CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 67F smoker w/ no medical care in over 15 years was transferred
from OSH with NSTEMI. Pt admitted to [**Hospital6 6640**] on
[**5-9**] with acute episode of SOB and pain radiating down both arms
and neck. EKG in ambulance demonstrated ST depressions in V2-V4,
ST elevations in II, III, and her cardiac enzymes were positive
with peak CPK 431 and troponin of 16.8. CTA was negative for PE.
She was placed on heparin gtt, integrillin gtt, plavix load,
beta blocker, high dose statin, and aspirin. Her ST segment
changes resolved but small Q-waves present in II and III. She
received lasix as needed for volume overload.

MEDICAL HISTORY: Hyperlipidemia, Hypertension, Tobacco use, s/p Hemorrhoidectomy

MEDICATION ON ADMISSION: OUTPATIENT:
none
.
TRANSFER MEDICATIONS:
Heparin gtt
Integrillin gtt
Plavix 75 mg daily
Aspirin 325mg daily
Protonix 40mg daily
Nitroglycerin paste
Metoprolol 50mg TID
Simvastatin 80mg daily
Ativan PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission
VS - 97.2 144/86 88 16 95% RA
Gen: well-appearing, NAD
HEENT: NCAT. Sclera anicteric. sclear anicteric, conjunctivae
slightly pale, OP clear w/ dentures, MMM
Neck: Supple with JVP of 8 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. +s3, III/VI blowing SEM at apex
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. soft R > L crackles
Abd: +BS. Soft, NTND.
Ext: No c/c/e..  Skin: No rashes.  Pulses:  2+ radial and 2+ DP
pulses bilat

FAMILY HISTORY: Her FH is notable for father with MI in his 40s and cardiac deat
at age 67. Mother died of old age at age [**Age over 90 **] and had thyroid
dysfunction

SOCIAL HISTORY: Patient is married to her husband for 50 years. She lives in
[**Location 20291**]. She is retired and used to work as a buyer for a
baby clothing company. She smokes [**2-12**] PPD currently,
40-pack-year hx. She denies any current EtoH use or prior abuse.
She denies any ellicits.
Subendocardial infarction, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified essential hypertension
Subendo infarct, initial,Ac systolic hrt failure,Crnry athrscl natve vssl,Mitral valve disorder,Hypertension NOS
Admission Date:  [**2177-5-11**]              Discharge Date:   [**2177-5-22**]

Date of Birth:  [**2110-2-10**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2177-5-12**] cardiac catheterization
[**2177-5-16**] Coronary Artery Bypass Graft x 4 (LIMA to LAD, SVG to OM,
SVG to OM, to LPDA)

History of Present Illness:
67F smoker w/ no medical care in over 15 years was transferred
from OSH with NSTEMI. Pt admitted to [**Hospital6 6640**] on
[**5-9**] with acute episode of SOB and pain radiating down both arms
and neck. EKG in ambulance demonstrated ST depressions in V2-V4,
ST elevations in II, III, and her cardiac enzymes were positive
with peak CPK 431 and troponin of 16.8. CTA was negative for PE.
She was placed on heparin gtt, integrillin gtt, plavix load,
beta blocker, high dose statin, and aspirin. Her ST segment
changes resolved but small Q-waves present in II and III. She
received lasix as needed for volume overload.

Past Medical History:
Hyperlipidemia, Hypertension, Tobacco use, s/p Hemorrhoidectomy

Social History:
Patient is married to her husband for 50 years. She lives in
[**Location 20291**]. She is retired and used to work as a buyer for a
baby clothing company. She smokes [**2-12**] PPD currently,
40-pack-year hx. She denies any current EtoH use or prior abuse.
She denies any ellicits.

Family History:
Her FH is notable for father with MI in his 40s and cardiac deat
at age 67. Mother died of old age at age [**Age over 90 **] and had thyroid
dysfunction

Physical Exam:
Admission
VS - 97.2 144/86 88 16 95% RA
Gen: well-appearing, NAD
HEENT: NCAT. Sclera anicteric. sclear anicteric, conjunctivae
slightly pale, OP clear w/ dentures, MMM
Neck: Supple with JVP of 8 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. +s3, III/VI blowing SEM at apex
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. soft R > L crackles
Abd: +BS. Soft, NTND.
Ext: No c/c/e..  Skin: No rashes.  Pulses:  2+ radial and 2+ DP
pulses bilat

Discharge
VS T98.4  HR 97 SR  BP 167/97  RR 18
Gen NAD
Neuro Oriented x3, nonfocal exam
Pulm scattered rhonchi
CV RRR, sternum stable incision CDI
Abdm soft, NT/+BS
Ext warm, palpable pulses, 2+ pedal edema

Pertinent Results:
[**2177-5-11**] 08:51PM   %HbA1c-6.4*
[**2177-5-11**] 05:43PM   GLUCOSE-100 UREA N-16 CREAT-0.8 SODIUM-141
POTASSIUM-3.8 CHLORIDE-103 TOTAL CO2-27 ANION GAP-15
[**2177-5-11**] 05:43PM   TSH-13*
[**2177-5-11**] 05:43PM   FREE T4-1.2
[**2177-5-11**] 05:43PM   WBC-6.3 RBC-4.37 HGB-13.6 HCT-39.4 MCV-90
MCH-31.0 MCHC-34.4 RDW-13.7
[**2177-5-11**] 05:43PM   PLT COUNT-206
[**2177-5-11**] 05:43PM   PT-12.5 PTT-44.1* INR(PT)-1.1
[**2177-5-22**] 05:20AM BLOOD WBC-7.7 RBC-3.56* Hgb-10.9* Hct-31.8*
MCV-89 MCH-30.8 MCHC-34.5 RDW-14.1 Plt Ct-265
[**2177-5-19**] 04:06AM BLOOD PT-12.1 PTT-40.1* INR(PT)-1.0
[**2177-5-22**] 05:20AM BLOOD Glucose-112* UreaN-15 Creat-0.7 Na-141
K-4.0 Cl-102 HCO3-28 AnGap-15

[**5-12**] Cardiac cath: 1.  Selective coronary angiography of this
left dominant system revealed 3 vessel coronary artery disease.
The LMCA had no angiographically apparent flow limiting
epicardial coronary artery disease.  The LAD had a 70% mid and a
60% mid vessel stenosis with mild diffuse disease.  The LCx had
a 90% mid vessel stenosis.  The RCA had an 80% proximal and an
80% mid-vessel lesion and was a small, non-dominant vessel. 2.
Resting hemodynamics revealed elevated right and left filling
pressures with LVEDP 24 mmHg and RVEDP 13 mmHg.  The pulmonary
artery systolic pressure was mildly elevated with a PASP of 31
mmHg.  The cardiac index was [**Month/Day (4) 61102**] at 1.93 L/min/m2.  There
was mild systemic systolic arterial hypertension with SBP 147
mmHg. 3.  There was no transvalvular gradient upon pullback of
the catheter from the left ventricle to the aorta. 4.  Left
ventriculography reealed [**3-16**]+ mitral regurgitation.  The LVEF
was calculated to be 25% with inferior akinesis and moderately
severe
anterior hypokinesis

[**5-16**]/ Echo: PRE-CPB:1. The left atrium is markedly dilated. No
spontaneous echo contrast is seen in the body of the left
atrium. A left atrial appendage thrombus cannot be excluded. 2.
No atrial septal defect is seen by 2D or color Doppler. 3. There
is mild symmetric left ventricular hypertrophy. The left
ventricular cavity is moderately dilated. There is severe
regional left ventricular systolic dysfunction with infero and
inferoseptal hypokinesis. LVEF is 25% 4. Right ventricular
chamber size and free wall motion are normal. 5. There are
simple atheroma in the aortic root. There are simple atheroma in
the ascending aorta. There are simple atheroma in the aortic
arch. There are complex (>4mm) atheroma in the descending
thoracic aorta. 6. There are three aortic valve leaflets. The
aortic valve leaflets (3) are mildly thickened. There is a
minimally increased gradient consistent with minimal aortic
valve stenosis. No aortic regurgitation is seen. 7. The mitral
valve leaflets are mildly thickened. No mass or vegetation is
seen on the mitral valve. Moderate to severe (3+) mitral
regurgitation is seen. There is a central jet with an annular
dimension of 2.7 cm. 8. Dr. [**Last Name (STitle) 914**] was notified in person of
the results. POST CPB: On infusions of epi, milrinone, neo.
Well-seated annuloplasty ring in the mitral position. No MR.
Gradient of 11 mmHg on inotropes with CO= 6.0, consistent with
mild MS. Dr. [**First Name (STitle) 6507**] present to perform 3-D views. Improved LV
systolic function with LVEF= 35%. No evidence of [**Male First Name (un) **]. Aortic
contour normal post decannulation.


[**5-13**] CAROTID U/S: Normal carotid study

CT HEAD W/O CONTRAST  [**2177-5-21**] 4:49 PM
CT HEAD W/O CONTRAST
Reason: eval for peri-operative CVA
[**Hospital 93**] MEDICAL CONDITION:
67 year old woman s/p MVring and CABG now w r-sided weakness
REASON FOR THIS EXAMINATION:
eval for peri-operative CVA
CONTRAINDICATIONS for IV CONTRAST: None.
HEAD CT
HISTORY: 67-year-old woman status post mitral valve ring and
CABG surgery, now with right-sided weakness.
TECHNIQUE: Contiguous non-contrast axial images of the head were
obtained.
FINDINGS: No comparisons are available.
There is a hypodensity involving the right occipital lobe which
is consistent with either subacute or old infarct. No acute
infarcts are identified. There is a minimal amount of
periventricular white matter hypodensities which likely
represent chronic microangiopathic change. Small perivascular
spaces are seen in the basal ganglia regions bilaterally.
There are no intracranial hemorrhages.
The visualized orbits are normal. The visualized paranasal
sinuses and mastoid air cells are clear. No suspicious bony
abnormalities are seen.
IMPRESSION: Subacute to old infarct of the right occipital lobe.

CHEST (PORTABLE AP)  [**2177-5-19**] 8:11 AM
CHEST (PORTABLE AP)
Reason: ? effusion, PTX
[**Hospital 93**] MEDICAL CONDITION:
67 year old woman with s/p cabg
REASON FOR THIS EXAMINATION:
? effusion, PTX
CHEST RADIOGRAPH
INDICATION: Followup.
COMPARISON: [**2177-5-18**].
As compared to the previous examination, there is a slight
increase in retrocardiac density, presumably caused by
atelectasis. The size of the cardiac silhouette is unchanged. No
newly appeared parenchymal opacities. No relevant overhydration.
The monitoring and support devices are in unchanged position.


Brief Hospital Course:
67F smoker w/ no medical care in over 15 years, untreated HTN,
was transferred from OSH with acute MI and antero-lateral
depressions and brief inferior elevations, and 3v-disease on
cardiac cath and severe MR [**First Name (Titles) **] [**Last Name (Titles) 61102**] EF 25-30%.
She was seen by cardiac surgery. SHe was cleared by dental. She
awaited plavix washout prior to being taken to the operating
room on [**5-16**] where she underwent a CABG x 4/MV Repair. She was
transferred to the ICU in stable condition on epi, milrnone, neo
and propofol. She remained intubated overnight and was
transfused for HCT 20. S right chest tube was placed for pleural
effusion. She was extubated on POD #1. She was followed by
psychiatry for delirium and started on haldol. She initially had
some right sided weakness, head CT showed old infarct. She was
seen by speech and swallow and was initially cleared for pureed
foods. She was transferred to the floor on POD #3. She was
re-evaluated by swallow and cleared for thin liquids and ground
solids. Her haldol was discontinued. She was started on
synthroid for TSH 21.  Her weakness improved. She was screened
for rehab and was discharged to rehabilitation at [**Hospital1 599**] of
[**Location (un) **] on POD #6.

Medications on Admission:
OUTPATIENT:
none
.
TRANSFER MEDICATIONS:
Heparin gtt
Integrillin gtt
Plavix 75 mg daily
Aspirin 325mg daily
Protonix 40mg daily
Nitroglycerin paste
Metoprolol 50mg TID
Simvastatin 80mg daily
Ativan PRN

Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid [**Location (un) **]: One (1)  PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) [**Location (un) **]: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Lisinopril 5 mg Tablet [**Location (un) **]: One (1) Tablet PO DAILY (Daily).

4. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
5. Levothyroxine 50 mcg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
6. Zocor 80 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day.
7. Citalopram 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY (Daily).

8. Nystatin 100,000 unit/mL Suspension [**Last Name (STitle) **]: Five (5) ML PO QID
(4 times a day) as needed.
9. Metoprolol Tartrate 50 mg Tablet [**Last Name (STitle) **]: Two (2) Tablet PO TID
(3 times a day).
10. Lorazepam 1 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO HS (at bedtime)
as needed.
11. Lasix 40 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
TBA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Myocardial Infarction
PMH: Hyperlipidemia, Hypertension, Tobacco use
PSH: Hemorrhoidectomy

Discharge Condition:
stable


Discharge Instructions:
1)Please shower daily. No baths. Pat dry incisions, do not rub.
2)Avoid creams and lotions to surgical incisions.
3)Call for redness or drainage from surgical wounds
4)No lifting more than 10 lbs for at least 10 weeks from
surgical date.
5)No driving for at least one month.

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2177-6-11**] 2:00
PCP [**Last Name (NamePattern4) **] [**2-12**] weeks, started on synthroid while in hospital, needs
TFTs rechecked in 6 weeks



Completed by:[**2177-5-22**]
{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified essential hypertension'}


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: 67F smoker w/ no medical care in over 15 years was transferred
from OSH with NSTEMI. Pt admitted to [**Hospital6 6640**] on
[**5-9**] with acute episode of SOB and pain radiating down both arms
and neck. EKG in ambulance demonstrated ST depressions in V2-V4,
ST elevations in II, III, and her cardiac enzymes were positive
with peak CPK 431 and troponin of 16.8. CTA was negative for PE.
She was placed on heparin gtt, integrillin gtt, plavix load,
beta blocker, high dose statin, and aspirin. Her ST segment
changes resolved but small Q-waves present in II and III. She
received lasix as needed for volume overload.

MEDICAL HISTORY: Hyperlipidemia, Hypertension, Tobacco use, s/p Hemorrhoidectomy

MEDICATION ON ADMISSION: OUTPATIENT:
none
.
TRANSFER MEDICATIONS:
Heparin gtt
Integrillin gtt
Plavix 75 mg daily
Aspirin 325mg daily
Protonix 40mg daily
Nitroglycerin paste
Metoprolol 50mg TID
Simvastatin 80mg daily
Ativan PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission
VS - 97.2 144/86 88 16 95% RA
Gen: well-appearing, NAD
HEENT: NCAT. Sclera anicteric. sclear anicteric, conjunctivae
slightly pale, OP clear w/ dentures, MMM
Neck: Supple with JVP of 8 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. +s3, III/VI blowing SEM at apex
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. soft R > L crackles
Abd: +BS. Soft, NTND.
Ext: No c/c/e..  Skin: No rashes.  Pulses:  2+ radial and 2+ DP
pulses bilat

FAMILY HISTORY: Her FH is notable for father with MI in his 40s and cardiac deat
at age 67. Mother died of old age at age [**Age over 90 **] and had thyroid
dysfunction

SOCIAL HISTORY: Patient is married to her husband for 50 years. She lives in
[**Location 20291**]. She is retired and used to work as a buyer for a
baby clothing company. She smokes [**2-12**] PPD currently,
40-pack-year hx. She denies any current EtoH use or prior abuse.
She denies any ellicits. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute systolic heart failure,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Unspecified essential hypertension'}
