CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 65M w/ HTN, newly diagnosed T2DM, who presented to his PCP's
office today for symptoms of CP that he attributed to GERD. Pt
developed epigastric pain on Tuesday after dinner and had
vomitting X 1. Pain resolved on its own but recurred again so
the pt saw his PCP [**Name Initial (PRE) 3011**]. However, as the pt was not prone to
GERD and had been having sx of DOE over the past 6 months, he
got an EKG which showed some "lateral changes". He was referred
to [**Hospital1 18**] for further workup. Over the past year or so, pt has
been having increasing dyspnea on exertion and gets SOB after
walking about a [**Age over 90 **] yards. Pt has chronic back pain, and
therefore exercises minimally. In the ED, Labs were significant
for trop of 0.26,EKG changes consistent with a diagnosis of
NSTEMI. He was admitted for further cardiac workup. Cardiac cath
today reveals significant coronary artery disease. Cardiac
surgery was consulted for evaluation of coronary
revascularization.

MEDICAL HISTORY: Hypertension
Diabetes Mellitus 2
Kidney stones (remote)
Lumbar Back Pain
Selective paraspinal muscular atrophy/weakness syndrome

MEDICATION ON ADMISSION: ATENOLOL 25 DAILY
VIT D3 DAILY
FLUTICASONE PRN
LISINOPRIL 10 DAILY
TRAZODONE 100MG QHS PRN
BABY ASA
MULTI VIT

ALLERGIES: Morphine / Bactrim

PHYSICAL EXAM: VS: BP= 122/77 HR= 58 RR= 16 O2 sat= 98% on 3L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is no family history of dementia. His father died of
cancer at age 60. His brother has a history of stroke and
diabetes.

SOCIAL HISTORY: Recently retired gentleman; lives in [**Location 13044**] with wife.
Ashkenazi [**Hospital1 **] descent.
-Tobacco history: ex smoker 25 years back (20 pack years)
-ETOH: occasional
-Illicit drugs: none
Subendocardial infarction, initial episode of care,Spinal muscular atrophy, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lumbago,Personal history of tobacco use,Pure hyperglyceridemia
Subendo infarct, initial,Spinal muscl atrophy NOS,Crnry athrscl natve vssl,Hypertension NOS,DMII wo cmp nt st uncntr,Lumbago,History of tobacco use,Pure hyperglyceridemia
Admission Date:  [**2110-2-13**]              Discharge Date:   [**2110-2-22**]

Date of Birth:  [**2044-10-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Morphine / Bactrim

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

Major Surgical or Invasive Procedure:
[**2110-2-14**] Cardiac cath
[**2110-2-18**] Coronary bypass grafting x3 with left internal mammary
artery to left anterior descending coronary artery; reverse
saphenous vein single graft from aorta to first obtuse marginal
coronary; reverse saphenous vein single graft from aorta to
distal right coronary artery

History of Present Illness:
65M w/ HTN, newly diagnosed T2DM, who presented to his PCP's
office today for symptoms of CP that he attributed to GERD. Pt
developed epigastric pain on Tuesday after dinner and had
vomitting X 1. Pain resolved on its own but recurred again so
the pt saw his PCP [**Name Initial (PRE) 3011**]. However, as the pt was not prone to
GERD and had been having sx of DOE over the past 6 months, he
got an EKG which showed some "lateral changes". He was referred
to [**Hospital1 18**] for further workup. Over the past year or so, pt has
been having increasing dyspnea on exertion and gets SOB after
walking about a [**Age over 90 **] yards. Pt has chronic back pain, and
therefore exercises minimally. In the ED, Labs were significant
for trop of 0.26,EKG changes consistent with a diagnosis of
NSTEMI. He was admitted for further cardiac workup. Cardiac cath
today reveals significant coronary artery disease. Cardiac
surgery was consulted for evaluation of coronary
revascularization.

Past Medical History:
Hypertension
Diabetes Mellitus 2
Kidney stones (remote)
Lumbar Back Pain
Selective paraspinal muscular atrophy/weakness syndrome

Social History:
Recently retired gentleman; lives in [**Location 13044**] with wife.
Ashkenazi [**Hospital1 **] descent.
-Tobacco history: ex smoker 25 years back (20 pack years)
-ETOH: occasional
-Illicit drugs: none

Family History:
There is no family history of dementia. His father died of
cancer at age 60. His brother has a history of stroke and
diabetes.

Physical Exam:
VS: BP= 122/77 HR= 58 RR= 16 O2 sat= 98% on 3L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple
CARDIAC: RRR, normal S1, S2. No m/r/g.
LUNGS:CTA
ABDOMEN: Soft, NTND.
EXTREMITIES: No c/c/e. No varicosities noted

PULSES:
Right: Carotid 2+ Femoral 2+  DP 2+
Left: Carotid 2+ Femoral 2+ DP 2+

Discharge Exam:
VS: T: 98.5  HR: 62-80 SR BP: 91-138/60 RR: 18 Sats: 98% RA
General: 65 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Card: RRR normal S1,S2 no murmur or gallop
Resp: decreased breath sounds at bases no crackles
GI: benign
Extr: warm 2+ edema bilateral, DP's 2+ (B)
Wound: sternal incision clean, dry, no erythema or click
Skin: multiple skin tears
Neuro: non-focal

Pertinent Results:
Echo [**2110-2-18**]: PRE-BYPASS: The left atrium is elongated. No
spontaneous echo contrast is seen in the body of the left atrium
or left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal. There
is mild regional left ventricular systolic dysfunction with
hypokinesis of the mid anteroseptal wall, distal septal and
anterior walls, and hypokinesis of the apex. Overall left
ventricular systolic function is mildly depressed (LVEF= 45-50
%). Right ventricular chamber size and free wall motion are
normal. There are simple atheroma in the descending thoracic
aorta. The aortic valve leaflets (3) are mildly thickened. There
is no aortic valve stenosis. Trace aortic regurgitation is seen.
The mitral valve leaflets are structurally normal. Mild (1+)
mitral regurgitation is seen. There is no pericardial effusion.
The coronary sinus is not dilated. Dr. [**Last Name (STitle) 914**] was notified in
person of the results at time of surgery.
POST-BYPASS: Post bypass patient is AV paced and receiving an
infusion of phenylephrine. LVEF= 50%. Mild mitral regurgitation
persists. Aorta intact post decannulation.
.
[**2110-2-14**] Cardiac cath: Total occluded LAD, 80% OMB, 90% RCA, for
CABG.
.
[**2110-2-14**] Carotid U/S: Right ICA <40% stenosis. Left ICA <40%
stenosis.

CXR: [**2110-2-22**]: 1. Status post median sternotomy with stable
postoperative cardiac and Preliminary Reportmediastinal
contours. Lung volumes remain low with linear opacities at both
Preliminary Reportbases and in the left upper lung suggestive of
patchy atelectasis. Crowding
Preliminary Reportof the pulmonary vasculature with no overt
pulmonary edema. Stable tiny left Preliminary Reportapical
pneumothorax. No large pleural effusions.

[**2110-2-21**] WBC-8.7 RBC-3.24* Hgb-10.2* Hct-29.7* MCV-92 MCH-31.6
MCHC-34.5 RDW-13.7 Plt Ct-142*
[**2110-2-13**] WBC-8.5 RBC-5.48 Hgb-17.0 Hct-48.7 MCV-89 MCH-31.0
MCHC-34.8 RDW-13.3 Plt Ct-220

[**2110-2-22**] UreaN-21* Creat-1.0 Na-138 K-4.9 Cl-101
[**2110-2-21**] Glucose-179* UreaN-17 Creat-1.0 Na-134 K-5.0 Cl-99
HCO3-25
[**2110-2-13**] Glucose-146* UreaN-19 Creat-1.1 Na-137 K-4.5 Cl-101
HCO3-24
[**2110-2-14**] ALT-41* AST-30 AlkPhos-78 Amylase-58 TotBili-0.8

Micro:[**2110-2-18**] MRSA SCREEN (Final [**2110-2-20**]):    No MRSA
isolated.


Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname 13045**] was admitted with a
myocardial infarction. He underwent cardiac work-up and cath
revealed severe three vessel coronary artery disease. He
underwent surgical work-up and received medical management while
awaiting Plavix wash-out. On [**2-18**] he was brought to the
operating room where he underwent a coronary artery bypass graft
x 4. Please see operative note for surgical details. Following
surgery he was transferred to the CVICU for invasive monitoring
in stable condition. Within several hours he was weaned from
sedation, awoke neurologically intact and extubated.Transferred
to the floor on POD #2 to begin increasing his activity level.
Gently diuresed toward his preop weight. Chest tubes and pacing
wires removed per protocol. Continued to make good progress and
was cleared for discharge to home with [**Hospital 119**] Homecare
services [**Telephone/Fax (1) 13046**] on POD4. He will follow-up as an out
patient.

Medications on Admission:
ATENOLOL 25 DAILY
VIT D3 DAILY
FLUTICASONE PRN
LISINOPRIL 10 DAILY
TRAZODONE 100MG QHS PRN
BABY ASA
MULTI VIT

Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every six
(6) hours as needed for pain.
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
4. fluticasone 110 mcg/actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. atenolol 25 mg Tablet Sig: One (1) Tablet PO once a day.
7. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
8. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
10 days.
Disp:*10 Tablet(s)* Refills:*0*
9. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
10. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary artery disease s/p Coronary artery bypass graft x 3
Myocardial infarction
Past medical history:
Hypertension
Diabetes Mellitus 2
Kidney stones (remote)
Lumbar Back Pain
Selective paraspinal muscular atrophy/weakness syndrome

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema bilateral 2+ 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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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

Wound check in the [**Hospital Unit Name **] [**Last Name (NamePattern1) **] [**Hospital Unit Name **]
[**2110-3-6**] at 10:15a

Surgeon: Dr. [**Last Name (STitle) 914**] [**2110-3-17**] at 1:30p in the [**Hospital Unit Name **] [**Last Name (NamePattern1) 10357**]

Cardiologist: Dr. [**First Name (STitle) **] [**Name (STitle) **] please call for a follow-up
appointment
in [**2-7**] weeks

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 2204**] in [**4-10**] weeks

**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:[**2110-2-22**]
{'Subendocardial infarction, initial episode of care,Spinal muscular atrophy, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lumbago,Personal history of tobacco use,Pure hyperglyceridemia'}


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: 65M w/ HTN, newly diagnosed T2DM, who presented to his PCP's
office today for symptoms of CP that he attributed to GERD. Pt
developed epigastric pain on Tuesday after dinner and had
vomitting X 1. Pain resolved on its own but recurred again so
the pt saw his PCP [**Name Initial (PRE) 3011**]. However, as the pt was not prone to
GERD and had been having sx of DOE over the past 6 months, he
got an EKG which showed some "lateral changes". He was referred
to [**Hospital1 18**] for further workup. Over the past year or so, pt has
been having increasing dyspnea on exertion and gets SOB after
walking about a [**Age over 90 **] yards. Pt has chronic back pain, and
therefore exercises minimally. In the ED, Labs were significant
for trop of 0.26,EKG changes consistent with a diagnosis of
NSTEMI. He was admitted for further cardiac workup. Cardiac cath
today reveals significant coronary artery disease. Cardiac
surgery was consulted for evaluation of coronary
revascularization.

MEDICAL HISTORY: Hypertension
Diabetes Mellitus 2
Kidney stones (remote)
Lumbar Back Pain
Selective paraspinal muscular atrophy/weakness syndrome

MEDICATION ON ADMISSION: ATENOLOL 25 DAILY
VIT D3 DAILY
FLUTICASONE PRN
LISINOPRIL 10 DAILY
TRAZODONE 100MG QHS PRN
BABY ASA
MULTI VIT

ALLERGIES: Morphine / Bactrim

PHYSICAL EXAM: VS: BP= 122/77 HR= 58 RR= 16 O2 sat= 98% on 3L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: There is no family history of dementia. His father died of
cancer at age 60. His brother has a history of stroke and
diabetes.

SOCIAL HISTORY: Recently retired gentleman; lives in [**Location 13044**] with wife.
Ashkenazi [**Hospital1 **] descent.
-Tobacco history: ex smoker 25 years back (20 pack years)
-ETOH: occasional
-Illicit drugs: none 

### Response:
{'Subendocardial infarction, initial episode of care,Spinal muscular atrophy, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Lumbago,Personal history of tobacco use,Pure hyperglyceridemia'}
