CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Mr. [**Known lastname 17283**] has a h/o MI several years ago, w/episode lasting 20
hours on day of admission.  Pt ruled in for NSTEMI.

MEDICAL HISTORY: HTN
hypercholesterolemia
colon CA-s/p hemicolectomy and chemotherapy
CAD
DM

MEDICATION ON ADMISSION: aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Acute respiratory failure,Iatrogenic pulmonary embolism and infarction,Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of large intestine,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Subendo infarct, initial,Acute respiratry failure,Iatrogen pulm emb/infarc,CHF NOS,Atrial fibrillation,Crnry athrscl natve vssl,Chr pulmon heart dis NEC,Hypertension NOS,Pure hypercholesterolem,Hx of colonic malignancy,DMII wo cmp nt st uncntr,Abn react-surg proc NEC
Admission Date:  [**2107-12-29**]              Discharge Date:   [**2108-1-24**]

Date of Birth:  [**2043-6-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 14964**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
s/p CABGx5 [**12-30**](LIMA-LAD, SVG-Diag, SVG-ramus-OM, SGV-RCA)
s/p tracheostomy [**1-18**] #8 Shiley
s/p PEG [**1-18**]


History of Present Illness:
Mr. [**Known lastname 17283**] has a h/o MI several years ago, w/episode lasting 20
hours on day of admission.  Pt ruled in for NSTEMI.

Past Medical History:
HTN
hypercholesterolemia
colon CA-s/p hemicolectomy and chemotherapy
CAD
DM

Pertinent Results:
[**2108-1-23**] 04:16AM BLOOD WBC-12.2* RBC-3.63* Hgb-10.6* Hct-32.7*
MCV-90 MCH-29.4 MCHC-32.6 RDW-14.4 Plt Ct-434
[**2108-1-23**] 04:16AM BLOOD Plt Ct-434
[**2108-1-23**] 04:16AM BLOOD PT-14.1* PTT-62.3* INR(PT)-1.3
[**2108-1-23**] 04:16AM BLOOD Glucose-60* UreaN-33* Creat-1.1 Na-135
K-4.2 Cl-101 HCO3-27 AnGap-11
[**2108-1-24**] 02:11AM BLOOD PT-15.3* PTT-85.7* INR(PT)-1.5

Brief Hospital Course:
Mr. [**Known lastname 17283**] is a 64 yo gentleman who was admitted on [**12-29**] with
unstable angina.  Cardiac catheterization showed LM and
significant vessel disease.  An intra-aortic balloon pump was
inserted due to ongoing angina and marginal hemodynamics. He was
taken to the operating room with Dr. [**Last Name (STitle) 70**] on [**12-30**] for a
CABGx5.  His ejection fraction in the operating room was 20%.
Postoperatively he was hemodynamically unstable for several
days, requiring inotropes and IABP.  On [**1-1**] he was taken to the
cardiac catheterization lab due to marginal hemodynamics which
showed that all of his bypass grafts were patent.  He also had
moderate hypoxia and an interventional pulmonary consult was
obtained.  It was recommended that the patient receive
bronchodilators.  His hypoxia gradually resolved and his
ventilator was weaned.  He was started on an ACE inhibitor in an
attempt to wean his inotropes, but it was discontinued due to an
elevated creatinine.  By POD#9 his inotropes were weaned and the
patient was able to diurese.  He was extubated from mechanical
ventilation on POD#11, but required intermittent BiPAP and was
re intubated on POD#14 due to hypoxia and work of breathing.
The patient underwent CT scan to evaluate for pulmonary emboli
which showed 2 small pulmonary emboli which were thought to be
clinically insignificant, but it was recommended that he be
anticoagulated.  He had bilateral lower extremity venous
dopplers preformed which were negative for evidence of DVT.  On
POD#19 he self extubated and after several hours was re
intubated for hypoxia and work of breathing.  On POD#19 he
underwent bedside tracheostomy and PEG placement.  He continued
to wean on the ventilator.  On POD#21 he underwent a
transthoracic echocardiogram which showed his ejection fraction
had improved to 30% with no significant valvular abnormalities.
On [**1-21**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] consult was obtained due to the patients
continued elevated blood sugar.  It was recommended that the
patient be started on Lantus insulin which was started without
difficulty.

Medications on Admission:
aspirin

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Fluticasone Propionate 110 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation [**Hospital1 **] (2 times a day).
5. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO once a
day.
6. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. Docusate Sodium 150 mg/15 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
8. Carvedilol 6.25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day).
9. Haloperidol 1 mg Tablet Sig: One (1) Tablet PO at bedtime.
10. Heparin Sod (Porcine) in D5W 100 unit/mL Parenteral Solution
Sig: 1000 (1000) units/hour Intravenous  infusion: until INR>2.0
goal PTT 50-70.
11. Furosemide 10 mg/mL Solution Sig: Forty (40) mg Injection
DAILY (Daily).
12. Coumadin 1 mg Tablet Sig: as directed Tablet PO once a day:
titrate for INR 2.0-3.0
5mg per PEG [**1-24**].
13. Isosorbide Dinitrate 10 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
14. Hydralazine HCl 25 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
15. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
16. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: [**12-18**]
Puffs Inhalation Q4H (every 4 hours).
17. Insulin Glargine 100 unit/mL Solution Sig: Forty (40) units
Subcutaneous at bedtime.
18. Insulin Regular Human 100 unit/mL Solution Sig: as directed
Injection tid: for blood sugar
<60 give [**12-18**] amp D50
121-150 4 units SC
151-160 8 units SC
161-200 12 units SC
201-250 14 units SC
251-300 16 units SC
301-350 18 units SC
351-400 20 units SC.
19. Insulin Regular Human 100 unit/mL Solution Sig: as directed
Injection bedtime: for blood sugar
<60 give [**12-18**] ampD50
BS 201-250 6units SC
BS 251-300 10unitsSC
BS 301-350 12unitsSC
BS 351-400 14unitsSC
.


Discharge Disposition:
Extended Care

Facility:
Northeast [**Hospital 17284**] Rehab

Discharge Diagnosis:
CAD
s/p urgent CABG
post op respiratory failure
s/p tracheostomy
s/p PEG
post op pulmonary emboli
HTN
post op atrial fibrillation
^chol
h/o colon CA s/p colectomy


Discharge Condition:
good

Discharge Instructions:
do not lift anything heavier than 10 pounds for 1 month


Followup Instructions:
follow up with Dr. [**Last Name (STitle) 17285**] in [**12-18**] weeks
follow up with Dr. [**Last Name (STitle) 70**] ([**Telephone/Fax (1) 170**]) in [**3-20**] weeks
follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 3512**]) when ready for
discharge from rehab
follow up with the [**Last Name (un) **] center ([**Telephone/Fax (1) 2378**]for diabetes
management when ready for discharge from rehab



Completed by:[**2108-1-24**]

Name:  [**Known lastname 2722**],[**Known firstname 140**]                  Unit No:   [**Numeric Identifier 2723**]

Admission Date:  [**2107-12-29**]              Discharge Date:   [**2108-1-24**]

Date of Birth:  [**2043-6-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2724**]
Addendum:
The patient was discharged to Northeast [**Hospital 2725**] Hospital in
[**Location (un) 437**] and had a question of respiratory distressed and was
transferred back to [**Hospital1 8**] 6 hours later.  He was stable on
readmission, diuresed,  and was screened by [**Hospital3 14**]
and is being discharged today in stable condition.

Discharge Disposition:
Extended Care

Facility:
Northeast [**Hospital 2726**] Rehab

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2727**] MD [**MD Number(1) 2728**]

Completed by:[**2108-1-26**]
{'Subendocardial infarction, initial episode of care,Acute respiratory failure,Iatrogenic pulmonary embolism and infarction,Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of large intestine,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Mr. [**Known lastname 17283**] has a h/o MI several years ago, w/episode lasting 20
hours on day of admission.  Pt ruled in for NSTEMI.

MEDICAL HISTORY: HTN
hypercholesterolemia
colon CA-s/p hemicolectomy and chemotherapy
CAD
DM

MEDICATION ON ADMISSION: aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Acute respiratory failure,Iatrogenic pulmonary embolism and infarction,Congestive heart failure, unspecified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of large intestine,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
