CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 50 y/o male with no known CAD who presented to OSH ER w/ acute
onset chest pain. Thought to be from his rotator cuff injury. On
day of admission, pain was substernal with no related n/v or
diaphoresis, SOB. Pt. transferred from [**Hospital1 **] ER to [**Hospital1 18**] for
cardiac cath and further management.

MEDICAL HISTORY: Acute Myocardial Infarction
Hypertension
Gastroesophageal Reflux Disease
s/p Bilat Hernia repair
L Rotator Cuff injury

MEDICATION ON ADMISSION: Nexium 40 po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.8 78SR 115/65 18 93% 2L 5'[**64**]" 99.8kg
General: Lying in bed in NAD
Neuro: A&O x 3, MAE, following commands, non-focal
HEENT: PERRLA w/ EOMI, anicteric, non-injected. MMM, -lesions
Neck: Supple, -JVD, -Bruits
Cardio: RRR, +s1 s2, -c/r/m/g
Pulm: CTAB -w/r/r
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -c/c/e, -varicosities, 2+ pulses
throughout

FAMILY HISTORY: Father had MI at 45 and bypass at age 65, no other family
members with CAD

SOCIAL HISTORY: Does not smoke, drinks socially but drinks three 12 packs per
week in the summer, no IVDA, works as a maintenance man and says
he walks about 10 miles/day at his job; used to exercise more
before he began having knee pain
Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Alcohol abuse, unspecified,Other iatrogenic hypotension,Unspecified essential hypertension,Esophageal reflux
AMI anterolateral, init,Crnry athrscl natve vssl,Cardiac dysrhythmias NEC,Alcohol abuse-unspec,Iatrogenc hypotnsion NEC,Hypertension NOS,Esophageal reflux
Admission Date:  [**2159-8-29**]              Discharge Date:   [**2159-9-4**]

Date of Birth:  [**2108-10-18**]             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 Coronary Artery Bypass Graft x 3 on [**2159-8-31**]
s/p Cardiac Catheterization on [**2159-8-29**]

History of Present Illness:
50 y/o male with no known CAD who presented to OSH ER w/ acute
onset chest pain. Thought to be from his rotator cuff injury. On
day of admission, pain was substernal with no related n/v or
diaphoresis, SOB. Pt. transferred from [**Hospital1 **] ER to [**Hospital1 18**] for
cardiac cath and further management.

Past Medical History:
Acute Myocardial Infarction
Hypertension
Gastroesophageal Reflux Disease
s/p Bilat Hernia repair
L Rotator Cuff injury

Social History:
Does not smoke, drinks socially but drinks three 12 packs per
week in the summer, no IVDA, works as a maintenance man and says
he walks about 10 miles/day at his job; used to exercise more
before he began having knee pain

Family History:
Father had MI at 45 and bypass at age 65, no other family
members with CAD

Physical Exam:
VS: 97.8 78SR 115/65 18 93% 2L 5'[**64**]" 99.8kg
General: Lying in bed in NAD
Neuro: A&O x 3, MAE, following commands, non-focal
HEENT: PERRLA w/ EOMI, anicteric, non-injected. MMM, -lesions
Neck: Supple, -JVD, -Bruits
Cardio: RRR, +s1 s2, -c/r/m/g
Pulm: CTAB -w/r/r
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -c/c/e, -varicosities, 2+ pulses
throughout

Pertinent Results:
Cardiac Catheterization [**8-29**]:
FINAL DIAGNOSIS:
1.Three vessel coronary artery disease.
2. Mildy elevated left sided pressures.
3. Acute anterior myocardial infarction, managed by acute ptca.
PTCA of
the diagonal 1.
Echo ([**2159-8-29**]):
EF 35%, no pericardial effusion. Left ventricular wall
thicknesses and cavity size are normal. Resting regional wall
motion abnormalities include near akinesis of the distal half of
the anterior septum and anterior wall, basal inferior wall, and
apex. The aortic valve leaflets appear structurally normal with
good leaflet excursion. Mild (1+) mitral regurgitation is seen.
There is no pericardial effusion.

[**2159-8-29**] 04:25PM BLOOD WBC-12.8* RBC-5.32 Hgb-15.9 Hct-42.5
MCV-80* MCH-30.0 MCHC-37.5* RDW-12.6 Plt Ct-199
[**2159-9-4**] 05:40AM BLOOD WBC-8.9 RBC-3.35* Hgb-9.7* Hct-28.1*
MCV-84 MCH-29.0 MCHC-34.5 RDW-13.2 Plt Ct-326
[**2159-8-29**] 04:25PM BLOOD PT-12.9 PTT-22.6 INR(PT)-1.1
[**2159-9-4**] 05:40AM BLOOD PT-12.9 INR(PT)-1.1
[**2159-8-29**] 04:25PM BLOOD Glucose-110* UreaN-17 Creat-0.9 Na-138
K-3.9 Cl-105 HCO3-23 AnGap-14
[**2159-9-4**] 05:40AM BLOOD Glucose-96 UreaN-16 Creat-0.8 Na-140
K-4.4 Cl-103 HCO3-30 AnGap-11
[**2159-8-29**] 04:25PM BLOOD Calcium-9.4 Phos-3.1 Mg-2.1
[**2159-8-30**] 04:27PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.015
[**2159-8-30**] 04:27PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-1 pH-8.0 Leuks-NEG

Brief Hospital Course:
As mentioned in the HPI, pt transferred from OSH for cath.
Cardiac cath revealed 3 vessel disease. Diagonal branch was
stented and pt was then referred for CABG for coronary
revascularization. On HD #3, pt was brought to the OR, where he
underwent Coronary Artery Bypass graft x 3. Please see op note
for details. Pt tolerated the procedure well and was transferred
to the CSRU in stable condition being titrated on Neo and
Propofol. Later on op day, pt was weaned from mechanical
ventilation and propofol and was extubated. By POD #1 he was
weaned from Neo and started on Lasix and b-blockers per
protocol. Also on POD #1 his chest tubes and Swan-Ganz catheter
were removed. On POD #3 pt had his epicardial pacing wires
removed and was transferred to telemetry floor. Pt. appeared to
be recovering well and had no post-op complications. PT was
seeing the pt during his post-op period and on POD #4 felt pt
was at level 5. His PE was unremarkable, labs were stable and pt
was d/c'd on POD #4 with VNA services and the appropriate f/u's.


Medications on Admission:
Nexium 40 po qd

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
3. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 10 days.
Disp:*20 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
4. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
5. 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*
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Atorvastatin Calcium 80 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
10. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*1*

Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Coronary [**Last Name (un) 64346**] Disease s/p Coronary Artery Bypass Graft x 3
Myocardial Infarction
Hypertension
Gastroesophageal Reflux Disease

Discharge Condition:
Good

Discharge Instructions:
Can take shower. Wash incisions with water and gentle soap.
Gently pat dry. Do not take bath or swim.
Do not apply lotions, creams, ointments, or powders to
incisions.
Do not drive for 1 month.
Do not lift greater than 10 pounds for 2 months.
Make/Keep all follow-up appointments.
Take all prescribed meds.
If you notice any drainage from incisions, redness, or fever,
please contact office.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 4 weeks.
Follow-up with PCP (Dr. [**Last Name (STitle) 18323**] in 2 weeks.
Follow-up with Cardiologist in 2 weeks.


Completed by:[**2159-9-4**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Alcohol abuse, unspecified,Other iatrogenic hypotension,Unspecified essential hypertension,Esophageal reflux'}


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: 50 y/o male with no known CAD who presented to OSH ER w/ acute
onset chest pain. Thought to be from his rotator cuff injury. On
day of admission, pain was substernal with no related n/v or
diaphoresis, SOB. Pt. transferred from [**Hospital1 **] ER to [**Hospital1 18**] for
cardiac cath and further management.

MEDICAL HISTORY: Acute Myocardial Infarction
Hypertension
Gastroesophageal Reflux Disease
s/p Bilat Hernia repair
L Rotator Cuff injury

MEDICATION ON ADMISSION: Nexium 40 po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.8 78SR 115/65 18 93% 2L 5'[**64**]" 99.8kg
General: Lying in bed in NAD
Neuro: A&O x 3, MAE, following commands, non-focal
HEENT: PERRLA w/ EOMI, anicteric, non-injected. MMM, -lesions
Neck: Supple, -JVD, -Bruits
Cardio: RRR, +s1 s2, -c/r/m/g
Pulm: CTAB -w/r/r
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -c/c/e, -varicosities, 2+ pulses
throughout

FAMILY HISTORY: Father had MI at 45 and bypass at age 65, no other family
members with CAD

SOCIAL HISTORY: Does not smoke, drinks socially but drinks three 12 packs per
week in the summer, no IVDA, works as a maintenance man and says
he walks about 10 miles/day at his job; used to exercise more
before he began having knee pain 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Other specified cardiac dysrhythmias,Alcohol abuse, unspecified,Other iatrogenic hypotension,Unspecified essential hypertension,Esophageal reflux'}
