CHIEF COMPLAINT: Positive stress test

PRESENT ILLNESS: This is a 72 year old male who was recently noted to have subtle
ECG changes but complaints of angina, shortness of breath, etc.
Stress test was positive at high workload(completed). Subsequent
cardiac catheterization revealed 60% left main with a >95%
proximal LAD lesion not ammenable to PCI/stenting. He was
therefore referred for surgical revascualrization.

MEDICAL HISTORY: Hypertension
History of Paroxsymal Atrial Fibrillation
History of ETOH Abuse
Benign Prostatic Hypertrophy
Basal Cell Carcinoma s/p resection

MEDICATION ON ADMISSION: Metoprolol XL 5omg daily, Plavix 75 mg daily - last dose
[**2161-11-6**], Hytrin 5mg daily, Avadart 0.5mg daily, ASA 325mg daily

ALLERGIES: Iodine / Tetracycline

PHYSICAL EXAM: Preop Exam

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Lives with: sign. other
Occupation: semi retired chemical engineer
Tobacco: cigar per week
ETOH: Occasional
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Atrial fibrillation,Examination of participant in clinical trial,Personal history of other malignant neoplasm of skin,Personal history of peptic ulcer disease
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Atrial fibrillation,Exam-clincal trial,Hx-skin malignancy NEC,Prsnl hst peptic ulcr ds
Admission Date:  [**2161-11-10**]              Discharge Date:   [**2161-11-14**]

Date of Birth:  [**2089-7-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Iodine / Tetracycline

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Positive stress test

Major Surgical or Invasive Procedure:
[**2161-11-10**] Two Vessel Coronary Artery Bypass Grafting(left
internal mammary artery to left anterior descending artery with
vein graft to obtuse marginal)


History of Present Illness:
This is a 72 year old male who was recently noted to have subtle
ECG changes but complaints of angina, shortness of breath, etc.
Stress test was positive at high workload(completed). Subsequent
cardiac catheterization revealed 60% left main with a >95%
proximal LAD lesion not ammenable to PCI/stenting. He was
therefore referred for surgical revascualrization.

Past Medical History:
Hypertension
History of Paroxsymal Atrial Fibrillation
History of ETOH Abuse
Benign Prostatic Hypertrophy
Basal Cell Carcinoma s/p resection

Social History:
Lives with: sign. other
Occupation: semi retired chemical engineer
Tobacco: cigar per week
ETOH: Occasional


Family History:
No premature coronary artery disease

Physical Exam:
Preop Exam

Pulse: Resp:  O2 sat:
B/P  Right: 112/60   Left: 112/60
Height:     Weight:

General:WDWN IN NAD
Skin: Dry [x] intact [x]Pale red lesions to LT midline upper
ant.
chest
HEENT: PERRLA x[] EOMI [x]
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 [x]
Neuro: Grossly intact
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

Discharge Exam
VS: T: 98.2  HR: 93 Afib  BP: 102/63  Sats: 99% RA  Wt: 64.4 Kg
(59 kg)
General: 72 year-old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: irregular
Resp:
GI: benign
Extr: warm no edema
Neuro: awake,alert oriented.  Walking independently


Pertinent Results:
[**2161-11-10**] Intraop TEE:
PREBYPASS
No spontaneous echo contrast is seen in the body of the left
atrium or left atrial appendage. No spontaneous echo contrast is
seen in the body of the right atrium. The coronary sinus is
dilated (diameter >15mm). Left ventricular wall thicknesses are
normal. The left ventricular cavity size is normal. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size is normal with normal free wall
contractility. There are simple atheroma in the descending
thoracic aorta. The aortic valve leaflets (3) are mildly
thickened. There is no aortic valve stenosis. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Trivial mitral regurgitation is seen. There is no
pericardial effusion.

POSTBYPASS
The patient is A-paced. Biventricular systolic function remains
normal. Trace mitral regurgitation and mild aortic insufficiency
persist. The thoracic aorta is intact

[**2161-11-14**] WBC-5.8 RBC-3.02* Hgb-9.0* Hct-26.1* MCV-87 MCH-29.7
MCHC-34.3 RDW-13.0 Plt Ct-198
[**2161-11-10**] WBC-5.7 RBC-2.72*# Hgb-8.3*# Hct-23.9*# MCV-88 MCH-30.5
MCHC-34.8 RDW-12.9 Plt Ct-100*
[**2161-11-14**] Glucose-115* UreaN-19 Creat-0.7 Na-139 K-3.9 Cl-102
HCO3-30
[**2161-11-10**] UreaN-15 Creat-0.6 Na-142 K-3.7 Cl-111* HCO3-24
AnGap-11
[**2161-11-14**] Mg-2.1

CXR:
[**2161-11-14**]: PA & Lat preliminary read small left lower lobe
effusion
[**2161-11-11**]: There is no pneumothorax. Cardiac size is top normal.
Left lower lobe opacities have worsened, consistent with
worsening atelectasis. There are  small bilateral pleural
effusions. Right IJ catheter remains in place.  Sternal wires
are aligned. Right apical calcified granuloma is unchanged.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted and underwent coronary artery bypass
grafting surgery by Dr. [**Last Name (STitle) **]. For surgical details, please
see operative note. Following the operation, he was brought to
the CVICU for invasive monitoring. Within 24 hours, he awoke
neurologically intact and was extubated without incident. He
maintained stable hemodynamics and transferred to the SDU on
postoperative day one. Chest tubes and pacing wires were removed
without complication.

Respiratory: aggressive pulmonary toilet, nebs, incentive
spirometer he titrated off oxygen with saturations 96% on room
air.

Cardiac: Intermittent paroxysmal atrial fibrillation was started
on amiodarone, beta-blocker dose increased with rate control of
90-100.  Blood pressure 100-110 hemodynamically stable.

GI: H2 blocker and bowel regime.

Nutrition: tolerated a cardiac healthy diet

Renal: renal function within normal range with good urine
output.

Incision: sternal incision clean, dry, intact, margins well
approximated no erythena

Heme: anticoagulation aspirin 325 mg & Plavix 75

Pain: Pain well control on acetaminophen and occasional
narcotic.

Disposition: he was seen by physical therapy and was discharged
to home with VNA on [**2161-11-14**].  He will follow-up with Dr.
[**Last Name (STitle) **] and his cardiologist as an outpatient.

Medications on Admission:
Metoprolol XL 5omg daily, Plavix 75 mg daily - last dose
[**2161-11-6**], Hytrin 5mg daily, Avadart 0.5mg daily, ASA 325mg daily


Discharge Medications:
1. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day: take with
lasix.
Disp:*5 Tab Sust.Rel. Particle/Crystal(s)* Refills:*1*
2. aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. terazosin 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
6. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO QHS (once a
day (at bedtime)).
8. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*5 Tablet(s)* Refills:*1*
9. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
10. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.
11. sotalol 80 mg Tablet Sig: One (1) Tablet PO once a day as
needed.
12. metoprolol succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO twice a day.
Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary Artery Disease, s/p CABG
Hypertension
History of Paroxysmal Atrial Fibrillation
History of ETOH Abuse


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
Please 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
Please 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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
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) **] [**Telephone/Fax (1) 170**] Date/Time:[**2161-12-3**] 1:00

Cardiologist: Dr. [**Last Name (STitle) **] please call for a follow-up appointment
next week for atrial fibrillation.

Please call to schedule appointments with your
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1728**] in [**4-20**] 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**



Completed by:[**2161-11-14**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Atrial fibrillation,Examination of participant in clinical trial,Personal history of other malignant neoplasm of skin,Personal history of peptic ulcer disease'}


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: Positive stress test

PRESENT ILLNESS: This is a 72 year old male who was recently noted to have subtle
ECG changes but complaints of angina, shortness of breath, etc.
Stress test was positive at high workload(completed). Subsequent
cardiac catheterization revealed 60% left main with a >95%
proximal LAD lesion not ammenable to PCI/stenting. He was
therefore referred for surgical revascualrization.

MEDICAL HISTORY: Hypertension
History of Paroxsymal Atrial Fibrillation
History of ETOH Abuse
Benign Prostatic Hypertrophy
Basal Cell Carcinoma s/p resection

MEDICATION ON ADMISSION: Metoprolol XL 5omg daily, Plavix 75 mg daily - last dose
[**2161-11-6**], Hytrin 5mg daily, Avadart 0.5mg daily, ASA 325mg daily

ALLERGIES: Iodine / Tetracycline

PHYSICAL EXAM: Preop Exam

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Lives with: sign. other
Occupation: semi retired chemical engineer
Tobacco: cigar per week
ETOH: Occasional 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Atrial fibrillation,Examination of participant in clinical trial,Personal history of other malignant neoplasm of skin,Personal history of peptic ulcer disease'}
