CHIEF COMPLAINT: coronary artery disease

PRESENT ILLNESS: This 49 year old truck driver experienced chest pressure while
sitting in his truck. He denies chest pain with exertion. A
stress test in [**2183-3-24**] was positive and stopped due to
fatigue. Cardiac catheterization on [**2183-4-23**] revealed
diffuse/calcific 3 vessel coronary disease with preserved LV
function. He was referred for revascularization.

MEDICAL HISTORY: Hypertension, Dyslipidemia, Dejenerative
Joint disease, Abnormal LFT's(prior to stopping ETOH), Diabetes
mellitus, + tobacco use

MEDICATION ON ADMISSION: Atenolol 25', ASA 325', Simvastatin 20',
Tylenol-PRN, Lisinopril 10', NTG-PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Mother MI @53yo/CABG in her late 60's. Father MI
@71yo. Maternal Grandmother MI @57yo, Maternal grandfather died
[**Name (NI) **] @39yo

SOCIAL HISTORY: Race: Caucaisian
Last Dental Exam:na
Lives with:wife and 6 year old daughter
Occupation:Truck driver
Tobacco: 60 pack years, [**3-27**] ppd down from 2ppd last year.
ETOH: stopped all ETOH in [**2181-10-24**]
Recreational drug use: remote marijuana
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Anemia, unspecified,Obesity, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified alcohol dependence, in remission,Tobacco use disorder
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Hypertension NOS,Anemia NOS,Obesity NOS,Osteoarthros NOS-unspec,DMII wo cmp nt st uncntr,Alcoh dep NEC/NOS-remiss,Tobacco use disorder
Admission Date:  [**2183-5-30**]              Discharge Date:   [**2183-6-3**]

Date of Birth:  [**2134-9-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
coronary artery disease

Major Surgical or Invasive Procedure:
Coronary artery bypass grafts x3(LIMA-LAD,SVG-diag,SVG-OM)
[**2183-5-30**]


History of Present Illness:
This 49 year old truck driver experienced chest pressure while
sitting in his truck. He denies chest pain with exertion. A
stress test in [**2183-3-24**] was positive and stopped due to
fatigue. Cardiac catheterization on [**2183-4-23**] revealed
diffuse/calcific 3 vessel coronary disease with preserved LV
function. He was referred for revascularization.


Past Medical History:
Hypertension, Dyslipidemia, Dejenerative
Joint disease, Abnormal LFT's(prior to stopping ETOH), Diabetes
mellitus, + tobacco use


Social History:
Race: Caucaisian
Last Dental Exam:na
Lives with:wife and 6 year old daughter
Occupation:Truck driver
Tobacco: 60 pack years, [**3-27**] ppd down from 2ppd last year.
ETOH: stopped all ETOH in [**2181-10-24**]
Recreational drug use: remote marijuana

Family History:
Mother MI @53yo/CABG in her late 60's. Father MI
@71yo. Maternal Grandmother MI @57yo, Maternal grandfather died
[**Name (NI) **] @39yo

Physical Exam:
Admission:

Pulse:  88     Resp: 18       O2 sat: 94% RA
B/P  Right: 158/108    Left:
Height:  5'9"   Weight: 275lbs

General:
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X]
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X]  Irregular []  NO m/r/g
Abdomen:Soft[X] non-distended[X] non-tender[X] bowel sounds +
[X]
 Obese
Extremities: Warm [X], well-perfused [X]  Edema: None
Varicosities: None [X]
Neuro: Grossly intact, non focal exam
Pulses:
Femoral      Right: 2+  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:
[**2183-6-1**] 07:00PM BLOOD WBC-9.6 RBC-3.81* Hgb-12.1* Hct-35.0*
MCV-92 MCH-31.7 MCHC-34.5 RDW-13.8 Plt Ct-128*
[**2183-6-1**] 02:35AM BLOOD WBC-9.9 RBC-3.51* Hgb-11.0* Hct-31.7*
MCV-90 MCH-31.2 MCHC-34.6 RDW-13.5 Plt Ct-106*
[**2183-6-1**] 07:00PM BLOOD Glucose-136* UreaN-15 Creat-0.9 Na-135
K-3.9 Cl-96 HCO3-30 AnGap-13


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 86803**] (Complete)
Done [**2183-5-30**] at 10:44:43 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2134-9-30**]
Age (years): 48 M  Hgt (in):
BP (mm Hg): 88/57  Wgt (lb):
HR (bpm): 74  BSA (m2):
Indication: Left ventricular function. Valvular heart disease.
Chest pain.
ICD-9 Codes: 746.9, 424.1, 424.2
Test Information
Date/Time: [**2183-5-30**] at 10:44    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 45823**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW6-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Annulus:  2.4 cm  <= 3.0 cm
Aorta - Sinus Level:  3.2 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.5 cm  <= 3.0 cm
Aorta - Ascending:  3.3 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm
Aortic Valve - Peak Gradient:  16 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  9 mm Hg
Aortic Valve - LVOT diam:  2.3 cm
Aortic Valve - Valve Area:  *1.5 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Normal LA and RA cavity sizes.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA and extending into the RV. PFO is
present. Left-to-right shunt across the interatrial septum at
rest.

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Normal regional LV systolic function. Low normal LVEF.

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

AORTA: Normal ascending aorta diameter. Simple atheroma in
descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). Mild
AS (area 1.2-1.9cm2). No AR.

MITRAL VALVE: Normal mitral valve leaflets. Trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.


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
PREBYPASS The left atrium and right atrium are normal in cavity
size. A patent foramen ovale is present. A left-to-right shunt
across the interatrial septum is seen at rest. Left ventricular
wall thicknesses are normal. The left ventricular cavity size is
normal. Regional left ventricular wall motion is normal. Overall
left ventricular systolic function is low normal (LVEF 50-55%).
Right ventricular chamber size and free wall motion are normal.
Right ventricular chamber size is normal. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) are mildly thickened. There is mild aortic valve
stenosis (valve area ~1.5cm2). No aortic regurgitation is seen.
The mitral valve leaflets are structurally normal. Trivial
mitral regurgitation is seen. There is no pericardial effusion.

POSTBYPASS
Biventricular systolic function is preserved. The study is
otherwise unchanged from prebypass.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2183-5-30**] 12:35


?????? [**2176**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Following admission he went to the Operating Room where cornary
bypass grafting was performed.  See operative note for details.
He weaned from bypass on  Neo synephrine and Propofol infusions
in stable condition.  Pressors were rapidly weaned off and he
was extubated without difficulty.  Beta blockers were begun and
he was diuresed towards his preoperative weight.He was
transferred to the step down unit for further monitoring.
Physical Therapy worked with him for strength and mobility.
Wounds were clean and healing well. CTs and temporary pacing
wires were removed per protocols, without complications.  He was
ready for discharge to home on POD 4.  Medications, precautions
and follow up were discussed with him.

Medications on Admission:
 Atenolol 25', ASA 325', Simvastatin 20',
Tylenol-PRN, Lisinopril 10', NTG-PRN


Discharge Medications:
1. 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*
2. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 7 days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
3. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*2*
4. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
7. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
coronary artery disease
obesity
hypertension
hyperlipidemia
degenerative joint disease
noninsulin dependent diabetes mellitus


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

Incisional pain managed with Percocet


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**]).

**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) **] on Thursday [**2183-6-19**] at 9:15am at [**Hospital 3856**] Heart Center #([**Telephone/Fax (2) 6256**])

Please call to schedule appointments with your

Primary Care:  Dr. [**First Name (STitle) **] [**Name (STitle) 48633**] ([**Telephone/Fax (1) 35142**]) in [**1-25**] weeks
Cardiologist:  Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1075**] in [**1-25**] weeks at [**Hospital3 1280**]. Can
be same day as with Dr. [**Last Name (STitle) **]
**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:[**2183-6-3**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Anemia, unspecified,Obesity, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified alcohol dependence, in remission,Tobacco use disorder'}


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: coronary artery disease

PRESENT ILLNESS: This 49 year old truck driver experienced chest pressure while
sitting in his truck. He denies chest pain with exertion. A
stress test in [**2183-3-24**] was positive and stopped due to
fatigue. Cardiac catheterization on [**2183-4-23**] revealed
diffuse/calcific 3 vessel coronary disease with preserved LV
function. He was referred for revascularization.

MEDICAL HISTORY: Hypertension, Dyslipidemia, Dejenerative
Joint disease, Abnormal LFT's(prior to stopping ETOH), Diabetes
mellitus, + tobacco use

MEDICATION ON ADMISSION: Atenolol 25', ASA 325', Simvastatin 20',
Tylenol-PRN, Lisinopril 10', NTG-PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Mother MI @53yo/CABG in her late 60's. Father MI
@71yo. Maternal Grandmother MI @57yo, Maternal grandfather died
[**Name (NI) **] @39yo

SOCIAL HISTORY: Race: Caucaisian
Last Dental Exam:na
Lives with:wife and 6 year old daughter
Occupation:Truck driver
Tobacco: 60 pack years, [**3-27**] ppd down from 2ppd last year.
ETOH: stopped all ETOH in [**2181-10-24**]
Recreational drug use: remote marijuana 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Anemia, unspecified,Obesity, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified alcohol dependence, in remission,Tobacco use disorder'}
