CHIEF COMPLAINT: SOB and angina

PRESENT ILLNESS: 67 yo female presented to OSH with chest pressure and SOB [**12-11**]
and ruled in for NSTEMI. Cath there revealed 90% LAD lesions, CX
90%, OM 50%, RCA 40% with EF 30% Significant MR also noted. Pt.
transferred for surgery at [**Hospital1 18**].

MEDICAL HISTORY: NSTEMI [**2199-12-11**]
HTN
elev. lipids
CHF diastolic ( EF 50%)
NIDDM
retinopathy
remote asthma

MEDICATION ON ADMISSION: ASA 325 mg daily
Zestril 2.5 mg [**Hospital1 **]
lopressor 25 mg Q 6h
protonix 40 mg daily
SS insulin
lipitor 80 mg QHS
duoneb prn q 4h
diazepam 2-5 mg prn
NTG paste 1" dermal q6h
heparin drip

ALLERGIES: Avelox / Codeine / Erythromycin / Glucophage / Glipizide /
Penicillins / Sulfa (Sulfonamides) / Tetracycline / Shellfish /
Aspartame

PHYSICAL EXAM: 95% on 2L NC
61.5 "   79.9 kg
T 100.3, 122/64    ST 110  RR 20
NAD, and oriented appropriately
NCAT, PERRL, EOMI,anicteric
neck supple with JVP to jaw
RRR S1 S2  no m/r/g
bibasilar rales
soft, NT, ND,no abd. bruits , no HSM
extrems no c/c/e skin unremarkable
2+ bil. fem/DP/PTs , no bruits

FAMILY HISTORY: sister with premature CAD/cabg
father with fatal MI at 59

SOCIAL HISTORY: no ETOH abuse
no current tobacco use
Subendocardial infarction, initial episode of care,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Cardiac complications, not elsewhere classified,Atrial fibrillation,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Family history of diabetes mellitus
Subendo infarct, initial,Mitral valve disorder,Crnry athrscl natve vssl,CHF NOS,Int inf clstrdium dfcile,Surg compl-heart,Atrial fibrillation,DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Anemia NOS,Asthma NOS,Fam hx-ischem heart dis,Fam hx-diabetes mellitus
Admission Date:  [**2199-12-13**]              Discharge Date:   [**2199-12-24**]

Date of Birth:  [**2132-6-19**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Avelox / Codeine / Erythromycin / Glucophage / Glipizide /
Penicillins / Sulfa (Sulfonamides) / Tetracycline / Shellfish /
Aspartame

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
SOB and angina

Major Surgical or Invasive Procedure:
cabg x3/MV repair  [**2199-12-16**] (LIMA to LAD, SVG to OM1, SVG to OM2,
28 mm CE annuloplasty band)

History of Present Illness:
67 yo female presented to OSH with chest pressure and SOB [**12-11**]
and ruled in for NSTEMI. Cath there revealed 90% LAD lesions, CX
90%, OM 50%, RCA 40% with EF 30% Significant MR also noted. Pt.
transferred for surgery at [**Hospital1 18**].

Past Medical History:
NSTEMI [**2199-12-11**]
HTN
elev. lipids
CHF diastolic ( EF 50%)
NIDDM
retinopathy
remote asthma

PSH: appy, cholecystectomy, cataract [**Doctor First Name **], fxs ankle and arm


Social History:
no ETOH abuse
no current tobacco use

Family History:
sister with premature CAD/cabg
father with fatal MI at 59

Physical Exam:
95% on 2L NC
61.5 "   79.9 kg
T 100.3, 122/64    ST 110  RR 20
NAD, and oriented appropriately
NCAT, PERRL, EOMI,anicteric
neck supple with JVP to jaw
RRR S1 S2  no m/r/g
bibasilar rales
soft, NT, ND,no abd. bruits , no HSM
extrems no c/c/e skin unremarkable
2+ bil. fem/DP/PTs , no bruits

Pertinent Results:
[**2199-12-24**] 07:10AM BLOOD WBC-18.0* RBC-3.75* Hgb-11.1* Hct-33.3*
MCV-89 MCH-29.7 MCHC-33.4 RDW-14.5 Plt Ct-547*
[**2199-12-23**] 03:44AM BLOOD WBC-20.9* RBC-3.87* Hgb-11.4* Hct-33.4*
MCV-86 MCH-29.4 MCHC-34.0 RDW-14.4 Plt Ct-436
[**2199-12-22**] 04:16AM BLOOD WBC-18.7* RBC-3.77* Hgb-11.4* Hct-33.2*
MCV-88 MCH-30.3 MCHC-34.4 RDW-14.5 Plt Ct-368
[**2199-12-24**] 07:10AM BLOOD Plt Ct-547*
[**2199-12-23**] 09:16AM BLOOD PT-19.8* INR(PT)-1.8*
[**2199-12-22**] 04:16AM BLOOD PT-17.4* PTT-26.3 INR(PT)-1.6*
[**2199-12-21**] 02:43AM BLOOD PT-17.4* INR(PT)-1.6*
[**2199-12-20**] 02:20AM BLOOD PT-17.3* PTT-27.4 INR(PT)-1.6*
[**2199-12-24**] 07:10AM BLOOD Glucose-154* UreaN-12 Creat-0.5 Na-137
K-3.9 Cl-97 HCO3-31 AnGap-13

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 76240**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 76241**]Portable TTE
(Complete) Done [**2199-12-18**] at 1:23:17 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2132-6-19**]
Age (years): 67 F  Hgt (in): 62
BP (mm Hg): 116/54  Wgt (lb): 210
HR (bpm): 92  BSA (m2): 1.95 m2
Indication: H/O cardiac surgery. Pericardial effusion.
Prosthetic valve function.
ICD-9 Codes: 423.9, V43.3, 424.0
Test Information
Date/Time: [**2199-12-18**] at 13:23    Interpret MD: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
[**Last Name (NamePattern1) **], MD
Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **],
RDCS
Doppler: Full Doppler and color Doppler Test Location: West
SICU/CTIC/VICU
Contrast: None Tech Quality: Suboptimal
Tape #: 2007W046-1:02 Machine: Vivid [**7-21**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.6 cm  <= 4.0 cm
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  0.9 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.3 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  3.1 cm
Left Ventricle - Fractional Shortening:  *0.28  >= 0.29
Left Ventricle - Ejection Fraction:  40% to 45%  >= 55%
Aorta - Sinus Level:  2.4 cm  <= 3.6 cm
Aorta - Ascending:  3.0 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.6 m/sec  <= 2.0 m/sec
Mitral Valve - E Wave:  1.6 m/sec
Mitral Valve - A Wave:  0.8 m/sec
Mitral Valve - E/A ratio:  2.00
Mitral Valve - E Wave deceleration time:  244 ms  140-250 ms
TR Gradient (+ RA = PASP):  *35 to 43 mm Hg  <= 25 mm Hg

Findings
This study was compared to the prior study of [**2199-12-14**].
LEFT ATRIUM: Mild LA enlargement.

LEFT VENTRICLE: Normal LV wall thickness and cavity size.
Mild-moderate regional LV systolic dysfunction. No resting LVOT
gradient.

RIGHT VENTRICLE: RV not well seen.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter.

AORTIC VALVE: ?# aortic valve leaflets. No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mitral
valve annuloplasty ring. No MS. Normal LV inflow pattern for
age.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Moderate PA
systolic hypertension.

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

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Frequent ventricular premature beats.

Conclusions
The left atrium is mildly dilated. Left ventricular wall
thicknesses and cavity size are normal. There is mild to
moderate regional left ventricular systolic dysfunction with
severe hypokinesis of the inferior and inferolateral walls and
apex. The number of aortic valve leaflets cannot be determined.
There is no aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. A mitral
valve annuloplasty ring is present. There is moderate pulmonary
artery systolic hypertension. There is no pericardial effusion.

Compared with the prior study (images reviewed) of [**2199-12-14**] ,
there is now a mitral valvuloplasty ring in position. There is
no mitral regurgitation. The estimated pulmonary artery systolic
pressure is slightly lower.

CHEST (PORTABLE AP)  [**2199-12-18**] 7:29 AM

CHEST (PORTABLE AP)

Reason: ? effusion

[**Hospital 93**] MEDICAL CONDITION:
67 year old woman with s/p cabg mv repair
REASON FOR THIS EXAMINATION:
? effusion
HISTORY: CABG and MVR repair.

FINDINGS: In comparison with study of [**12-16**], the endotracheal
tube and nasogastric tube have been removed. The Swan-Ganz
catheter tip now lies within the proximal right pulmonary
artery. Left chest tube remains in place. Some atelectatic
changes are again seen at the bases.

CHEST (PORTABLE AP)  [**2199-12-18**] 4:31 PM

CHEST (PORTABLE AP); -77 BY DIFFERENT PHYSICIAN

Reason: s/p ct removal ? ptx

[**Hospital 93**] MEDICAL CONDITION:
67 year old woman with s/p cabg
REASON FOR THIS EXAMINATION:
s/p ct removal ? ptx
PORTABLE UPRIGHT CHEST, [**2199-12-18**]

COMPARISON: Previous study of earlier the same day.

INDICATION: Chest tube removal.

Following removal of left-sided chest tube, no pneumothorax is
identified. Mediastinal drain has also been removed. Swan-Ganz
catheter remains in place with tip terminating in proximal left
pulmonary artery. Vascular engorgement and perihilar haziness
are minimally improved. Bibasilar atelectasis is slightly
improved and right pleural effusion appears slightly smaller.

Brief Hospital Course:
Admitted [**12-13**]  from EMMC, and pre-op workup completed over the
weekend. Underwent CABG x3/MV repair with Dr. [**Last Name (STitle) **] on [**12-16**].
Transferred to the CVICU in stable condition on levophed,
milrinone, epinephrine, and insulin drips. Extubated on POD #1,
and went into A fib overnight. Converted with amiodarone. Given
48 hours of peiop vancomycin as she was in the hospital
preoperatively. Flagyl started for C. diff. Chest tubes and
pacing wires removed without incident. Vanco PO also started.
Drips also weaned over the next few days. Beta blockade titrated
and gentle diuresis continued. Coumadin and amiodarone started
for continued Afib. Remained in the CVICU over the weekend as
private room not avail. on the floor given C. Diff. Cleared for
discharge to rehab on POD #8 Target INR 2.0-2.5 for A fib.

Medications on Admission:
ASA 325 mg daily
Zestril 2.5 mg [**Hospital1 **]
lopressor 25 mg Q 6h
protonix 40 mg daily
SS insulin
lipitor 80 mg QHS
duoneb prn q 4h
diazepam 2-5 mg prn
NTG paste 1" dermal q6h
heparin drip

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 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. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
5. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
6. Zestril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day
for 1 weeks: 400 mg daily x 1 week, then 200 mg daily.
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 2 weeks.
11. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 2 weeks.
12. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 8 days.
13. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily):
check INR [**12-26**] and PRN, and dose accordingly.
14. Vancomycin 250 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 8 days.


Discharge Disposition:
Extended Care

Facility:
TBA

Discharge Diagnosis:
NSTEMI
CAD/MR   s/p cab x3/MV repair
postop A fib
elev. lipids
HTN
CHF
NIDDM
retinopathy
asthma

Discharge Condition:
stable

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

Followup Instructions:
see Dr. [**Last Name (STitle) 26160**] in [**1-15**] weeks
see Dr. [**Last Name (STitle) **] in [**2-16**] weeks
see Dr. [**Last Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]


Completed by:[**2199-12-24**]
{'Subendocardial infarction, initial episode of care,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Cardiac complications, not elsewhere classified,Atrial fibrillation,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Family history of diabetes mellitus'}


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: SOB and angina

PRESENT ILLNESS: 67 yo female presented to OSH with chest pressure and SOB [**12-11**]
and ruled in for NSTEMI. Cath there revealed 90% LAD lesions, CX
90%, OM 50%, RCA 40% with EF 30% Significant MR also noted. Pt.
transferred for surgery at [**Hospital1 18**].

MEDICAL HISTORY: NSTEMI [**2199-12-11**]
HTN
elev. lipids
CHF diastolic ( EF 50%)
NIDDM
retinopathy
remote asthma

MEDICATION ON ADMISSION: ASA 325 mg daily
Zestril 2.5 mg [**Hospital1 **]
lopressor 25 mg Q 6h
protonix 40 mg daily
SS insulin
lipitor 80 mg QHS
duoneb prn q 4h
diazepam 2-5 mg prn
NTG paste 1" dermal q6h
heparin drip

ALLERGIES: Avelox / Codeine / Erythromycin / Glucophage / Glipizide /
Penicillins / Sulfa (Sulfonamides) / Tetracycline / Shellfish /
Aspartame

PHYSICAL EXAM: 95% on 2L NC
61.5 "   79.9 kg
T 100.3, 122/64    ST 110  RR 20
NAD, and oriented appropriately
NCAT, PERRL, EOMI,anicteric
neck supple with JVP to jaw
RRR S1 S2  no m/r/g
bibasilar rales
soft, NT, ND,no abd. bruits , no HSM
extrems no c/c/e skin unremarkable
2+ bil. fem/DP/PTs , no bruits

FAMILY HISTORY: sister with premature CAD/cabg
father with fatal MI at 59

SOCIAL HISTORY: no ETOH abuse
no current tobacco use 

### Response:
{'Subendocardial infarction, initial episode of care,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Intestinal infection due to Clostridium difficile,Cardiac complications, not elsewhere classified,Atrial fibrillation,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Asthma, unspecified type, unspecified,Family history of ischemic heart disease,Family history of diabetes mellitus'}
