CHIEF COMPLAINT: Angina

PRESENT ILLNESS: 46 year old gentleman with known coronary artery disease s/p
multiple PCI's, past MI and VF arrest who has been experiencing
jaw pain over the past few weeks. He underwent a cardiac
catheterization which revealed severe left main and three vessel
disease. Given these findings, he was referred for surgical
management.

MEDICAL HISTORY: CAD
PCI/Stent [**8-8**], [**4-9**]
Myocardial infarction [**8-8**]
Cardiomyopathy
VF Arrest [**2113**]
PVD
HTN
Hyperlipidemia

MEDICATION ON ADMISSION: Plavix 75'
Lipitor 80'
Lisinopril 10'
Toprol XL 100'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 55 SB   16  115/72  117/74  72" 284lbs
GEN: NAD
Skin: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM
LUNGS: CTA
HEART: RRR, Nl S1-S2, No M/R/G
ABD: S/NT/ND/NABS
EXT: Warm, well perfused, no C/C/E. 2+ Pulses. No varicosities.
NEURO: Nonfocal. No carotid bruits

FAMILY HISTORY: Mother w/ CAD

SOCIAL HISTORY: Tobacco: 0.5 pack X 15 years
EtOH: 1qwk
Limited exercise
Publisher of a magazine, lives in [**Location 5028**] with wife
Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Family history of ischemic heart disease
Crnry athrscl natve vssl,Prim cardiomyopathy NEC,Angina pectoris NEC/NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Periph vascular dis NOS,Old myocardial infarct,Status-post ptca,History of tobacco use,Fam hx-ischem heart dis
Admission Date:  [**2116-6-4**]              Discharge Date:   [**2116-6-9**]

Date of Birth:  [**2069-12-1**]             Sex:   M

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:
[**2116-6-5**] - CABGx3 (Left internal mammary artery->Left anterior
descending artery, Vein->Ramus, Vein->Diagonal artery)
[**2116-6-4**] - Cardiac Catheterization


History of Present Illness:
46 year old gentleman with known coronary artery disease s/p
multiple PCI's, past MI and VF arrest who has been experiencing
jaw pain over the past few weeks. He underwent a cardiac
catheterization which revealed severe left main and three vessel
disease. Given these findings, he was referred for surgical
management.

Past Medical History:
CAD
PCI/Stent [**8-8**], [**4-9**]
Myocardial infarction [**8-8**]
Cardiomyopathy
VF Arrest [**2113**]
PVD
HTN
Hyperlipidemia


Social History:
Tobacco: 0.5 pack X 15 years
EtOH: 1qwk
Limited exercise
Publisher of a magazine, lives in [**Location 5028**] with wife


Family History:
Mother w/ CAD

Physical Exam:
55 SB   16  115/72  117/74  72" 284lbs
GEN: NAD
Skin: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM
LUNGS: CTA
HEART: RRR, Nl S1-S2, No M/R/G
ABD: S/NT/ND/NABS
EXT: Warm, well perfused, no C/C/E. 2+ Pulses. No varicosities.
NEURO: Nonfocal. No carotid bruits

Pertinent Results:
.
[**2116-6-9**] 05:55AM BLOOD WBC-12.2* RBC-3.15* Hgb-10.4* Hct-29.4*
MCV-93 MCH-33.0* MCHC-35.4* RDW-13.8 Plt Ct-304#
[**2116-6-5**] 06:47PM BLOOD PT-15.1* PTT-37.4* INR(PT)-1.3*
[**2116-6-9**] 05:55AM BLOOD Glucose-135* UreaN-21* Creat-1.1 Na-139
K-4.3 Cl-104 HCO3-27 AnGap-12

[**2116-6-4**] Carotid duplex ultrasound
No stenosis of the carotid arteries bilaterally.

[**2116-6-4**] Cardiac Catheterization
1- Selective coronary angiography of this right-dominant system
reveald
progression of known multivessel CAD. The LMCA had a distal 80%
lesion
with haziness suggestive of an active lesion. The LAD stent was
widely
patent with mild disease in the distal vessel. The D1 was a
large branch
with mild disease. The LCX had a 90% origin stenosis. The RCA
was a
dominant vessel with widely patent stent. There was mild disease

involving the proximal and distal RCA segments. Additionally, a
60%
stenosis was apparent in the RPDA.
2- Limited hemodynamic assessment revelaed mildly elevated LVEDP
(14
mmHg) at baseline. Following left ventriculography, the LVED was

moderately elevated to 20 mmHg. The systemic arterial blood
pressure
was normal 125/79 mmHg.
3- left ventriculography revealed normal left ventricular
systolic
function with LVEF 55%.

[**2116-6-5**] Echocardiogram
PRE-BYPASS:
The left atrium is normal in size. No spontaneous echo contrast
or thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler. There is mild symmetric left ventricular hypertrophy
with normal cavity size. There is moderate regional left
ventricular systolic dysfunction with apical hypokinesis
excepting the apical lateral segment.. Overall left ventricular
systolic function is moderately depressed (LVEF= 35 %). Right
ventricular chamber size and free wall motion are normal. There
are simple 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 structurally normal. Mild (1+) mitral regurgitation is seen.
There is no pericardial effusion. Dr. [**Last Name (STitle) 914**] was notified in
person of the results on Mr.[**Known lastname 2819**] at 1330hrs before CPB.
Post_Bypass:
Overall LVEF 40%. Patient is on no inotropes.
Mild MR, Trivial TR.
Normal RV systolic function.
Thoracic aortic contour is well preserved

CHEST (PORTABLE AP)  [**2116-6-8**] 9:25 AM

CHEST (PORTABLE AP)

Reason: ? ptx s/p ct removal

[**Hospital 93**] MEDICAL CONDITION:
46 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
? ptx s/p ct removal
HISTORY: Status post chest tube removal following CABG.

FINDINGS: In comparison with study of [**6-5**], all of the tubes have
been removed. Low lung volumes but no evidence of pneumothorax.
Residual atelectatic changes are seen, especially at the left
base

Brief Hospital Course:
Mr. [**Known lastname 2819**] was admitted to the [**Hospital1 18**] on [**2116-6-4**] for further workup
of his angina. He underwent a cardiac catheterization which
revealed severe left main and three vessel coronary artery
disease. Given the severity of his disease, the cardiac surgical
service was consulted for surgical management. He was worked-up
in the usual preoperative manner including a carotid duplex
ultrasound which showed no significant carotid artery stenosis.
On [**2116-6-5**], Mr. [**Known lastname 2819**] was taken to the operating room where he
underwent coronary artery bypass grafting to three vessels.
Please see operative note for details. Postoperatively he was
taken to the cardiac surgical intensive care unit for
monitoring. By postoperative day one, Mr. [**Known lastname 2819**] had awoke
neurologically intact and was extubated. Beta blockade, aspirin
and a statin were resumed. Plavix was also resumed as he had
prior stents. On postoperative day two, he was transferred to
the step down unit for further recovery. He was gently diuresed
towards his preoperatived weight. The physical therapy service
was consulted for assistance with his postoperative strength and
mobility. Mr. [**Known lastname 2819**] continued to make steady progress and was
discharged home on postoperative day four. He will follow-up
with Dr. [**Last Name (STitle) 914**], Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) 64402**] as an outpatient.

Medications on Admission:
Plavix 75'
Lipitor 80'
Lisinopril 10'
Toprol XL 100'

Discharge Medications:
1. 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:*0*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Lopressor 50 mg Tablet Sig: 1.5 Tablets PO twice a day.
Disp:*90 Tablet(s)* Refills:*0*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
Two (2) Tab Sust.Rel. Particle/Crystal PO once a day for 1
weeks.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
CAD s/p CABGx3
Hyperlipidemia
HTN
STEMI [**8-8**]
VF arrest
PTCA/STenting [**8-8**] and [**4-9**]
Cardiomyopathy
Obesity


Discharge Condition:
Stable


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 177**] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 170**]  Follow-up appointment
should be in 1 month
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 4022**]  Follow-up
appointment should be in 2 weeks
Provider: [**Name10 (NameIs) 64403**],[**First Name3 (LF) **] L.  [**Telephone/Fax (1) 32949**]  Follow-up appointment
should be in 2 weeks



Completed by:[**2116-6-9**]
{'Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,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: 46 year old gentleman with known coronary artery disease s/p
multiple PCI's, past MI and VF arrest who has been experiencing
jaw pain over the past few weeks. He underwent a cardiac
catheterization which revealed severe left main and three vessel
disease. Given these findings, he was referred for surgical
management.

MEDICAL HISTORY: CAD
PCI/Stent [**8-8**], [**4-9**]
Myocardial infarction [**8-8**]
Cardiomyopathy
VF Arrest [**2113**]
PVD
HTN
Hyperlipidemia

MEDICATION ON ADMISSION: Plavix 75'
Lipitor 80'
Lisinopril 10'
Toprol XL 100'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 55 SB   16  115/72  117/74  72" 284lbs
GEN: NAD
Skin: Unremarkable
HEENT: Unremarkable
NECK: Supple, FROM
LUNGS: CTA
HEART: RRR, Nl S1-S2, No M/R/G
ABD: S/NT/ND/NABS
EXT: Warm, well perfused, no C/C/E. 2+ Pulses. No varicosities.
NEURO: Nonfocal. No carotid bruits

FAMILY HISTORY: Mother w/ CAD

SOCIAL HISTORY: Tobacco: 0.5 pack X 15 years
EtOH: 1qwk
Limited exercise
Publisher of a magazine, lives in [**Location 5028**] with wife 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other primary cardiomyopathies,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Personal history of tobacco use,Family history of ischemic heart disease'}
