CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 79 yo F with severe 3VD, CAD s/p CABG two weeks ago who was at
the TCU at [**Hospital3 1280**] doing well when she developed [**11-22**]
sub-sternal chest pain.  EKG done there revealed ST elevations
in V1-V3.  She had been recently admitted to [**Hospital1 18**] from [**1-6**] with chest pain which occurred following vomiting
coffee ground material.  She underwent a cardiac catheterization
which showed 40-50 percent left main, proximal LAD, diagonal,
circumflex, OM and PDA stenosis.  She had some large hemoptysis
prior to CABG, she underwent an upper GI endoscopy which showed
no active bleeding and she was cleared for surgery.  She
underwent CABG x 5 with a LIMA to the diag, saphenous vein graft
to the LAD, saphenous vein graft to the ramus, saphenous vein
graft to the OM, and saphenous vein graft to the PDA.
Cardiac catheterization here showed T/O SVG-LAD, SVG-RDA,
SVT-RAMUS, 80% stenosis at touch down.  Was stented X2 in native
LAD.  Transferred to CCU with plan to eventually stent ramus and
pda.

MEDICAL HISTORY: Coronary artery disease.
Hypothyroidism.
Asthma.
Skin CA.
Meniere's disease.
GERD.
Left ear deafness.
Left shoulder arthritis getting steroid shots

MEDICATION ON ADMISSION: 1. Lopressor 25 mg [**Hospital1 **].
2. Lasix 20 mg [**Hospital1 **].
3. Colace 100 mg [**Hospital1 **].
4. Potassium chloride 20 mEq [**Hospital1 **].
5. Aspirin 81 mg once daily.
6. Tylenol 325-650 q 4 h prn.
7. Advair 250/50, 1-2 puffs [**Hospital1 **].
8. Synthroid 88 mcg once daily.
9. Singulair 10 mg once daily.
10.Pantoprazole 40 mg once daily.

ALLERGIES: Erythromycin Base / Promethazine

PHYSICAL EXAM: Vital signs:
Temp 99.8, Pulse 90, BP 106/81, RR 18, 100% on 4L NC
General: sedated and confused
HEENT: PERRLA, OP clear, MM dry
Lungs: CTA bilaterally, no crackles or wheezes
CV: RRR nl S1S2 no R/M/G
Abd: Soft NT/ND positive BS
Ext: no clubbing, cyanosis, or edema, groin site with venous
sheath in place, some bruising
Neuro: confused

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-smoker, non-drinker, family very involved in care
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Other affections of shoulder region, not elsewhere classified
Subendo infarct, initial,CHF NOS,Crnry athrscl natve vssl,Hypertension NOS,Asthma NOS,Hypothyroidism NOS,Shoulder region dis NEC
Admission Date:  [**2112-1-23**]              Discharge Date:   [**2112-1-28**]

Date of Birth:  [**2032-7-23**]             Sex:   F

Service: MEDICINE

Allergies:
Erythromycin Base / Promethazine

Attending:[**First Name3 (LF) 2074**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Cardiac catheterization with intervention on native LAD, second
repeat cardiac catheterization with intervention on native PDA


History of Present Illness:
79 yo F with severe 3VD, CAD s/p CABG two weeks ago who was at
the TCU at [**Hospital3 1280**] doing well when she developed [**11-22**]
sub-sternal chest pain.  EKG done there revealed ST elevations
in V1-V3.  She had been recently admitted to [**Hospital1 18**] from [**1-6**] with chest pain which occurred following vomiting
coffee ground material.  She underwent a cardiac catheterization
which showed 40-50 percent left main, proximal LAD, diagonal,
circumflex, OM and PDA stenosis.  She had some large hemoptysis
prior to CABG, she underwent an upper GI endoscopy which showed
no active bleeding and she was cleared for surgery.  She
underwent CABG x 5 with a LIMA to the diag, saphenous vein graft
to the LAD, saphenous vein graft to the ramus, saphenous vein
graft to the OM, and saphenous vein graft to the PDA.
Cardiac catheterization here showed T/O SVG-LAD, SVG-RDA,
SVT-RAMUS, 80% stenosis at touch down.  Was stented X2 in native
LAD.  Transferred to CCU with plan to eventually stent ramus and
pda.


Past Medical History:
Coronary artery disease.
Hypothyroidism.
Asthma.
Skin CA.
Meniere's disease.
GERD.
Left ear deafness.
Left shoulder arthritis getting steroid shots

Social History:
non-smoker, non-drinker, family very involved in care

Family History:
non-contributory

Physical Exam:
Vital signs:
Temp 99.8, Pulse 90, BP 106/81, RR 18, 100% on 4L NC
General: sedated and confused
HEENT: PERRLA, OP clear, MM dry
Lungs: CTA bilaterally, no crackles or wheezes
CV: RRR nl S1S2 no R/M/G
Abd: Soft NT/ND positive BS
Ext: no clubbing, cyanosis, or edema, groin site with venous
sheath in place, some bruising
Neuro: confused

Pertinent Results:
[**2112-1-28**] 06:05AM BLOOD WBC-10.6 RBC-3.29* Hgb-10.1* Hct-30.1*
MCV-92 MCH-30.8 MCHC-33.6 RDW-14.1 Plt Ct-371
[**2112-1-24**] 04:44AM BLOOD WBC-9.5 RBC-3.56* Hgb-11.0* Hct-32.1*
MCV-90 MCH-31.0 MCHC-34.4 RDW-14.2 Plt Ct-435
[**2112-1-28**] 06:05AM BLOOD Plt Ct-371
[**2112-1-27**] 06:25AM BLOOD PT-13.3 PTT-31.6 INR(PT)-1.1
[**2112-1-24**] 12:33AM BLOOD Plt Ct-402#
[**2112-1-24**] 04:44AM BLOOD PT-13.1 PTT-28.8 INR(PT)-1.1
[**2112-1-28**] 06:05AM BLOOD Glucose-91 UreaN-11 Creat-0.8 Na-135
K-4.1 Cl-101 HCO3-27 AnGap-11
[**2112-1-24**] 04:44AM BLOOD Glucose-117* UreaN-15 Creat-0.9 Na-139
K-4.1 Cl-104 HCO3-27 AnGap-12
[**2112-1-24**] 12:33AM BLOOD K-3.8
[**2112-1-28**] 06:05AM BLOOD CK(CPK)-26
[**2112-1-24**] 12:33AM BLOOD CK(CPK)-165*
[**2112-1-24**] 12:33AM BLOOD CK-MB-18* MB Indx-10.9*
[**2112-1-28**] 06:05AM BLOOD Calcium-9.8 Phos-2.4* Mg-2.0
[**2112-1-24**] 04:44AM BLOOD Calcium-9.5 Phos-3.3 Mg-1.6

Cardiac Catheterizations:
[**2112-1-23**]
1. Severe three vessel disease of the native coronary arteries
with
graft occlusion of the SVG-LAD and SVG-PDA with touchdown
stenosis of
the SVG-Ramus.
2. Elevated right sided filling pressures.
3. Mild to moderate pulmonary hypertension.
4. PCI of the upper pole distal LAD.
5. Acute myocardial infarction.


Brief Hospital Course:
1. CAD - 79 year old female with CAD s/p recent CABG presenting
with chest pain, inferior STEMI, found to have two T/O vein
grafts and one 80% stenosis at the touchdown of her SVG-Ramus.
She was transferred here for emergent catheterization and her
native LAD was stented.  Post intervention she was having severe
nausea and was admitted to the CCU for further monitoring and
care.  She did well post catheterization.  She had no events and
was transferred from the CCU to the floor.  Her ASA, Plavix,
Lipitor, beta-blocker and ACE-I were continued.  She was taken
back to the catheterizion lab for intervention on her SVG-PDA.
A stent was placed in her native PDA.  She did well after her
second catheterization.  She was discharged on ASA,
Beta-blocker, ACE-I, and Plavix for 12 months.
.
2. pump- On presentation to the CCU she was felt to be fluid
overloaded by exam.  She was treated with IV Lasix.  A repeat
Echo was performed which showed: "Left ventricular wall
thickness, cavity  size, and systolic function are normal
(LVEF>55%). Due to suboptimal technical quality, a focal wall
motion abnormality cannot be fully excluded (post-op septal
motion). Mild (1+) mitral regurgitation is seen."  On discharge
her lungs were clear and she was no longer felt to be fluid
overloaded.
.
3. GI- She had presented on her last admission with GI bleed.
During this admission she was closely monitored and had no
further bleeding.  Her HCT remained stable, she had no guiaic
positive stools.  She was maintained on Protonix 40 PO BID.
.
4. Hypothyroidism - During this hospitalization she was
continued on Levoxyl.
.
5. Asthma - She was continued on Singulair and flovent inh
during this hospitalization.

6. Mild renal insufficiency - After her first catheterization
she had a slight increase in her creatinine.  She was well
hydrated prior to her second catheterization and given mucomyst
[**Hospital1 **] for 4 dosages.

7. Shoulder pain - She was evaluated by Rheumatology for her
shoulder pain.  It was felt that she would benefit from
out-patient rheumatology.

Medications on Admission:
1. Lopressor 25 mg [**Hospital1 **].
2. Lasix 20 mg [**Hospital1 **].
3. Colace 100 mg [**Hospital1 **].
4. Potassium chloride 20 mEq [**Hospital1 **].
5. Aspirin 81 mg once daily.
6. Tylenol 325-650 q 4 h prn.
7. Advair 250/50, 1-2 puffs [**Hospital1 **].
8. Synthroid 88 mcg once daily.
9. Singulair 10 mg once daily.
10.Pantoprazole 40 mg once daily.


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).

4. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
7. Levothyroxine Sodium 88 mcg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
8. Montelukast Sodium 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
10. Simethicone 80 mg Tablet, Chewable Sig: 0.5-1 Tablet,
Chewable PO QID (4 times a day) as needed.
11. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 4480**] [**Hospital 4094**] Hospital - [**Location (un) 1110**]

Discharge Diagnosis:
Coronary artery disease s/p CABG X5 now S/P stenting of native
LAD and native PDA.
Secondary diagnosis
1. hypertension
2. Asthma
3. Hypothyroidism


Discharge Condition:
Good, able to walk around with walker, same level of functioning
as prior to this admission.

Discharge Instructions:
Return to the hospital with any chest pain, shortness of breath,
bleeding.  It is very important for you to tell people about any
pain or problems that you experience.
Take all medications as prescribed.
Come in for all follow up appointments as scheduled.

Followup Instructions:
Follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 3658**] in [**2-13**] weeks.
Follow up with Dr. [**Last Name (STitle) 32255**] ([**Telephone/Fax (1) 59704**] in [**3-17**] weeks following
discharge from rehabilitation and with Dr. [**Last Name (STitle) **] in 4 weeks.
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Other affections of shoulder region, not elsewhere classified'}


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: 79 yo F with severe 3VD, CAD s/p CABG two weeks ago who was at
the TCU at [**Hospital3 1280**] doing well when she developed [**11-22**]
sub-sternal chest pain.  EKG done there revealed ST elevations
in V1-V3.  She had been recently admitted to [**Hospital1 18**] from [**1-6**] with chest pain which occurred following vomiting
coffee ground material.  She underwent a cardiac catheterization
which showed 40-50 percent left main, proximal LAD, diagonal,
circumflex, OM and PDA stenosis.  She had some large hemoptysis
prior to CABG, she underwent an upper GI endoscopy which showed
no active bleeding and she was cleared for surgery.  She
underwent CABG x 5 with a LIMA to the diag, saphenous vein graft
to the LAD, saphenous vein graft to the ramus, saphenous vein
graft to the OM, and saphenous vein graft to the PDA.
Cardiac catheterization here showed T/O SVG-LAD, SVG-RDA,
SVT-RAMUS, 80% stenosis at touch down.  Was stented X2 in native
LAD.  Transferred to CCU with plan to eventually stent ramus and
pda.

MEDICAL HISTORY: Coronary artery disease.
Hypothyroidism.
Asthma.
Skin CA.
Meniere's disease.
GERD.
Left ear deafness.
Left shoulder arthritis getting steroid shots

MEDICATION ON ADMISSION: 1. Lopressor 25 mg [**Hospital1 **].
2. Lasix 20 mg [**Hospital1 **].
3. Colace 100 mg [**Hospital1 **].
4. Potassium chloride 20 mEq [**Hospital1 **].
5. Aspirin 81 mg once daily.
6. Tylenol 325-650 q 4 h prn.
7. Advair 250/50, 1-2 puffs [**Hospital1 **].
8. Synthroid 88 mcg once daily.
9. Singulair 10 mg once daily.
10.Pantoprazole 40 mg once daily.

ALLERGIES: Erythromycin Base / Promethazine

PHYSICAL EXAM: Vital signs:
Temp 99.8, Pulse 90, BP 106/81, RR 18, 100% on 4L NC
General: sedated and confused
HEENT: PERRLA, OP clear, MM dry
Lungs: CTA bilaterally, no crackles or wheezes
CV: RRR nl S1S2 no R/M/G
Abd: Soft NT/ND positive BS
Ext: no clubbing, cyanosis, or edema, groin site with venous
sheath in place, some bruising
Neuro: confused

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: non-smoker, non-drinker, family very involved in care 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Unspecified acquired hypothyroidism,Other affections of shoulder region, not elsewhere classified'}
