CHIEF COMPLAINT: unstable angina

PRESENT ILLNESS: Mr. [**Known lastname **]  is a 70-year-old male with history of
hypertension.  Four days prior to admission, he began having
intermittent left-sided chest "twinging" without associated
nausea, vomitting, or diaphoresis.  He denied an exertional,
pleuritic, or positional component.  He presented to [**Hospital **], where an EKG showed NSR with a possible old anterior
myocardial infarction.  His chest radiograph was clear.  His
cardiac enzymes were cycled and found to be negative.  He then
underwent a stress echo showing reportedly ischemic EKG changes
as well as septal hypokinesis. He was transferred to [**Hospital1 18**] for
cardiac catheterization.

MEDICAL HISTORY: Hypertension
Asthma
COPD
S/P inguinal hernia repair
Cataract surgery
1. CARDIAC RISK FACTORS: Hypertension
2. CARDIAC HISTORY:  none

MEDICATION ON ADMISSION: At home:
Lisinopril 5 mg daily
Hydrochlorothiazide 25 mg daily
Flovent b.i.d.
Atrovent twice a day
Albuterol q.i.d.
At [**Location (un) 620**]:
Simvastatin 80 mg daily
Metoprolol 25 mg daily
Atrovent b.i.d.
Albuterol q.i.d.
Aspirin 325 mg daily
Lisinopril 5 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: BP 153/68 P76 RR18 93%RA (baseline per patient)
GENERAL: Not in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with normal JVP.
CARDIAC: PMI non displaced. RR, normal S1, S2. No m/r/g. No S3
or S4.
LUNGS: Resp were unlabored, no accessory muscle use. Diffuse
wheezes bilaterally. Prolonged expiratory phase.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No ulcers.
PULSES:
Right: Femoral 2+ DP 2+ PT 2+
Left: Femoral 2+ DP 2+ PT 2+

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: He lives with his wife.  [**Name (NI) **] is a retired carpenter.  He is a
former smoker.
Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Intermediate coronary syndrome,Unspecified essential hypertension,Chronic obstructive asthma, unspecified,Atrial fibrillation
Crnry athrscl natve vssl,Pneumonia, organism NOS,Intermed coronary synd,Hypertension NOS,Chronic obst asthma NOS,Atrial fibrillation
Admission Date:  [**2172-7-29**]              Discharge Date:   [**2172-8-7**]

Date of Birth:  [**2102-5-18**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
unstable angina

Major Surgical or Invasive Procedure:
s/p coronary artery bypass grafting times three (LIMA to LAD,
SVG to ramus/OM/PDA)


History of Present Illness:
Mr. [**Known lastname **]  is a 70-year-old male with history of
hypertension.  Four days prior to admission, he began having
intermittent left-sided chest "twinging" without associated
nausea, vomitting, or diaphoresis.  He denied an exertional,
pleuritic, or positional component.  He presented to [**Hospital **], where an EKG showed NSR with a possible old anterior
myocardial infarction.  His chest radiograph was clear.  His
cardiac enzymes were cycled and found to be negative.  He then
underwent a stress echo showing reportedly ischemic EKG changes
as well as septal hypokinesis. He was transferred to [**Hospital1 18**] for
cardiac catheterization.

Throughout his hospital stay at [**Hospital1 **] [**Location (un) 620**] and then at [**Hospital1 **]
[**Location (un) 86**], patient continued to have continuous but fluctuating
chest pain ranging [**12-15**] to [**4-14**] with description similar to above.
 EKG was unchanged.  He was taken to cardiac catheterization
where he was found to have 3VD including proximal LAD and LCX
lesions.  After the procedure his pain continued. The night
prior to admission, complaining of [**3-20**] chest pain, EKG was
unchnaged.  He received nitro SL x 2, morphine 2 mg x 2.
Heparin gtt was started.  Pain improved from [**3-20**] to [**12-21**].
Several hours later patient awoke with 3/10 chest pain. Nitro
gtt was started at a low dose with minimal relief.  He was
transferred to the CCU.
.
On acceptance to CCU service, Mr. [**Known lastname **] complained of ongoing
1/10 chest pain but felt otherwise well.  Shortly after arrival
to the CCU the patient went to the cath lab for aortic baloon
pump which was placed without complication.  While on the table
he became chest pain free.
.
Review of systems notable for chest pain as above and chronic
cough, unchanged recently.  Cardiac review of systems is notable
for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle
edema, palpitations, syncope or presyncope.

Past Medical History:
Hypertension
Asthma
COPD
S/P inguinal hernia repair
Cataract surgery
1. CARDIAC RISK FACTORS: Hypertension
2. CARDIAC HISTORY:  none

Social History:
He lives with his wife.  [**Name (NI) **] is a retired carpenter.  He is a
former smoker.

Family History:
Non-contributory.

Physical Exam:
VS: BP 153/68 P76 RR18 93%RA (baseline per patient)
GENERAL: Not in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with normal JVP.
CARDIAC: PMI non displaced. RR, normal S1, S2. No m/r/g. No S3
or S4.
LUNGS: Resp were unlabored, no accessory muscle use. Diffuse
wheezes bilaterally. Prolonged expiratory phase.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No ulcers.
PULSES:
Right: Femoral 2+ DP 2+ PT 2+
Left: Femoral 2+ DP 2+ PT 2+

Pertinent Results:
Cardiac catheterization [**2172-7-29**]:
1. Coronary angiography in this left dominant system revealed
three
vessel disease. The LMCA had an eccentric 30% distal stenosis.
The LAD
had a 60% stenosis proximally and 70% in the mid vessel. The LCx
had 70%
proximal stenosis and 80% stenosis in the mid vessel. The RCA
was non
dominant and had diffuse disease.
2. The LAD stenoses were interrogated using a Radi pressure
wire.  In
serial, the FFR was reduced to 0.74 after hyperemia induced by
the
administration of IC adenosine.
3. Limited resting hemodynamics revealed moderate systemic
arterial
systolic hypertension with an SBP of 151 mmHg.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Moderate systemic hypertension.
ECHO [**2172-7-30**]:
The left atrium is mildly dilated. The estimated right atrial
pressure is 0-5 mmHg. Left ventricular wall thicknesses and
cavity size are normal. Due to suboptimal technical quality, a
focal wall motion abnormality cannot be fully excluded. Overall
left ventricular systolic function is normal (LVEF>55%). Tissue
Doppler imaging suggests a normal left ventricular filling
pressure (PCWP<12mmHg). The right ventricular cavity is mildly
dilated with normal free wall contractility. The ascending aorta
is mildly dilated. The aortic valve leaflets are mildly
thickened (?#). There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. Trivial mitral
regurgitation is seen. The left ventricular inflow pattern
suggests impaired relaxation. The pulmonary artery systolic
pressure could not be determined. There is a trivial/physiologic
pericardial effusion.
IMPRESSION: Suboptimal image quality. Overall normal left
ventricular systolic function.
Carotid US [**2172-7-30**]:
Impression: Right ICA stenosis <40%.
Left ICA with no stenosis.
Preop labs
[**2172-7-29**] 06:15PM   PT-14.1* PTT-139.3* INR(PT)-1.2*
[**2172-7-29**] 06:15PM   PLT COUNT-393
[**2172-7-29**] 06:15PM   WBC-12.8* RBC-5.13 HGB-13.8* HCT-42.2 MCV-82
MCH-26.9* MCHC-32.7 RDW-14.3
[**2172-7-29**] 06:15PM   %HbA1c-5.7
[**2172-7-29**] 06:15PM   VIT B12-612
[**2172-7-29**] 06:15PM   ALBUMIN-4.0
[**2172-7-29**] 06:15PM   ALT(SGPT)-17 AST(SGOT)-16 ALK PHOS-82
AMYLASE-40 TOT BILI-0.6
[**2172-7-29**] 06:15PM   GLUCOSE-112* UREA N-13 CREAT-0.6 SODIUM-128*
POTASSIUM-4.3 CHLORIDE-94* TOTAL CO2-27 ANION GAP-11
Discharge labs
[**2172-8-7**] 07:10AM BLOOD WBC-15.0* RBC-3.54* Hgb-9.9* Hct-30.4*
MCV-86 MCH-27.9 MCHC-32.5 RDW-14.6 Plt Ct-626*
[**2172-8-7**] 09:20AM BLOOD PT-14.0* INR(PT)-1.2*
[**2172-8-7**] 07:10AM BLOOD Plt Ct-626*
[**2172-8-7**] 07:10AM BLOOD Glucose-82 UreaN-18 Creat-0.6 Na-138
K-4.1 Cl-98 HCO3-31 AnGap-13
[**Known lastname 2922**],[**Known firstname 275**] R [**Medical Record Number 79761**] M  70  [**2102-5-18**]
Radiology Report CHEST (PA & LAT) Study Date of [**2172-8-6**] 3:29 PM

[**Hospital 93**] MEDICAL CONDITION: 70 year old man s/p CABG
REASON FOR THIS EXAMINATION:  evaluate for pleural effusions
Final Report
FINDINGS: PA and lateral chest views were obtained with patient
in upright
position. Comparison is made with the preoperative chest
examination of
[**2172-7-30**]. At that time, the patient had received an
intra-aortic
balloon pump device apparently in preparation for emergent
bypass surgery.
The patient was not in failure at that time. Now the patient
demonstrates the presence of bypass surgery including sternotomy
wires and multiple surgical clips in the left-sided anterior
mediastinum consistent with the procedure.
There remain some linear basal densities on the bases and mild
blunting of
both lateral pleural sinuses, slightly more on the left than on
the right.
This corresponds to minor blunting also of the posterior pleural
sinuses seen on the lateral view. Evidence of sizeable left
lower lobe atelectasis that existed previous postoperative
examinations has disappeared. No new pulmonary abnormalities are
present and no significant pulmonary ongestive pattern is
identified.
IMPRESSION: Satisfactory postoperative findings. Minor pleural
blunting
remains but no significant atelectasis or infiltrates are
identified.
DR. [**First Name (STitle) **] [**Initials (NamePattern5) 3250**] [**Last Name (NamePattern5) 3251**]
Approved: [**Doctor First Name **] [**2172-8-6**] 5:55 PM



Brief Hospital Course:
Mr. [**Known lastname **] is a 70-year-old man with a history of
hypertension, presenting with unstable angina and a
catheterization showing 3-vessel-disease including proximal LAD
lesion.  Balloon pump was placed resulting in cessation of chest
pain.  He was taken to the operating room on [**7-31**] and underwent
a coronary artery bypass grafting times three (LIMA to LAD, SVG
to ramus/OM/PDA) performed by Dr. [**Last Name (STitle) **].  Please see the
operative note for details.  He tolerated this procedure well
and was transferred in critical but stable condition to the
surgical intensive care unit.  He had intermittant atrial
fibrillation and was treated with lopressor, amiodarone and was
started on coumadin.  He received solumedrol for chronic
obstructive pulmonary disease and Vancomycin for a presumed
pneumonia by chest radiograph.  A sputum sample grew methicillin
resistant staph, but the infectious disease service felt that
the sample was contaminated.  Multiple subsequent samples were
obtained but all were contaminated with normal oropharyngeal
flora and Mr. [**Known lastname 14301**] [**Last Name (NamePattern1) **] count trended down.  Bactrim was
started for an erythematous sternal incision. His chest tubes
were removed and he was transferred to the surgical step down
floor.  His epicardial wires were removed.  He was seen in
consultation by the physical therapy service and he was screened
for rehab.  Aggressive diuresis and pulmonary toilet was
undertaken and Mr. [**Known lastname 14301**] pulmonary status improved with
this regimen.  The remainder of his post operative course was
uneventful. By post-operative day seven he was ready for
discharge to rehab with continued aggressive pulmonary toilet
and conditioning. He was transferred to [**Hospital3 **] on
[**8-7**].

Medications on Admission:
At home:
Lisinopril 5 mg daily
Hydrochlorothiazide 25 mg daily
Flovent b.i.d.
Atrovent twice a day
Albuterol q.i.d.
At [**Location (un) 620**]:
Simvastatin 80 mg daily
Metoprolol 25 mg daily
Atrovent b.i.d.
Albuterol q.i.d.
Aspirin 325 mg daily
Lisinopril 5 mg daily

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
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:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Warfarin 3 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for 1
doses: Will need INR checked daily while in rehab.  INR goal for
atrial fibrillation is [**1-14**].  Patient is on both Bactrim and Amio
so INR may rise quickly.
Disp:*30 Tablet(s)* Refills:*0*
6. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two
(2) Tablet Sustained Release PO once a day for 2 weeks.
7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
8. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/fever.
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
400mg QD x1 week then
200mg QD.
10. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
11. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
12. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 10 days.
13. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
14. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
15. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
16. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) puffs Inhalation QID and prn.
17. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

18. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).
19. Warfarin 2 mg Tablet Sig: as directed Tablet PO Once Daily
at 4 PM: Target INR 2-2.5
Patient to receive 4 mg on [**8-5**], then as directed based on INR.

20. Furosemide 10 mg/mL Solution Sig: Forty (40) mg Injection
TID (3 times a day): please adjust dose based on weights and
respiratory status.
21. Sodium Chloride 0.9 % 0.9 % Parenteral Solution Sig: Three
(3) ML Intravenous DAILY (Daily) as needed for flush.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
coronary artery disease s/p Urgent coronary artery bypass
grafting
x4:  Left internal mammary artery grafted to left anterior
descending, reverse saphenous vein graft to the marginal
branch, ramus intermedius branch and left posterior
descending artery.
Intermittant post operative atrial fibrillation
PMH: COPD, asthma
PSH: s/p bilat. inguinal hernia repair [**10-18**], s/p circumcision
[**10-18**], s/p bilateral cataract surgery


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, 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 [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr [**Last Name (STitle) **](cardiac surgeon)in 4 weeks([**Telephone/Fax (1) 170**]please call
for appointment
Dr [**Last Name (STitle) 8446**](PCP)in [**1-14**] weeks([**Telephone/Fax (1) 17753**]please call for
appointment
Dr [**Last Name (STitle) 50213**] in [**1-14**] weeks ([**Telephone/Fax (1) 4105**]please call for appointment
Will need INR checked daily while in rehab. INR goal for atrial
fibrillation is 2-2.5.



Completed by:[**2172-8-7**]
{'Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Intermediate coronary syndrome,Unspecified essential hypertension,Chronic obstructive asthma, unspecified,Atrial fibrillation'}


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: unstable angina

PRESENT ILLNESS: Mr. [**Known lastname **]  is a 70-year-old male with history of
hypertension.  Four days prior to admission, he began having
intermittent left-sided chest "twinging" without associated
nausea, vomitting, or diaphoresis.  He denied an exertional,
pleuritic, or positional component.  He presented to [**Hospital **], where an EKG showed NSR with a possible old anterior
myocardial infarction.  His chest radiograph was clear.  His
cardiac enzymes were cycled and found to be negative.  He then
underwent a stress echo showing reportedly ischemic EKG changes
as well as septal hypokinesis. He was transferred to [**Hospital1 18**] for
cardiac catheterization.

MEDICAL HISTORY: Hypertension
Asthma
COPD
S/P inguinal hernia repair
Cataract surgery
1. CARDIAC RISK FACTORS: Hypertension
2. CARDIAC HISTORY:  none

MEDICATION ON ADMISSION: At home:
Lisinopril 5 mg daily
Hydrochlorothiazide 25 mg daily
Flovent b.i.d.
Atrovent twice a day
Albuterol q.i.d.
At [**Location (un) 620**]:
Simvastatin 80 mg daily
Metoprolol 25 mg daily
Atrovent b.i.d.
Albuterol q.i.d.
Aspirin 325 mg daily
Lisinopril 5 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: BP 153/68 P76 RR18 93%RA (baseline per patient)
GENERAL: Not in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor
or cyanosis of the oral mucosa. No xanthalesma.
NECK: Supple with normal JVP.
CARDIAC: PMI non displaced. RR, normal S1, S2. No m/r/g. No S3
or S4.
LUNGS: Resp were unlabored, no accessory muscle use. Diffuse
wheezes bilaterally. Prolonged expiratory phase.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No ulcers.
PULSES:
Right: Femoral 2+ DP 2+ PT 2+
Left: Femoral 2+ DP 2+ PT 2+

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: He lives with his wife.  [**Name (NI) **] is a retired carpenter.  He is a
former smoker. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Intermediate coronary syndrome,Unspecified essential hypertension,Chronic obstructive asthma, unspecified,Atrial fibrillation'}
