CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Pt is a 57 year old male with a h/o htn admitted to [**Hospital 6451**] hospital on [**2-13**] with chest pain, viral symptoms,
dehydration, and acute renal failure. At the time of
presentation, he was complaining of 1 week of cough, congestion,
diarrhea, vomiting, and weakness. His cough was noted to be
productive of greenish-red sputum. He also noted some atypical
chest pain, occurring with coughing. with creat up to 3.4/bun
126.

MEDICAL HISTORY: Hypertension, rt ing hernia repair

MEDICATION ON ADMISSION: lisinopril
hctz/triamterene
atenolol 50 mg daily

ALLERGIES: Penicillins / Shellfish Derived

PHYSICAL EXAM: Admission:
VS: T: 97.6, BP: 144/98, HR: 68, RR: 18, O2: 99% on RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Fam hx is sig for htn and CAD in father. [**Name (NI) **] sisters with DM
and renal failure requiring dialysis.

SOCIAL HISTORY: Pt is a school bus driver. He quit smoking 3 months ago. ~10
pk/yr smoking hx. Occasional social EtOH. He is married and has
children. He lives with his family in [**Hospital1 1474**] MA.
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Bronchitis, not specified as acute or chronic,Enlargement of lymph nodes,Examination of participant in clinical trial,Other and unspecified angina pectoris,Unspecified erythematous condition
Crnry athrscl natve vssl,Hypertension NOS,Bronchitis NOS,Enlargement lymph nodes,Exam-clincal trial,Angina pectoris NEC/NOS,Erythematous cond NOS
Admission Date:  [**2122-2-16**]              Discharge Date:   [**2122-2-23**]

Date of Birth:  [**2065-2-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Shellfish Derived

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
CABG


History of Present Illness:
Pt is a 57 year old male with a h/o htn admitted to [**Hospital 6451**] hospital on [**2-13**] with chest pain, viral symptoms,
dehydration, and acute renal failure. At the time of
presentation, he was complaining of 1 week of cough, congestion,
diarrhea, vomiting, and weakness. His cough was noted to be
productive of greenish-red sputum. He also noted some atypical
chest pain, occurring with coughing. with creat up to 3.4/bun
126.

At the OSH, he troponins were mildly elevated in the setting of
ARF but CKs were negative. ECG had ? of mild inferior ST
depressions. A pulmonary consultation was obtained for URI
symptoms and ? hemoptysis and he was started on levofloxacin for
bronchitis. Patient symptoms improved w/ abx and hydration on
the floor. A renal consultation was obtained and ARF was felt to
be due to dehydration. He ace inhibitor, hctz/triamterene were
held and his creat improved to 1.0 with IVF hydration. On
[**2122-2-16**] an ETT-MIBI was performed on which he completed 5
minutes of [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] protocol w/ 5/10 chest pain, 3mm global ST
depression, and nuclear imaging showed EF 31% with fixed
inferior and reversible anterior defects. He was then
transferred to [**Hospital1 18**] for catheterization.

In [**Hospital1 18**] cath lab, patient was found to have 2V CAD w/ 95% LAD
lesion and TO RCA w/ L->R collaterals. No intervention was
performed and CT surgery was consulted for potential CABG. Upon
transfer to the floor, patient is asymptomatic. He denies any
current chest pain or discomfort, SOB, nausea, diarrhea,
constipation. He does note a mild persistent cough.

On ROS, he notes a chest sensation similar to what he felt
during his ETT over the last several months with heavy exertion
ass with SOB. He denies any frank chest pain. No orthopnea, PND.



Past Medical History:
Hypertension, rt ing hernia repair

Social History:
Pt is a school bus driver. He quit smoking 3 months ago. ~10
pk/yr smoking hx. Occasional social EtOH. He is married and has
children. He lives with his family in [**Hospital1 1474**] MA.

Family History:
Fam hx is sig for htn and CAD in father. [**Name (NI) **] sisters with DM
and renal failure requiring dialysis.

Physical Exam:
Admission:
VS: T: 97.6, BP: 144/98, HR: 68, RR: 18, O2: 99% on RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

Neck: Supple with JVP low
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e
Groin: + R femoral bruit. R groin site CDI w/o hematoma.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 2+ Femoral 2+ DP 1+ PT 1+
Left: Carotid 2+ Femoral 2+ DP 1+ PT 1+

Discharge:
VS T 98.7 HR 89SR  BP 98/62  RR 18  O2sat 98% RA
Gen NAD
Neuro A&Ox3 nonfocal exam
CV RRR no M/R/G. Sternum stable, incision CDI
Pulm diminished bases
Abdm soft, NT/+BS
Ext warm, [**12-10**]+ edema bilat


Pertinent Results:
[**2122-2-16**] 07:10PM   GLUCOSE-164* UREA N-17 CREAT-0.9 SODIUM-136
POTASSIUM-4.2 CHLORIDE-105 TOTAL CO2-23 ANION GAP-12
[**2122-2-16**] 07:10PM   ALT(SGPT)-18 AST(SGOT)-17 CK(CPK)-101 ALK
PHOS-61 AMYLASE-82 TOT BILI-0.5
[**2122-2-16**] 07:10PM   CK-MB-5 cTropnT-0.39*
[**2122-2-16**] 07:10PM   ALBUMIN-3.5
[**2122-2-16**] 07:10PM   %HbA1c-6.0*
[**2122-2-16**] 07:10PM   WBC-5.5 RBC-4.10* HGB-12.8* HCT-36.3* MCV-89
MCH-31.1 MCHC-35.2* RDW-12.7
[**2122-2-16**] 07:10PM   PLT COUNT-306
[**2122-2-16**] 07:10PM   PT-15.0* PTT-29.4 INR(PT)-1.3*
[**2122-2-23**] 06:15AM BLOOD WBC-10.4 RBC-2.55* Hgb-8.1* Hct-22.9*
MCV-90 MCH-32.0 MCHC-35.5* RDW-13.2 Plt Ct-307
[**2122-2-23**] 06:15AM BLOOD Plt Ct-307
[**2122-2-19**] 11:29AM BLOODCarotid US bilateral: IMPRESSION: No
evidence of significant ICA stenosis on either side.
 PT-16.2* PTT-40.4* INR(PT)-1.5*
[**2122-2-23**] 06:15AM BLOOD Glucose-85 UreaN-14 Creat-0.9 Na-139
K-4.4 Cl-106 HCO3-27 AnGap-10

Carotid US bilateral: IMPRESSION: No evidence of significant ICA
stenosis on either side.

RADIOLOGY  Final Report
CHEST (PORTABLE AP)  [**2122-2-20**] 2:14 PM
CHEST (PORTABLE AP)
Reason: r/o ptx
[**Hospital 93**] MEDICAL CONDITION:
57 year old man s/p cabg and ct removal
REASON FOR THIS EXAMINATION:
r/o ptx
PORTABLE CHEST ON [**2122-2-20**]
COMPARISON: [**2122-2-19**].
INDICATION: Chest tube removal.
Various lines and tubes have been removed, with no pneumothorax.
Lung volumes are low, with worsening bibasilar atelectasis and
new small bilateral pleural effusions. No other substantial
changes since the recent study.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 99333**] (Complete)
Done [**2122-2-19**] at 9:43:25 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2065-2-9**]
Age (years): 57 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: cabg
ICD-9 Codes: 428.0, 402.90, 786.05, 786.51, 799.02, 440.0, 424.0

Test Information
Date/Time: [**2122-2-19**] at 09:43    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW-:1 Machine: aw2
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:  5.0 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  25% to 30%  >= 55%
Aorta - Ascending:  3.0 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.2 cm  <= 2.5 cm
Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.
LEFT VENTRICLE: Severely depressed LVEF.
RIGHT VENTRICLE: Mild global RV free wall hypokinesis.
AORTA: Normal ascending aorta diameter. Complex (>4mm) atheroma
in the descending thoracic aorta.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
MITRAL VALVE: Moderately thickened mitral valve leaflets.
Trivial MR.
TRICUSPID VALVE: Physiologic TR.
PULMONIC VALVE/PULMONARY ARTERY: No 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 TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Pre-CPB: No spontaneous echo contrast is seen in the left atrial
appendage. Overall left ventricular systolic function is
severely depressed (LVEF= 25 - 30 %). with mild global RV
hypokinesis.The LV shows hypokinesis or akinesis of all walls
except the lateral wall.
There are complex (>4mm) atheroma in the descending thoracic
aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. The mitral
valve leaflets are moderately thickened. Trivial mitral
regurgitation is seen.
There is no pericardial effusion.
Post CPB: The patient is in SR, with Epinephrine infusing.
Improved biventricular systolic fxn. The anterior and inferior
walls show slightly better activity, as does the septum, though
all remain hypokinetic. The RV functions well.
No AI, no MR.
Aorta intact.
I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2122-2-19**] 10:36



Brief Hospital Course:
57 year old man admitted to [**Hospital3 417**] Hospital [**2-13**] with
atypical chest pain and viral symptoms. Found to have acute
renal failure which improved with hydration. He was also noted
to have EKG changes and eleevated Troponin. A stress test was
positive then he was transferred to [**Hospital1 18**] on [**2-16**] for cardiac
catheterization which revealed 3 vessel disease and EF 35%. He
was referred to cardiac surgery and on [**2-19**] he was brought to
the operating room for coroany bypass grafting. Please see OR
report for details, in summary he had CABG x3 with
LIMA-LAD,SVG-OM, SVG-PDA. His bypass time was 65 Minutes with a
crossclamp of 54 minutes. He tolerated the operation well and
was transfewred to the cardiac surgery ICU in stable condition.
He did well in the immedicate post-op period , his anesthesia
was reversed, he was weaned from the ventilator and extubated.
On POD 1 his chest tubes were removed and he was transferred to
the floors for continued post-op care. Over the next several
days his activity was advanced with the assistance of PT and
nursing, his medications were adjusted and on POD 4 it was
decided he was stable and ready to be discharged home with
visiting nurses.

Medications on Admission:
lisinopril
hctz/triamterene
atenolol 50 mg daily


Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
2. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two
(2) Tablet Sustained Release PO once a day.
Disp:*60 Tablet Sustained Release(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. 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:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
s/p CABG x3(LIMA-LAD,SVG-OM, SVG-PDA)[**2-19**]
PMH: CAD, HTN, Rt Ing hernia repair


Discharge Condition:
stable


Discharge Instructions:
keep wounds clean and dry. OK to shower, no bathing or swimming.
Take all medications as prescribed.
Call for any fever, redness or drainage from wounds

Followup Instructions:
[**Hospital 409**] clinic in 2 weeks
Dr [**Last Name (STitle) **] in 4 weeks
Dr [**Last Name (STitle) 28549**] in [**2-10**] weeks
A lymph node was seen on the CT scan of your chest.  Please have
a repeat CT scan performed within three months to re-evaluate
this lymph node.



Completed by:[**2122-2-23**]

Name:  [**Known lastname **],[**Known firstname 4076**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 875**]             Unit No:   [**Numeric Identifier 15902**]

Admission Date:  [**2122-2-16**]              Discharge Date:   [**2122-2-23**]

Date of Birth:  [**2065-2-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Shellfish Derived

Attending:[**First Name3 (LF) 741**]
Addendum:
A 2 week [**Last Name (un) **] of Ciprofloxacin 500mg [**Hospital1 **] was added on day of
discharge as the patient had mild erythema of sternal wound

Discharge Disposition:
Home With Service

Facility:
[**Hospital1 328**] VNA

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2122-2-23**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Bronchitis, not specified as acute or chronic,Enlargement of lymph nodes,Examination of participant in clinical trial,Other and unspecified angina pectoris,Unspecified erythematous condition'}


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: Pt is a 57 year old male with a h/o htn admitted to [**Hospital 6451**] hospital on [**2-13**] with chest pain, viral symptoms,
dehydration, and acute renal failure. At the time of
presentation, he was complaining of 1 week of cough, congestion,
diarrhea, vomiting, and weakness. His cough was noted to be
productive of greenish-red sputum. He also noted some atypical
chest pain, occurring with coughing. with creat up to 3.4/bun
126.

MEDICAL HISTORY: Hypertension, rt ing hernia repair

MEDICATION ON ADMISSION: lisinopril
hctz/triamterene
atenolol 50 mg daily

ALLERGIES: Penicillins / Shellfish Derived

PHYSICAL EXAM: Admission:
VS: T: 97.6, BP: 144/98, HR: 68, RR: 18, O2: 99% on RA
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Fam hx is sig for htn and CAD in father. [**Name (NI) **] sisters with DM
and renal failure requiring dialysis.

SOCIAL HISTORY: Pt is a school bus driver. He quit smoking 3 months ago. ~10
pk/yr smoking hx. Occasional social EtOH. He is married and has
children. He lives with his family in [**Hospital1 1474**] MA. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Bronchitis, not specified as acute or chronic,Enlargement of lymph nodes,Examination of participant in clinical trial,Other and unspecified angina pectoris,Unspecified erythematous condition'}
