CHIEF COMPLAINT: Chest pain/dyspnea on exertion

PRESENT ILLNESS: Mr. [**Known lastname 71155**] is a 74 year old man who presented to the emergency
department on [**2-5**] with chest pain and dyspnea on exertion over
the past couple of months and increasing over the past two
weeks. His cath on [**2177-2-7**] revealed three vessel
disease.

MEDICAL HISTORY: 1. Hypertension
2. Hyperlipidemia
3. Diabetes type 2
4. Anemia (Colonoscopy at BU about 3 yrs ago was negative)

MEDICATION ON ADMISSION: Imdur 30 mg Tablet Sustained Release 24 hr daily
Nitroglycerin 0.4 mg Sublingual PRN
Aspirin 325 mg daily
Amlodipine 10 mg daily
Minoxidil 10 mg daily
Gipizide 5 mg Tablet Extended Rel 24 hr daily
Hydralazine 50 mg [**Hospital1 **]
Metoprolol succinate 25 mg Tablet Sustained Release 24 hr daily
Lisinopril 80 mg daily
Lovastatin 80 mg daily
Metformin 1,000 mg [**Hospital1 **]
Ferrous sulfate 600 mg daily
Multivitamin Tablet daily

ALLERGIES: Soy / Propofol

PHYSICAL EXAM: VS WNL

FAMILY HISTORY: His father died at 78 from CAD. His mother died at 77 from a
CVA. A brother had CABG at 76. A sister also had a CABG at age
76.

SOCIAL HISTORY: He lives in [**Location 5450**] by the Sea with his wife. [**Name (NI) **] is a retired
bookkeeper.
-Tobacco history: Never smoker.
-ETOH: Denies.
-Illicit drugs: Denies.
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
Crnry athrscl natve vssl,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2177-3-18**]              Discharge Date:   [**2177-3-22**]

Date of Birth:  [**2102-3-2**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Soy / Propofol

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain/dyspnea on exertion


Major Surgical or Invasive Procedure:
[**2177-3-18**]
Coronary artery bypass grafting x5:  Left internal mammary
artery to left anterior descending artery; and saphenous vein
grafts to the diagonal and right coronary artery, and a
sequential graft to the ramus intermedius and then the obtuse
marginal.


History of Present Illness:
Mr. [**Known lastname 71155**] is a 74 year old man who presented to the emergency
department on [**2-5**] with chest pain and dyspnea on exertion over
the past couple of months and increasing over the past two
weeks. His cath on [**2177-2-7**] revealed three vessel
disease.

Past Medical History:
1. Hypertension
2. Hyperlipidemia
3. Diabetes type 2
4. Anemia (Colonoscopy at BU about 3 yrs ago was negative)

Social History:
He lives in [**Location 5450**] by the Sea with his wife. [**Name (NI) **] is a retired
bookkeeper.
-Tobacco history: Never smoker.
-ETOH: Denies.
-Illicit drugs: Denies.


Family History:
His father died at 78 from CAD. His mother died at 77 from a
CVA. A brother had CABG at 76. A sister also had a CABG at age
76.


Physical Exam:
VS WNL

General: No acute distress
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] Irregular [] Murmur -
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[x]
Extremities: Warm [X], well-perfused [X] Edema/Varicosities:
None
[x]
Neuro: Grossly intact[X]
Pulses:
Femoral      Right: 2+   Left: 2+
DP           Right: 1+   Left: 1+
PT           [**Name (NI) 167**]: 1+   Left: 1+
Radial       Right: 1+   Left: 1+

Carotid Bruit    Right: -    Left: -


Pertinent Results:
[**2177-3-20**] 04:30AM BLOOD WBC-9.6 RBC-3.43* Hgb-10.2* Hct-29.3*
MCV-85 MCH-29.6 MCHC-34.7 RDW-14.0 Plt Ct-184
[**2177-3-20**] 04:30AM BLOOD Glucose-160* UreaN-30* Creat-1.7* Na-133
K-4.1 Cl-100 HCO3-27 AnGap-10
[**2177-3-19**] 03:36AM BLOOD Glucose-129* UreaN-22* Creat-1.3* Na-138
K-4.8 Cl-106 HCO3-24 AnGap-13
[**2177-3-19**] 03:36AM BLOOD WBC-9.0 RBC-3.69* Hgb-10.9* Hct-31.9*
MCV-87 MCH-29.5 MCHC-34.1 RDW-14.2 Plt Ct-172

[**2177-3-18**]
Intraop TEE
Prebypass
No atrial septal defect is seen by 2D or color Doppler. Regional
left ventricular wall motion is normal. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. The ascending
aorta is mildly dilated. There are simple atheroma in the
descending thoracic aorta. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. Trace
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Mild (1+) mitral regurgitation is seen. There
is no pericardial effusion.
Post bypass
Patient is AV paced and receiving an infusion of phenylephrine.
Biventricular systolic function is unchanged. Aorta is intact
post decannulation.

Brief Hospital Course:
The patient was brought to the operating room on [**3-18**] where the
patient underwent CABG x5(LIMA-LAD,SVG-Diag,SVG-RI-OM,SVG-PDA).
Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.

POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was neurologically intact
and hemodynamically stable, weaned from inotropic and
vasopressor support.  Beta blocker was initiated and the patient
was gently diuresed toward the preoperative weight.  The patient
was transferred to the telemetry floor for further recovery.

Chest tubes and pacing wires were discontinued without
complication.  The patient was evaluated by the physical therapy
service for assistance with strength and mobility.  By the time
of discharge on POD 4 the patient was ambulating freely, the
wound was healing and pain was controlled with oral analgesics.


The patient was discharged to rehab in good condition with
appropriate follow up instructions.

Medications on Admission:
Imdur 30 mg Tablet Sustained Release 24 hr daily
Nitroglycerin 0.4 mg Sublingual PRN
Aspirin 325 mg daily
Amlodipine 10 mg daily
Minoxidil 10 mg daily
Gipizide 5 mg Tablet Extended Rel 24 hr daily
Hydralazine 50 mg [**Hospital1 **]
Metoprolol succinate 25 mg Tablet Sustained Release 24 hr daily
Lisinopril 80 mg daily
Lovastatin 80 mg daily
Metformin 1,000 mg [**Hospital1 **]
Ferrous sulfate 600 mg daily
Multivitamin Tablet daily

NKDA

Discharge Medications:
1. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. hydralazine 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
5. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
6. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
10. codeine sulfate 30 mg Tablet Sig: One (1) Tablet PO Q4H
(every 4 hours) as needed for pain: prn.
11. glipizide 5 mg Tablet Sig: One (1) Tablet PO twice a day.
12. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a
day.
13. Insulin
Insulin SC Sliding Scale

Breakfast Lunch Dinner Bedtime

Regular

Glucose Insulin Dose

0-70      mg/dL Proceed with hypoglycemia protocol
71-119    mg/dL 0   Units 0   Units 0   Units 0   Units
120-159   mg/dL 2   Units 2   Units 2   Units 0   Units
160-199   mg/dL 4   Units 4   Units 4   Units 2   Units
200-239   mg/dL 6   Units 6   Units 6   Units 4   Units
240-280   mg/dL 8   Units 8   Units 8   Units 6   Units
> 280     mg/dL Notify M.D.
14. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for fever, pain.
15. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO Q12H (every 12 hours)
for 7 days.
16. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days.
17. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for dyspnea.
18. ipratropium bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for dyspnea.
19. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
20. lovastatin 40 mg Tablet Sig: Two (2) Tablet PO once a day.
21. FerrouSul 325 mg (65 mg Iron) Tablet Sig: One (1) Tablet PO
once a day.
22. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
Blueberry [**Doctor Last Name **] Healthcare - [**Hospital1 **]

Discharge Diagnosis:
Coronary Artery Disease


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


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**]
**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:

Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2177-4-7**] 2:45

Cardiologist: Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2385**], MD Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2177-5-13**] 11:20

Please call to schedule appointments with your
Primary Care Dr. [**First Name (STitle) **] in [**5-6**] weeks [**Telephone/Fax (1) 71156**]

**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:[**2177-3-22**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}


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/dyspnea on exertion

PRESENT ILLNESS: Mr. [**Known lastname 71155**] is a 74 year old man who presented to the emergency
department on [**2-5**] with chest pain and dyspnea on exertion over
the past couple of months and increasing over the past two
weeks. His cath on [**2177-2-7**] revealed three vessel
disease.

MEDICAL HISTORY: 1. Hypertension
2. Hyperlipidemia
3. Diabetes type 2
4. Anemia (Colonoscopy at BU about 3 yrs ago was negative)

MEDICATION ON ADMISSION: Imdur 30 mg Tablet Sustained Release 24 hr daily
Nitroglycerin 0.4 mg Sublingual PRN
Aspirin 325 mg daily
Amlodipine 10 mg daily
Minoxidil 10 mg daily
Gipizide 5 mg Tablet Extended Rel 24 hr daily
Hydralazine 50 mg [**Hospital1 **]
Metoprolol succinate 25 mg Tablet Sustained Release 24 hr daily
Lisinopril 80 mg daily
Lovastatin 80 mg daily
Metformin 1,000 mg [**Hospital1 **]
Ferrous sulfate 600 mg daily
Multivitamin Tablet daily

ALLERGIES: Soy / Propofol

PHYSICAL EXAM: VS WNL

FAMILY HISTORY: His father died at 78 from CAD. His mother died at 77 from a
CVA. A brother had CABG at 76. A sister also had a CABG at age
76.

SOCIAL HISTORY: He lives in [**Location 5450**] by the Sea with his wife. [**Name (NI) **] is a retired
bookkeeper.
-Tobacco history: Never smoker.
-ETOH: Denies.
-Illicit drugs: Denies. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
