CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: This 79 year old male with a history of hypertension who has
been experiencing chest pain and dyspnea with exertion since
[**2172-6-18**].  He reports that he feels chest pain and that his
breathing becomes labored when walking up [**Doctor Last Name **]
or up stairs.  His symptoms subside within seconds after he
rests. He failed a stress test and his subsequent cardiac cath
revealed multivessel coronary artery disease. Cardiac surgery
was consulted for revascularization.

MEDICAL HISTORY: HTN
Right rotator cuff surgery 5 yrs ago
Appendectomy in his 50s
Tonsillectomy

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] -  - 20 mg Tablet - 1 Tablet(s) by mouth
once daily
LISINOPRIL -  10 mg Tablet - 1Tablet(s) by mouth once daily
TIMOLOL

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Family History:noncontributory

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:edentulous
Lives with:wife
Occupation:electrician.
Tobacco:quit in the [**2121**]
ETOH:denies
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Other specified retention of urine,Thrombocytopenia, unspecified,Anemia, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Parox ventric tachycard,Hypertension NOS,Oth spcf retention urine,Thrombocytopenia NOS,Anemia NOS
Name:  [**Known lastname 13806**],[**Known firstname 1332**]                    Unit No:   [**Numeric Identifier 13807**]

Admission Date:  [**2172-10-1**]              Discharge Date:   [**2172-10-6**]

Date of Birth:  [**2092-11-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 135**]
Addendum:
Mr.[**Known lastname **] failed to void for a second trial. Bladder scan
revealed >900 cc retained. A foley catheter was reinserted. He
has not been seen by a Urologist in the past. The Urology
service was consulted prior to his discharge. Per urology, a
voiding trial in 5 days was arranged for Monday [**2172-10-12**] at
10:30 Am  on [**Hospital Ward Name **] 3.

Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern4) 137**] MD [**MD Number(2) 138**]

Completed by:[**2172-10-6**]

Admission Date:  [**2172-10-1**]              Discharge Date:   [**2172-10-6**]

Date of Birth:  [**2092-11-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
chest pain


Major Surgical or Invasive Procedure:
Coronary artery bypass grafting x5(Left internal mammary artery
to left anterior descending artery; reverse saphenous vein graft
to the diagonal artery, obtuse marginal artery; sequential vein
graft to the posterior left ventricle branch artery and the
posterior descending artery)on [**2172-10-1**].


History of Present Illness:
This 79 year old male with a history of hypertension who has
been experiencing chest pain and dyspnea with exertion since
[**2172-6-18**].  He reports that he feels chest pain and that his
breathing becomes labored when walking up [**Doctor Last Name **]
or up stairs.  His symptoms subside within seconds after he
rests. He failed a stress test and his subsequent cardiac cath
revealed multivessel coronary artery disease. Cardiac surgery
was consulted for revascularization.


Past Medical History:
HTN
Right rotator cuff surgery 5 yrs ago
Appendectomy in his 50s
Tonsillectomy

Social History:
Race:caucasian
Last Dental Exam:edentulous
Lives with:wife
Occupation:electrician.
Tobacco:quit in the [**2121**]
ETOH:denies


Family History:
Family History:noncontributory


Physical Exam:
Admission Physical Exam

Pulse: 80 Resp:17  O2 sat: 100%
B/P  137/71
Height: 5 feet 9 inches    Weight:196 pounds

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
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[x]
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:-    Left:-

Pertinent Results:
[**2172-10-4**] 05:45AM BLOOD WBC-10.7 RBC-3.34* Hgb-10.7* Hct-29.9*
MCV-89 MCH-31.9 MCHC-35.8* RDW-13.8 Plt Ct-132*
[**2172-10-1**] 12:08PM BLOOD WBC-5.8 RBC-2.76*# Hgb-9.1*# Hct-24.9*#
MCV-90 MCH-32.9* MCHC-36.6* RDW-12.9 Plt Ct-123*
[**2172-10-2**] 03:54AM BLOOD PT-12.4 PTT-27.6 INR(PT)-1.0
[**2172-10-1**] 01:31PM BLOOD PT-14.0* PTT-35.3* INR(PT)-1.2*
[**2172-10-4**] 05:45AM BLOOD Glucose-116* UreaN-22* Creat-1.2 Na-137
K-4.2 Cl-100 HCO3-30 AnGap-11
[**2172-10-1**] 01:31PM BLOOD UreaN-16 Creat-0.9 Na-139 K-4.1 Cl-111*
HCO3-24 AnGap-8


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname 900**]       [**Hospital1 18**] [**Numeric Identifier 87167**] (Complete)
Done [**2172-10-1**] at 10:50:06 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]
[**Last Name (NamePattern4) 18**] - Department of Cardiac S
[**Last Name (NamePattern1) 439**], 2A
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2092-11-12**]
Age (years): 79 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Intraoperative TEE for CABG
ICD-9 Codes: 424.2
Test Information
Date/Time: [**2172-10-1**] at 10:50    Interpret MD: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Name Initial (MD) **] [**Name8 (MD) 4901**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW2-: Machine: AW5
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  3.9 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Aorta - Sinus Level:  3.5 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.9 cm  <= 3.0 cm
Aorta - Ascending:  3.2 cm  <= 3.4 cm
Aortic Valve - Peak Gradient:  8 mm Hg  < 20 mm Hg
Aortic Valve - LVOT diam:  2.0 cm

Findings
LEFT ATRIUM: No spontaneous echo contrast or thrombus in the
LA/LAA or the RA/RAA. Good (>20 cm/s) LAA ejection velocity. All
four pulmonary veins identified and enter the left atrium.

RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness, cavity size,
and global systolic function (LVEF>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Focal
calcifications in aortic root. Normal ascending aorta diameter.
Simple atheroma in ascending aorta. Focal calcifications in
ascending aorta. Simple atheroma in aortic arch. Normal
descending aorta diameter. Simple atheroma in descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. [**Male First Name (un) **] of the
mitral chordae (normal variant). No resting LVOT gradient. No
MS. Physiologic MR (within normal limits).

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
Physiologic (normal) PR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient.
Conclusions
PRE BYPASS No spontaneous echo contrast or thrombus is seen in
the body of the left atrium/left atrial appendage or the body of
the right atrium/right atrial appendage. No atrial septal defect
is seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size, and global systolic function are normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the ascending aorta. There are
simple atheroma in the aortic arch. There are simple atheroma in
the descending thoracic aorta. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Physiologic mitral regurgitation is seen (within
normal limits). Dr. [**Last Name (STitle) **] was notified in person of the results in
the operating room at the time of the study.

POST BYPASS The patient is atrially paced. There is normal
biventricular systolic function. The chordal [**Male First Name (un) **] is more
prominent and there may be some slight valvular [**Male First Name (un) **] but a
significant gradient does not exist. The mitral regurgitation is
now mild but appears central. The thoracic aorta appears intact
after decannulation. No other significant changes from the
pre-bypass study.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting physician
[**Last Name (NamePattern4) **] [**2172-10-1**] 12:23


?????? [**2164**] CareGroup IS. All rights reserved.


Brief Hospital Course:
[**2172-10-1**] Mr. [**Known lastname **] was taken to the operating room and
underwent Coronary artery bypass grafting x5 ( Left internal
mammary artery to left anterior descending artery;
reverse saphenous vein graft to the diagonal artery, obtuse
marginal artery; sequential vein graft to the posterior left
ventricle branch artery and the posterior descending artery)
with Dr. [**Last Name (STitle) **]. Please see operative report for further details.
He tolerated the procedure well and was transferred to the CVICU
intubated and sedated in critical but stable condition. He awoke
neurologically intact and was extubated without difficulty. All
lines and drains were discontinued in a timely fashion. He was
weaned off pressors and Beta-blocker/Statin/Aspirin and diuresis
was initiated. POD#1 he was transferred to the step down unit
for further monitoring. Physical therapy was consulted for
evaluation of strength and mobility. [**10-4**] the foley cath was
discontinued and he failed to void. A foley was reinserted,
Flomax was initiated and ultimately prior to discharge
Mr.[**Known lastname **] [**Last Name (Titles) **]. He continued to progress and was cleared by
Dr.[**Last Name (STitle) **] for discharge to home with VNA on POD# 5. All follow up
appointments were advised.


Medications on Admission:
ATORVASTATIN [LIPITOR] -  - 20 mg Tablet - 1 Tablet(s) by mouth
once daily
LISINOPRIL -  10 mg Tablet - 1Tablet(s) by mouth once daily
TIMOLOL

Discharge Medications:
1. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
2. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. 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*
5. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
6. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
8. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
9. tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*60 Capsule, Sust. Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
Coronary artery disease
s/p CABG x5 on [**2172-10-1**]
Hypertension


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**]
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:
Recommended Follow-up:
You are scheduled for the following appointments
Surgeon: Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] #[**Telephone/Fax (1) 170**] an appointment was arranged
for Wed, [**2172-10-28**] at 1pm
Cardiologist:Dr [**First Name8 (NamePattern2) 122**] [**MD Number(4) 87168**] office will contact you on
[**10-7**] with an appointment
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**
Please call to schedule appointments with your PCP: [**Name10 (NameIs) **]
[**Name11 (NameIs) 17996**] in [**12-21**] weeks



Completed by:[**2172-10-6**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Other specified retention of urine,Thrombocytopenia, unspecified,Anemia, unspecified'}


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: This 79 year old male with a history of hypertension who has
been experiencing chest pain and dyspnea with exertion since
[**2172-6-18**].  He reports that he feels chest pain and that his
breathing becomes labored when walking up [**Doctor Last Name **]
or up stairs.  His symptoms subside within seconds after he
rests. He failed a stress test and his subsequent cardiac cath
revealed multivessel coronary artery disease. Cardiac surgery
was consulted for revascularization.

MEDICAL HISTORY: HTN
Right rotator cuff surgery 5 yrs ago
Appendectomy in his 50s
Tonsillectomy

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] -  - 20 mg Tablet - 1 Tablet(s) by mouth
once daily
LISINOPRIL -  10 mg Tablet - 1Tablet(s) by mouth once daily
TIMOLOL

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: Family History:noncontributory

SOCIAL HISTORY: Race:caucasian
Last Dental Exam:edentulous
Lives with:wife
Occupation:electrician.
Tobacco:quit in the [**2121**]
ETOH:denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Other specified retention of urine,Thrombocytopenia, unspecified,Anemia, unspecified'}
