CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: This 69 year old male has a history of several months of
exertional angina, relieved with rest. Not stated
whatprecipitates pain.  EST positive (2mm ST depression
inferolat) at Stage I(3min) of [**Doctor First Name **] protocol.  Cathed today to
show
significant LAD/Cx dz, transferred, painfree, to [**Hospital1 18**].

MEDICAL HISTORY: HTN
hypercholesterolemia
BPH
"reactive
airway disease"

MEDICATION ON ADMISSION: Atenolol 50mg/daily
Crestor 10mg/D
ASA81mg/D
Flomax 0.4mg/D
Lisinopril 20mg/D

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: Resp:14  O2 sat:100% RA
B/P  Right:130/72    Left: 130/74
Height: 69"     Weight:81kg

FAMILY HISTORY: Unremarkable

SOCIAL HISTORY: Lives with his wife.
Cigs: none
ETOH: none
Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Intermediate coronary syndrome,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Crnry athrscl natve vssl,Iatrogenic pneumothorax,Intermed coronary synd,Abn react-anastom/graft,Hyperlipidemia NEC/NOS,Hypertension NOS,Asthma NOS,BPH w/o urinary obs/LUTS
Admission Date:  [**2176-9-16**]              Discharge Date:   [**2176-9-24**]

Date of Birth:  [**2107-8-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
s/p CABGx3(LIMA->LAD, SVG->OM1, OM3) [**2176-9-18**]


History of Present Illness:
This 69 year old male has a history of several months of
exertional angina, relieved with rest. Not stated
whatprecipitates pain.  EST positive (2mm ST depression
inferolat) at Stage I(3min) of [**Doctor First Name **] protocol.  Cathed today to
show
significant LAD/Cx dz, transferred, painfree, to [**Hospital1 18**].


Past Medical History:
HTN
hypercholesterolemia
BPH
"reactive
airway disease"


Social History:
Lives with his wife.
Cigs: none
ETOH: none


Family History:
Unremarkable

Physical Exam:
Pulse: Resp:14  O2 sat:100% RA
B/P  Right:130/72    Left: 130/74
Height: 69"     Weight:81kg

General:WDWN in NAD
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 no
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]  obese
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right:3  Left:3
DP           Right:3  Left:3
PT           [**Name (NI) 167**]:3  Left:3
Radial       Right:   Left:

Carotid Bruit        Right:N    Left:N


Pertinent Results:
[**Known lastname **], [**Known firstname 83131**]       [**Hospital1 18**] [**Numeric Identifier 83132**]
(Complete) Done [**2176-9-18**] at 1:09:43 PM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2107-8-9**]
Age (years): 69 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Left ventricular function. Mitral valve disease.
ICD-9 Codes: 440.0, 396.9
Test Information
Date/Time: [**2176-9-18**] at 13:09    Interpret MD: [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**],
MD
Test Type: TEE (Complete)
3D imaging. Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 929**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW02-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.6 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  4.4 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  *0.5 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *0.5 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.6 cm  <= 5.6 cm
Aorta - Sinus Level:  3.0 cm  <= 3.6 cm
Aorta - Ascending:  2.6 cm  <= 3.4 cm

Findings
Multiplanar reconstructions were generated and confirmed on an
independent workstation.

LEFT ATRIUM: Mild LA enlargement. No spontaneous echo contrast
or thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness and cavity
size.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal ascending aorta diameter. Simple atheroma in
ascending aorta. Normal descending aorta diameter. Simple
atheroma in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
Mildly thickened aortic valve leaflets (?#). No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial
MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.

Conclusions
PRE-BYPASS: The left atrium is mildly dilated. No spontaneous
echo contrast or thrombus is seen in the body of the left atrium
or left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler. Left ventricular wall thicknesses and cavity
size are normal. Right ventricular chamber size and free wall
motion are normal. There are simple atheroma in the ascending
aorta. 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. The
aortic valve leaflets are mildly thickened . There is no aortic
valve stenosis. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is no pericardial effusion.

POST-BYPASS: Patient is on no inotropic agents post-bypass. No
changes from pre-bypass findings. Left ventricular function is
normal. The aorta appears to be intact post decannulation. All
findings communicated to surgical team.
  Interpretation assigned to [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting
physician



Brief Hospital Course:
This patient was transferred from [**Hospital6 5016**] on
[**2176-9-17**] and underwent CABGx3(LIMA->LAD, SVG->OM1, OM3).  The
cross clamp time was 51 minutes with a total bypass time of 62
minutes.  He tolerated the procedure well and was transferred to
the CVIVU in stable condition on Neo and Propofol.  He was
extubated on the post op night and had his chest tubes
discontinued on POD 1.  He was transferred to the floor on POD
1. His chest tubes and pacing wires were removed per protocol.
The post chest tube removal chest XRAY revealed at PTX and Mr.
[**Known lastname 33419**] was also symptomatic with low oxygen saturation. A chest
tube was re-inserted into the right pleural space and was placed
to suction with lung re-expansion. The chest tube was placed to
water seal on POD# 5 without PTX. Chest tube was removed and CXR
post removal resulted in a left sided small apical pneumothorax
which was stable on multiple subsequent chest radiographs.  The
patient was discharged to home after review of these radiographs
by Dr. [**First Name (STitle) **] [**Name (STitle) **] with the understanding that Mr. [**Known lastname 33419**]
should return  in three days to repeat a chest radiograph.  All
follow-up appointments were advised.

Medications on Admission:
Atenolol 50mg/daily
Crestor 10mg/D
ASA81mg/D
Flomax 0.4mg/D
Lisinopril 20mg/D


Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
2. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
3. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*75 Tablet(s)* Refills:*0*
8. Lisinopril 5 mg Tablet Sig: Two (2) Tablet PO once a day: [**2-9**]
home dose.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
HTN
hypercholesterolemia
BPH
reactive airway disease
coronary artery disease


Discharge Condition:
Good.


Discharge Instructions:
Take medications as directed on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs. for 2 months.
Shower daily, let water flow over wounds, pat dry with a towel.
Do not use lotions, powders, or creams on wounds.
Call our office for temp.>101.5, sternal drainage.

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.
Make an appointment with Dr. [**Last Name (STitle) 29065**] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) 83133**] for 2-3 weeks.
Please obtain a chest CXR on Friday [**2176-9-27**] at [**Hospital1 18**].



Completed by:[**2176-9-24**]
{'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Intermediate coronary syndrome,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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 69 year old male has a history of several months of
exertional angina, relieved with rest. Not stated
whatprecipitates pain.  EST positive (2mm ST depression
inferolat) at Stage I(3min) of [**Doctor First Name **] protocol.  Cathed today to
show
significant LAD/Cx dz, transferred, painfree, to [**Hospital1 18**].

MEDICAL HISTORY: HTN
hypercholesterolemia
BPH
"reactive
airway disease"

MEDICATION ON ADMISSION: Atenolol 50mg/daily
Crestor 10mg/D
ASA81mg/D
Flomax 0.4mg/D
Lisinopril 20mg/D

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: Resp:14  O2 sat:100% RA
B/P  Right:130/72    Left: 130/74
Height: 69"     Weight:81kg

FAMILY HISTORY: Unremarkable

SOCIAL HISTORY: Lives with his wife.
Cigs: none
ETOH: none 

### Response:
{'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Intermediate coronary syndrome,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
