CHIEF COMPLAINT: 43M with R flank pain and recent chest pain

PRESENT ILLNESS: 43 year old male with h/o DMII, HTN,
Hyperlipidemia and recent nephrolithiasis who was admitted to
[**Hospital1 18**] [**9-8**] with recurrent right flank pain and chest pain.

MEDICAL HISTORY: DMII (diet controlled)
Hypertension
Hyperlipidemia
Fatty liver
H/o alcohol abuse(quit 23 years ago)
H/o renal colic in the past
Right ureteral stent placement [**8-/2173**] due to right sided
nephrolithiasis

MEDICATION ON ADMISSION: Simvastatin 40mg po daily
ASA 81 mg po daily
MVI

ALLERGIES: Percocet / Vicodin / Levofloxacin / Oxycodone

PHYSICAL EXAM: Vitals: T:97 BP:145/86 P:76 R:18 O2:95%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, tongue midline
and pink
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, +mild suprapubic tenderness, otherwise nt/nd,
bs+; liver edge 1cm below costal margin by percussion and
palpatation
Back: no CVA tenderness, no paraspinal tenderness
Ext: WWP, no peripheral edema, 2+ pulses

FAMILY HISTORY: Uncles with MI.
Parents with DM and HTN.
Older borther with kidney stones.

SOCIAL HISTORY: Lives in [**Location (un) 8973**] City with his fiancee.
He works as an administrator at a recovery facility for
alcoholics and people with drug abuse problems. [**Name (NI) **] himself used
to be an alcoholic, but had his last drink 23 years ago.
He also used to smoke 2ppd for 21 years, but quit 9 years ago.
He also used illicit drugs, but never IVDU.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Calculus of ureter,Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Old myocardial infarction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Alcoholic fatty liver,Other and unspecified alcohol dependence, in remission,Esophageal reflux,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,Calculus of ureter,Hemorrhage complic proc,Effusion NEC exc tb,Old myocardial infarct,Hyperlipidemia NEC/NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Alcoholic fatty liver,Alcoh dep NEC/NOS-remiss,Esophageal reflux,Abn react-anastom/graft
Admission Date:  [**2173-9-8**]              Discharge Date:   [**2173-9-23**]

Date of Birth:  [**2129-9-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Percocet / Vicodin / Levofloxacin / Oxycodone

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
43M with R flank pain and recent chest pain

Major Surgical or Invasive Procedure:
[**2173-9-17**]
1. Coronary artery bypass grafting x4 with left internal mammary
artery to left anterior descending coronary artery; reverse
saphenous vein single graft from the aorta to the first diagonal
coronary artery; reverse saphenous vein single graft from aorta
to the second
obtuse marginal coronary artery; as well as reverse saphenous
vein graft to the distal right coronary artery.
2. Endoscopic left greater saphenous vein harvesting.

[**2173-9-14**]
Cardiac Catheterization


History of Present Illness:
43 year old male with h/o DMII, HTN,
Hyperlipidemia and recent nephrolithiasis who was admitted to
[**Hospital1 18**] [**9-8**] with recurrent right flank pain and chest pain.

He was originally admitted to [**Location (un) 8973**] Hospital one week prior
and found to have a right 8mm UPJ stone and 9mm lower pole stone
in the kidney.  He underwent right ureteral stent placement.  He
has continued to have right flank pain and hematuria and
returned
to the emergency [****].

In the ED, he experienced a 3 hour episode of substernal chest
pressure.  He reports it started shortly after eating breakfast.

It was accompanied by nausea, which he feels may be related to
the pain medication he was given.  He also reports associated
shortness of breath.This resolved prior to the resolution of the
chest pain.  He denies pain radiation,vomiting or diaphoresis.

He has multiple risk factors for CAD including HTN, T2DM, fatty
liver, and recent significant family stress.  In addition, his
ECGs are concerning for coronary ischemia given the dynamic
changes with his episode of chest pressure.  His troponin
also elevated somewhat from his admission troponin, and on [**9-13**]
+Stress Test. Cardiac cath was performed on [**9-14**]. Significant
coronary artery disease was revealed. Cardiac surgery was
consulted for revascularization.


Past Medical History:
DMII (diet controlled)
Hypertension
Hyperlipidemia
Fatty liver
H/o alcohol abuse(quit 23 years ago)
H/o renal colic in the past
Right ureteral stent placement [**8-/2173**] due to right sided
nephrolithiasis

PSH:
cystogram
retrograde pyelogram- R stent-[**2173-9-9**]


Social History:
Lives in [**Location (un) 8973**] City with his fiancee.
He works as an administrator at a recovery facility for
alcoholics and people with drug abuse problems. [**Name (NI) **] himself used
to be an alcoholic, but had his last drink 23 years ago.
He also used to smoke 2ppd for 21 years, but quit 9 years ago.
He also used illicit drugs, but never IVDU.

Family History:
Uncles with MI.
Parents with DM and HTN.
Older borther with kidney stones.

Physical Exam:
Vitals: T:97 BP:145/86 P:76 R:18 O2:95%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, tongue midline
and pink
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, +mild suprapubic tenderness, otherwise nt/nd,
bs+; liver edge 1cm below costal margin by percussion and
palpatation
Back: no CVA tenderness, no paraspinal tenderness
Ext: WWP, no peripheral edema, 2+ pulses

Pertinent Results:
Admission Labs:
 - [**2173-9-8**] 08:40PM   GLUCOSE-91 UREA N-9 CREAT-0.7 SODIUM-135
(repeat 5.6*) POTASSIUM-8.0* CHLORIDE-102 TOTAL CO2-23 ANION
GAP-18
 - [**2173-9-8**] 08:40PM   WBC-8.8 RBC-5.03 HGB-15.6 HCT-44.3 MCV-88
MCH-31.0 MCHC-35.2* RDW-14.2 PLT COUNT-336
 - [**2173-9-8**] 05:47PM URINE  COLOR-Straw APPEAR-Clear SP
[**Last Name (un) 155**]-1.008 BLOOD-LG NITRITE-NEG PROTEIN-75 GLUCOSE-NEG
KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-MOD RBC->50
WBC-[**6-3**]* BACTERIA-FEW YEAST-NONE EPI-0-2
[**2173-9-9**] 09:00AM BLOOD cTropnT-<0.01
[**2173-9-9**] 04:00PM BLOOD cTropnT-0.02*
[**2173-9-11**] 11:51AM BLOOD %HbA1c-6.3* eAG-134*

Discharge Labs:
[**2173-9-22**] 03:56AM BLOOD WBC-6.9 RBC-2.97* Hgb-8.9* Hct-26.4*
MCV-89 MCH-29.9 MCHC-33.6 RDW-15.5 Plt Ct-416
[**2173-9-22**] 03:56AM BLOOD Plt Ct-416
[**2173-9-20**] 02:10AM BLOOD PT-13.5* PTT-24.7 INR(PT)-1.2*
[**2173-9-22**] 03:56AM BLOOD Glucose-125* UreaN-18 Creat-0.6 Na-140
K-3.7 Cl-101 HCO3-31 AnGap-12
[**2173-9-14**] 06:49PM BLOOD ALT-48* AST-38 LD(LDH)-203 AlkPhos-104
Amylase-53 TotBili-0.9

Radiology
[**2173-9-8**] KUB: Renal stent in proper position.

Radiology Report CHEST (PA & LAT) Study Date of [**2173-9-21**] 3:13 PM

[**Hospital 93**] MEDICAL CONDITION: 44 year old man with s/p cabg
REASON FOR THIS EXAMINATION:    eval for effusion POD 4 s/p cabg

Final Report FINDINGS: Right middle lobe opacification with
sharp lateral edge is again seen and stable since [**2173-9-9**],
possibly atelectasis versus fibrosis. Slight reduction in
retrocardiac opacification likely due to decrease in left
pleural effusion and atelectasis. Stable postoperative
mediastinal widening. Stable moderate-to-large cardiac
silhouette. Hilar contours are normal.
IMPRESSION: Decreased retrocardiac opacity likely due to
decreased effusion and atelectasis. Stable right mid lung
opacification of unclear etiology may represent scarring.
Consider chest CT to better evaluate when patient clinically
appropriate.
DR. [**First Name (STitle) 10900**] BISHOP

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Date/Time: [**2173-9-17**] at 10:11    Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**],
MD
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  0.8 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *5.7 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  4.0 cm
Left Ventricle - Fractional Shortening:  0.30  >= 0.29
Left Ventricle - Ejection Fraction:  55%  >= 55%
Left Ventricle - Stroke Volume:  66 ml/beat
Aorta - Sinus Level:  3.2 cm  <= 3.6 cm
Aorta - Ascending:  2.3 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.1 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  5 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  3 mm Hg
Aortic Valve - LVOT VTI:  21
Aortic Valve - LVOT diam:  2.0 cm
Aortic Valve - Valve Area:  *2.8 cm2  >= 3.0 cm2
Mitral Valve - MVA (P [**12-26**] T):  3.3 cm2
Mitral Valve - E Wave:  0.7 m/sec
Mitral Valve - A Wave:  0.4 m/sec
Mitral Valve - E/A ratio:  1.75
Findings
LEFT ATRIUM: No spontaneous echo contrast or thrombus in the
body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. Good (>20 cm/s) LAA ejection velocity.
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.
LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal ascending aorta diameter. Normal descending aorta
diameter. Simple atheroma in descending aorta.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
MITRAL VALVE: No MVP. No MS. Trivial MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
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. Results were personally reviewed with the MD
caring for the patient.
Conclusions
Pre CPB:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium or left atrial appendage.
No atrial septal defect is seen by 2D or color Doppler.
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation.
There is no mitral valve prolapse. Trivial mitral regurgitation
is seen.
Dr. [**Last Name (STitle) 914**] was notified in person of the results.
Post CPB:
Preserved biventricular systolic function. LVEF 55%
Intact thoracic aorta.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2173-9-17**] 18:35



Brief Hospital Course:
43 year old male who was admitted to [**Hospital1 18**] [**9-8**] with recurrent
right flank pain and chest pain.
Originally admitted to [**Location (un) 8973**] Hospital one week prior found
to have a right 8mm UPJ stone and 9mm lower pole stone in the
kidney.  He underwent right ureteral stent placement.  He has
continued to have right flank pain and hematuria and returned
to the emergency [****].
In the ED, he experienced a 3 hour episode of substernal chest
pressure. His ECGs were concerning for coronary ischemia.  His
troponin was elevated somewhat on [**9-13**] he had a +Stress Test.
Cardiac cath was performed on [**9-14**]. Significant coronary artery
disease was revealed. Cardiac surgery was consulted for
revascularization.
He was brought to the operating room on [**9-17**] for coronary artery
bypass grafting.
Please see operative report for details, in summary he had:
1. Coronary artery bypass grafting x4 with left internal mammary
artery to left anterior descending coronary artery; reverse
saphenous vein single graft from the
    aorta to the first diagonal coronary artery; reverse
saphenous vein single graft from aorta to the second obtuse
marginal coronary artery; as well as reverse
saphenous vein graft to the distal right coronary artery.
2. Endoscopic left greater saphenous vein harvesting.
His BYPASS TIME was 89 minutes with a CROSSCLAMP TIME of 74
minutes. He tolerated the operation well and post-operatively
was transferred to the cardiac surgery ICU in stable condition.
He remained hemodynamically stable in the immediate post-op
period. On the day of surgery he woke neurologically intact and
was extubated. He required low dose Neosynephrine to support his
blood pressure and stayed in the ICU on POD1. All tubes lines
nad drains were removed per cardiac surgery protocol.
After his chest tubes were removed he developed white out of the
left side and a chest tube was placed, it subsequently drained
1.5L of serosang fluid. On POD 3 he was transferred from the ICU
to the stepdown floor. Once on the stepdown floor he worked with
the nursing and physical therapy staff to regain his strenghth
and mobility. The remainder of his post-operative course was
uneventful.
He was discharged home with services on POD6. He is to follow up
with Dr [**Last Name (STitle) 914**] in 3 weeks.


Medications on Admission:
Simvastatin 40mg po daily
ASA 81 mg po daily
MVI


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
4. 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*
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
8. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical DAILY (Daily) for 2
weeks.
Disp:*14 Adhesive Patch, Medicated(s)* Refills:*0*
9. Potassium Chloride 10 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO once a day for 2
weeks.
10. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).
Disp:*270 Tablet(s)* Refills:*2*
11. Fentanyl 25 mcg/hr Patch 72 hr Sig: One (1) patch
Transdermal every seventy-two (72) hours for 2 weeks.
Disp:*4 patches* Refills:*0*
12. Ibuprofen 600 mg Tablet Sig: Six Hundred (600) mg PO Q8H
(every 8 hours) as needed for pain.


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
s/p coronary bypass graft x4
PMH:
Coronary Artery disease
DMII (diet controlled)
Hypertension
Hyperlipidemia
Fatty liver
H/o alcohol abuse(quit 23 years ago)
H/o renal colic in the past
Right ureteral stent placement [**8-/2173**] due to right sided
nephrolithiasis
PSH: cystogram
retrograde pyelogram R stent-[**2173-9-9**]


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



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**] on [**10-12**] at 1:30pm
Cardiologist: need to identify cardiologist

Please call to schedule appointments with your
Primary Care Dr.[**First Name8 (NamePattern2) 3095**] [**Last Name (NamePattern1) **] in [**3-29**] weeks
Urologist as needed

**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:[**2173-9-23**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Calculus of ureter,Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Old myocardial infarction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Alcoholic fatty liver,Other and unspecified alcohol dependence, in remission,Esophageal reflux,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: 43M with R flank pain and recent chest pain

PRESENT ILLNESS: 43 year old male with h/o DMII, HTN,
Hyperlipidemia and recent nephrolithiasis who was admitted to
[**Hospital1 18**] [**9-8**] with recurrent right flank pain and chest pain.

MEDICAL HISTORY: DMII (diet controlled)
Hypertension
Hyperlipidemia
Fatty liver
H/o alcohol abuse(quit 23 years ago)
H/o renal colic in the past
Right ureteral stent placement [**8-/2173**] due to right sided
nephrolithiasis

MEDICATION ON ADMISSION: Simvastatin 40mg po daily
ASA 81 mg po daily
MVI

ALLERGIES: Percocet / Vicodin / Levofloxacin / Oxycodone

PHYSICAL EXAM: Vitals: T:97 BP:145/86 P:76 R:18 O2:95%RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, tongue midline
and pink
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, +mild suprapubic tenderness, otherwise nt/nd,
bs+; liver edge 1cm below costal margin by percussion and
palpatation
Back: no CVA tenderness, no paraspinal tenderness
Ext: WWP, no peripheral edema, 2+ pulses

FAMILY HISTORY: Uncles with MI.
Parents with DM and HTN.
Older borther with kidney stones.

SOCIAL HISTORY: Lives in [**Location (un) 8973**] City with his fiancee.
He works as an administrator at a recovery facility for
alcoholics and people with drug abuse problems. [**Name (NI) **] himself used
to be an alcoholic, but had his last drink 23 years ago.
He also used to smoke 2ppd for 21 years, but quit 9 years ago.
He also used illicit drugs, but never IVDU. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Calculus of ureter,Hemorrhage complicating a procedure,Other specified forms of effusion, except tuberculous,Old myocardial infarction,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Alcoholic fatty liver,Other and unspecified alcohol dependence, in remission,Esophageal reflux,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'}
