CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 76 y/o male with exertional chest pain. Had abnormal ETT and was
then referred for cardiac cath. Cath revealed severe 3 vessel
disease with a 70% left main lesion.

MEDICAL HISTORY: Hyperlipidemia, Hypertension, Gastroesophageal Reflux Disease,
Cervical and Lumbar Disc Disease, Pleural thickening d/t
Asbestos exposrure, Benign Prostatic Hypertrophy, Depression,
Sleep Apnea, h/o TIA, s/p AAA repair [**2147**], s/p Appendectomy, s/p
Tonsillectomy, s/p Laminectomy, s/p Bilat. Rotator cuff repairs,
s/p Bilat. knee surgery, s/p Left breast lumpectomy, s/p TURP,
s/p Penile Implant with replacement [**2147**], s/p Bilat. hernia
repair, s/p ankle pin placement

MEDICATION ON ADMISSION: Simvastatin 40mg qd, Toprol XL 25mg qd, Nexium 40mg qd, Detrol
4mg qd, Lisinopril 10mg qd, Quinine 260mg qd, Aspirin 325mg qd,
Plavix 75mg qd, Ambien prn

ALLERGIES: Prozac

PHYSICAL EXAM: VS: 59 22 143/68 5'9" 93kg
General: NAD
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, FROM, -JVD, -Carotid Bruits
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft NT/ND, +BS, healed AAA scar
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Mother with CAD at unkown age

SOCIAL HISTORY: Quit in [**2114**]. Social ETOH.
Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other and unspecified angina pectoris,Postlaminectomy syndrome, lumbar region,Mitral valve disorders,Acidosis,Unspecified pleural effusion,Asbestosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Foreign body in main bronchus,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Long-term (current) use of anticoagulants,Long QT syndrome,Unspecified erythematous condition,Other iatrogenic hypotension,Obstructive sleep apnea (adult)(pediatric)
Crnry athrscl natve vssl,Atrial fibrillation,Angina pectoris NEC/NOS,Postlaminect synd-lumbar,Mitral valve disorder,Acidosis,Pleural effusion NOS,Asbestosis,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Foreign body bronchus,Resp obstr-inhal obj NEC,Long-term use anticoagul,Long QT syndrome,Erythematous cond NOS,Iatrogenc hypotnsion NEC,Obstructive sleep apnea
Admission Date:  [**2153-1-22**]              Discharge Date:   [**2153-2-3**]

Date of Birth:  [**2076-3-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Prozac

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2153-1-22**] Coronary Artery Bypass Graft x 3 (LIMA to LAD, SVG to OM,
SVG to Diag)

History of Present Illness:
76 y/o male with exertional chest pain. Had abnormal ETT and was
then referred for cardiac cath. Cath revealed severe 3 vessel
disease with a 70% left main lesion.

Past Medical History:
Hyperlipidemia, Hypertension, Gastroesophageal Reflux Disease,
Cervical and Lumbar Disc Disease, Pleural thickening d/t
Asbestos exposrure, Benign Prostatic Hypertrophy, Depression,
Sleep Apnea, h/o TIA, s/p AAA repair [**2147**], s/p Appendectomy, s/p
Tonsillectomy, s/p Laminectomy, s/p Bilat. Rotator cuff repairs,
s/p Bilat. knee surgery, s/p Left breast lumpectomy, s/p TURP,
s/p Penile Implant with replacement [**2147**], s/p Bilat. hernia
repair, s/p ankle pin placement

Social History:
Quit in [**2114**]. Social ETOH.

Family History:
Mother with CAD at unkown age

Physical Exam:
VS: 59 22 143/68 5'9" 93kg
General: NAD
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, FROM, -JVD, -Carotid Bruits
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft NT/ND, +BS, healed AAA scar
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2153-1-22**] Echo: PRE-BYPASS: The interatrial septum is aneurysmal.
No atrial septal defect is seen by 2D, color Doppler, or bubble
study. Left ventricular wall thicknesses and cavity size are
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The aortic arch is mildly dilated with simple
atheroma. The descending thoracic aorta is mildly dilated with
complex (>4mm) atheroma. There are three aortic valve leaflets.
There is no aortic valve stenosis. Trace aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. Mild (1+)
to at worst mild to moderate (2+) mitral regurgitation is seen.
Pulmonarty vein flow is normal. The mitral annulus is not
dilated. There is a mild partial prolapse of P2.  POST-BYPASS:
Pt is [**Name (NI) 107919**], on phenylepherine drip. Preserved biventricular
function. LVEF >55%. Mitral regurtigation is now trace to mild
(1+). Aortic contours are intact. Remaining exam is unchanged.
All findings discussed with surgeons at the time of the exam.
[**1-23**] Echo: Emergency TEE in CSRU for hypotension. No atrial
septal defect is seen by 2D or color Doppler. Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. Left ventricular systolic function is
hyperdynamic (EF>75%). Right ventricular chamber size and free
wall motion are normal. There are simple atheroma in the
descending thoracic aorta. The aortic valve leaflets (3) are
mildly thickened. There is no aortic valve stenosis. Trace
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is systolic anterior motion ([**Male First Name (un) **]) of the
mitral valve leaflets. This [**Male First Name (un) **] is extremely dynamic. An LVOT
gradient of 50 mm Hg was measured. With vasopressors, this
gradient was seen to improve to near 20 mmHg. There is moderate
(2+)mitral regurgitation associated with this [**Male First Name (un) **]. It is dynamic
as well. The mitral regurgitation jet is eccentric. The
tricuspid valve leaflets are mildly thickened.
[**1-31**] Head CT: 1. No acute intracranial hemorrhage. No fracture.
2. Scattered mastoid air cell opacification on the right.
[**2-1**] CXR: Grossly stable bibasilar atelectasis and small pleural
effusions.
[**2153-1-22**] 01:42PM BLOOD WBC-17.4*# RBC-2.67*# Hgb-9.1*#
Hct-25.6*# MCV-96 MCH-34.0* MCHC-35.4* RDW-14.2 Plt Ct-150
[**2153-1-26**] 02:42AM BLOOD WBC-11.8* RBC-3.17* Hgb-10.5* Hct-29.3*
MCV-92 MCH-33.2* MCHC-36.0* RDW-15.6* Plt Ct-89*
[**2153-1-31**] 07:30AM BLOOD WBC-8.5 RBC-2.92* Hgb-9.2* Hct-27.3*
MCV-94 MCH-31.4 MCHC-33.6 RDW-15.6* Plt Ct-209
[**2153-2-1**] 07:11AM BLOOD Hct-26.6* Plt Ct-256
[**2153-1-22**] 01:42PM BLOOD PT-16.0* PTT-33.6 INR(PT)-1.5*
[**2153-1-28**] 08:59PM BLOOD PT-13.4* PTT-38.1* INR(PT)-1.2*
[**2153-2-2**] 06:25AM BLOOD PT-17.6* PTT-71.4* INR(PT)-1.6*
[**2153-1-23**] 04:14AM BLOOD Glucose-180* UreaN-15 Creat-0.9 Na-135
K-4.4 Cl-108 HCO3-20* AnGap-11
[**2153-1-31**] 07:30AM BLOOD Glucose-106* UreaN-22* Creat-0.7 Na-138
K-4.1 Cl-101 HCO3-31 AnGap-10

Brief Hospital Course:
Mr. [**Known lastname 107917**] was admitted to the [**Hospital1 18**] on [**2153-1-22**]. He was taken
directly to the operating room where he underwent coronary
artery bypass grafting to three vessels. Please see operative
report for surgical details. Following surgery he was
transferred to the CSRU for invasive monitoring in stable
condition. During initial post-op course he became hypotensive
requiring multiple pressors. Echocardiogram was preformed to r/o
tamponade, but instead found systolic anterior motion ([**Male First Name (un) **]) of
the mitral valve leaflets. His hemodynamics abruptly stabilized
and a repeat Echocardiogram which showed that he had a baseline
chordal [**Male First Name (un) **] and the outflow obstruction becomes obstructive with
mild to moderate eccentric mitral regurgitation and an LVOT
gradient of about 20 mm Hg. As he was somewhat acidotic and
hypoxic, a bronchoscopy was performed which removed a moderate
amount of thick right sided secretions. Tube feeds were started
to maintain his nutrition. After his inotropes were weaned off,
aspirin, beta blockade and a statin were resumed. He developed
atrial fibrillation for which amiodarone was given. Heparin was
started as a bridge to coumadin for his atrial fibrillation. On
postoperative day five, Mr, [**Known lastname 107917**] was extubated. The
cardiology service was consulted who arranged for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of
hearts monitor to monitor his QT interval and incidence of
arrythmia. As there was a concern for aspiration with oral
intake, a swallow study was performed. No overt signs of
aspiration were noted and his diet was advanced to regular. On
[**2153-1-30**], Mr. [**Known lastname 107917**] was transferred to the step down unit for
further recovery. He continued to be gently diuresed towards his
preoperative weight. The physical therapy service worked with
him daily to help increase his postoperative strength and
mobility. As his atrial fibrillation was tachycardic alternating
with rate control, the electrophysiology service was consulted.
Amiodarone, beta blockade and coumadin were continued and he
returned to a normal sinus rhythm. Over the next several days,
his INR became therapeutic and heparin was discontinued. Keflex
for 2 weeks was started for mild mid sternotomy erythema. He
continued to make steady progress and was discharged home on
postoperative day twelve. He will follow-up with Dr. [**Last Name (STitle) 1290**],
his cardiologist and his primary care physician as an
outpatient. Dr. [**Last Name (STitle) 107920**] will follow his coumadin dosing for an
INR of 2.0-2.5 for atrial fibrillation.


Medications on Admission:
Simvastatin 40mg qd, Toprol XL 25mg qd, Nexium 40mg qd, Detrol
4mg qd, Lisinopril 10mg qd, Quinine 260mg qd, Aspirin 325mg qd,
Plavix 75mg qd, Ambien prn

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:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO twice a day
for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
6. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 2 weeks.
Disp:*28 Packet(s)* Refills:*0*
7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Please take 400mg [**Hospital1 **] until [**2-6**] and then decrease 400mg
once daily for 7 days. then decrease to 200 mg daily until
follow up with cardiologist .
Disp:*60 Tablet(s)* Refills:*0*
8. Warfarin 2 mg Tablet Sig: Two (2) Tablet PO ONCE (Once) for 2
days: please take 4mg [**2-3**] and [**2-4**] and have INR checked [**2-5**]
with results to Dr [**Last Name (STitle) 8682**] .
Disp:*60 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*0*
10. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
11. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
12. Outpatient [**Name (NI) **] Work
PT/INR as needed
Results to Dr [**Last Name (STitle) 8682**] at [**Telephone/Fax (1) 445**]
13. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q8H (every
8 hours) for 14 days.
Disp:*42 Capsule(s)* Refills:*0*
14. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
TBA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3
Post-operative Atrial Fibrillation
PMH: Hyperlipidemia, Hypertension, Gastroesophageal Reflux
Disease,  Cervical and Lumbar Disc Disease, Pleural thickening
d/t Asbestos exposrure, Benign Prostatic Hypertrophy,
Depression, Sleep Apnea, h/o TIA, s/p AAA repair [**2147**], s/p
Appendectomy, s/p Tonsillectomy, s/p Laminectomy, s/p Bilat.
Rotator cuff repairs, s/p Bilat. knee surgery, s/p Left breast
lumpectomy, s/p TURP, s/p Penile Implant with replacement [**2147**],
s/p Bilat. hernia repair, s/p ankle pin placement

Discharge Condition:
Good

Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) **] in [**1-20**] weeks
Dr. [**Last Name (STitle) 8682**] in [**12-19**] weeks
Coumadin will be followed by Dr. [**Last Name (STitle) 8682**] Phone ([**Telephone/Fax (1) 17909**]
Fax ([**Telephone/Fax (1) 107921**]


Completed by:[**2153-2-9**]
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other and unspecified angina pectoris,Postlaminectomy syndrome, lumbar region,Mitral valve disorders,Acidosis,Unspecified pleural effusion,Asbestosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Foreign body in main bronchus,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Long-term (current) use of anticoagulants,Long QT syndrome,Unspecified erythematous condition,Other iatrogenic hypotension,Obstructive sleep apnea (adult)(pediatric)'}


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: 76 y/o male with exertional chest pain. Had abnormal ETT and was
then referred for cardiac cath. Cath revealed severe 3 vessel
disease with a 70% left main lesion.

MEDICAL HISTORY: Hyperlipidemia, Hypertension, Gastroesophageal Reflux Disease,
Cervical and Lumbar Disc Disease, Pleural thickening d/t
Asbestos exposrure, Benign Prostatic Hypertrophy, Depression,
Sleep Apnea, h/o TIA, s/p AAA repair [**2147**], s/p Appendectomy, s/p
Tonsillectomy, s/p Laminectomy, s/p Bilat. Rotator cuff repairs,
s/p Bilat. knee surgery, s/p Left breast lumpectomy, s/p TURP,
s/p Penile Implant with replacement [**2147**], s/p Bilat. hernia
repair, s/p ankle pin placement

MEDICATION ON ADMISSION: Simvastatin 40mg qd, Toprol XL 25mg qd, Nexium 40mg qd, Detrol
4mg qd, Lisinopril 10mg qd, Quinine 260mg qd, Aspirin 325mg qd,
Plavix 75mg qd, Ambien prn

ALLERGIES: Prozac

PHYSICAL EXAM: VS: 59 22 143/68 5'9" 93kg
General: NAD
HEENT: EOMI, PERRL, NC/AT
Neck: Supple, FROM, -JVD, -Carotid Bruits
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft NT/ND, +BS, healed AAA scar
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Mother with CAD at unkown age

SOCIAL HISTORY: Quit in [**2114**]. Social ETOH. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other and unspecified angina pectoris,Postlaminectomy syndrome, lumbar region,Mitral valve disorders,Acidosis,Unspecified pleural effusion,Asbestosis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Foreign body in main bronchus,Inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation,Long-term (current) use of anticoagulants,Long QT syndrome,Unspecified erythematous condition,Other iatrogenic hypotension,Obstructive sleep apnea (adult)(pediatric)'}
