CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 61 year old male with angina over last year relieved with rest.
Presented to OSH when angina did not relieve with rest and ruled
in for NSTEMI.  Transferred for cardiac catherization

MEDICAL HISTORY: Hypertension
Angina
Heart Failure
Atrial Fibrillation
Skin Cancer

MEDICATION ON ADMISSION: lopressor, lipitor, ASA, pepcid, Solumedrol, Plavix,

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: Discharge
Neuro: alert, oriented x3, strength R=L [**3-20**], no vision left eye,
normal vision right eye
Pulmonary: lungs clear to auscultation bilaterally
Cardiac: RRR +murmur 2/6 SEM, no rub/gallop
Sternal incision: healing no erythema, no drainage, sternum
stable
Abdomen: soft, nontender, nondistended, +bowel sounds last BM
[**10-12**]
Extremeties: warm, edema +1 nonpitting, pulses palpable
Leg incision: endovascular harvest, healing, no drainage, no
erythema

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Works at [**Company **] globe, is married
Tobacco - denies
ETOH - [**2-16**]/day
Acute myocardial infarction of other anterior wall, initial episode of care,Acute kidney failure, unspecified,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Thrombocytopenia, unspecified,Drug-induced delirium,Phlebitis and thrombophlebitis of upper extremities, unspecified,Functional disturbances following cardiac surgery,Other diuretics causing adverse effects in therapeutic use,Congestive heart failure, unspecified,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Atrial fibrillation,Other chronic pulmonary heart diseases,Other iatrogenic hypotension,Other disorders of optic nerve,Depressive disorder, not elsewhere classified,Insomnia, unspecified,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension
AMI anterior wall, init,Acute kidney failure NOS,Hemorrhage complic proc,Surg compl-heart,Thrombocytopenia NOS,Drug-induced delirium,Phlbts vn NOS up extrm,Hrt dis postcardiac surg,Adv eff diuretics NEC,CHF NOS,Adv eff benzodiaz tranq,Atrial fibrillation,Chr pulmon heart dis NEC,Iatrogenc hypotnsion NEC,Optic nerve disorder NEC,Depressive disorder NEC,Insomnia NOS,Anemia NOS,Crnry athrscl natve vssl,Hypertension NOS
Admission Date:  [**2137-9-19**]              Discharge Date:   [**2137-10-12**]

Date of Birth:  [**2075-12-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Iodine; Iodine Containing

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

Major Surgical or Invasive Procedure:
s/p CABGx5(LIMA->LAD, SVG-.pLAD, Ramus, PDA, LCX) [**2137-9-19**]
Reexploration for bleeding.
Cardiac catherization


History of Present Illness:
61 year old male with angina over last year relieved with rest.
Presented to OSH when angina did not relieve with rest and ruled
in for NSTEMI.  Transferred for cardiac catherization

Past Medical History:
Hypertension
Angina
Heart Failure
Atrial Fibrillation
Skin Cancer

Social History:
Works at [**Company **] globe, is married
Tobacco - denies
ETOH - [**2-16**]/day

Family History:
Non contributory

Physical Exam:
Discharge
Neuro: alert, oriented x3, strength R=L [**3-20**], no vision left eye,
normal vision right eye
Pulmonary: lungs clear to auscultation bilaterally
Cardiac: RRR +murmur 2/6 SEM, no rub/gallop
Sternal incision: healing no erythema, no drainage, sternum
stable
Abdomen: soft, nontender, nondistended, +bowel sounds last BM
[**10-12**]
Extremeties: warm, edema +1 nonpitting, pulses palpable
Leg incision: endovascular harvest, healing, no drainage, no
erythema


Pertinent Results:
RENAL U.S.; DUPLEX DOP ABD/PEL LIMITED

Reason: r/o RAS

[**Hospital 93**] MEDICAL CONDITION:
61 year old man s/p CABGx5 with acutely increased creatinine
REASON FOR THIS EXAMINATION:
r/o RAS
INDICATION: Status post CABG with acutely increased creatinine.
Rule out renal artery stenosis.

RENAL ULTRASOUND: No prior examinations. The kidneys are normal
in size and appearance. The right kidney measures 13.6 cm and
left kidney measures 13.2 cm. There are normal arterial
waveforms in the parenchyma bilaterally. The maximum RI on the
right is 0.76 and on the left is 0.8 (both of which are
minimally elevated). There is no evidence of renal artery
stenosis. No hydronephrosis, stone, or mass. The bladder is
filled with fluid and shows no wall thickening or focal masses.

IMPRESSION: Minimally elevated resistive indices in both
kidneys, with no evidence of renal artery stenosis.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) 18394**] [**Name (STitle) 18395**]

CHEST (PA & LAT)  [**2137-10-11**] 6:30 PM

CHEST (PA & LAT)

Reason: evaluate pleural effusion

[**Hospital 93**] MEDICAL CONDITION:
61 year old man s/p CABG
REASON FOR THIS EXAMINATION:
evaluate pleural effusion
INDICATION: Status post CABG, evaluate pleural effusion.

PA AND LATERAL CHEST: Compared to [**2137-10-10**]. Left-sided PICC line
is unchanged in position with its tip in the distal SVC. There
is no pneumothorax. There remains a small left pleural effusion
not significantly changed and a small amount of linear
atelectasis at the left mid lung base. Calcified left hilar
adenopathy again seen. Heart remains upper limits of normal in
size. No significant short interval change.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.


Conclusions:
The left atrium is mildly dilated. There is mild symmetric left
ventricular
hypertrophy with normal cavity size. Overall left ventricular
systolic
function is moderately depressed (EF 35-40%). Due to the
suboptimal image
quality, a regional wall motion abnormality cannot be excluded.
Right
ventricular chamber size is normal. There is mild global right
ventricular
free wall hypokinesis. The ascending aorta is mildly dilated.
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. There is a small pericardial effusion. The effusion
is echo dense,
consistent with blood, inflammation or other cellular elements.
There are no
echocardiographic signs of tamponade.

IMPRESSION: Small echodense pericardial effusion without
echocardiographic
signs of tamponade. Moderate left ventricular systolic
dysfunction. Mild
aortic regurgitation.

Compared with the prior study (images reviewed) of [**2137-10-3**],
the pericardial
effusion is smaller. The other findings are similar.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**], MD on [**2137-10-10**] 14:51.

MRA head
IMPRESSION:
1. No evidence of orbital abnormality on limited sections
through the orbits.

2. Evidence of atherosclerotic disease, but without marked
stenoses or occlusion among the major arteries of the circle of
[**Location (un) 431**]. Because of the limitations of the study, the ophthalmic
arteries are not well visualized on either side.

3. Multiple small foci of T2 hyperintensity suggestive of prior
tiny infarcts in the cerebral white matte bilaterally. A few of
these demonstrate faintly increased signal also on
diffusion-weighted imaging, suggesting that they may be either
subacute or chronic.


Brief Hospital Course:
Transferred in from OSH and underwent cardiac catherization that
resulted in intra aortic balloon pump placement and transferred
to operating room emergently [**9-19**].  Please see catherization
report for further details.  He underwent coronary artery bypass
graft x5, please see operative report for further details.  He
was transferred to the CSRU on Neo and propofol with IABP.  He
received FFP, protamine, and platlets for post operative
bleeding, and then returned to operating room for reexploration,
please see operative report for further details.  He was
transferred to CSRU for continued management.  He continued with
tachycardia not responsive to esmolol was changed to cardizem
with better control, required vasopressors for hypotension.  On
postoperative day [**1-16**] the IABP was weaned and removed, he
continued on vasopressors, cardizem was discontinued and he was
started on beta blockers.  He remained intubated due to
hemodynamics and agitation.  Agitation continued with weaning of
sedation, diuresed, and betablocker increased.  Postoperative
day [**4-18**] tolerated CPAP and was extubated but was confused moving
all extremeties. Blood pressure and heart rate labile, labetolol
started.  Postoperative [**6-20**] he went into atrial fibrillation and
treated with Amiodarone and beta blockers. He remained in the
CSRU due to agitation on CIWA d/t ETOH withdrawal, hemodynamic,
and respiratory management.  Psychiatry consulted due to
continued delirium and medications adjusted.  Anticoagulation
was started for atrial fibrillation with coumadin on POD [**11-25**].
On postoperative 14/13 he was ready for transfer to [**Hospital Ward Name **] 2 with
a sitter, he continued with confusion at times, in/out atrial
fibrillation.  He continued to progress and physical activity
increased, he became more oriented, and was able to wean off
ativan and sitter.  On posterative day 20/19 he complained of
not being able to see out of left eye - opthamology evaluated
with question of posterior ischemic optic neuropathy which is
diagnosis by exclusion and he underwent MRI.  Plan for follow up
with opthamology in clinic no medical intervention at this time.
 On postoperative day 21/20 creatinine elevated with decreased
sodium. Fluid intake was increased, renal consulted,
echocardiogram (EF 35-40%).  All diuretics, ACE inhibitors, and
NSAID discontinued.  Creatinine decreased on Postoperative day
23/22 but sodium remained decreased and placed on free water
restriction with plan for chemistry to be rechecked [**10-14**] at
rehab.  He was ready for discharge to rehab with plan for lab
checks.

Medications on Admission:
lopressor, lipitor, ASA, pepcid, Solumedrol, Plavix,

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
11. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
12. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Diltiazem HCl 180 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
14. Haloperidol 1 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
15. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
16. Outpatient Lab Work
please check SMA 7 and HCT [**10-14**]
17. Warfarin 1 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily):
please give 0.5mg [**10-13**] and check INR [**10-14**] .


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - [**Location (un) 550**]

Discharge Diagnosis:
Coronary artery disease.
HTN
Delirium.


Discharge Condition:
Good


Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs for 2 months.
Shower daily, let water flow over wounds, pat dry with a towel.
Do not use lotions, powders, or creams on wounds.
Call our office for sternal drainage, temp>101.5.
Please have SMA 7, HCT, INR checked [**10-14**]
Free water restriction for hyponatremia

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) 131**] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) 4469**] for 2-3 weeks.
Make an appointment with Dr. [**Last Name (STitle) 914**] for 4 weeks.
Make an appointment to see your local opthamologist after
discharge.
Make an appointment to see Dr. [**Last Name (STitle) 22897**] with Neuro-opthamology
after discharge. Phone #[**Telephone/Fax (1) 253**].
Please have SMA 7, HCT, and INR drawn [**10-14**]


Completed by:[**2137-10-12**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute kidney failure, unspecified,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Thrombocytopenia, unspecified,Drug-induced delirium,Phlebitis and thrombophlebitis of upper extremities, unspecified,Functional disturbances following cardiac surgery,Other diuretics causing adverse effects in therapeutic use,Congestive heart failure, unspecified,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Atrial fibrillation,Other chronic pulmonary heart diseases,Other iatrogenic hypotension,Other disorders of optic nerve,Depressive disorder, not elsewhere classified,Insomnia, unspecified,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}


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

PRESENT ILLNESS: 61 year old male with angina over last year relieved with rest.
Presented to OSH when angina did not relieve with rest and ruled
in for NSTEMI.  Transferred for cardiac catherization

MEDICAL HISTORY: Hypertension
Angina
Heart Failure
Atrial Fibrillation
Skin Cancer

MEDICATION ON ADMISSION: lopressor, lipitor, ASA, pepcid, Solumedrol, Plavix,

ALLERGIES: Penicillins / Iodine; Iodine Containing

PHYSICAL EXAM: Discharge
Neuro: alert, oriented x3, strength R=L [**3-20**], no vision left eye,
normal vision right eye
Pulmonary: lungs clear to auscultation bilaterally
Cardiac: RRR +murmur 2/6 SEM, no rub/gallop
Sternal incision: healing no erythema, no drainage, sternum
stable
Abdomen: soft, nontender, nondistended, +bowel sounds last BM
[**10-12**]
Extremeties: warm, edema +1 nonpitting, pulses palpable
Leg incision: endovascular harvest, healing, no drainage, no
erythema

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Works at [**Company **] globe, is married
Tobacco - denies
ETOH - [**2-16**]/day 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Acute kidney failure, unspecified,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Thrombocytopenia, unspecified,Drug-induced delirium,Phlebitis and thrombophlebitis of upper extremities, unspecified,Functional disturbances following cardiac surgery,Other diuretics causing adverse effects in therapeutic use,Congestive heart failure, unspecified,Benzodiazepine-based tranquilizers causing adverse effects in therapeutic use,Atrial fibrillation,Other chronic pulmonary heart diseases,Other iatrogenic hypotension,Other disorders of optic nerve,Depressive disorder, not elsewhere classified,Insomnia, unspecified,Anemia, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}
