CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 67 y/o male with known h/o hypertension and increased
cholesterol c/o chest pain, shortness of breath and fatigue.
Underwent cath which revealed left main disease and proximal LAD
disease.

MEDICAL HISTORY: Hypertension, Hypercholesterolemia, Asthma, Spinal Stenosis,
Gastroesophageal Reflux Disease, Fibromyalgia, Gout, Stroke in
[**2189**], Sleep Apnea, s/p Back surgery, s/p Appendectomy, s/p
C-section x 2, s/p Bilat. Carpal Tunnel Release

MEDICATION ON ADMISSION: Toprol XL 25 mg PO daily, Spironolactone 12.5 mg PO daily,
Singular 10 mg PO daily, ASA 325 mg PO daily, Cardizem 360 mg PO
daily, Allopurinol 300 mg PO daily, Colchicine PRN, Crestor 20
mg PO daily, Prevacid 20 mg PO BID, Lunesta
Albuterol MDI PRN, Epogen weekly

ALLERGIES: Aspirin / Morphine / Tape / Codeine

PHYSICAL EXAM: VS: 90 14 180/84 61" 195#
Gen: WDWN female in NAD
Skin: Warm, dry -lesions
HEENT: NCAT, PERRL, Anicteric sclera, op benign
Neck: Supple, FROM, -JVD, -Carotid bruit
Chest: CTAB -w/r/r
Heart: RRR, 2/6 systolic blowing murmur
Abd: Soft, NT, ND, +BS
Ext: Warm, well-erfused, trace [**Last Name (un) **], -varicosities
Neuro: Z&O x 3, MAE, non-focal

FAMILY HISTORY: Brother died of MI @ age 62.

SOCIAL HISTORY: Pt. lives with a friend.
Jehovah's Witness
Cigs: quit 40 yrs. ago
ETOH: rare
Coronary atherosclerosis of native coronary artery,Acidosis,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Asthma, unspecified type, unspecified,Esophageal reflux,Gout, unspecified,Pure hypercholesterolemia,Other late effects of cerebrovascular disease
Crnry athrscl natve vssl,Acidosis,Obstructive sleep apnea,Hypertension NOS,Asthma NOS,Esophageal reflux,Gout NOS,Pure hypercholesterolem,Late effect CV dis NEC
Admission Date:  [**2191-5-2**]              Discharge Date:   [**2191-5-6**]

Date of Birth:  [**2123-9-9**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Aspirin / Morphine / Tape / Codeine

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2191-5-2**] Coronary Artery Bypass Graft x 2 (LIMA to LAD, SVG to
OM)

History of Present Illness:
67 y/o male with known h/o hypertension and increased
cholesterol c/o chest pain, shortness of breath and fatigue.
Underwent cath which revealed left main disease and proximal LAD
disease.

Past Medical History:
Hypertension, Hypercholesterolemia, Asthma, Spinal Stenosis,
Gastroesophageal Reflux Disease, Fibromyalgia, Gout, Stroke in
[**2189**], Sleep Apnea, s/p Back surgery, s/p Appendectomy, s/p
C-section x 2, s/p Bilat. Carpal Tunnel Release

Social History:
Pt. lives with a friend.
Jehovah's Witness
Cigs: quit 40 yrs. ago
ETOH: rare

Family History:
Brother died of MI @ age 62.

Physical Exam:
VS: 90 14 180/84 61" 195#
Gen: WDWN female in NAD
Skin: Warm, dry -lesions
HEENT: NCAT, PERRL, Anicteric sclera, op benign
Neck: Supple, FROM, -JVD, -Carotid bruit
Chest: CTAB -w/r/r
Heart: RRR, 2/6 systolic blowing murmur
Abd: Soft, NT, ND, +BS
Ext: Warm, well-erfused, trace [**Last Name (un) **], -varicosities
Neuro: Z&O x 3, MAE, non-focal

Pertinent Results:
[**5-2**] Echo: Pre Bypass: The left atrium is mildly dilated. No
atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy with normal cavity
size. Regional left ventricular wall motion is normal. Overall
left ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. There
are simple atheroma in the aortic arch. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. Trivial mitral
regurgitation is seen. There is no mitral stenosis. The
posterior leaflet appears thickened, but coapts adequately.
There is no pericardial effusion. Post Bypass: Preserved
Biventricular function LVEF >55%. Mitral regurgitation is now
mild. Aortic contours intact. Remaing exam unchanged. All
findings discussed with surgeons at the time of the exam.
CXR [**5-4**]: Following removal of multiple lines and tubes, there
is no evidence of pneumothorax. Lung volumes are low. The heart
is likely stable in size allowing for lower lung volumes.
Worsening opacities are present in both lower lungs, left
greater than right, and may be due to worsening atelectasis, but
superimposed aspiration should be considered in the appropriate
clinical setting.
[**2191-5-2**] 10:00AM BLOOD WBC-14.4* RBC-3.52*# Hgb-9.6*# Hct-29.4*#
MCV-84 MCH-27.4 MCHC-32.8 RDW-18.4* Plt Ct-226
[**2191-5-6**] 07:10AM BLOOD WBC-10.4 RBC-3.77* Hgb-10.7* Hct-32.2*
MCV-85 MCH-28.3 MCHC-33.1 RDW-17.3* Plt Ct-309
[**2191-5-2**] 10:00AM BLOOD PT-13.6* PTT-50.4* INR(PT)-1.2*
[**2191-5-6**] 07:10AM BLOOD PT-12.7 PTT-27.4 INR(PT)-1.1
[**2191-5-2**] 11:20AM BLOOD UreaN-10 Creat-0.5 Cl-111* HCO3-27
[**2191-5-6**] 07:10AM BLOOD Glucose-116* UreaN-15 Creat-0.6 Na-138
K-4.0 Cl-95* HCO3-32 AnGap-15

Brief Hospital Course:
Ms. [**Known lastname **] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On the day of admission
she was brought to the operating room where she underwent a
coronary artery bypass graft x 2. Please see op report for
surgical details. Following surgery she was transferred to the
CSRU for invasive monitoring in stable condition. Within 24
hours she was weaned from sedation, awoke neurologically intact
and extubated without incident. On post-op day one beta blockers
and diuretics were started and pt was gently diuresed towards
her pre-op weight. On post-op day two chest tubes and epicardial
pacing wires were removed. And she was then transferred to the
telemetry floor for the remainder of her hospital course. Over
the nest two days Ms. [**Known lastname **] continued to recover without
complications and worked with physical therapy for strength and
mobility. On post-op day four she appeared to be doing well but
would benefit from additional physical therapy. She therefore
was discharged on this day to a rehab facility and will make
follow-up appointments with the appropriate physicians.

Medications on Admission:
Toprol XL 25 mg PO daily, Spironolactone 12.5 mg PO daily,
Singular 10 mg PO daily, ASA 325 mg PO daily, Cardizem 360 mg PO
daily, Allopurinol 300 mg PO daily, Colchicine PRN, Crestor 20
mg PO daily, Prevacid 20 mg PO BID, Lunesta
Albuterol MDI PRN, Epogen weekly

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
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:*1*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
4. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*1*
5. Furosemide 40 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
6. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
7. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
10. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours).
11. Prevacid 30 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 15644**] Long Term Health - [**Location (un) 47**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 2
PMH: Hypertension, Hypercholesterolemia, Asthma, Spinal
Stenosis, Gastroesophageal Reflux Disease, Fibromyalgia, Gout,
Stroke in [**2189**], Sleep Apnea, s/p Back surgery, s/p Appendectomy,
s/p C-section x 2, s/p Bilat. Carpal Tunnel Release

Discharge Condition:
Good

Discharge Instructions:
[**Month (only) 116**] shower, no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) **] in [**2-12**] weeks
Dr. [**Last Name (STitle) **] in [**1-11**] weeks
Make appointments with all providers.


Completed by:[**2191-5-6**]
{'Coronary atherosclerosis of native coronary artery,Acidosis,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Asthma, unspecified type, unspecified,Esophageal reflux,Gout, unspecified,Pure hypercholesterolemia,Other late effects of cerebrovascular 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

PRESENT ILLNESS: 67 y/o male with known h/o hypertension and increased
cholesterol c/o chest pain, shortness of breath and fatigue.
Underwent cath which revealed left main disease and proximal LAD
disease.

MEDICAL HISTORY: Hypertension, Hypercholesterolemia, Asthma, Spinal Stenosis,
Gastroesophageal Reflux Disease, Fibromyalgia, Gout, Stroke in
[**2189**], Sleep Apnea, s/p Back surgery, s/p Appendectomy, s/p
C-section x 2, s/p Bilat. Carpal Tunnel Release

MEDICATION ON ADMISSION: Toprol XL 25 mg PO daily, Spironolactone 12.5 mg PO daily,
Singular 10 mg PO daily, ASA 325 mg PO daily, Cardizem 360 mg PO
daily, Allopurinol 300 mg PO daily, Colchicine PRN, Crestor 20
mg PO daily, Prevacid 20 mg PO BID, Lunesta
Albuterol MDI PRN, Epogen weekly

ALLERGIES: Aspirin / Morphine / Tape / Codeine

PHYSICAL EXAM: VS: 90 14 180/84 61" 195#
Gen: WDWN female in NAD
Skin: Warm, dry -lesions
HEENT: NCAT, PERRL, Anicteric sclera, op benign
Neck: Supple, FROM, -JVD, -Carotid bruit
Chest: CTAB -w/r/r
Heart: RRR, 2/6 systolic blowing murmur
Abd: Soft, NT, ND, +BS
Ext: Warm, well-erfused, trace [**Last Name (un) **], -varicosities
Neuro: Z&O x 3, MAE, non-focal

FAMILY HISTORY: Brother died of MI @ age 62.

SOCIAL HISTORY: Pt. lives with a friend.
Jehovah's Witness
Cigs: quit 40 yrs. ago
ETOH: rare 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acidosis,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Asthma, unspecified type, unspecified,Esophageal reflux,Gout, unspecified,Pure hypercholesterolemia,Other late effects of cerebrovascular disease'}
