CHIEF COMPLAINT: angina

PRESENT ILLNESS: 81 yo female working as a scrub nurse when she developed chest
pain. Relieved with rest, but had another episode when walking.
Presented to ER at OSH with elevated troponin. Had 2u PRBCs for
Hct 29.1 there. Cath revealed RCA 95%, LAD 80%, Cx 60%. Echo
showed EF 70%, LV wall motion abnormalitites, LVH and diastolic
dysfunction. Transferred to [**Hospital1 18**] for surgical evaluation for
cabg.

MEDICAL HISTORY: HTN
elev. chol.
prior cataract surgs
NSTEMI

MEDICATION ON ADMISSION: lipitor 10 mg daily
norvasc 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.2    HR 75  126/76  RR 20  96% RA sat
well-appearing, NAD
no bruits or JVD
CTAB
RRR, no murmur or rub
soft, NT, ND abd
extrems warm, no c/c/e

FAMILY HISTORY: father with CAD

SOCIAL HISTORY: works as OR nurse
[**First Name (Titles) **] [**Last Name (Titles) **] or tobacco use
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Intermediate coronary syndrome,Unspecified pleural effusion,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs,Hypopotassemia,Family history of ischemic heart disease
Crnry athrscl natve vssl,CHF NOS,Intermed coronary synd,Pleural effusion NOS,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem,Nonsp abn intrathor NEC,Hypopotassemia,Fam hx-ischem heart dis
Admission Date:  [**2156-6-16**]              Discharge Date:   [**2156-6-25**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
angina

Major Surgical or Invasive Procedure:
cabg x3 on [**2156-6-18**]  (LIMA to LAD, SVG to OM, SVG to RCA)
mediastinal exploration [**2156-6-19**]


History of Present Illness:
81 yo female working as a scrub nurse when she developed chest
pain. Relieved with rest, but had another episode when walking.
Presented to ER at OSH with elevated troponin. Had 2u PRBCs for
Hct 29.1 there. Cath revealed RCA 95%, LAD 80%, Cx 60%. Echo
showed EF 70%, LV wall motion abnormalitites, LVH and diastolic
dysfunction. Transferred to [**Hospital1 18**] for surgical evaluation for
cabg.

Past Medical History:
HTN
elev. chol.
prior cataract surgs
NSTEMI


Social History:
works as OR nurse
[**First Name (Titles) **] [**Last Name (Titles) **] or tobacco use

Family History:
father with CAD

Physical Exam:
97.2    HR 75  126/76  RR 20  96% RA sat
well-appearing, NAD
no bruits or JVD
CTAB
RRR, no murmur or rub
soft, NT, ND abd
extrems warm, no c/c/e

Pertinent Results:
[**2156-6-24**] 07:25AM BLOOD WBC-12.2* RBC-3.35* Hgb-10.3* Hct-30.7*
MCV-92 MCH-30.9 MCHC-33.7 RDW-14.0 Plt Ct-251#
[**2156-6-24**] 07:25AM BLOOD Plt Ct-251#
[**2156-6-25**] 06:40AM BLOOD UreaN-24* Creat-0.9 K-4.6
[**2156-6-19**] 08:35AM BLOOD ALT-15 AST-58* LD(LDH)-362* AlkPhos-38*
Amylase-240* TotBili-0.6
[**2156-6-19**] 08:35AM BLOOD Lipase-11
[**2156-6-24**] 07:25AM BLOOD Mg-2.4
[**2156-6-16**] 10:13PM BLOOD %HbA1c-5.6 [Hgb]-DONE [A1c]-DONE
[**2156-6-19**] 03:26AM BLOOD Cortsol-19.7

FINAL REPORT


INDICATION: 81-year-old female with CAD. Rule out infiltrate or
effusion.

COMPARISON: [**2156-6-23**].

PA AND LATERAL CHEST RADIOGRAPHS: The cardiomediastinal
silhouette is
moderately enlarged and unchanged. There is a moderate-sized
left pleural
effusion with subpulmonic component and a small right pleural
effusion. No
definite focal opacities are seen. No evidence of pneumothorax
or pulmonary
edema.

IMPRESSION:
1. Unchanged moderate-sized left pleural effusion.
2. Unchanged small right pleural effusion.
THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10270**]

DR. [**First Name (STitle) 8085**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 8086**]


Approved: [**Doctor First Name **] [**2156-6-24**] 11:04 PM
FINAL REPORT


CAROTID SERIES COMPLETE.

REASON: Preop.

FINDINGS: Duplex evaluation was performed of both carotid
arteries. Minimal
plaques identified.

On the right, peak systolic velocities are 39, 47, and 58 in the
ICA, CCA, and
ECA respectively. This is consistent with no stenosis.

On the left, peak systolic velocities are 40, 43, and 64 in the
ICA, CCA, and
ECA respectively. This is consistent with no stenosis.

There is antegrade flow in both vertebral arteries.

IMPRESSION: No evidence of stenosis in either carotid artery.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]


Approved: WED [**2156-6-23**] 9:39 AM
Procedure Date:[**2156-6-17**]




Brief Hospital Course:
Admitted on [**2156-6-16**] for cabg by Dr. [**Last Name (STitle) 914**]. Carotid US showed
no significant disease. Underwent cabg x3 on [**6-18**] and was
transferred to the CSRU in stable condition. Had decreased CO on
POD #1 with elevated filling pressures. Echo showed ? RV clot
compression and she was taken back to OR for mediastinal
re-exploration which was negative for tamponade.Transferred back
to the CSRU on neo and propofol drips; milrinone and levophed
drips added. Gentle diuresis was started while she was being
weaned from the vent. Extubated on [**6-21**] and BP meds adjusted to
decrease hypertension. Chest tubes removed. Had episode of AFib
which converted back to SR and she was transferred to the floor
to begin to increase her activity level. Pacing wires removed
without incident on [**6-24**]. Cleared for discharge to rehab on [**6-25**].
Pt. is to follow up as per discharge instructions.

Medications on Admission:
lipitor 10 mg daily
norvasc 10 mg daily

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 2
weeks.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
7. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Albuterol 90 mcg/Actuation Aerosol Sig: 2-4 Puffs Inhalation
Q4H (every 4 hours) as needed.
9. Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
10. Albuterol Sulfate 0.083 % Solution Sig: One (1) nebulizer
Inhalation Q6H (every 6 hours) as needed.
11. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

12. Furosemide 10 mg/mL Solution Sig: Twenty (20) mg IV
Injection [**Hospital1 **] (2 times a day) for 3 days.
13. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days: to start after finishing 3 days of IV lasix on [**6-29**]; may
change to po then.


Discharge Disposition:
Extended Care

Facility:
[**Doctor Last Name **] [**Doctor Last Name **] hospital

Discharge Diagnosis:
cabg x 3 with mediastinal re-exploration
HTN
elev. chol.
s/p cataract surgeries
CAD
NSTEMI


Discharge Condition:
stable


Discharge Instructions:
may shower over incisions and pat dry
no lotions, creams or powders on any incision
call for fever greater than 100, redness or drainage
no driving for one month
no lifting greater than 10 pounds for 10 weeks

Followup Instructions:
follow up with Dr. [**First Name (STitle) 4640**] in [**12-22**] weeks
follow up with Dr. [**Last Name (STitle) 3659**] in [**1-23**] weeks
follow up with Dr. [**Last Name (STitle) 914**] in 4 weeks  [**Telephone/Fax (1) 170**]



Completed by:[**2156-6-25**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Intermediate coronary syndrome,Unspecified pleural effusion,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs,Hypopotassemia,Family history of ischemic heart disease'}


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: 81 yo female working as a scrub nurse when she developed chest
pain. Relieved with rest, but had another episode when walking.
Presented to ER at OSH with elevated troponin. Had 2u PRBCs for
Hct 29.1 there. Cath revealed RCA 95%, LAD 80%, Cx 60%. Echo
showed EF 70%, LV wall motion abnormalitites, LVH and diastolic
dysfunction. Transferred to [**Hospital1 18**] for surgical evaluation for
cabg.

MEDICAL HISTORY: HTN
elev. chol.
prior cataract surgs
NSTEMI

MEDICATION ON ADMISSION: lipitor 10 mg daily
norvasc 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 97.2    HR 75  126/76  RR 20  96% RA sat
well-appearing, NAD
no bruits or JVD
CTAB
RRR, no murmur or rub
soft, NT, ND abd
extrems warm, no c/c/e

FAMILY HISTORY: father with CAD

SOCIAL HISTORY: works as OR nurse
[**First Name (Titles) **] [**Last Name (Titles) **] or tobacco use 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Intermediate coronary syndrome,Unspecified pleural effusion,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia,Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs,Hypopotassemia,Family history of ischemic heart disease'}
