CHIEF COMPLAINT: chest pain after elective cath

PRESENT ILLNESS: 76 yo male recently cathed for evaluation in preparation of
probable valve surgery. He had a known history of AS/AI from
echo done [**4-16**]. This also showed EF 60%, mild MR,, peak AV
gradient 48mm, [**Location (un) 109**] 1.3 cm2, dilated aortic root. Cath [**5-6**]
showed 60% ostial LM, LAD 90%, RCA 90%.Transferred in from MWMC
after experiencing chest pain post-cath.

MEDICAL HISTORY: prostate CA/TURP
spinal stenosis
COPD
GERD/PUD
colon polyps
hemorrhoid surgery
elev. chol.

MEDICATION ON ADMISSION: norvasc 10 mg daily
benazepril 10 mg daily
nexium 40 mg [**Hospital1 **]
ASA
gaviscon
lupron
detrol LA 4 mg daily
toprol XL 50 mg daily
fosamax 70 mg weekly
metamucil
selenium

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD, pain free
HR 61  137/47  97% on 2LNC  RR 18
RRR  4/6 SEM at USB
neck nilat transmitted murmur vs. bruits ( left greater than
right)
CTAB anterolateral
warm, no edema, 1+ pedal pulses, no varicosities
soft, NT, ND

FAMILY HISTORY: brother died of ESRD at age  71 (angina)
mother with "heart problems"

SOCIAL HISTORY: no tobacco now, quit 15 years ago
no ETOH currently
lives with wife
Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension,Calculus of kidney,Other diseases of lung, not elsewhere classified,Aortic valve disorders,Intermediate coronary syndrome,Chronic airway obstruction, not elsewhere classified
Crnry athrscl natve vssl,Hx-prostatic malignancy,Hypertension NOS,Calculus of kidney,Other lung disease NEC,Aortic valve disorder,Intermed coronary synd,Chr airway obstruct NEC
Admission Date:  [**2172-5-6**]              Discharge Date:   [**2172-5-14**]

Date of Birth:  [**2096-5-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
AVR/CABG x3 on [**2172-5-8**]  ( 21mm CE pericardial valve, LIMA to
LAD, SVG to OM, SVG to PDA)


History of Present Illness:
76 yo male recently cathed for evaluation in preparation of
probable valve surgery. He had a known history of AS/AI from
echo done [**4-16**]. This also showed EF 60%, mild MR,, peak AV
gradient 48mm, [**Location (un) 109**] 1.3 cm2, dilated aortic root. Cath [**5-6**]
showed 60% ostial LM, LAD 90%, RCA 90%.Transferred in from MWMC
after experiencing chest pain post-cath.

Past Medical History:
prostate CA/TURP
spinal stenosis
COPD
GERD/PUD
colon polyps
hemorrhoid surgery
elev. chol.


Social History:
no tobacco now, quit 15 years ago
no ETOH currently
lives with wife

Family History:
brother died of ESRD at age  71 (angina)
mother with "heart problems"

Physical Exam:
NAD, pain free
HR 61  137/47  97% on 2LNC  RR 18
RRR  4/6 SEM at USB
neck nilat transmitted murmur vs. bruits ( left greater than
right)
CTAB anterolateral
warm, no edema, 1+ pedal pulses, no varicosities
soft, NT, ND


Pertinent Results:
[**2172-5-13**] 05:30AM BLOOD WBC-10.6 RBC-3.62* Hgb-11.0* Hct-32.0*
MCV-88 MCH-30.4 MCHC-34.4 RDW-15.4 Plt Ct-176
[**2172-5-6**] 02:42PM BLOOD WBC-8.0 RBC-4.05* Hgb-12.3* Hct-36.6*
MCV-90 MCH-30.5 MCHC-33.8 RDW-13.8 Plt Ct-248
[**2172-5-13**] 05:30AM BLOOD PT-13.7* PTT-23.9 INR(PT)-1.2*
[**2172-5-13**] 05:30AM BLOOD Plt Ct-176
[**2172-5-12**] 08:45AM BLOOD Glucose-194* UreaN-25* Creat-1.1 Na-136
K-3.8 Cl-97 HCO3-26 AnGap-17
[**2172-5-13**] 05:30AM BLOOD UreaN-24* Creat-1.2 K-4.5
[**2172-5-6**] 02:42PM BLOOD Glucose-103 UreaN-21* Creat-1.0 Na-139
K-4.2 Cl-104 HCO3-25 AnGap-14
[**2172-5-12**] 08:45AM BLOOD Calcium-8.3* Phos-2.9 Mg-2.0
[**2172-5-6**] 02:42PM BLOOD %HbA1c-6.6* [Hgb]-DONE [A1c]-DONE


INDICATION: 75-year-old with aortic stenosis, aortic
insufficiency and
coronary artery disease, preop examination to assess
calcification of the
aorta.

TECHNIQUE: MDCT images of the chest without IV contrast. Coronal
and
sagittal reformatted images were obtained.

FINDINGS: There is mild centrilobular emphysema. Minimal
atelectatic changes
are seen at the lung bases. There is also mild scarring or
atelectasis
anteriorly in the right lower lobe. There is an 8.5-mm nodule
seen in the
right lower lobe abutting the major fissure near the diaphragm.
Several
smaller 1-3 mm peripheral nodules are seen scattered throughout
the right and
left lung. The bronchi are patent to the segmental level. There
are no
pleural effusions. There is no pathologic axillary, mediastinal,
or hilar
lymphadenopathy.

The heart is enlarged. Dense calcification is seen within the
left anterior
descending and circumflex arteries, as well as in the aortic
valve. Dense
atherosclerotic calcification is also seen within the ascending
aorta and
throughout the aortic arch. There is no pericardial effusion.

In the imaged portion of the upper abdomen, bilateral
nonobstructing renal
stones are seen. The largest measures 4 mm in the right upper
pole. A single
granuloma is seen within the left lobe of the liver.
Degenerative changes are
seen within the thoracic spine. In addition, a bone Island is
seen within the
T8 vertebral body.

Multiplanar reformatted images confirm the above findings and
demonstrate the
dense aortic arch calcification.

IMPRESSION:
1. Mild emphysema.
2. 8.5 mm right lower lobe nodule abutting the major fissure
near the
diaphragm. Three-month followup CT is recommended. Several
smaller sub 5 mm
bilateral peripheral nodules can also be reassessed at that
time.
3. Dense coronary, aortic valve, and aortic arch calcification.
4. Bilateral nephrolithiasis.
THE STUDY AND THE REPORT WERE REVIEWED BY THE STAFF RADIOLOGIST.

DR. [**First Name (STitle) 7853**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5785**]


Approved: FRI [**2172-5-8**] 9:25 AM
Procedure Date:[**2172-5-7**]


Brief Hospital Course:
Admitted in [**2172-5-6**] to CSRU and seen by the cardiology team.
Referred to Dr. [**Last Name (STitle) **] for surgery. Heparin drip was started,
and a nitroglycerin drip was also started . Carotid studies
performed as well as CT scan of chest to evaluate the aorta.This
was shown to be heavily calcified with bilateral pulm. nodules
and renal calculi. Underwent AVR/CABG x3 on [**5-8**]. Transferred to
CSRU in stable condition on insulin, epinephrine, propofol, and
neosynephrine drips. Remained on epinephrine, insulin, and
nitroglycerin drips on POD #1.Extubated, chest tubes were
removed, and gentle diuresis was begun. On POD #2, epinephrine
weaning continued and beta blockade was started. Swan was
removed and he was transferred to the floor on POD #3 to begin
increasing his activity level. He had an episode of A fib on
[**5-13**], and amiodarone and coumadin were started. He converted to
SR and coumadin was discontinued. He will go home on amiodarone
today after 24 hours in SR. Cleared for discharge to home with
VNA services on POD #6. Patient is also to follow up with Dr.
[**Last Name (STitle) **] for evaluation of the pulmonary nodules.

Medications on Admission:
norvasc 10 mg daily
benazepril 10 mg daily
nexium 40 mg [**Hospital1 **]
ASA
gaviscon
lupron
detrol LA 4 mg daily
toprol XL 50 mg daily
fosamax 70 mg weekly
metamucil
selenium

Discharge Medications:
1. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 7 days.
Disp:*14 Packet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
3. 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*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
10. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 7 days: then 200 mg [**Hospital1 **] for 7 days, then 200 mg daily
 ongoing.
Disp:*60 Tablet(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
VNA of [**Location (un) 5871**]-[**Location (un) 6159**]

Discharge Diagnosis:
s/p AVR/ cabg x3
prostate CA
elev. chol.
COPD
PUD/GERD
spinal stenosis
TURP
bilat. pulm. nodules
colon polyps
renal calculi
HTN


Discharge Condition:
stable


Discharge Instructions:
no lotions, creams or powders on any incision
no driving for one month
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 101, redness, or drainage
may shower over incisions and pat dry

Followup Instructions:
see Dr. [**Last Name (STitle) **] in [**1-13**] weeks
See Dr. [**First Name (STitle) 1075**] in [**2-14**] weeks
see Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Follow up with Dr. [**Last Name (STitle) **] from thoracic surgery to evaluate
pulmonary nodules. Your appt. with him is on Thursday [**5-21**] at
9:30 AM on [**Hospital Ward Name 23**] 9, [**Hospital1 18**] [**Hospital Ward Name **].  [**Telephone/Fax (1) 170**]



Completed by:[**2172-5-14**]
{'Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension,Calculus of kidney,Other diseases of lung, not elsewhere classified,Aortic valve disorders,Intermediate coronary syndrome,Chronic airway obstruction, not elsewhere classified'}


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 after elective cath

PRESENT ILLNESS: 76 yo male recently cathed for evaluation in preparation of
probable valve surgery. He had a known history of AS/AI from
echo done [**4-16**]. This also showed EF 60%, mild MR,, peak AV
gradient 48mm, [**Location (un) 109**] 1.3 cm2, dilated aortic root. Cath [**5-6**]
showed 60% ostial LM, LAD 90%, RCA 90%.Transferred in from MWMC
after experiencing chest pain post-cath.

MEDICAL HISTORY: prostate CA/TURP
spinal stenosis
COPD
GERD/PUD
colon polyps
hemorrhoid surgery
elev. chol.

MEDICATION ON ADMISSION: norvasc 10 mg daily
benazepril 10 mg daily
nexium 40 mg [**Hospital1 **]
ASA
gaviscon
lupron
detrol LA 4 mg daily
toprol XL 50 mg daily
fosamax 70 mg weekly
metamucil
selenium

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD, pain free
HR 61  137/47  97% on 2LNC  RR 18
RRR  4/6 SEM at USB
neck nilat transmitted murmur vs. bruits ( left greater than
right)
CTAB anterolateral
warm, no edema, 1+ pedal pulses, no varicosities
soft, NT, ND

FAMILY HISTORY: brother died of ESRD at age  71 (angina)
mother with "heart problems"

SOCIAL HISTORY: no tobacco now, quit 15 years ago
no ETOH currently
lives with wife 

### Response:
{'Coronary atherosclerosis of native coronary artery,Personal history of malignant neoplasm of prostate,Unspecified essential hypertension,Calculus of kidney,Other diseases of lung, not elsewhere classified,Aortic valve disorders,Intermediate coronary syndrome,Chronic airway obstruction, not elsewhere classified'}
