CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 78 year old male with new onset substernal chest pain and
presented to outside emergency department, underwent cardiac
catherization with intra aortic balloon pump insertion.  Ruled
in for anterior wall myocardial infarction based on ST elevation
and troponin I 1.48 CK MB 18.

MEDICAL HISTORY: Asthma
Hepatitis C
Diabetes mellitus
Hypertension

MEDICATION ON ADMISSION: ASA 81 mg daily
Lisinopril/HCTZ 20/25 daily
Atenolol 50 daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General NAD
Skin rash chest
HEENT Benign
Neck supple full ROM no bruit
Chest CTA bilat
Heart RRR no M/R/G
Abd soft, ND, NT, +BS
Ext warm well perfused, pulses palpable
Neuro nonfocal, alert, oriented to time, place, person

FAMILY HISTORY: Brother +CAD

SOCIAL HISTORY: Lives with daughter
tobacco quit 20 years ago
Acute myocardial infarction of anterolateral wall, initial episode of care,Pulmonary collapse,Asthma, unspecified type, unspecified,Unspecified viral hepatitis C without hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other second degree atrioventricular block
AMI anterolateral, init,Pulmonary collapse,Asthma NOS,Hpt C w/o hepat coma NOS,DMII wo cmp nt st uncntr,Atrial fibrillation,Hypertension NOS,Crnry athrscl natve vssl,Av block-2nd degree NEC
Admission Date:  [**2146-7-20**]              Discharge Date:   [**2146-7-29**]

Date of Birth:  [**2068-1-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Emergent Coronary artery bypass graft x4 (LIMA>LAD, SVG>DIAG,
SVG>OM, SVG>RCA) [**7-20**]


History of Present Illness:
78 year old male with new onset substernal chest pain and
presented to outside emergency department, underwent cardiac
catherization with intra aortic balloon pump insertion.  Ruled
in for anterior wall myocardial infarction based on ST elevation
and troponin I 1.48 CK MB 18.

Past Medical History:
Asthma
Hepatitis C
Diabetes mellitus
Hypertension

Social History:
Lives with daughter
tobacco quit 20 years ago

Family History:
Brother +CAD

Physical Exam:
General NAD
Skin rash chest
HEENT Benign
Neck supple full ROM no bruit
Chest CTA bilat
Heart RRR no M/R/G
Abd soft, ND, NT, +BS
Ext warm well perfused, pulses palpable
Neuro nonfocal, alert, oriented to time, place, person

Pertinent Results:
[**2146-7-27**] 05:36AM BLOOD WBC-10.9
[**2146-7-26**] 05:20AM BLOOD WBC-13.1* RBC-3.92* Hgb-12.6* Hct-37.4*
MCV-95 MCH-32.0 MCHC-33.6 RDW-16.1* Plt Ct-223
[**2146-7-20**] 09:48PM BLOOD WBC-8.0 RBC-3.93* Hgb-13.4* Hct-36.9*
MCV-94 MCH-34.1* MCHC-36.3* RDW-13.2 Plt Ct-179
[**2146-7-27**] 05:36AM BLOOD PT-19.5* INR(PT)-1.8*
[**2146-7-26**] 05:20AM BLOOD Plt Ct-223
[**2146-7-20**] 09:48PM BLOOD Plt Ct-179
[**2146-7-20**] 09:48PM BLOOD PT-16.2* PTT-76.8* INR(PT)-1.4*
[**2146-7-27**] 05:36AM BLOOD K-3.4
[**2146-7-26**] 05:20AM BLOOD Glucose-127* UreaN-20 Creat-0.8 Na-140
K-3.3 Cl-102 HCO3-24 AnGap-17
[**2146-7-20**] 09:48PM BLOOD Glucose-267* UreaN-12 Creat-0.8 Na-137
K-3.9 Cl-104 HCO3-25 AnGap-12
[**2146-7-24**] 12:45AM BLOOD ALT-31 AST-95* AlkPhos-49 TotBili-1.0
[**2146-7-20**] 09:48PM BLOOD ALT-90* AST-225* LD(LDH)-517* AlkPhos-54
TotBili-0.4
[**2146-7-20**] 09:48PM BLOOD CK-MB-151* cTropnT-2.50*
[**2146-7-27**] 05:36AM BLOOD Mg-2.1
[**2146-7-20**] 09:48PM BLOOD %HbA1c-7.9*

Radiology Report CHEST (PA & LAT) Study Date of [**2146-7-26**] 3:40 PM



[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2146-7-26**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 79429**]
Reason: f/u atx, effusionq



[**Hospital 93**] MEDICAL CONDITION:
   78 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
   f/u atx, effusionq



Final Report
REASON FOR EXAMINATION: Followup of a patient after CABG.

PA and lateral upright chest radiograph was compared to prior
study obtained
[**2146-7-22**].

Patient is after median sternotomy and CABG. The
cardiomediastinal silhouette
is stable. There is overall improvement in bibasilar opacities
consistent
with atelectasis. Small bilateral pleural effusions
demonstrated, left more
than right, decreased since the prior study. There is no
evidence of
pneumothorax or mediastinal air.

IMPRESSION: Overall improvement in bibasilar aeration with still
present left
basilar atelectasis. Small bilateral pleural effusions, left
more than right.
No pneumothorax. No failure.

DR. [**First Name4 (NamePattern1) 2618**] [**Last Name (NamePattern1) 2619**]
Approved: WED [**2146-7-27**] 10:01 AM


Cardiology Report ECG Study Date of [**2146-7-26**]  12:39:38 PM


Sinus rhythm and frequent atrial ectopy. Low limb lead voltage.
Prior
anteroseptal myocardial infarction. There is T wave inversion in
leads V1-V3
consistent with further evolution of acute anterior wall
myocardial infarction
recorded on [**2146-7-21**]. Followup and clinical correlation are
suggested.


Read by: [**Last Name (LF) 578**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 579**]

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
86 200 78 368/413 0 65 99


[**Known lastname **], [**Known firstname 1569**]       [**Hospital1 18**] [**Numeric Identifier 79430**] (Complete)
Done [**2146-7-20**] at 11:15:11 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2068-1-14**]
Age (years): 78 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: CABG WITH IABP
ICD-9 Codes: 402.90, 786.05, 786.51, 799.02, 440.0, 410.91,
424.0
Test Information
Date/Time: [**2146-7-20**] at 23:15    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: AW3
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  0.9 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.0 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  40% to 45%  >= 55%
Aorta - Ascending:  2.8 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm

Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

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

AORTA: Normal ascending aorta diameter. Simple atheroma in
descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild to
moderate ([**12-8**]+) MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) 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.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Pre-CPB:
LV systolic fxn is reduced to an EF of 40 - 45%. The septum,
antero-septal and infero-septal walls are hypokinetic.
No spontaneous echo contrast is seen in the left atrial
appendage.
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
An IABP is seen well-positioned in the proximal descending
aorta.
The aortic valve leaflets are mildly thickened. No aortic
regurgitation is seen.
The mitral valve leaflets are mildly thickened. Mild to moderate
([**12-8**]+) mitral regurgitation is seen.
There is no pericardial effusion.

Post-CPB:
Patient is AV-Paced, on a NTG infusion.
RV systolic fxn is good.
LV systolic fxn is improved to an EF of 45 - 50%. The septum
shows improved motion compared to pre-bypass.
MR remains 1 - 2+.
No AI. 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) **] [**2146-7-21**] 02:25


Brief Hospital Course:
Transferred in from outside hospital with intra aortic balloon
pump and went emergently to the operating room for coronary
artery bypass graft.  See operative report for further details.
He was transferred to the intensive care unit for furthe
hemodynamic monitoring.  He was weaned from sedation, awoke, and
was extubated in the first twenty four hours.  He remained with
the intra aortic balloon pump until POD 1 due to hemodynamic
instability when it was weaned.  He was started on ACE inhibitor
and IABP was weaned and removed.  Cardiology was consulted for
heart block postoperatively which was second degree mobitz type
1, beta blockers were started and titrated up.  He continued to
do well and remained on the intensive care unit as oral
medications were titrated and he was weaned from vasodilators.
He had atrial fibrillation on post op day 3 and was treated with
increased beta blockers and amiodarone.  He returned to sinus
rhythm but continued to have episodes of atrial fibrillation
with rate controlled, and he was started on coumadin for
anticoagulation.  He continued to do well and was discharged to
rehab on post op 6.

Medications on Admission:
ASA 81 mg daily
Lisinopril/HCTZ 20/25 daily
Atenolol 50 daily

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: Two (2) Tablet Sustained Release 24 hr PO DAILY (Daily).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every six (6) hours as needed for pain.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) for 1 months: 30 day course started [**7-24**], then
discontinue .
8. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day.
9. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
10. Warfarin 1 mg Tablet Sig: INR 2-2.5  Tablets PO once a day:
please dose based on INR results - goal INR 2-2.5 for atrial
fibrillation
received 3mg [**7-26**] and [**7-27**].


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 931**] House Nursing & Rehabilitation Center - [**Location (un) 932**]

Discharge Diagnosis:
Coronary artery disease s/p CABG
Acute myocardial infarction with post infarction angina
Type 1 second degree heart block
Post operative atrial fibrillation
Diabetes mellitus
Hypertension
Asthma
Hepatitis C


Discharge Condition:
Good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Please call to schedule all appointments
Dr. [**Last Name (STitle) 914**] ([**Telephone/Fax (1) 170**]) in 4 weeks
Dr. [**First Name8 (NamePattern2) 3403**] [**Last Name (NamePattern1) 5456**] ([**Telephone/Fax (1) 79431**]in [**1-9**] weeks
Dr. [**First Name4 (NamePattern1) 919**] [**Last Name (NamePattern1) 911**] in [**1-9**] weeks



Completed by:[**2146-7-27**]

Name:  [**Known lastname 12764**],[**Known firstname **]                    Unit No:   [**Numeric Identifier 12765**]

Admission Date:  [**2146-7-20**]              Discharge Date:   [**2146-7-29**]

Date of Birth:  [**2068-1-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1543**]
Addendum:
Following discharge, Mr. [**Known lastname **] was readmitted back to the [**Hospital1 8**]
with reported agitation/altered mental status/aggressive
behavior on admission to the rehabilitation facility. His
medications were resumed and Haldol was initiated. Over several
days, his mental status improved. At discharge, he should remain
on Haldol with attempt to wean in the near future.

In regards to his postoperative atrial fibrillation, no further
episodes of atrial fibrillation were noted on readmission. He
should remain on Amiodarone for one month only per Ep
recommendations. Amiodarone should be discontinued given his
history of Type I second degree AV block. He will remain on
Warfarin with a goal INR between 2.0 - 2.5. His discharge
Warfarin dose will be 1mg as 3mg caused him to have a
supratherapeutic prothrombin time. He should remain on Warfarin
until followup with his local cardiologist.

Given his low-normal ejection fraction, he is to remain on beta
blockade, ACEI along with Lasix. Medications should be titrated
accordingly.

Pertinent Results:
[**2146-7-29**] 05:20AM BLOOD WBC-11.8* RBC-3.74* Hgb-12.0* Hct-36.1*
MCV-96 MCH-32.1* MCHC-33.2 RDW-16.2* Plt Ct-293
[**2146-7-26**] 05:20AM BLOOD WBC-13.1* RBC-3.92* Hgb-12.6* Hct-37.4*
MCV-95 MCH-32.0 MCHC-33.6 RDW-16.1* Plt Ct-223
[**2146-7-25**] 02:27AM BLOOD WBC-14.4* RBC-3.50* Hgb-11.1* Hct-32.4*
MCV-92 MCH-31.6 MCHC-34.2 RDW-15.9* Plt Ct-193
[**2146-7-24**] 12:45AM BLOOD WBC-19.7* RBC-3.29* Hgb-10.6* Hct-29.9*
MCV-91 MCH-32.2* MCHC-35.5* RDW-15.9* Plt Ct-152
[**2146-7-29**] 05:20AM BLOOD PT-33.2* INR(PT)-3.5*
[**2146-7-28**] 01:00PM BLOOD PT-41.8* INR(PT)-4.6*
[**2146-7-28**] 09:30AM BLOOD PT-39.0* INR(PT)-4.2*
[**2146-7-27**] 05:36AM BLOOD PT-19.5* INR(PT)-1.8*
[**2146-7-25**] 02:27AM BLOOD PT-18.1* INR(PT)-1.7*
[**2146-7-29**] 05:20AM BLOOD Glucose-73 UreaN-12 Creat-0.9 Na-138
K-4.0 Cl-101 HCO3-25 AnGap-16
[**2146-7-28**] 09:30AM BLOOD K-4.4
[**2146-7-26**] 05:20AM BLOOD Glucose-127* UreaN-20 Creat-0.8 Na-140
K-3.3 Cl-102 HCO3-24 AnGap-17
[**2146-7-25**] 02:27AM BLOOD Glucose-118* UreaN-25* Creat-0.8 Na-140
K-3.6 Cl-103 HCO3-27 AnGap-14
[**2146-7-24**] 12:45AM BLOOD Glucose-90 UreaN-26* Creat-0.8 Na-141
K-3.4 Cl-107 HCO3-24 AnGap-13
[**2146-7-23**] 02:04AM BLOOD Glucose-153* UreaN-20 Creat-0.7 Na-142
K-4.1 Cl-109* HCO3-20* AnGap-17

Discharge Disposition:
Extended Care

Facility:
Meadowbrook - [**Location (un) 271**]

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2146-7-29**]
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Pulmonary collapse,Asthma, unspecified type, unspecified,Unspecified viral hepatitis C without hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other second degree atrioventricular block'}


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: 78 year old male with new onset substernal chest pain and
presented to outside emergency department, underwent cardiac
catherization with intra aortic balloon pump insertion.  Ruled
in for anterior wall myocardial infarction based on ST elevation
and troponin I 1.48 CK MB 18.

MEDICAL HISTORY: Asthma
Hepatitis C
Diabetes mellitus
Hypertension

MEDICATION ON ADMISSION: ASA 81 mg daily
Lisinopril/HCTZ 20/25 daily
Atenolol 50 daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General NAD
Skin rash chest
HEENT Benign
Neck supple full ROM no bruit
Chest CTA bilat
Heart RRR no M/R/G
Abd soft, ND, NT, +BS
Ext warm well perfused, pulses palpable
Neuro nonfocal, alert, oriented to time, place, person

FAMILY HISTORY: Brother +CAD

SOCIAL HISTORY: Lives with daughter
tobacco quit 20 years ago 

### Response:
{'Acute myocardial infarction of anterolateral wall, initial episode of care,Pulmonary collapse,Asthma, unspecified type, unspecified,Unspecified viral hepatitis C without hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other second degree atrioventricular block'}
