r
Heart: RRR, +S1S2, -c/r/m/g
Abd: Soft, NT/ND, +BS

FAMILY HISTORY: Brother with PTCA in his 80's. Father with Angina in his 60's.
Another brother with a stroke in his 60's.

SOCIAL HISTORY: Smoked as much as 4 ppd for many years, but quit about 20 years
ago.
Prior moderate-heave ETOH use, now 4 beers/wk
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Obesity, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Gout NOS,Obesity NOS
Admission Date:  [**2138-1-7**]              Discharge Date:   [**2138-1-10**]

Date of Birth:  [**2074-1-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Ether

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2138-1-7**] Coronary Artery Bypass Graft x 3 (LIMA to LAD, vein
grafts to obtuse marginal and PDA)

History of Present Illness:
The patient is a 63 year-old male with mutliple cardiac risk
factors who has been experiencing increasing angina. He
underwent a stress test which was stopped d/t fatigue and chest
discomfort. It was positve for ST segment depression in the
inferolateral leads and nuclear imaging revealed moderate
reversible inferoapical defect with global hypokinesis. He then
underwent a cardiac catheterization which revealed left main and
3 vessel disease but preserved left ventricular function. He was
subsequently referred for cardiac surgery.

Past Medical History:
Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obesity
Gout
Benign Prostatic Hypertrophy
Hearing Impairment
Rheumatic fever as a child
Prior moderate-heavy ETOH use, non recent
Back pain, cervical spondylosis, radiculopathy
s/p hand surgery

Social History:
Smoked as much as 4 ppd for many years, but quit about 20 years
ago.
Prior moderate-heave ETOH use, now 4 beers/wk

Family History:
Brother with PTCA in his 80's. Father with Angina in his 60's.
Another brother with a stroke in his 60's.

Physical Exam:
VS: 60 15 140/70 97% 72" 240#
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, -JVD
Lungs: CTAB -w/r/r
Heart: RRR, +S1S2, -c/r/m/g
Abd: Soft, NT/ND, +BS

Pertinent Results:
[**2138-1-9**] 07:10AM BLOOD WBC-9.1 RBC-3.25* Hgb-9.6* Hct-25.6*
MCV-79* MCH-29.7 MCHC-37.6* RDW-14.6 Plt Ct-164
[**2138-1-7**] 11:44AM BLOOD PT-16.4* PTT-29.0 INR(PT)-1.9
[**2138-1-9**] 07:10AM BLOOD Glucose-172* UreaN-12 Creat-0.8 Na-138
K-4.1 Cl-104 HCO3-25 AnGap-13
[**2138-1-9**] 07:10AM BLOOD Mg-1.8

Brief Hospital Course:
Patient was a same day admit with previous pre-operative testing
and on [**2138-1-7**] he was brought to the operating room where he
underwent a coronary artery bypass graft x 3. Please see op note
for surgical details. Following surgery, he was transferred to
the CSRU in stable condition on Neosyenphrine gtt. Later on op
day pt was weaned from mechanical ventilation and sedation and
extubated. He was neurologically intact. On post-operative day
one Inotropic support was weaned off, pt appeard stable and
diuretics and b-blockers were initiated. He maintained stable
hemodynamics and was then transferred to the telemetry floor.
Beta blockade was advanced as tolerated. He remained in a normal
sinus rhythm. All chest tubes and wires were removed without
complication. By postoperative day three, he weaned from oxygen
with 96% room air saturations. He experienced a transient fever,
up to 101.0 with negative workup. UA was negative and chest
x-ray was notable for only atelectasis and small bilateral
pleural effusions. His fever was attributed to atelectasis. Due
to his excellent progress, he was cleared for discharge by Dr.
[**Last Name (STitle) **] on postoperative day three. At time of discharge, he was
afebrile, his BP ranged in the 130's/ 70's with a heart rate of
80-90. All surgical wounds were clean, dry and intact. All
appropriate follow up appointments were arranged.

Medications on Admission:
Avandamet 4/1000mg [**Hospital1 **], Glyset 100mg [**Hospital1 **], Glipizide 10mg qd,
Lipitor 80mg qd, Benazepril 20mg qd, Flomax 0.4mg qd, Xenical
120mg qd, Coreg 6.25mg [**Hospital1 **], Aspirin 81mg qd, Vitamin D 400bid,
Slow Mg 64mg [**Hospital1 **]

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. 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*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
5. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*1*
6. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
8. Glipizide 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
9. Rosiglitazone 2 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
10. Xenical 120 mg Capsule Sig: One (1) Capsule PO qd ().
Disp:*30 Capsule(s)* Refills:*0*
11. Glyset 100 mg Tablet Sig: One (1) Tablet PO bid ().
Disp:*60 Tablet(s)* Refills:*0*
12. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24HR(s)* Refills:*0*
13. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
14. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for
7 days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern MA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3
Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obesity
Gout

Discharge Condition:
good

Discharge Instructions:
Can take shower. Wash incisions with warm water and gentle soap.
Gently pat dry. Do not apply lotions, creams, ointments, or
powders to incisions. Do not bath or swim.
Do not drive for 1 month.
Do not lift greater than 10 pounds for 2 months.
If you notice redness or drainage from incisions, or develop
fever greater than 101, please contact office immediately.

Followup Instructions:
Dr. [**Last Name (STitle) **] 3 weeks
Dr [**Last Name (STitle) **] in [**2-10**] weeks
Local cardiologist in 2 weeks


Completed by:[**2138-2-12**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Obesity, 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: The patient is a 63 year-old male with mutliple cardiac risk
factors who has been experiencing increasing angina. He
underwent a stress test which was stopped d/t fatigue and chest
discomfort. It was positve for ST segment depression in the
inferolateral leads and nuclear imaging revealed moderate
reversible inferoapical defect with global hypokinesis. He then
underwent a cardiac catheterization which revealed left main and
3 vessel disease but preserved left ventricular function. He was
subsequently referred for cardiac surgery.

MEDICAL HISTORY: Hypertension
Hypercholesterolemia
Diabetes Mellitus
Obesity
Gout
Benign Prostatic Hypertrophy
Hearing Impairment
Rheumatic fever as a child
Prior moderate-heavy ETOH use, non recent
Back pain, cervical spondylosis, radiculopathy
s/p hand surgery

MEDICATION ON ADMISSION: Avandamet 4/1000mg [**Hospital1 **], Glyset 100mg [**Hospital1 **], Glipizide 10mg qd,
Lipitor 80mg qd, Benazepril 20mg qd, Flomax 0.4mg qd, Xenical
120mg qd, Coreg 6.25mg [**Hospital1 **], Aspirin 81mg qd, Vitamin D 400bid,
Slow Mg 64mg [**Hospital1 **]

ALLERGIES: Penicillins / Ether

PHYSICAL EXAM: VS: 60 15 140/70 97% 72" 240#
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, -JVD
Lungs: CTAB -w/r/r
Heart: RRR, +S1S2, -c/r/m/g
Abd: Soft, NT/ND, +BS

FAMILY HISTORY: Brother with PTCA in his 80's. Father with Angina in his 60's.
Another brother with a stroke in his 60's.

SOCIAL HISTORY: Smoked as much as 4 ppd for many years, but quit about 20 years
ago.
Prior moderate-heave ETOH use, now 4 beers/wk 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Obesity, unspecified'}
