CHIEF COMPLAINT: Fatigue, chest heaviness

PRESENT ILLNESS: 65 yo M with increasing fatigue and chest heaviness with normal
activity over past 10 days. PCP referred pt for stress test.
During stress test pt had
chest pain/SOB/diaphoresis with ST depressions. Cardiac
Catherization:[**2146-7-22**] [**Hospital1 18**]:LM dz

MEDICAL HISTORY: HTN, lipids, melanoma removed x3, GERD, preDM, s/p L knee
arthroplasty, s/p hernia repair

MEDICATION ON ADMISSION: Medications at home:
Lipitor 20mg daily
Alleve PRN
OSH meds: lipitor 80mg daily
Metoprolol 25 mg
ASA 325mg

ALLERGIES: Codeine

PHYSICAL EXAM: Height: 5'[**46**]"    Weight:260 lbs
General:
Skin: Dry [x] intact []
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: IABP  Left: 2+
DP           Right: 2+  Left:2+
PT           [**Name (NI) 167**]: 2+  Left:2+
Radial       Right: 2+  Left:2+
Carotid Bruit        Right: no   Left: no

FAMILY HISTORY: Brother -CABG

SOCIAL HISTORY: Occupation:Retired, Lives with wife, [**Name (NI) **]:Caucasian
Tobacco: denies, ETOH 3drinks/mo
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Esophageal reflux,Other abnormal glucose,Personal history of malignant melanoma of skin,Other postprocedural status
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Esophageal reflux,Abnormal glucose NEC,Hx-malig skin melanoma,Post-proc states NEC
Admission Date:  [**2146-7-22**]              Discharge Date:   [**2146-7-26**]

Date of Birth:  [**2081-1-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Codeine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Fatigue, chest heaviness


Major Surgical or Invasive Procedure:
[**2146-7-22**]: Coronary Artery Bypass Graft Surgery with LIMA-> Left
anterior descending artery, Reverse saphenous vein graft->Ramus,
obtuse marginal


History of Present Illness:
65 yo M with increasing fatigue and chest heaviness with normal
activity over past 10 days. PCP referred pt for stress test.
During stress test pt had
chest pain/SOB/diaphoresis with ST depressions. Cardiac
Catherization:[**2146-7-22**] [**Hospital1 18**]:LM dz


Past Medical History:
HTN, lipids, melanoma removed x3, GERD, preDM, s/p L knee
arthroplasty, s/p hernia repair


Social History:
Occupation:Retired, Lives with wife, [**Name (NI) **]:Caucasian
Tobacco: denies, ETOH 3drinks/mo


Family History:
Brother -CABG


Physical Exam:
Height: 5'[**46**]"    Weight:260 lbs
General:
Skin: Dry [x] intact []
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: IABP  Left: 2+
DP           Right: 2+  Left:2+
PT           [**Name (NI) 167**]: 2+  Left:2+
Radial       Right: 2+  Left:2+
Carotid Bruit        Right: no   Left: no


Pertinent Results:
[**2146-7-22**] 03:05PM   PT-13.3 PTT-60.5* INR(PT)-1.1
[**2146-7-22**] 03:05PM   PLT COUNT-163
[**2146-7-22**] 03:05PM   WBC-7.6 RBC-5.24 HGB-15.3 HCT-45.1 MCV-86
MCH-29.3 MCHC-34.0 RDW-13.6
[**2146-7-22**] 03:05PM   %HbA1c-6.1*
[**2146-7-22**] 03:05PM   ALBUMIN-4.1
[**2146-7-22**] 03:05PM   ALT(SGPT)-36 AST(SGOT)-22 CK(CPK)-133 ALK
PHOS-78 AMYLASE-89 TOT BILI-1.0
[**2146-7-22**] 03:05PM   GLUCOSE-116* UREA N-16 CREAT-1.1 SODIUM-140
POTASSIUM-4.0 CHLORIDE-105 TOTAL CO2-24 ANION GAP-15
[**2146-7-26**] 09:30AM BLOOD WBC-12.2* RBC-3.11* Hgb-9.0* Hct-27.3*
MCV-88 MCH-29.0 MCHC-33.2 RDW-14.8 Plt Ct-206
[**2146-7-26**] 09:30AM BLOOD Plt Ct-206
[**2146-7-26**] 09:30AM BLOOD Glucose-121* UreaN-20 Creat-0.9 Na-140
K-4.2 Cl-103 HCO3-29 AnGap-12
TEE
[**2146-7-22**]
Referring Physician
[**Name9 (PRE) **], [**Name9 (PRE) **] [**Name Initial (PRE) **].
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2081-1-24**]
Age (years): 65 M  Hgt (in): 70
BP (mm Hg): /  Wgt (lb): 260
HR (bpm):  BSA (m2): 2.34 m2
Indication: Chest pain. Coronary artery disease. Shortness of
breath.
Test Information
Date/Time: [**2146-7-22**] at 17:32    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 32862**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW2-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.3 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.4 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.5 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55% to 65%  >= 55%
Aorta - Annulus:  2.4 cm  <= 3.0 cm
Aorta - Sinus Level:  3.6 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.4 cm  <= 3.0 cm
Aorta - Ascending:  *3.7 cm  <= 3.4 cm
Aorta - Arch:  *3.1 cm  <= 3.0 cm
Aorta - Descending Thoracic:  *3.0 cm  <= 2.5 cm
Findings
LEFT ATRIUM: No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. No
ASD by 2D or color Doppler.
LEFT VENTRICLE: Mild symmetric LVH. Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal aortic diameter at the sinus level. Mildly dilated
ascending aorta. Mildly dilated aortic arch. Mildly dilated
descending aorta. Simple atheroma in descending aorta.
AORTIC VALVE: Normal aortic valve leaflets (3). No AR.
MITRAL VALVE: Mild (1+) MR.
TRICUSPID VALVE: Tricuspid valve not well visualized.
Physiologic TR.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
No 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. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Prebypass:
No mass/thrombus is seen in 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.
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The ascending aorta is mildly dilated. The aortic arch is mildly
dilated. The descending thoracic aorta is mildly dilated. There
are simple atheroma in the descending thoracic aorta. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion. No aortic regurgitation is seen. Mild (1+) mitral
regurgitation is seen. There is no pericardial effusion. There
is an intra-aortic ballon pump in the descending aorta
immediately distal to the aortic arch. The left subclavian
artery is not seen. All findings were communicated with the
surgeon at the onset of the operation.
Postbypass:
The intraaortic balloon pump is on 1:2 post bypass, otherwise
the patient is receiving no inotropic support. The left and
right ventricular function are normal. All other findings are
consistent with prebypass findings. The aorta is intact
post-decannulation. All findings communicated with the surgeon
post bypass.
[**Known lastname **],[**Known firstname 177**] [**Medical Record Number 84964**] M  65  [**2081-1-24**]
Radiology Report CHEST (PORTABLE AP) Study Date of [**2146-7-24**] 7:52
AM
[**Hospital 93**] MEDICAL CONDITION:
   65 year old man with CABG
REASON FOR THIS EXAMINATION:
   ? ptx after CT removal
FINDINGS: In comparison with the study of [**7-23**], the left chest
tube has been removed and there is no evidence of pneumothorax.
Right IJ sheath remains in place, but the IABP has been removed.
Postoperative changes are again seen at the left base.
DR. [**First Name11 (Name Pattern1) 1569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 11006**]




Brief Hospital Course:
Pt admitted with increasing fatigue and chest heaviness-->
referred for stress test in which patient had CP with ST
depressions. Referred for emergent coronary artery bypass
surgery x 3.  See Operative report for details. He was
transferred to the CVICU intubated for hemodynamic management
and care.  He was weaned from the ventilator and extubated on
POD#1.  His IABP and JP's were also pulled on POD#1 and pt
remained hemodynamically stable.  All vasoactive medications
were weaned off and the patient was started on beta
blockers/ASA/statin.  His chest tubes and pacing wires were
removed per protocol.  He was transferred to the floor POD#3 and
evaluated and treated by physical therapy.  He was cleared for
discharge to home with VNA services on [**7-26**]


Medications on Admission:
Medications at home:
Lipitor 20mg daily
Alleve PRN
OSH meds: lipitor 80mg daily
Metoprolol 25 mg
ASA 325mg


Discharge Medications:
1. 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:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two
(2) Tablet Sustained Release PO once a day for 2 weeks.
Disp:*28 Tablet Sustained Release(s)* Refills:*0*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
7. Tramadol 50 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
[**2146-7-22**]: Coronary Artery Bypass Graft Surgery with LIMA-> Left
anterior descending artery, Reverse saphenous vein graft->Ramus,
obtuse marginal

PMH: HTN, Melanoma removed x3,GERD,L Knee Arthroscopy x2, Hernia
repair


Discharge Condition:
Good


Discharge Instructions:
Please shower daily including washing incisions, 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, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**Last Name (STitle) **] in 1 week
Dr. [**Last Name (STitle) **] [**1-4**] weeks
Please call for appointments
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2146-7-26**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Esophageal reflux,Other abnormal glucose,Personal history of malignant melanoma of skin,Other postprocedural status'}


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: Fatigue, chest heaviness

PRESENT ILLNESS: 65 yo M with increasing fatigue and chest heaviness with normal
activity over past 10 days. PCP referred pt for stress test.
During stress test pt had
chest pain/SOB/diaphoresis with ST depressions. Cardiac
Catherization:[**2146-7-22**] [**Hospital1 18**]:LM dz

MEDICAL HISTORY: HTN, lipids, melanoma removed x3, GERD, preDM, s/p L knee
arthroplasty, s/p hernia repair

MEDICATION ON ADMISSION: Medications at home:
Lipitor 20mg daily
Alleve PRN
OSH meds: lipitor 80mg daily
Metoprolol 25 mg
ASA 325mg

ALLERGIES: Codeine

PHYSICAL EXAM: Height: 5'[**46**]"    Weight:260 lbs
General:
Skin: Dry [x] intact []
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  Edema none
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: IABP  Left: 2+
DP           Right: 2+  Left:2+
PT           [**Name (NI) 167**]: 2+  Left:2+
Radial       Right: 2+  Left:2+
Carotid Bruit        Right: no   Left: no

FAMILY HISTORY: Brother -CABG

SOCIAL HISTORY: Occupation:Retired, Lives with wife, [**Name (NI) **]:Caucasian
Tobacco: denies, ETOH 3drinks/mo 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Esophageal reflux,Other abnormal glucose,Personal history of malignant melanoma of skin,Other postprocedural status'}
