CHIEF COMPLAINT: angina

PRESENT ILLNESS: 87 yo male with NSTEMI, angina and DOE originally seen [**7-25**] by
Dr. [**Last Name (STitle) **]. Refused CABG at that time. Readmitted [**8-11**] with
recurrent angina and IV heparin started.

MEDICAL HISTORY: - CAD s/p cath w/ no interventions
- pacemaker
- COPD
- HTN
- hyperlipidemia
- paroxysmal a-fib (refused coumadin in past)
- sleep apnea not on C-PAP
- IBS
- depression
- TIA

MEDICATION ON ADMISSION: plavix 75 mg daily
ASA 325 mg daily
lasix 30 mg daily
prilosec 20 mg daily
metoprolol 75 mg [**Hospital1 **]
zocor 80 mg daily
ativan
nitro
MVI

ALLERGIES: Cephradine

PHYSICAL EXAM: 66"   77 kg
96.5 T  HR 71  RR 18  102/65   97% 2L
NAD
non-icteric
neck supple, no carotid bruits
lungs clear
RRR
abd soft, NT, ND
extrems. warm, well-perfused

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: no tob since [**2066**]'s, no alcohol. lives in [**Location **]
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Acidosis,Cardiac complications, not elsewhere classified,Atrial fibrillation,Subendocardial infarction, subsequent episode of care,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Irritable bowel syndrome,Personal history of other diseases of circulatory system,Cardiac pacemaker in situ,Knee joint replacement
Crnry athrscl natve vssl,CHF NOS,Chr airway obstruct NEC,Chronic kidney dis NOS,Acidosis,Surg compl-heart,Atrial fibrillation,Subendo infarct, subseq,Hyperlipidemia NEC/NOS,Hy kid NOS w cr kid I-IV,Obstructive sleep apnea,Depressive disorder NEC,Irritable bowel syndrome,Hx-circulatory dis NEC,Status cardiac pacemaker,Joint replaced knee
Admission Date:  [**2113-8-11**]              Discharge Date:   [**2113-8-23**]


Service: CARDIOTHORACIC

Allergies:
Cephradine

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

Major Surgical or Invasive Procedure:
off pump cabg x4   [**2113-8-15**]  (LIMA to LAD, SVG to RAMUS with Y
grafts to SVG to OM and SVG to PDA)


History of Present Illness:
87 yo male with NSTEMI, angina and DOE originally seen [**7-25**] by
Dr. [**Last Name (STitle) **]. Refused CABG at that time. Readmitted [**8-11**] with
recurrent angina and IV heparin started.

Past Medical History:
- CAD s/p cath w/ no interventions
- pacemaker
- COPD
- HTN
- hyperlipidemia
- paroxysmal a-fib (refused coumadin in past)
- sleep apnea not on C-PAP
- IBS
- depression
- TIA

Social History:
no tob since [**2066**]'s, no alcohol. lives in [**Location **]

Family History:
There is no family history of premature coronary artery disease
or sudden death.

Physical Exam:
66"   77 kg
96.5 T  HR 71  RR 18  102/65   97% 2L
NAD
non-icteric
neck supple, no carotid bruits
lungs clear
RRR
abd soft, NT, ND
extrems. warm, well-perfused


Pertinent Results:
[**2113-8-21**] 06:40AM BLOOD WBC-12.8* RBC-3.39* Hgb-9.8* Hct-29.3*
MCV-86 MCH-29.0 MCHC-33.6 RDW-17.5* Plt Ct-233#
[**2113-8-21**] 06:40AM BLOOD Plt Ct-233#
[**2113-8-21**] 06:40AM BLOOD Glucose-96 UreaN-62* Creat-2.8* Na-141
K-4.0 Cl-106 HCO3-25 AnGap-14
[**2113-8-15**] 04:37AM BLOOD ALT-20 AST-23 AlkPhos-110 TotBili-0.4

No spontaneous echo contrast is seen in the body of the left
atrium or left
atrial appendage. A left-to-right shunt across the interatrial
septum is seen
at rest. A secundum type atrial septal defect is present. Left
ventricular
wall thicknesses are normal. The left ventricular cavity is
moderately
dilated. There is severe regional left ventricular systolic
dysfunction with
severe septal, apical, and mid to lateral anterior and
anterolateral
hypokinesis/akinesis. The inferior, lateral and inferolateral
walls are
moserately hypokinetic in the basal to mid segement but are
severely depressed
apically. The ejection fraction is in the 15-20% range. An
apical left
ventricular thrombus is not seen but can not be completely ruled
out. Right
ventricular chamber size and free wall motion are normal. The
ascending aorta
is moderately dilated. There are complex (>4mm) atheroma in the
aortic arch.
The descending thoracic aorta is moderately dilated and sverely
tortuous.
Spontaneous echo contrast, indicative of decreased blood flow,
is seen in the
descending thoracic aorta. There are complex (>4mm) atheroma in
the descending
thoracic aorta. The wall of the descending aorta is quite thick
- this may be
complex atheroma but an intramural hematoma or an old dissection
can not be
completely ruled out. 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. Mild (1+) mitral
regurgitation is
seen. There is a trivial/physiologic pericardial effusion.

After completion of bypass grafting, the right ventricle
continues to display
normal function. The focal abnormalities in the left ventricle
persist. The
function of the lateral, inferior, and inferolateral walls is
slightly
improved. The ejection fraction is around 20%. No other change
from pre-CPB
findings.




[**2113-8-21**] 06:40AM BLOOD WBC-12.8* RBC-3.39* Hgb-9.8* Hct-29.3*
MCV-86 MCH-29.0 MCHC-33.6 RDW-17.5* Plt Ct-233#
[**2113-8-21**] 06:40AM BLOOD Plt Ct-233#
[**2113-8-15**] 01:38PM BLOOD PT-15.6* PTT-39.4* INR(PT)-1.4*
[**2113-8-22**] 07:00AM BLOOD Glucose-100 UreaN-57* Creat-2.7* Na-141
K-3.9 Cl-106 HCO3-24 AnGap-15
[**2113-8-21**] 06:40AM BLOOD Glucose-96 UreaN-62* Creat-2.8* Na-141
K-4.0 Cl-106 HCO3-25 AnGap-14
[**2113-8-20**] 05:40AM BLOOD Creat-2.8* K-3.8
[**2113-8-19**] 05:20AM BLOOD Glucose-95 UreaN-47* Creat-2.5* Na-137
K-3.6 Cl-104 HCO3-21* AnGap-16
[**2113-8-23**] 06:50AM BLOOD WBC-11.5* RBC-3.47* Hgb-9.9* Hct-30.5*
MCV-88 MCH-28.6 MCHC-32.6 RDW-17.4* Plt Ct-340
[**2113-8-23**] 06:50AM BLOOD Plt Ct-340
[**2113-8-23**] 06:50AM BLOOD Glucose-80 UreaN-54* Creat-2.5* Na-140
K-4.2 Cl-106 HCO3-25 AnGap-13

Brief Hospital Course:
Admitted for recurrent angina on [**8-11**] and heparin started.
Further eval. revealed a calcified aorta on chest CT. Eight beat
run of NSVT on [**8-14**]. OPCABG x4 performed by Dr. [**First Name (STitle) **] on [**8-15**].
Transferred to the CSRU in stable condition on phenylephrine and
propofol drips. Extubated on the morning of POD #2 and pacer
interrogated by EP service. Transferred to the floor on POD #3
to begin increasing his activity level. Went into A fib and oral
amiodarone started. Gentle diuresis continued. Pacing wires and
chest tubes removed without incident. He continued to refuse to
take any medication. He had an 8 beat run of VTach and was seen
by electrophysiology given his EF of 15%. He will follow up as
an outpatient. He was also seen by psychiatry, after which he
agreed to take some of his cardiac medication. He was ready for
discharge to rehab on [**8-23**].

Medications on Admission:
plavix 75 mg daily
ASA 325 mg daily
lasix 30 mg daily
prilosec 20 mg daily
metoprolol 75 mg [**Hospital1 **]
zocor 80 mg daily
ativan
nitro
MVI

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 3 months.
4. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
7. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
8. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).
9. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
400 mg daily x 1 week, then 200 mg daily ongoing.
10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
11. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 11496**] - [**Location (un) **]

Discharge Diagnosis:
CAD s/p OPCABG x4
TIAs
COPD
elev. lipids
PA Fib
CHF
sleep apnea
IBS
diverticulitis
CRI
depression
epistaxis


Discharge Condition:
stable


Discharge Instructions:
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call surgeon for fever greater than 100.5, redness or drainage
no lotions creams, powders or ointments on any incision
SHOWER daily and pat incisions dry

Followup Instructions:
see Dr. [**Last Name (STitle) 27542**] in [**1-17**] weeks
see Dr. [**Last Name (STitle) 11493**] in [**2-18**] weeks
see Dr. [**First Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]


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

Completed by:[**2113-8-23**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Acidosis,Cardiac complications, not elsewhere classified,Atrial fibrillation,Subendocardial infarction, subsequent episode of care,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Irritable bowel syndrome,Personal history of other diseases of circulatory system,Cardiac pacemaker in situ,Knee joint replacement'}


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: angina

PRESENT ILLNESS: 87 yo male with NSTEMI, angina and DOE originally seen [**7-25**] by
Dr. [**Last Name (STitle) **]. Refused CABG at that time. Readmitted [**8-11**] with
recurrent angina and IV heparin started.

MEDICAL HISTORY: - CAD s/p cath w/ no interventions
- pacemaker
- COPD
- HTN
- hyperlipidemia
- paroxysmal a-fib (refused coumadin in past)
- sleep apnea not on C-PAP
- IBS
- depression
- TIA

MEDICATION ON ADMISSION: plavix 75 mg daily
ASA 325 mg daily
lasix 30 mg daily
prilosec 20 mg daily
metoprolol 75 mg [**Hospital1 **]
zocor 80 mg daily
ativan
nitro
MVI

ALLERGIES: Cephradine

PHYSICAL EXAM: 66"   77 kg
96.5 T  HR 71  RR 18  102/65   97% 2L
NAD
non-icteric
neck supple, no carotid bruits
lungs clear
RRR
abd soft, NT, ND
extrems. warm, well-perfused

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: no tob since [**2066**]'s, no alcohol. lives in [**Location **] 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Acidosis,Cardiac complications, not elsewhere classified,Atrial fibrillation,Subendocardial infarction, subsequent episode of care,Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Obstructive sleep apnea (adult)(pediatric),Depressive disorder, not elsewhere classified,Irritable bowel syndrome,Personal history of other diseases of circulatory system,Cardiac pacemaker in situ,Knee joint replacement'}
