CHIEF COMPLAINT: Unstable angina

PRESENT ILLNESS: This 56 year old male with hyperlipidemia has  a 3 year history
of stable, exertional angina.  He has deferred catheterizationa
dnposiible interventions.  Over the past  few months his
episodes have increased in frequency and with less exertion,
being precipitated with the cold weather.  There was a
reversible inferior wall defect on a nuclear stress test a year
ago.

MEDICAL HISTORY: recently diagnosed Bell's palsy
hypertension
hyperlipidemia
Migraines
depression
benign prostatic hypertrophy

MEDICATION ON ADMISSION: Citalopram [Celexa] 20 mg Tablet QD
Metoprolol Succinate [Toprol XL]50 mg QD
Nitroglycerin [NitroQuick] 0.4 mg Tablet
Simvastatin 80 mg Tablet QD
Sumatriptan [Imitrex] 25 mg Tablet PRN
Aspirin 81 mg Tablet
Multivitamin
Prednisone 60mg qd - day 1 of 6d
Valcyclovir 1000mg - day 1 of 1 week

ALLERGIES: Compazine / Lipitor / Percocet

PHYSICAL EXAM: Discharge:
VS T99.2  BP 100/57  HR 75-SR  RR 20 O2sat 94%-RA
General: Pale appearing male w/ right facial drop from Bells
Palsey in NAD.
HEENT: right facial droop. Right eye w/ blurred vision -
corrected w/ eyeglasses. Remainer of HEENT of exam unremarkable.
COR: RRR S1,S2
Chest: Lungs CTA bilat. Sternal incision C/D/I w/ stable
sternum. There is a click noted over the left sternal border at
the articulation of the first rib.
ABD: Large round, softly distended w/ positive bowel sounds.
Passing stool and flatus.
Extrem: trace pedal edema bilat.
Neuro; facial droop as previously stated otherwise intact.

FAMILY HISTORY: Father had angina starting in 50s and died in 70s of CHF vs
Emphysema

SOCIAL HISTORY: Never smoked.
Drinks wine occasionally.
Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Paralytic ileus,Intermediate coronary syndrome,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,Bell's palsy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Depressive disorder, not elsewhere classified,Anal fissure,Abrasion or friction burn of face, neck, and scalp except eye, without mention of infection,Unspecified accident
Crnry athrscl natve vssl,Iatrogenic pneumothorax,Paralytic ileus,Intermed coronary synd,Abn react-anastom/graft,Bell's palsy,Hypertension NOS,Hyperlipidemia NEC/NOS,BPH w/o urinary obs/LUTS,Migrne unsp wo ntrc mgrn,Depressive disorder NEC,Anal fissure,Abrasion head,Accident NOS
Admission Date:  [**2153-2-11**]              Discharge Date:   [**2153-2-27**]

Date of Birth:  [**2096-12-4**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Compazine / Lipitor / Percocet

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Unstable angina

Major Surgical or Invasive Procedure:
Coronary artery bypass grafts x 5
(LIMA-LAD,SV-Dg1,SV-Dg2,SV-OM,SV-RCA) [**2153-2-16**]
Left heart catheterization, coronary angiogram
right closed thoracostomy


History of Present Illness:
This 56 year old male with hyperlipidemia has  a 3 year history
of stable, exertional angina.  He has deferred catheterizationa
dnposiible interventions.  Over the past  few months his
episodes have increased in frequency and with less exertion,
being precipitated with the cold weather.  There was a
reversible inferior wall defect on a nuclear stress test a year
ago.

He awoke with angina the night of admission lasting 10 minutes,
followed by nausea and vomiting. He had recurrent pain in the ED
where he was given ASA and lovenox.

Catheterization revealed triple vessel disease with a left main
component.  He was referred for revascularization.

Past Medical History:
recently diagnosed Bell's palsy
hypertension
hyperlipidemia
Migraines
depression
benign prostatic hypertrophy

Social History:
Never smoked.
Drinks wine occasionally.

Family History:
Father had angina starting in 50s and died in 70s of CHF vs
Emphysema

Physical Exam:
Discharge:
VS T99.2  BP 100/57  HR 75-SR  RR 20 O2sat 94%-RA
General: Pale appearing male w/ right facial drop from Bells
Palsey in NAD.
HEENT: right facial droop. Right eye w/ blurred vision -
corrected w/ eyeglasses. Remainer of HEENT of exam unremarkable.
COR: RRR S1,S2
Chest: Lungs CTA bilat. Sternal incision C/D/I w/ stable
sternum. There is a click noted over the left sternal border at
the articulation of the first rib.
ABD: Large round, softly distended w/ positive bowel sounds.
Passing stool and flatus.
Extrem: trace pedal edema bilat.
Neuro; facial droop as previously stated otherwise intact.

Pertinent Results:
[**2153-2-11**] 10:00PM   CK-MB-3 cTropnT-<0.01
[**2153-2-19**] 06:10AM BLOOD WBC-11.8* RBC-2.99* Hgb-9.8* Hct-25.7*
MCV-86 MCH-32.8* MCHC-38.0* RDW-14.8 Plt Ct-268#
[**2153-2-18**] 02:53AM BLOOD Glucose-111* UreaN-17 Creat-1.2 Na-130*
K-3.9 Cl-99 HCO3-29 AnGap-6*


[**2153-2-27**] 05:35AM BLOOD WBC-10.6 RBC-3.29* Hgb-9.9* Hct-28.1*
MCV-86 MCH-30.1 MCHC-35.2* RDW-15.4 Plt Ct-427
[**2153-2-27**] 05:35AM BLOOD Plt Ct-427
[**2153-2-23**] 04:58AM BLOOD PT-13.4 PTT-34.2 INR(PT)-1.1
[**2153-2-27**] 05:35AM BLOOD Glucose-100 UreaN-12 Creat-1.1 Na-137
K-3.5 Cl-102 HCO3-28 AnGap-11
[**2153-2-23**] 04:58AM BLOOD ALT-23 AST-24 LD(LDH)-281* AlkPhos-58
Amylase-53 TotBili-0.7
[**2153-2-12**] 11:30AM BLOOD %HbA1c-5.4
[**2153-2-12**] 11:30AM BLOOD Triglyc-93 HDL-38 CHOL/HD-3.8 LDLcalc-86

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname 92708**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 92709**] (Complete)
Done [**2153-2-16**] at 9:51:47 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2096-12-4**]
Age (years): 56 M  Hgt (in): 65
BP (mm Hg): 145/78  Wgt (lb): 192
HR (bpm): 67  BSA (m2): 1.95 m2
Indication: Intraoperative TEE for CABG procedure. Coronary
artery disease. Hypertension. Left ventricular function.
Preoperative assessment. Shortness of breath. Valvular heart
disease.
ICD-9 Codes: 786.05, 786.51, 440.0, 424.1, 424.0
Test Information
Date/Time: [**2153-2-16**] at 09:51    Interpret MD: [**Name6 (MD) 1509**] [**Name8 (MD) 1510**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1510**], MD
Doppler: Limited Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Suboptimal
Tape #: 2009AW1-: Machine: [**Doctor Last Name 11422**] 3D
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Diastolic Dimension:  4.4 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Ascending:  2.6 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.0 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  4 mm Hg  < 20 mm Hg
Mitral Valve - E Wave:  0.8 m/sec
Mitral Valve - A Wave:  0.7 m/sec
Mitral Valve - E/A ratio:  1.14
Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. No ASD by 2D or color
Doppler.
LEFT VENTRICLE: Normal regional LV systolic function. Overall
normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Simple atheroma in descending aorta.
AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Mild (1+) AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
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. Results were personally reviewed with the
MD caring for the patient.
Conclusions
Prebypass
1. No atrial septal defect is seen by 2D or color Doppler.
2. Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. There are simple atheroma in the descending thoracic aorta.
5. The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Mild (1+) aortic regurgitation is seen.

6. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen.
7. Dr. [**Last Name (STitle) 914**] was notified in person of the results on
[**2153-2-16**] at 830am.
8. Very poor transgastric views.
Post Bypass
1. Patient is in sinus rhythm and receiving an infusion of
phenylephrine.
2. Biventricular systolic function is preserved.
3. Aorta intact post decannulation.
4. Mitral regurgitation is trivial.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**Name6 (MD) 1509**] [**Name8 (MD) 1510**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2153-2-16**] 15:01
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SUPINE AND ERECT ABDOMINAL RADIOGRAPHS
INDICATION: Postoperative ileus, evaluate for interval change.
COMPARISON: [**2153-2-20**].
FINDINGS: The patient has had recent CABG with persistent
dilated loops of
air and fluid filled large bowel consistent with postoperative
ileus. There is no pneumatosis however cecal loops measure up to
12cm, There are surgical clips in the left upper quadrant. There
is no free air. There is a degenerative change in the lumbar
spine. There is persistent retrocardiac atelectasis.
IMPRESSION: Severe colonic ileus without pneumatosis. Consider
rectal tube
for decompression.
The study and the report were reviewed by the staff radiologist.

DR. [**First Name4 (NamePattern1) 19115**] [**Last Name (NamePattern1) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: [**First Name8 (NamePattern2) **] [**2153-2-22**] 11:58 PM
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SUPINE AND ERECT ABDOMINAL RADIOGRAPHS
INDICATION: Postoperative ileus, evaluate for interval change.

COMPARISON: [**2153-2-20**].
FINDINGS: The patient has had recent CABG with persistent
dilated loops of
air and fluid filled large bowel consistent with postoperative
ileus. There is no pneumatosis however cecal loops measure up to
12cm, There are surgical clips in the left upper quadrant. There
is no free air. There is a degenerative change in the lumbar
spine. There is persistent retrocardiac atelectasis.
IMPRESSION: Severe colonic ileus without pneumatosis. Consider
rectal tube
for decompression.
The study and the report were reviewed by the staff radiologist.

DR. [**First Name4 (NamePattern1) 19115**] [**Last Name (NamePattern1) **]
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: [**First Name8 (NamePattern2) **] [**2153-2-22**] 11:58 PM
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    [**Known lastname 92708**],[**Known firstname **] [**Medical Record Number 92710**] M  56  [**2096-12-4**]
Radiology Report CHEST (PA & LAT) Study Date of [**2153-2-26**] 2:38 PM

[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2153-2-26**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 92711**]
Reason: eval sternal integrity
 [**Hospital 93**] MEDICAL CONDITION:
   56 year old man with "chest pain" probable muscular
REASON FOR THIS EXAMINATION:
   eval sternal integrity
COMPARISON: [**2153-2-24**].
PA AND LATERAL CHEST RADIOGRAPHS: There is no evidence of
sternal dehiscence. Lung volumes are again low with bibasilar
atelectasis that is overall unchanged. There are small bilateral
pleural effusions. There is no pneumothorax.
The study and the report were reviewed by the staff radiologist.

DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]
DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**]
Approved: [**First Name8 (NamePattern2) **] [**2153-2-27**] 10:02 AM
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    [**Known lastname 92708**],[**Known firstname **] [**Medical Record Number 92710**] M  56  [**2096-12-4**]
Cardiology Report C.CATH Study Date of [**2153-2-12**]
BRIEF HISTORY:
Mr. [**Known lastname **]  is a 56 year old man with a history of chronic
stable
angina, hypertension, and hypercholesterolemia who presented
with
unstable angina and negative cardiac markers. He had a stress
echo one
year ago that showed reversible inferior wall and distal septal
hypokinesis at peak exercise. He is now referred for cardiac
catheterization for evaluation of his coronary arteries.
INDICATIONS FOR CATHETERIZATION:
Unstable angina
PROCEDURE:
Left Heart Catheterization: was performed by percutaneous entry
of the
right femoral artery, using a 5 French left [**Last Name (un) 2699**] catheter,
advanced
to the ascending aorta through a 5 French introducing sheath.
Coronary Angiography: was performed in multiple projections
using a 5
French JL4 and a 5 French JR4 catheter, with manual contrast
injections.
Supravalvular Aortography: was performed in the 30 degrees [**Doctor Last Name **]
projection, using 40 ml of contrast injected at 20 ml/sec,
through the
angled pigtail catheter.
Conscious Sedation:  was provided with appropriate monitoring
performed by
a member of the nursing staff.
HEMODYNAMICS RESULTS BODY SURFACE AREA:  m2
  HEMOGLOBIN: gms %
  FICK REST
**PRESSURES
AORTA {s/d/m} 131/75/83
**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**RIGHT CORONARY
1) PROXIMAL RCA   DISCRETE 60
2) MID RCA   DIFFUSELY DISEASED
2A) ACUTE MARGINAL   NORMAL
3) DISTAL RCA   NORMAL
4) R-PDA   NORMAL
4A) R-POST-LAT   NORMAL
4B) R-LV   NORMAL
**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**LEFT CORONARY
5) LEFT MAIN   DISCRETE 50
6) PROXIMAL LAD   DISCRETE 60
6A) SEPTAL-1   NORMAL
7) MID-LAD   DISCRETE 90
8) DISTAL LAD   NORMAL
9) DIAGONAL-1   DISCRETE 50
10) DIAGONAL-2   DISCRETE 60
12) PROXIMAL CX   NORMAL
13) MID CX   NORMAL
13A) DISTAL CX   NORMAL
14) OBTUSE MARGINAL-1   DISCRETE 50
15) OBTUSE MARGINAL-2   NORMAL
TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 0 hour31 minutes.
Arterial time = 0 hour25 minutes.
Fluoro time = 7.2 minutes.
Contrast injected:
          Non-ionic low osmolar (isovue, optiray...), vol 85 ml
Premedications:
          Fentanyl  25 mcg IV
Anesthesia:
          1% Lidocaine subq.
Anticoagulation:
Other medication:
          Versed 1 mg iv
          Zofran 4 mg iv
          Nitroglycerin 20 mcg/min iv gtt
Cardiac Cath Supplies Used:
          - ALLEGIANCE, CUSTOM STERILE PACK
          - [**Company **], LEFT HEART KIT
          5FR [**Company **], MULTIPACK
COMMENTS:
1. Selective coronary angiography of this right dominant system
revealed
three vessel coronary artery disease. The LMCA had a 50% distal
stenosis. The LAD had a proximal 60% stenosis followed by an
aneurysmal
segment. The mid LAD had a 90% stenosis and the distal LAD had a
70%
stenosis. The D1 had a 50% lesion at the origin and the D2 had a
60%
stenosis at the origin. The Lcx was small and the OM1 had a
proximal 50%
stenosis. The RCA had an ostial 60% lesion with mild luminal
irregularities. There was visible villing with contrast of the
RA.
2. Limited resting hemodynamics revealed normal central pressure
of
131/75 mmHg.
3. Supravalvular aortography showed minimal aortic
regurgitation, no
dissection and late filling of what is presumably the RA.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Referred for CT surgery
3. Minimal aortic regurgitation.
ATTENDING PHYSICIAN: [**Name10 (NameIs) 2052**],[**Name11 (NameIs) 2053**] [**Name Initial (NameIs) **].
REFERRING PHYSICIAN: [**Name10 (NameIs) 2052**],[**Name11 (NameIs) 2053**] [**Name Initial (NameIs) **].
CARDIOLOGY FELLOW: [**Doctor Last Name 28713**],[**Doctor First Name 28714**]
ATTENDING STAFF: [**Last Name (LF) **],[**First Name3 (LF) **] S.




Brief Hospital Course:
Patient admitted with unstable angina. Following admission he
remained stable on IV NTG.  Enzymes were negative for infarction
and cardiac surgical consultation was obtained after
catheterization revealed sever three vessel disease.

On [**2153-2-16**] he went to the Operating Room where quintuple bypass
grafting was performed as noted.  He weaned from bypass easily
on low dose neosynephrine.
He remained stable, was extubated and weaned from pressors.  He
was transferred to the floor on POD 1.  On POD 2 he was found to
have a large right pneumothorax and a CT was placed with re
expansion of the lung.  Mediastinal and left CTs were left due
to serous drainage.  Left and mediastinal tube were removed,
along with pacing wires on the third postoperative day.  There
was no air leak from the right tube, however, it was left in
place. He was diuresed toward his preoperative weight and
mobilization was begun. Pain was controlled with narcotics and
non steroidals. Mr.[**Known lastname **] was placed on a liquid diet due to his
abdominal discomfort- softly distended,with dilated loops of
bowel seen on x-ray, despite his passing flatus and moving his
bowels. Liver function tests were followed, and narcotics
minimized.

He developed progressive colonic dilatation despite feeling
fairly well, passing flatus and having multiple bowel movements.
He was transferred to the ICU due to this.  He received
neostigmine twice, without significant change.  He felt well,
was mobilized and continued to pass flatus. A rectal tube was
placed, without any change in status.  A repeat KUB on  [**2-24**] was
significantly improved,the rectal tube was removed and he
transferred back to the floor.  He was kept NPO except for
medications.

On POD#6  the right CT was able to be removed. He continued to
progress and he was ready for discharge to home with services on
POD #11. All follow up appointments were advised.


Medications on Admission:
Citalopram [Celexa] 20 mg Tablet QD
Metoprolol Succinate [Toprol XL]50 mg QD
Nitroglycerin [NitroQuick] 0.4 mg Tablet
Simvastatin 80 mg Tablet QD
Sumatriptan [Imitrex] 25 mg Tablet PRN
Aspirin 81 mg Tablet
Multivitamin
Prednisone 60mg qd - day 1 of 6d
Valcyclovir 1000mg - day 1 of 1 week


Discharge Medications:
1. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for 2 weeks.
Disp:*50 Tablet(s)* Refills:*0*
5. White Petrolatum-Mineral Oil 42.5-56.8 % Ointment Sig: [**2-16**]
Appls Ophthalmic QID (4 times a day) as needed.
Disp:*1 * Refills:*0*
6. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
s/p coronary artery bypass grafts x 5
Unstable Angina
Hyperlipidemia
Bell's Palsy
depression
benign prostatic hypertrophy
migraine headaches


Discharge Condition:
good


Discharge Instructions:
no lifting greater than 10 pounds for 10 weeks
no driving for 4 weeks and off all narcotics
shower daily. no baths or swimming 6 weeks
no lotions, creams or powders to incisions
report any fever greater than 100.5
report any redness of, or drainage from incisions
report any weight gain gretaer than 2 pounds a day or 5 pounds a
week
take all medications as directed

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
[**Hospital 409**] clinic in 2 weeks
Dr. [**First Name8 (NamePattern2) 4559**] [**Last Name (NamePattern1) 58**] in [**2-16**] weeks ([**Telephone/Fax (1) 3329**])
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 696**] in 2 weeks
please call for appointments



Completed by:[**2153-2-27**]
{"Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Paralytic ileus,Intermediate coronary syndrome,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,Bell's palsy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Depressive disorder, not elsewhere classified,Anal fissure,Abrasion or friction burn of face, neck, and scalp except eye, without mention of infection,Unspecified accident"}


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: Unstable angina

PRESENT ILLNESS: This 56 year old male with hyperlipidemia has  a 3 year history
of stable, exertional angina.  He has deferred catheterizationa
dnposiible interventions.  Over the past  few months his
episodes have increased in frequency and with less exertion,
being precipitated with the cold weather.  There was a
reversible inferior wall defect on a nuclear stress test a year
ago.

MEDICAL HISTORY: recently diagnosed Bell's palsy
hypertension
hyperlipidemia
Migraines
depression
benign prostatic hypertrophy

MEDICATION ON ADMISSION: Citalopram [Celexa] 20 mg Tablet QD
Metoprolol Succinate [Toprol XL]50 mg QD
Nitroglycerin [NitroQuick] 0.4 mg Tablet
Simvastatin 80 mg Tablet QD
Sumatriptan [Imitrex] 25 mg Tablet PRN
Aspirin 81 mg Tablet
Multivitamin
Prednisone 60mg qd - day 1 of 6d
Valcyclovir 1000mg - day 1 of 1 week

ALLERGIES: Compazine / Lipitor / Percocet

PHYSICAL EXAM: Discharge:
VS T99.2  BP 100/57  HR 75-SR  RR 20 O2sat 94%-RA
General: Pale appearing male w/ right facial drop from Bells
Palsey in NAD.
HEENT: right facial droop. Right eye w/ blurred vision -
corrected w/ eyeglasses. Remainer of HEENT of exam unremarkable.
COR: RRR S1,S2
Chest: Lungs CTA bilat. Sternal incision C/D/I w/ stable
sternum. There is a click noted over the left sternal border at
the articulation of the first rib.
ABD: Large round, softly distended w/ positive bowel sounds.
Passing stool and flatus.
Extrem: trace pedal edema bilat.
Neuro; facial droop as previously stated otherwise intact.

FAMILY HISTORY: Father had angina starting in 50s and died in 70s of CHF vs
Emphysema

SOCIAL HISTORY: Never smoked.
Drinks wine occasionally. 

### Response:
{"Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Paralytic ileus,Intermediate coronary syndrome,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,Bell's palsy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Depressive disorder, not elsewhere classified,Anal fissure,Abrasion or friction burn of face, neck, and scalp except eye, without mention of infection,Unspecified accident"}
