CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 72 year old male with PMH significant for HTN,
Hypercholesteremia, who was awakened from sleep with chest pain
which was nonradiating, rated at 9/10, worsened with exertion,
releived with NTG.  He called EMS and was evaluated [**Hospital 28448**] Center and was found to have three vessel
disease on cardiac cath.  He was transferred to [**Hospital1 18**] for CABG

MEDICAL HISTORY: HTN, Spinal Stenosis, Etoh abuse, Rosacea, Hypercholesteremia,
s/p cholecystectomy, s/p lumbar laminectomy and fusion in '[**36**],
s/p tonsillectomy and adenoidectomy, Skin cancers, Paget's
disease.

MEDICATION ON ADMISSION: Prilosec, Verapamil, ASA, Zetia

ALLERGIES: Lipitor

PHYSICAL EXAM: Neuro:Nonfocal, A&Ox3
HEENT: NCAT, EOMI, MMM
Chest:B/S CTAB, resp unlab
ABD: S/NT/ND/BS+
EXT: No C/C/E 2+ DP Bilaterally

FAMILY HISTORY: Four children alive and well, father died of colon cancer at
86y/o.  Mother died of CHF at 88y/o.

SOCIAL HISTORY: Married, lives at home with wife, retired as letter carrier, two
glasses of wine per day, quit smoking over 20years ago
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia
Subendo infarct, initial,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2174-2-4**]              Discharge Date:   [**2174-2-12**]

Date of Birth:  [**2101-12-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Lipitor

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
CABGx4 (LIMA->Diag, SVG->LAD, SVG->OM, SVG->PDA)


History of Present Illness:
72 year old male with PMH significant for HTN,
Hypercholesteremia, who was awakened from sleep with chest pain
which was nonradiating, rated at 9/10, worsened with exertion,
releived with NTG.  He called EMS and was evaluated [**Hospital 28448**] Center and was found to have three vessel
disease on cardiac cath.  He was transferred to [**Hospital1 18**] for CABG

Past Medical History:
HTN, Spinal Stenosis, Etoh abuse, Rosacea, Hypercholesteremia,
s/p cholecystectomy, s/p lumbar laminectomy and fusion in '[**36**],
s/p tonsillectomy and adenoidectomy, Skin cancers, Paget's
disease.

Social History:
Married, lives at home with wife, retired as letter carrier, two
glasses of wine per day, quit smoking over 20years ago

Family History:
Four children alive and well, father died of colon cancer at
86y/o.  Mother died of CHF at 88y/o.

Physical Exam:
Neuro:Nonfocal, A&Ox3
HEENT: NCAT, EOMI, MMM
Chest:B/S CTAB, resp unlab
ABD: S/NT/ND/BS+
EXT: No C/C/E 2+ DP Bilaterally


Pertinent Results:
[**2174-2-11**] 07:55AM BLOOD WBC-8.2 RBC-3.12* Hgb-10.5* Hct-28.2*
MCV-90 MCH-33.6* MCHC-37.2* RDW-13.3 Plt Ct-147*
[**2174-2-8**] 01:17PM BLOOD PT-14.1* PTT-33.0 INR(PT)-1.3
[**2174-2-12**] 05:50AM BLOOD Glucose-111* UreaN-17 Creat-1.0 Na-134
K-4.7 Cl-98 HCO3-28 AnGap-13
[**2174-2-8**] 10:42PM BLOOD ALT-102* AST-72* LD(LDH)-304*
AlkPhos-213* Amylase-128* TotBili-0.9
[**2174-2-5**] 05:00AM BLOOD Triglyc-101 HDL-55 CHOL/HD-3.6
LDLcalc-124
CHEST (PA & LAT)  [**2174-2-11**] 9:18 AM

CHEST (PA & LAT)

Reason: ? pleural effusion

[**Hospital 93**] MEDICAL CONDITION:
72 year old man with 3VD s/p CABG and CT removal
REASON FOR THIS EXAMINATION:
? pleural effusion
INDICATION: 72-year-old with three vessel disease, question
pleural effusion.

COMPARISON: [**2174-2-9**].

PA AND LATERAL CHEST RADIOGRAPHS: Patient is status post CABG
and median sternotomy wires are again seen. There has been
interval removal of the right IJ introducer sheath. There is no
evidence of pneumothorax. Cardiomediastinal silhouette is
stable. There is decreasing left retrocardiac opacity likely
representing atelectasis. Moderate sized left pleural effusion
also appears to have slightly decreased in size. The right lung
is clear. Note is made of a dilated loop of large bowel in the
left upper quadrant.

IMPRESSION:
1. Slight decrease in left retrocardiac opacity representing
atelectasis and effusion.
2. Dilated loop of bowel in the left upper quadrant. Clinically
correlate.


Brief Hospital Course:
Mr. [**Known lastname 28449**] was transferred from an OSH and admitted to the
[**Hospital1 18**] on [**2174-2-4**] for further management of his CAD.  Upon
review of OSH records he was found to have a NSTEMI and three
vessel disease, 80% LCx, 80% pLAD, 70% mLAD, 80% D1, 90% RCA,
95% PDA, with EF 60%.  He was admitted to the CCU and continued
on beta blockade, aspirin, and heparin.  On [**2174-2-8**] he
successfully underwent CABGx4 (LIMA->DIAG, SVG->LAD, SVG->OM,
SVG->PDA)  CPB time 80min, Cross clamp time 67min.  Afterward he
was transferred to the Cardiac surgery recovery unit in stable
condition and awakened neurologically intake.  On POD 2 He was
weaned from ventilator support, and extubated.  His pressors
were weaned and chest tubes removed.  He was then transferred to
the Stepdown unit for further recovery.  He was gently diuresed
to his preoperative weight, beta blockade and aspirin therapy
were resumed, and physical therapy service was consulted to
assist with her postoperative strength and mobility.  On POD 3
his epicardial pacing wires were removed without complication,
he continued to improve his ability to ambulate including
climbing stairs without respiratory distress or chest pain.  He
did complain of back pain associated with his spinal stenosis
for which he was given Toradol with good effect.  On POD 4 Mr.
[**Known lastname 28449**] was 6kg above his preop weight with good exercise
tolerance, no SOB, or Chest pain.  He was able to have a bowel
movement with MOM without further difficulty.  His blood
pressure was stable in the 90's/60's, pulse in the 70-80's.  His
sternotomy and leg incision were clean, dry, and intact without
evidence of infection.  He was discharged home on POD 4 with
services in good condition, cardiac diet, sternal precautions,
lasix 20mg po QD for 10 days, and instructed to follow up with
his PCP and cardiologist in [**2-14**] weeks.

Medications on Admission:
Prilosec, Verapamil, ASA, Zetia

Discharge Medications:
1. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 10
days.
Disp:*40 Capsule, Sustained Release(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. 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*
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
Disp:*45 Tablet(s)* Refills:*2*
8. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
Disp:*20 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 8117**] VNA

Discharge Diagnosis:
CAD, HTN, Hypercholesteremia, Spinal Stenosis, Paget's Disease,
Skin Cancer

Discharge Condition:
Good


Discharge Instructions:
Shower, wash incisions with mild soap and water and pat dry. No
lotions, creams or powders to incisions.
Call with fever, redness or drainage from incision, or weight
gain more than 2 pounds in one day or five pounds in one week.
No lifting more than 10 pounds.
No driving until follow up with surgeon.


Followup Instructions:
Dr. [**Last Name (STitle) **], [**Telephone/Fax (1) 170**], in four weeks
Dr. [**Last Name (STitle) **], [**Telephone/Fax (1) 4775**]
Dr. [**Last Name (STitle) 120**] or cardiology referral from PCP [**Last Name (NamePattern4) **] [**2-14**] weeks



Completed by:[**2174-2-12**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: 72 year old male with PMH significant for HTN,
Hypercholesteremia, who was awakened from sleep with chest pain
which was nonradiating, rated at 9/10, worsened with exertion,
releived with NTG.  He called EMS and was evaluated [**Hospital 28448**] Center and was found to have three vessel
disease on cardiac cath.  He was transferred to [**Hospital1 18**] for CABG

MEDICAL HISTORY: HTN, Spinal Stenosis, Etoh abuse, Rosacea, Hypercholesteremia,
s/p cholecystectomy, s/p lumbar laminectomy and fusion in '[**36**],
s/p tonsillectomy and adenoidectomy, Skin cancers, Paget's
disease.

MEDICATION ON ADMISSION: Prilosec, Verapamil, ASA, Zetia

ALLERGIES: Lipitor

PHYSICAL EXAM: Neuro:Nonfocal, A&Ox3
HEENT: NCAT, EOMI, MMM
Chest:B/S CTAB, resp unlab
ABD: S/NT/ND/BS+
EXT: No C/C/E 2+ DP Bilaterally

FAMILY HISTORY: Four children alive and well, father died of colon cancer at
86y/o.  Mother died of CHF at 88y/o.

SOCIAL HISTORY: Married, lives at home with wife, retired as letter carrier, two
glasses of wine per day, quit smoking over 20years ago 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia'}
