CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 56 yo M with history of CAD s/p cath [**2096**] showing 3VD undergoing
medical managment, CHF with EF 20%, DM, and severe PVD presents
with intermittent chest pressure/tightness. The patient was in
USOH until the morning of admission when he suffered chest
tightness, progressive in freuqency over the day. The episode
that morning lasted five minutes, then resolved with nitro. The
next several episodes were also releived with nitro. He pain was
localized to the left size of his chest. He denies associated
SOB, LHD/dizziness, N/V, diaphoresis, palpitations.
Pt presented to the ER and was pain-free. In the ED, he was
afebrile, BP 163/86 HR 82, 99% RA. He was started on heparin gtt
and nitro gtt and given Lopressor 5mg IV and 25mg po as well as
aspirin.
Cardiac cath [**1-5**] showing 3VD and referred for coronary artery
bypass grafting.

MEDICAL HISTORY: 1. CAD s/p cardiac catheterization [**2096**] which demonstrated
severe 3V CAD, apical akinesis and 3+ MR -- treated medically.
2. CHF: Echo ([**8-21**]) EF 20%, mild LAD, severely dilated LV,
severe global LV hypokinesis, left ventricular systolic function
is severely depressed, 1+ MR
3. Diabetes Mellitus type I, has had for over 40 years, on
insulin pump.
4. Status post kidney transplant in [**2082**]
5. Severe PVD, s/p left BKA in [**2083**] and right BKA in [**2091**]
6. Status post left cataract removal in [**2093**], and now has a
significant right cataract

MEDICATION ON ADMISSION: Lipitor 10 mg daily, Digoxin 0.125 mg daily, Lopressor 25mg [**Hospital1 **],
Lasix 20 mg daily, Fosamax 70 mg qweek, Prednisone 5 mg daily,
Azothioprine 50mg daily, Aspirin 325 mg daily, Lisinopril 20 mg
a day, and Insulin via pump

ALLERGIES: Penicillins

PHYSICAL EXAM: Temp 98; BP 157/79; Pulse 65; Resp 18; O2 sat 100% RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes
moist
Neck - JVP 9cm, no cervical lymphadenopathy, no bruits
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, distant HS
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds, LLQ kidney palapble with scar C/D/I
Back - No costovertebral angle tendernes
Extr - bilateral stums, right side dressed with ACE banadage, no
edema
Neuro - non focal
Skin - No rash

FAMILY HISTORY: M- DM2, alive age 84
F- died 72 from lung cancer
3 brother alive and healthy

SOCIAL HISTORY: Lives with wife. Denies tobacco. Occ alcohol. On disability.
Prior banker. Lives at [**Hospital3 28354**] in [**Location (un) **] with wife, no
children. Has LE prosthesis.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Kidney replaced by transplant,Anemia, unspecified,Below knee amputation status
Crnry athrscl natve vssl,Intermed coronary synd,CHF NOS,DMI wo cmp nt st uncntrl,Kidney transplant status,Anemia NOS,Status amput below knee
Admission Date:  [**2103-1-4**]              Discharge Date:   [**2103-1-23**]

Date of Birth:  [**2046-6-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

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

Major Surgical or Invasive Procedure:
Cardiac catheterization.
Cornary artery bypass graft x 3.


History of Present Illness:
56 yo M with history of CAD s/p cath [**2096**] showing 3VD undergoing
medical managment, CHF with EF 20%, DM, and severe PVD presents
with intermittent chest pressure/tightness. The patient was in
USOH until the morning of admission when he suffered chest
tightness, progressive in freuqency over the day. The episode
that morning lasted five minutes, then resolved with nitro. The
next several episodes were also releived with nitro. He pain was
localized to the left size of his chest. He denies associated
SOB, LHD/dizziness, N/V, diaphoresis, palpitations.
Pt presented to the ER and was pain-free. In the ED, he was
afebrile, BP 163/86 HR 82, 99% RA. He was started on heparin gtt
and nitro gtt and given Lopressor 5mg IV and 25mg po as well as
aspirin.
Cardiac cath [**1-5**] showing 3VD and referred for coronary artery
bypass grafting.


Past Medical History:
1. CAD s/p cardiac catheterization [**2096**] which demonstrated
severe 3V CAD, apical akinesis and 3+ MR -- treated medically.
2. CHF: Echo ([**8-21**]) EF 20%, mild LAD, severely dilated LV,
severe global LV hypokinesis, left ventricular systolic function
is severely depressed, 1+ MR
3. Diabetes Mellitus type I, has had for over 40 years, on
insulin pump.
4. Status post kidney transplant in [**2082**]
5. Severe PVD, s/p left BKA in [**2083**] and right BKA in [**2091**]
6. Status post left cataract removal in [**2093**], and now has a
significant right cataract

Social History:
Lives with wife. Denies tobacco. Occ alcohol. On disability.
Prior banker. Lives at [**Hospital3 28354**] in [**Location (un) **] with wife, no
children. Has LE prosthesis.

Family History:
M- DM2, alive age 84
F- died 72 from lung cancer
3 brother alive and healthy

Physical Exam:
Temp 98; BP 157/79; Pulse 65; Resp 18; O2 sat 100% RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes
moist
Neck - JVP 9cm, no cervical lymphadenopathy, no bruits
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, distant HS
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds, LLQ kidney palapble with scar C/D/I
Back - No costovertebral angle tendernes
Extr - bilateral stums, right side dressed with ACE banadage, no
edema
Neuro - non focal
Skin - No rash

Pertinent Results:
[**2103-1-22**] 05:18AM BLOOD WBC-10.9 RBC-2.54* Hgb-8.1* Hct-25.1*
MCV-99* MCH-31.7 MCHC-32.1 RDW-15.3 Plt Ct-505*
[**2103-1-5**] 05:44PM BLOOD Neuts-83.3* Lymphs-12.8* Monos-3.1
Eos-0.4 Baso-0.4
[**2103-1-22**] 05:18AM BLOOD Plt Ct-505*
[**2103-1-22**] 05:18AM BLOOD Glucose-91 UreaN-21* Creat-1.1 Na-139
K-4.2 Cl-103 HCO3-30* AnGap-10
[**2103-1-12**] 02:58AM BLOOD ALT-13 AST-19 AlkPhos-28* Amylase-12
TotBili-0.3
[**2103-1-22**] 05:18AM BLOOD Calcium-8.6 Phos-3.8 Mg-1.8
[**2103-1-5**] 05:44PM BLOOD %HbA1c-6.3*

Brief Hospital Course:
Mr. [**Known lastname 57100**] is a 56 yo M with history of CAD s/p cath [**2096**] showing
3VD undergoing medical managment, CHF with EF 20%, DM, and
severe PVD.  He presented this admission with intermittent chest
pressure/tightness. The patient was in USOH until the morning of
admission when he suffered chest tightness, progressive in
freuqency over the day. The episode that morning lasted five
minutes, then resolved with nitro. The next several episodes
were also releived with nitro. He pain was localized to the left
size of his chest. He denies associated SOB, LHD/dizziness, N/V,
diaphoresis, palpitations.
Cardiac cath [**1-5**] showing 60% pLAD, 90% mLAD, subtotal occlusion
of D1 and D2, 60% D3, 70% OM4, 60% OM2, small OM1 and OM2, 80%
RCA.
He was referred for coronary artey bypass grafting at this time.
 Pre-op workup included carotid us (no evidence of stenosis in
eother carotid artery), LE vein studies, repeat echo (EF
20-25%), renal consult and ID consult.It was decide that patient
was safe to preceed to the OR.
He underwent a coronary artey bypass graft x 3 with LIMA to the
LAD, SVG to the RPL, and SVG to  the PDA  on [**2103-1-9**] with Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**].  Please see OR report for full details.
He was initially slow to [**Doctor Last Name **] from ventilator but was
successfully weened and extubated on the morning of post-op day
one.  [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 387**] consult was also obtained on that day for optimal
glucose management.
One POD 2, he remained hemodynamically stable.  And underwent
initial evaluation by physical therpay.
POD 3 was significant for sternal drainage and strict sternal
precations were initiated as well as IV vancomycin.
On POD day 4 he was transferred to the floor for ongoing
recovery and rehabilitation.
The next several days were uneventful with ongoing physical
therapy and monitoring of sternal wound with administration of
intravenous vancomycin.  He also continued to be closely
followed by the [**Last Name (un) **] team and was restarted on his insulin
pump on POD 7.
Mr. [**Known lastname 57100**] had an open wound on his right BKA stump for which
vascular was following him and on POD 11 ([**2103-1-19**]) it was decided
that he resume use of prosthesis on that side, allowing for
significantly increased ability to ambulate and participate in
physical therapy.
His last documented sternal drainage was [**2103-1-19**].  He was
continued in vancomycin for the full 14 day course and it was
discontined on [**1-23**].  It was felt that Mr. [**Known lastname 57100**] would be safe
for discharge to rehabilitation at this time but there was some
difficulty finding a rehabilitation facility that would
accomodate him.
On POD 14, following discontinuation of vancomycin and increase
in activity with bilateral prostheses in place, Mr. [**Known lastname 57100**] is
awaiting a rehabilitation bed.

Medications on Admission:
Lipitor 10 mg daily, Digoxin 0.125 mg daily, Lopressor 25mg [**Hospital1 **],
Lasix 20 mg daily, Fosamax 70 mg qweek, Prednisone 5 mg daily,
Azothioprine 50mg daily, Aspirin 325 mg daily, Lisinopril 20 mg
a day, and Insulin via pump

Discharge Medications:
1. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 2
weeks.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
4. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 3 months.
5. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. Prednisone 2.5 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
7. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
8. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 2 weeks.
10. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO DAILY (Daily).
11. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).

13. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Azathioprine 50 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 2716**] [**Last Name (un) **] - [**Location (un) 55**]

Discharge Diagnosis:
1. CAD, s/p Coronary artery bypass graft x 3.
2. CHF EF 20%/post-op EF 40%.
3. Diabetes Mellitus type I
4. Status post kidney transplant in [**2082**]
5. Severe PVD, s/p left BKA in [**2083**] and right BKA in [**2091**]


Discharge Condition:
Good

Discharge Instructions:
Shower daily and wash incisionw with soap and water -- rinse
well.  Do NOT apply any creams, lotions, powders, or ointments.
No swimming or bathing in a tub.
No driving for 6 weeks.
No lifting greater than 5 pounds.
Strict sternal precautions -- limited use of upper extremities.

Followup Instructions:
Schedule appointment with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 284**] ([**Telephone/Fax (1) 285**])
following discharge from rehab.
Schedule appointment with Dr. [**Last Name (STitle) 70**] in 4 weeks.
Schedule appointment with Dr. [**Last Name (STitle) 16004**] in [**12-22**] weeks.



Completed by:[**2103-1-23**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Kidney replaced by transplant,Anemia, unspecified,Below knee amputation status'}


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: 56 yo M with history of CAD s/p cath [**2096**] showing 3VD undergoing
medical managment, CHF with EF 20%, DM, and severe PVD presents
with intermittent chest pressure/tightness. The patient was in
USOH until the morning of admission when he suffered chest
tightness, progressive in freuqency over the day. The episode
that morning lasted five minutes, then resolved with nitro. The
next several episodes were also releived with nitro. He pain was
localized to the left size of his chest. He denies associated
SOB, LHD/dizziness, N/V, diaphoresis, palpitations.
Pt presented to the ER and was pain-free. In the ED, he was
afebrile, BP 163/86 HR 82, 99% RA. He was started on heparin gtt
and nitro gtt and given Lopressor 5mg IV and 25mg po as well as
aspirin.
Cardiac cath [**1-5**] showing 3VD and referred for coronary artery
bypass grafting.

MEDICAL HISTORY: 1. CAD s/p cardiac catheterization [**2096**] which demonstrated
severe 3V CAD, apical akinesis and 3+ MR -- treated medically.
2. CHF: Echo ([**8-21**]) EF 20%, mild LAD, severely dilated LV,
severe global LV hypokinesis, left ventricular systolic function
is severely depressed, 1+ MR
3. Diabetes Mellitus type I, has had for over 40 years, on
insulin pump.
4. Status post kidney transplant in [**2082**]
5. Severe PVD, s/p left BKA in [**2083**] and right BKA in [**2091**]
6. Status post left cataract removal in [**2093**], and now has a
significant right cataract

MEDICATION ON ADMISSION: Lipitor 10 mg daily, Digoxin 0.125 mg daily, Lopressor 25mg [**Hospital1 **],
Lasix 20 mg daily, Fosamax 70 mg qweek, Prednisone 5 mg daily,
Azothioprine 50mg daily, Aspirin 325 mg daily, Lisinopril 20 mg
a day, and Insulin via pump

ALLERGIES: Penicillins

PHYSICAL EXAM: Temp 98; BP 157/79; Pulse 65; Resp 18; O2 sat 100% RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes
moist
Neck - JVP 9cm, no cervical lymphadenopathy, no bruits
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, distant HS
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds, LLQ kidney palapble with scar C/D/I
Back - No costovertebral angle tendernes
Extr - bilateral stums, right side dressed with ACE banadage, no
edema
Neuro - non focal
Skin - No rash

FAMILY HISTORY: M- DM2, alive age 84
F- died 72 from lung cancer
3 brother alive and healthy

SOCIAL HISTORY: Lives with wife. Denies tobacco. Occ alcohol. On disability.
Prior banker. Lives at [**Hospital3 28354**] in [**Location (un) **] with wife, no
children. Has LE prosthesis. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Kidney replaced by transplant,Anemia, unspecified,Below knee amputation status'}
