CHIEF COMPLAINT: unstable angina

PRESENT ILLNESS: This 86 year old man with known 3 vessel coronary artery disease
s/p cath [**2124-6-7**]. He has a history of hypertension, dyslipidemia
and non insulin dependent diabetes. He was diagnosed with a
right thalamic stroke in [**2124-2-1**] with a left carotid
stenosis.  Echo at the time revealed an LVEF of 45% with mild
global hypokinesis. Subsequent ETT revealed evidence of an
inferior MI with mild ischemia, LVEF 30-35%. He was referred
previously to [**Hospital1 18**] for left heart catheterization which
revealed 3 vessel disease. It was decided at that time that he
would be treated with medical management. He reports that he
has had intermittent chest pain over the past three weeks. [**8-7**]
he was recathed at OSH and transferred to [**Hospital1 18**] for evaluation
of revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Non insulin dependent diabetes
Prior silent MI by ETT
[**2124-2-27**]: right thalamic stroke with left hemiparesis, treated at
[**Hospital1 2025**]. Plavix initiated.
Frequency Ventricular ectopy
Hypothyroidism
[**2104**] skin cancer
Possible Sleep apnea
Chronic gout with admit to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] with acute episode
involving right knee, s/p tap
Anemia
Glaucoma
Hard of hearing (has hearing aids but has not used since his
stroke)
Ocular migraines
Hx of frequent falls
Short term memory loss
Bilateral cataract surgery

MEDICATION ON ADMISSION: ALLOPURINOL- 300 mg Tablet - 1
Tablet(s) by mouth daily
AMITRIPTYLINE - 25 mg Tablet - 1 Tablet(s) by mouth
daily,CLOPIDOGREL [PLAVIX]75 mg Tablet - 1 Tablet(s) by mouth
daily
GLIPIZIDE- 10 mg Tablet - 1 Tablet(s) by mouth twice a day
INDOMETHACIN  25 mg Capsule -1 Capsule(s) by mouth three times a
day
ISOSORBIDE MONONITRATE 30 mg Tablet Extended Release 24 hr -
1 Tablet(s) by mouth once a day
LEVOTHYROXINE 25 mcg Tablet -1 Tablet(s) by mouth daily
LOSARTAN - 25 mg Tablet - 1 Tablet(s) by mouth daily
METFORMIN 500 mg Tablet - 1 Tablet(s) by mouth twice a day
OMEPRAZOLE [PRILOSEC]- Dosage uncertain
SIMVASTATIN - 40 mg Tablet - 1Tablet(s) by mouth daily

ALLERGIES: Penicillins / Belladonna

PHYSICAL EXAM: Pulse: 86 Resp: 20- O2 sat: 95% RA
B/P  127/87
Height: [**5-6**]"    Weight:140LB

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Patient is divorced and lives alone. He recently
moved into [**Location (un) 7661**] [**Hospital3 400**]. He has two
children.  His daughter [**Name (NI) **] [**Name (NI) 56051**] is highly involved in
his
care, but she lives one hour away in NH. The other daughter
lives
in [**Name (NI) 12000**].
Smoked during world war II.
He does not drink
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Unspecified essential hypertension,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified psychosis,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Gout, unspecified,Unspecified hearing loss,Loss of weight,Old myocardial infarction,Personal history of other malignant neoplasm of skin,Long-term (current) use of antiplatelet/antithrombotic,History of fall
Crnry athrscl natve vssl,Intermed coronary synd,Late ef-hemplga side NOS,Hypertension NOS,Anemia NOS,DMII wo cmp nt st uncntr,Psychosis NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Gout NOS,Hearing loss NOS,Abnormal loss of weight,Old myocardial infarct,Hx-skin malignancy NEC,Lng use antiplte/thrmbtc,Personal history of fall
Admission Date:  [**2124-8-7**]              Discharge Date:   [**2124-8-15**]

Date of Birth:  [**2038-3-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Belladonna

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
unstable angina


Major Surgical or Invasive Procedure:
[**2124-8-9**] - CABG x3 (free LIMA to LAD, SVG to OM, SVG to PDA)


History of Present Illness:
This 86 year old man with known 3 vessel coronary artery disease
s/p cath [**2124-6-7**]. He has a history of hypertension, dyslipidemia
and non insulin dependent diabetes. He was diagnosed with a
right thalamic stroke in [**2124-2-1**] with a left carotid
stenosis.  Echo at the time revealed an LVEF of 45% with mild
global hypokinesis. Subsequent ETT revealed evidence of an
inferior MI with mild ischemia, LVEF 30-35%. He was referred
previously to [**Hospital1 18**] for left heart catheterization which
revealed 3 vessel disease. It was decided at that time that he
would be treated with medical management. He reports that he
has had intermittent chest pain over the past three weeks. [**8-7**]
he was recathed at OSH and transferred to [**Hospital1 18**] for evaluation
of revascularization.

Past Medical History:
Hypertension
Hyperlipidemia
Non insulin dependent diabetes
Prior silent MI by ETT
[**2124-2-27**]: right thalamic stroke with left hemiparesis, treated at
[**Hospital1 2025**]. Plavix initiated.
Frequency Ventricular ectopy
Hypothyroidism
[**2104**] skin cancer
Possible Sleep apnea
Chronic gout with admit to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] with acute episode
involving right knee, s/p tap
Anemia
Glaucoma
Hard of hearing (has hearing aids but has not used since his
stroke)
Ocular migraines
Hx of frequent falls
Short term memory loss
Bilateral cataract surgery


Social History:
Patient is divorced and lives alone. He recently
moved into [**Location (un) 7661**] [**Hospital3 400**]. He has two
children.  His daughter [**Name (NI) **] [**Name (NI) 56051**] is highly involved in
his
care, but she lives one hour away in NH. The other daughter
lives
in [**Name (NI) 12000**].
Smoked during world war II.
He does not drink

Family History:
non-contributory

Physical Exam:
Pulse: 86 Resp: 20- O2 sat: 95% RA
B/P  127/87
Height: [**5-6**]"    Weight:140LB

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

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema [] _____
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right:   Left:
DP           Right:   Left:
PT           [**Name (NI) 167**]:   Left:
Radial       Right:   Left:

Carotid Bruit  none appreciated, pulses  Right:2+    Left:2+


Pertinent Results:
[**2124-8-8**] Carotid Ultrasound
1. There is 40% stenosis in the right ICA and 40-59% stenosis in
the left
ICA.
2. Mild heterogeneous plaque in the left ICA and minimal amount
of plaque in the right carotid bulb.

[**2124-8-9**] ECHO
Conclusions
PRE-BYPASS: No spontaneous echo contrast or thrombus is seen in
the body of the left atrium/left atrial appendage or the body of
the right atrium/right atrial appendage. The interatrial septum
is aneurysmal. No atrial septal defect is seen by 2D or color
Doppler. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is moderately depressed (LVEF=35%). Doppler
parameters are most consistent with Grade I (mild) left
ventricular diastolic dysfunction. The right ventricular cavity
is dilated with normal free wall contractility. There are simple
atheroma in the ascending aorta. The aortic arch is mildly
dilated. There are complex (>4mm) atheroma in the aortic arch.
The descending thoracic aorta is mildly dilated. There are
simple atheroma in the descending thoracic aorta. The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present. Trace aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is no pericardial effusion. Dr. [**Last Name (STitle) **]
was notified in person of the results in the operating room at
the time of the study.

POST-BYPASS: The patient is receiving epinephrine by infusion.
The right ventricle displays normal systolic function. The left
ventricle displays some improvement in global systolic function
with an ejection fraction of about 45%. Valvular function is
unchanged. The thoracic aorta is inatct after decannulation.

[**2124-8-7**] CT scan
1. No appreciable supra-annular calcification in minimally
dilated, ascending thoracic aorta.
2. Severe coronary arterial calcifications.
3. 4mm pulmonary nodule in the right lower lobe warrants CT
reevaluation in 12 months, a reasonable adaption of the
[**Last Name (un) 8773**] guidelines

[**2124-8-14**] 12:25AM BLOOD WBC-7.4 RBC-3.50* Hgb-10.7* Hct-31.5*
MCV-90 MCH-30.6 MCHC-34.0 RDW-15.2 Plt Ct-227
[**2124-8-13**] 05:30AM BLOOD WBC-8.1 RBC-3.68* Hgb-11.1* Hct-32.2*
MCV-88 MCH-30.3 MCHC-34.5 RDW-15.2 Plt Ct-216#
[**2124-8-14**] 12:25AM BLOOD Glucose-243* UreaN-28* Creat-1.3* Na-141
K-4.7 Cl-107 HCO3-25 AnGap-14
[**2124-8-13**] 05:30AM BLOOD Glucose-94 UreaN-16 Creat-0.9 Na-142
K-3.6 Cl-105 HCO3-25 AnGap-16
[**2124-8-12**] 06:55AM BLOOD Glucose-183* UreaN-19 Creat-1.0 Na-140
K-3.7 Cl-103 HCO3-27 AnGap-14

Brief Hospital Course:
Mr. [**Known lastname 89339**] was admitted to the [**Hospital1 18**] on [**2124-8-7**] via transfer
from an outside hospital for further management of his coronary
artery disease. He was worked up in the usual preoperative
manner. A carotid duplex ultrasound was obtained which revealed
a 40-59% stenosis in the left internal carotid artery and mild
disease in the right. A CT scan showed no significant
intracranial process, no appreciable supra-annular calcification
in minimally dilated, ascending thoracic aorta and 4mm pulmonary
nodule in the right lower lobe warrants CT reevaluation in 12
months. On [**2124-8-9**], Mr. [**Known lastname 89339**] was taken to the operating room
where he underwent coronary artery bypass grafting. Please see
operative note for details. Postoperatively he was taken to the
intensive care unit for monitoring.
POD 1 found the patient extubated, alert and oriented and
breathing comfortably.  The patient was hemodynamically stable,
weaned from inotropic and vasopressor support.  He was confused
initially and treated with Haldol.  Confusion cleared and he was
alert and oriented x 3 by POD 4.  Beta blocker was initiated and
the patient was gently diuresed toward the preoperative weight.
The patient was transferred to the telemetry floor for further
recovery.  Chest tubes and pacing wires were discontinued
without complication.  The patient was evaluated by the physical
therapy service for assistance with strength and mobility.  Mr.
[**Known lastname 89339**] was not started on an ACE Inhibitor, as his blood
pressure would not tolerate it.  This should be considered as an
outpatient.  By the time of discharge on POD #6 the patient was
ambulating with assistance, the wound was healing and pain was
controlled with oral analgesics.  The patient was discharged to
[**Location (un) 16493**]Rehab of [**Location 9583**] in good condition with
appropriate follow up instructions.


Medications on Admission:
ALLOPURINOL- 300 mg Tablet - 1
Tablet(s) by mouth daily
AMITRIPTYLINE - 25 mg Tablet - 1 Tablet(s) by mouth
daily,CLOPIDOGREL [PLAVIX]75 mg Tablet - 1 Tablet(s) by mouth
daily
GLIPIZIDE- 10 mg Tablet - 1 Tablet(s) by mouth twice a day
INDOMETHACIN  25 mg Capsule -1 Capsule(s) by mouth three times a
day
ISOSORBIDE MONONITRATE 30 mg Tablet Extended Release 24 hr -
1 Tablet(s) by mouth once a day
LEVOTHYROXINE 25 mcg Tablet -1 Tablet(s) by mouth daily
LOSARTAN - 25 mg Tablet - 1 Tablet(s) by mouth daily
METFORMIN 500 mg Tablet - 1 Tablet(s) by mouth twice a day
OMEPRAZOLE [PRILOSEC]- Dosage uncertain
SIMVASTATIN - 40 mg Tablet - 1Tablet(s) by mouth daily

Medications - OTC
DOCUSATE SODIUM -  (Prescribed by Other Provider) - 100 mg
Capsule - 1 Capsule(s) by mouth twice a day
MULTIVITAMIN -  (Prescribed by Other Provider

Discharge Medications:
1. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. glipizide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
3. pilocarpine HCl 4 % Drops Sig: One (1) Drop Ophthalmic Q6H
(every 6 hours).
4. timolol maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **]
(2 times a day).
5. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
6. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. indomethacin 25 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
9. amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*0*
10. allopurinol 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
13. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
14. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
15. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
16. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain, fever.
17. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
18. insulin regular human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): per attached sliding scale.
19. levothyroxine 25 mcg Tablet Sig: One (1) Tablet PO once a
day.
20. metoprolol tartrate 25 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day): Hold for HR<60,SBP<90.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 39857**] - [**Location 9583**]

Discharge Diagnosis:
Coronary artery disease s/p CABG x3
Hyperlipidemia
Non insulin dependent diabetes
Prior silent MI by ETT
[**2124-2-27**]: right thalamic stroke with left hemiparesis, treated at
[**Hospital1 2025**]. Plavix initiated.
Frequency Ventricular ectopy
Hypothyroidism
[**2104**] skin cancer
Possible Sleep apnea
Chronic gout with admit to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] with acute episode
involving right knee, s/p tap
Anemia
Glaucoma
Hard of hearing (has hearing aids but has not used since his
stroke)
Ocular migraines
Hx of frequent falls
Short term memory loss
Bilateral cataract surgery


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with assistance, deconditioned
Incisional pain managed with Ultram, Tylenol
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema - trace


Discharge Instructions:
1) 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.
2) Please NO lotions, cream, powder, or ointments to incisions.
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart provided.
4) No driving for approximately one month and while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon when you will likely be cleared to drive.
5) No lifting more than 10 pounds for 10 weeks
6) 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. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**], Thursday, [**2124-9-14**] 1:00
Cardiologist: [**Doctor Last Name **]-Te [**Doctor First Name **] [**Telephone/Fax (1) 65733**], [**9-5**] at 2:00pm

Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 83352**] in [**4-4**] weeks

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



Completed by:[**2124-8-15**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Unspecified essential hypertension,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified psychosis,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Gout, unspecified,Unspecified hearing loss,Loss of weight,Old myocardial infarction,Personal history of other malignant neoplasm of skin,Long-term (current) use of antiplatelet/antithrombotic,History of fall'}


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

PRESENT ILLNESS: This 86 year old man with known 3 vessel coronary artery disease
s/p cath [**2124-6-7**]. He has a history of hypertension, dyslipidemia
and non insulin dependent diabetes. He was diagnosed with a
right thalamic stroke in [**2124-2-1**] with a left carotid
stenosis.  Echo at the time revealed an LVEF of 45% with mild
global hypokinesis. Subsequent ETT revealed evidence of an
inferior MI with mild ischemia, LVEF 30-35%. He was referred
previously to [**Hospital1 18**] for left heart catheterization which
revealed 3 vessel disease. It was decided at that time that he
would be treated with medical management. He reports that he
has had intermittent chest pain over the past three weeks. [**8-7**]
he was recathed at OSH and transferred to [**Hospital1 18**] for evaluation
of revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Non insulin dependent diabetes
Prior silent MI by ETT
[**2124-2-27**]: right thalamic stroke with left hemiparesis, treated at
[**Hospital1 2025**]. Plavix initiated.
Frequency Ventricular ectopy
Hypothyroidism
[**2104**] skin cancer
Possible Sleep apnea
Chronic gout with admit to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] with acute episode
involving right knee, s/p tap
Anemia
Glaucoma
Hard of hearing (has hearing aids but has not used since his
stroke)
Ocular migraines
Hx of frequent falls
Short term memory loss
Bilateral cataract surgery

MEDICATION ON ADMISSION: ALLOPURINOL- 300 mg Tablet - 1
Tablet(s) by mouth daily
AMITRIPTYLINE - 25 mg Tablet - 1 Tablet(s) by mouth
daily,CLOPIDOGREL [PLAVIX]75 mg Tablet - 1 Tablet(s) by mouth
daily
GLIPIZIDE- 10 mg Tablet - 1 Tablet(s) by mouth twice a day
INDOMETHACIN  25 mg Capsule -1 Capsule(s) by mouth three times a
day
ISOSORBIDE MONONITRATE 30 mg Tablet Extended Release 24 hr -
1 Tablet(s) by mouth once a day
LEVOTHYROXINE 25 mcg Tablet -1 Tablet(s) by mouth daily
LOSARTAN - 25 mg Tablet - 1 Tablet(s) by mouth daily
METFORMIN 500 mg Tablet - 1 Tablet(s) by mouth twice a day
OMEPRAZOLE [PRILOSEC]- Dosage uncertain
SIMVASTATIN - 40 mg Tablet - 1Tablet(s) by mouth daily

ALLERGIES: Penicillins / Belladonna

PHYSICAL EXAM: Pulse: 86 Resp: 20- O2 sat: 95% RA
B/P  127/87
Height: [**5-6**]"    Weight:140LB

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Patient is divorced and lives alone. He recently
moved into [**Location (un) 7661**] [**Hospital3 400**]. He has two
children.  His daughter [**Name (NI) **] [**Name (NI) 56051**] is highly involved in
his
care, but she lives one hour away in NH. The other daughter
lives
in [**Name (NI) 12000**].
Smoked during world war II.
He does not drink 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Unspecified essential hypertension,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified psychosis,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Gout, unspecified,Unspecified hearing loss,Loss of weight,Old myocardial infarction,Personal history of other malignant neoplasm of skin,Long-term (current) use of antiplatelet/antithrombotic,History of fall'}
