CHIEF COMPLAINT: Chest pressure

PRESENT ILLNESS: 76 yo female with hx PAF and CHF who is status post 2 previous
electrical cardioversions presented [**8-14**] to OSH with chest
presssure under bilateral breasts. She had an echo performed
[**2117-4-22**] which showed concentric LVH with EF 47% [**Location (un) 109**] 1.8 cm 1+
AI, 1+ TR. Last cardioversion was done [**2117-9-22**]. She presented to
OSH on Sun with chest pressure which developed at rest. She had
not taken Lasix for 4 days prior to presentation. She was found
to be in RAF in the ED, was started on Diltiazem gtt and Lasix
80 IV BID. She was cath'd [**8-18**] and found to be have 3 vessel
CAD. Transferred to [**Hospital1 18**] for CABG/MAZE.

MEDICAL HISTORY: Atrial fibrillation
Hypertension
Hyperlipidemia
Obesity
History of cellulitis bilateral lower extremities last year

MEDICATION ON ADMISSION: Calcium 1500 mg po daily
Coumadin 4 mg alternating with 5 mg (Tues, Friday only)
Lasix 40 po daily - skips occassionally
Lisinopril 20 mg daily
Metoprolol 12.5 mg [**Hospital1 **]
Zocor 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98.5
Pulse: 93 AF Resp:18  O2 sat:2L 94%
B/P  Right: 108/79    Left:
Height:5'5"     Weight: 297#

FAMILY HISTORY: No premature coronary artery disease
Father MI < 55 [] Died in 70's MI  Mother < 65 [] Died in 70's
from Rheumatic fever

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 2 years ago, per patient she was told she
needs
tooth extracted from upper left
Lives with: Husband, [**Name (NI) **]
Contact: [**Name (NI) **]
Occupation: Retired lobbyist for the [**Location (un) 3844**] Police
Association
Cigarettes: Smoked no [] yes [x] last cigarette 14 years old
Other Tobacco use:
ETOH: < 1 drink/week []  [**2-7**] drinks/week [x] >8 drinks/week []
Illicit drug use - none
Coronary atherosclerosis of native coronary artery,Acidosis,Urinary tract infection, site not specified,Systolic heart failure, unspecified,Body Mass Index 45.0-49.9, adult,Unspecified pleural effusion,Intermediate coronary syndrome,Oliguria and anuria,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Pressure ulcer, other site,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Examination of participant in clinical trial,Knee joint replacement,Anemia, unspecified,Other specified erythematous conditions,Other iatrogenic hypotension,Leukorrhea, not specified as infective,Long-term (current) use of anticoagulants
Crnry athrscl natve vssl,Acidosis,Urin tract infection NOS,Systolic hrt failure NOS,BMI 45.0-49.9, adult,Pleural effusion NOS,Intermed coronary synd,Oliguria & anuria,Oth gram negatv bacteria,Pressure ulcer, site NEC,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Obesity NOS,Exam-clincal trial,Joint replaced knee,Anemia NOS,Erythematous cond NEC,Iatrogenc hypotnsion NEC,Noninfect vag leukorrhea,Long-term use anticoagul
Admission Date:  [**2118-8-19**]              Discharge Date:   [**2118-8-29**]

Date of Birth:  [**2041-9-23**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pressure

Major Surgical or Invasive Procedure:
[**2118-8-22**] 1. Coronary bypass grafting x 2 with left internal
mammary artery to the left anterior descending coronary artery;
reverse saphenous vein single graft from aorta to distal right
coronary artery.
2. Full left-sided Maze procedure with a combination of Atricure
bipolar system and the CryoCath with resection of left atrial
appendage.

History of Present Illness:
76 yo female with hx PAF and CHF who is status post 2 previous
electrical cardioversions presented [**8-14**] to OSH with chest
presssure under bilateral breasts. She had an echo performed
[**2117-4-22**] which showed concentric LVH with EF 47% [**Location (un) 109**] 1.8 cm 1+
AI, 1+ TR. Last cardioversion was done [**2117-9-22**]. She presented to
OSH on Sun with chest pressure which developed at rest. She had
not taken Lasix for 4 days prior to presentation. She was found
to be in RAF in the ED, was started on Diltiazem gtt and Lasix
80 IV BID. She was cath'd [**8-18**] and found to be have 3 vessel
CAD. Transferred to [**Hospital1 18**] for CABG/MAZE.

Past Medical History:
Atrial fibrillation
Hypertension
Hyperlipidemia
Obesity
History of cellulitis bilateral lower extremities last year

Social History:
Race: Caucasian
Last Dental Exam: 2 years ago, per patient she was told she
needs
tooth extracted from upper left
Lives with: Husband, [**Name (NI) **]
Contact: [**Name (NI) **]
Occupation: Retired lobbyist for the [**Location (un) 3844**] Police
Association
Cigarettes: Smoked no [] yes [x] last cigarette 14 years old
Other Tobacco use:
ETOH: < 1 drink/week []  [**2-7**] drinks/week [x] >8 drinks/week []
Illicit drug use - none

Family History:
No premature coronary artery disease
Father MI < 55 [] Died in 70's MI  Mother < 65 [] Died in 70's
from Rheumatic fever

Physical Exam:
T 98.5
Pulse: 93 AF Resp:18  O2 sat:2L 94%
B/P  Right: 108/79    Left:
Height:5'5"     Weight: 297#

General: AA) x 3 in NAD
Skin: Dry [] intact [] Chronic lower extremity changes
bilaterally
HEENT: PERRLA [x] EOMI [x]
Neck: Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x] Distant breath sounds
Heart: RRR []  Irregular [x]  Murmur [II/VI SEM] Distant heart
sounds
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] Obese
Extremities: Warm [x], well-perfused [x]  Edema trace LE edema
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right:1+   Left:1+
DP           Right:1+   Left:1+
PT           [**Name (NI) 167**]:1+   Left:1+
Radial       Right:2+   Left:2+

Carotid Bruit        Right:none  Left:none

Pertinent Results:
[**2118-8-19**] Vein Mapping: The right greater saphenous vein is patent
throughout with the caliber of 0.33 to 0.46 in the thigh and
0.30 to 0.37 in the calf. The left greater saphenous vein is
also patent with a caliber ranging from 0.34 to 0.54 in the
thigh and 0.26 to 0.31 in the calf.

[**2118-8-19**] Carotid U/S: 1. No significant carotid artery stenosis
bilaterally. 2. Mild atherosclerotic plaques in the carotid
bulbs and internal carotid arteries bilaterally.

[**2118-8-22**] Echo: PRE-BYPASS: Moderate to severe spontaneous echo
contrast is seen in the body of the left atrium. Moderate to
severe spontaneous echo contrast is present in the left atrial
appendage. The left atrial appendage emptying velocity is
depressed (<0.2m/s). A left atrial appendage thrombus cannot be
excluded. No atrial septal defect is seen by 2D or color
Doppler. Left ventricular wall thicknesses are normal. The left
ventricular cavity is moderately dilated. There is mild regional
left ventricular systolic dysfunction with basal and mid
inferoseptal and inferior wall hypokinesis. Overall left
ventricular systolic function is moderately depressed (LVEF=
35-45 %). The remaining left ventricular segments contract
normally. Right ventricular chamber size and free wall motion
are normal. The ascending aorta is mildly dilated. There are
simple atheroma in the ascending aorta. There are simple
atheroma in the aortic arch. The descending thoracic aorta is
mildly dilated. There are simple atheroma in the descending
thoracic aorta. The aortic valve leaflets are moderately
thickened. There is mild aortic valve stenosis (valve area
1.2-1.9cm2). Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are moderately thickened. Trivial mitral
regurgitation is seen. There is a small pericardial effusion.
Dr. [**Last Name (STitle) 914**] was notified in person of the results at time of
surgery.

POST-BYPASS: The patient is on an epinephrine infusion. The
patient is now A-paced. Inferoseptal and inferior wall
hypokinesis is still present, though slightly improved from
pre-bypass exam. Estimated EF is 45%. Right ventricular function
is unchanged. Mild aortic regurgitation is seen. Mild aortic
stenosis is unchanged. Trivial mitral regurgitation is seen. The
ascending aorta, aortic arch, and descending thoracic aorta are
intact.
[**2118-8-29**] 08:50AM BLOOD WBC-12.0* RBC-3.66* Hgb-10.1* Hct-30.9*
MCV-84 MCH-27.5 MCHC-32.5 RDW-16.0* Plt Ct-310
[**2118-8-19**] 05:17PM BLOOD WBC-9.6 RBC-4.99 Hgb-13.5 Hct-40.1
MCV-80* MCH-27.1 MCHC-33.7 RDW-15.0 Plt Ct-294
[**2118-8-29**] 08:50AM BLOOD PT-22.5* INR(PT)-2.1*
[**2118-8-29**] 08:50AM BLOOD UreaN-36* Creat-0.9 Na-139 K-4.5 Cl-99
[**2118-8-19**] 05:17PM BLOOD Glucose-133* UreaN-35* Creat-1.2* Na-139
K-4.0 Cl-92* HCO3-40* AnGap-11
[**2118-8-25**] 01:51AM BLOOD ALT-10 AST-36 AlkPhos-66 TotBili-3.1*

Brief Hospital Course:
Mrs. [**Known lastname **] was transferred to [**Hospital1 18**] for surgical evaluation.
Upon admission she received medical management and underwent
pre-operative work-up. She was brought to the operating room on
[**8-22**] where she underwent a coronary artery bypass graft x 2 with
left internal mammary artery to the left anterior descending
coronary artery;
reverse saphenous vein single graft from aorta to distal right
coronary artery/ Full left-sided Maze procedure with a
combination of Atricure bipolar system and the CryoCath with
resection of left atrial appendage.CARDIOPULMONARY BYPASS TIME:
115 minutes. CROSS-CLAMP TIME:  95 minutes. Please see operative
report for further surgical details. Following surgery she was
transferred to the CVICU for invasive monitoring in stable
condition. She arrived intubated, on propofol, levo, epi and was
a-paced over SB 40's for optimal cardiac function. Sedation was
weaned,she was found to be neurologically intact and extubated
without incident that postop night. Pressors were slow to wean
off as she was acidotic, requiring blood, and epi was
discontinued. Dobutamine was added for continued hemodynamic
support. Betablocker was initially held due to hypotension and
bradycardia. Once pressors and inotropy were weaned off  by
POD#4 Coreg and Digoxin were started. Amiodarone was initiated
for MAZE and post-op rapid a-fib. Mrs[**Last Name (un) 91505**]  heart rate
and hypotension improved. An Ace was added but she became
hypotensive and was discontinued. She continued to progress and
on [**8-26**] she transferred to the step down unit for further
monitoring. Physical Therapy was consulted for evaluation of
strength and mobility. Anticoagulation was initiated for
postoperative AFib/MAZE. Gynecology was consulted due to
persistent vaginal discharge. She had initially been consulted
by gyn preop and a dose of Diflucan was given, however the micro
resulted in nonfungal organisms. She was placed on Metronidazole
po x 7 days per gynecology. The remainder of her hospital course
was essentially uneventful. She was cleared for discharge to
[**Hospital3 **] in [**Hospital1 3597**] on POD# 7. All follow up appointments
were advised.

Medications on Admission:
Calcium 1500 mg po daily
Coumadin 4 mg alternating with 5 mg (Tues, Friday only)
Lasix 40 po daily - skips occassionally
Lisinopril 20 mg daily
Metoprolol 12.5 mg [**Hospital1 **]
Zocor 20 mg daily

Discharge Medications:
1. potassium chloride 10 mEq [**Hospital1 8426**] Extended Release Sig: Two
(2) [**Hospital1 8426**] Extended Release PO BID (2 times a day).
2. amiodarone 200 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO TID (3 times
a day) for 3 days: then decrease to 200mg [**Hospital1 **] x 1 week then
200mg po daily until seen by cardiologist.
3. warfarin 1 mg [**Hospital1 8426**] Sig: as directed [**Hospital1 8426**] PO DAILY (Daily)
as needed for AFib.
4. calcium carbonate 200 mg calcium (500 mg) [**Hospital1 8426**], Chewable
Sig: One (1) [**Hospital1 8426**], Chewable PO DAILY (Daily).
5. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day) as needed for groin and skin folds.
6. senna 8.6 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO BID (2 times a
day).
7. simvastatin 10 mg [**Hospital1 8426**] Sig: Two (2) [**Hospital1 8426**] PO DAILY
(Daily).
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. ranitidine HCl 150 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO DAILY
(Daily).
10. aspirin 81 mg [**Hospital1 8426**], Delayed Release (E.C.) Sig: One (1)
[**Hospital1 8426**], Delayed Release (E.C.) PO DAILY (Daily).
11. insulin regular human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED): per sliding scale.
12. digoxin 250 mcg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO once a day.
13. carvedilol 6.25 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO BID (2
times a day).
14. metronidazole 500 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO BID (2
times a day) for 7 days.
15. furosemide 40 mg [**Hospital1 8426**] Sig: One (1) [**Hospital1 8426**] PO BID (2 times
a day).
16. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q2H (every 2 hours) as
needed for wheezing.
17. ipratropium bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
18. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours).
19. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
20. warfarin 1 mg [**Hospital1 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] once a day: INR
goal >2 for AF/MAZE/LAA ligation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
Coronary artery disease s/p coronary artery bypass graft x 2
Atrial fibrillation s/p MAZE procedure
Past medical history:
Hypertension
Hyperlipidemia
Obesity
History of cellulitis bilateral lower extremities last year

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesia
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema +1 bilaterally


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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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) 914**] on [**2118-10-4**] at 1pm
Cardiologist: Dr.[**Name (NI) 68097**] office will call to arrange
appointment

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 1492**] in [**4-5**] 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:[**2118-8-29**]
{'Coronary atherosclerosis of native coronary artery,Acidosis,Urinary tract infection, site not specified,Systolic heart failure, unspecified,Body Mass Index 45.0-49.9, adult,Unspecified pleural effusion,Intermediate coronary syndrome,Oliguria and anuria,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Pressure ulcer, other site,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Examination of participant in clinical trial,Knee joint replacement,Anemia, unspecified,Other specified erythematous conditions,Other iatrogenic hypotension,Leukorrhea, not specified as infective,Long-term (current) use of anticoagulants'}


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 pressure

PRESENT ILLNESS: 76 yo female with hx PAF and CHF who is status post 2 previous
electrical cardioversions presented [**8-14**] to OSH with chest
presssure under bilateral breasts. She had an echo performed
[**2117-4-22**] which showed concentric LVH with EF 47% [**Location (un) 109**] 1.8 cm 1+
AI, 1+ TR. Last cardioversion was done [**2117-9-22**]. She presented to
OSH on Sun with chest pressure which developed at rest. She had
not taken Lasix for 4 days prior to presentation. She was found
to be in RAF in the ED, was started on Diltiazem gtt and Lasix
80 IV BID. She was cath'd [**8-18**] and found to be have 3 vessel
CAD. Transferred to [**Hospital1 18**] for CABG/MAZE.

MEDICAL HISTORY: Atrial fibrillation
Hypertension
Hyperlipidemia
Obesity
History of cellulitis bilateral lower extremities last year

MEDICATION ON ADMISSION: Calcium 1500 mg po daily
Coumadin 4 mg alternating with 5 mg (Tues, Friday only)
Lasix 40 po daily - skips occassionally
Lisinopril 20 mg daily
Metoprolol 12.5 mg [**Hospital1 **]
Zocor 20 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 98.5
Pulse: 93 AF Resp:18  O2 sat:2L 94%
B/P  Right: 108/79    Left:
Height:5'5"     Weight: 297#

FAMILY HISTORY: No premature coronary artery disease
Father MI < 55 [] Died in 70's MI  Mother < 65 [] Died in 70's
from Rheumatic fever

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: 2 years ago, per patient she was told she
needs
tooth extracted from upper left
Lives with: Husband, [**Name (NI) **]
Contact: [**Name (NI) **]
Occupation: Retired lobbyist for the [**Location (un) 3844**] Police
Association
Cigarettes: Smoked no [] yes [x] last cigarette 14 years old
Other Tobacco use:
ETOH: < 1 drink/week []  [**2-7**] drinks/week [x] >8 drinks/week []
Illicit drug use - none 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acidosis,Urinary tract infection, site not specified,Systolic heart failure, unspecified,Body Mass Index 45.0-49.9, adult,Unspecified pleural effusion,Intermediate coronary syndrome,Oliguria and anuria,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms,Pressure ulcer, other site,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Examination of participant in clinical trial,Knee joint replacement,Anemia, unspecified,Other specified erythematous conditions,Other iatrogenic hypotension,Leukorrhea, not specified as infective,Long-term (current) use of anticoagulants'}
