CHIEF COMPLAINT: Chest Pain, Dyspnea on Exertion

PRESENT ILLNESS: 84 yoM with abnormal ETT, cath with 3VD.

MEDICAL HISTORY: Complete Heart Block s/p PPM [**2152**], ?SVT, Gout, s/p left Total
Hip Replacement, s/p hernia repair, s/p l cataract surgery

MEDICATION ON ADMISSION: lasix, colchicine, asa

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: pleasant, NAD HR 71, BP 138/76 RR 18
Skin unremarkable
HEENT unremarkable
Neck supple, FROM, -JVD
Lungs CTAB
Heart RRR no M/R/G
Abd Soft NT/ND +BS
Extrem cool, 2+ edema, 2+femoral and radila pulses, 1+ DP&PT, no
carotid bruits

FAMILY HISTORY: NC

SOCIAL HISTORY: retired
lives with wife
no [**Name2 (NI) **]
+etoh, stopped about 1 month ago
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Mechanical complication due to cardiac pacemaker (electrode),Alcohol abuse, unspecified,Chronic kidney disease, unspecified,Ostium secundum type atrial septal defect,Other nonspecific abnormal results of function study of cardiovascular system,Gout, unspecified
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Atrial fibrillation,Malfunc cardiac pacemake,Alcohol abuse-unspec,Chronic kidney dis NOS,Secundum atrial sept def,Abn cardiovasc study NEC,Gout NOS
Admission Date:  [**2153-9-20**]              Discharge Date:   [**2153-9-29**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest Pain, Dyspnea on Exertion

Major Surgical or Invasive Procedure:
[**2153-9-20**] Coronary Artery Bypass Graft x 4 (LIMA->LAD, SVG->OM,
Diag, PDA), Atrial Septal Defect Closure

History of Present Illness:
84 yoM with abnormal ETT, cath with 3VD.

Past Medical History:
Complete Heart Block s/p PPM [**2152**], ?SVT, Gout, s/p left Total
Hip Replacement, s/p hernia repair, s/p l cataract surgery

Social History:
retired
lives with wife
no [**Name2 (NI) **]
+etoh, stopped about 1 month ago

Family History:
NC

Physical Exam:
pleasant, NAD HR 71, BP 138/76 RR 18
Skin unremarkable
HEENT unremarkable
Neck supple, FROM, -JVD
Lungs CTAB
Heart RRR no M/R/G
Abd Soft NT/ND +BS
Extrem cool, 2+ edema, 2+femoral and radila pulses, 1+ DP&PT, no
carotid bruits

Pertinent Results:
Echo [**9-20**]: Pre Bypass The left atrium is markedly dilated. There
is a bidirectional shunt across the interatrial septum at rest.
A small secundum atrial septal defect is present. Overall left
ventricular systolic function is mildly depressed. Resting
regional wall motion abnormalities include mild to moderate
hypokinesia of the basal, mid and apical portions of the
inferior and inferolateral walls. The aortic root is mildly
dilated. There are simple atheroma in the aortic root. The
ascending aorta is mildly dilated. There are simple atheroma in
the ascending aorta and descending thoracic aorta. There is no
aortic valve stenosis. Mild (1+) aortic regurgitation is seen.
Mild to moderate ([**2-12**]+)mitral regurgitation is seen. Post
Bypass: Biventricular systolic function is unchanged. Mild
Mitral regurgitation persists. Trivial left to right flow across
the interatrial septum.
CXR [**9-28**]:

[**2153-9-20**] 12:50PM BLOOD WBC-11.4*# RBC-2.93* Hgb-9.2* Hct-26.3*
MCV-90 MCH-31.4 MCHC-35.0 RDW-14.3 Plt Ct-138*
[**2153-9-26**] 07:25AM BLOOD WBC-8.2 RBC-2.74* Hgb-8.6* Hct-25.2*
MCV-92 MCH-31.5 MCHC-34.3 RDW-14.3 Plt Ct-348#
[**2153-9-20**] 12:50PM BLOOD PT-17.0* PTT-38.4* INR(PT)-1.6*
[**2153-9-21**] 03:08AM BLOOD PT-13.0 PTT-27.7 INR(PT)-1.1
[**2153-9-20**] 01:53PM BLOOD UreaN-13 Creat-0.7 Cl-110* HCO3-23
[**2153-9-26**] 07:25AM BLOOD Glucose-103 UreaN-16 Creat-1.1 Na-139
K-4.1 Cl-100 HCO3-31 AnGap-12

Brief Hospital Course:
Mr. [**Known lastname **] was taken to the operating room on [**2153-9-20**] where he
underwent a CABG x 4. Please see operative report for surgical
details. He was transferred to the CSRU for invasive monitoring
in stable condition. Later on op day he was weaned from
sedation, awoke neurologically intact and extubated. He was
transfused 2 units PRBCs for low HCT. On post-op day two he was
seen by EP and his pacemaker was interrogated. EP continued to
followe Mr. [**Known lastname **] during hospital course. His vasoactive drips
were weaned off on post-op day two and he was tansferred to the
SDU on post-op day three. Chest tubes were removed on post-op
day two. Beta blockers and diuretics were intiated and he was
gently diuresed towards his pre-op weight. Epicardial pacing
wires were removed on post-op day four. Physical therapy
followed patient during entire post-op period for strength and
mobility. He continued to recover well and was discharged home
in good condition with VNA services and the appropriate
follow-up appointments.

Medications on Admission:
lasix, colchicine, asa

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. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
3. 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*
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. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*0*
6. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
8. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO Q12H (every 12
hours) for 14 days.
Disp:*60 Tablet(s)* Refills:*0*
9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Four (4) Capsule, Sustained Release PO once a day for 2 weeks.
Disp:*56 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Coronary Artery Disease, Atrial Seotal Defect s/p Coronary
Artery Bypass Graft x 4, ASD closure
PMH: Complete Heart Block s/p PPM [**2152**], ?SVT, Gout, s/p left
Total Hip Replacement, s/p hernia repair, s/p l cataract surgery

Discharge Condition:
Good

Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No heavy lifting or driving until follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) **] 4 weeks
Dr. [**Last Name (STitle) **]  (PCP/cardiologist) 2 weeks
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Mechanical complication due to cardiac pacemaker (electrode),Alcohol abuse, unspecified,Chronic kidney disease, unspecified,Ostium secundum type atrial septal defect,Other nonspecific abnormal results of function study of cardiovascular system,Gout, 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, Dyspnea on Exertion

PRESENT ILLNESS: 84 yoM with abnormal ETT, cath with 3VD.

MEDICAL HISTORY: Complete Heart Block s/p PPM [**2152**], ?SVT, Gout, s/p left Total
Hip Replacement, s/p hernia repair, s/p l cataract surgery

MEDICATION ON ADMISSION: lasix, colchicine, asa

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: pleasant, NAD HR 71, BP 138/76 RR 18
Skin unremarkable
HEENT unremarkable
Neck supple, FROM, -JVD
Lungs CTAB
Heart RRR no M/R/G
Abd Soft NT/ND +BS
Extrem cool, 2+ edema, 2+femoral and radila pulses, 1+ DP&PT, no
carotid bruits

FAMILY HISTORY: NC

SOCIAL HISTORY: retired
lives with wife
no [**Name2 (NI) **]
+etoh, stopped about 1 month ago 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Mechanical complication due to cardiac pacemaker (electrode),Alcohol abuse, unspecified,Chronic kidney disease, unspecified,Ostium secundum type atrial septal defect,Other nonspecific abnormal results of function study of cardiovascular system,Gout, unspecified'}
