CHIEF COMPLAINT: Exertional chest pain

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 71 yo female with history of CAD s/p angioplasty
of LAD in [**2175-6-14**], diabetes, and carotid disease with chest
discomfort over the past month with mild exertion who was
referred for catheterization. A complex restensosis of her
intramyocardial LAD was found in addition to diagonal artery
disease. Based on her significant LAD disease she is referred to
Dr. [**Last Name (STitle) **] for surgical evaluation.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Diabetes type II
Carotid artery disease
Asthma
Sinusitis
Pancreatisis [**2172**]
Colon polyp removed [**2174**]
Mild arthritis in the winter
Kidney stones 35 years ago
s/p tonsillectomy
Bilateral cataract surgery
s/p PPM for presyncope

MEDICATION ON ADMISSION: Lipitor 40mg daily
Advair Disk 250 mcg/50mcg 1 inhalation each day
Metformin 500mg one tablet once daily
Toprol XL 25mg two tablets in am and two tablets in pm
Singular 10mg once a day
Ambien 10mg daily at hs
Aspirin 325mg daily
Calcium with vitamin D 600mg/400IU daily
Plavix 75mg daily - last dose [**2175-9-26**]
Claritin 10mg daily
Quinapril Hcl 40mg daily
Fish oil 1000mg daily
Vitamin A, C, E twice daily
Albuterol inhalation PRN

ALLERGIES: Codeine / Protamine Sulfate

PHYSICAL EXAM: Pulse: 80 SR  Resp: 18  O2 sat: 98% RA
B/P  Right: 169/78   Left: 173/74
Height:4'[**76**]"    Weight:61.2 kg (135 lbs)

FAMILY HISTORY: Mother died of breath cancer age 54; brother had brain cancer

SOCIAL HISTORY: Lives alone. Occasional wine. 10 pack year history of tobacco,
quit over 35 years ago. Denies recreational drug use. Does not
use any assistive devices to ambulate. Daughter helps pt make
medical decisions and is her HCP.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Asthma, unspecified type, unspecified,Percutaneous transluminal coronary angioplasty status,Personal history of urinary calculi,Personal history of colonic polyps
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Ocl crtd art wo infrct,Asthma NOS,Status-post ptca,Prsnl hst urnr dsrd calc,Prsnl hst colonic polyps
Admission Date:  [**2175-10-2**]              Discharge Date:   [**2175-10-6**]

Date of Birth:  [**2104-2-12**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine / Protamine Sulfate

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Exertional chest pain

Major Surgical or Invasive Procedure:
[**2175-10-2**] Three Vessel Coronary Artery Bypass Grafting utilizing
the left internal mammary artery to left anterior descending
artery with vein grafts to diagonal and obtuse marginal.


History of Present Illness:
Mrs. [**Known lastname **] is a 71 yo female with history of CAD s/p angioplasty
of LAD in [**2175-6-14**], diabetes, and carotid disease with chest
discomfort over the past month with mild exertion who was
referred for catheterization. A complex restensosis of her
intramyocardial LAD was found in addition to diagonal artery
disease. Based on her significant LAD disease she is referred to
Dr. [**Last Name (STitle) **] for surgical evaluation.


Past Medical History:
Hypertension
Hyperlipidemia
Diabetes type II
Carotid artery disease
Asthma
Sinusitis
Pancreatisis [**2172**]
Colon polyp removed [**2174**]
Mild arthritis in the winter
Kidney stones 35 years ago
s/p tonsillectomy
Bilateral cataract surgery
s/p PPM for presyncope


Social History:
Lives alone. Occasional wine. 10 pack year history of tobacco,
quit over 35 years ago. Denies recreational drug use. Does not
use any assistive devices to ambulate. Daughter helps pt make
medical decisions and is her HCP.


Family History:
Mother died of breath cancer age 54; brother had brain cancer

Physical Exam:
Pulse: 80 SR  Resp: 18  O2 sat: 98% RA
B/P  Right: 169/78   Left: 173/74
Height:4'[**76**]"    Weight:61.2 kg (135 lbs)

General: WDWN female in NAD
Skin: Warm, dry and intact. NO C/C/E
HEENT: NCAT, PERRLA, EOMI< Sclera anicteric, OP benign
Neck:  Supple [X] Full ROM [X] No JVD
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] No M/R/G
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X]
Extremities: Warm [X], well-perfused [X]  No Edema
Varicosities: Spider veins present (B). Mild anterior
varicosities below knee but GSV appears suitable.
Neuro: Grossly intact
Pulses:
Femoral      Right: 2  Left: 2
DP           Right: 1  Left: 1
PT           [**Name (NI) 167**]: 1  Left: 1
Radial       Right: 2  Left: 1

Carotid Bruit        Right: Mild bruit   Left: None


Pertinent Results:
[**2175-10-2**] Intraop TEE --
Pre-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage. 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 descending thoracic
aorta. The aortic valve leaflets (3) are mildly thickened. There
is no aortic valve stenosis. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is no pericardial effusion.

Post-CPB:
Patient is AV-Paced, on NTG infusion. Preserved biventricular
systolic fxn. Trace MR. [**First Name (Titles) **] [**Last Name (Titles) **]. Aorta intact. Other parameters as
pre-bypass.

[**2175-10-5**] 05:50AM BLOOD WBC-11.7* RBC-3.00* Hgb-9.0* Hct-27.1*
MCV-90 MCH-29.9 MCHC-33.2 RDW-14.3 Plt Ct-182
[**2175-10-5**] 05:50AM BLOOD Plt Ct-182
[**2175-10-5**] 05:50AM BLOOD Glucose-84 UreaN-27* Creat-0.6 Na-140
K-3.8 Cl-104 HCO3-31 AnGap-9

Brief Hospital Course:
On [**10-2**] Ms. [**Known lastname **] was admitted and taken to the operating room
where she underwent coronary artery bypass grafting x 3 (left
internal mammary artery to left anterior descending artery with
vein grafts to diagonal and obtuse marginal) with Dr.[**Last Name (STitle) **].
Cross clamp time was 46 minutes. Cardiopulmonary Bypass time was
62 minutes. Please refer to Dr.[**Name (NI) 5572**] operative note for
further surgical details. She was intubated and sedated,
transferred to the CVICU in critical but stable condition.
Within 24 hours, she awoke neurologically intact and was
extubated without incident. All lines and drains were
discontinued in a timely fashion. Beta-blocker/Statin/ASA/Plavix
and diuresis was initiated. She continued to progress and was
transferred to the step down unit for further monitoring.
Physical therapy was consulted for evaluation. The remainder of
her postoperative course was essentially uneventful. She was
cleared by Dr.[**Last Name (STitle) **] for discharge to rehab on POD# four.  All
follow up appointments were advised.


Medications on Admission:
Lipitor 40mg daily
Advair Disk 250 mcg/50mcg 1 inhalation each day
Metformin 500mg one tablet once daily
Toprol XL 25mg two tablets in am and two tablets in pm
Singular 10mg once a day
Ambien 10mg daily at hs
Aspirin 325mg daily
Calcium with vitamin D 600mg/400IU daily
Plavix 75mg daily - last dose [**2175-9-26**]
Claritin 10mg daily
Quinapril Hcl 40mg daily
Fish oil 1000mg daily
Vitamin A, C, E twice daily
Albuterol inhalation PRN


Discharge Medications:
1. 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*
2. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
3. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
Disp:*20 Tablet(s)* Refills:*2*
5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 10
days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*
6. Metformin 500 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
7. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*60 Disk with Device(s)* Refills:*2*
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
11. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation every four (4) hours as
needed for shortness of breath or wheezing.
Disp:*qs * Refills:*0*
13. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-16**]
Drops Ophthalmic PRN (as needed) as needed for itching/redness.
Disp:*qs * Refills:*0*
14. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
Disp:*30 ML(s)* Refills:*0*
15. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
Disp:*30 Suppository(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1186**] - [**Location (un) 538**]

Discharge Diagnosis:
Coronary Artery Disease, s/p CABG
Hypertension
Hyperlipidemia
Diabetes mellitus type II
Carotid Disease
Prior PPM(for presyncope)


Discharge Condition:
Good


Discharge Instructions:
1)No driving for one month
2)No lifting more than 10 lbs for at least 10 weeks from the
date of surgery
3)Please shower daily. Wash surgical incisions with soap and
water only.
4)Do not apply lotions, creams or ointments to any surgical
incision.
5)Please call cardiac surgeon immediately if you experience
fever, excessive weight gain and/or signs of a wound
infection(erythema, drainage, etc...). Office number is
[**Telephone/Fax (1) 170**].
6)Call with any additional questions or concerns.


Followup Instructions:
Dr. [**Last Name (STitle) **] in [**3-19**] weeks, call for appt [**Telephone/Fax (1) 170**]
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**1-17**] weeks, call for appt
Dr. [**Last Name (STitle) 6924**] in [**1-17**] weeks, call for appt ([**Telephone/Fax (2) 79498**]
Wound check on [**Hospital Ward Name 121**] 6 as directed



Completed by:[**2175-10-6**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Asthma, unspecified type, unspecified,Percutaneous transluminal coronary angioplasty status,Personal history of urinary calculi,Personal history of colonic polyps'}


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: Exertional chest pain

PRESENT ILLNESS: Mrs. [**Known lastname **] is a 71 yo female with history of CAD s/p angioplasty
of LAD in [**2175-6-14**], diabetes, and carotid disease with chest
discomfort over the past month with mild exertion who was
referred for catheterization. A complex restensosis of her
intramyocardial LAD was found in addition to diagonal artery
disease. Based on her significant LAD disease she is referred to
Dr. [**Last Name (STitle) **] for surgical evaluation.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Diabetes type II
Carotid artery disease
Asthma
Sinusitis
Pancreatisis [**2172**]
Colon polyp removed [**2174**]
Mild arthritis in the winter
Kidney stones 35 years ago
s/p tonsillectomy
Bilateral cataract surgery
s/p PPM for presyncope

MEDICATION ON ADMISSION: Lipitor 40mg daily
Advair Disk 250 mcg/50mcg 1 inhalation each day
Metformin 500mg one tablet once daily
Toprol XL 25mg two tablets in am and two tablets in pm
Singular 10mg once a day
Ambien 10mg daily at hs
Aspirin 325mg daily
Calcium with vitamin D 600mg/400IU daily
Plavix 75mg daily - last dose [**2175-9-26**]
Claritin 10mg daily
Quinapril Hcl 40mg daily
Fish oil 1000mg daily
Vitamin A, C, E twice daily
Albuterol inhalation PRN

ALLERGIES: Codeine / Protamine Sulfate

PHYSICAL EXAM: Pulse: 80 SR  Resp: 18  O2 sat: 98% RA
B/P  Right: 169/78   Left: 173/74
Height:4'[**76**]"    Weight:61.2 kg (135 lbs)

FAMILY HISTORY: Mother died of breath cancer age 54; brother had brain cancer

SOCIAL HISTORY: Lives alone. Occasional wine. 10 pack year history of tobacco,
quit over 35 years ago. Denies recreational drug use. Does not
use any assistive devices to ambulate. Daughter helps pt make
medical decisions and is her HCP. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Asthma, unspecified type, unspecified,Percutaneous transluminal coronary angioplasty status,Personal history of urinary calculi,Personal history of colonic polyps'}
