CHIEF COMPLAINT: relatively asymptomatic

PRESENT ILLNESS: 77 yo male with prior MI in [**2110**] inCX territory. Had DES to LAD
and CX at that time. Recent cardiolite scan showed infero-apical
ischemia with EF 58%. Cath revealed LAD/diag dz. Referred for
CABG.

MEDICAL HISTORY: CAD
HTN
elev. lipids
NIDDM
MI [**2110**] (Cypher stents LAD and CX)
PVD
bil. carotid dz s/p right CEA [**2112**]
hypothyroidism

MEDICATION ON ADMISSION: ASA 325 mg daily
levoxyl 125 mcg daily
lipitor daily
lopressor every third day
metformin 500 mg [**Hospital1 **]
diovan 160 mg daily
plavix 75 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 5'[**17**]"  160#
HR 68 reg  RR14  right 184/82    left 184/82
NAD
psoriaticplaques bil. knees
HEENT unremarkable
neck supple, full ROM, no carotid bruits
CTAB
RRR, no murmur
soft, NT, ND, + BS; midline scar well-healed
warm, well-perfused
no varicosities or edema noted
neuro grossly intact
2+ bil. fems/DP/PT/radials/carotids

FAMILY HISTORY: NC

SOCIAL HISTORY: retired
lives with girlfriend
75 pack/year hx; quit [**2085**]
quit ETOH 45 years ago
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Unspecified acquired hypothyroidism,Other nonspecific abnormal results of function study of cardiovascular system,Personal history of tobacco use,Phlebitis and thrombophlebitis of upper extremities, unspecified,Atrial fibrillation,Anemia, unspecified,Hypoxemia,Abnormal coagulation profile
Crnry athrscl natve vssl,Intermed coronary synd,Old myocardial infarct,Status-post ptca,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Periph vascular dis NOS,Hypothyroidism NOS,Abn cardiovasc study NEC,History of tobacco use,Phlbts vn NOS up extrm,Atrial fibrillation,Anemia NOS,Hypoxemia,Abnrml coagultion prfile
Name:  [**Known lastname **],[**Known firstname **]                   Unit No:   [**Numeric Identifier 11368**]

Admission Date:  [**2116-8-18**]              Discharge Date:   [**2116-8-26**]

Date of Birth:  [**2039-3-2**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 741**]
Addendum:
Discharge postponed until [**2116-8-26**] due to elevated INR on
[**2116-8-25**]. Coumadin was discontinued and Vitamin K 10mg SC was
administered. A repeat INR on day of discharge was down from 4.9
to 2.0. Dr.[**Last Name (STitle) **] cleared Mr.[**Known lastname **] for discharge to home
without Coumadin.

Discharge Disposition:
Home With Service

Facility:
[**Hospital3 413**] VNA

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2116-8-26**]

Admission Date:  [**2116-8-18**]              Discharge Date:   [**2116-8-26**]

Date of Birth:  [**2039-3-2**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
relatively asymptomatic

Major Surgical or Invasive Procedure:
OPCABG x1 (LIMA to LAD)  [**2116-8-18**]


History of Present Illness:
77 yo male with prior MI in [**2110**] inCX territory. Had DES to LAD
and CX at that time. Recent cardiolite scan showed infero-apical
ischemia with EF 58%. Cath revealed LAD/diag dz. Referred for
CABG.

Past Medical History:
CAD
HTN
elev. lipids
NIDDM
MI [**2110**] (Cypher stents LAD and CX)
PVD
bil. carotid dz s/p right CEA [**2112**]
hypothyroidism

Social History:
retired
lives with girlfriend
75 pack/year hx; quit [**2085**]
quit ETOH 45 years ago

Family History:
NC


Physical Exam:
5'[**17**]"  160#
HR 68 reg  RR14  right 184/82    left 184/82
NAD
psoriaticplaques bil. knees
HEENT unremarkable
neck supple, full ROM, no carotid bruits
CTAB
RRR, no murmur
soft, NT, ND, + BS; midline scar well-healed
warm, well-perfused
no varicosities or edema noted
neuro grossly intact
2+ bil. fems/DP/PT/radials/carotids

Pertinent Results:
Conclusions
Pregraft
The left atrium is dilated. 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%).
The right ventricular cavity is moderately dilated
There are simple atheroma in the aortic arch. There are simple
atheroma in the descending thoracic aorta.

The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Mild (1+) aortic regurgitation is seen.

The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. There is no pericardial effusion.
Dr. [**Last Name (STitle) **] was notified in person of the results on [**Known firstname **]
[**Known lastname 8273**] at 1330hours.

Postgraft:
Preserved biventricular systolic function.
LVEF 55%.
Mild to moderate TR.
NO regional wall motional abnormalities.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2116-8-20**] 16:08


?????? [**2110**] CareGroup IS. All rights reserved.

[**2116-8-21**] 07:34PM BLOOD WBC-13.2* RBC-3.34* Hgb-10.7* Hct-31.0*
MCV-93 MCH-31.9 MCHC-34.4 RDW-13.1 Plt Ct-204
[**2116-8-18**] 03:43PM BLOOD WBC-17.0*# RBC-4.19* Hgb-13.4* Hct-36.8*
MCV-88 MCH-32.0 MCHC-36.4* RDW-13.5 Plt Ct-255
[**2116-8-20**] 03:14AM BLOOD PT-14.6* PTT-30.7 INR(PT)-1.3*
[**2116-8-18**] 03:43PM BLOOD PT-14.6* PTT-26.8 INR(PT)-1.3*
[**2116-8-21**] 07:34PM BLOOD Glucose-135* UreaN-23* Creat-1.2 Na-138
K-4.4 Cl-106 HCO3-22 AnGap-14
[**2116-8-19**] 02:00AM BLOOD Glucose-114* UreaN-12 Creat-1.0 Na-139
K-4.7 Cl-113* HCO3-20* AnGap-11

  [**Known lastname **],[**Known firstname **] [**Medical Record Number 64112**] M  77  [**2039-3-2**]

Radiology Report CHEST (PORTABLE AP) Study Date of [**2116-8-20**] 9:42
PM


[**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG CSRU [**2116-8-20**] SCHED
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 64113**]
Reason: s/p CABG w/hypoxia-r/o PTX/effusion



[**Hospital 93**] MEDICAL CONDITION:
   77 year old man with
REASON FOR THIS EXAMINATION:
   s/p CABG w/hypoxia-r/o PTX/effusion



Provisional Findings Impression: PSS FRI [**2116-8-21**] 1:11 PM
PFI: Mild bibasilar atelectasis and small left pleural effusion
unchanged
since earlier on [**8-20**]. Heart size is top normal. No
pneumothorax.


Final Report
AP CHEST, 09:55 P.M. [**8-20**]

HISTORY: CABG. Hypoxia.

IMPRESSION: AP chest compared to [**8-18**] and [**2120-8-20**]:23
p.m.

Relatively mild bibasilar atelectasis unchanged since earlier in
the day or
[**8-18**]. Pleural effusion, if any, is minimal, on the left
following
removal of left pleural tube. Heart is top normal size, though
increased
since [**8-18**]. Right lung clear.



*

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: FRI [**2116-8-21**] 1:57 PM

  Imaging Lab



Brief Hospital Course:
Admitted [**8-18**] and underwent surgery with Dr. [**Last Name (STitle) **].
transferred tothe CVICU in stable condition on phenylephrine and
propofol drips. Extubated on the morning of POD #1. Chest tubes
and pacing wires removed on POD #2. Went into A fib and coumadin
started. Amio was bolused and and a drip was started. Several
hours later his heart rate blocked down to the upper 40s, BP
stable. Amio was discontinued and over the next several days the
beta-blocker was optimized as HR and BP would tolerate. He was
transferred to the floor on POD #3 to begin increasing his
activity level. The remainder of his postoperative course was
essentially uneventful. On POD #7 it was felt that he was ready
for discharge to home with VNA. Dr[**Last Name (STitle) 64114**] office was contact[**Name (NI) **]
and [**Name2 (NI) 64115**] to follow Mr.[**Known lastname 64116**] INR and Coumadin dosing for 1
month, INR goal 2.0 for in/out of AFib postoperatively. All
necessary follow up appointments were instructed.

Medications on Admission:
ASA 325 mg daily
levoxyl 125 mcg daily
lipitor daily
lopressor every third day
metformin 500 mg [**Hospital1 **]
diovan 160 mg daily
plavix 75 mg daily

Discharge Medications:
1. Aspirin 81 mg [**Hospital1 8426**], Delayed Release (E.C.) Sig: One (1)
[**Hospital1 8426**], Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 [**Hospital1 8426**], Delayed Release (E.C.)(s)* Refills:*0*
2. Atorvastatin 40 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO HS (at
bedtime).
Disp:*30 [**Hospital1 8426**](s)* Refills:*0*
3. Levothyroxine 125 mcg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO DAILY
(Daily).
Disp:*30 [**Hospital1 8426**](s)* Refills:*0*
4. Metformin 500 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO BID (2 times a
day).
Disp:*60 [**Hospital1 8426**](s)* Refills:*0*
5. Metoprolol Tartrate 25 mg [**Hospital1 8426**] Sig: 0.5 [**Hospital1 8426**] PO BID (2
times a day).
Disp:*30 [**Hospital1 8426**](s)* Refills:*0*
6. Furosemide 20 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO once a day for
3 days.
Disp:*3 [**Hospital1 8426**](s)* Refills:*0*
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
8. Ranitidine HCl 150 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO DAILY
(Daily).
Disp:*30 [**Hospital1 8426**](s)* Refills:*0*
9. Ibuprofen 400 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO Q6H (every 6
hours) as needed.
Disp:*120 [**Hospital1 8426**](s)* Refills:*0*
10. Propoxyphene N-Acetaminophen 100-650 mg [**Hospital1 8426**] Sig: [**12-25**]
Tablets PO Q4H (every 4 hours) as needed.
Disp:*45 [**Month/Day (2) 8426**](s)* Refills:*0*
11. Warfarin 1 mg [**Month/Day (2) 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] Once Daily at 4
PM: **As [**Name8 (MD) **] MD orders.
Disp:*60 [**Name8 (MD) 8426**](s)* Refills:*0*
12. Warfarin 2 mg [**Name8 (MD) 8426**] Sig: One (1) [**Name8 (MD) 8426**] PO ONCE (Once) for
1 days: tonight [**2116-8-25**].
Disp:*30 [**Month/Day/Year 8426**](s)* Refills:*0*
13. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours) as needed: for wheezing.
Disp:*1 * Refills:*0*
14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 3
days.
Disp:*3 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
15. Plavix 75 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO once a day.
Disp:*30 [**Month/Day/Year 8426**](s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
CAD s/p OPCABG x1
HTN
elev. lipids
NIDDM
MI [**2110**] (Cypher stents LAD and CX)
PVD
bil. carotid dz s/p right CEA [**2112**]
hypothyroidism
postop A fib

Discharge Condition:
good


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


Followup Instructions:
see Dr. [**Last Name (STitle) 7389**] in [**12-25**] weeks
see Dr. [**Last Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]



Completed by:[**2116-8-25**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Unspecified acquired hypothyroidism,Other nonspecific abnormal results of function study of cardiovascular system,Personal history of tobacco use,Phlebitis and thrombophlebitis of upper extremities, unspecified,Atrial fibrillation,Anemia, unspecified,Hypoxemia,Abnormal coagulation profile'}


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: relatively asymptomatic

PRESENT ILLNESS: 77 yo male with prior MI in [**2110**] inCX territory. Had DES to LAD
and CX at that time. Recent cardiolite scan showed infero-apical
ischemia with EF 58%. Cath revealed LAD/diag dz. Referred for
CABG.

MEDICAL HISTORY: CAD
HTN
elev. lipids
NIDDM
MI [**2110**] (Cypher stents LAD and CX)
PVD
bil. carotid dz s/p right CEA [**2112**]
hypothyroidism

MEDICATION ON ADMISSION: ASA 325 mg daily
levoxyl 125 mcg daily
lipitor daily
lopressor every third day
metformin 500 mg [**Hospital1 **]
diovan 160 mg daily
plavix 75 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 5'[**17**]"  160#
HR 68 reg  RR14  right 184/82    left 184/82
NAD
psoriaticplaques bil. knees
HEENT unremarkable
neck supple, full ROM, no carotid bruits
CTAB
RRR, no murmur
soft, NT, ND, + BS; midline scar well-healed
warm, well-perfused
no varicosities or edema noted
neuro grossly intact
2+ bil. fems/DP/PT/radials/carotids

FAMILY HISTORY: NC

SOCIAL HISTORY: retired
lives with girlfriend
75 pack/year hx; quit [**2085**]
quit ETOH 45 years ago 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Peripheral vascular disease, unspecified,Unspecified acquired hypothyroidism,Other nonspecific abnormal results of function study of cardiovascular system,Personal history of tobacco use,Phlebitis and thrombophlebitis of upper extremities, unspecified,Atrial fibrillation,Anemia, unspecified,Hypoxemia,Abnormal coagulation profile'}
