CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 53 y/o male with known coronary artery disease s/p LCx stent and
brachytherapy now with increased exertional chest pain and
shortness of breath. Referred for cardiac cath.

MEDICAL HISTORY: Coronary Artery Disease s/p LCx stent [**8-17**], s/p Brachytherapy
[**11-16**], Hypertension, Hyperlipidemia, Hypothyroidism, s/p
Tonsillectomy

MEDICATION ON ADMISSION: Plavix, Atenolol, Imdur, Levothyroxine, Simvastatin, Aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 74 20 136/86 6' 255#
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: SOft, NT/ND +BS
Ext: Warm, well-perfused -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: 2 brothers with stents. Father MI/CABG at age 70.

SOCIAL HISTORY: Construction worker. Quit smoking 15 yrs ago after 2ppd x 20yrs.
Denies ETOH use.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2184-1-23**]              Discharge Date:   [**2184-1-27**]

Date of Birth:  [**2130-3-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2184-1-23**] Cardiac Catheterization
[**2184-1-23**] Urgent Two Vessel Coronary Artery Bypass Grafting
utilizing the LIMA to LAD, and vein graft to obtuse marginal.

History of Present Illness:
53 y/o male with known coronary artery disease s/p LCx stent and
brachytherapy now with increased exertional chest pain and
shortness of breath. Referred for cardiac cath.

Past Medical History:
Coronary Artery Disease s/p LCx stent [**8-17**], s/p Brachytherapy
[**11-16**], Hypertension, Hyperlipidemia, Hypothyroidism, s/p
Tonsillectomy

Social History:
Construction worker. Quit smoking 15 yrs ago after 2ppd x 20yrs.
Denies ETOH use.

Family History:
2 brothers with stents. Father MI/CABG at age 70.

Physical Exam:
VS: 74 20 136/86 6' 255#
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: SOft, NT/ND +BS
Ext: Warm, well-perfused -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2184-1-25**] CXR: Moderate left pleural effusion and small right
pleural effusion are more conspicuous in this examination given
the difference in positioning. There are low lung volumes that
accentuate the cardiac silhouette. There has been interval
increase in left lower lobe retrocardiac atelectasis. Patient is
post-median sternotomy and CABG. Post-operative
cardiomediastinal silhouette is stable. In the lateral view,
anterior pneumomediastinum is seen.
[**2184-1-23**] Cardiac Cath: 1.  Selective coronary angiography of this
right dominant system revealed severe left main and two vessel
coronary artery disease.  The LMCA had an eccentric distal 80%
lesion.  The LAD had a proximal 80% lesion.  The LCX had an
ostial and proximal 90% lesion and a subtotal occluded OM2.  The
RCA had < 50% lesion. 2.  Limited resting hemodynamics revealed
normal systemic arterial pressure of 122/82 mm Hg.  There was
mildly elevated left sided filling pressures with LVEDP of 22 mm
Hg.  There was no transvalvular gradient upon pullback of the
catheter from LV to [**Month/Day/Year 5236**]. 3.  Left ventriculography revealed
normal wall motion with a preserved ejection fraction of 60-65%.
 There was no mitral regurgitation.
[**2184-1-23**] Echo: Pre-CPB: No spontaneous echo contrast is seen in
the left atrial appendage. Overall left ventricular systolic
function is mildly depressed (LVEF= 45 - 50 %). Right
ventricular chamber size and free wall motion are normal. There
are simple atheroma in the descending thoracic [**Month/Day/Year 5236**]. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no pericardial effusion. Post-CPB: Biventricular systolic fxn.
remains mildly depressed. Trivial MR. [**First Name (Titles) **] [**Last Name (Titles) 5235**]. Other
parameters as pre-bypass.

[**2184-1-23**] 08:40AM BLOOD WBC-4.1 RBC-4.25* Hgb-12.6* Hct-35.6*
MCV-84 MCH-29.6 MCHC-35.3* RDW-13.3 Plt Ct-201
[**2184-1-26**] 04:25AM BLOOD WBC-9.0 RBC-2.74* Hgb-8.5* Hct-23.8*
MCV-87 MCH-31.2 MCHC-35.9* RDW-14.2 Plt Ct-212
[**2184-1-27**] 04:30AM BLOOD Hct-24.1*
[**2184-1-23**] 12:30PM BLOOD PT-12.6 PTT-23.2 INR(PT)-1.1
[**2184-1-23**] 08:40AM BLOOD Glucose-145* UreaN-12 Creat-1.0 Na-138
K-4.0 Cl-105 HCO3-24 AnGap-13
[**2184-1-26**] 04:25AM BLOOD Glucose-124* UreaN-23* Creat-1.3* Na-136
K-4.4 Cl-100 HCO3-29 AnGap-11
[**2184-1-23**] 08:40AM BLOOD ALT-30 AST-22 AlkPhos-57 TotBili-1.1
[**2184-1-26**] 04:25AM BLOOD Calcium-8.3* Phos-2.5* Mg-2.1

Brief Hospital Course:
Mr. [**Known lastname 78087**] [**Last Name (Titles) 1834**] a cardiac cath on [**2184-1-23**]. Cath revealed
severe 80% left main disease. Due to this disease and his
increasing angina he was urgently brought to the operating room
on [**1-23**]. He [**Month/Day (4) 1834**] a coronary artery bypass graft x 2. Please
see operative report for surgical details. Following surgery he
was brought to the CVICU for invasive monitoring in stable
condition. Very early on post-op day 1 he was weaned from
sedation, awoke neurologically [**Month/Day (4) 5235**] and extubated. On post-op
day one his chest tubes were removed and he was started on beta
blockers and diuretics. He was gently diuresed towards his
pore-op weight. Later on this day he was transferred to the
telemetry floor for further care. Epicardial pacing wires were
removed on post-op day three. He worked with physical therapy
during his post-op course for strength and mobility. And on
post-op day four he appeared suitable for discharge home with
VNA services and the appropriate follow-up appointments.

Medications on Admission:
Plavix, Atenolol, Imdur, Levothyroxine, Simvastatin, Aspirin

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:*11*
3. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Ferrous Gluconate 300 mg (35 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*1*
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 1 weeks.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
10. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
11. Levoxyl 25 mcg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*1*

Discharge Disposition:
Home With Service

Facility:
TBA

Discharge Diagnosis:
Coronary Artery Disease - s/p Coronary Artery Bypass Graft x 2
PMH: s/p LCx stent [**8-17**], s/p Brachytherapy [**11-16**], Hypertension,
Hyperlipidemia, Hypothyroidism, s/p tonsillectomy

Discharge Condition:
Good

Discharge Instructions:
1)Please shower daily. No baths. Pat dry incisions, do not rub.
2)Avoid creams and lotions to surgical incisions.
3)Call cardiac surgeon if there is concern for wound infection.
4)No lifting more than 10 lbs for at least 10 weeks from
surgical date.
5)No driving for at least one month.

Followup Instructions:
[**Hospital Ward Name 121**] 2 for wound check in 2 weeks
Dr. [**Last Name (STitle) 914**] in [**3-20**] weeks, call for appt
Dr. [**Last Name (STitle) **] or [**Last Name (un) **] in [**1-18**] weeks, call for appt
Dr. [**First Name (STitle) **] in [**1-18**] weeks, call for appt


Completed by:[**2184-1-27**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}


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: 53 y/o male with known coronary artery disease s/p LCx stent and
brachytherapy now with increased exertional chest pain and
shortness of breath. Referred for cardiac cath.

MEDICAL HISTORY: Coronary Artery Disease s/p LCx stent [**8-17**], s/p Brachytherapy
[**11-16**], Hypertension, Hyperlipidemia, Hypothyroidism, s/p
Tonsillectomy

MEDICATION ON ADMISSION: Plavix, Atenolol, Imdur, Levothyroxine, Simvastatin, Aspirin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 74 20 136/86 6' 255#
Skin: Unremarkable
HEENT: EOMI, PERRL, NCAT
Neck: Supple, FROM, -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: SOft, NT/ND +BS
Ext: Warm, well-perfused -edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: 2 brothers with stents. Father MI/CABG at age 70.

SOCIAL HISTORY: Construction worker. Quit smoking 15 yrs ago after 2ppd x 20yrs.
Denies ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
