CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: Mr. [**Known lastname 74255**] is an 82 year old male with recent admission to
[**Hospital6 33**] for chest pain. Myoview cardiac imaging was
equivocal and the patient was discharged with cardiology
follow-up. On the day of admission, cardiac catheterization at
[**Hospital6 33**] revealed left main and three vessel
coronary artery disease.  He was subsequently transferred for
surgical revascularization. On transfer, he was stable and pain
free on medical therapy.

MEDICAL HISTORY: Hypertension
Benign prostatic hyperplasia
Hyperlipidemia

MEDICATION ON ADMISSION: Avodart 0.5 daily
metoprolol 50mg [**Hospital1 **]
aspirin 325mg daily
lipitor 10mg hs
HCTZ 25mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:79 Resp:18  O2 sat: 100RA
B/P  Right:  169/64  Left:
Height:     Weight: 91kg

FAMILY HISTORY: Denies premature coronary artery disease

SOCIAL HISTORY: Race:aucasian
Lives with:wife -[**Name (NI) 90793**]
Contact:    wife                  Phone #[**Telephone/Fax (1) 90794**]
[**Name2 (NI) **]ttes: Smoked no [] yes [x-quit 60 years ago]
ETOH: < 1 drink/week []  [**3-4**] drinks/week [x] >8 drinks/week []
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Phlebitis and thrombophlebitis of upper extremities, unspecified,Unspecified transient mental disorder in conditions classified elsewhere,Cardiac complications, not elsewhere classified,Anemia, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Retention of urine, unspecified,Personal history of tobacco use,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,Phlbts vn NOS up extrm,Transient mental dis NOS,Surg compl-heart,Anemia NOS,Hypertension NOS,BPH w/o urinary obs/LUTS,Hyperlipidemia NEC/NOS,Retention urine NOS,History of tobacco use,Abn react-anastom/graft
Admission Date:  [**2165-8-29**]              Discharge Date:   [**2165-9-4**]

Date of Birth:  [**2083-4-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**8-30**]:Coronary artery bypass grafting x4 with left internal
mammary artery to left anterior descending coronary artery;
reverse saphenous vein single graft from aorta to first diagonal
coronary artery; reverse saphenous vein single graft from the
aorta to first obtuse
marginal coronary artery; reverse saphenous vein single graft
from aorta to the posterior descending coronary artery


History of Present Illness:
Mr. [**Known lastname 74255**] is an 82 year old male with recent admission to
[**Hospital6 33**] for chest pain. Myoview cardiac imaging was
equivocal and the patient was discharged with cardiology
follow-up. On the day of admission, cardiac catheterization at
[**Hospital6 33**] revealed left main and three vessel
coronary artery disease.  He was subsequently transferred for
surgical revascularization. On transfer, he was stable and pain
free on medical therapy.


Past Medical History:
Hypertension
Benign prostatic hyperplasia
Hyperlipidemia


Social History:
Race:aucasian
Lives with:wife -[**Name (NI) 90793**]
Contact:    wife                  Phone #[**Telephone/Fax (1) 90794**]
[**Name2 (NI) **]ttes: Smoked no [] yes [x-quit 60 years ago]
ETOH: < 1 drink/week []  [**3-4**] drinks/week [x] >8 drinks/week []


Family History:
Denies premature coronary artery disease

Physical Exam:
Pulse:79 Resp:18  O2 sat: 100RA
B/P  Right:  169/64  Left:
Height:     Weight: 91kg

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 [] grade ______
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: groin site   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:
[**2165-8-29**] WBC-8.9 RBC-4.82 Hgb-14.9 Hct-44.2 Plt Ct-234
[**2165-8-29**] PT-11.6 PTT-19.8* INR(PT)-1.0
[**2165-8-29**] Glucose-141* UreaN-14 Creat-1.0 Na-139 K-3.7 Cl-99
HCO3-29 A
[**2165-8-29**] ALT-15 AST-19 LD(LDH)-200 AlkPhos-53 TotBili-0.4
[**2165-8-29**] Albumin-4.5
[**2165-8-29**] %HbA1c-5.6 eAG-114
.
[**2165-9-3**] WBC-8.6 RBC-2.77* Hgb-8.7* Hct-24.9*  Plt Ct-193
[**2165-9-2**] WBC-11.1* RBC-3.12* Hgb-9.6* Hct-27.7* Plt Ct-157
[**2165-9-1**] WBC-11.0 RBC-2.96* Hgb-9.4* Hct-27.0* Plt Ct-161
[**2165-9-3**] Glucose-166* UreaN-23* Creat-1.0 Na-138 K-4.0 Cl-102
HCO3-26
[**2165-9-2**] Glucose-107* UreaN-23* Creat-1.1 Na-138 K-4.0 Cl-101
HCO3-27
[**2165-9-1**] Glucose-150* UreaN-15 Creat-1.0 Na-131* K-3.9 Cl-97
HCO3-27
[**2165-9-3**] 08:00AM BLOOD Mg-2.1
.


Brief Hospital Course:
The patient was admitted to the hospital and brought to the
operating room on [**2165-8-30**] where the patient underwent a coronary
artery bypass grafting x4 with left internal
mammary artery to left anterior descending coronary artery;
reverse saphenous vein single graft from aorta to first diagonal
coronary artery; reverse saphenous vein single graft from the
aorta to first obtuse marginal coronary artery; reverse
saphenous vein single graft from aorta to the posterior
descending coronary artery.
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, confused, oriented x 1 but breathing
comfortably. The patient was neurologically intact and
hemodynamically stable on no inotropic or vasopressor support.
He was kept in the CVICU for confusion/aggitation and treated
with Haldol.  Beta blocker was initiated and the patient was
gently diuresed toward the preoperative weight. Patient was
started on Amiodarone for paroxysmal atrial fibrillation.
Amiodarone was titrated while beta blockade was advanced as
tolerated. The patient was transferred to the telemetry floor
for further recovery. His mental status slowly improved and
Haldol was no longer required. He remained in a normal sinus
rhythm and no further episodes of atrial fibrillation were
noted. The patient was evaluated by the physical therapy service
for assistance with strength and mobility.  By the time of
discharge on postoperative five, the patient was ambulating
freely, the wound was healing and pain was controlled with
Tylenol.  The patient was discharged [**Hospital **] Healthcare Center
in good condition with appropriate follow up instructions.

Medications on Admission:
Avodart 0.5 daily
metoprolol 50mg [**Hospital1 **]
aspirin 325mg daily
lipitor 10mg hs
HCTZ 25mg daily


Discharge Medications:
1. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/temp.
9. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO twice a day:
400 mg twice a day for one week then decrease to 400 mg once a
day on [**9-11**], for one week then decrease to 200 mg daily on [**9-18**]
until follow up .
10. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
11. metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO twice a
day.
12. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day. Tablet(s)


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Healthcare

Discharge Diagnosis:
Coronary Artery Disease s/p CABG
Hypertension
Benign prostatic hyperplasia
Hyperlipidemia
Postop Atrial Fibrillation, resolved
Postop Confusion
Postop Right Arm Phlebitis


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Tylenol
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Trace
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
Surgeon: Dr [**Last Name (STitle) 914**] [**Telephone/Fax (1) 170**] [**2165-10-1**] @ 1PM
Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11300**] [**2165-10-8**] @ 12PM

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 32467**] in [**4-30**] weeks [**Telephone/Fax (1) 85079**]

**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:[**2165-9-4**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Phlebitis and thrombophlebitis of upper extremities, unspecified,Unspecified transient mental disorder in conditions classified elsewhere,Cardiac complications, not elsewhere classified,Anemia, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Retention of urine, unspecified,Personal history of tobacco use,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Mr. [**Known lastname 74255**] is an 82 year old male with recent admission to
[**Hospital6 33**] for chest pain. Myoview cardiac imaging was
equivocal and the patient was discharged with cardiology
follow-up. On the day of admission, cardiac catheterization at
[**Hospital6 33**] revealed left main and three vessel
coronary artery disease.  He was subsequently transferred for
surgical revascularization. On transfer, he was stable and pain
free on medical therapy.

MEDICAL HISTORY: Hypertension
Benign prostatic hyperplasia
Hyperlipidemia

MEDICATION ON ADMISSION: Avodart 0.5 daily
metoprolol 50mg [**Hospital1 **]
aspirin 325mg daily
lipitor 10mg hs
HCTZ 25mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:79 Resp:18  O2 sat: 100RA
B/P  Right:  169/64  Left:
Height:     Weight: 91kg

FAMILY HISTORY: Denies premature coronary artery disease

SOCIAL HISTORY: Race:aucasian
Lives with:wife -[**Name (NI) 90793**]
Contact:    wife                  Phone #[**Telephone/Fax (1) 90794**]
[**Name2 (NI) **]ttes: Smoked no [] yes [x-quit 60 years ago]
ETOH: < 1 drink/week []  [**3-4**] drinks/week [x] >8 drinks/week [] 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Phlebitis and thrombophlebitis of upper extremities, unspecified,Unspecified transient mental disorder in conditions classified elsewhere,Cardiac complications, not elsewhere classified,Anemia, unspecified,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Retention of urine, unspecified,Personal history of tobacco use,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
