CHIEF COMPLAINT: transfer from OSH for cath
shortness of breath

PRESENT ILLNESS: 62 year old man with DM2,HTN, OSA who presented to OSH on advice
from PCP with worsening SOB and DOE [[**2130-2-13**]] found to have a
new cardiomyopathy with an EF of 40% with diffuse hypokinesis,
now being transferred for cardiac catherization.  Pt describes
DOE over several years durationbut progressively worse in last
few months to point where he is now unable to walk across a
standard room.  No Sx c/w angina.  Remaining compliants included
LE edema. Otherwise denied F/C/S, cough, CP, abd pain, N/V/D.

MEDICAL HISTORY: DM2- new diagnosis, no current treatment
HTN
OSA- not currently on CPAP, scheduled for outpt sleep study
no previously-known CAD

MEDICATION ON ADMISSION: MEDS outpatient:
ASA 81mg qd
MVI qd
fish oil capsules
.
MEDS on transfer:
lasix 80IV QD
Metoprolol 25 [**Hospital1 **]
Lisinopril 10 qd
Aldactone 25 QID
ASA 81
ancef
s/p pneumonocccal vaccine yesterday

ALLERGIES: Benadryl

PHYSICAL EXAM: T 97.3, HR 98, BP 117/71, RR 18, O2sat 96%RA
Gen: comfortable, speaking in full sentences, pleasant, lying in
bed in NAD
HEENT: R eye laterally deviated, sclerae anicteric, MMM, OP
clear
Neck: No LAD. Lying flat so unable to approximate JVD, no CB b/l
CV: RRR, nl S1S2, no M/R/G
Lungs:  CTAB anteriorly, no wheeze or rales
Abd: +BS, soft, obese, NT, ND, no fluid wave, no HSM
Ext: trace LE edema to 1/4calf b/l, DP 2+ bilaterally, R groin
cath site- c/d/i, no hematoma/ooze/bruit/tenderness
Neuro: A&O x 3, appropriate, R eye laterally deviated, h/o R eye
blindness

FAMILY HISTORY: both mother and father died of MIs in their 50s

SOCIAL HISTORY: Works as heavy machinery mechanic; married and lives with wife,
3 daughters; +[**Name2 (NI) **]- 120pk-yr history, quit 13y ago; no EtOH/IVDU
Coronary atherosclerosis of native coronary artery,Acute combined systolic and diastolic heart failure,Cellulitis and abscess of leg, except foot,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Unspecified sleep apnea,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Ac syst/diastol hrt fail,Cellulitis of leg,Hyperlipidemia NEC/NOS,Hypertension NOS,Sleep apnea NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2130-2-17**]              Discharge Date:   [**2130-2-25**]

Date of Birth:  [**2067-3-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Benadryl

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
transfer from OSH for cath
shortness of breath

Major Surgical or Invasive Procedure:
cardiac catheterization

History of Present Illness:
62 year old man with DM2,HTN, OSA who presented to OSH on advice
from PCP with worsening SOB and DOE [[**2130-2-13**]] found to have a
new cardiomyopathy with an EF of 40% with diffuse hypokinesis,
now being transferred for cardiac catherization.  Pt describes
DOE over several years durationbut progressively worse in last
few months to point where he is now unable to walk across a
standard room.  No Sx c/w angina.  Remaining compliants included
LE edema. Otherwise denied F/C/S, cough, CP, abd pain, N/V/D.

.
OSH Course:  Ruled out for MI by CEs. He was diuresed for 20lbs.
 FOund to have mild cellulitis of the left leg, which improved
on Ancef.
.
Currently Pt feels better with improved SOB.  He has no CP, N/V,
abd pain.  He reports his L leg pain and swelling are also
improved.

Past Medical History:
DM2- new diagnosis, no current treatment
HTN
OSA- not currently on CPAP, scheduled for outpt sleep study
no previously-known CAD

Social History:
Works as heavy machinery mechanic; married and lives with wife,
3 daughters; +[**Name2 (NI) **]- 120pk-yr history, quit 13y ago; no EtOH/IVDU

Family History:
both mother and father died of MIs in their 50s

Physical Exam:
T 97.3, HR 98, BP 117/71, RR 18, O2sat 96%RA
Gen: comfortable, speaking in full sentences, pleasant, lying in
bed in NAD
HEENT: R eye laterally deviated, sclerae anicteric, MMM, OP
clear
Neck: No LAD. Lying flat so unable to approximate JVD, no CB b/l
CV: RRR, nl S1S2, no M/R/G
Lungs:  CTAB anteriorly, no wheeze or rales
Abd: +BS, soft, obese, NT, ND, no fluid wave, no HSM
Ext: trace LE edema to 1/4calf b/l, DP 2+ bilaterally, R groin
cath site- c/d/i, no hematoma/ooze/bruit/tenderness
Neuro: A&O x 3, appropriate, R eye laterally deviated, h/o R eye
blindness


Pertinent Results:
Cardiology Report C.CATH Study Date of [**2130-2-17**]


*** Not Signed Out ***

BRIEF HISTORY:   Patient is a 63 year old male who has not
sought care
for many years.  He presented to [**Hospital3 4107**] last week with
CHF.  He
was diuresed 20 pounds and diagnosed with having diabetes.  EF
was 40%
on echo with mild LVH.  He is now referred for cath for new
diagnosis of
cardiomyopathy.

INDICATIONS FOR CATHETERIZATION:
CHF, cardiomyopathy

PROCEDURE:
RIGHT HEART CATH- was performed via 8F sheath in Right Femoral
Vein via
a PA catheter.
LEFT HEART CATH- was performed via a 5F sheath in Right Femoral
Artery.
Multiple projections of coronary arteries were performed with 5F
JL4 and
JR4.
VENTRICULOGRAM was performed wia a 5F pigtail with 39 cc of
contrast
injected over 3 seconds.
Conscious Sedation:  was provided with appropriate monitoring
performed by
a member of the nursing staff.

HEMODYNAMICS RESULTS BODY SURFACE AREA:  2.09 m2
  HEMOGLOBIN: 10.9 gms %
  FICK
**PRESSURES
RIGHT ATRIUM {a/v/m} 22/20/16
RIGHT VENTRICLE {s/ed} 54/20
PULMONARY ARTERY {s/d/m} 54/28/39
PULMONARY WEDGE {a/v/m} 33/35/31
LEFT VENTRICLE {s/ed} 102/35
AORTA {s/d/m} 102/67/82
**CARDIAC OUTPUT
HEART RATE {beats/min} 96
RHYTHM SINUS
O2 CONS. IND {ml/min/m2} 125
CARD. OP/IND FICK {l/mn/m2} 4.4/2.1
**RESISTANCES
SYSTEMIC VASC. RESISTANCE 1200
PULMONARY VASC. RESISTANCE 146

**% SATURATION DATA (NL)
SVC LOW 53
PA MAIN 53
AO 93
**ARTERIAL BLOOD GAS
INSPIRED O2 CONCENTR'N 21


LEFT VENTRICULOGRAPHY:
Volumetric data:
          LV ejection fraction (nl 50%-80%).                35
Qualitative wall motion:
[**Doctor Last Name **]:
          1. Antero basal -    hypokinetic
          2. Antero lateral -  hypokinetic
          3. Apical -          hypokinetic
          4. Inferior -        hypokinetic
          5. Postero basal -   hypokinetic
Other findings:
Mitral valve showed the following abnormalities.
          1. Regurgitation 1+.
Aortic valve was normal.


**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**RIGHT CORONARY
1) PROXIMAL RCA   DIFFUSELY DISEASED
2) MID RCA   DISCRETE 95
2A) ACUTE MARGINAL   NORMAL
3) DISTAL RCA   DIFFUSELY DISEASED

**ARTERIOGRAPHY RESULTS MORPHOLOGY % STENOSIS COLLAT. FROM
**LEFT CORONARY
5) LEFT MAIN   DISCRETE 40
6) PROXIMAL LAD   DISCRETE 90
6A) SEPTAL-1   NORMAL
7) MID-LAD   NORMAL
8) DISTAL LAD   NORMAL
9) DIAGONAL-1   NORMAL
10) DIAGONAL-2   NORMAL
11) INTERMEDIUS   DIFFUSELY DISEASED
12) PROXIMAL CX   DIFFUSELY DISEASED
13) MID CX   DISCRETE 60
13A) DISTAL CX   DISCRETE 95
14) OBTUSE MARGINAL-1   DISCRETE 80
15) OBTUSE MARGINAL-2   DIFFUSELY DISEASED
16) OBTUSE MARGINAL-3   DISCRETE 90
17) LEFT PDA   NORMAL


TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 36 minutes.
Arterial time = 23 minutes.
Fluoro time = 5 minutes.
Contrast:
          Non-ionic low osmolar (isovue, optiray...), vol 94 ml,
Indications - Renal
Premedications:
          ASA 325 mg P.O.
          Lasix and aldactone
Anesthesia:
          1% Lidocaine subq.
Anticoagulation:
Other medication:
          Fentanyl 25mcg IV
          Lasix 60mg IV
          Versed 1mg IV
Cardiac Cath Supplies Used:
          200CC MALLINCRODT, OPTIRAY 200CC
          100CC MALLINCRODT, OPTIRAY 100CC


COMMENTS:     1.  Selective coronary angiography in this
co-dominant
patient revealed severe three vessel native coronary disease.
The LMCA
had a distal 40% stenosis.  The LAD had a 90% long tubular
stenosis
proximally.  The LCX system was diffusely diseased with 80%
large OM1,
small diffusely diseased OM2 and 90% large OM3.  The mid LCX had
a 60%
lesion and the distal LCX had a 95% lesion before the last
posterolateral.  The ramus was small and diffusely diseased with
a 95%
mid lesion.  It gave off a very small PDA.
2.  Resting hemodynamics revealed severe elevation of right and
left
sided filling pressures with mean RA of 16mmHG and mean PCWP of
31mmHG.
The LVEDP was also elevated at 35mmHG and there was
moderate-severe
elevation of pulmonary pressures with mean PA of 39mmHG.  The
cardiac
index was depressed at 2.11.  There was no gradient on aortic
valve
pullback.  Systemic blood pressure was normal at 106/67
3.  Ventriculogram revealed moderate global hypokinesis with a
dilated
ventricule. There was severe anteroapical hypokinesis. EF was
about 35%
with mild mitral regurgitation.

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Moderate systolic dysfunction
3. Severe diastolic dysfunction with elevated right and left
filling
pressures and reduced cardiac index.

ATTENDING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].
REFERRING PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **]
CARDIOLOGY FELLOW: [**Last Name (LF) 38290**],[**First Name3 (LF) **] M.
ATTENDING STAFF: [**Last Name (LF) **],[**First Name3 (LF) **] E.


Cardiology Report ECHO Study Date of [**2130-2-20**]



PATIENT/TEST INFORMATION:
Indication: Left ventricular function.
Height: (in) 67
Weight (lb): 218
BSA (m2): 2.10 m2
BP (mm Hg): 105/58
HR (bpm): 86
Status: Inpatient
Date/Time: [**2130-2-20**] at 11:49
Test: Portable TTE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2006W002-0:49
Test Location: [**Location 11648**]/[**Hospital Ward Name 121**] 6
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
  DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: *4.7 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: *5.6 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: *5.4 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Inferolateral Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: 5.1 cm (nl <= 5.6 cm)
Left Ventricle - Systolic Dimension: 3.9 cm
Left Ventricle - Fractional Shortening: *0.24 (nl >= 0.29)
Left Ventricle - Ejection Fraction: 30% to 35% (nl >=55%)
Aorta - Valve Level: 3.0 cm (nl <= 3.6 cm)
Aorta - Ascending: 3.1 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: 1.2 m/sec (nl <= 2.0 m/sec)
Mitral Valve - E Wave: 1.1 m/sec
Mitral Valve - A Wave: 0.3 m/sec
Mitral Valve - E/A Ratio: 3.67
TR Gradient (+ RA = PASP): *28 mm Hg (nl <= 25 mm Hg)
Pulmonic Valve - Peak Velocity: 1.0 m/sec (nl <= 1.0 m/s)

INTERPRETATION:

Findings:

LEFT ATRIUM: Mild LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. Normal
interatrial septum.
No ASD by 2D or color Doppler.

LEFT VENTRICLE: Moderate global LV hypokinesis. No resting LVOT
gradient.

RIGHT VENTRICLE: RV hypertrophy. Normal RV chamber size. Mild
global RV free
wall hypokinesis.

AORTA: Normal aortic root diameter. Normal ascending aorta
diameter.

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

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. Mild
[1+] TR. Mild
PA systolic hypertension.

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

PERICARDIUM: No pericardial effusion.

Conclusions:
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or
color Doppler. There is moderate global left ventricular
hypokinesis. The
right ventricular free wall is hypertrophied. Right ventricular
chamber size
is normal. There is mild global right ventricular free wall
hypokinesis. 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. Mild (1+) mitral regurgitation is seen. The tricuspid
valve
leaflets are mildly thickened. There is mild pulmonary artery
systolic
hypertension. There is no pericardial effusion.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD on [**2130-2-20**] 14:00.
[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**First Name3 (LF) **]

Cardiology Report ECG Study Date of [**2130-2-21**]  3:48:38 PM


Sinus rhythm
Old anteroseptal infarct
Low QRS voltages in precordial leads
Nonspecific ST-T wave changes
Since previous tracing, no significant change


Read by: [**Last Name (LF) **],[**First Name3 (LF) **] J.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
90 144 78 362/409.71 69 12 85



Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2130-2-17**] for further
management of his congestive heart failure. His catheterization
at [**Hospital1 18**] revealed significant 3 vessel disease with a depressed
LVEF.  Please see catheterization report for details.  Given the
severity of his disease, the cardiac surgical service was
consulted for surgical revascularization. He was worked-up in
the usual preoperative manner.  On [**2130-2-21**] he successfully
underwent CABGx3 (LIMA->LAD, SVG->OM, SVG->PDA).  Afterward he
was transferred to the Cardiac surgery recovery unit in stable
condition and awakened neurologically intake.   He was weaned
from ventilator support, extubated, and pressors were weaned.
On POD 2 he was then transferred to the Stepdown unit for
further recovery.  His chest tubes were removed without
complication.  He was gently diuresed to his preoperative
weight, beta blockade and aspirin therapy were resumed, and
physical therapy service was consulted to assist with his
postoperative strength and mobility. Electrolytes were repleted
as needed.  On POD 3 his epicardial pacing wires were removed
without complication, he continued to improve his ability to
ambulate including climbing stairs without respiratory distress
or chest pain.  On POD 4 the [**Last Name (un) **] diabetes clinic was
consulted regarding diabetic teaching for Mr. [**Known lastname **] newly
diagnosed diabetes.  Follow up for management of his diabetes
will be done at the [**Hospital1 1474**] clininc.  On POD 5 Mr. [**Known lastname **]
was 5kg his preop weight with good exercise tolerance, no SOB,
or Chest pain.  His blood pressure was stable.  His sternotomy
and leg incision were clean, dry, and intact without evidence of
infection.  He was discharged home on POD 5 with services in
good condition, cardiac diet, sternal precautions, and
instructed to follow up with his PCP/cardiologist in [**1-16**] weeks.
He will follow up with Dr. [**Last Name (STitle) **] in four weeks.


Medications on Admission:
MEDS outpatient:
ASA 81mg qd
MVI qd
fish oil capsules
.
MEDS on transfer:
lasix 80IV QD
Metoprolol 25 [**Hospital1 **]
Lisinopril 10 qd
Aldactone 25 QID
ASA 81
ancef
s/p pneumonocccal vaccine yesterday

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 14 days.
Disp:*28 Tablet(s)* Refills:*0*
3. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 14
days.
Disp:*56 Capsule, Sustained Release(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. 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*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
8. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
11. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Reglan 10 mg Tablet Sig: One (1) Tablet PO every six (6)
hours.
Disp:*30 Tablet(s)* Refills:*2*
13. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection four times a day: follow SSI.
Disp:*qs 30* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
CAD, HTN, Hyperlipidemia, DM type 2, right eye blindness


Discharge Condition:
Good


Discharge Instructions:
Shower, wash incisions with mild soap and water and pat dry. No
lotions, creams or powders to incisions.
Call with fever >101, redness or drainage from incision, or
weight gain more than 2 pounds in one day or five pounds in one
week.
No lifting more than 10 pounds for 10 weeks.
No driving until follow up with surgeon.


Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in four weeks [**Telephone/Fax (1) 170**]
Follow up with Dr. [**Last Name (STitle) 31187**] in one to two weeks [**Telephone/Fax (1) 64680**]



Completed by:[**2130-2-25**]
{'Coronary atherosclerosis of native coronary artery,Acute combined systolic and diastolic heart failure,Cellulitis and abscess of leg, except foot,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Unspecified sleep apnea,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: transfer from OSH for cath
shortness of breath

PRESENT ILLNESS: 62 year old man with DM2,HTN, OSA who presented to OSH on advice
from PCP with worsening SOB and DOE [[**2130-2-13**]] found to have a
new cardiomyopathy with an EF of 40% with diffuse hypokinesis,
now being transferred for cardiac catherization.  Pt describes
DOE over several years durationbut progressively worse in last
few months to point where he is now unable to walk across a
standard room.  No Sx c/w angina.  Remaining compliants included
LE edema. Otherwise denied F/C/S, cough, CP, abd pain, N/V/D.

MEDICAL HISTORY: DM2- new diagnosis, no current treatment
HTN
OSA- not currently on CPAP, scheduled for outpt sleep study
no previously-known CAD

MEDICATION ON ADMISSION: MEDS outpatient:
ASA 81mg qd
MVI qd
fish oil capsules
.
MEDS on transfer:
lasix 80IV QD
Metoprolol 25 [**Hospital1 **]
Lisinopril 10 qd
Aldactone 25 QID
ASA 81
ancef
s/p pneumonocccal vaccine yesterday

ALLERGIES: Benadryl

PHYSICAL EXAM: T 97.3, HR 98, BP 117/71, RR 18, O2sat 96%RA
Gen: comfortable, speaking in full sentences, pleasant, lying in
bed in NAD
HEENT: R eye laterally deviated, sclerae anicteric, MMM, OP
clear
Neck: No LAD. Lying flat so unable to approximate JVD, no CB b/l
CV: RRR, nl S1S2, no M/R/G
Lungs:  CTAB anteriorly, no wheeze or rales
Abd: +BS, soft, obese, NT, ND, no fluid wave, no HSM
Ext: trace LE edema to 1/4calf b/l, DP 2+ bilaterally, R groin
cath site- c/d/i, no hematoma/ooze/bruit/tenderness
Neuro: A&O x 3, appropriate, R eye laterally deviated, h/o R eye
blindness

FAMILY HISTORY: both mother and father died of MIs in their 50s

SOCIAL HISTORY: Works as heavy machinery mechanic; married and lives with wife,
3 daughters; +[**Name2 (NI) **]- 120pk-yr history, quit 13y ago; no EtOH/IVDU 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute combined systolic and diastolic heart failure,Cellulitis and abscess of leg, except foot,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Unspecified sleep apnea,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
