CHIEF COMPLAINT: Chest discomfort with exertion referred for cardiac
catheterization.

PRESENT ILLNESS: 68 y.o male with chest discomfort on exertion, was referred for
cardiac catheterization. Catheterization report on [**2124-11-8**]
showed an EF of 60%, no MR LAD:40-50%, LCX: 90%, RCA 100%. He
was then referred to for cardiac surgery.

MEDICAL HISTORY: PMH: DM type 2, AF, DJD, anxiety, arthritis.
PSH:L TKR, Cervical fusion C2-4, Tonsillectomy, Rt hernia
repairx2, Lipoma removal rt chest
[**Last Name (un) 1724**]: Zetia 10', Celexa 20', Digoxin 0.25', Avodart 0.5',
Metformin 500", Gluburide 2.5", Verapamil 240 QA & 120 QP,
Lipitor 40', Doxasosin 4', Coumadin 10(3x/wk)15(4x/wk), ASA 81',

MEDICATION ON ADMISSION: Zetia 10mg daily
Celexa 20mg daily
Digoxin 0.25mg daily
Metformin 500mg [**Hospital1 **]
Avodart 0.5mg daily
Glyburide 2.5mg [**Hospital1 **]
Verapamil 120mg QPM
Lipitor 40mg bedtime
Doxazosin 4mg daily
Coumadin 10mg 3X/wk
Coumadin 15mg 4X/wk
ASA 81mg daily
SL Nitro PRN

ALLERGIES: Simvastatin

PHYSICAL EXAM: Admission Physical Exam [**11-8**]
Pulse:64, Resp: 18, BP R: 143/77 L:132/91 Height: 5'9", Wgt:
240lbs
General: NAD
Skin: Unremarkable well healed scar R chest
HEENT: Unremarkable, glasses
Chest: Lungs CTA bilat
Heart: RRR
Abdomen: Obese, benign
Extremities: Well-perfused, no edema
Varicosities: None
Neuro: None focal
Pulses:
Femoral, BP, PT Radial equal bilaterally +2
Carotid bruit: none bilaterally

FAMILY HISTORY: Family history:
Race: Caucasian
Brother died from MI at age 65
Father had an MI in his early 60s
Sister had a stroke at age 59.

SOCIAL HISTORY: Occupation: Financial
Tobacco: Quit [**2088**] [**12-15**] ppdX33yrs
ETOH: [**4-16**] drinks/week
Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Anxiety state, unspecified,Long-term (current) use of insulin
Crnry athrscl natve vssl,Secundum atrial sept def,Angina pectoris NEC/NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Hyperlipidemia NEC/NOS,Atrial fibrillation,Anxiety state NOS,Long-term use of insulin
Admission Date:  [**2124-11-8**]              Discharge Date:   [**2124-11-15**]

Date of Birth:  [**2056-10-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Simvastatin

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest discomfort with exertion referred for cardiac
catheterization.

Major Surgical or Invasive Procedure:
[**11-9**] CABGx3(LIMA-LAD,SVG-OM,SVG-PDA)ASD closure/Ligation of [**Name Prefix (Prefixes) **]
[**Last Name (Prefixes) 1916**]


History of Present Illness:
68 y.o male with chest discomfort on exertion, was referred for
cardiac catheterization. Catheterization report on [**2124-11-8**]
showed an EF of 60%, no MR LAD:40-50%, LCX: 90%, RCA 100%. He
was then referred to for cardiac surgery.

Past Medical History:
PMH: DM type 2, AF, DJD, anxiety, arthritis.
PSH:L TKR, Cervical fusion C2-4, Tonsillectomy, Rt hernia
repairx2, Lipoma removal rt chest
[**Last Name (un) 1724**]: Zetia 10', Celexa 20', Digoxin 0.25', Avodart 0.5',
Metformin 500", Gluburide 2.5", Verapamil 240 QA & 120 QP,
Lipitor 40', Doxasosin 4', Coumadin 10(3x/wk)15(4x/wk), ASA 81',



Social History:
Occupation: Financial
Tobacco: Quit [**2088**] [**12-15**] ppdX33yrs
ETOH: [**4-16**] drinks/week

Family History:
Family history:
Race: Caucasian
Brother died from MI at age 65
Father had an MI in his early 60s
Sister had a stroke at age 59.


Physical Exam:
Admission Physical Exam [**11-8**]
Pulse:64, Resp: 18, BP R: 143/77 L:132/91 Height: 5'9", Wgt:
240lbs
General: NAD
Skin: Unremarkable well healed scar R chest
HEENT: Unremarkable, glasses
Chest: Lungs CTA bilat
Heart: RRR
Abdomen: Obese, benign
Extremities: Well-perfused, no edema
Varicosities: None
Neuro: None focal
Pulses:
Femoral, BP, PT Radial equal bilaterally +2
Carotid bruit: none bilaterally

Discharge Physical Exam [**11-15**]
Neuro: None-focal
Pulmonary: Decreased air L base
Sternal incision: No drainage, no erythema
Abdomen: Soft, non-tender, bowel sound present
Extremities: Warm, no edema, 1+ pedal pulses
Leg incision: LLE, EVH dry and intact


Pertinent Results:
[**2124-11-8**] 01:30PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.037*
[**2124-11-8**] 01:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2124-11-8**] 11:30AM   GLUCOSE-115* UREA N-19 CREAT-0.7 SODIUM-133
POTASSIUM-4.1 CHLORIDE-99 TOTAL CO2-27 ANION GAP-11
[**2124-11-8**] 11:30AM   ALT(SGPT)-18 AST(SGOT)-15 ALK PHOS-47 TOT
BILI-0.5
[**2124-11-8**] 11:30AM   ALBUMIN-3.7
[**2124-11-8**] 11:30AM   %HbA1c-6.6*
[**2124-11-8**] 11:30AM   WBC-8.5 RBC-4.66 HGB-13.8* HCT-41.3 MCV-89
MCH-29.7 MCHC-33.5 RDW-14.2
[**2124-11-8**] 11:30AM   PLT COUNT-285
[**2124-11-8**] 11:30AM   PT-13.1 PTT-26.4 INR(PT)-1.1

[**2124-11-14**] 07:35AM BLOOD WBC-13.1* RBC-2.94* Hgb-8.9* Hct-25.8*
MCV-88 MCH-30.2 MCHC-34.3 RDW-14.4 Plt Ct-308#
[**2124-11-15**] 07:15AM BLOOD PT-15.3* INR(PT)-1.3*
[**2124-11-14**] 07:35AM BLOOD Plt Ct-308#
[**2124-11-14**] 07:35AM BLOOD Glucose-107* UreaN-36* Creat-0.9 Na-136
K-4.1 Cl-96 HCO3-32 AnGap-12

   RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2124-11-11**] 2:50 PM

CHEST (PORTABLE AP)

Reason: Evaluate for effusion

[**Hospital 93**] MEDICAL CONDITION:
68 year old man with
REASON FOR THIS EXAMINATION:
Evaluate for effusion
PORTABLE CHEST, [**2124-11-11**] AT 15:02

COMPARISON STUDY: [**2124-11-10**].

CLINICAL INFORMATION: Effusion.

FINDINGS:

Since the prior study, there is mild interval increase in the
left-sided pleural effusion, which is now moderate. There is
continued left lower lobe consolidation. The right lung is
relatively clear. Cardiomediastinal silhouette is within normal
limits. There is a median sternotomy.

IMPRESSION:

Interval increase in left pleural effusion. Left lower lobe
atelectasis.

DR. [**First Name11 (Name Pattern1) 3993**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3994**]
Approved: SUN [**2124-11-12**] 8:11 AM

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 75587**] (Complete)
Done [**2124-11-9**] at 9:30:40 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2056-10-19**]
Age (years): 68 M  Hgt (in): 70
BP (mm Hg): 140/80  Wgt (lb): 240
HR (bpm): 65  BSA (m2): 2.26 m2
Indication: Intraoperative TEE for CABG, ASD closure, LAA
ligation
ICD-9 Codes: 745.5, 410.91, 427.31, 786.51, 440.0
Test Information
Date/Time: [**2124-11-9**] at 09:30    Interpret MD: [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**],
MD
Test Type: TEE (Complete)
3D imaging. Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5740**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2007AW4-: Machine: 4
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.4 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Annulus:  2.5 cm  <= 3.0 cm
Aorta - Sinotubular Ridge:  2.7 cm  <= 3.0 cm
Aorta - Ascending:  *3.7 cm  <= 3.4 cm
Aorta - Descending Thoracic:  *2.9 cm  <= 2.5 cm

Findings
Multiplanar reconstructions were generated and confirmed on an
independent workstation.

LEFT ATRIUM: Moderate to severe spontaneous echo contrast in the
body of the LA. Depressed LAA emptying velocity (<0.2m/s) Cannot
exclude LAA thrombus.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Left-to-right shunt
across the interatrial septum at rest. Secundum ASD.

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Low normal LVEF.

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

AORTA: Mildly dilated aortic sinus. Mildly dilated ascending
aorta. Normal aortic arch diameter. Simple atheroma in aortic
arch. Mildly dilated descending aorta. Simple atheroma in
descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AR.


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

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic PR.

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 rhythm appears
to be atrial fibrillation. Results were personally reviewed with
the MD caring for the patient.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-BYPASS:
1. Moderate spontaneous echo contrast is seen in the body of the
left atrium. The left atrial appendage emptying velocity is
depressed (<0.2m/s). A left atrial appendage thrombus cannot be
excluded. There is prominence of the pectinate muscles.
2. A left-to-right shunt across the interatrial septum is seen
at rest. A secundum type atrial septal defect is present.
3. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is low normal (LVEF 50-55%). There is
hypokinesis of the inferior and inferior lateral walls from the
mid=papillary to apical levels.
4. Right ventricular chamber size and free wall motion are
normal.
5. The aortic root is mildly dilated at the sinus level. The
ascending aorta is mildly dilated. There are simple atheroma in
the aortic arch. The descending thoracic aorta is mildly
dilated. There are simple atheroma in the descending thoracic
aorta.
6. The aortic valve leaflets (3) are mildly thickened. No aortic
regurgitation is seen.
7. The mitral valve leaflets are mildly thickened. Trivial
mitral regurgitation is seen. A2 scallop is notable for a torn
chordae.

POST-BYPASS:
Pt removed from cardiopulmonary bypass on phenylephrine infusion
and AV paced.
1. Biventricular function is maintained, regional wall
abnormalites as noted pre-bypass.
2. ASD is closed; there is no flow across the intra-atrial
septum.
3. The left atrial appendage has been obliterated.
4. Aortic contours are intact post-decannulation.
I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting
physician



Brief Hospital Course:
Mr [**Known lastname 3077**] was admitted on [**11-8**] for cardiac catheterization which
revealed 3VDs and was then referred to for cardiac surgery. He
was brought to the operating room on [**11-9**] and underwent a
CABGX3 LIMA-LAD, SVG-OM, SVG-PDA, ASD closure and Ligation of L
Atrial Appendage without any immediate complication. He was then
transferred to the intensive care in stable condition. He
received Vancomycin in during his perioperative period because
he was inpatient prior to his surgery. He did well in the
immediate period, he anesthesia was reversed and he was weaned
off the ventilator and extubated. On POD1 he was weaned off of
his vasoactive infusions and his CTs were removed followed by a
CXR that showed no pneumothorax. On POD2, he had and episode of
rapid AF and was treated with beta-blockers and anticoagulation.
On POD3 he was transferred to F6 for further post-operative care
management. Over the last couple of days, he has advance his
activity level with the help of physical therapy. On POD6 it was
decided that he was stable and ready to transfer out to a
rehabilitation center for further management of his physical
activity. His INR will be followed by [**Hospital1 **] TCU at discharge
and then by Dr [**First Name (STitle) **] when discharge from the rehabilitation
center.

Medications on Admission:
Zetia 10mg daily
Celexa 20mg daily
Digoxin 0.25mg daily
Metformin 500mg [**Hospital1 **]
Avodart 0.5mg daily
Glyburide 2.5mg [**Hospital1 **]
Verapamil 120mg QPM
Lipitor 40mg bedtime
Doxazosin 4mg daily
Coumadin 10mg 3X/wk
Coumadin 15mg 4X/wk
ASA 81mg daily
SL Nitro PRN


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every [**3-17**]
hours as needed.
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 2
weeks.
Disp:*qs Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
6. Warfarin 10 mg Tablet Sig: 10mg alt w/15mg Tablets PO once a
day: target INR 2-2.5
Previously 10mg alt with 15mg
Pt to receive 10mg on [**11-15**].
Disp:*qs Tablet(s)* Refills:*0*
7. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*qs Tablet(s)* Refills:*2*
8. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*qs Tablet(s)* Refills:*2*
9. Doxazosin 4 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*qs Tablet(s)* Refills:*2*
10. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*qs Tablet(s)* Refills:*2*
11. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO once a day.
Disp:*qs Capsule(s)* Refills:*2*
12. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*qs Tablet(s)* Refills:*0*
13. Digoxin 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*qs Tablet(s)* Refills:*0*
14. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*qs Tablet(s)* Refills:*2*
15. Verapamil 240 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
Disp:*qs Tablet Sustained Release(s)* Refills:*2*
16. Verapamil 120 mg Tablet Sig: One (1) Tablet PO QPM (once a
day (in the evening)).
Disp:*qs Tablet(s)* Refills:*2*
17. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 weeks.
Disp:*qs Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] [**Hospital 1108**] Rehab Unit at
[**Hospital6 1109**] - [**Location (un) 1110**]

Discharge Diagnosis:
CAD now s/p CABG
DM2, Afib, DJD, Anxiety, arthritis,
L TKR, Cervical fusion C2-4, Tonsillectomy, Rt hernia repairx2,
Lipoma removal rt chest


Discharge Condition:
Good.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No  lifting more than 10 pounds or driving until follow up with
surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) 1295**] 2 weeks
Dr. [**First Name (STitle) **] 2 weeks
Dr. [**First Name (STitle) **] 4 weeks


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2124-11-15**]
{'Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Anxiety state, unspecified,Long-term (current) use of insulin'}


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 discomfort with exertion referred for cardiac
catheterization.

PRESENT ILLNESS: 68 y.o male with chest discomfort on exertion, was referred for
cardiac catheterization. Catheterization report on [**2124-11-8**]
showed an EF of 60%, no MR LAD:40-50%, LCX: 90%, RCA 100%. He
was then referred to for cardiac surgery.

MEDICAL HISTORY: PMH: DM type 2, AF, DJD, anxiety, arthritis.
PSH:L TKR, Cervical fusion C2-4, Tonsillectomy, Rt hernia
repairx2, Lipoma removal rt chest
[**Last Name (un) 1724**]: Zetia 10', Celexa 20', Digoxin 0.25', Avodart 0.5',
Metformin 500", Gluburide 2.5", Verapamil 240 QA & 120 QP,
Lipitor 40', Doxasosin 4', Coumadin 10(3x/wk)15(4x/wk), ASA 81',

MEDICATION ON ADMISSION: Zetia 10mg daily
Celexa 20mg daily
Digoxin 0.25mg daily
Metformin 500mg [**Hospital1 **]
Avodart 0.5mg daily
Glyburide 2.5mg [**Hospital1 **]
Verapamil 120mg QPM
Lipitor 40mg bedtime
Doxazosin 4mg daily
Coumadin 10mg 3X/wk
Coumadin 15mg 4X/wk
ASA 81mg daily
SL Nitro PRN

ALLERGIES: Simvastatin

PHYSICAL EXAM: Admission Physical Exam [**11-8**]
Pulse:64, Resp: 18, BP R: 143/77 L:132/91 Height: 5'9", Wgt:
240lbs
General: NAD
Skin: Unremarkable well healed scar R chest
HEENT: Unremarkable, glasses
Chest: Lungs CTA bilat
Heart: RRR
Abdomen: Obese, benign
Extremities: Well-perfused, no edema
Varicosities: None
Neuro: None focal
Pulses:
Femoral, BP, PT Radial equal bilaterally +2
Carotid bruit: none bilaterally

FAMILY HISTORY: Family history:
Race: Caucasian
Brother died from MI at age 65
Father had an MI in his early 60s
Sister had a stroke at age 59.

SOCIAL HISTORY: Occupation: Financial
Tobacco: Quit [**2088**] [**12-15**] ppdX33yrs
ETOH: [**4-16**] drinks/week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atrial fibrillation,Anxiety state, unspecified,Long-term (current) use of insulin'}
