CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 72 year old male that started to experience chest pain with mild
activity which usually resolved with 1 SL NTG.  More recently he
has been woken up with chest pain at night, which resolves with
position changes.  He denies any shortness of
breath, but does complain of occasional lightheadnedness.  He
had an abnormal stress test on [**2184-9-28**] and presented for cardiac
catherization which revealed coronary artery disease and intra
aortic balloon pump was placed. Cardiac surgery was consulted
for coronary revascularization.

MEDICAL HISTORY: Sciatica
MI [**2177**]
CAD s/p stent to OM (BMS)[**2177**]
HTN
Hyperlipidemia
Skin cancer
dental extractions
claudication
cataract surgery [**84**] years ago
left leg bypass 10 yrs ago had to be redone 4 months later
(used bilateral legs for vein harvesting. Left with first
surgery
right with second )c/b "staph infection" requiring PICC line and
4 weeks antibiotics
cholecystectomy

MEDICATION ON ADMISSION: FUROSEMIDE 20 mg daily
LISINOPRIL Dosage uncertain
OLMESARTAN 20 mg daily
ROSUVASTATIN 40 mg daily
VERAPAMIL Dosage uncertain
ASPIRIN 81 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Mom died age 62 h/o PVD and HF

SOCIAL HISTORY: Lives with:wife
supportive children and grandchildren
Occupation:retired custodian
Tobacco:quit 10 years ago. 100 pack year history
ETOH:denies
Coronary atherosclerosis of native coronary artery,Chronic diastolic heart failure,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Personal history of other malignant neoplasm of skin,Other and unspecified angina pectoris,Other iatrogenic hypotension
Crnry athrscl natve vssl,Chr diastolic hrt fail,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Anemia NOS,Ath ext ntv at w claudct,Hx-skin malignancy NEC,Angina pectoris NEC/NOS,Iatrogenc hypotnsion NEC
Admission Date:  [**2184-10-1**]              Discharge Date:   [**2184-10-9**]

Date of Birth:  [**2112-8-20**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
[**2184-10-1**] Cardiac Catheterization
[**2184-10-4**] Coronary artery bypass graft x4: Left internal mammary
artery to left anterior descending artery, and saphenous vein
sequential grafting to obtuse marginal and the left posterior
descending artery, and saphenous vein graft to diagonal artery.


History of Present Illness:
72 year old male that started to experience chest pain with mild
activity which usually resolved with 1 SL NTG.  More recently he
has been woken up with chest pain at night, which resolves with
position changes.  He denies any shortness of
breath, but does complain of occasional lightheadnedness.  He
had an abnormal stress test on [**2184-9-28**] and presented for cardiac
catherization which revealed coronary artery disease and intra
aortic balloon pump was placed. Cardiac surgery was consulted
for coronary revascularization.



Past Medical History:
Sciatica
MI [**2177**]
CAD s/p stent to OM (BMS)[**2177**]
HTN
Hyperlipidemia
Skin cancer
dental extractions
claudication
cataract surgery [**84**] years ago
left leg bypass 10 yrs ago had to be redone 4 months later
(used bilateral legs for vein harvesting. Left with first
surgery
right with second )c/b "staph infection" requiring PICC line and
4 weeks antibiotics
cholecystectomy


Social History:
Lives with:wife
supportive children and grandchildren
Occupation:retired custodian
Tobacco:quit 10 years ago. 100 pack year history
ETOH:denies


Family History:
Mom died age 62 h/o PVD and HF


Physical Exam:
Admission Physical Exam

Pulse:48 Resp:18  O2 sat: 99 2L
B/P  Right:  155/79  Left: 143/42
Height: 5ft 7in    Weight: 215lbs

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 []  Murmur IABP sound
Abdomen: Soft [x] non-distended [x] non-tender []  bowel sounds
+
[x]
Extremities: Warm [x], well-perfused [x]  Edema +1 Varicosities:
None [x] Incisions on both lower extermities
Neuro: Grossly intact
Pulses:
Femoral      Right:   Left: +2
DP           Right: +1  Left: +1
PT           [**Name (NI) 167**]:  +1 Left: +1
Radial       Right: +2  Left: +2

Carotid Bruit        Right:  0  Left: 0


Pertinent Results:
[**2184-10-8**] 04:45AM BLOOD WBC-7.7 RBC-3.21* Hgb-9.6* Hct-28.5*
MCV-89 MCH-29.9 MCHC-33.6 RDW-14.8 Plt Ct-205
[**2184-10-1**] 03:05PM BLOOD WBC-7.5 RBC-4.33* Hgb-12.9* Hct-36.5*
MCV-84 MCH-29.8 MCHC-35.4* RDW-14.2 Plt Ct-182
[**2184-10-4**] 04:38PM BLOOD PT-14.4* PTT-36.5* INR(PT)-1.2*
[**2184-10-1**] 03:05PM BLOOD PT-12.7 PTT-28.7 INR(PT)-1.1
[**2184-10-8**] 04:45AM BLOOD Glucose-101* UreaN-19 Creat-1.0 Na-142
K-4.1 Cl-103 HCO3-32 AnGap-11
[**2184-10-1**] 03:05PM BLOOD UreaN-21* Creat-1.0 Na-136 K-4.1 Cl-101
HCO3-27 AnGap-12
[**2184-10-1**] 03:05PM BLOOD ALT-21 AST-22 AlkPhos-77 TotBili-0.4


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 45915**]Portable TTE
(Complete) Done [**2184-10-8**] at 11:25:41 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2112-8-20**]
Age (years): 72 M  Hgt (in): 67
BP (mm Hg): 91/41  Wgt (lb): 215
HR (bpm): 52  BSA (m2): 2.09 m2
Indication: Coronary artery disease. H/O cardiac surgery. Mitral
valve disease.
ICD-9 Codes: 746.4, 424.0
Test Information
Date/Time: [**2184-10-8**] at 11:25    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD

Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**Name2 (NI) 8154**] Bzymek,
RDCS
Doppler: Full Doppler and color Doppler Test Location: [**Location 13333**]/[**Hospital Ward Name 121**] 6
Contrast: Definity Tech Quality: Suboptimal
Tape #: 2010W051-0:41 Machine: Vivid [**8-10**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.7 cm  <= 4.0 cm
Left Ventricle - Ejection Fraction:  65%  >= 55%
Left Ventricle - Stroke Volume:  118 ml/beat
Left Ventricle - Cardiac Output:  6.12 L/min
Left Ventricle - Cardiac Index:  2.93  >= 2.0 L/min/M2
Aorta - Sinus Level:  2.9 cm  <= 3.6 cm
Aortic Valve - Peak Velocity:  *2.6 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *27 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  13 mm Hg
Aortic Valve - LVOT pk vel:  1.50 m/sec
Aortic Valve - LVOT VTI:  34
Aortic Valve - LVOT diam:  2.1 cm
Aortic Valve - Valve Area:  *2.0 cm2  >= 3.0 cm2
Mitral Valve - E Wave:  1.0 m/sec
Mitral Valve - A Wave:  0.8 m/sec
Mitral Valve - E/A ratio:  1.25
Mitral Valve - E Wave deceleration time:  182 ms  140-250 ms
TR Gradient (+ RA = PASP):  *29 to 31 mm Hg  <= 25 mm Hg

Findings
This study was compared to the prior study of [**2184-10-2**].
Intravenous administration of echo contrast was used due to poor
native endocardial border definition.

LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
global systolic function (LVEF>55%). Suboptimal technical
quality, a focal LV wall motion abnormality cannot be fully
excluded. Overall normal LVEF (>55%). No resting LVOT gradient.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
Paradoxic septal motion consistent with prior cardiac surgery.

AORTIC VALVE: Mildly thickened aortic valve leaflets. Minimal
AS. Mild to moderate ([**2-7**]+) AR.

MITRAL VALVE: Normal mitral valve leaflets. No MS. Eccentric MR
jet. Moderate (2+) MR.

TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. No
TS. Mild [1+] TR. Mild PA systolic hypertension.

PULMONIC VALVE/PULMONARY ARTERY: No PS.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - bandages,
defibrillator pads or electrodes. Suboptimal image quality as
the patient was difficult to position.
Conclusions
Suboptimal image quality. Echo contrast used. Left ventricular
wall thickness, cavity size, and global systolic function appear
normal (LVEF>55%). Due to suboptimal technical quality, a focal
wall motion abnormality cannot be fully excluded. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion appear normal. The
aortic valve leaflets are mildly thickened (?#). There is a
minimally increased gradient consistent with minimal aortic
valve stenosis. Mild to moderate ([**2-7**]+) aortic regurgitation is
suggested. The mitral valve leaflets are structurally normal. On
post contrast images, an eccentric, posteriorly directed jet of
at least moderate (2+) mitral regurgitation is suggested but not
confirmed due to poor image quality. The tricuspid valve
leaflets are mildly thickened. There is mild pulmonary artery
systolic hypertension. There is no pericardial effusion.

Compared with the prior study (images reviewed) of [**2184-10-2**],
the LVEF appears improved. Changes in MR [**Name13 (STitle) 45916**] are difficult
to assess. A TEE is therefore suggested.
  Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2184-10-8**] 12:01


?????? [**2177**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Mr.[**Known lastname **] presented for elective cardiac catheterization and was
noted to have left main coronary artery disease.  During
catheterization, he had intractable anginal pain, so he
underwent placement of Intra-aortic Balloon Pump placement with
resolution of chest pain. He underwent preoperative workup and
in the cardiac care unit. The intra aortic balloon pump was
weaned and removed.  On [**10-4**] he was brought to the operating
room and underwent coronary artery bypass graft surgery x4: Left
internal mammary artery to left anterior descending artery, and
saphenous vein sequential grafting to obtuse marginal and the
left posterior descending artery, and saphenous vein graft to
diagonal artery. See operative report for further details.  He
received vancomycin for perioperative antibiotics and was
transfered to the intensive care unit for post operative
management on epinephrine.  In the first twenty four hours he
was weaned from sedation, awoke neurologically intact, and was
extubated without complications.  All lines and drains were
discontinued in a timely fashion. The epinephrine was weaned off
and he was started on betablockers/Statin/Aspirin and diuresis.
On POD#1 he continued to progress and was transferred to the
floor for further monitoring.  Physical therapy worked with him
on strength and mobility.  The remainder of his postoperative
course was essentially uneventful. On POD#5 he was cleared by
Dr.[**Last Name (STitle) **] for discharge to home with VNA. All follow up
appointments were advised.



Medications on Admission:
FUROSEMIDE 20 mg daily
LISINOPRIL Dosage uncertain
OLMESARTAN 20 mg daily
ROSUVASTATIN 40 mg daily
VERAPAMIL Dosage uncertain
ASPIRIN 81 mg daily


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Crestor 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
3. 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:*0*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day for
10 days: then resume preop dose of 20mg once daily.
Disp:*90 Tablet(s)* Refills:*0*
6. Rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO QHS (once a
day (at bedtime)).
Disp:*60 Tablet(s)* Refills:*2*
7. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: One (1)
Tablet PO Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
8. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days: then decrease to 200 mg once daily.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Coronary artery disease s/p CABG
Sciatica
myocardial infarction
Prvious coronary stent [**2177**]
Hypertension
Hyperlipidemia
Skin cancer
Claudication
cataracts


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with vicodin
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right - healing well, no erythema or drainage. Edema
Leg Left calf  - 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 [**First Name (STitle) **] Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2184-11-1**] 1:15
Cardiologist: Dr [**Last Name (STitle) 7047**] - currently on vacation - cardiac
surgery office will call you with appointment

Please call to schedule appointments with your
Primary Care Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5936**] in [**5-10**] weeks [**Telephone/Fax (1) 6699**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2184-10-9**]
{'Coronary atherosclerosis of native coronary artery,Chronic diastolic heart failure,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Personal history of other malignant neoplasm of skin,Other and unspecified angina pectoris,Other iatrogenic hypotension'}


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 pain

PRESENT ILLNESS: 72 year old male that started to experience chest pain with mild
activity which usually resolved with 1 SL NTG.  More recently he
has been woken up with chest pain at night, which resolves with
position changes.  He denies any shortness of
breath, but does complain of occasional lightheadnedness.  He
had an abnormal stress test on [**2184-9-28**] and presented for cardiac
catherization which revealed coronary artery disease and intra
aortic balloon pump was placed. Cardiac surgery was consulted
for coronary revascularization.

MEDICAL HISTORY: Sciatica
MI [**2177**]
CAD s/p stent to OM (BMS)[**2177**]
HTN
Hyperlipidemia
Skin cancer
dental extractions
claudication
cataract surgery [**84**] years ago
left leg bypass 10 yrs ago had to be redone 4 months later
(used bilateral legs for vein harvesting. Left with first
surgery
right with second )c/b "staph infection" requiring PICC line and
4 weeks antibiotics
cholecystectomy

MEDICATION ON ADMISSION: FUROSEMIDE 20 mg daily
LISINOPRIL Dosage uncertain
OLMESARTAN 20 mg daily
ROSUVASTATIN 40 mg daily
VERAPAMIL Dosage uncertain
ASPIRIN 81 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Mom died age 62 h/o PVD and HF

SOCIAL HISTORY: Lives with:wife
supportive children and grandchildren
Occupation:retired custodian
Tobacco:quit 10 years ago. 100 pack year history
ETOH:denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic diastolic heart failure,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Atherosclerosis of native arteries of the extremities with intermittent claudication,Personal history of other malignant neoplasm of skin,Other and unspecified angina pectoris,Other iatrogenic hypotension'}
