CHIEF COMPLAINT: Chest pain and dyspnea on exertion

PRESENT ILLNESS: 82 year old male with known coronary artery disease and aortic
stenosis.  s/p CABG in [**2177**] and PCI [**8-12**].  Referred for cardiac
catherization due to chest pain that revealed CAD, cardiac
surgery consulted.

MEDICAL HISTORY: Hypertension
Coronary Artery Disease
Aortic Stenosis
Myocardial infarction
Left basilic vein thrombosis [**8-6**]
Parkinson's disease
BPH
Diverticulosis
Arthritis
s/p cabg [**2177**]
bilateral cataract surgery
tonsillectomy
Excision of colon polyps

MEDICATION ON ADMISSION: ASA 325mg daily
Metoprolol 50mg daily
Simvastatin 20mg daily
Imdur 30mg daily
Azilect 1mg daily
Calcium 500mg daily
Lasix 40mg daily
Mirapex 1mg TID
MVI daily
Vit B12 500mcg daily
Vit E 400 IU daily
Vit C 500mg daily

ALLERGIES: Sinemet Cr

PHYSICAL EXAM: General well appearing
Skin unremarkable
HEENT unremarkable
Neck supple full ROM
Chest CTA bilat
Heart RRR
Abd soft, NT, ND, +BS
Ext warm well perfused no edema
varicosities none
Neuro grossly intact except baseline tremors

FAMILY HISTORY: Father deceased from heart disease in 60's

SOCIAL HISTORY: Retired electrical engineer, widowed
Tobacco denies
Lives with daughter
ETOH [**Name2 (NI) **]
Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Drug-induced psychotic disorder with hallucinations,Aortic valve disorders,Unspecified fall,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified essential hypertension,Other and unspecified angina pectoris,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Paralysis agitans,Pure hypercholesterolemia,Other primary cardiomyopathies
Crnry athrscl natve vssl,Ac on chr syst hrt fail,Drug psy dis w hallucin,Aortic valve disorder,Fall NOS,Abn react-urinary cath,Hypertension NOS,Angina pectoris NEC/NOS,BPH w/o urinary obs/LUTS,Paralysis agitans,Pure hypercholesterolem,Prim cardiomyopathy NEC
Name:  [**Known lastname 6300**],[**Known firstname **] W               Unit No:   [**Numeric Identifier 6301**]

Admission Date:  [**2184-1-15**]              Discharge Date:   [**2184-1-21**]

Date of Birth:  [**2101-6-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sinemet Cr

Attending:[**First Name3 (LF) 4551**]
Addendum:
Please add ace inhibitor when blood pressure can tolerate.

Discharge Disposition:
Extended Care

Facility:
[**Location (un) 1132**] - [**Location (un) 407**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 358**] MD [**MD Number(1) 359**]

Completed by:[**2184-1-21**]

Admission Date:  [**2184-1-15**]              Discharge Date:   [**2184-1-21**]

Date of Birth:  [**2101-6-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sinemet Cr

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Chest pain and dyspnea on exertion

Major Surgical or Invasive Procedure:
s/p redo sternotomy coronary artery bypass graft x2 (saphenous
vein graft > left anterior descending, saphenous vein graft >
posterior descending artery) Aortic valve replacement (23mm
biocor porcine st jude valve) [**2184-1-15**]


History of Present Illness:
82 year old male with known coronary artery disease and aortic
stenosis.  s/p CABG in [**2177**] and PCI [**8-12**].  Referred for cardiac
catherization due to chest pain that revealed CAD, cardiac
surgery consulted.

Past Medical History:
Hypertension
Coronary Artery Disease
Aortic Stenosis
Myocardial infarction
Left basilic vein thrombosis [**8-6**]
Parkinson's disease
BPH
Diverticulosis
Arthritis
s/p cabg [**2177**]
bilateral cataract surgery
tonsillectomy
Excision of colon polyps

Social History:
Retired electrical engineer, widowed
Tobacco denies
Lives with daughter
ETOH [**Name2 (NI) **]


Family History:
Father deceased from heart disease in 60's

Physical Exam:
General well appearing
Skin unremarkable
HEENT unremarkable
Neck supple full ROM
Chest CTA bilat
Heart RRR
Abd soft, NT, ND, +BS
Ext warm well perfused no edema
varicosities none
Neuro grossly intact except baseline tremors

Pertinent Results:
[**2184-1-20**] 07:25AM BLOOD WBC-9.6 RBC-2.76* Hgb-8.6* Hct-25.0*
MCV-91 MCH-31.0 MCHC-34.3 RDW-16.4* Plt Ct-129*
[**2184-1-20**] 07:25AM BLOOD Glucose-88 UreaN-28* Creat-1.0 Na-144
K-4.0 Cl-108 HCO3-29 AnGap-11
RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2184-1-18**] 8:20 AM

CHEST (PORTABLE AP)

Reason: ? ptx ms/p ct removal

[**Hospital 93**] MEDICAL CONDITION:
82 year old man with s/p avr
REASON FOR THIS EXAMINATION:
? ptx ms/p ct removal
CLINICAL HISTORY: Status post AVR, chest tube removed.

CHEST:

No pneumothorax is present. Bilateral pleural effusions are
again seen slightly less than on the prior occasion.

Both left chest tube and right mediastinal tube have been
removed.

IMPRESSION: No pneumothorax.

DR. [**First Name11 (Name Pattern1) 3347**] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) 5034**]
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 35384**] (Complete)
Done [**2184-1-15**] at 9:55:18 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 1112**] W.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2101-6-24**]
Age (years): 82 M  Hgt (in): 71
BP (mm Hg): 142/78  Wgt (lb): 130
HR (bpm): 65  BSA (m2): 1.76 m2
Indication: Intraoperative TEE for redosternotomy, redo CABG,
AVR
ICD-9 Codes: 427.89, 786.51, 440.0, 424.1, 424.0, 424.3
Test Information
Date/Time: [**2184-1-15**] at 09:55    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5740**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW2-: Machine: [**Pager number **]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  1.0 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *5.9 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  35%  >= 55%
Aorta - Annulus:  2.2 cm  <= 3.0 cm
Aorta - Sinus Level:  3.3 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  3.0 cm  <= 3.0 cm
Aorta - Ascending:  *3.8 cm  <= 3.4 cm
Aorta - Descending Thoracic:  *2.6 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  *7.2 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  *205 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  120 mm Hg
Aortic Valve - LVOT diam:  2.0 cm
Aortic Valve - Valve Area:  *0.5 cm2  >= 3.0 cm2

Findings
LEFT ATRIUM: Dilated LA. Good (>20 cm/s) LAA ejection velocity.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Normal interatrial
septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal LV wall thickness. Mildly dilated LV
cavity. Moderately depressed LVEF.

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

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

AORTIC VALVE: Three aortic valve leaflets. Severely
thickened/deformed aortic valve leaflets. Severe AS (AoVA
<0.8cm2). Trace AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Significant PR.

PERICARDIUM: No pericardial effusion.

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. The patient received antibiotic prophylaxis. No
TEE related complications. Frequent ventricular premature beats.
patient.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-BYPASS:
1. The left atrium is dilated.
2. No atrial septal defect is seen by 2D or color Doppler.
3. The left ventricular cavity is mildly dilated. Overall left
ventricular systolic function is moderately depressed (LVEF= 35
%). After infusion of dobutamine at 2.5mcg/kg/min, LVEF improved
to 45%. There is noted apical inferior, apical anterior akinesis
and apical akinesis. The mid-papillary segments are hypokinetic.
4. Right ventricular chamber size and free wall motion are
normal.
5. The ascending aorta is mildly dilated. There are simple
atheroma in the aortic arch. The descending thoracic aorta is
mildly dilated. There are simple atheroma in the descending
thoracic aorta.
6. There are three aortic valve leaflets. The aortic valve
+eaflets are severely thickened/calcified. There is severe
aortic valve stenosis (area <0.8cm2). Trace aortic regurgitation
is seen.
7. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen.
8. Mild (1+) pulmonic regurgitation is seen.
9. There is no pericardial effusion.

POST-Bypass:
Pt removed from cardiopulmonary bypass on dobutamine gtt
2.5mcg/kg/min and phenylephrine infusion and AV paced.
1. There is a bioprosthesis in the aortic valve position. There
is good leaflet excurion, the valve is well seated, there is no
paravalvular leak or aortic regugitation. The mean gradient
across the valve is 14mmHg at CO of 3L/min.
2. Biventricular function is unchanged LVEF 35%.
3. Degree of mitral regurgitation has decreased from mild to
trivial. Pulmonic and tricuspid valves are unchanged.
4. Aortic contours are intact post-decannulation.
I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician






Brief Hospital Course:
Mr. [**Known lastname 4020**] was admitted to the [**Hospital1 18**] on [**2184-1-15**] for elective
surgical management of his coronary artery and aortic valve
disease. He was taken directly to the operating room where he
underwent a redo sternotomy with coronary artery bypass grafting
to two vessels and an aortic valve replacement with a Biocor
porcine St. Jude valve. Postoperatively he was taken to the
cardiac surgical intensive care unit. On postoperative day one,
Mr. [**Known lastname 4020**] [**Last Name (Titles) 5058**] neurologically intact and was extubated. He
was gently diuresed towards his preoperative weight. Mr.
[**Known lastname 4020**] developed some confusion with narcotics and the
neurology service was consulted. It was felt that the narcotics
caused an acute exacerbation of his parkinson's disease and
narcotics were subsequently held. His confusion improved. On
postoperative day four, Mr. [**Known lastname 4020**] was transferred to the
step down unit for further recovery. The physical therapy
service worked with him daily for assistance with his strength
and ambulation. Mr. [**Known lastname 4020**] had a fall where he pulled out his
foley catheter. He had some hematuria however this quickly
resolved without any difficulty voiding. Mr. [**Known lastname 4020**] continued
to make steady progress and was discharged to [**Hospital **] rehab on
postoperative day six. He will follow-up with Dr. [**Last Name (STitle) **], his
cardiologist and his primary care physician as an outpatient.

Medications on Admission:
ASA 325mg daily
Metoprolol 50mg daily
Simvastatin 20mg daily
Imdur 30mg daily
Azilect 1mg daily
Calcium 500mg daily
Lasix 40mg daily
Mirapex 1mg TID
MVI daily
Vit B12 500mcg daily
Vit E 400 IU daily
Vit C 500mg daily


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
2. Selegiline HCl 5 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Mirapex 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO DAILY (Daily).
6. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
7. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Cyanocobalamin 500 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY
(Daily).
11. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
12. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 2
weeks.
13. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 2
weeks.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 1036**] - [**Location (un) 620**]

Discharge Diagnosis:
Coronary artery disease s/p CABG
Aortic Stenosis s/p AVR
Hypertension
Elevated cholesterol
Parkinson Disease
BPH
s/p CABG [**2177**]
Arthritis


Discharge Condition:
Good


Discharge Instructions:
1) Please shower daily including washing incisions, no baths or
swimming.
2) Monitor wounds for infection - redness, drainage, or
increased pain. Call ([**Telephone/Fax (1) 1504**] with any wound issues.
3) Report any fever greater than 101
4) Report any weight gain of greater than 2 pounds in 24 hours
or 5 pounds in a week
5) No creams, lotions, powders, or ointments to incisions
6) No driving for approximately one month
7) No lifting more than 10 pounds for 10 weeks
8) Please call with any questions or concerns [**Telephone/Fax (1) 170**]
9) Please do not take your Azilect - this has been replaced by
Selegiline 5 mg twice a day. You need to follow up with movement
disorder clinic in 1 month. [**Telephone/Fax (1) 1942**]
10) Take lasix and potassium daily for 2 weeks. Then be
evaluated by Dr. [**Last Name (STitle) **] for continued diuretic need. Monitor
electrolytes and replete as needed while on lasix.


Followup Instructions:
Dr [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment
Dr [**Last Name (STitle) **] after discharge from rehab ([**Telephone/Fax (1) 19980**]) please call
for appointment
Dr [**Last Name (STitle) **] in 2 weeks - ([**Telephone/Fax (1) 8937**] Please call for
appointment
Please call to schedule appointment for movement disorder clinic
[**Telephone/Fax (1) 1942**] to be seen in 1 month. Can be seen by Dr. [**Last Name (STitle) **],
[**Last Name (LF) 951**], [**First Name3 (LF) **] or [**Doctor Last Name **].



Completed by:[**2184-1-21**]
{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Drug-induced psychotic disorder with hallucinations,Aortic valve disorders,Unspecified fall,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified essential hypertension,Other and unspecified angina pectoris,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Paralysis agitans,Pure hypercholesterolemia,Other primary cardiomyopathies'}


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 and dyspnea on exertion

PRESENT ILLNESS: 82 year old male with known coronary artery disease and aortic
stenosis.  s/p CABG in [**2177**] and PCI [**8-12**].  Referred for cardiac
catherization due to chest pain that revealed CAD, cardiac
surgery consulted.

MEDICAL HISTORY: Hypertension
Coronary Artery Disease
Aortic Stenosis
Myocardial infarction
Left basilic vein thrombosis [**8-6**]
Parkinson's disease
BPH
Diverticulosis
Arthritis
s/p cabg [**2177**]
bilateral cataract surgery
tonsillectomy
Excision of colon polyps

MEDICATION ON ADMISSION: ASA 325mg daily
Metoprolol 50mg daily
Simvastatin 20mg daily
Imdur 30mg daily
Azilect 1mg daily
Calcium 500mg daily
Lasix 40mg daily
Mirapex 1mg TID
MVI daily
Vit B12 500mcg daily
Vit E 400 IU daily
Vit C 500mg daily

ALLERGIES: Sinemet Cr

PHYSICAL EXAM: General well appearing
Skin unremarkable
HEENT unremarkable
Neck supple full ROM
Chest CTA bilat
Heart RRR
Abd soft, NT, ND, +BS
Ext warm well perfused no edema
varicosities none
Neuro grossly intact except baseline tremors

FAMILY HISTORY: Father deceased from heart disease in 60's

SOCIAL HISTORY: Retired electrical engineer, widowed
Tobacco denies
Lives with daughter
ETOH [**Name2 (NI) **] 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Drug-induced psychotic disorder with hallucinations,Aortic valve disorders,Unspecified fall,Urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Unspecified essential hypertension,Other and unspecified angina pectoris,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Paralysis agitans,Pure hypercholesterolemia,Other primary cardiomyopathies'}
