CHIEF COMPLAINT: rest angina

PRESENT ILLNESS: This [**Age over 90 **] year old male with prior infarction and chronic atrial
fibrillation presented with worsening chest pain both at rest
and activity. He presented to he hospital with chest pressure
sub sternally non radiating not associated with any other
symptoms. He was started on a Heparin infusion. cardiac
catheterization revealed significant disease and cardiac surgery
was consulted for consideration for surgical revascularization.

MEDICAL HISTORY: coronary artery disease,remote non-STEMI
Chronic diastolic heart failure
chronic atrial fibrillation
noninsulin dependentg diabetes mellitus
hypertension
Hyperlipidemia
Gout
Glaucoma
-Hypothyroidism
s/p left total hip arthroplasty
s/p bilateral hernia repairs
s/p Cataract surgery

MEDICATION ON ADMISSION: (confirmed with pt and HCP on [**2136-9-3**])
[**Name2 (NI) 93014**]l 150 mg
amlodipine 2.5 mg [**Hospital1 **]
aranesp 40 mcg every 2 months
ASA 325 mg PO QD
cosopt 1 drop right eye [**Hospital1 **]
furosemide 80 mg PO BID
glypizide 5 mg ER
Iron 65 mg PO QD
isosorbide MN ER 120 mg
levothyroxine 88 mcg
lipitor 80 mg
lumigan 1 drop each eye
nitroglycerin .4 mg PRN
spectrovite 1 tab

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:70's regular Resp:16  O2 sat: 97% on RA
B/P  Right: 157/60   Left: 148/70
Height: 5ft 9"    Weight: 64.1kg

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
DM on mother's side.

SOCIAL HISTORY: Lives at home in [**Location (un) **] with companion, Ms. [**Last Name (Titles) 93013**]- his
significant other, who is also HCP.  Previous college art
professor. 10 pack year history of smoking, quit at age 38.
Denies any alcohol, IVDU.
Subendocardial infarction, initial episode of care,Chronic kidney disease, Stage V,Chronic diastolic heart failure,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Percutaneous transluminal coronary angioplasty status,Right bundle branch block,Atrial fibrillation,Other and unspecified hyperlipidemia,Gout, unspecified,Unspecified acquired hypothyroidism,Unspecified glaucoma,Cataract extraction status,Hip joint replacement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Retention of urine, unspecified,Other nonspecific abnormal finding of lung field
Subendo infarct, initial,Chron kidney dis stage V,Chr diastolic hrt fail,Old myocardial infarct,Hyp kid NOS w cr kid V,Crnry athrscl natve vssl,Aortic valve disorder,Status-post ptca,Rt bundle branch block,Atrial fibrillation,Hyperlipidemia NEC/NOS,Gout NOS,Hypothyroidism NOS,Glaucoma NOS,Cataract extract status,Joint replaced hip,DMII wo cmp nt st uncntr,Retention urine NOS,Ot nonsp ab fnd lung fld
Admission Date:  [**2136-9-3**]              Discharge Date:   [**2136-9-13**]


Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
rest angina

Major Surgical or Invasive Procedure:
[**2136-9-7**]
Urgent coronary artery bypass graft x6:  (Left internal mammary
artery to left anterior descending artery; and saphenous vein
graft sequential grafting to obtuse marginal and the high
diagonal; and saphenous vein grafts to the second diagonal,
posterior descending
artery and posterior ventricular branch).

left heart catheterization, coronary angiogram


History of Present Illness:
This [**Age over 90 **] year old male with prior infarction and chronic atrial
fibrillation presented with worsening chest pain both at rest
and activity. He presented to he hospital with chest pressure
sub sternally non radiating not associated with any other
symptoms. He was started on a Heparin infusion. cardiac
catheterization revealed significant disease and cardiac surgery
was consulted for consideration for surgical revascularization.


Past Medical History:
coronary artery disease,remote non-STEMI
Chronic diastolic heart failure
chronic atrial fibrillation
noninsulin dependentg diabetes mellitus
hypertension
Hyperlipidemia
Gout
Glaucoma
-Hypothyroidism
s/p left total hip arthroplasty
s/p bilateral hernia repairs
s/p Cataract surgery


Social History:
Lives at home in [**Location (un) **] with companion, Ms. [**Last Name (Titles) 93013**]- his
significant other, who is also HCP.  Previous college art
professor. 10 pack year history of smoking, quit at age 38.
Denies any alcohol, IVDU.

Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
DM on mother's side.

Physical Exam:
Pulse:70's regular Resp:16  O2 sat: 97% on RA
B/P  Right: 157/60   Left: 148/70
Height: 5ft 9"    Weight: 64.1kg

Five Meter Walk Test #1_______ #2 _________  #3_________

General:
Skin: Dry [x] intact [x]lower extremity vascular skin changes
HEENT: PERRLA [] EOMI []irregular pupils bilaterally and
sluggish
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [x] grade _3/6_____
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused []  Edema [x] lower ext
bilaterally_____ Varicosities: None [x]
Neuro: Grossly intact [] lower ext weak to resistence, otherwise
no focal findings
Pulses:
Femoral      Right: +2  Left:+2
DP           Right: trace  Left:Trace
PT           [**Name (NI) 167**]: Trace  Left:Trace
Radial       Right:+2   Left:+2

Carotid Bruit        Right: +   Left:+


Pertinent Results:
[**2136-9-10**] 05:03AM BLOOD WBC-6.7 RBC-3.60* Hgb-11.4* Hct-33.8*
MCV-94 MCH-31.7 MCHC-33.8 RDW-17.1* Plt Ct-123*
[**2136-9-9**] 03:15AM BLOOD WBC-8.1 RBC-3.45* Hgb-10.9* Hct-31.5*
MCV-91 MCH-31.5 MCHC-34.5 RDW-17.7* Plt Ct-105*
[**2136-9-11**] 06:00AM BLOOD Glucose-129* UreaN-66* Creat-2.4* Na-139
K-4.0 Cl-104 HCO3-27 AnGap-12
[**2136-9-10**] 05:03AM BLOOD Glucose-171* UreaN-60* Creat-2.4* Na-139
K-4.4 Cl-104 HCO3-25 AnGap-14
[**2136-9-9**] 03:15AM BLOOD Glucose-149* UreaN-53* Creat-2.1* Na-139
K-4.0 Cl-106 HCO3-25 AnGap-12
[**2136-9-8**] 04:05AM BLOOD Glucose-158* Creat-1.7* Na-140 K-4.3
Cl-111* HCO3-22 AnGap-11
[**2136-9-12**] 06:15AM BLOOD WBC-7.8 RBC-3.16* Hgb-10.1* Hct-30.4*
MCV-96 MCH-31.9 MCHC-33.1 RDW-16.4* Plt Ct-130*
[**2136-9-10**] 05:03AM BLOOD WBC-6.7 RBC-3.60* Hgb-11.4* Hct-33.8*
MCV-94 MCH-31.7 MCHC-33.8 RDW-17.1* Plt Ct-123*
[**2136-9-13**] 08:50AM BLOOD Na-141 K-5.0 Cl-105
[**2136-9-13**] 05:12AM BLOOD UreaN-67* Creat-2.2* Na-141 K-5.2* Cl-105

[**2136-9-7**]
TTE
PRE-BYPASS: No spontaneous echo contrast is seen in the body of
the left atrium or left atrial appendage. No atrial septal
defect is seen by 2D or color Doppler. There is mild symmetric
left ventricular hypertrophy. The left ventricular cavity size
is normal. 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.
There are simple atheroma in the aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets are moderately thickened. There is heavy calcification
of the non-coronary cusp. There is moderate aortic valve
stenosis (valve area 1.0-1.2cm2). Trace aortic regurgitation is
seen. The mitral valve leaflets are moderately thickened. Trace
to mild mitral regurgitation is seen. There is no pericardial
effusion. Dr. [**Last Name (STitle) **] was notified in person of the
results at time of surgery.
POST-BYPASS: The patient is AV paced. The patient is on no
inotropes. Biventricular function is unchanged. Mitral
regurgitation is unchanged. Aortic stenosis and aortic
insufficiency are unchanged. The aorta is intact
post-decannulation.


Brief Hospital Course:
The patient had minimally elevated troponins and was pain free
on Heparin.  Catheterization revealed significant disesase and
revascularization was undertaken.  On [**9-7**] he went to the
Operating Room where sextuple bypass was performed.  He weaned
from bypass on Propofol, Neo Synephrine and Insulin infusions.

He was extubated on POD 1 and weaned from pressors.  Beta
blockers and diuretics were begun.  Physical Therapy was
consulted for strength and mobility.  Medications for
hypertension were titrated to good effect.  The Foley catheter
was reinserted for retention and Flomax was begun.  The catheter
will be left in at transfer to rehab and is to be removed for
another voiding trial after several days of Flomax.  chest tubes
and temporary pacemaker wires were removed per protocol without
incident.

The admission CXR revealed two small lesions of the left chest.
These have been present since [**2131**].  A CT scan demonstrated some
growth of these, along with apical scarring.  Thoracic surgery
was consulted and a PET-CT was recommended.  The patient refused
further workup or intervention at this time for the lung
nodules.  He will follow up with his primary care physician in
the future.

Discharge medications, restrictions and precautions are as
noted. Follow up appointments were also arranged. He was
discharged to [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] on POD 6 for further recovery prior
to returning home.




Medications on Admission:
(confirmed with pt and HCP on [**2136-9-3**])
[**Name2 (NI) 93014**]l 150 mg
amlodipine 2.5 mg [**Hospital1 **]
aranesp 40 mcg every 2 months
ASA 325 mg PO QD
cosopt 1 drop right eye [**Hospital1 **]
furosemide 80 mg PO BID
glypizide 5 mg ER
Iron 65 mg PO QD
isosorbide MN ER 120 mg
levothyroxine 88 mcg
lipitor 80 mg
lumigan 1 drop each eye
nitroglycerin .4 mg PRN
spectrovite 1 tab

-Herbal Medications:  melatonin

Discharge Medications:
1. Aranesp (polysorbate) 40 mcg/mL Solution Sig: One (1)
Injection every 2 months: per nephrologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4920**].

2. glipizide 5 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet
Extended Rel 24 hr PO once a day.
3. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Lumigan 0.01 % Drops Sig: One (1) drop Ophthalmic once a day:
1 drop each eye.
6. Spectravite     Tablet Sig: One (1) Tablet PO once a day.
7. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain for 4 weeks.
Disp:*50 Tablet(s)* Refills:*0*
8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever or pain.
9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
10. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO DAILY (Daily).
11. hydralazine 25 mg Tablet Sig: One (1) Tablet PO four times a
day.
12. Lumigan 0.03 % Drops Sig: One (1)  Ophthalmic once a day:
OU.
13. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
14. amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO twice a day.

15. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
17. ferrous sulfate 325 mg (65 mg iron) Tablet Sig: One (1)
Tablet PO once a day.
18. multivitamin     Tablet Sig: One (1) Tablet PO DAILY
(Daily).
19. allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
20. dorzolamide-timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
21. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
22. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO Q6H
(every 6 hours) as needed for constipation.
23. insulin glargine 100 unit/mL Solution Sig: One (1)
Subcutaneous once a day: 20 Units Glargine at breakfast.
24. insulin lispro 100 unit/mL Solution Sig: One (1)
Subcutaneous four times a day: see attached sliding scale.
25. Outpatient Lab Work
Chem 7 on Saturday, [**9-15**]


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] - [**Location (un) 538**]

Discharge Diagnosis:
non-ST-elevation myocardial infarction
Aortic stenosis
coronary artery disease
s/p coronary artery bypass grafts x6
Non-insulin dependent diabetes
Hypertension
Hyperlipidemia
Chronic renal failure, stage V
Hypothyroidism
Hyperparathyroidism
history of atrial fibrillation
right bundle-branch block for years
s/p left total hip replacement


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with Percoet
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema + serous drainage from JP
site and lower saph vein harvest site.
1 + Edema


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr [**First Name (STitle) **] on ([**Telephone/Fax (1) 170**]) on [**10-15**] at 1:00 pm
Cardiologist: Dr [**First Name (STitle) 437**] on [**10-8**] at 10:30 am

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) 2204**] in [**2-28**] weeks ([**Telephone/Fax (1) 2205**])

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


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

Completed by:[**2136-9-13**]
{'Subendocardial infarction, initial episode of care,Chronic kidney disease, Stage V,Chronic diastolic heart failure,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Percutaneous transluminal coronary angioplasty status,Right bundle branch block,Atrial fibrillation,Other and unspecified hyperlipidemia,Gout, unspecified,Unspecified acquired hypothyroidism,Unspecified glaucoma,Cataract extraction status,Hip joint replacement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Retention of urine, unspecified,Other nonspecific abnormal finding of lung field'}


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: rest angina

PRESENT ILLNESS: This [**Age over 90 **] year old male with prior infarction and chronic atrial
fibrillation presented with worsening chest pain both at rest
and activity. He presented to he hospital with chest pressure
sub sternally non radiating not associated with any other
symptoms. He was started on a Heparin infusion. cardiac
catheterization revealed significant disease and cardiac surgery
was consulted for consideration for surgical revascularization.

MEDICAL HISTORY: coronary artery disease,remote non-STEMI
Chronic diastolic heart failure
chronic atrial fibrillation
noninsulin dependentg diabetes mellitus
hypertension
Hyperlipidemia
Gout
Glaucoma
-Hypothyroidism
s/p left total hip arthroplasty
s/p bilateral hernia repairs
s/p Cataract surgery

MEDICATION ON ADMISSION: (confirmed with pt and HCP on [**2136-9-3**])
[**Name2 (NI) 93014**]l 150 mg
amlodipine 2.5 mg [**Hospital1 **]
aranesp 40 mcg every 2 months
ASA 325 mg PO QD
cosopt 1 drop right eye [**Hospital1 **]
furosemide 80 mg PO BID
glypizide 5 mg ER
Iron 65 mg PO QD
isosorbide MN ER 120 mg
levothyroxine 88 mcg
lipitor 80 mg
lumigan 1 drop each eye
nitroglycerin .4 mg PRN
spectrovite 1 tab

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:70's regular Resp:16  O2 sat: 97% on RA
B/P  Right: 157/60   Left: 148/70
Height: 5ft 9"    Weight: 64.1kg

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.
DM on mother's side.

SOCIAL HISTORY: Lives at home in [**Location (un) **] with companion, Ms. [**Last Name (Titles) 93013**]- his
significant other, who is also HCP.  Previous college art
professor. 10 pack year history of smoking, quit at age 38.
Denies any alcohol, IVDU. 

### Response:
{'Subendocardial infarction, initial episode of care,Chronic kidney disease, Stage V,Chronic diastolic heart failure,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Percutaneous transluminal coronary angioplasty status,Right bundle branch block,Atrial fibrillation,Other and unspecified hyperlipidemia,Gout, unspecified,Unspecified acquired hypothyroidism,Unspecified glaucoma,Cataract extraction status,Hip joint replacement,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Retention of urine, unspecified,Other nonspecific abnormal finding of lung field'}
