CHIEF COMPLAINT: Chest pain, presyncoble episode and dizziness

PRESENT ILLNESS: 60 year old male with a history of hypertension, psoriatic
arthritis who has suffered from "costochondritic chest pain"
with exertion over the past few years. Finally underwent stress
test with exercise portion showing ischemic ST changes. Echo
portion unrevealing. Went to diagnostic cath with severe LMCA
70-80% stenosis, otherwise with 70-80% lesions in LAD, Cx, RCA.
He is now being referred to cardiac surgery for
revascularization.

MEDICAL HISTORY: Psoriatic arthritis
Gastroesophageal reflux disease
Depression
s/p right Rotator cuff repair

MEDICATION ON ADMISSION: CLOBETASOL -  (Prescribed by Other Provider) - Dosage uncertain
LISINOPRIL - 10 mg Tablet - 1 Tablet(s) by mouth once a day
(started one week ago)
SIMVASTATIN 10mg 1tab po qhs (one week ago started)
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release(E.C.) - 1 Tablet(s) by mouth twice a day
SERTRALINE -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth once daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:72 Resp:18  O2 sat:100/RA
B/P  Right:169/97    Left:141/91
Height:5'9"     Weight:144 lbs

FAMILY HISTORY: His father died of a heart attack at age 63.
His mother had [**Name2 (NI) 499**] cancer at age 64.  Paternal grandmother
with cancer 82.
No known h/o sudden cardiac death.

SOCIAL HISTORY: He is an LPN.
He has a male partner x23 years. They are currently not sexually
active(His partner is HIV positive). They have not had sexual
relations since his HIV diagnosis, Mr. [**Known lastname 31620**] last HIV test
was five years ago.
+ tobacco/He smokes one-half pack a day for 15 years.
+ ETOH use.
Occasional recreational drug use (Marijuana 2-3x/week).
Coronary atherosclerosis of native coronary artery,Hyposmolality and/or hyponatremia,Other emphysema,Hypocalcemia,Other diseases of lung, not elsewhere classified,Psoriatic arthropathy,Other and unspecified angina pectoris,Iatrogenic pneumothorax,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Tobacco use disorder,Esophageal reflux,Anemia, unspecified,Depressive disorder, not elsewhere classified,Family history of ischemic heart disease
Crnry athrscl natve vssl,Hyposmolality,Emphysema NEC,Hypocalcemia,Other lung disease NEC,Psoriatic arthropathy,Angina pectoris NEC/NOS,Iatrogenic pneumothorax,Hypertension NOS,Hyperlipidemia NEC/NOS,Tobacco use disorder,Esophageal reflux,Anemia NOS,Depressive disorder NEC,Fam hx-ischem heart dis
Name:  [**Known lastname 4359**],[**Known firstname 63**] J              Unit No:   [**Numeric Identifier 16941**]

Admission Date:  [**2133-6-10**]              Discharge Date:   [**2133-6-16**]

Date of Birth:  [**2072-10-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 265**]
Addendum:
Preoperative Xray noted right apical nodule, due to post
operative pneumothorax was unable to reevaluate.  Plan for
repeat chest xray PA/LAT and Lordotic view to reevaluate when
returns [**6-24**] for wound check

Discharge Disposition:
Home With Service

Facility:
[**Hospital 136**] Homecare

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**]

Completed by:[**2133-6-16**]

Admission Date:  [**2133-6-10**]              Discharge Date:   [**2133-6-16**]

Date of Birth:  [**2072-10-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest pain, presyncoble episode and dizziness

Major Surgical or Invasive Procedure:
[**2133-6-12**] Coronary artery bypass graft x 5 (Left internal mammary
artery to left anterior descending. Saphenous vein graft to
ramus, Saphenous vein graft to OM1 to OM2, Saphenous vein graft
to PLV)

[**6-10**] Cardiac Cath

History of Present Illness:
60 year old male with a history of hypertension, psoriatic
arthritis who has suffered from "costochondritic chest pain"
with exertion over the past few years. Finally underwent stress
test with exercise portion showing ischemic ST changes. Echo
portion unrevealing. Went to diagnostic cath with severe LMCA
70-80% stenosis, otherwise with 70-80% lesions in LAD, Cx, RCA.
He is now being referred to cardiac surgery for
revascularization.

Past Medical History:
Psoriatic arthritis
Gastroesophageal reflux disease
Depression
s/p right Rotator cuff repair

Social History:
He is an LPN.
He has a male partner x23 years. They are currently not sexually
active(His partner is HIV positive). They have not had sexual
relations since his HIV diagnosis, Mr. [**Known lastname 31620**] last HIV test
was five years ago.
+ tobacco/He smokes one-half pack a day for 15 years.
+ ETOH use.
Occasional recreational drug use (Marijuana 2-3x/week).

Family History:
His father died of a heart attack at age 63.
His mother had [**Name2 (NI) 499**] cancer at age 64.  Paternal grandmother
with cancer 82.
No known h/o sudden cardiac death.

Physical Exam:
Pulse:72 Resp:18  O2 sat:100/RA
B/P  Right:169/97    Left:141/91
Height:5'9"     Weight:144 lbs

General: NAD, WGWN
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur []
Abdomen: Soft [x] non-distended [x] non-tender [x]  +BS [x]
Extremities: Warm [x], well-perfused [x]  Edema []
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: 2+  Left:2+
DP           Right: 2+  Left:2+
PT           [**Name (NI) 167**]: 2+  Left:2+
Radial       Right: 2+  Left:2+

Carotid Bruit:  no bruits

Pertinent Results:
Echo [**2133-6-12**]: Pre-CPB: No spontaneous echo contrast is seen in
the left atrial appendage. Overall left ventricular systolic
function is low normal (LVEF 50-55%). Right ventricular chamber
size and free wall motion are normal. There are simple atheroma
in the descending thoracic aorta. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic stenosis or aortic regurgitation. The mitral valve
leaflets are mildly thickened. Mild (1+) mitral regurgitation is
seen. There is no pericardial effusion. Post-CPB: The patient is
in SR, on noinotropes. Preserved biventricular systolic fxn.
Trace MR, no AI. Aorta intact.

Carotid U/S [**2133-6-11**]: Right ICA no stenosis. Left ICA <40%
stenosis.

Cardiac cath [**2133-6-10**]: 1. Selective coronary angiography of this
right dominant system revealed left main and two vessel coronary
artery disease. The LMCA was found to have a 70-80% distal left
main stenosis. The LAD had diffuse 40% stenosis with 40%
stenosis at the origin of a larger 2nd diagnonal branch. The LCX
had 70-80% proximal and mid-LCX stenosis extending to include
origins of 1st and 2nd OM. The ramus has a 70% proximal
stenosis, but is a small vessel. There are multiple sequential
50% stenosies within the proximal and distal RCA with a 70%
stenosis in mid-RCA. 2. Limited resting hemodynamics revealed
systemic arterial normotension with central aortic pressure of
130/77.
Admission:
[**2133-6-10**] 12:35PM   PT-12.4 INR(PT)-1.0
[**2133-6-10**] 03:00PM   PLT COUNT-265
[**2133-6-10**] 03:00PM   WBC-11.2* RBC-4.34* HGB-13.3* HCT-38.8*
MCV-89 MCH-30.7 MCHC-34.4 RDW-13.9
[**2133-6-10**] 03:00PM   %HbA1c-5.8 eAG-120
[**2133-6-10**] 03:00PM   calTIBC-348 VIT B12-473 FERRITIN-53 TRF-268
[**2133-6-10**] 03:00PM   ALBUMIN-3.9 CALCIUM-7.3* MAGNESIUM-2.2
IRON-59 CHOLEST-183
[**2133-6-10**] 03:00PM   ALT(SGPT)-3 AST(SGOT)-5 CK(CPK)-60 ALK
PHOS-5* AMYLASE-2 TOT BILI-0.5 DIR BILI-0.1 INDIR BIL-0.4
[**2133-6-10**] 03:00PM   GLUCOSE-107* UREA N-11 CREAT-0.3* SODIUM-129*
POTASSIUM-3.4 CHLORIDE-95* TOTAL CO2-26 ANION GAP-11
[**2133-6-10**] 04:49PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-7.0
LEUK-NEG
Discharge:

[**2133-6-16**] 04:50AM BLOOD WBC-11.5* RBC-3.47* Hgb-10.7* Hct-31.2*
MCV-90 MCH-30.9 MCHC-34.4 RDW-14.0 Plt Ct-266
[**2133-6-16**] 04:50AM BLOOD Plt Ct-266
[**2133-6-16**] 04:50AM BLOOD Glucose-128* UreaN-19 Creat-1.1 Na-140
K-4.6 Cl-101 HCO3-29 AnGap-15

Radiology Report CHEST (PORTABLE AP) Study Date of [**2133-6-15**] 7:38
AM
INDICATION: Status post CABG, follow up bilateral
pneumothoraces.
Final Report: [**MD Number(3) 25633**] x-ray showing bilateral pneumothoraces,
unchanged from prior exam. There is also unchanged lung
scarring. Cardiomediastinal and hilar contours appear normal.
IMPRESSION: Stable appearance of bilateral pneumothoraces.
The study and the report were reviewed by the staff radiologist.

DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 42222**]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]


Brief Hospital Course:
Mr. [**Known lastname 9035**] was initially admitted to the cardiology serviceto
work up exertional chest pain for several years. He underwent
stress testing which showed ischemic ST changes. He was then
brought for a cardiac catheterization which revealed severe left
main and three vessel disease. Cardiac surgery was consulted and
he underwent usual pre-operative work-up. On [**6-12**] he was brought
to the operating room where he underwent a coronary artery
bypass graft x5. Please see operative report for surgical
details. In summary he had: Urgent coronary artery bypass graft
x5:  Left internal mammary artery to left anterior ascending
artery; saphenous vein sequential graft, obtuse marginal-1 and
2; saphenous vein grafts to ramus; saphenous vein graft
to posterior left ventricular branch. Endoscopic harvesting of
the long saphenous vein. His cardiopulmonary bypass time was92
minutes with a crossclamp of 81 minutes. He tolerated the
operation well and following surgery he was transferred to the
CVICU for invasive monitoring in stable condition. He was
hemodynamically stable in the immediate post-op period, was
weaned from sedation, awoke neurologically intact and was
extubated. On post-op day one he was started on beta-blockers
and diuretics and was gently diuresed towards his pre-op weight.
Also on post-op day one he was transferred to the step-down
floor for further recovery. All tubes lines and drains were
removed per cardiac surgery protocol. The remainder of his
hospital course was uneventful. Over several days, beta blockade
was advanced as tolerated. He remained in a normal sinus rhythm.
He continued to make clinical improvement with diuresis and was
eventually cleared for discharge to home on postoperative day 4.

Medications on Admission:
CLOBETASOL -  (Prescribed by Other Provider) - Dosage uncertain
LISINOPRIL - 10 mg Tablet - 1 Tablet(s) by mouth once a day
(started one week ago)
SIMVASTATIN 10mg 1tab po qhs (one week ago started)
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release(E.C.) - 1 Tablet(s) by mouth twice a day
SERTRALINE -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth once daily

NAPROXEN SODIUM [ALEVE] -  OTC prn joint pain

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. 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*
3. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*70 Tablet(s)* Refills:*0*
4. Zoloft 100 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
5. Lopressor 100 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*
6. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
8. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary artery disease s/p coronary artery bypass graft x 5
Past medical history:
Psoriatic arthritis
Gastroesophageal reflux disease
Depression
s/p right Rotator cuff repair

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with percocet as needed
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema none


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage.
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the
chart.
No driving for one month or while taking narcotics. Driving will
be discussed at follow up appointment with surgeon.
No lifting more than 10 pounds for 10 weeks.
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
You are scheduled for the following appointments
Wound check: Cardiac surgery office Wednesday [**6-24**] at 10:15 am
Surgeon: Dr. [**First Name (STitle) **] on Monday [**7-6**] at 1:15 pm
Cardiologist: Dr[**Name (NI) 3733**] [**Telephone/Fax (1) 62**] on [**7-17**] at 1:20 pm

Please call to schedule appointments with your
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**3-10**] weeks [**Telephone/Fax (1) 250**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2133-6-16**]
{'Coronary atherosclerosis of native coronary artery,Hyposmolality and/or hyponatremia,Other emphysema,Hypocalcemia,Other diseases of lung, not elsewhere classified,Psoriatic arthropathy,Other and unspecified angina pectoris,Iatrogenic pneumothorax,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Tobacco use disorder,Esophageal reflux,Anemia, unspecified,Depressive disorder, not elsewhere classified,Family history of ischemic heart disease'}


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, presyncoble episode and dizziness

PRESENT ILLNESS: 60 year old male with a history of hypertension, psoriatic
arthritis who has suffered from "costochondritic chest pain"
with exertion over the past few years. Finally underwent stress
test with exercise portion showing ischemic ST changes. Echo
portion unrevealing. Went to diagnostic cath with severe LMCA
70-80% stenosis, otherwise with 70-80% lesions in LAD, Cx, RCA.
He is now being referred to cardiac surgery for
revascularization.

MEDICAL HISTORY: Psoriatic arthritis
Gastroesophageal reflux disease
Depression
s/p right Rotator cuff repair

MEDICATION ON ADMISSION: CLOBETASOL -  (Prescribed by Other Provider) - Dosage uncertain
LISINOPRIL - 10 mg Tablet - 1 Tablet(s) by mouth once a day
(started one week ago)
SIMVASTATIN 10mg 1tab po qhs (one week ago started)
PANTOPRAZOLE -  (Prescribed by Other Provider) - 40 mg Tablet,
Delayed Release(E.C.) - 1 Tablet(s) by mouth twice a day
SERTRALINE -  (Prescribed by Other Provider) - 100 mg Tablet - 1
Tablet(s) by mouth once daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:72 Resp:18  O2 sat:100/RA
B/P  Right:169/97    Left:141/91
Height:5'9"     Weight:144 lbs

FAMILY HISTORY: His father died of a heart attack at age 63.
His mother had [**Name2 (NI) 499**] cancer at age 64.  Paternal grandmother
with cancer 82.
No known h/o sudden cardiac death.

SOCIAL HISTORY: He is an LPN.
He has a male partner x23 years. They are currently not sexually
active(His partner is HIV positive). They have not had sexual
relations since his HIV diagnosis, Mr. [**Known lastname 31620**] last HIV test
was five years ago.
+ tobacco/He smokes one-half pack a day for 15 years.
+ ETOH use.
Occasional recreational drug use (Marijuana 2-3x/week). 

### Response:
{'Coronary atherosclerosis of native coronary artery,Hyposmolality and/or hyponatremia,Other emphysema,Hypocalcemia,Other diseases of lung, not elsewhere classified,Psoriatic arthropathy,Other and unspecified angina pectoris,Iatrogenic pneumothorax,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Tobacco use disorder,Esophageal reflux,Anemia, unspecified,Depressive disorder, not elsewhere classified,Family history of ischemic heart disease'}
