CHIEF COMPLAINT: chest pain with exertion

PRESENT ILLNESS: 63 yo male with known AFib who presented to  OSH ER with angina
on exertion. Cardiology workup included cath which revealed 80%
LM , 100% RCA, and EF 50%.
Transferred to [**Hospital1 18**] for cabg evaluaton with Dr. [**Last Name (STitle) 914**].

MEDICAL HISTORY: AFib
HTN
elev. chol.
pacer for tachy-brady syndrome
CAD

MEDICATION ON ADMISSION: sotalol
coumadin
lipitor
lopid
digoxin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.6  105/81  HR 69   97% RA sat
CTAB
S1 S2
soft, NT, ND
+ radials/fem/DP/ PT pulses

FAMILY HISTORY: both parents with ruptured [**Name (NI) 67655**]
father with MI

SOCIAL HISTORY: [**3-15**] drinks per day
smokes one PPD for 40 years
no recr. drugs
lives with wife
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension,Cardiac pacemaker in situ
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,Hypertension NOS,Status cardiac pacemaker
Admission Date:  [**2176-7-20**]              Discharge Date:   [**2176-7-27**]

Date of Birth:  [**2112-8-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
chest pain with exertion

Major Surgical or Invasive Procedure:
[**2176-7-23**] CABG x 4 (LIMA to LAD, SVG to Diag sequenced to OM, SVG
to RCA) Maze cryoablation/left atrial appendage ligation


History of Present Illness:
63 yo male with known AFib who presented to  OSH ER with angina
on exertion. Cardiology workup included cath which revealed 80%
LM , 100% RCA, and EF 50%.
Transferred to [**Hospital1 18**] for cabg evaluaton with Dr. [**Last Name (STitle) 914**].

Past Medical History:
AFib
HTN
elev. chol.
pacer for tachy-brady syndrome
CAD

Social History:
[**3-15**] drinks per day
smokes one PPD for 40 years
no recr. drugs
lives with wife

Family History:
both parents with ruptured [**Name (NI) 67655**]
father with MI

Physical Exam:
96.6  105/81  HR 69   97% RA sat
CTAB
S1 S2
soft, NT, ND
+ radials/fem/DP/ PT pulses


Pertinent Results:
[**2176-7-25**] 07:25AM BLOOD WBC-13.4* RBC-3.27* Hgb-10.9* Hct-32.1*
MCV-98 MCH-33.3* MCHC-34.0 RDW-12.4 Plt Ct-149*
[**2176-7-26**] 08:10AM BLOOD Hct-29.3*
[**2176-7-27**] 04:59AM BLOOD PT-19.9* INR(PT)-1.9*
[**2176-7-25**] 07:25AM BLOOD Glucose-149* UreaN-12 Creat-0.7 Na-138
K-3.8 Cl-102 HCO3-26 AnGap-14
[**2176-7-26**] 08:10AM BLOOD K-4.4
[**2176-7-24**] 01:40AM BLOOD ALT-39 AST-227* LD(LDH)-605* AlkPhos-53
Amylase-18 TotBili-0.4
[**2176-7-25**] 07:25AM BLOOD Mg-2.1
[**2176-7-20**] 07:23PM BLOOD %HbA1c-6.3* [Hgb]-DONE [A1c]-DONE

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 67656**] (Complete)
Done [**2176-7-23**] at 10:04:14 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**]
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2112-8-3**]
Age (years): 63 M  Hgt (in): 71
BP (mm Hg): 118/58  Wgt (lb): 170
HR (bpm): 85  BSA (m2): 1.97 m2
Indication: Aortic valve disease. Coronary artery disease.
Mitral valve disease. Intraop CABG, eval aorta, lv function
ICD-9 Codes: 424.1, 424.0, 440.0
Test Information
Date/Time: [**2176-7-23**] at 10:04    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2006AW599-0:07 Machine: 3
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *5.8 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.3 cm  <= 5.2 cm
Left Atrium - Peak Pulm Vein S:  0.2 m/s
Left Atrium - Peak Pulm Vein D:  0.5 m/s
Right Atrium - Four Chamber Length:  5.0 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.3 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  3.9 cm
Left Ventricle - Fractional Shortening:  *0.26  >= 0.29
Left Ventricle - Ejection Fraction:  40% to 45%  >= 55%
Aorta - Valve Level:  2.4 cm  <= 3.6 cm
Aorta - Ascending:  2.7 cm  <= 3.4 cm
Aorta - Arch:  2.5 cm  <= 3.0 cm
Aorta - Descending Thoracic:  2.4 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  0.8 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  3 mm Hg  < 20 mm Hg
Aortic Valve - Valve Area:  3.4 cm2  >= 3.0 cm2
Mitral Valve - Peak Velocity:  0.6 m/sec
Mitral Valve - E Wave:  0.6 m/sec
Mitral Valve - A Wave:  0.2 m/sec
Mitral Valve - E/A ratio:  3.00

Findings
LEFT ATRIUM: Moderate LA enlargement. Elongated LA. No
spontaneous echo contrast in the body of the LA. No
mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. No spontaneous echo contrast is
seen in the LAA. No thrombus in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA. Lipomatous hypertrophy of the
interatrial septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness. Normal LV
cavity size. Mild-moderate regional LV systolic dysfunction.
Mildly depressed LVEF.

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

AORTA: Normal aortic root diameter. Focal calcifications in
aortic root. Normal ascending aorta diameter. Normal aortic arch
diameter. There are complex (>4mm) atheroma in the aortic arch.
Normal descending aorta diameter. There are complex (>4mm)
atheroma in the descending thoracic aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). Mildly thickened
aortic valve leaflets (3). No AS. No AS. Mild (1+) AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS.
Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
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. No TEE related complications. The patient was under
general anesthesia throughout the procedure.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Pre bypass: The left atrium is moderately dilated and elongated.
No spontaneous echo contrast is seen in the body of the left
atrium. No mass/thrombus is seen in the left atrium or left
atrial appendage. No atrial septal defect is seen by 2D or color
Doppler. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. There is mild to moderate
regional left ventricular systolic dysfunction. Resting regional
wall motion abnormalities include inferobasal akinesis, mid to
distal inferior moderate to severe hypokinesis, distal
anteroseptal moderate hypokinesis. Septal wall motion
paradoxical, consistent with ventricular pacing. The remaining
left ventricular segments contract normally. Right ventricular
chamber size and free wall motion are normal. There are complex
(>4mm) atheroma in the distal aortic arch. There are complex
(>4mm) atheroma in the descending thoracic aorta. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion. The aortic valve leaflets (3) are mildly thickened
but aortic stenosis is not present. Mild (1+) central aortic
regurgitation is seen. Aortic regurgitatant jet takes up less
than 25% of LVOT area by color m-mode analysis. The mitral valve
leaflets are mildly thickened, but structurally normal. . Mild
(1+) central mitral regurgitation is seen, with a slight.
component to posterior direction. The mitral annulus measures
4-4.5 cm on average. Vena contracta measures 2-5 mm. Mitral
regurgitation changes with loading conditons,but at worst is no
more than mild to moderate. Some of the subvalvular appratus
feeding the anterior mitral leaflet is calcified, but the
leaflet itself is freely mobile. Pacing wires are seen in the RA
and RV. A Pulmonary artery catheter is seen entering the PA via
the RA and RV. There is mild tricuspid regurgitation

Post Bypass: Pt is av paced, on phenylepherine infusion. LVEF
improved to 50%. Basal inferior wall remains severely
hypokinetic to akinetic, but mid and distal inferior wall now
only mildly hypokinetic. Distal anterioseptal wall motion
improved to mild hypokinesis. Septum motion remains paradoxical
c/w pacing. Mitral regurgitation remains mild (1+) and central.
Aortic insufficiency remains mild (1+) and central. Tricuspid
regurgitation remains mild (1+). Aortic contours intact.
Remaining exam unchanged. Findings discussed with surgeons at
the time of the exam.

Post bypass:
I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician

STUDY: Carotid series complete.

REASON: Preop CABG.

FINDINGS: Duplex evaluation was performed of bilateral carotid
arteries.
There is minimal plaque noted bilaterally.

On the right, peak systolic velocities in cm/sec are 80, 87 and
125 in the
ICA, CCA, and ECA respectively. ICA end-diastolic velocity is
35. ICA/CCA
ratio is 0.9. This is consistent with less than 40% stenosis.

On the left, peak velocities are 81, 80, and 66 in the ICA, CCA,
and ECA
respectively. ICA end-diastolic velocity is 32. ICA/CCA ratio is
1.0. This
is consistent with less than 40% stenosis.

There is antegrade vertebral artery flow bilaterally.

IMPRESSION: Bilateral less than 40% carotid stenosis.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]


Approved: WED [**2176-7-24**] 1:23 PM
Procedure Date:[**2176-7-22**]



?????? [**2173**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Admitted on [**7-20**] and underwent pre-op work-up for cabg.Remained
on a heparin drip and had an EP evaluation. Carotid US results
as noted above. CABG x4/Maze performed on [**7-23**] by Dr. [**Last Name (STitle) 914**].
Transferred to the CSRU in stable condition on a propofol drip.
Extubated successfully and sotalol restarted. Had some RUQ abd
pain and US ruled out cholelithiasis. Total bilirubin was
normal.Symptoms then resolved. Coumadin started on POD #1. Chest
tubes were removed and he was transferred to the floor to begin
increasing his activity level. Followed by the EP service.
Pacing wires removed without incident on POD #2.Received abx
coverage for some chest tube site drainage on POD #3. Cleared
for discharge to home with [**Doctor Last Name **] of Hearts monitor and VNA
services on POD #4. Coumadin dosing and INR to be followed by
Dr. [**Last Name (STitle) 6062**]. First blood draw Monday [**7-29**] with results to Dr.
[**Last Name (STitle) 6062**]. Dr. [**Last Name (STitle) **] will do follow up for KOH monitor.

Medications on Admission:
sotalol
coumadin
lipitor
lopid
digoxin

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
3. 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:*0*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
8. Sotalol 80 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*0*
9. Sotalol 120 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
10. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
11. Furosemide 20 mg Tablet Sig: Five (5) Tablet PO DAILY
(Daily) for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
12. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO DAILY (Daily) for 5 days.
Disp:*30 Capsule, Sustained Release(s)* Refills:*0*
13. Warfarin 3 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*- dosing per Dr. [**Last Name (STitle) 6062**]


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
CAD
PAF
SSS s/p PPM
HTN
tobacco abuse
elev. chol

Discharge Condition:
Good.


Discharge Instructions:
Shower, no baths, no lotions creams or powders to incisions.
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
No heavy lifting or driving until follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) 6062**] 2 weeks and for coumadin dosing
Dr. [**Last Name (STitle) **] for [**Doctor Last Name **] of Hearts follow up
Dr. [**Last Name (STitle) 914**] 4 weeks
Dr. [**Last Name (STitle) 13175**] 2 weeks



Completed by:[**2176-8-12**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension,Cardiac pacemaker in situ'}


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 with exertion

PRESENT ILLNESS: 63 yo male with known AFib who presented to  OSH ER with angina
on exertion. Cardiology workup included cath which revealed 80%
LM , 100% RCA, and EF 50%.
Transferred to [**Hospital1 18**] for cabg evaluaton with Dr. [**Last Name (STitle) 914**].

MEDICAL HISTORY: AFib
HTN
elev. chol.
pacer for tachy-brady syndrome
CAD

MEDICATION ON ADMISSION: sotalol
coumadin
lipitor
lopid
digoxin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.6  105/81  HR 69   97% RA sat
CTAB
S1 S2
soft, NT, ND
+ radials/fem/DP/ PT pulses

FAMILY HISTORY: both parents with ruptured [**Name (NI) 67655**]
father with MI

SOCIAL HISTORY: [**3-15**] drinks per day
smokes one PPD for 40 years
no recr. drugs
lives with wife 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Unspecified essential hypertension,Cardiac pacemaker in situ'}
