CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This 70 year old white female
has a known history of coronary artery disease and is status
post myocardial infarction in [**2103**], with multivessel disease
by catheterization at that point, which was medically
managed.  She now presents with chest pain at rest for two
days and borderline increased troponin with a non Q wave
myocardial infarction.  She is now admitted for cardiac
catheterization.

MEDICAL HISTORY: Myocardial infarction in [**2103**].

MEDICATION ON ADMISSION: 1. Glucophage.
2. Diovan.
3. Zetia.
4. Lipitor.
5. Toprol.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: PE: VS  97.9       60    90/60     20    96% RA
Gen: very pleasant, NAD, lying flat in bed
HEENT: PERRL, EOMI, OP clear
Neck: no JVD,
Lungs: CTA bilat, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: NABS, NT/ND, NABS
Extr: PT 1+ bilat, no c/c/e
Neuro: grossly intact
Right groin: some ooze, no hematoma, no bruit

FAMILY HISTORY: Significant for coronary artery disease.

SOCIAL HISTORY: She lives alone, quit smoking fifteen years
ago, has a twenty pack year history and does not drink
alcohol.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem
Admission Date: [**2108-11-9**]        Discharge Date: [**2108-11-19**]

Date of Birth:  [**2038-3-16**]        Sex:  F

Service:  CSU


HISTORY OF PRESENT ILLNESS:  This 70 year old white female
has a known history of coronary artery disease and is status
post myocardial infarction in [**2103**], with multivessel disease
by catheterization at that point, which was medically
managed.  She now presents with chest pain at rest for two
days and borderline increased troponin with a non Q wave
myocardial infarction.  She is now admitted for cardiac
catheterization.

PAST MEDICAL HISTORY:  Myocardial infarction in [**2103**].

History of noninsulin dependent diabetes mellitus.

Hypertension.

Hypercholesterolemia.

Paroxysmal atrial fibrillation.

Status post appendectomy.

Status post hernia repair.

Status post left knee surgery.

Status post tonsillectomy.

ALLERGIES:  She has no known drug allergies.

MEDICATIONS ON ADMISSION:
1. Glucophage.
2. Diovan.
3. Zetia.
4. Lipitor.
5. Toprol.


SOCIAL HISTORY:  She lives alone, quit smoking fifteen years
ago, has a twenty pack year history and does not drink
alcohol.

FAMILY HISTORY:  Significant for coronary artery disease.

REVIEW OF SYMPTOMS:  Unremarkable.

PHYSICAL EXAMINATION:  On physical examination, she is an
elderly white female in no apparent distress.  Vital signs
stable and afebrile.  Head, eyes, ears, nose and throat
examination is normocephalic and atraumatic.  Extraocular
movements are intact.  The oropharynx is benign.  The neck is
supple, full range of motion, no lymphadenopathy or
thyromegaly.  Carotids are two plus and equal bilaterally
without bruits.  Lungs are clear to auscultation and
percussion.  Cardiovascular examination reveals irregular
rhythm, normal S1 and S2, with no murmurs, rubs or gallops.
The abdomen is soft, obese, nontender, with positive bowel
sounds, no masses or hepatosplenomegaly.  Extremities were
without cyanosis, clubbing or edema.  Neurologic examination
was nonfocal.

HOSPITAL COURSE:  She was admitted for cardiac
catheterization, which revealed an 80 percent left anterior
descending coronary artery stenosis, 90 percent left
circumflex stenosis and an 80 percent right coronary artery
stenosis with an ejection fraction of 62 percent.  Dr.
[**Last Name (STitle) 70**] was consulted.  The patient had some angina while
awaiting surgery and on [**2108-11-12**], she underwent a coronary
artery bypass graft times four with left internal mammary
artery to the left anterior descending coronary artery,
saphenous vein graft to right coronary artery, obtuse
marginal one and obtuse marginal two sequential.  Cross clamp
time was 52 minutes, total bypass time was 79 minutes.  The
patient was transferred to the CSRU on Neo-Synephrine and
Propofol in stable condition.  She was extubated on
postoperative day number one.  She had a short run of atrial
fibrillation, which quickly resolved with Lopressor and one
bolus of Amiodarone.  She had her chest tubes out on
postoperative day number two.  She was transferred to the
floor on postoperative day number three.  She continued to
require aggressive diuresis as she was quite fluid
overloaded.  She had her epicardial pacing wires discontinued
on postoperative day number four.  She continued to improve
and was discharged to home on postoperative day number seven
in stable condition.

Her laboratories on discharge were hematocrit 32.6, white
blood cell count 8.6, platelet count 394,000.  Sodium 145,
potassium 4.4, chloride 106, CO2 29, blood urea nitrogen 14,
creatinine 0.8, blood sugar 128.

MEDICATIONS ON DISCHARGE:
1. Aspirin 81 mg p.o. daily.
2. Colace 100 mg p.o. twice a day.
3. Glyburide 2.5 mg p.o. daily.
4. Zetia 10 mg p.o. daily.
5. Amiodarone 400 mg p.o. twice a day for seven days, then
   400 mg p.o. daily for seven days, then decrease to 200 mg
   p.o. daily.
6. Lipitor 80 mg p.o. daily.
7. Vicodin one to two p.o. q4-6hours p.r.n. pain.
8. Potassium 20 mEq p.o. twice a day for ten days.
9. Lopressor 50 mg p.o. twice a day.
10.      Lasix 40 mg p.o. twice a day for ten days.
11.      Iron 325 mg p.o. daily.
12.      Vitamin C 500 mg p.o. twice a day.
13.      Multivitamin one p.o. daily.


FOLLOW UP:  She will be followed up with Dr. [**Last Name (STitle) 9955**] in
one to two weeks, Dr. [**First Name (STitle) **] in two to three weeks and Dr.
[**Last Name (STitle) 70**] in four weeks.

DISCHARGE DIAGNOSES:  Coronary artery disease.

Noninsulin dependent diabetes mellitus.

Hypertension.

Hypercholesterolemia.

Paroxysmal atrial fibrillation.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**]

Dictated By:[**Last Name (NamePattern1) 18588**]
MEDQUIST36
D:  [**2108-11-19**] 18:08:22
T:  [**2108-11-19**] 19:14:27
Job#:  [**Job Number 30154**]


Admission Date:  [**2108-11-9**]              Discharge Date:   [**2108-11-19**]

Date of Birth:  [**2038-3-16**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 14964**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
74 yo female, h/o CAD, s/p catheterization in [**2103**] showing 3vd
(being medically managed since that time), paroxysmal aflutter
in context of MI, DJD, sciatica, who presented to [**Hospital1 **] on [**11-7**] with chest pain, ruling in with peak troponin
of 0.8 with negative CK's.  She reports first feeling chest pain
on [**11-7**] starting in the morning, at rest.  She reports
radiation to the arms bilaterally (described as tingling) and
shortness of breath. This lasted until 4pm and went away after
administration of 1 SLTNG.  She went out to dinner with her son,
and upon returning to dinner, reports repeat of chest pain.  She
then called EMS, who gave her 325 mg ASA which immediately
relieved the pain.  She was taken to [**Hospital1 46**] at this time, was
pain free, EKG without changes, initial tn-I was 0.149.  She was
admitted to telemetry, treated with lovenox, had possible
transient episode of afib, had recurrent cp on morning of [**11-9**]
at 5am, woke her from sleep, relieved in 10 min with O2.  Tn-I
peaked at 0.8, was trending down on transfer.  TTE was performed
before transfer.

Catheterization here revealed extensive 3VD, and pt is being
referred for CABG.

Cardiac history:
[**12/2103**]: ETT- EF=57%, normal wall motion, fixed defect inferior
wall without reversible perfusion defect consistent with
inferior wall infarct
[**12/2103**] Cardiac catheterization: EF=60%, 1+ MR
[**Name13 (STitle) 167**]: 40% prox RCA, discrete mid RCA, normal acute marginal
(right dominant system)
Left: 50% prox LAD, 30% mid LAD, 70% distal LAD
      D1-50% discrete, D2-70% discrete
      Prox CX-nl, mid-60%, distal-nl
      OM1-70-80%
      OM2-nl, post LV-nl
[**12-25**]: Cardiolite stress: fixed anterior defect and inferior
scar, nl LV, EF=62%, septal hypokinesis
[**2108-11-9**]: Cath-right dominant, LAD twin system with 80% stenosis
in diagonal pole, LCX serial 90% stenosis in OM1, 90% OM2, RCA
80 % mid

SH: Former smoker, quit 16 yrs ago ([**12-23**] ppd x 35 yrs)
quit etoh 16 yrs agi
Separated
Former payroll assistant


Past Medical History:
PMH:
Sciatica in right leg
Appendectomy
Toxemia in pregnancy x 2
DJD
Hernia Repair
Tonsillectomy and adenoidectomy
Left knee surgery [**1-23**] trauma
Menopausal since age 40


Social History:
Lives in split level home with son
Denies tobacco or EtOH


Family History:
FH:
Mother died age 28 from cerebral hemorrhage
FAther died age 47 from MI
Brother age 63 with colon cancer
Son with HTN and Asthma
Daughter s/p liver tx, ?viral hepatitis


Physical Exam:
PE: VS  97.9       60    90/60     20    96% RA
Gen: very pleasant, NAD, lying flat in bed
HEENT: PERRL, EOMI, OP clear
Neck: no JVD,
Lungs: CTA bilat, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: NABS, NT/ND, NABS
Extr: PT 1+ bilat, no c/c/e
Neuro: grossly intact
Right groin: some ooze, no hematoma, no bruit

Pertinent Results:
LAbs: see attached

EKG: NSR, q's in II, III, avf; no real ST/T changes; no real
change

TTE at [**Hospital1 46**]: results pending, will obtain

Brief Hospital Course:
A/P: 70 yo female, h/o CAD with severe 3vd, presenting from OSH
with chest pain and positive troponins, transferred here for
cardiac catheterization which revealed 3vd, no intervention.  Pt
now referred for CABG.

1.  CAD: pt s/p cath showing 3vd, no intervention performed.
She was referred for CABG and accepted by the CT surgery
service.  Preoperative TTE, CXR, and UA were obtained.  She was
kept pain free prior to transfer to surgery service with NTG as
needed.  She was stable at time of transfer.  Her ASA, beta
blocker, Diovan, Lipitor, and Zetia were continued in-house.


2.  Pump: pt with apparently normal EF on prior TTE's and on
current cath.  She had no signs of volume overload with
post-catheterization IVF's

3.  Rhythm: pt with history of aflutter/?afib in context of MI;
transient, asympt. She had no events on telemetry.

4.  DM: continue glyburide; will hold metformin given cath,
future CABG, cover with SSI, goal FSBG<140.

5.  Rash: pt with eczematous rash on back of hairline, foul
odor; will consider derm consult if continues to expand.  RAsh
was stable.

6.  Dispo: She was transferred to the cardiac surgery service
for CABG

Medications on Admission:
Allergies: NKDA

Meds on Admission:
Metformin 1000mg [**Hospital1 **]
Toprol 200mg daily
Lipitor 80mg daily
Zetia 10mg daily
Glyburide 2.5mg daily
Diovan 80 mg daily
ASA 81 mg daily
Nitroquick

NKDA


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. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Amiodarone HCl 200 mg Tablet Sig: Two (2) Tablet PO twice a
day for 7 days: After 7 days decrease to 400 mg PO qd for 7
days, then decrease to 200 mg PO qd.
Disp:*60 Tablet(s)* Refills:*1*
6. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
8. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO BID (2 times a day) for 10
days.
Disp:*40 Capsule, Sustained Release(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 twice a day for 10
days.
Disp:*20 Tablet(s)* Refills:*0*
11. Ferrous Gluconate 325 mg Tablet Sig: One (1) Tablet PO once
a day.
Disp:*30 Tablet(s)* Refills:*2*
12. Vitamin C 500 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
13. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
Coronary artery disease.


Discharge Condition:
Good.

Discharge Instructions:
Follow medications on discharge instructions.
You may not drive for 4 weeks.
You may not lift more than 10 lbs. for 3 months.
You should shower, let water flow over wounds, pat dry with a
towel.

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) 9955**] for 1-2 weeks.
Make an appointment with Dr. [**First Name (STitle) **] for 2-3 weeks.
Make an appointment with Dr. [**Last Name (STitle) 70**] for 6 weeks.
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: This 70 year old white female
has a known history of coronary artery disease and is status
post myocardial infarction in [**2103**], with multivessel disease
by catheterization at that point, which was medically
managed.  She now presents with chest pain at rest for two
days and borderline increased troponin with a non Q wave
myocardial infarction.  She is now admitted for cardiac
catheterization.

MEDICAL HISTORY: Myocardial infarction in [**2103**].

MEDICATION ON ADMISSION: 1. Glucophage.
2. Diovan.
3. Zetia.
4. Lipitor.
5. Toprol.

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: PE: VS  97.9       60    90/60     20    96% RA
Gen: very pleasant, NAD, lying flat in bed
HEENT: PERRL, EOMI, OP clear
Neck: no JVD,
Lungs: CTA bilat, no w/r/r
CV: RRR, nl s1/s2, no m/r/g
Abd: NABS, NT/ND, NABS
Extr: PT 1+ bilat, no c/c/e
Neuro: grossly intact
Right groin: some ooze, no hematoma, no bruit

FAMILY HISTORY: Significant for coronary artery disease.

SOCIAL HISTORY: She lives alone, quit smoking fifteen years
ago, has a twenty pack year history and does not drink
alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia'}
