CHIEF COMPLAINT: exertional chest pain

PRESENT ILLNESS: 70 yo M admitted to OSH with 2 weeks of exertional chest pain.

MEDICAL HISTORY: GERD, peptic ulcer disease, prosate cancer, depression, ETOH,
s/p Bilroth (I vs II?), CCY

MEDICATION ON ADMISSION: Protonix 40 mg daily, Lexapro 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD HR 55 BP 144/76
Lungs CTAB
Heart RRR distant heart sounds
Abdomen soft/NT/ND, well healed chole & [**Doctor First Name **] scars
No edema, +pp
no varicosities
no carotid bruits

FAMILY HISTORY: NC

SOCIAL HISTORY: lives alone
daugther lives downstairs
10 years sober
quit tobacco 30 years ago.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acidosis,Personal history of peptic ulcer disease,Esophageal reflux,Depressive disorder, not elsewhere classified,Sciatica,Atrial fibrillation,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Long-term (current) use of antiplatelet/antithrombotic,Encounter for therapeutic drug monitoring
Crnry athrscl natve vssl,Intermed coronary synd,Acidosis,Prsnl hst peptic ulcr ds,Esophageal reflux,Depressive disorder NEC,Sciatica,Atrial fibrillation,Hypertension NOS,History of tobacco use,Hx-prostatic malignancy,Hx of irradiation,Lng use antiplte/thrmbtc,Therapeutic drug monitor
Admission Date:  [**2159-11-12**]              Discharge Date:   [**2159-11-19**]

Date of Birth:  [**2089-9-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
exertional chest pain

Major Surgical or Invasive Procedure:
cabg x4  [**2159-11-15**]  (LIMA to LAD, SVG to OM1, SVG to OM2, SVG to
PDA)


History of Present Illness:
70 yo M admitted to OSH with 2 weeks of exertional chest pain.

Past Medical History:
GERD, peptic ulcer disease, prosate cancer, depression, ETOH,
s/p Bilroth (I vs II?), CCY

Social History:
lives alone
daugther lives downstairs
10 years sober
quit tobacco 30 years ago.

Family History:
NC

Physical Exam:
NAD HR 55 BP 144/76
Lungs CTAB
Heart RRR distant heart sounds
Abdomen soft/NT/ND, well healed chole & [**Doctor First Name **] scars
No edema, +pp
no varicosities
no carotid bruits

Pertinent Results:
[**2159-11-19**] 06:35AM BLOOD WBC-6.5 RBC-3.01* Hgb-8.9* Hct-25.8*
MCV-86 MCH-29.6 MCHC-34.5 RDW-14.1 Plt Ct-167
[**2159-11-19**] 06:35AM BLOOD Plt Ct-167
[**2159-11-19**] 06:35AM BLOOD PT-11.7 PTT-23.1 INR(PT)-1.0
[**2159-11-19**] 06:35AM BLOOD Glucose-98 UreaN-24* Creat-0.9 Na-139
K-4.4 Cl-101 HCO3-31 AnGap-11
[**2159-11-19**] 06:35AM BLOOD ALT-22 AST-16 LD(LDH)-211 AlkPhos-58
TotBili-0.5

PA AND LATERAL CHEST ON [**2159-11-18**] AT 11:55
Lines and tubes have been removed and there is no PTX. Some
subsegmental atelectatic changes are seen at the bases
bilaterally. There is evidence of bilateral effusions
posteriorly. Some basilar airspace disease seen on the lateral
view, not well localized, may be corresponding to retrocardiac
densities on the frontal film. Distinction of that finding
between atelectasis and pneumonia cannot be made
radiographically.

IMPRESSION: Findings consistent with expected post-operative
course and no PTX after multiple tube removal. Basilar
atelectatic changes are likely, though pneumonia cannot be
excluded radiographically.

Echo [**11-15**]
PRE-BYPASS: The left atrium is moderately dilated. 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. Overall left ventricular systolic
function is normal (LVEF>55%). Right ventricular chamber size
and free wall motion are normal. The aortic root is markedly
dilated at the sinus level. The sinuses of Valsalva are dilated.
There is a sinus of Valsalva aneurysm. The ascending aorta is
mildly dilated. The descending thoracic aorta is mildly dilated.
There are simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. The aortic valve leaflets
(3) are mildly thickened. There is no aortic valve stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is moderate thickening of the mitral
valve chordae. Trivial mitral regurgitation is seen. There is no
pericardial effusion.

Post CPB:
Preserved [**Hospital1 **]-venytricular systolic function.
No other change


Brief Hospital Course:
Cardiac catheterization showed complex disease and cardiac
surgery was consulted. As Mr. [**Known lastname 4886**] had received plavix, he
awaited plavix washout and was taken to the operating room on
[**11-15**] where he underwent a CABG x 4. He was transferred to the
ICU in critical but stable condition. He was extubated later
that same day. He was transferred to the floor on POD #1. He did
well postoperatively. He did have atrial fibrillation for which
he was given amiodarone and increased lopressor. He converted to
a normal sinus rhythm. He otherwise did well postoperatively and
was ready for discharge home on POD #4.

Medications on Admission:
Protonix 40 mg daily, Lexapro 10 mg daily

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
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. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. Zocor 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
7. Escitalopram 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Ferrous Gluconate 300 (35) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
13. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
Disp:*45 Tablet(s)* Refills:*2*
14. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400 mg [**Hospital1 **] x 6 days, then 400 daily x 1 week. then 200
mg daily until follow up with cardiologist.
Disp:*120 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
CAD  s/p cabg x4
prostate Ca with XRT
PUD/GERD s/p Billroth proc. 30 years ago
depression
sciatica


Discharge Condition:
good


Discharge Instructions:
SHOWER DAILY and pat incisons dry
no lotions, creams, or powders on any incision
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100.5, redness, or drainage


Followup Instructions:
see Dr. [**Last Name (STitle) **] in [**1-23**] weeks
see Dr. [**Last Name (STitle) **] in [**2-24**] weeks
see Dr. [**Last Name (STitle) **] in 4 weeks   [**Telephone/Fax (1) 170**]



Completed by:[**2159-11-19**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acidosis,Personal history of peptic ulcer disease,Esophageal reflux,Depressive disorder, not elsewhere classified,Sciatica,Atrial fibrillation,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Long-term (current) use of antiplatelet/antithrombotic,Encounter for therapeutic drug monitoring'}


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: exertional chest pain

PRESENT ILLNESS: 70 yo M admitted to OSH with 2 weeks of exertional chest pain.

MEDICAL HISTORY: GERD, peptic ulcer disease, prosate cancer, depression, ETOH,
s/p Bilroth (I vs II?), CCY

MEDICATION ON ADMISSION: Protonix 40 mg daily, Lexapro 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD HR 55 BP 144/76
Lungs CTAB
Heart RRR distant heart sounds
Abdomen soft/NT/ND, well healed chole & [**Doctor First Name **] scars
No edema, +pp
no varicosities
no carotid bruits

FAMILY HISTORY: NC

SOCIAL HISTORY: lives alone
daugther lives downstairs
10 years sober
quit tobacco 30 years ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Acidosis,Personal history of peptic ulcer disease,Esophageal reflux,Depressive disorder, not elsewhere classified,Sciatica,Atrial fibrillation,Unspecified essential hypertension,Personal history of tobacco use,Personal history of malignant neoplasm of prostate,Personal history of irradiation, presenting hazards to health,Long-term (current) use of antiplatelet/antithrombotic,Encounter for therapeutic drug monitoring'}
