CHIEF COMPLAINT: New onset chest pain with activity for 3-4 months w/+ stress
test

PRESENT ILLNESS: 46 yo male with asthma,
hyperlipidemia, and positive family history of CAD who has had
3-4 months of chest pain that radiated to left arm and jaw w/
activity. Had positive stress test w/ Dr. [**Last Name (STitle) 76257**]. Had left
heart catheterization w/ 3 vessel disease.

MEDICAL HISTORY: asthma, hypertension, hyperlipidemia

MEDICATION ON ADMISSION: simvastatin 40', atenolol 25', ASA, Proair

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: father + CAD

SOCIAL HISTORY: lives with wife and 2 children.
works in softwear field.
non- smoker, non- drinker.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,Hyperlipidemia NEC/NOS,Asthma NOS,Fam hx-ischem heart dis,Hypertension NOS
Admission Date:  [**2155-8-27**]              Discharge Date:   [**2155-9-2**]

Date of Birth:  [**2109-1-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
New onset chest pain with activity for 3-4 months w/+ stress
test

Major Surgical or Invasive Procedure:
Coronary artery disease s/p coronary artery bypass graft x 3
(LIMA-LAD, SVG-RI, SVG-PDA)


History of Present Illness:
46 yo male with asthma,
hyperlipidemia, and positive family history of CAD who has had
3-4 months of chest pain that radiated to left arm and jaw w/
activity. Had positive stress test w/ Dr. [**Last Name (STitle) 76257**]. Had left
heart catheterization w/ 3 vessel disease.


Past Medical History:
asthma, hypertension, hyperlipidemia

Social History:
lives with wife and 2 children.
works in softwear field.
non- smoker, non- drinker.

Family History:
father + CAD

Physical Exam:
Physical Exam

Pulse: Resp:  O2 sat:
B/P  Right:    Left:
Height:  5' 6"   Weight: 77.10 kg

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular [x]  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [], well-perfused []  Edema Varicosities: None
[]
Neuro: Grossly intact
Pulses:
Femoral      Right:  mynx device Left: +2
DP           Right:  +2 Left:+2
PT           [**Name (NI) 167**]:   +2 Left:+2
Radial       Right: +2  Left:+2

Carotid Bruit none       Right: +2   Left:+2


Pertinent Results:
[**2155-8-27**] 05:15PM   PT-12.8 PTT-31.8 INR(PT)-1.1
[**2155-8-27**] 05:15PM   PLT COUNT-261
[**2155-8-27**] 05:15PM   WBC-6.4 RBC-4.72 HGB-14.8 HCT-43.4 MCV-92
MCH-31.3 MCHC-34.1 RDW-12.5
[**2155-8-27**] 05:15PM   %HbA1c-5.5
[**2155-8-27**] 05:15PM   ALBUMIN-4.7 MAGNESIUM-2.4
[**2155-8-27**] 05:15PM   ALT(SGPT)-31 AST(SGOT)-19 LD(LDH)-157 ALK
PHOS-64 AMYLASE-68 TOT BILI-0.6
[**2155-8-27**] 05:15PM   GLUCOSE-92 UREA N-12 CREAT-1.2 SODIUM-142
POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-27 ANION GAP-14
[**2155-8-27**] 09:47PM URINE  RBC-0-2 WBC-0-2 BACTERIA-NONE YEAST-NONE
EPI-0-2
[**2155-8-27**] 09:47PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG

[**2155-9-1**] 03:58PM BLOOD WBC-7.8 RBC-3.44* Hgb-10.5* Hct-30.8*
MCV-90 MCH-30.5 MCHC-34.0 RDW-13.6 Plt Ct-266#
[**2155-9-1**] 03:58PM BLOOD Plt Ct-266#
[**2155-8-29**] 12:32PM BLOOD PT-14.3* PTT-39.5* INR(PT)-1.2*
[**2155-9-1**] 05:46AM BLOOD Glucose-98 UreaN-11 Creat-1.1 Na-140
K-4.5 Cl-106 HCO3-27 AnGap-12
 Final Report
PA AND LATERAL CHEST FROM [**9-1**]
HISTORY: Question interval change after CABG.
IMPRESSION: PA and lateral chest compared to [**8-29**] and
19:
Small bilateral pleural effusions have probably increased since
[**8-27**].
No pneumothorax. Moderate bibasilar atelectasis, left greater
than right,
slightly improved. The lungs are clear of pneumonia or edema.
There may be
bronchiectasis in the right middle lung, not an acute finding.
Cardiomediastinal silhouette has a normal postoperative
appearance. Right
jugular line ends at the superior cavoatrial junction. No
pneumothorax.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Echo
Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.
LEFT VENTRICLE: Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal ascending aorta diameter. Simple atheroma in
descending aorta.
AORTIC VALVE: Trace AR.
MITRAL VALVE: 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
Pe-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
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.
Trace aortic regurgitation is seen.
Trivial mitral regurgitation is seen.
There is no pericardial effusion.
Post-CPB:
Normal biventricular systolic fxn.
Trace MR [**First Name (Titles) **] [**Last Name (Titles) **]. Aorta intact.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD



Brief Hospital Course:
Mr. [**Known lastname 84491**] was admitted to [**Hospital1 18**] after cardaic cath at MWMC was
postive for 3 vessel disease. He remained pain free, was started
on IV heparin and was taken to the OR on [**2155-8-29**] for CABG
X3(LIMA-LAD, SVG to RI, SVG to PDA). See operative note for
details. He was weaned and extubated and transferred to the step
down unit on POD#1. He was started on betablockers, and diuresed
toward his pre-op weight. Statin therapy was resumed. His chest
tubes and pacing wires were removed per protocol. His activity
level was gradually advanced and he was evaluated by physical
therapy for stength and conditioning prior to discharge to home
on POD#4.


Medications on Admission:
simvastatin 40', atenolol 25', ASA, Proair

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:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
6. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours).
Disp:*qs qs* Refills:*0*
7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Lopressor 50 mg Tablet Sig: 2.5 Tablets PO twice a day:
please take 125 mg dose which is two tablets and a [**12-13**] tablet.
Disp:*150 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA, [**Hospital1 1559**]

Discharge Diagnosis:
asthma, hyperlipidemia, hypertension
Coronary artery disease s/p coronary artery bypass graft x 3
(LIMA-LAD, SVG-RI, SVG-PDA)


Discharge Condition:
good


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.

Followup Instructions:
Please call to schedule appointments
[**Telephone/Fax (1) **] Dr [**Last Name (STitle) **] in [**1-14**] weeks at [**Hospital1 **] heart center
([**Telephone/Fax (2) 6256**])
Primary care Dr [**Last Name (STitle) **] in [**12-13**] weeks
Cardiologist Dr [**Last Name (STitle) 76257**] 1-2 weeks [**Hospital1 **] heart center
([**Telephone/Fax (2) 6256**])



Completed by:[**2155-9-2**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Unspecified essential hypertension'}


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: New onset chest pain with activity for 3-4 months w/+ stress
test

PRESENT ILLNESS: 46 yo male with asthma,
hyperlipidemia, and positive family history of CAD who has had
3-4 months of chest pain that radiated to left arm and jaw w/
activity. Had positive stress test w/ Dr. [**Last Name (STitle) 76257**]. Had left
heart catheterization w/ 3 vessel disease.

MEDICAL HISTORY: asthma, hypertension, hyperlipidemia

MEDICATION ON ADMISSION: simvastatin 40', atenolol 25', ASA, Proair

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: father + CAD

SOCIAL HISTORY: lives with wife and 2 children.
works in softwear field.
non- smoker, non- drinker. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Unspecified essential hypertension'}
