CHIEF COMPLAINT: Heartburn

PRESENT ILLNESS: 59 yo male with hx of recently
diagnosed diabetes, GERD and remote tobacco hx who presented on
[**5-25**] to [**Hospital 1727**] Medical Center ED with sudden onset of substernal,
nonradiating chest pain that felt like "the worst heartburn of
his life".  He was walking on the 16th hole of the golf course
when he developed [**8-15**] heartburn. He took Tums with no relief
and
then went to the ED. Discomfort relieved with nitroglycerin in
the ER. His EKG showed only nonspecific changes and his troponin
was elevated to 0.05. Cardiac cath [**5-25**] revealed 3 vessel CAD -
he was loaded with 300 mg Plavix.  He was started on a Heparin
gtt, beta blocker, baby ASA, and statin.  He was transferred to
[**Hospital1 18**] for CABG evaluation.

MEDICAL HISTORY: Type 2 DM
Hyperlipidemia
GERD
Remote hx of tobacco abuse - quit 20 years ago
CAD
Past Surgical History: Tonsillectomy and adenoidectomy as child,
appy, right rotator cuff repair 4 years ago

MEDICATION ON ADMISSION: Metformin 1000 mg [**Hospital1 **]
Lipitor 40 mg daily -  started recently
Prilosec 20 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse:65 Resp:18  O2 sat:97% RA
B/P  Right:158/94    Left:
Height:5'8"     Weight:105.9 kg
General:AAO x 3 in NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] Obese
Extremities: Warm [x], well-perfused [x]  Edema - none
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:2+   Left:2+
PT           [**Name (NI) 167**]:2+   Left:2+
Radial       Right:2+   Left:2+

FAMILY HISTORY: No significant cardiac family hx

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 1 year ago  - multiple caps
Lives with: Wife
Occupation: RN educator at [**Doctor Last Name 497**]
Tobacco: Quit 20 years ago - previously smoked 1 ppd x 20 years
ETOH: 2 beers/day
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Personal history of tobacco use
Subendo infarct, initial,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Esophageal reflux,Hyperlipidemia NEC/NOS,History of tobacco use
Admission Date:  [**2114-5-28**]              Discharge Date:   [**2114-6-5**]

Date of Birth:  [**2055-3-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

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


Major Surgical or Invasive Procedure:
s/p Coronary artery bypass grafting x3 with left internal
mammary artery, left anterior descending coronary; reverse
saphenous vein single graft from the aorta to ramus intermedius
coronary artery; reverse saphenous vein single graft from aorta
to the posterior descending coronary artery.


History of Present Illness:
59 yo male with hx of recently
diagnosed diabetes, GERD and remote tobacco hx who presented on
[**5-25**] to [**Hospital 1727**] Medical Center ED with sudden onset of substernal,
nonradiating chest pain that felt like "the worst heartburn of
his life".  He was walking on the 16th hole of the golf course
when he developed [**8-15**] heartburn. He took Tums with no relief
and
then went to the ED. Discomfort relieved with nitroglycerin in
the ER. His EKG showed only nonspecific changes and his troponin
was elevated to 0.05. Cardiac cath [**5-25**] revealed 3 vessel CAD -
he was loaded with 300 mg Plavix.  He was started on a Heparin
gtt, beta blocker, baby ASA, and statin.  He was transferred to
[**Hospital1 18**] for CABG evaluation.


Past Medical History:
Type 2 DM
Hyperlipidemia
GERD
Remote hx of tobacco abuse - quit 20 years ago
CAD
Past Surgical History: Tonsillectomy and adenoidectomy as child,
appy, right rotator cuff repair 4 years ago


Social History:
Race: Caucasian
Last Dental Exam: 1 year ago  - multiple caps
Lives with: Wife
Occupation: RN educator at [**Doctor Last Name 497**]
Tobacco: Quit 20 years ago - previously smoked 1 ppd x 20 years
ETOH: 2 beers/day


Family History:
No significant cardiac family hx


Physical Exam:
Pulse:65 Resp:18  O2 sat:97% RA
B/P  Right:158/94    Left:
Height:5'8"     Weight:105.9 kg
General:AAO x 3 in NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] Obese
Extremities: Warm [x], well-perfused [x]  Edema - none
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:2+   Left:2+
PT           [**Name (NI) 167**]:2+   Left:2+
Radial       Right:2+   Left:2+

Carotid Bruit        Right:none    Left:none


Pertinent Results:
[**2114-6-5**] 05:12AM BLOOD WBC-8.1 RBC-3.16* Hgb-10.2* Hct-29.0*
MCV-92 MCH-32.2* MCHC-35.1* RDW-13.4 Plt Ct-148*#
[**2114-5-29**] 12:20AM BLOOD WBC-8.7 RBC-4.63 Hgb-14.4 Hct-41.9 MCV-90
MCH-31.1 MCHC-34.4 RDW-13.1 Plt Ct-156
[**2114-6-1**] 01:42PM BLOOD PT-13.6* PTT-29.1 INR(PT)-1.2*
[**2114-6-5**] 05:12AM BLOOD Glucose-124* UreaN-17 Creat-1.0 Na-137
K-3.9 Cl-101 HCO3-28 AnGap-12
[**2114-5-29**] 12:20AM BLOOD Glucose-137* UreaN-15 Creat-1.1 Na-138
K-4.5 Cl-103 HCO3-26 AnGap-14
[**2114-5-31**] 05:10PM BLOOD ALT-127* AST-59* LD(LDH)-205 AlkPhos-101
Amylase-27 TotBili-0.7


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 51203**] (Complete)
Done [**2114-6-1**] at 11:01:34 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2055-3-24**]
Age (years): 59 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: CABG
ICD-9 Codes: 786.05, 786.51, 424.0
Test Information
Date/Time: [**2114-6-1**] at 11:01    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2011AW-:1 Machine: us2
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Descending Thoracic:  2.3 cm  <= 2.5 cm

Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

LEFT VENTRICLE: Low normal LVEF.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal ascending aorta diameter. Simple atheroma in
descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial
MR.

TRICUSPID VALVE: Physiologic TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Pre-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is low normal (LVEF
50-55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
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. Trivial mitral
regurgitation is seen.
There is no pericardial effusion.

Post-CPB:
The patient is in SR, with no inotropes.
The views are technically suboptimal.
What can be seen shows preserved biventricular systolic fxn.
Trace MR, no AI. Aorta intact.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician


?????? [**2106**] CareGroup IS. All rights reserved.


Brief Hospital Course:
On [**2114-6-1**] Mr.[**Known lastname 4223**] was taken to the operating room and
underwent Coronary artery bypass grafting x3 (left internal
mammary artery, left anterior descending coronary; reverse
saphenous vein single graft from the aorta to ramus intermedius
coronary artery; reverse saphenous vein single graft from aorta
to the posterior descending coronary artery) with Dr.[**Last Name (STitle) 914**].
Please see operative report for further surgical details.TIME:
Cardiopulmonary bypass time is 105 minutes.  Cross-clamp time
was 85 minutes. He tolerated the procedure well and was
transferred to the CVICU intubated and sedated. He awoke
neurologically intact and was extubated without difficulty. He
weaned off pressors and was started on
Beta-blocker/Aspirin/Statin and diuresis. All lines and drains
were discontinued in a timely fashion. POD#1 he was transferred
to the step down unit for further monitoring. Physical Therapy
was consulted for evaluation of strength and mobility. The
remainder of his hospital course was essentially uneventful. On
POD#4 he was cleared for discharge to home with VNA services.
All follow up appointments were advised.


Medications on Admission:
Metformin 1000 mg [**Hospital1 **]
Lipitor 40 mg daily -  started recently
Prilosec 20 mg daily

Meds on transfer: PRN NTG, Simvastatin 40 mg q hs, Metoprolol 25
mg q 6 hrs, ASA 81 mg daily, Prilosec 20 mg daily, Heparin 1350
units/hr


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. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
Disp:*60 Tablet(s)* Refills:*0*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
5. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
6. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. tramadol 50 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
8. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*0*
11. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day for 7 days.
Disp:*7 Tablet, ER Particles/Crystals(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Southern [**State **] health and homecare services

Discharge Diagnosis:
coronary artery disease
s/p Coronary artery bypass grafting x3 with left internal
mammary artery, left anterior descending coronary; reverse
saphenous vein single graft from the aorta to ramus intermedius
coronary artery; reverse saphenous vein single graft from aorta
to the posterior descending coronary artery.
Secondary:
Type 2 DM
Hyperlipidemia
GERD
Remote hx of tobacco abuse - quit 20 years ago
CAD
Past Surgical History: Tonsillectomy and adenoidectomy as child,
appy, right rotator cuff repair 4 years ago


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema
1+LLE


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr.[**Last Name (STitle) 914**] #[**Telephone/Fax (1) 170**]
Cardiologist:Dr.[**Last Name (STitle) 9764**] in [**Location (un) **]

Please call to schedule appointments with your
Primary Care Dr. [**First Name (STitle) **],[**First Name3 (LF) **] W. [**Telephone/Fax (1) 4775**] in [**1-7**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**




Completed by:[**2114-6-5**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Personal history of tobacco use'}


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: Heartburn

PRESENT ILLNESS: 59 yo male with hx of recently
diagnosed diabetes, GERD and remote tobacco hx who presented on
[**5-25**] to [**Hospital 1727**] Medical Center ED with sudden onset of substernal,
nonradiating chest pain that felt like "the worst heartburn of
his life".  He was walking on the 16th hole of the golf course
when he developed [**8-15**] heartburn. He took Tums with no relief
and
then went to the ED. Discomfort relieved with nitroglycerin in
the ER. His EKG showed only nonspecific changes and his troponin
was elevated to 0.05. Cardiac cath [**5-25**] revealed 3 vessel CAD -
he was loaded with 300 mg Plavix.  He was started on a Heparin
gtt, beta blocker, baby ASA, and statin.  He was transferred to
[**Hospital1 18**] for CABG evaluation.

MEDICAL HISTORY: Type 2 DM
Hyperlipidemia
GERD
Remote hx of tobacco abuse - quit 20 years ago
CAD
Past Surgical History: Tonsillectomy and adenoidectomy as child,
appy, right rotator cuff repair 4 years ago

MEDICATION ON ADMISSION: Metformin 1000 mg [**Hospital1 **]
Lipitor 40 mg daily -  started recently
Prilosec 20 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Pulse:65 Resp:18  O2 sat:97% RA
B/P  Right:158/94    Left:
Height:5'8"     Weight:105.9 kg
General:AAO x 3 in NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] Obese
Extremities: Warm [x], well-perfused [x]  Edema - none
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:2+   Left:2+
PT           [**Name (NI) 167**]:2+   Left:2+
Radial       Right:2+   Left:2+

FAMILY HISTORY: No significant cardiac family hx

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 1 year ago  - multiple caps
Lives with: Wife
Occupation: RN educator at [**Doctor Last Name 497**]
Tobacco: Quit 20 years ago - previously smoked 1 ppd x 20 years
ETOH: 2 beers/day 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Personal history of tobacco use'}
