CHIEF COMPLAINT: chest discomfort, MI

PRESENT ILLNESS: 70M with no medical follow up in over 30 years- recently
underwent stenting of the distal SFA for ischemic foot in
[**Month (only) 956**].  He was discharged home and did okay until he
developed chest discomfort on [**5-12**].  He was admitted and ruled
in for NQWMI and mild CHF.  Cath today reveals 90% left main
CAD. Cardiac surgery consulted for surgical revascularization.

MEDICAL HISTORY: hypertension, peripheral vascular disease, s/p stent to SFA,
NSTEMI [**2180-5-15**]

MEDICATION ON ADMISSION: CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth once a day
LISINOPRIL -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth once a day
METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 50 mg
Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth qam
SIMVASTATIN -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth once a day
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 Tablet(s) by mouth once a day

ALLERGIES: Percocet

PHYSICAL EXAM: Pulse: 54SR  Resp: 14  O2 sat: 94%
B/P  Right:    Left: 155/82
Height:     Weight: 86.2kg

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Race: caucasian
Last Dental Exam: edentulous
Lives with: alone
Occupation: retired police officer, drives cab
Tobacco: 1ppd x 50yrs- current
ETOH: Was drinking 1 gallon of whisky a week until his admission
in [**Month (only) 956**]. Currently drinking [**1-22**] a gallon per week
Subendocardial infarction, subsequent episode of care,Alcohol withdrawal delirium,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Congestive heart failure, unspecified,Tobacco use disorder,Other and unspecified hyperlipidemia,Leukocytosis, unspecified,Anemia, unspecified,Other and unspecified alcohol dependence, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication
Subendo infarct, subseq,Delirium tremens,Obs chr bronc w(ac) exac,Hyperosmolality,Atrial fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Ocl mlt bi art wo infrct,CHF NOS,Tobacco use disorder,Hyperlipidemia NEC/NOS,Leukocytosis NOS,Anemia NOS,Alcoh dep NEC/NOS-unspec,Ath ext ntv at w claudct
Admission Date:  [**2180-5-19**]              Discharge Date:   [**2180-5-30**]

Date of Birth:  [**2109-5-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Percocet

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
chest discomfort, MI


Major Surgical or Invasive Procedure:
Urgent coronary artery bypass graft x4.  Left internal  mammary
artery to left anterior descending artery and saphenous vein
grafts to ramus, obtuse marginal and posterior descending
arteries.


History of Present Illness:
70M with no medical follow up in over 30 years- recently
underwent stenting of the distal SFA for ischemic foot in
[**Month (only) 956**].  He was discharged home and did okay until he
developed chest discomfort on [**5-12**].  He was admitted and ruled
in for NQWMI and mild CHF.  Cath today reveals 90% left main
CAD. Cardiac surgery consulted for surgical revascularization.


Past Medical History:
hypertension, peripheral vascular disease, s/p stent to SFA,
NSTEMI [**2180-5-15**]


Social History:
Race: caucasian
Last Dental Exam: edentulous
Lives with: alone
Occupation: retired police officer, drives cab
Tobacco: 1ppd x 50yrs- current
ETOH: Was drinking 1 gallon of whisky a week until his admission
in [**Month (only) 956**]. Currently drinking [**1-22**] a gallon per week


Family History:
noncontributory

Physical Exam:
Pulse: 54SR  Resp: 14  O2 sat: 94%
B/P  Right:    Left: 155/82
Height:     Weight: 86.2kg

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [] EOMI [x] fixed pupils (cataracts)
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [] no edema or varicosities
Neuro: Grossly intact x
Pulses:
Femoral      Right: cath  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: NP  Left: NP
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right:    Left: no bruits appreciated


Pertinent Results:
[**2180-5-29**] 04:15PM BLOOD WBC-10.8 RBC-3.48* Hgb-10.7* Hct-33.3*
MCV-96 MCH-30.8 MCHC-32.2 RDW-16.0* Plt Ct-354
[**2180-5-19**] 08:30AM BLOOD WBC-12.2* RBC-4.14* Hgb-14.0 Hct-42.2
MCV-102* MCH-33.8* MCHC-33.2 RDW-15.8* Plt Ct-417
[**2180-5-28**] 04:58AM BLOOD PT-18.7* PTT-30.7 INR(PT)-1.7*
[**2180-5-19**] 08:30AM BLOOD PT-10.8 PTT-22.8 INR(PT)-0.9
[**2180-5-29**] 04:15PM BLOOD Glucose-89 UreaN-14 Creat-0.8 Na-138
K-4.1 Cl-103 HCO3-25 AnGap-14
[**2180-5-19**] 08:30AM BLOOD Glucose-85 UreaN-22* Creat-0.7 Na-143
K-3.3 Cl-106 HCO3-24 AnGap-16
[**2180-5-28**] 04:58AM BLOOD ALT-53* AST-32 LD(LDH)-322* AlkPhos-72
Amylase-84 TotBili-0.5
[**2180-5-21**] 04:05AM BLOOD ALT-17 AST-31 LD(LDH)-314* AlkPhos-33*
Amylase-58 TotBili-0.3


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 86524**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 86525**] (Complete)
Done [**2180-5-19**] at 7:25:32 PM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2109-5-14**]
Age (years): 71 M  Hgt (in): 72
BP (mm Hg): 124/78  Wgt (lb): 190
HR (bpm): 68  BSA (m2): 2.09 m2
Indication: Coronary artery disease. Left ventricular function.
Mitral valve disease.
ICD-9 Codes: 786.05, 786.51, 424.0
Test Information
Date/Time: [**2180-5-19**] at 19:25    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW001-0:00 Machine: AW1
Echocardiographic Measurements
Results  Measurements  Normal Range
Aorta - Annulus:  2.3 cm  <= 3.0 cm
Aorta - Sinus Level:  3.3 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.6 cm  <= 3.0 cm
Aorta - Ascending:  *3.9 cm  <= 3.4 cm

Findings
LEFT ATRIUM: Normal LA and RA cavity sizes. No spontaneous echo
contrast or thrombus in the body of 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 regional LV systolic dysfunction.
Inferobasal LV aneurysm.

RIGHT VENTRICLE: Borderline normal RV systolic function.

AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root. Mildly dilated ascending aorta.
Normal aortic arch diameter. Simple atheroma in aortic arch.
Normal descending aorta diameter. Simple atheroma in descending
aorta.

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

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild to
moderate ([**1-22**]+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) 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.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Pre-bypass: The left atrium and right atrium are normal in
cavity size. No spontaneous echo contrast or thrombus is seen in
the body of the left atrium or left atrial appendage. No atrial
septal defect is seen by 2D or color Doppler. There is mild
regional left ventricular systolic dysfunction with LVEF = 45%.
There is an inferobasal left ventricular aneurysm. with
borderline normal free wall function. The ascending aorta is
mildly dilated. There are simple atheroma in the aortic arch.
There are simple atheroma in the descending thoracic aorta. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. The mitral valve
leaflets are mildly thickened. Mild to moderate ([**1-22**]+) mitral
regurgitation is seen. There is no pericardial effusion.

Post-bypass:

PRELIMINARY REPORT developed by a Cardiology Fellow. Not
reviewed/approved by the Attending Echo Physician.
  [**Name Initial (NameIs) **] certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician


?????? [**2173**] CareGroup IS. All rights reserved.


Brief Hospital Course:
[**2180-5-19**] Mr.[**Known lastname **] was taken urgently to the operating room and
underwent urgent coronary artery bypass graft x4.(Left internal
mammary artery to left anterior descending artery and saphenous
vein grafts to ramus, obtuse marginal and posterior descending
arteries).Please refer to the operative for further details. He
tolerated the procedure well and was transferred to the CVICU on
NeoSynephrine and Propofol. Weaned off pressors and sedation, he
awoke neurologically intact, however he was then placed on
Fentnyl/Versed drips to assist him through delerium
tremens.POD#3 he was extubated without difficulty. He remained
confused  and intermittently delerious.All lines and drains were
discontinued in a timely fashion. Beta-blocker/Aspirin/Statin,
and diuresis were initiated. Swallowing evaluation performed due
to  postextubation dysphagia. Diet advanced with recovery.
Mr.[**Known lastname 86526**] mental status gradually improved and on POD#10 he was
transferred to the step down unit for further monitoring.
Physical therapy was consulted for evaluation of his strength
and mobility. He continued to progress and was cleared by
Dr.[**First Name (STitle) **] for discharge to [**Hospital 21341**] rehabilitation in [**Location (un) 6151**] on
POD# 11. All follow up appointments were advised.


Medications on Admission:
CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth once a day
LISINOPRIL -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth once a day
METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 50 mg
Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth qam
SIMVASTATIN -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth once a day
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 Tablet(s) by mouth once a day


Discharge Medications:
1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheezes.
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
5. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 7 days.
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO twice a day
for 7 days.
10. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
**Cardiologist to reevaluate  need to continue Amio.
11. Ultram 50 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
12. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
13. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
14. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital 21341**] Rehabilitation and Nursing Center - [**Location (un) 6151**]

Discharge Diagnosis:
coronary artery disease
s/p Urgent coronary artery bypass graft x4.  Left internal
mammary artery to left anterior descending artery and saphenous
vein grafts to ramus, obtuse marginal and posterior descending
arteries.
hypertension, peripheral vascular disease, s/p stent to SFA,
NSTEMI [**2180-5-15**]


Discharge Condition:
Alert and oriented x3, nonfocal.
Ambulating with  steady gait.

Incisional pain managed with Percocet

Incisions:

Sternal - healing well, no erythema or drainage

Leg Right- healing well, no erythema or drainage. Edema:


Discharge Instructions:
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.

No lotions, cream, powder, or ointments to incisions.
Each morning you should weigh yourself and then in the evening
take your temperature, These should be written down on the chart
.
No driving for approximately one month, until follow up with
surgeon.
No lifting more than 10 pounds for 10 weeks.
Please call with any questions or concerns ([**Telephone/Fax (1) 170**]).
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge of sternal wound.



**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.[**First Name (STitle) **] #[**Telephone/Fax (1) 170**] appointment arranged for
[**2180-6-26**] at 1:15pm
A PCP (Primary Care Physician)#[**Telephone/Fax (1) 250**] was arranged for you
with an appointment for [**2180-6-20**] with Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 6522**], [**Hospital 6308**]-[**Location (un) 453**] in the [**Hospital Ward Name 23**] building, Atrium suite
Please call to schedule appointments with your
Cardiologist:  Dr [**First Name8 (NamePattern2) 518**] [**Last Name (NamePattern1) 8579**] in [**1-22**] 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


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

Completed by:[**2180-5-30**]
{'Subendocardial infarction, subsequent episode of care,Alcohol withdrawal delirium,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Congestive heart failure, unspecified,Tobacco use disorder,Other and unspecified hyperlipidemia,Leukocytosis, unspecified,Anemia, unspecified,Other and unspecified alcohol dependence, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication'}


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: chest discomfort, MI

PRESENT ILLNESS: 70M with no medical follow up in over 30 years- recently
underwent stenting of the distal SFA for ischemic foot in
[**Month (only) 956**].  He was discharged home and did okay until he
developed chest discomfort on [**5-12**].  He was admitted and ruled
in for NQWMI and mild CHF.  Cath today reveals 90% left main
CAD. Cardiac surgery consulted for surgical revascularization.

MEDICAL HISTORY: hypertension, peripheral vascular disease, s/p stent to SFA,
NSTEMI [**2180-5-15**]

MEDICATION ON ADMISSION: CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth once a day
LISINOPRIL -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth once a day
METOPROLOL SUCCINATE -  (Prescribed by Other Provider) - 50 mg
Tablet Sustained Release 24 hr - 1 Tablet(s) by mouth qam
SIMVASTATIN -  (Prescribed by Other Provider) - 20 mg Tablet - 1
Tablet(s) by mouth once a day
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 Tablet(s) by mouth once a day

ALLERGIES: Percocet

PHYSICAL EXAM: Pulse: 54SR  Resp: 14  O2 sat: 94%
B/P  Right:    Left: 155/82
Height:     Weight: 86.2kg

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Race: caucasian
Last Dental Exam: edentulous
Lives with: alone
Occupation: retired police officer, drives cab
Tobacco: 1ppd x 50yrs- current
ETOH: Was drinking 1 gallon of whisky a week until his admission
in [**Month (only) 956**]. Currently drinking [**1-22**] a gallon per week 

### Response:
{'Subendocardial infarction, subsequent episode of care,Alcohol withdrawal delirium,Obstructive chronic bronchitis with (acute) exacerbation,Hyperosmolality and/or hypernatremia,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Congestive heart failure, unspecified,Tobacco use disorder,Other and unspecified hyperlipidemia,Leukocytosis, unspecified,Anemia, unspecified,Other and unspecified alcohol dependence, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication'}
