CHIEF COMPLAINT: persistant AFIB, RCA disease on cath

PRESENT ILLNESS: The patient is 56-year-old gentleman who was
initially sent to me for minimally invasive Maze procedure
for paroxysmal atrial fibrillation. The patient had longer
and longer episodes of atrial fibrillation and now
constitutes persistent atrial fibrillation. One time he was
admitted for his minimally invasive Maze procedure and a left
atrial clot was noted in his left atrial appendage and he
underwent anticoagulation for that with subsequent resolution
of his left atrial thrombus. The last time he was admitted to
hospital for the minimally invasive Maze procedure, a
diagnostic cardiac cath was performed by Dr. [**First Name4 (NamePattern1) 401**] [**Last Name (NamePattern1) 1295**] due
to some atherosclerosis which was noted on the preoperative
CT angiogram to evaluate his left atrium. The diagnostic
cardiac cath revealed anomalous right coronary artery with a
significant lesion within the mid to proximal segment as well
as a subtotally occluded first obtuse marginal coronary
artery. The decision was therefore made to proceed with
concomitant Maze on top of a coronary artery bypass grafting
procedure. The patient therefore agreed to proceed

MEDICAL HISTORY: Paroxysmal Atrial Fibrillation [**2159**]
Tachybrady Syndrome s/p PPM [**11-4**]
Stroke [**1-4**]
Upper GI bleed
Hepatitis C in the setting of IV drug use
Diabetes
Hpertension
Oesity

MEDICATION ON ADMISSION: Lisinopril 40/D,Hctz 25/D,Coumadin 5mg/D(LD [**1-30**]),ToprolXL
100/D,Glargine 35u dinner,Humalog SSI(bfst,lunch,HS),VitC,Fish
oil.

ALLERGIES: Fentanyl

PHYSICAL EXAM: General: well appearing male in NAD. generalized edema noted.
VS: 98.5, 126/78, 102, 20, 98% on RA
HEENT: unremarkable
Chest: CTA bilat. Sternal incision well approx, no redness, no
drainage. sternum stable.
COR: RRR S1, S2
ABD: soft, round, NT, ND, +bowel sounds, +flatus.
Extrem: bilat Extrem edema.
Neuro: intact.

FAMILY HISTORY: There is a family history of diabetes and early stroke in his
mother.

SOCIAL HISTORY: He is a prior smoker.  He is currently self-employed as an
exterminator.  He used to use IV drugs but does not use them
anymore.
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Coronary artery anomaly,Drug-induced psychotic disorder with hallucinations,Atrial fibrillation,Other ill-defined heart diseases,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,Opioid abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obesity, unspecified,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Examination of participant in clinical trial
Crnry athrscl natve vssl,Surg compl-heart,Coronary artery anomaly,Drug psy dis w hallucin,Atrial fibrillation,Ill-defined hrt dis NEC,Abn react-anastom/graft,Opioid abuse-unspec,Chrnc hpt C wo hpat coma,DMII wo cmp nt st uncntr,Hypertension NOS,Obesity NOS,Long-term use anticoagul,Status cardiac pacemaker,Hx TIA/stroke w/o resid,Exam-clincal trial
Admission Date:  [**2167-2-3**]              Discharge Date:   [**2167-2-10**]

Date of Birth:  [**2110-8-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Fentanyl

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
persistant AFIB, RCA disease on cath

Major Surgical or Invasive Procedure:
CABG x2, MAZE, LAA ligation


History of Present Illness:
The patient is 56-year-old gentleman who was
initially sent to me for minimally invasive Maze procedure
for paroxysmal atrial fibrillation. The patient had longer
and longer episodes of atrial fibrillation and now
constitutes persistent atrial fibrillation. One time he was
admitted for his minimally invasive Maze procedure and a left
atrial clot was noted in his left atrial appendage and he
underwent anticoagulation for that with subsequent resolution
of his left atrial thrombus. The last time he was admitted to
hospital for the minimally invasive Maze procedure, a
diagnostic cardiac cath was performed by Dr. [**First Name4 (NamePattern1) 401**] [**Last Name (NamePattern1) 1295**] due
to some atherosclerosis which was noted on the preoperative
CT angiogram to evaluate his left atrium. The diagnostic
cardiac cath revealed anomalous right coronary artery with a
significant lesion within the mid to proximal segment as well
as a subtotally occluded first obtuse marginal coronary
artery. The decision was therefore made to proceed with
concomitant Maze on top of a coronary artery bypass grafting
procedure. The patient therefore agreed to proceed

Past Medical History:
Paroxysmal Atrial Fibrillation [**2159**]
Tachybrady Syndrome s/p PPM [**11-4**]
Stroke [**1-4**]
Upper GI bleed
Hepatitis C in the setting of IV drug use
Diabetes
Hpertension
Oesity

Social History:
He is a prior smoker.  He is currently self-employed as an
exterminator.  He used to use IV drugs but does not use them
anymore.


Family History:
There is a family history of diabetes and early stroke in his
mother.

Physical Exam:
General: well appearing male in NAD. generalized edema noted.
VS: 98.5, 126/78, 102, 20, 98% on RA
HEENT: unremarkable
Chest: CTA bilat. Sternal incision well approx, no redness, no
drainage. sternum stable.
COR: RRR S1, S2
ABD: soft, round, NT, ND, +bowel sounds, +flatus.
Extrem: bilat Extrem edema.
Neuro: intact.

Pertinent Results:
[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 104665**]Portable TTE
(Complete) Done [**2167-2-10**] at 11:00:00 AM      PRELIMINARY
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: [**2110-8-10**]
Age (years): 56 M  Hgt (in): 74
BP (mm Hg): 131/76  Wgt (lb): 280
HR (bpm): 80  BSA (m2): 2.51 m2
Indication: Pericardial effusion.
ICD-9 Codes: 423.9, 424.1, 424.0, 424.2
Test Information
Date/Time: [**2167-2-10**] at 11:00    Interpret MD: [**First Name11 (Name Pattern1) 553**] [**Last Name (NamePattern4) 4133**], MD

Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**First Name8 (NamePattern2) 4134**] [**Last Name (NamePattern1) 4135**],
RDCS
Doppler: Full Doppler and color Doppler Test Location: [**Location 13333**]/[**Hospital Ward Name 121**] 6
Contrast: None Tech Quality: Adequate
Tape #: 2009W006-0:20 Machine: Vivid [**8-4**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *5.3 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *5.8 cm  <= 5.2 cm
Right Atrium - Four Chamber Length:  *5.5 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.9 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  3.2 cm
Left Ventricle - Fractional Shortening:  0.35  >= 0.29
Left Ventricle - Ejection Fraction:  >= 60%  >= 55%
Aorta - Sinus Level:  *4.0 cm  <= 3.6 cm
Aortic Valve - Peak Velocity:  1.6 m/sec  <= 2.0 m/sec
Mitral Valve - E Wave:  1.2 m/sec
TR Gradient (+ RA = PASP):  *45 mm Hg  <= 25 mm Hg
Pericardium - Effusion Size:  1.5 cm

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV.

LEFT VENTRICLE: Normal LV cavity size. Overall normal LVEF
(>55%). No resting LVOT gradient.

RIGHT VENTRICLE: Dilated RV cavity.

AORTA: Moderately dilated aortic sinus.

AORTIC VALVE: Mildly thickened aortic valve leaflets. Mild (1+)
AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial
MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.
Moderate PA systolic hypertension.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
No PS.

PERICARDIUM: Small to moderate pericardial effusion. Sgnificant,
accentuated respiratory variation in mitral/tricuspid valve
inflows, c/w impaired ventricular filling.
Conclusions
The left ventricular cavity size is normal. Overall left
ventricular systolic function is normal (LVEF>55%). The right
ventricular cavity is dilated The aortic root is moderately
dilated at the sinus level. The aortic valve leaflets are mildly
thickened. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is moderate pulmonary artery
systolic hypertension. There is a small to moderate sized
pericardial effusion. There is significant, accentuated
respiratory variation in mitral/tricuspid valve inflows,
consistent with impaired ventricular filling. The effusion is
partially echodense consistent with some degree of organization.

  Interpretation assigned to [**First Name11 (Name Pattern1) 553**] [**Last Name (NamePattern4) 4133**], MD, Interpreting
physician

Pathology Examination

Name Birthdate    Age     Sex Pathology #     [**Hospital1 18**] [**Known lastname 104666**],[**Known firstname **]       [**2110-8-10**]    56 Male      [**Numeric Identifier 104667**] [**Numeric Identifier **]
Report to:   DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
Gross Description by:   DR. [**Last Name (STitle) **]. [**Doctor Last Name 395**]/mtd



SPECIMEN SUBMITTED: Atrial Appendage.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2167-2-5**] [**2167-2-5**] [**2167-2-7**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/ttl

DIAGNOSIS:



Atrial appendage:
Focal muscle hypertrophy, slight mural fibrotic changes.

Clinical: Coronary artery disease, coronary artery bypass graft.
Gross: The specimen is received fresh in a container labeled
with the patient's name, "[**Known firstname 25368**] [**Known lastname 11622**]", the medical record
number and additionally labeled "left atrial appendage". It
consists of an atrial appendage measuring 4 x 2 x 0.5 cm. There
is a 4 cm staple line at the resection margin. The specimen is
opened revealing approximately 5 cc of blood but no thrombi. The
appendage wall appears unremarkable. Representative sections are
submitted in cassette A.


Brief Hospital Course:
pt was admitted [**2167-2-3**] for heparinization prior to Maze, CABG. A
pre-operative ECH was done- see results section.
He was taken to the OR on HD#2 [**2167-2-5**] for CABG , Maze. See
operative note for details.
[**Name (NI) **] pt was admitted to tne Cardiac ICU for invasive
monioring. Extubated on POD#1 and transferred from the ICU to
the floor. Diuresed, started on lopressor and coumadin.
Developed SVT- treated w/ sotalol and lopressor dose increased.
Progressed well and passed activity requirements for d/c home w/
VNA follow up.
D/C'd to home on 5mg coumadin and INR follow up w/ [**Hospital3 **]
coumadin clinic.

Medications on Admission:
Lisinopril 40/D,Hctz 25/D,Coumadin 5mg/D(LD [**1-30**]),ToprolXL
100/D,Glargine 35u dinner,Humalog SSI(bfst,lunch,HS),VitC,Fish
oil.

Discharge Medications:
1. 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*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Insulin Glargine 100 unit/mL Solution Sig: Forty (40) units
Subcutaneous Q PM: resume preop schedule.
7. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days: then decrease 40mg daily for 10 days.
Disp:*30 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
9. Sotalol 80 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day).
Disp:*90 Tablet(s)* Refills:*2*
10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day) as needed.
Disp:*50 Tablet(s)* Refills:*0*
11. Outpatient Lab Work
INR check [**2166-2-10**] then as directed. Goal INR 2.0-2.5
12. humalog insulin
humalog insilun per sliding scale according to finger stick.
Resume preoperative sliding scale schedule


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 1280**] Home care

Discharge Diagnosis:
CABG x2 (SVG>OM, SVG>DRCA),MAZEw/ LAA ligation. [**2-5**]
CVA(w/o residua),DM,HTN,obesity,remote IVDA,HepC,SSS(s/p
PPM),h/o UGIB,PAF


Discharge Condition:
good


Discharge Instructions:
No driving for 4 weeks
No lifting more than 10 pounds for 10 weeks.
Shower daily, No tub bathing or swimming for 6 weeks.
No lotion, creams or powders to incisions
Report any fever greater than 100.5
You should have the VNA draw your blood INR and fax the [**Hospital **] coumadin clinic [**Telephone/Fax (1) 6256**]

Followup Instructions:
Follow up with:
Dr. [**Last Name (STitle) 914**] in [**4-1**] weeks
Dr. [**First Name (STitle) 1075**] and Dr. [**Last Name (STitle) 83774**] in [**3-3**] weeks
Dr. [**Last Name (STitle) 104668**] your PCP [**Last Name (NamePattern4) **] 2 weeks.


Completed by:[**2167-2-10**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Coronary artery anomaly,Drug-induced psychotic disorder with hallucinations,Atrial fibrillation,Other ill-defined heart diseases,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,Opioid abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obesity, unspecified,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Examination of participant in clinical trial'}


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: persistant AFIB, RCA disease on cath

PRESENT ILLNESS: The patient is 56-year-old gentleman who was
initially sent to me for minimally invasive Maze procedure
for paroxysmal atrial fibrillation. The patient had longer
and longer episodes of atrial fibrillation and now
constitutes persistent atrial fibrillation. One time he was
admitted for his minimally invasive Maze procedure and a left
atrial clot was noted in his left atrial appendage and he
underwent anticoagulation for that with subsequent resolution
of his left atrial thrombus. The last time he was admitted to
hospital for the minimally invasive Maze procedure, a
diagnostic cardiac cath was performed by Dr. [**First Name4 (NamePattern1) 401**] [**Last Name (NamePattern1) 1295**] due
to some atherosclerosis which was noted on the preoperative
CT angiogram to evaluate his left atrium. The diagnostic
cardiac cath revealed anomalous right coronary artery with a
significant lesion within the mid to proximal segment as well
as a subtotally occluded first obtuse marginal coronary
artery. The decision was therefore made to proceed with
concomitant Maze on top of a coronary artery bypass grafting
procedure. The patient therefore agreed to proceed

MEDICAL HISTORY: Paroxysmal Atrial Fibrillation [**2159**]
Tachybrady Syndrome s/p PPM [**11-4**]
Stroke [**1-4**]
Upper GI bleed
Hepatitis C in the setting of IV drug use
Diabetes
Hpertension
Oesity

MEDICATION ON ADMISSION: Lisinopril 40/D,Hctz 25/D,Coumadin 5mg/D(LD [**1-30**]),ToprolXL
100/D,Glargine 35u dinner,Humalog SSI(bfst,lunch,HS),VitC,Fish
oil.

ALLERGIES: Fentanyl

PHYSICAL EXAM: General: well appearing male in NAD. generalized edema noted.
VS: 98.5, 126/78, 102, 20, 98% on RA
HEENT: unremarkable
Chest: CTA bilat. Sternal incision well approx, no redness, no
drainage. sternum stable.
COR: RRR S1, S2
ABD: soft, round, NT, ND, +bowel sounds, +flatus.
Extrem: bilat Extrem edema.
Neuro: intact.

FAMILY HISTORY: There is a family history of diabetes and early stroke in his
mother.

SOCIAL HISTORY: He is a prior smoker.  He is currently self-employed as an
exterminator.  He used to use IV drugs but does not use them
anymore. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Coronary artery anomaly,Drug-induced psychotic disorder with hallucinations,Atrial fibrillation,Other ill-defined heart diseases,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,Opioid abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obesity, unspecified,Long-term (current) use of anticoagulants,Cardiac pacemaker in situ,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Examination of participant in clinical trial'}
