CHIEF COMPLAINT: chest pain, shortness of breath

PRESENT ILLNESS: The patient is an 82  year old male who developed chest pain
while snow-blowing and called 911.  He presented to the [**Hospital1 18**],
[**Location (un) 620**] and was transferred to [**Location (un) 86**] for catheterization.  He
ruled in for non-ST elevation myocardial infarction.

MEDICAL HISTORY: coronary artery disease
hypertension
benign prostatic hyperplasia
hyperlipidemia
polyps of vocal cords

MEDICATION ON ADMISSION: sertraline 50mg daily
lisinopril 2.5mg daily
simvastatin 20mg daily
diovan 80mg daily
doxazosin
lipitor 10mg daily
clonazepam
finasteride 5mg daily
glucosamine chondroitin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS: 116/56, 80, 23
Gen: NAD
HEENT: unremarkable
Neck: supple, full ROM
Chest: lungs CTAB
Heart: RRR
Abd: +BS, soft, non-tender, non-distended
Ext: warm, well-perfused, no edema
Neuro: grossly intact

FAMILY HISTORY: no history of premature coronary disease

SOCIAL HISTORY: semi-retired
lives with wife
denies tobacco
drinks red wine daily
denies recreational drugs
Coronary atherosclerosis of native coronary artery,Rupture of chordae tendineae,Intermediate coronary syndrome,Hemorrhage complicating a procedure,Acidosis,Delirium due to conditions classified elsewhere,Mitral valve disorders,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other and unspecified hyperlipidemia,Hypotension, unspecified,Urinary complications, not elsewhere classified,Oliguria and anuria,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,Unspecified personality disorder
Crnry athrscl natve vssl,Chordae tendinae rupture,Intermed coronary synd,Hemorrhage complic proc,Acidosis,Delirium d/t other cond,Mitral valve disorder,Hypertension NOS,BPH w/o urinary obs/LUTS,Abn react-cardiac cath,Hyperlipidemia NEC/NOS,Hypotension NOS,Surg compl-urinary tract,Oliguria & anuria,Abn react-anastom/graft,Personality disorder NOS
Admission Date:  [**2151-12-28**]              Discharge Date:   [**2152-1-3**]

Date of Birth:  [**2069-3-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
chest pain, shortness of breath

Major Surgical or Invasive Procedure:
coronary artery bypass x 2, mitral valve repair, repair of right
femoral artery [**2151-12-28**]


History of Present Illness:
The patient is an 82  year old male who developed chest pain
while snow-blowing and called 911.  He presented to the [**Hospital1 18**],
[**Location (un) 620**] and was transferred to [**Location (un) 86**] for catheterization.  He
ruled in for non-ST elevation myocardial infarction.

Past Medical History:
coronary artery disease
hypertension
benign prostatic hyperplasia
hyperlipidemia
polyps of vocal cords

Social History:
semi-retired
lives with wife
denies tobacco
drinks red wine daily
denies recreational drugs

Family History:
no history of premature coronary disease

Physical Exam:
Admission:
VS: 116/56, 80, 23
Gen: NAD
HEENT: unremarkable
Neck: supple, full ROM
Chest: lungs CTAB
Heart: RRR
Abd: +BS, soft, non-tender, non-distended
Ext: warm, well-perfused, no edema
Neuro: grossly intact


Pertinent Results:
[**2152-1-3**] 06:40AM BLOOD WBC-8.0 RBC-3.17* Hgb-9.6* Hct-27.6*
MCV-87 MCH-30.2 MCHC-34.7 RDW-14.0 Plt Ct-390#
[**2152-1-3**] 06:40AM BLOOD Glucose-125* UreaN-39* Creat-1.1 Na-142
K-4.4 Cl-105 HCO3-30 AnGap-11
[**2152-1-2**] 06:45AM BLOOD Mg-2.9*



[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 93124**] (Complete)
Done [**2151-12-28**] at 6:09:50 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2069-3-11**]
Age (years): 82 M  Hgt (in): 68
BP (mm Hg): /  Wgt (lb): 180
HR (bpm):  BSA (m2): 1.96 m2
Indication: Chest pain. Coronary artery disease. Left
ventricular function. Right ventricular function. Valvular heart
disease.
ICD-9 Codes: 410.91, 440.0, 413.9, 414.8, 424.1, 424.0
Test Information
Date/Time: [**2151-12-28**] at 18:09    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Last Name (NamePattern5) 9958**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW0-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.7 cm  <= 4.0 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:  5.5 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Aorta - Annulus:  2.2 cm  <= 3.0 cm
Aorta - Sinus Level:  *3.8 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.3 cm  <= 3.0 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aorta - Arch:  2.1 cm  <= 3.0 cm
Aorta - Descending Thoracic:  *2.6 cm  <= 2.5 cm
Mitral Valve - Mean Gradient:  1 mm Hg
Mitral Valve - Pressure Half Time:  58 ms
Mitral Valve - MVA (P [**12-10**] T):  3.8 cm2
Mitral Valve - [**Last Name (un) **]:  0.38 cm2
Mitral Valve - Regurgitation Volume:  55 ml
Pulmonic Valve - Peak Velocity:  0.7 m/sec  <= 1.5 m/sec
Pericardium - Effusion Size:  1.0 cm

Findings
LEFT ATRIUM: Mild LA enlargement.

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: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness. Top
normal/borderline dilated LV cavity size. Normal regional LV
systolic function. Overall normal LVEF (>55%).

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

AORTA: Normal diameter of aorta at the sinus, ascending and arch
levels. Mildly dilated aortic sinus. Normal ascending aorta
diameter. Normal aortic arch diameter. Mildly dilated descending
aorta. Simple atheroma in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Mild to
moderate ([**12-10**]+) AR.

MITRAL VALVE: Partial mitral leaflet flail. Eccentric MR jet.
Moderate to severe (3+) MR.

TRICUSPID VALVE: Physiologic TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

PERICARDIUM: Small to moderate 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. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient.
Conclusions
PRE-BYPASS: The left atrium is mildly dilated. No atrial septal
defect is seen by 2D or color Doppler. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is top
normal/borderline dilated. Regional left ventricular wall motion
is normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The diameters of ascending aorta and arrch levels
are normal. The aortic root is mildly dilated at the sinus
level. The descending thoracic aorta is mildly dilated. There
are simple atheroma in the descending thoracic aorta. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis. Mild to moderate ([**12-10**]+) aortic
regurgitation is seen. There appears to be flail of the P3
leaflet of the mitral valve. An eccentric jet of moderate to
severe (3+) mitral regurgitation is seen. There is a small to
moderate sized pericardial effusion.

POST BYPASS: The patient is AV paced and on an infusion of
phenylephrine. Left and right ventricular function is preserved.
The aorta is intact. A mitral valve repair has been performed
and an annuloplasty band placed. There is now no MR. Mild to
moderate AR persists. The remainder of the examination is
unchanged.

Dr. [**Last Name (STitle) **] was notified in person of the results in the
operating room.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2151-12-29**] 09:51


?????? [**2145**] CareGroup IS. All rights reserved.


Brief Hospital Course:
The patient was brought to the operating room emergently due to
bleeding in the right groin at the site of the intraortic
balloon pump.  He underwent CABG x 2, mitral valve repair with
28mm [**Doctor Last Name **] [**Last Name (un) 3843**] Band and repair of the right femoral
artery (by Dr. [**Last Name (STitle) 1391**].  Please see operative report for
further details.  Overall the patient tolerated the procedure
well and was transferred to the CVICU post operatively for
further monitoring.  On POD 1 the patient remained intubated and
hemodynamics were supported with phenylephrine, norepinephrine
and epinephrine.  Within 24 hours of surgery, the patient was
extubated and the balloon pump was discontinued.  Vasoactive
drips were weaned off.  The patient was transferred to the
telemetry floor on POD 3.  Chest tubes and pacing wires were
discontinued without complication.  The patient was gently
diuresed toward his preoperative weight.  Social work consult
was obtained for family's concern of patient's history of
emotional/verbal abuse towards family members, including wife
who recently had a stroke.  Additionally, geriatrics consult was
obtained for further management of this issue.  The geriatrics
team will continue to follow the patient when he is discharged
to rehab.  The patient made reasonable progress
post-operatively.  He was discharged to the [**Hospital 100**] Rehab on POD
6.

Medications on Admission:
sertraline 50mg daily
lisinopril 2.5mg daily
simvastatin 20mg daily
diovan 80mg daily
doxazosin
lipitor 10mg daily
clonazepam
finasteride 5mg daily
glucosamine chondroitin

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
2. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

5. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours) as needed.
7. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
9. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
10. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.
12. Ayr Saline Gel     Spray, Non-Aerosol Sig: One (1)  Nasal
once a day.
13. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
14. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
15. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed.
16. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours).
17. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day.



Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
coronary artery disease
PMH:
hypertension
benign prostatic hyperplasia
vocal cord polyps
hyperlipidemia


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]  in 1 week
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1728**] in [**1-11**] weeks [**Telephone/Fax (1) 14148**]
Please call for appointments
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2152-1-3**]
{'Coronary atherosclerosis of native coronary artery,Rupture of chordae tendineae,Intermediate coronary syndrome,Hemorrhage complicating a procedure,Acidosis,Delirium due to conditions classified elsewhere,Mitral valve disorders,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other and unspecified hyperlipidemia,Hypotension, unspecified,Urinary complications, not elsewhere classified,Oliguria and anuria,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,Unspecified personality disorder'}


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, shortness of breath

PRESENT ILLNESS: The patient is an 82  year old male who developed chest pain
while snow-blowing and called 911.  He presented to the [**Hospital1 18**],
[**Location (un) 620**] and was transferred to [**Location (un) 86**] for catheterization.  He
ruled in for non-ST elevation myocardial infarction.

MEDICAL HISTORY: coronary artery disease
hypertension
benign prostatic hyperplasia
hyperlipidemia
polyps of vocal cords

MEDICATION ON ADMISSION: sertraline 50mg daily
lisinopril 2.5mg daily
simvastatin 20mg daily
diovan 80mg daily
doxazosin
lipitor 10mg daily
clonazepam
finasteride 5mg daily
glucosamine chondroitin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:
VS: 116/56, 80, 23
Gen: NAD
HEENT: unremarkable
Neck: supple, full ROM
Chest: lungs CTAB
Heart: RRR
Abd: +BS, soft, non-tender, non-distended
Ext: warm, well-perfused, no edema
Neuro: grossly intact

FAMILY HISTORY: no history of premature coronary disease

SOCIAL HISTORY: semi-retired
lives with wife
denies tobacco
drinks red wine daily
denies recreational drugs 

### Response:
{'Coronary atherosclerosis of native coronary artery,Rupture of chordae tendineae,Intermediate coronary syndrome,Hemorrhage complicating a procedure,Acidosis,Delirium due to conditions classified elsewhere,Mitral valve disorders,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Other and unspecified hyperlipidemia,Hypotension, unspecified,Urinary complications, not elsewhere classified,Oliguria and anuria,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,Unspecified personality disorder'}
