CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: The patient is a 66 year old male with a history of CAD s/p DES
to LAD in [**4-20**], hyperlipidemia, borderline diabetes who
presented to an OSH with chest pain and was transferred for
cardiac catheterization.  The patient was in his usual state of
health and chest pain free until the day prior to admission,
when he was welding a piece of metal in his car which lit a
[**Doctor Last Name **] and caught on fire.  He used a fire extinguisher in the
garage to try to put out the fire, but the extinguisher ran out.
 He then made [**2-16**] trips carrying 5 gallon pales full of water to
finally put out the fire.  This episode occurred at 3:30 pm, and
immediately after he noticed a band of chest pressure from
"nipple to nipple."  The pain peaked at 8/10 and did not
radiate.  He initially felt SOB after running with the pales,
but did not feel SOB once he had settled down.  He also felt
sweaty because he was running with his work jacket, but no
diaphoresis after that.  He denied nausea/vomiting.  He also
noticed a burning "harsh feeling" in his throat, which he
thought was secondary to smoke inhalation.  He ate 2 dinner
rolls at home which helped with his throat pain, but his chest
pain persisted so his family drove him to the OSH ED.  He took
ASA for the 7 days prior to this episode.

MEDICAL HISTORY: 1. Coronary artery disesase
-  Cath ([**4-20**]): LAD mid 80% stenosis, stented with drug eluting
stent as part of the ENDEAVOR-IV study.  LM, LCx, RCA normal.
2. Hyperlipidemia: Lipid Panel ([**5-21**]) Chol: 179, TG 279, HDL 39,
LDL 102
3. Hypertension
4. Borderline diabetes: HgA1c 6.9% 11/06
5. Epididymitis
6. s/p Appendectomy
7. s/p 3 prior hernia repairs
8. s/p Removal of a lipoma from his back
9. Anemia, baseline Hct 35-38

MEDICATION ON ADMISSION: CURRENT MEDICATIONS:
Aspirin 325mg daily
Atenolol 25 mg daily
Lisinopril 10 mg daily
Ezetimibe 10 mg daily
Lipitor 40mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS -  t 97.3, bp 119/63, hr 57, rr 18, SaO2 99% on 2L
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with no evidence of JVD.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Soft R carotid bruit.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Quiet BS.  Soft, NT, distended/obese abdomen. No HSM or
tenderness.
Ext: No lower extremity edema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Radial 2+ DP 1+ PT 1+
Left: Radial 2+ DP 1+ PT 1+

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.  His father died of a stroke at age 68 and also
had hypertension.  His mother died at the age of 62 due to
metastatic lung cancer.

SOCIAL HISTORY: Tobacco denies
ETOH occassional drink
works as a charter bus driver and occasionally must lift luggage
to and from his bus.
He is married with two adult children.
Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,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,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anemia, unspecified,Other symptoms involving cardiovascular system
Crnry athrscl natve vssl,Subendo infarct, initial,Surg compl-heart,Atrial fibrillation,Abn react-anastom/graft,Status-post ptca,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Anemia NOS,Cardiovas sys symp NEC
Admission Date:  [**2200-1-21**]              Discharge Date:   [**2200-1-28**]

Date of Birth:  [**2133-7-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Cardiac Catherization [**2200-1-21**]
s/p Coronary artery bypass graft x3 (Left internal mammary
artery > left anterior descending, Saphenous vein graft > RAMUS,
saphenous vein graft > obtuse marginal) [**2200-1-23**]


History of Present Illness:
The patient is a 66 year old male with a history of CAD s/p DES
to LAD in [**4-20**], hyperlipidemia, borderline diabetes who
presented to an OSH with chest pain and was transferred for
cardiac catheterization.  The patient was in his usual state of
health and chest pain free until the day prior to admission,
when he was welding a piece of metal in his car which lit a
[**Doctor Last Name **] and caught on fire.  He used a fire extinguisher in the
garage to try to put out the fire, but the extinguisher ran out.
 He then made [**2-16**] trips carrying 5 gallon pales full of water to
finally put out the fire.  This episode occurred at 3:30 pm, and
immediately after he noticed a band of chest pressure from
"nipple to nipple."  The pain peaked at 8/10 and did not
radiate.  He initially felt SOB after running with the pales,
but did not feel SOB once he had settled down.  He also felt
sweaty because he was running with his work jacket, but no
diaphoresis after that.  He denied nausea/vomiting.  He also
noticed a burning "harsh feeling" in his throat, which he
thought was secondary to smoke inhalation.  He ate 2 dinner
rolls at home which helped with his throat pain, but his chest
pain persisted so his family drove him to the OSH ED.  He took
ASA for the 7 days prior to this episode.


Past Medical History:
1. Coronary artery disesase
-  Cath ([**4-20**]): LAD mid 80% stenosis, stented with drug eluting
stent as part of the ENDEAVOR-IV study.  LM, LCx, RCA normal.
2. Hyperlipidemia: Lipid Panel ([**5-21**]) Chol: 179, TG 279, HDL 39,
LDL 102
3. Hypertension
4. Borderline diabetes: HgA1c 6.9% 11/06
5. Epididymitis
6. s/p Appendectomy
7. s/p 3 prior hernia repairs
8. s/p Removal of a lipoma from his back
9. Anemia, baseline Hct 35-38

Social History:
Tobacco denies
ETOH occassional drink
works as a charter bus driver and occasionally must lift luggage
to and from his bus.
He is married with two adult children.

Family History:
There is no family history of premature coronary artery disease
or sudden death.  His father died of a stroke at age 68 and also
had hypertension.  His mother died at the age of 62 due to
metastatic lung cancer.

Physical Exam:
VS -  t 97.3, bp 119/63, hr 57, rr 18, SaO2 99% on 2L
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with no evidence of JVD.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Soft R carotid bruit.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Quiet BS.  Soft, NT, distended/obese abdomen. No HSM or
tenderness.
Ext: No lower extremity edema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Radial 2+ DP 1+ PT 1+
Left: Radial 2+ DP 1+ PT 1+


Pertinent Results:
[**2200-1-28**] 07:15AM BLOOD WBC-8.9 RBC-3.13* Hgb-9.1* Hct-27.5*
MCV-88 MCH-29.2 MCHC-33.3 RDW-14.4 Plt Ct-362
[**2200-1-28**] 07:15AM BLOOD PT-14.1* INR(PT)-1.2*
[**2200-1-28**] 07:15AM BLOOD Glucose-128* UreaN-25* Creat-1.2 Na-139
K-4.5 Cl-99 HCO3-30 AnGap-15
RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2200-1-26**] 1:09 PM

CHEST (PORTABLE AP)

Reason: ? effusion

[**Hospital 93**] MEDICAL CONDITION:
66 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
? effusion
CLINICAL HISTORY: Status post CABG, evaluate for effusion.

CHEST AP:

Heart is enlarged. Some blunting of the left costophrenic angle
and loss of the left hemidiaphragm suggest the presence of a
left pleural effusion. The right side appears clear. Atelectasis
is still present at the left base.

IMPRESSION: Left effusion and atelectasis persist.

DR. [**First Name11 (Name Pattern1) 3347**] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 5034**]
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 65577**] (Complete)
Done [**2200-1-23**] at 3:16:26 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2133-7-10**]
Age (years): 66 M  Hgt (in): 68
BP (mm Hg): 120/60  Wgt (lb): 225
HR (bpm): 45  BSA (m2): 2.15 m2
Indication: Coronary artery bypass grafting
ICD-9 Codes: 440.0, 413.9
Test Information
Date/Time: [**2200-1-23**] at 15:16    Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3893**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW04-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Diastolic Dimension:  4.7 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aortic Valve - Peak Velocity:  1.0 m/sec  <= 2.0 m/sec

Findings
LEFT ATRIUM: No spontaneous echo contrast or thrombus in the
LA/LAA or the RA/RAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

LEFT VENTRICLE: Mild symmetric LVH with normal cavity size and
regional/global systolic function (LVEF>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Complex (>4mm) atheroma in the descending thoracic aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Trace AR.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic 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. No TEE related complications. The patient appears
to be in sinus rhythm. Resting bradycardia (HR<60bpm). Results
Conclusions
PRE-BYPASS:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. There is mild symmetric left
ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. There are simple
atheroma in the aortic arch. There are complex (>4mm) atheroma
in the descending thoracic aorta. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. Trace
aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no pericardial effusion.
Post_Bypass:
Preserved normal biventricular systolic function. Overall LVEF
55%.
Trivial MR. [**First Name (Titles) **] [**Last Name (Titles) **]. Trace AI.
Intact thoracic aorta post decannulation
Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2200-1-23**] 15:20






Brief Hospital Course:
Transferred for outside hospital after ruling in for NSTEMI for
cardiac catherization.  Cardiac catherization revealed coronary
atery disease and he was referred to cardiac surgery for
surgical evaluation.  He underwent preoperative work up and went
to the operating [****] for coronary artery bypass graft.
See operative for further details.  He was transferred to the
ICU for hemodynamic monitoring.  In the first 24 hours sedation
was weaned, he woke neurologically intact and he was extubated
without incidence.  He was transferred to the post op floor on
POD 1.  He was started on beta blockers and gently diuresised
towards his preoperative weight.  Physical therapy worked with
him for strength and mobiliy.  On POD 2 he went into atrial
fibrillation that converted with beta blockers.  He continued to
have intermittent afib and was started on Amiodorone.  He
converted to SR and was discharged to home on POD#5 in stable
condition.
Dr. [**Last Name (STitle) **] was called regarding coumadin follow up and the pt.
will have an INR drawn on [**2200-1-30**].


Medications on Admission:
CURRENT MEDICATIONS:
Aspirin 325mg daily
Atenolol 25 mg daily
Lisinopril 10 mg daily
Ezetimibe 10 mg daily
Lipitor 40mg daily


Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
[**Date Range **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
2. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
[**Date Range **]:*30 Tablet(s)* Refills:*0*
3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 6-8 hours
as needed.
[**Date Range **]:*60 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Date Range **]:*60 Capsule(s)* Refills:*0*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
[**Date Range **]:*30 Tablet(s)* Refills:*2*
6. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
[**Date Range **]:*30 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
[**Date Range **]:*60 Tablet(s)* Refills:*2*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
10 days.
[**Date Range **]:*10 Tablet(s)* Refills:*0*
9. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO once
a day for 10 days: Please take with Lasix.
[**Date Range **]:*10 Packet(s)* Refills:*0*
10. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 7 days: Then decrease to 1 tab twice daily for 7
days, then decrease to 1 tab daily until follow up with MD.
[**Last Name (Titles) **]:*90 Tablet(s)* Refills:*0*
11. Warfarin 2.5 mg Tablet Sig: Two (2) Tablet PO QPM: Take as
directed by MD. Daily dose may vary according to INR.
[**Last Name (Titles) **]:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
vna southeastern ma

Discharge Diagnosis:
Coronary artery disease s/p CABG
Atrial Fibrillation (post op)
NSTEMI
Hypercholesterolemia
Diabetes mellitus type 2


Discharge Condition:
Good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2385**], MD Phone:[**Telephone/Fax (1) 2386**]
Date/Time:[**2200-2-24**] 11:00

Please call to schedule appointments with
Dr [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Dr [**Last Name (STitle) **] in [**1-15**] weeks [**Telephone/Fax (1) 65578**]
Wound check [**Hospital Ward Name **] 6 please schedule with RN [**Telephone/Fax (1) 3071**]



Completed by:[**2200-1-28**]
{'Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,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,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anemia, unspecified,Other symptoms involving cardiovascular system'}


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: The patient is a 66 year old male with a history of CAD s/p DES
to LAD in [**4-20**], hyperlipidemia, borderline diabetes who
presented to an OSH with chest pain and was transferred for
cardiac catheterization.  The patient was in his usual state of
health and chest pain free until the day prior to admission,
when he was welding a piece of metal in his car which lit a
[**Doctor Last Name **] and caught on fire.  He used a fire extinguisher in the
garage to try to put out the fire, but the extinguisher ran out.
 He then made [**2-16**] trips carrying 5 gallon pales full of water to
finally put out the fire.  This episode occurred at 3:30 pm, and
immediately after he noticed a band of chest pressure from
"nipple to nipple."  The pain peaked at 8/10 and did not
radiate.  He initially felt SOB after running with the pales,
but did not feel SOB once he had settled down.  He also felt
sweaty because he was running with his work jacket, but no
diaphoresis after that.  He denied nausea/vomiting.  He also
noticed a burning "harsh feeling" in his throat, which he
thought was secondary to smoke inhalation.  He ate 2 dinner
rolls at home which helped with his throat pain, but his chest
pain persisted so his family drove him to the OSH ED.  He took
ASA for the 7 days prior to this episode.

MEDICAL HISTORY: 1. Coronary artery disesase
-  Cath ([**4-20**]): LAD mid 80% stenosis, stented with drug eluting
stent as part of the ENDEAVOR-IV study.  LM, LCx, RCA normal.
2. Hyperlipidemia: Lipid Panel ([**5-21**]) Chol: 179, TG 279, HDL 39,
LDL 102
3. Hypertension
4. Borderline diabetes: HgA1c 6.9% 11/06
5. Epididymitis
6. s/p Appendectomy
7. s/p 3 prior hernia repairs
8. s/p Removal of a lipoma from his back
9. Anemia, baseline Hct 35-38

MEDICATION ON ADMISSION: CURRENT MEDICATIONS:
Aspirin 325mg daily
Atenolol 25 mg daily
Lisinopril 10 mg daily
Ezetimibe 10 mg daily
Lipitor 40mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS -  t 97.3, bp 119/63, hr 57, rr 18, SaO2 99% on 2L
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no
pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with no evidence of JVD.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Soft R carotid bruit.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Quiet BS.  Soft, NT, distended/obese abdomen. No HSM or
tenderness.
Ext: No lower extremity edema.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Radial 2+ DP 1+ PT 1+
Left: Radial 2+ DP 1+ PT 1+

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.  His father died of a stroke at age 68 and also
had hypertension.  His mother died at the age of 62 due to
metastatic lung cancer.

SOCIAL HISTORY: Tobacco denies
ETOH occassional drink
works as a charter bus driver and occasionally must lift luggage
to and from his bus.
He is married with two adult children. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,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,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Anemia, unspecified,Other symptoms involving cardiovascular system'}
