CHIEF COMPLAINT: right sided lip numbness, indigestion

PRESENT ILLNESS: 74 yo F who presented to [**Hospital3 3583**] ED with right sided lip
numbness. MRI and TEE neg by report. Dc'd home and outpatient
stress test done with EKG changes. Cath showed 3 VD. Referred
for surgery.

MEDICAL HISTORY: Emphysema, Osteoporosis, Stage I breast cancer s/p right
lumpectomy ALND + XRT [**2090**], Bursitis, Melanoma s/p excision,
Diverticulosis, h/o MRSA, Tonsillectomy, D&C, 4 polyps removal c
colonoscopy

MEDICATION ON ADMISSION: Actonel 35 [**Last Name (LF) 77843**], [**First Name3 (LF) **] 325', Vit D 400'

ALLERGIES: Codeine

PHYSICAL EXAM: HR 66 RR 16 BP 150/77
NAD
Lungs CTAB
Heart RRR
Abdomen benign
Some varicosed veins

FAMILY HISTORY: history of stroke and MI in [**6-6**] siblings

SOCIAL HISTORY: retired
tobacco: < 1 ppd x 50 years, quit [**7-5**]
etoh: 4 glasses of wine per week.
Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Other emphysema,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Personal history of malignant melanoma of skin,Personal history of other diseases of digestive system,Personal history of tobacco use,Family history of ischemic heart disease,Family history of stroke (cerebrovascular)
Crnry athrscl natve vssl,Iatrogenc hypotnsion NEC,Emphysema NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx of breast malignancy,Hx of irradiation,Hx-malig skin melanoma,Prsnl hst ot spf dgst ds,History of tobacco use,Fam hx-ischem heart dis,Family hx-stroke
Admission Date:  [**2104-3-31**]              Discharge Date:   [**2104-4-5**]

Date of Birth:  [**2029-5-22**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
right sided lip numbness, indigestion

Major Surgical or Invasive Procedure:
[**3-31**] CABG x 3 (LIMA -> LAD, SVG -> OM, SVG -> RCA)


History of Present Illness:
74 yo F who presented to [**Hospital3 3583**] ED with right sided lip
numbness. MRI and TEE neg by report. Dc'd home and outpatient
stress test done with EKG changes. Cath showed 3 VD. Referred
for surgery.

Past Medical History:
Emphysema, Osteoporosis, Stage I breast cancer s/p right
lumpectomy ALND + XRT [**2090**], Bursitis, Melanoma s/p excision,
Diverticulosis, h/o MRSA, Tonsillectomy, D&C, 4 polyps removal c
colonoscopy

Social History:
retired
tobacco: < 1 ppd x 50 years, quit [**7-5**]
etoh: 4 glasses of wine per week.

Family History:
history of stroke and MI in [**6-6**] siblings

Physical Exam:
HR 66 RR 16 BP 150/77
NAD
Lungs CTAB
Heart RRR
Abdomen benign
Some varicosed veins

Pertinent Results:
[**2104-4-5**] 07:05AM BLOOD

WBC-5.6 RBC-2.64* Hgb-8.6* Hct-25.5* MCV-97 MCH-32.6* MCHC-33.8
RDW-13.4 Plt Ct-340

[**2104-4-5**] 07:05AM BLOOD

Glucose-98 UreaN-9 Creat-0.5 Na-142 K-4.5 Cl-105 HCO3-30
AnGap-12

CHEST (PA & LAT)  [**2104-4-3**] 1:52 PM

CHEST PA AND LATERAL: There are bilateral pleural effusions and
atelectatic changes. There is slight enlargement of the heart
and slight widening of the mediastinum. The right IJ is in the
lower SVC. No pneumothorax is detected. There is no evidence of
pneumonia.

IMPRESSION: Bilateral pleural effusions and atelectatic change,
slight enlargement of the heart and mediastinum, all grossly
unchanged, all consistent with post-operative change.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.6 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
[**Hospital1 **] - Ascending:  *3.5 cm  <= 3.4 cm
[**Hospital1 **] - Descending Thoracic:  2.3 cm  <= 2.5 cm

Findings

LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

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

[**Hospital1 **]: Normal ascending [**Hospital1 5236**] diameter. Complex (>4mm) atheroma
in the aortic arch. Complex (>4mm) atheroma in the descending
thoracic [**Hospital1 5236**].

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets. Trace AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild to
moderate ([**1-30**]+) MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) 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. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.

Conclusion
Pre-CPB: LV shows good systolic fxn, with mild HK of the
anterior septum. No spontaneous echo contrast is seen in the
left atrial appendage. Right ventricular chamber size and free
wall motion are normal. There are complex (>4mm) atheroma in the
aortic arch. There are complex (>4mm) atheroma in the descending
thoracic [**Month/Day (2) 5236**]. There are three aortic valve leaflets. The
aortic valve leaflets are mildly thickened. Trace aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Mild to moderate ([**1-30**]+) mitral regurgitation is seen.
There is no pericardial effusion.

Post-CPB: Patient is AV paced, on an infusion of NTG.
Preserved biventricular systolic fx. No AI, trace MR. [**First Name (Titles) **] [**Last Name (Titles) 18350**]t.


Brief Hospital Course:
She was taken to the operating room on [**3-31**] where she underwent a
CABG x 3. She was transferred to the ICU in stable condition on
neo and propofol. She was extubated later that same day. She was
transferred to the floor on POD #1. She did well
postoperatively. She was started on keflex for some erythema
surrounding her sternal incision. Chest tubes / foley / PW out
with out sequele. PT consult. Pt stable for home

Medications on Admission:
Actonel 35 [**Last Name (LF) 77843**], [**First Name3 (LF) **] 325', Vit D 400'

Discharge Medications:
1. [**Last Name (un) 1724**]
Actonel 35 [**Last Name (LF) 77843**], [**First Name3 (LF) **] 325', Vit D 400'
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 7 days.
Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
6. 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*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 5 days.
Disp:*20 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
CAD s/p CABG
PMH: Emphysema, Osteoporosis, Stage I breast cancer s/p right
lumpectomy ALND + XRT [**2090**], Bursitis, Melanoma s/p excision,
Diverticulosis, h/o MRSA, Tonsillectomy, D&C, 4 polyps removal c
colonoscopy


Discharge Condition:
Stable.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or p

Followup Instructions:
Dr. [**First Name (STitle) 27598**] 2 weeks
Dr. [**Last Name (STitle) 5310**] 2 weeks
Dr. [**Last Name (STitle) **] 4 weeks



Completed by:[**2104-4-5**]
{'Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Other emphysema,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Personal history of malignant melanoma of skin,Personal history of other diseases of digestive system,Personal history of tobacco use,Family history of ischemic heart disease,Family history of stroke (cerebrovascular)'}


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: right sided lip numbness, indigestion

PRESENT ILLNESS: 74 yo F who presented to [**Hospital3 3583**] ED with right sided lip
numbness. MRI and TEE neg by report. Dc'd home and outpatient
stress test done with EKG changes. Cath showed 3 VD. Referred
for surgery.

MEDICAL HISTORY: Emphysema, Osteoporosis, Stage I breast cancer s/p right
lumpectomy ALND + XRT [**2090**], Bursitis, Melanoma s/p excision,
Diverticulosis, h/o MRSA, Tonsillectomy, D&C, 4 polyps removal c
colonoscopy

MEDICATION ON ADMISSION: Actonel 35 [**Last Name (LF) 77843**], [**First Name3 (LF) **] 325', Vit D 400'

ALLERGIES: Codeine

PHYSICAL EXAM: HR 66 RR 16 BP 150/77
NAD
Lungs CTAB
Heart RRR
Abdomen benign
Some varicosed veins

FAMILY HISTORY: history of stroke and MI in [**6-6**] siblings

SOCIAL HISTORY: retired
tobacco: < 1 ppd x 50 years, quit [**7-5**]
etoh: 4 glasses of wine per week. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other iatrogenic hypotension,Other emphysema,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of breast,Personal history of irradiation, presenting hazards to health,Personal history of malignant melanoma of skin,Personal history of other diseases of digestive system,Personal history of tobacco use,Family history of ischemic heart disease,Family history of stroke (cerebrovascular)'}
