CHIEF COMPLAINT: Transferred for cardiac catheterization from [**Hospital1 1474**] ER

PRESENT ILLNESS: 72 year old man with htn, hyperlipidemia, DM, +FH, Many prior
PCIs. Last here [**6-30**] with direct stenting of distal LAD with a
2.0 x 12 mm Bare metal [**Month/Year (2) **]. Recently off of aspirin and Plavix
due to severe back pain and plans to have epidural injection to
back. Today was exerting himself when had severe back pain and
chest pain. Presented to OSH ([**Hospital 1474**] Hospital) w/in 10min c/o
([**8-5**]) midsternal CP, and was noted to be pale, diaphoretic.
Troponin bumped to 1.1. CPK 186, MB 7.6.
.
At [**Name (NI) 1474**], pt started on heparin gtt, nitroglycerin gtt, 2mg
morphine, sl nitro, asa 325, 300 plavix. Pt continued to have
chest pain, so was transferred to [**Hospital1 18**] for cath.
.
Cath showed: TO pLAD, s/p PCTA of lesion, with IVUS of LAD

MEDICAL HISTORY: - CAD.
[**6-30**] PCI and bare metal [**Month/Year (2) **] to dLAD (90% distal lesion) (LV
gram: nl EF)
[**1-31**] PCI of mLAD with DES
[**7-29**] PCI of mRCA with DES, PCI of OM1 with DES
[**8-28**] instent restenosis of D1, 70% focal instent restenosis of
RCA: brachytherapy to both lesions
[**6-27**] TOd prox RCA 4 stents to RCA, rotational arthectomy and
[**Month/Year (2) **] to D1 [**8-27**] PTCA and [**Month/Year (2) **] to RCA
.
Cath showed [**2189-11-30**]: The LMCA had a proximal 20% stenosis. The
LAD was acalcified vessel which was totally occluded after D1
with no filling of the distal vessel by collaterals. The LCX was
a nondominant vessel with mild diffuse disease and a wideply
patent OM1 [**Month/Day/Year **]. The RCA was a dominant vessel with a distal
50-60% in-[**Month/Day/Year **] restenosis. Successful PTCA of the mid LAD.
Final angiography revealed a 10% residual stenosis in the mid
LAD and moderate diffuse disease in the
distal vessel.
.
[**2189-12-1**] Repeat Cardiac CATH:
-three vessel disease
-LMCA w/ 20% stenosis
-LAD widely patent with TIMI 3 epicardial flow. Moderate diffuse
disease in the distal LAD was unchanged from [**2189-11-30**]. The LCX
including the OM1 [**Month/Day/Year **] was widely patent. The dominant RCA had
a 50-65% in-[**Month/Day/Year **] restenosis distally but no other
angiographically significant disease. Limited resting
hemodynamics revealed low normal systemic arterial pressures
while on a TNG gtt.
.
- DM II.
- HTN.
- Gout.
- LBP.

MEDICATION ON ADMISSION: Home Medications:
Metoprolol 50 mg PO BID
Metformin 500 mg PO QID (held)
Imdur 30 mg PO qd
Plavix 75 mg PO qd
ASA 81 mg PO qd
?Darvocet
.
Allergies: ?lipitor causes joint pain

ALLERGIES: Indocin / Lipitor

PHYSICAL EXAM: PE: VS: 98.7 BP 135/80 HR 55 R 16 98% 2L
Gen: NAD
HEENT: EOMI, PERRL
Neck: supple, no LAD
Chest: CTAB
CV: RRR nl s1 s2 no mrg
Abd: soft, NT, obese +bs
Ext: no edema, full pulses at DP and PT bilaterally
Neuro: CN 2-12 intact, moves all 4, sensation intact. No gross
deficits.

FAMILY HISTORY: F died MI at age 74, son had [**Name2 (NI) **] at age 48.

SOCIAL HISTORY: Tob 100 py. Quit 13 y ago. Denies extensive EtOH use. Leaves
with wife, has children and grandchildren, but no sick contacts.
Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Angiodysplasia of stomach and duodenum with hemorrhage,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
AMI anterior wall, init,Comp-oth cardiac device,Angio stm/dudn w hmrhg,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr
Admission Date:  [**2189-11-30**]              Discharge Date:   [**2189-12-6**]

Date of Birth:  [**2117-5-21**]             Sex:   M

Service: MEDICINE

Allergies:
Indocin / Lipitor

Attending:[**First Name3 (LF) 5295**]
Chief Complaint:
Transferred for cardiac catheterization from [**Hospital1 1474**] ER


Major Surgical or Invasive Procedure:
Cardiac catheterization status post stenting of LAD
Esophagogastroduodenoscopy with cauterization of two gastric
arterio-venous malformations


History of Present Illness:
72 year old man with htn, hyperlipidemia, DM, +FH, Many prior
PCIs. Last here [**6-30**] with direct stenting of distal LAD with a
2.0 x 12 mm Bare metal [**Month/Year (2) **]. Recently off of aspirin and Plavix
due to severe back pain and plans to have epidural injection to
back. Today was exerting himself when had severe back pain and
chest pain. Presented to OSH ([**Hospital 1474**] Hospital) w/in 10min c/o
([**8-5**]) midsternal CP, and was noted to be pale, diaphoretic.
Troponin bumped to 1.1. CPK 186, MB 7.6.
.
At [**Name (NI) 1474**], pt started on heparin gtt, nitroglycerin gtt, 2mg
morphine, sl nitro, asa 325, 300 plavix. Pt continued to have
chest pain, so was transferred to [**Hospital1 18**] for cath.
.
Cath showed: TO pLAD, s/p PCTA of lesion, with IVUS of LAD


Past Medical History:
- CAD.
[**6-30**] PCI and bare metal [**Month/Year (2) **] to dLAD (90% distal lesion) (LV
gram: nl EF)
[**1-31**] PCI of mLAD with DES
[**7-29**] PCI of mRCA with DES, PCI of OM1 with DES
[**8-28**] instent restenosis of D1, 70% focal instent restenosis of
RCA: brachytherapy to both lesions
[**6-27**] TOd prox RCA 4 stents to RCA, rotational arthectomy and
[**Month/Year (2) **] to D1 [**8-27**] PTCA and [**Month/Year (2) **] to RCA
.
Cath showed [**2189-11-30**]: The LMCA had a proximal 20% stenosis. The
LAD was acalcified vessel which was totally occluded after D1
with no filling of the distal vessel by collaterals. The LCX was
a nondominant vessel with mild diffuse disease and a wideply
patent OM1 [**Month/Day/Year **]. The RCA was a dominant vessel with a distal
50-60% in-[**Month/Day/Year **] restenosis. Successful PTCA of the mid LAD.
Final angiography revealed a 10% residual stenosis in the mid
LAD and moderate diffuse disease in the
distal vessel.
.
[**2189-12-1**] Repeat Cardiac CATH:
-three vessel disease
-LMCA w/ 20% stenosis
-LAD widely patent with TIMI 3 epicardial flow. Moderate diffuse
disease in the distal LAD was unchanged from [**2189-11-30**]. The LCX
including the OM1 [**Month/Day/Year **] was widely patent. The dominant RCA had
a 50-65% in-[**Month/Day/Year **] restenosis distally but no other
angiographically significant disease. Limited resting
hemodynamics revealed low normal systemic arterial pressures
while on a TNG gtt.
.
- DM II.
- HTN.
- Gout.
- LBP.


Social History:
Tob 100 py. Quit 13 y ago. Denies extensive EtOH use. Leaves
with wife, has children and grandchildren, but no sick contacts.

.


Family History:
F died MI at age 74, son had [**Name2 (NI) **] at age 48.

Physical Exam:
PE: VS: 98.7 BP 135/80 HR 55 R 16 98% 2L
Gen: NAD
HEENT: EOMI, PERRL
Neck: supple, no LAD
Chest: CTAB
CV: RRR nl s1 s2 no mrg
Abd: soft, NT, obese +bs
Ext: no edema, full pulses at DP and PT bilaterally
Neuro: CN 2-12 intact, moves all 4, sensation intact. No gross
deficits.


Pertinent Results:
Labs from Outside Hospital notable for:
CK: 80 (10.40am)->186 (2.20pm)
CKMB: 1.5 (10.40am)->7.6 (2.20pm)
Troponin-I <0.01 (0.0-1.4) @10.40am->1.1 (2.20pm)
CHOL: 115, TRI:249, HDL:21, LDL:44
HCT 32.1
Cr 1.2
.
EKG [**2189-11-30**]: NSR, rate: 60bpm, q-waves in [**Last Name (LF) 1105**], [**First Name3 (LF) **]-elevations in
V2-4.
.
Studies:
[**2190-11-30**] EKG: NSR with rate 60s, more prominent T-waves in V2-4.
Interval decrease in prominence of Q-waves in [**Month/Day/Year 1105**].
.

.
[**2189-12-6**] 06:53AM BLOOD WBC-6.9 RBC-3.78* Hgb-11.7* Hct-33.2*
MCV-88 MCH-30.9 MCHC-35.2* RDW-15.6* Plt Ct-178
[**2189-12-5**] 07:10AM BLOOD WBC-8.0 RBC-3.98*# Hgb-12.1*# Hct-34.0*
MCV-86 MCH-30.5 MCHC-35.6* RDW-15.3 Plt Ct-161
[**2189-12-4**] 06:20AM BLOOD WBC-7.2 RBC-3.04* Hgb-9.4* Hct-25.3*
MCV-83 MCH-30.8 MCHC-36.9* RDW-15.2 Plt Ct-148*
[**2189-12-3**] 09:36AM BLOOD WBC-10.1 RBC-3.50* Hgb-10.6* Hct-29.3*
MCV-84 MCH-30.4 MCHC-36.3* RDW-14.8 Plt Ct-147*
[**2189-12-2**] 11:27PM BLOOD Hct-24.0*
[**2189-12-2**] 04:09PM BLOOD WBC-13.2*# RBC-3.34*# Hgb-9.9*# Hct-28.1*
MCV-84 MCH-29.7 MCHC-35.3* RDW-14.6 Plt Ct-202
[**2189-12-2**] 07:00AM BLOOD WBC-8.5 RBC-2.63* Hgb-7.8* Hct-22.5*
MCV-86 MCH-29.7 MCHC-34.7 RDW-14.3 Plt Ct-202
[**2189-12-2**] 12:08AM BLOOD Hct-24.5* Plt Ct-213
[**2189-12-1**] 07:00PM BLOOD Hct-26.5*
[**2189-12-1**] 07:30AM BLOOD WBC-9.5# RBC-2.83*# Hgb-8.1*# Hct-24.0*#
MCV-85 MCH-28.7 MCHC-33.9 RDW-14.2 Plt Ct-233
[**2189-12-6**] 06:53AM BLOOD PT-13.0 PTT-22.9 INR(PT)-1.1
[**2189-12-4**] 06:20AM BLOOD Plt Ct-148*
[**2189-12-4**] 06:20AM BLOOD PT-13.5* PTT-20.5* INR(PT)-1.2
[**2189-12-2**] 04:09PM BLOOD PT-14.1* PTT-19.6* INR(PT)-1.3
[**2189-12-2**] 07:00AM BLOOD PT-14.2* PTT-20.0* INR(PT)-1.4
[**2189-12-6**] 06:53AM BLOOD Glucose-147* UreaN-24* Creat-1.1 Na-143
K-4.1 Cl-110* HCO3-22 AnGap-15
[**2189-12-2**] 04:09PM BLOOD ALT-36 AST-74* TotBili-0.3
[**2189-12-2**] 07:00AM BLOOD CK(CPK)-751*
[**2189-12-1**] 07:30AM BLOOD CK(CPK)-2460*
[**2189-12-1**] 01:46AM BLOOD CK(CPK)-3517*
[**2189-11-30**] 09:50PM BLOOD CK(CPK)-3673*
[**2189-12-2**] 07:00AM BLOOD CK-MB-27* MB Indx-3.6 cTropnT-6.04*
[**2189-12-1**] 07:30AM BLOOD CK-MB-217* MB Indx-8.8* cTropnT-8.70*
[**2189-12-1**] 01:46AM BLOOD CK-MB-343* MB Indx-9.8* cTropnT-14.04*
[**2189-11-30**] 09:50PM BLOOD CK-MB-359* MB Indx-9.8* cTropnT-20.80*
[**2189-12-1**] 07:30AM BLOOD Calcium-8.5 Phos-3.0 Mg-1.4*
[**2189-12-6**] 06:53AM BLOOD Calcium-9.4 Phos-3.6 Mg-2.0
============================
STUDIES:
CXR [**2189-11-30**]: Borderline cardiomedaly. CHF pattern and bilateral
pulmonary infilterates, probably edema. Pneumonia not excluded.
.
[**2189-11-30**] Cardiac catheterization
COMMENTS:
1. Selective coronsry angiography if this right dominant system
revealed
three vessel CAD. The LMCA had a proximal 20% stenosis. The LAD
was a
calcified vessel which was totally occluded after D1 with no
filling of
the distal vessel by collaterals. The LCX was a nondominant
vessel with
mild diffuse disease and a wideply patent OM1 [**Month/Day/Year **]. The RCA was
a
dominant vessel with a distal 50-60% in-[**Month/Day/Year **] restenosis.
2. Resting hemodynamics revealed mildly elevated right and left
sided
filling pressures (mRAP 9 mmHg, mPCW 15 mmHg). Systemic arterial

pressures were normal. The cardiac index was reduced at 1.7
l/min/m2.
3. Successful PTCA of the mid LAD. Final angiography revealed a
10%
residual stenosis in the mid LAD and moderate diffuse disease in
the
distal vessel. There was no angiographic evidence of dissection
and
there was TIMI 3 epicardial blood flow (see PTCA comments).

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. Acute MI managed by PTCA of the LAD.
.
[**2189-12-1**] Cardiac catheterization
COMMENTS:
1. Selective coronary angiography of this right dominant system
revealed
three vessel disease. The LMCA had a proximal 20% stenosis. The
LAD was
widely patent with TIMI 3 epicardial flow. The moderate diffuse
disease
in the distal LAD was unchanged from yesterday. The LCX
including the
OM1 [**Month/Day/Year **] was widely patent. The dominant RCA had a 50-65%
in-[**Month/Day/Year **]
restenosis distally but no other angiographically significant
disease.
2. Limited resting hemodynamics revealed low normal systemic
arterial
pressures while on a TNG gtt.

FINAL DIAGNOSIS:
1. Three vessel coronary artery disease, without angiographic
flow
limiting lesions.
.
[**2189-12-1**] Cardiac ECHO
LVEF 25%
IMPRESSION: Extensive regional left ventricular systolic
dysfunction and
distal right ventricular hypokinesis c/w CAD (proximal LAD
lesion).


Brief Hospital Course:
The pt is a 72 year old male with a history significant for
coronary artery disease and multiple cardiac risk factors
including multiple PCI, HTN, DM, who presented with chest pain
and was noted to have an ST-elevation myocardial infarction in
the setting of stopping aspirin and Plavix for a planned
epidural injection for back pain. The [**Hospital **] hospital course was
significant for the following events:
.
CARDIAC: ISCHEMIA
The pt underwent a cardiac catheterization which revealed an
in-[**Hospital **] restenosis within the LAD for which the pt underwent
balloon angioplasty. The procedure was technically difficult and
required multiple attempts to balloon open the stenotic lesion.
The patient left the lab in stable condition but with continued
5/10 chest pain. The pt's post procedure ECG was not
significantly changed from pre procedure. In the post-procedure
period the pt continued to complain of chest pain and was noted
to have a slight exacerbation of STE's V2-V4 from 1-1.5 mm. Due
to the recurrent chest pain in the post-cath period, the pt
underwent a re look angiography which revealed stable three
vessel coronary artery disease, without angiographic flow or
limiting lesions. When the chest pain persisted in the post-re
look cath period, it was thought that the pt had a possible
pericarditic element to the pain. The pt was started on
ibuprofen (with GI prophylaxis). However, a day after being
started on NSAIDs, the pt noted a large melanotic bowel movement
and was noted to be guaiac positive (guaiac negative on
admission). The pt subsequently became hypotensive and required
IV fluids and at least 8 units of blood. He was transferred to
the ICU for closer monitoring. An emergent EGD showed multiple
areas with angioectasias in the stomach body with blood in the
fundus. The pt underwent electrocautery of the angioectasias and
had an uneventful recovery. He was monitored with serial
hematocrits and was discharged when his hematocrit was stable.
The pt was maintained on aspirin, beta-[**Last Name (LF) 7005**], [**First Name3 (LF) **] acting
nitrates and Plavix. Due to previous history of severe ankle
edema/pain secondary to high dose Lipitor, the pt was initially
not started on a Statin. The pt was instructed to meet with his
cardiologist on discharge to determine if it was safe for him to
re-start on a Statin that may be better tolerated ex. Pravachol.

.
CARDIAC: PUMP
The pt was noted to have an ejection fraction of 25%. The pt was
noted to have a normal left atrium, left ventricular wall
thicknesses and cavity size. There was moderate to severe
regional left ventricular systolic dysfunction with severe
hypokinesis/akinesis of the septum, anterior walls, and apex. No
masses or thrombi were seen in the left ventricle. Right
ventricular chamber size was normal with focal hypokinesis of
the distal free wall. The aortic valve leaflets appeared to be
structurally normal with good leaflet excursion. No aortic
regurgitation was seen. The mitral valve appeared structurally
normal with trivial mitral regurgitation. There was no mitral
valve prolapse. The estimated pulmonary artery systolic pressure
was normal. There was no pericardial effusion.
The pt was also noted to have a cardiac index of less than 2 and
was given Lasix in the post-cath period. Of note, the pt has
been on an ACE-inhibitor in the past, but did not tolerate for
it for unclear reasons.
.
CARDIAC: RHYTHM
The pt was noted to be in normal sinus rhythm and had no
arrhythmias during the hospital stay.
.
HYPERTENSION:
The pt was continued on metoprolol for blood pressure control..
.
HYPERLIPIDEMIA:
The pt was not given a trial of Lipitor or other Statin. He was
advised to discuss addition of a Statin with his primary
cardiologist as an out-patient.
.
DIABETES MELLITUS:
The patient's metformin was held in the immediate pre and
post-cath period. The pt was maintained on an insulin sliding
scale while in the hospital.
.
FEN:
The pt was maintained on a diabetic, heart healthy diet with
repletion of electrolytes as needed.
.
PROPHYLAXIS:
Pantoprazole and bowel regimen.
.
CODE STATUS: Full code

Medications on Admission:
Home Medications:
Metoprolol 50 mg PO BID
Metformin 500 mg PO QID (held)
Imdur 30 mg PO qd
Plavix 75 mg PO qd
ASA 81 mg PO qd
?Darvocet
.
Allergies: ?lipitor causes joint pain


Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*3*
2. Sodium Chloride 0.65 % Aerosol, Spray Sig: [**12-28**] Sprays Nasal
QID (4 times a day) as needed.
Disp:*30 * Refills:*0*
3. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*0*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Metoprolol Tartrate 25 mg Tablet Sig: [**12-28**] Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
6. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual every 5 minutes as needed for chest pain.
Disp:*200 tablets* Refills:*2*
7. Outpatient Lab Work
CBC, Chem 10.  Please call results to Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
[**Telephone/Fax (1) 3183**].
8. Metformin 500 mg Tablet Sig: One (1) Tablet PO four times a
day.
9. Aspirin EC 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
10. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO twice a day
as needed for gout for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
11. Lancets     Misc Sig: ASDIR lancets Miscell.  four times a
day.
Disp:*1 month* Refills:*2*
12. Test Strips
One touch test strips
Disp: One month supply
Refills: #2


Discharge Disposition:
Home

Discharge Diagnosis:
Instent thrombosis with mid-LAD occlusion
Severe Upper gastrointestinal bleed
Arteriovenous malformations in stomach
Diabetes Mellitus 2


Discharge Condition:
Good- Hct stabilized following transfusions cauterization of
AVM.  Last hematocrit = 33.2.


Discharge Instructions:
Please go immediately to the nearest emergency department if you
have chest pain, palpitations, chest pressure, bruising or
swelling in your groin, lightheadedness, BLACK or TARRY or
BLOODY looking stools, excessive tiredness or loss of
consciousness.

Go to any clinical laboratory to have your blood drawn on
Tuesday [**2189-12-8**] to recheck your blood counts.  These results
should be called to your primary care doctor.

You have undergone a cardiac catheterization and a [**Month/Day/Year **] has
been placed in one of the arteries of your heart. You will need
to continue a medication called "Plavix" (clopidogrel) for at
least 9 months, and aspirin for life. Do not stop taking these
medications unless you are instructed to do so by your
cardiologist.
.
There has been a change to some of your medications. Please read
the attached list of medications carefully. Call your
cardiologist if you have ANY questions.
.
You need to call your cardiologist and schedule an appoitnment
within the next 2 weeks. Your cardiologist may need to adjust
the doses of some of your medications.
.
You should also call your primary care physician's office and
set up an appointment to see him within the next week.  At that
time you should also ask for a referral to a gastroenterologist.

Do not take ibuprofen, naproxen or any other non-steroidal
anti-inflammatory drugs other than aspirin.

Followup Instructions:
You need to call your cardiologist and schedule an appoitnment
within the next 2 weeks.
.
You should also call your primary care physician's office and
set up an appointment to see him within the week.  When you see
your primary care physician, [**Name10 (NameIs) **] should discuss restarting your
Imdur, metoprolol at regular dose.




Completed by:[**2190-2-2**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Angiodysplasia of stomach and duodenum with hemorrhage,Coronary atherosclerosis of native coronary artery,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: Transferred for cardiac catheterization from [**Hospital1 1474**] ER

PRESENT ILLNESS: 72 year old man with htn, hyperlipidemia, DM, +FH, Many prior
PCIs. Last here [**6-30**] with direct stenting of distal LAD with a
2.0 x 12 mm Bare metal [**Month/Year (2) **]. Recently off of aspirin and Plavix
due to severe back pain and plans to have epidural injection to
back. Today was exerting himself when had severe back pain and
chest pain. Presented to OSH ([**Hospital 1474**] Hospital) w/in 10min c/o
([**8-5**]) midsternal CP, and was noted to be pale, diaphoretic.
Troponin bumped to 1.1. CPK 186, MB 7.6.
.
At [**Name (NI) 1474**], pt started on heparin gtt, nitroglycerin gtt, 2mg
morphine, sl nitro, asa 325, 300 plavix. Pt continued to have
chest pain, so was transferred to [**Hospital1 18**] for cath.
.
Cath showed: TO pLAD, s/p PCTA of lesion, with IVUS of LAD

MEDICAL HISTORY: - CAD.
[**6-30**] PCI and bare metal [**Month/Year (2) **] to dLAD (90% distal lesion) (LV
gram: nl EF)
[**1-31**] PCI of mLAD with DES
[**7-29**] PCI of mRCA with DES, PCI of OM1 with DES
[**8-28**] instent restenosis of D1, 70% focal instent restenosis of
RCA: brachytherapy to both lesions
[**6-27**] TOd prox RCA 4 stents to RCA, rotational arthectomy and
[**Month/Year (2) **] to D1 [**8-27**] PTCA and [**Month/Year (2) **] to RCA
.
Cath showed [**2189-11-30**]: The LMCA had a proximal 20% stenosis. The
LAD was acalcified vessel which was totally occluded after D1
with no filling of the distal vessel by collaterals. The LCX was
a nondominant vessel with mild diffuse disease and a wideply
patent OM1 [**Month/Day/Year **]. The RCA was a dominant vessel with a distal
50-60% in-[**Month/Day/Year **] restenosis. Successful PTCA of the mid LAD.
Final angiography revealed a 10% residual stenosis in the mid
LAD and moderate diffuse disease in the
distal vessel.
.
[**2189-12-1**] Repeat Cardiac CATH:
-three vessel disease
-LMCA w/ 20% stenosis
-LAD widely patent with TIMI 3 epicardial flow. Moderate diffuse
disease in the distal LAD was unchanged from [**2189-11-30**]. The LCX
including the OM1 [**Month/Day/Year **] was widely patent. The dominant RCA had
a 50-65% in-[**Month/Day/Year **] restenosis distally but no other
angiographically significant disease. Limited resting
hemodynamics revealed low normal systemic arterial pressures
while on a TNG gtt.
.
- DM II.
- HTN.
- Gout.
- LBP.

MEDICATION ON ADMISSION: Home Medications:
Metoprolol 50 mg PO BID
Metformin 500 mg PO QID (held)
Imdur 30 mg PO qd
Plavix 75 mg PO qd
ASA 81 mg PO qd
?Darvocet
.
Allergies: ?lipitor causes joint pain

ALLERGIES: Indocin / Lipitor

PHYSICAL EXAM: PE: VS: 98.7 BP 135/80 HR 55 R 16 98% 2L
Gen: NAD
HEENT: EOMI, PERRL
Neck: supple, no LAD
Chest: CTAB
CV: RRR nl s1 s2 no mrg
Abd: soft, NT, obese +bs
Ext: no edema, full pulses at DP and PT bilaterally
Neuro: CN 2-12 intact, moves all 4, sensation intact. No gross
deficits.

FAMILY HISTORY: F died MI at age 74, son had [**Name2 (NI) **] at age 48.

SOCIAL HISTORY: Tob 100 py. Quit 13 y ago. Denies extensive EtOH use. Leaves
with wife, has children and grandchildren, but no sick contacts. 

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Other complications due to other cardiac device, implant, and graft,Angiodysplasia of stomach and duodenum with hemorrhage,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
