CHIEF COMPLAINT: Unstable angina/Hypotension

PRESENT ILLNESS: 65 year old female found unresponisve and transported to outside
hospital where she was found to have ST depressions and third
degree heart block. She was intubated and medflighted to the
[**Hospital1 18**] for cardiac catheterization. This revealed a subtotal left
main occlusion. As she was hypotensive and in cardiogenic shock,
an intra-aortic balloon pump was placed. the cardiac surgical
service was emergently contact[**Name (NI) **] for surgical revascularization.

MEDICAL HISTORY: Coronary artery disease s/p CABGx4 [**2152-2-6**]
Cardiogenic shock
Unstable angina
Hyperlipidemia
Diabetes
Transient ischemic attack
Embolic stroke
Hypothyroid
Chronic obstructive pulmonary disease

MEDICATION ON ADMISSION: Lipitor 20', Metformin 1500 qAM, 1000 qPM, Actos 45', Aggrenox
25/200', Synthroid 125 mcg'

ALLERGIES: Morphine

PHYSICAL EXAM: Mean arterial pressure 70
GEN: Unstable on neosynephrine and levophed. Intubated and
sedated.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Active smoker.
Acute myocardial infarction of unspecified site, initial episode of care,Cardiogenic shock,Acidosis,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unilateral paralysis of vocal cords or larynx, partial,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
AMI NOS, initial,Cardiogenic shock,Acidosis,Crnry athrscl natve vssl,Atrial fibrillation,Vocal paral unilat part,Chr airway obstruct NEC,Hypothyroidism NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2152-2-6**]              Discharge Date:   [**2152-2-18**]

Date of Birth:  [**2086-9-1**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Morphine

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Unstable angina/Hypotension

Major Surgical or Invasive Procedure:
[**2152-2-7**] - Coronary artery bypass grafting to four vessels on
intra-aortic balloon pump. (left internal mammary artery->Left
anterior descending artery, Saphenous vein Y-graft->Obtuse
marginal artery and Diagonal artery, Saphenous vein graft->Right
coronary artery).


History of Present Illness:
65 year old female found unresponisve and transported to outside
hospital where she was found to have ST depressions and third
degree heart block. She was intubated and medflighted to the
[**Hospital1 18**] for cardiac catheterization. This revealed a subtotal left
main occlusion. As she was hypotensive and in cardiogenic shock,
an intra-aortic balloon pump was placed. the cardiac surgical
service was emergently contact[**Name (NI) **] for surgical revascularization.


Past Medical History:
Coronary artery disease s/p CABGx4 [**2152-2-6**]
Cardiogenic shock
Unstable angina
Hyperlipidemia
Diabetes
Transient ischemic attack
Embolic stroke
Hypothyroid
Chronic obstructive pulmonary disease

Social History:
Active smoker.

Family History:
Unknown

Physical Exam:
Mean arterial pressure 70
GEN: Unstable on neosynephrine and levophed. Intubated and
sedated.

Pertinent Results:
[**2152-2-6**] ECHO
PRE-BYPASS:

1. The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or color Doppler.
2. Overall left ventricular systolic function is mildly
depressed (LVEF= 45%). with borderline normal free wall RV
function.
3. There are simple atheroma in the aortic arch. There are
complex (>4mm) atheroma in the descending thoracic aorta. No
thoracic aortic dissection is seen. The balloon pump tip is seen
about 6 cm below the left subclavian take off.
4. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. No aortic regurgitation is seen.
5. The mitral valve leaflets are mildly thickened. Mild to
moderate ([**11-26**]+) mitral regurgitation is seen.
6. There is a small pericardial effusion.
7. There is a moderate left pleural effusion.
8. Dr.[**Last Name (STitle) **] was notified in person of the results during
the surgery at 1320 on [**2152-2-6**]

POST BYPASS

1. Patient is on epinephrine and phenylephrine infusions and AV
paced.
2. LVEF is 45%
3. Mild mitral regurgitation persists.
4. Aorta intact post decannulation.


[**2152-2-17**] 05:16AM BLOOD WBC-10.2 RBC-3.36* Hgb-9.8* Hct-30.2*
MCV-90 MCH-29.0 MCHC-32.3 RDW-15.6* Plt Ct-293
[**2152-2-17**] 05:16AM BLOOD Plt Ct-293
[**2152-2-14**] 01:34AM BLOOD PT-14.3* PTT-26.4 INR(PT)-1.2*
[**2152-2-17**] 05:16AM BLOOD Glucose-103 UreaN-33* Creat-0.8 Na-142
K-4.5 Cl-106 HCO3-33* AnGap-8
[**2152-2-8**] 03:18AM BLOOD ALT-22 AST-182* LD(LDH)-1098* AlkPhos-67
Amylase-67 TotBili-0.4

Brief Hospital Course:
Ms. [**Name13 (STitle) 2427**] was admitted emergently on [**2152-2-6**] for a cardiac
catheterization. This revealed a subtotal occlusion of her left
main coronary artery. An intra-aortic balloon pump was placed as
she was hypotensive in cardiogenic shock. She was taken
emergently to the operating room where she underwent coronary
artery bypass grafting to four vessels. Please see operative
note for details. Postoperatively she was taken to the cardiac
surgical intensive care unit for monitoring. On postoperative
day one, her intra-aortic balloon pump was weaned and removed
without complication. As a sputum culture from the outside
hospital returned positive for Haemophilus influenza,
levofloxacin was started. She remained intubated due to acidosis
and volume overload. She underwent a bronchoscopy for clearance
of her left lower lobe secretions. Sputum cultures were again
sent.  The patient was extubated but required re-intubation.
She did have a left pleural effusion and was diuresed
aggressively on a lasix drip.  Steroids were started.
Respiratory status improved and she was subsequently extubated.
The patient did complain of a hoarse voice and was seen by ENT.
She was found to have temporary right vocal cord paralysis and
the recommendation was to observe and follow up with ENT as an
outpatient.
The patient was started on diamox for contraction alkalosis.
Chest tubes and pacing wires were discontinued without
complication.  She was transferred to the floor on POD 8.  The
patient continued to make progress with physical therapy and was
discharged to rehab in good condition on POD 12.

Medications on Admission:
Lipitor 20', Metformin 1500 qAM, 1000 qPM, Actos 45', Aggrenox
25/200', Synthroid 125 mcg'

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
8. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours).
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
10. Beclomethasone Dipropionate 80 mcg/Actuation Aerosol Sig:
One (1)  Inhalation TID (3 times a day).
11. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
12. Potassium Chloride 20 mEq Packet Sig: One (1)  PO Q12H
(every 12 hours).
13. prednisone taper
PredniSONE 40 mg  po BID  Duration: 2 Doses Start: After 50 mg
tapered dose.
PredniSONE 60 mg  po  daily  Duration: 1 Doses Start: After 40
mg tapered dose.
PredniSONE 50 mg po daily Duration: 1 Doses Start: After 60 mg
tapered dose.
PredniSONE 40 mg  po daily Duration: 1 Doses Start: After 50 mg
tapered dose.
PredniSONE 30 mg po daily Duration: 1 Doses Start: After 40 mg
tapered dose.
PredniSONE 20 mg  po  daily  Duration: 2 Doses Start: After 30
mg tapered dose.
PredniSONE 10 mg po daily Duration: 2 Doses Start: After 20 mg
tapered dose.
PredniSONE 5 mg  po  daily Duration: 5 Doses Start: After 10 mg
tapered dose.
PredniSONE 2.5 mg po daily Duration: 5 Doses Start: After 5 mg
tapered dose.

14. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a
day.
Disp:*60 Tablet(s)* Refills:*2*
15. Insulin Glargine 100 unit/mL Solution Sig: Twenty Five (25)
units Subcutaneous once a day: decrease dose as prednisone dose
decreases.
Disp:*750 units* Refills:*2*
16. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
17. Acetazolamide Sodium 500 mg Recon Soln Sig: One (1) Recon
Soln Injection Q12H (every 12 hours) for 2 doses.
Disp:*2 Recon Soln(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
St [**Hospital **] Healthcare Center - [**Hospital1 189**]

Discharge Diagnosis:
CAD s/p CABGx4 [**2152-2-6**]
Cardiogenic shock
Unstable angina
Hyperlipidemia
Diabetes
Transient ischemic attack
Hypothyroid
Chronic obstructive pulmonary disease


Discharge Condition:
Stable


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns.

Followup Instructions:
Please follow-up with Dr. [**First Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Please follow-up with Dr. [**Last Name (STitle) **] (cardiologist) in [**12-28**] weeks.
Please follow-up with Dr. [**First Name (STitle) 28622**] Attar in [**12-28**] weeks. [**Telephone/Fax (1) 24306**]

Scheduled appointment:
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Phone:[**Telephone/Fax (1) 11767**] Date/Time:[**2152-3-9**] 9:20


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

Completed by:[**2152-2-18**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Cardiogenic shock,Acidosis,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unilateral paralysis of vocal cords or larynx, partial,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}


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: Unstable angina/Hypotension

PRESENT ILLNESS: 65 year old female found unresponisve and transported to outside
hospital where she was found to have ST depressions and third
degree heart block. She was intubated and medflighted to the
[**Hospital1 18**] for cardiac catheterization. This revealed a subtotal left
main occlusion. As she was hypotensive and in cardiogenic shock,
an intra-aortic balloon pump was placed. the cardiac surgical
service was emergently contact[**Name (NI) **] for surgical revascularization.

MEDICAL HISTORY: Coronary artery disease s/p CABGx4 [**2152-2-6**]
Cardiogenic shock
Unstable angina
Hyperlipidemia
Diabetes
Transient ischemic attack
Embolic stroke
Hypothyroid
Chronic obstructive pulmonary disease

MEDICATION ON ADMISSION: Lipitor 20', Metformin 1500 qAM, 1000 qPM, Actos 45', Aggrenox
25/200', Synthroid 125 mcg'

ALLERGIES: Morphine

PHYSICAL EXAM: Mean arterial pressure 70
GEN: Unstable on neosynephrine and levophed. Intubated and
sedated.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Active smoker. 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Cardiogenic shock,Acidosis,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unilateral paralysis of vocal cords or larynx, partial,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
