CHIEF COMPLAINT: Exertional chest pain

PRESENT ILLNESS: Mr. [**Known lastname 95961**] is a 52 year-old male who recently complained of
exertional chest pain.  Subsequent work-up for this complaint
revealed a positive stress test and three vessel coronary artery
disease. Referred for surgical evaluation.

MEDICAL HISTORY: Mr. [**Known lastname 95961**] has a past medical history of hypertension, NIDDM,
hyperlipidemia, depression, and eczema.  His surgical history
included a tonsillectomy.

MEDICATION ON ADMISSION: metformin  100mg [**Hospital1 **]
paroxetine 10 mg daily
crestor 10 mg daily
ibuprofen 600 mg prn
glyburide 5 mg daily
metoprolol 25 mg [**Hospital1 **]
ASA 325 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 98  RR 18   right 153/99  left  133/83  6'2"   235 #
NAD
neck supple with full ROM
CTAB
RRR no murmur
soft NT, ND,  + mBS
warm, well-perfused with 1+ LLE edema
LLE varicosities, none on right
2+ bil. fem/DP/PT/radials
no carotid bruit present

FAMILY HISTORY: brother with [**Name2 (NI) **] at age 56

SOCIAL HISTORY: retired chef on disability
lives with girlfriend
quit drinking 23 years ago
quit smoking 23 years ago
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
Crnry athrscl natve vssl,CHF NOS,Mitral valve disorder,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2101-11-16**]              Discharge Date:   [**2101-11-22**]

Date of Birth:  [**2049-4-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Exertional chest pain

Major Surgical or Invasive Procedure:
[**2101-11-16**] Coronary Artery Bypass Graft x4, Mitral Valve Repair
(28mm CE annuloplasty Band)


History of Present Illness:
Mr. [**Known lastname 95961**] is a 52 year-old male who recently complained of
exertional chest pain.  Subsequent work-up for this complaint
revealed a positive stress test and three vessel coronary artery
disease. Referred for surgical evaluation.

Past Medical History:
Mr. [**Known lastname 95961**] has a past medical history of hypertension, NIDDM,
hyperlipidemia, depression, and eczema.  His surgical history
included a tonsillectomy.

Social History:
retired chef on disability
lives with girlfriend
quit drinking 23 years ago
quit smoking 23 years ago

Family History:
brother with [**Name2 (NI) **] at age 56

Physical Exam:
HR 98  RR 18   right 153/99  left  133/83  6'2"   235 #
NAD
neck supple with full ROM
CTAB
RRR no murmur
soft NT, ND,  + mBS
warm, well-perfused with 1+ LLE edema
LLE varicosities, none on right
2+ bil. fem/DP/PT/radials
no carotid bruit present

Pertinent Results:
[**2101-11-21**] 12:50PM BLOOD WBC-7.3 RBC-2.87* Hgb-9.1* Hct-25.6*
MCV-89 MCH-31.9 MCHC-35.7* RDW-14.0 Plt Ct-213
[**2101-11-21**] 12:50PM BLOOD Plt Ct-213
[**2101-11-18**] 02:47AM BLOOD PT-13.5* PTT-28.7 INR(PT)-1.2*
[**2101-11-21**] 12:50PM BLOOD Glucose-81 UreaN-18 Creat-1.0 Na-136
K-3.9 Cl-98 HCO3-29 AnGap-13
[**2101-11-21**] 12:50PM BLOOD Mg-2.2

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname 95962**]       [**Hospital1 18**] [**Numeric Identifier 95963**] (Complete)
Done [**2101-11-16**] at 2:05:42 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: [**2049-4-8**]
Age (years): 52 M  Hgt (in): 69
BP (mm Hg): 100/60  Wgt (lb): 230
HR (bpm): 84  BSA (m2): 2.19 m2
Indication: Coronary artery disease. Left ventricular function.
Mitral valve disease.
ICD-9 Codes: 786.05, 424.0
Test Information
Date/Time: [**2101-11-16**] at 14:05    Interpret MD: [**Name6 (MD) 3892**]
[**Name8 (MD) 3893**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3893**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2006AW01-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *6.0 cm  <= 5.6 cm
Aorta - Sinus Level:  2.5 cm  <= 3.6 cm
Aorta - Ascending:  3.0 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.0 m/sec  <= 2.0 m/sec

Findings
The patient at the initial exam did have mild MR. However, MR
became dynamic at varying stages to even become a 3plus at one
stage as shown in the images. This was consulted with Dr.[**First Name (STitle) **]
and the same informed to Dr.[**Last Name (STitle) **].
LEFT ATRIUM: Dilated LA. No spontaneous echo contrast or
thrombus in the LA/LAA or the RA/RAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or
color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Moderately dilated LV
cavity. No LV aneurysm. Severe regional LV systolic dysfunction.
Severe global LV hypokinesis.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Normal
descending aorta diameter. Focal calcifications in descending
aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

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

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. No TEE related complications. The TEE probe was
passed with assistance from the anesthesioology staff using a
laryngoscope. The patient was under general anesthesia
throughout the procedure. Suboptimal image quality - poor echo
windows. The patient appears to be in sinus rhythm. Results were

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-BYPASS:
The left atrium is dilated. 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. No atrial septal defect is seen by 2D or color
Doppler.
Left ventricular wall thicknesses are normal. The left
ventricular cavity is moderately dilated. No left ventricular
aneurysm is seen. There is severe global LV systolic dysfunction
with focalities in the apex, septal and inferior walls.
Right ventricular chamber size and free wall motion are normal.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is no
mitral valve prolapse. The mitral regurgitant jet was eccentric,
varying in time and quantity reflecting an ischemic basis. The
annulus was 34-36mm and the left atrium and ventricle were
dilated. There was blunting of pulmonary venous inflow when
moderate to severe MR [**First Name (Titles) **] [**Last Name (Titles) 48613**].
There is no pericardial effusion.

Post-Bypass:
Overall LVEF 35% on milrinone.
Mild improvement of focal LV systolic function.
Normal RV systolic function.
A prosthesis is seen on the mitral annulus stable and well
seated. There was no m itral regurgitation seen. Mean pressure
gradient across the mitral valve was 4mm of Hg.
Aortic contour is well preserved.
Trivial TR/.
I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician

FINAL REPORT


REASON FOR EXAMINATION: Follow up of patient after CABG.

PA and lateral upright chest graft compared to [**2101-11-19**].


Additional improvement of the bilateral atelectasis has been
observed with
still remaining left retrocardiac atelectasis. The left pleural
effusion has
been decreased. There are no new consolidations. There is no
pneumothorax.
The sternal wires are intact. There is no evidence of congestive
heart
failure.

IMPRESSION: Improvement of bilateral plate-like atelectasis.
Unchanged left
lower lobe atelectasis. Remaining left tiny pleural effusion.
THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**]

DR. [**First Name8 (NamePattern2) 4075**] [**Last Name (NamePattern1) 5999**]


Approved: MON [**2101-11-21**] 5:11 PM
Procedure Date:[**2101-11-21**]




?????? [**2097**] CareGroup IS. All rights reserved.




Brief Hospital Course:
Admitted on [**2101-11-16**] and underwent cabg x4/MV repair with Dr.
[**Last Name (STitle) **]. Transferred to the CSRU in stable condition on
levophed, propofol, and milrinone drips. Extubated the next
morning and transferred to the floor on POD #2 to begin
increasing his activity level. Beta blockade and ACE inhibitor
started and gentle diuresis continued. Pacing wires and chest
tubes removed without incident. Cleared for discharge to home on
POD #6 with VNA services.

Medications on Admission:
metformin  100mg [**Hospital1 **]
paroxetine 10 mg daily
crestor 10 mg daily
ibuprofen 600 mg prn
glyburide 5 mg daily
metoprolol 25 mg [**Hospital1 **]
ASA 325 mg daily

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*0*
6. Paroxetine HCl 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
8. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*0*
9. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
10. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
11. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
12. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR
Sig: 2.5 Tablet Sustained Release 24HRs PO DAILY (Daily).
Disp:*75 Tablet Sustained Release 24HR(s)* Refills:*0*
13. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 2 weeks: please take twice a day for 1 week and then
decrease to once a day for one week .
Disp:*21 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA/[**Location (un) 86**]

Discharge Diagnosis:
Coronary Artery Disease s/p CABG
Mitral Regurgitation s/p MV repair
Hypertension
Diabetes Mellitus
Hyperlipidemia
Depression
Eczema


Discharge Condition:
Good


Discharge Instructions:
[**Month (only) 116**] shower, no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns

Followup Instructions:
Dr [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2102-12-7**] 9:20am
Dr [**Last Name (STitle) **] in 1 week ([**Telephone/Fax (1) 589**]) please call for appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])



Completed by:[**2101-12-15**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,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: Exertional chest pain

PRESENT ILLNESS: Mr. [**Known lastname 95961**] is a 52 year-old male who recently complained of
exertional chest pain.  Subsequent work-up for this complaint
revealed a positive stress test and three vessel coronary artery
disease. Referred for surgical evaluation.

MEDICAL HISTORY: Mr. [**Known lastname 95961**] has a past medical history of hypertension, NIDDM,
hyperlipidemia, depression, and eczema.  His surgical history
included a tonsillectomy.

MEDICATION ON ADMISSION: metformin  100mg [**Hospital1 **]
paroxetine 10 mg daily
crestor 10 mg daily
ibuprofen 600 mg prn
glyburide 5 mg daily
metoprolol 25 mg [**Hospital1 **]
ASA 325 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 98  RR 18   right 153/99  left  133/83  6'2"   235 #
NAD
neck supple with full ROM
CTAB
RRR no murmur
soft NT, ND,  + mBS
warm, well-perfused with 1+ LLE edema
LLE varicosities, none on right
2+ bil. fem/DP/PT/radials
no carotid bruit present

FAMILY HISTORY: brother with [**Name2 (NI) **] at age 56

SOCIAL HISTORY: retired chef on disability
lives with girlfriend
quit drinking 23 years ago
quit smoking 23 years ago 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Mitral valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
