CHIEF COMPLAINT: angina, SOB

PRESENT ILLNESS: 73 yo male with + stress test first admitted on [**6-18**] for cardiac
cath. This showed 90% LAD, 90% diag 1, 80% OM1, 100% RCA. Prior
stress echo showed EF 15-20%. Pt returns for cabg with Dr.
[**Last Name (STitle) 914**].

MEDICAL HISTORY: CAD, s/p anterior wall STEMI in [**8-9**] stents to proximal and
mid LAD
CHF, EF 20% (TTE [**2146**])
Hypertension
Hyperlipidemia
Chronic renal insufficiency, baseline Cr ~2.0
GI bleed in setting of elevated INR [**9-9**]
Bipolar disorder
Paroxysmal afib
ICD placed [**12-9**]-has never fired
cholecystectomy
appendectomy
tonsillectomy
hiatal hernia
[**12/2132**] MVA right leg trauma
mild pancreatitis d/t Tegretol
nephrogenic diabetes insipidus
L4-5 disc fusion

MEDICATION ON ADMISSION: ASA 81 mg daily
plavix 75 ng daily
diovan 80 mg daily
metoprolol 50 mg [**Hospital1 **]
zocor 80 mg daily
lasix 20 mg daily
lithium 150 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 60  RR 15  137/76  5'[**52**]"   104.3 kg
skin/HEENT unremarkable
neck full ROM with no bruit appreciated
CTAB
RRR no murmur
abd soft, NT, ND, + BS
extrems warm and well-perfused with no edema
right fem cath site, left fem NP
2+ bilat. DP/radials
PTs non-palp.
no varicosities
neuro grossly intact

FAMILY HISTORY: (+) FHx CAD: both parents had MI's in their 70's.

SOCIAL HISTORY: lives alone. Former ETOH abuse, stable with AA. Former smoker
(35 years/<1ppd). No children.
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atrial fibrillation,Intermediate coronary syndrome,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Bipolar disorder, unspecified,Automatic implantable cardiac defibrillator in situ
Crnry athrscl natve vssl,CHF NOS,Atrial fibrillation,Intermed coronary synd,Hyp kid NOS w cr kid V,End stage renal disease,Bipolar disorder NOS,Status autm crd dfbrltr
Admission Date:  [**2148-7-10**]              Discharge Date:   [**2148-7-16**]

Date of Birth:  [**2075-4-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
angina, SOB

Major Surgical or Invasive Procedure:
cabg x5/Maze/stapling of left atrial appendage [**2148-7-10**]
(LIMA to LAD, SVG to diag, sequenced to OM, SVG to PDA, SVG to
PL)


History of Present Illness:
73 yo male with + stress test first admitted on [**6-18**] for cardiac
cath. This showed 90% LAD, 90% diag 1, 80% OM1, 100% RCA. Prior
stress echo showed EF 15-20%. Pt returns for cabg with Dr.
[**Last Name (STitle) 914**].

Past Medical History:
CAD, s/p anterior wall STEMI in [**8-9**] stents to proximal and
mid LAD
CHF, EF 20% (TTE [**2146**])
Hypertension
Hyperlipidemia
Chronic renal insufficiency, baseline Cr ~2.0
GI bleed in setting of elevated INR [**9-9**]
Bipolar disorder
Paroxysmal afib
ICD placed [**12-9**]-has never fired
cholecystectomy
appendectomy
tonsillectomy
hiatal hernia
[**12/2132**] MVA right leg trauma
mild pancreatitis d/t Tegretol
nephrogenic diabetes insipidus
L4-5 disc fusion


Social History:
lives alone. Former ETOH abuse, stable with AA. Former smoker
(35 years/<1ppd). No children.


Family History:
(+) FHx CAD: both parents had MI's in their 70's.

Physical Exam:
HR 60  RR 15  137/76  5'[**52**]"   104.3 kg
skin/HEENT unremarkable
neck full ROM with no bruit appreciated
CTAB
RRR no murmur
abd soft, NT, ND, + BS
extrems warm and well-perfused with no edema
right fem cath site, left fem NP
2+ bilat. DP/radials
PTs non-palp.
no varicosities
neuro grossly intact

Pertinent Results:
[**2148-7-15**] 03:30PM BLOOD WBC-11.0 RBC-3.12* Hgb-9.6* Hct-26.9*
MCV-86 MCH-30.9 MCHC-35.9* RDW-14.6 Plt Ct-200
[**2148-7-16**] 09:00AM BLOOD PT-18.3* INR(PT)-1.7*
[**2148-7-15**] 03:30PM BLOOD Plt Ct-200
[**2148-7-11**] 03:04AM BLOOD Fibrino-224
[**2148-7-15**] 03:30PM BLOOD Glucose-111* UreaN-40* Creat-2.1* Na-138
K-5.1 Cl-106 HCO3-25 AnGap-12
[**2148-7-10**] 10:22PM BLOOD ALT-38 AST-93* AlkPhos-72 Amylase-125*
TotBili-0.3
[**2148-7-11**] 12:39AM BLOOD Lipase-51
[**2148-7-15**] 03:30PM BLOOD Calcium-9.0 Phos-3.6 Mg-2.6

FINAL REPORT


INDICATION: Evaluate for infiltrate or effusion.

COMPARISON: [**2148-7-11**].

TECHNIQUE: PA and lateral chest.

FINDINGS: Since the previous examination, the mediastinal
drains, left-sided
chest tube, endotracheal tube, nasogastric tube, right internal
jugular venous
access sheath and pulmonary artery catheter has been removed.
There is stable
postoperative widening of the cardiomediastinal silhouette.
Small right
pleural effusion is unchanged and small left pleural effusion is
slightly
increased. There is no pneumothorax.

IMPRESSION: Bilateral pleural effusions, increased on the left.
Status post
removal of multiple lines and tubes. No pneumothorax.
THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name (STitle) 8913**] R.M. SUN

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]


Approved: MON [**2148-7-15**] 11:09 AM
Procedure Date:[**2148-7-15**]


Brief Hospital Course:
Admitted [**7-10**] and underwent cabg x5/Maze/stapling of left atrial
appendage.Transferred to the CSRU in stable condition on
epinephrine, phenylephrine and propofol drips. Off all drips on
POD #1 after corrected acidemia and 3 units PRBCs overnight.
Extubated that afternoon and coumadin/amiodarone started for
post-Maze. EP consulted , chest tubes removed,and pt.
transferred to the floor to begin increasing his activity
level.Pacing wires removed without incident on POD #3.Amiodarone
decreased per EP recs. He continued to make good progress on the
floor while waiting for his INR to rise.Cleared for discharge to
home with VNA services on POD #6. He is to have first blood draw
on Th. [**7-18**] and coumadin dosing/INR follow up with Dr. [**First Name (STitle) **] as
per discharge instructions.

Medications on Admission:
ASA 81 mg daily
plavix 75 ng daily
diovan 80 mg daily
metoprolol 50 mg [**Hospital1 **]
zocor 80 mg daily
lasix 20 mg daily
lithium 150 mg daily

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
2. 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*
3. 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*
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Lithium Carbonate 150 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
Disp:*30 Capsule(s)* Refills:*2*
7. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
Disp:*2 MDI* Refills:*1*
8. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
10. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
11. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO once a day for
2 days: 3 mg on [**7-16**] & [**7-17**], then INR to be drawn, results
called to Dr. [**First Name (STitle) **] for continued Coumadin dosing .
Disp:*120 Tablet(s)* Refills:*0*
12. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
13. Aerobid 250 mcg/Actuation Aerosol Sig: One (1) puff
Inhalation twice a day.
Disp:*1 MDI* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
CAD
Afib
MI
CHF
prior coronary stents
elev. chol
CRI
prior GI bleed
HTN
ICD
bipolar disorder
s/p ORIF left leg


Discharge Condition:
stable


Discharge Instructions:
may shower over incisions and pat dry
no lotions, creams or powders on any incision
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100, redness or drainage

first blod draw.Thurs [**7-18**] with INR to be called to Dr. [**First Name (STitle) **]
at [**Telephone/Fax (1) 29643**];fax [**Telephone/Fax (1) 7531**]  ; daily coumadin dosing per
Dr.[**First Name (STitle) **]

Followup Instructions:
first blood draw Thursday, [**2148-7-18**] with coumadin dosing per
Dr.[**First Name (STitle) **]
follow up with Dr. [**Last Name (STitle) **] in [**1-8**] weeks
follow up with Dr. [**Last Name (STitle) 914**] in 4 weeks  [**Telephone/Fax (1) 170**]
Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.



Completed by:[**2148-7-17**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atrial fibrillation,Intermediate coronary syndrome,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Bipolar disorder, unspecified,Automatic implantable cardiac defibrillator 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: angina, SOB

PRESENT ILLNESS: 73 yo male with + stress test first admitted on [**6-18**] for cardiac
cath. This showed 90% LAD, 90% diag 1, 80% OM1, 100% RCA. Prior
stress echo showed EF 15-20%. Pt returns for cabg with Dr.
[**Last Name (STitle) 914**].

MEDICAL HISTORY: CAD, s/p anterior wall STEMI in [**8-9**] stents to proximal and
mid LAD
CHF, EF 20% (TTE [**2146**])
Hypertension
Hyperlipidemia
Chronic renal insufficiency, baseline Cr ~2.0
GI bleed in setting of elevated INR [**9-9**]
Bipolar disorder
Paroxysmal afib
ICD placed [**12-9**]-has never fired
cholecystectomy
appendectomy
tonsillectomy
hiatal hernia
[**12/2132**] MVA right leg trauma
mild pancreatitis d/t Tegretol
nephrogenic diabetes insipidus
L4-5 disc fusion

MEDICATION ON ADMISSION: ASA 81 mg daily
plavix 75 ng daily
diovan 80 mg daily
metoprolol 50 mg [**Hospital1 **]
zocor 80 mg daily
lasix 20 mg daily
lithium 150 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 60  RR 15  137/76  5'[**52**]"   104.3 kg
skin/HEENT unremarkable
neck full ROM with no bruit appreciated
CTAB
RRR no murmur
abd soft, NT, ND, + BS
extrems warm and well-perfused with no edema
right fem cath site, left fem NP
2+ bilat. DP/radials
PTs non-palp.
no varicosities
neuro grossly intact

FAMILY HISTORY: (+) FHx CAD: both parents had MI's in their 70's.

SOCIAL HISTORY: lives alone. Former ETOH abuse, stable with AA. Former smoker
(35 years/<1ppd). No children. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atrial fibrillation,Intermediate coronary syndrome,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Bipolar disorder, unspecified,Automatic implantable cardiac defibrillator in situ'}
