CHIEF COMPLAINT: shoulder pain

PRESENT ILLNESS: 79M w/ CAD, AS, DM, HTN, hyperlipidemia p/w acute onset
bilateral shoulder pain occuring at rest, radiating down the
arms, associated w/ SOB and mild diaphoresis. Notably, the
patient has had subacute crescendo angina over the course of
weeks to months refractory to SL nitro, prompting use of a nitro
patch at night. He sleeps sitting upright in a chair due to
orthopnea. He notes intermittent LE swelling. He has had a week
h/o URI symptoms, dry cough, and occasional chills. The
patient's wife notes that he had LOC and a fall 1 month ago. He
has not had fever, abdominal pain, or N/V/D. He has not had sick
contacts or recent travel.
He presented to [**Hospital1 **]-[**Location (un) 620**] where BP 144/75 HR 79 RR 20 O2sat 95%
RA. EKG showed diffuse 2-[**Street Address(2) 79078**] depressions. He
was given plavix 600 mg, heparin gtt, and nitro gtt prior to
transfer to [**Hospital1 18**]. In our ED, T 98.8 HR 71 BP 118/56 RR 22 O2sat
99% RA. EKG showed resolution of STD in II,III,F (c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 620**]
EKG), <1 mm STE in V1-V2, and persistent >1 mm STD in V4-V5. He
was started on nitro gtt for persistent CP and heparin gtt,
which was d/c'd when noted to be guaiac positive. He was
transferred to the floor for further evaluation. He is currently
pain-free off nitro. Ruled in for NSTEMI.

MEDICAL HISTORY: CAD
dCHF (EF 55-60% [**2179-4-23**] TTE)
AS ([**Location (un) 109**] 1.0 cm2 [**2179-4-23**] TTE)
DMII
HTN
hyperlipidemia
prostate CA s/p prostatectomy

MEDICATION ON ADMISSION: ASA 325 mg daily, plavix 75 mg daily, atenolol 25 mg daily,
isosorbide 30 mg qAM, norvasc 1.25 mg qPM, lasix 60 mg daily,
metformin 500 [**Hospital1 **], lipitor 80 mg daily, klor-con 20 mEq [**Hospital1 **],
nitro patch 0.4 mg/hr, oscal 600+ BIDa, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
5'8"  190#
V/S - T 97.5 HR 68 BP 122/64 RR 18 O2sat 99% 2L.
GEN: Elderly obese male lying flat in bed, NAD
HEENT: NC/AT, sclera anicteric, PERRL, EOMI, OP clear with dry
MM
Neck: Supple, JVP difficult to assess due to habitus
CV: RRR nl S1S2 III/VI SEM @ LUSB no r/g
PULM: L basilar crackles no wheeze/rhonchi
ABD: soft obese NTND normoactive BS
Ext: warm, dry w/ 1+ PT/DP pulses, 1+ symmetrical pitting LE
edema

FAMILY HISTORY: Mother had CVA. Father had bladder CA. No known h/o premature
CAD.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **], MA. Retired salesman. Former 3
pack/day smoker, quit >30 years ago. Currently smokes a pipe.
Drinks 2-4 ETOH 2-3x/week.
Aortic valve disorders,Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Delirium due to conditions classified elsewhere,Hyperosmolality and/or hypernatremia,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Dysphagia, unspecified,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Anemia, unspecified,Orthopnea,Oliguria and anuria,Alcohol abuse, unspecified,Nonspecific abnormal findings in stool contents,Atherosclerosis of aorta,Personal history of malignant neoplasm of prostate,Other postprocedural status
Aortic valve disorder,Subendo infarct, initial,Chr syst/diastl hrt fail,Delirium d/t other cond,Hyperosmolality,Pleural effusion NOS,Crnry athrscl natve vssl,Hypertension NOS,Dysphagia NOS,Iatrogenc hypotnsion NEC,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Anemia NOS,Orthopnea,Oliguria & anuria,Alcohol abuse-unspec,Abn find-stool contents,Aortic atherosclerosis,Hx-prostatic malignancy,Post-proc states NEC
Admission Date:  [**2180-10-2**]              Discharge Date:   [**2180-10-21**]

Date of Birth:  [**2101-6-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
shoulder pain

Major Surgical or Invasive Procedure:
cardiac catheterization  [**2180-10-5**]
[**2180-10-6**] AVR ( 21mm St. [**Male First Name (un) 923**] porcine)/ cabg x3 (LIMA to LAD, SVG
to OM, SVG to RCA)

History of Present Illness:
79M w/ CAD, AS, DM, HTN, hyperlipidemia p/w acute onset
bilateral shoulder pain occuring at rest, radiating down the
arms, associated w/ SOB and mild diaphoresis. Notably, the
patient has had subacute crescendo angina over the course of
weeks to months refractory to SL nitro, prompting use of a nitro
patch at night. He sleeps sitting upright in a chair due to
orthopnea. He notes intermittent LE swelling. He has had a week
h/o URI symptoms, dry cough, and occasional chills. The
patient's wife notes that he had LOC and a fall 1 month ago. He
has not had fever, abdominal pain, or N/V/D. He has not had sick
contacts or recent travel.
He presented to [**Hospital1 **]-[**Location (un) 620**] where BP 144/75 HR 79 RR 20 O2sat 95%
RA. EKG showed diffuse 2-[**Street Address(2) 79078**] depressions. He
was given plavix 600 mg, heparin gtt, and nitro gtt prior to
transfer to [**Hospital1 18**]. In our ED, T 98.8 HR 71 BP 118/56 RR 22 O2sat
99% RA. EKG showed resolution of STD in II,III,F (c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 620**]
EKG), <1 mm STE in V1-V2, and persistent >1 mm STD in V4-V5. He
was started on nitro gtt for persistent CP and heparin gtt,
which was d/c'd when noted to be guaiac positive. He was
transferred to the floor for further evaluation. He is currently
pain-free off nitro. Ruled in for NSTEMI.

Past Medical History:
CAD
dCHF (EF 55-60% [**2179-4-23**] TTE)
AS ([**Location (un) 109**] 1.0 cm2 [**2179-4-23**] TTE)
DMII
HTN
hyperlipidemia
prostate CA s/p prostatectomy

Social History:
Lives with wife in [**Name (NI) **], MA. Retired salesman. Former 3
pack/day smoker, quit >30 years ago. Currently smokes a pipe.
Drinks 2-4 ETOH 2-3x/week.

Family History:
Mother had CVA. Father had bladder CA. No known h/o premature
CAD.

Physical Exam:
ADMISSION PHYSICAL EXAM
5'8"  190#
V/S - T 97.5 HR 68 BP 122/64 RR 18 O2sat 99% 2L.
GEN: Elderly obese male lying flat in bed, NAD
HEENT: NC/AT, sclera anicteric, PERRL, EOMI, OP clear with dry
MM
Neck: Supple, JVP difficult to assess due to habitus
CV: RRR nl S1S2 III/VI SEM @ LUSB no r/g
PULM: L basilar crackles no wheeze/rhonchi
ABD: soft obese NTND normoactive BS
Ext: warm, dry w/ 1+ PT/DP pulses, 1+ symmetrical pitting LE
edema

Pertinent Results:
[**2180-10-2**] @ 0856 - SR @ 70 bpm, LAD, <1 mm STE R, <1 mm STD
II,F,V3, <2 mm STD V4-V5; QTc 453 ms
[**10-6**] Echo: Pre-CPB: The left atrium and right atrium are normal
in cavity size. No mass/thrombus is seen in the left atrium or
left atrial appendage. Left ventricular wall thicknesses are
normal. The left ventricular cavity size is normal. No left
ventricular aneurysm is seen. There is moderate regional left
ventricular systolic dysfunction with LVEF approximately 30-35%.
. No masses or thrombi are seen in the left ventricle. The
remaining left ventricular segments contract normally. Right
ventricular chamber size and free wall motion are normal. There
are simple atheroma in the aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets are severely thickened/deformed. There is severe aortic
stenosis. ([**Location (un) 109**]~ 0.8-0.9 cm2) Trace aortic regurgitation is seen.
The aortic regurgitation jet is eccentric. The mitral valve
leaflets are structurally normal. Mild (1+) mitral regurgitation
is seen. There is no pericardial effusion. POSTBYPASS: The pt is
receiving an infusion of milrinone at 0.15 uck/kg/min and
norepinephrine at 0.08 ucg/kg/min. There is preserved RV
systolic. LV systolic function is mildly improved in the setting
of inotropes (Walls that contact[**Name (NI) **] well prebypass are more
hyperdynamic/walls that were hypokinetic remain hypokinetic)
There is a well seated bioprosthesis in the aortic position.
There is a perivalvular AI jet originating in the area outside
and between the left and right coronary cusps of the prosthesis.
The AI is moderate (2+) in quantity. The remaining study is
unchanged from prebypass.
[**10-2**] Cath: 1. Selective coronary angiography of this right
dominant system
demonstrated 3-vessel disease. The LMCA is short and heavily
calcified. The LAD is totally occluded proximally. There is
collateral flow from left to left and right to left. The LCX is
non-dominant with a discrete 90% OM2 lesion. The RCA is a
dominant vessel with an 80% lesion at the origin and is heavily
calcified. There are robust right to left collaterals. 2.
Resting hemodynamics revealed a systolic arterial blood pressure
of 133/62 mmHg.

[**2180-10-19**] 02:16AM BLOOD WBC-14.5* RBC-3.55* Hgb-11.0* Hct-33.2*
MCV-94 MCH-30.9 MCHC-32.9 RDW-16.0* Plt Ct-334
[**2180-10-9**] 02:10AM BLOOD PT-13.5* PTT-32.1 INR(PT)-1.2*
[**2180-10-20**] 11:50AM BLOOD Glucose-183* UreaN-27* Creat-1.0 Na-141
K-3.7 Cl-105
[**Known lastname **],[**Known firstname **] [**Age over 90 79079**] M  79  [**2101-6-9**]

Radiology Report CHEST (PORTABLE AP) Study Date of [**2180-10-19**] 7:12
AM


[**Last Name (LF) **],[**First Name7 (NamePattern1) 1112**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] CSRU [**2180-10-19**] SCHED
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 79080**]
Reason: evaluate effusions



[**Hospital 93**] MEDICAL CONDITION:
   79 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
   evaluate effusions
Final Report
SINGLE VIEW OF THE CHEST [**2180-10-19**]

HISTORY: 79-year-old man, status post CABG; evaluate effusions.

FINDINGS: Single bedside AP examination labeled "supine at 7:25
a.m." is
compared with upright studies obtained the preceding day. The
patient is
status post recent CABG with midline surgical staples in situ
and intact
sternal cerclage wires. Allowing for the positioning, the
overall appearance
is not much changed. There is persistent LV enlargement without
vascular
congestion and only small bilateral pleural effusions. There is
right more
than left basilar subsegmental atelectasis, with no other
airspace process.
Atherosclerotic calcification of the thoracic aorta is
redemonstrated.

IMPRESSION: Status post recent CABG without CHF or significant
effusion.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7593**]
Approved: FRI [**2180-10-20**] 2:12 PM





Brief Hospital Course:
As mentioned in the HPI, Mr. [**Known lastname **] presented to an OSH with a
NSTEMI. He was medically managed and transferred to [**Hospital1 18**] for
further care. On [**10-5**] he underwent a cardiac cath which revealed
three vessel coronary artery disease and aortic stenosis. On
[**10-6**] he was brought to the operating room where he underwent a
coronary artery bypass graft and aortic valve replacement.
Please see operative report for surgical details. Following
surgery he was transferred to the CVICU for invasive monitoring
in stable condition. Remained on Levophed, milrinone, and
vasopressin drips which were slowly weaned over a few days.
Within 25 hours he was weaned from sedation, awoke
neurologically intact and extubated. On post-op day four chest
tubes were removed. Bedside swallowing eval. performed on
post-op day five as he had some dysphagia with emesis along with
altered mental status. He slowly developed worsening pulmonary
edema despite aggressively pulmonary toilet. He required a right
thoracentesis for an effusion on post-op day twelve. He also had
thoracentesis on the left and his respiratory status improved.
He was intermittently on BIPAP at night and no longer requires
this.  His mental status and respiratory status improved and he
was discharged to rehab in stable condition on POD#15.

Medications on Admission:
ASA 325 mg daily, plavix 75 mg daily, atenolol 25 mg daily,
isosorbide 30 mg qAM, norvasc 1.25 mg qPM, lasix 60 mg daily,
metformin 500 [**Hospital1 **], lipitor 80 mg daily, klor-con 20 mEq [**Hospital1 **],
nitro patch 0.4 mg/hr, oscal 600+ BIDa, MVI

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:*2*
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q4H (every 4 hours) as
needed.
5. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO PRN (as needed)
as needed for K<4.0.
11. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
12. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
13. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed.
14. Insulin Glargine 100 unit/mL Solution Sig: Twenty Five (25)
units Subcutaneous once a day.
15. Insulin Lispro 100 unit/mL Solution Sig: various
Subcutaneous four times a day: ss.
16. Fosamax 70 mg Tablet Sig: One (1) Tablet PO once a week.
17. Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day.



Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Aortic Stenosis s/p Aortic valve replacement
CAD s/p Coronary artery bypass graft x 3
PMH: Hypercholesterolemia, ETOH abuse, h/o prostate CA, s/p
prostatectomy, NIDDM, HTN

Discharge Condition:
Good

Discharge Instructions:
No lifting more than 10 pounds for 10 weeks
Shower daily,no baths or swimming
No creams, lotions or powders to incisions
No driving for 4 weeks and off narcotics
Take all prescribed medications as directed
Report any wound drainage/redness or fever greater than 101 to
our office.


Followup Instructions:
Followup with Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
followup with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 2 weeks
see Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 79081**] in [**3-12**] weeks


Completed by:[**2180-10-21**]
{'Aortic valve disorders,Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Delirium due to conditions classified elsewhere,Hyperosmolality and/or hypernatremia,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Dysphagia, unspecified,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Anemia, unspecified,Orthopnea,Oliguria and anuria,Alcohol abuse, unspecified,Nonspecific abnormal findings in stool contents,Atherosclerosis of aorta,Personal history of malignant neoplasm of prostate,Other postprocedural status'}


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: shoulder pain

PRESENT ILLNESS: 79M w/ CAD, AS, DM, HTN, hyperlipidemia p/w acute onset
bilateral shoulder pain occuring at rest, radiating down the
arms, associated w/ SOB and mild diaphoresis. Notably, the
patient has had subacute crescendo angina over the course of
weeks to months refractory to SL nitro, prompting use of a nitro
patch at night. He sleeps sitting upright in a chair due to
orthopnea. He notes intermittent LE swelling. He has had a week
h/o URI symptoms, dry cough, and occasional chills. The
patient's wife notes that he had LOC and a fall 1 month ago. He
has not had fever, abdominal pain, or N/V/D. He has not had sick
contacts or recent travel.
He presented to [**Hospital1 **]-[**Location (un) 620**] where BP 144/75 HR 79 RR 20 O2sat 95%
RA. EKG showed diffuse 2-[**Street Address(2) 79078**] depressions. He
was given plavix 600 mg, heparin gtt, and nitro gtt prior to
transfer to [**Hospital1 18**]. In our ED, T 98.8 HR 71 BP 118/56 RR 22 O2sat
99% RA. EKG showed resolution of STD in II,III,F (c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 620**]
EKG), <1 mm STE in V1-V2, and persistent >1 mm STD in V4-V5. He
was started on nitro gtt for persistent CP and heparin gtt,
which was d/c'd when noted to be guaiac positive. He was
transferred to the floor for further evaluation. He is currently
pain-free off nitro. Ruled in for NSTEMI.

MEDICAL HISTORY: CAD
dCHF (EF 55-60% [**2179-4-23**] TTE)
AS ([**Location (un) 109**] 1.0 cm2 [**2179-4-23**] TTE)
DMII
HTN
hyperlipidemia
prostate CA s/p prostatectomy

MEDICATION ON ADMISSION: ASA 325 mg daily, plavix 75 mg daily, atenolol 25 mg daily,
isosorbide 30 mg qAM, norvasc 1.25 mg qPM, lasix 60 mg daily,
metformin 500 [**Hospital1 **], lipitor 80 mg daily, klor-con 20 mEq [**Hospital1 **],
nitro patch 0.4 mg/hr, oscal 600+ BIDa, MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM
5'8"  190#
V/S - T 97.5 HR 68 BP 122/64 RR 18 O2sat 99% 2L.
GEN: Elderly obese male lying flat in bed, NAD
HEENT: NC/AT, sclera anicteric, PERRL, EOMI, OP clear with dry
MM
Neck: Supple, JVP difficult to assess due to habitus
CV: RRR nl S1S2 III/VI SEM @ LUSB no r/g
PULM: L basilar crackles no wheeze/rhonchi
ABD: soft obese NTND normoactive BS
Ext: warm, dry w/ 1+ PT/DP pulses, 1+ symmetrical pitting LE
edema

FAMILY HISTORY: Mother had CVA. Father had bladder CA. No known h/o premature
CAD.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **], MA. Retired salesman. Former 3
pack/day smoker, quit >30 years ago. Currently smokes a pipe.
Drinks 2-4 ETOH 2-3x/week. 

### Response:
{'Aortic valve disorders,Subendocardial infarction, initial episode of care,Chronic combined systolic and diastolic heart failure,Delirium due to conditions classified elsewhere,Hyperosmolality and/or hypernatremia,Unspecified pleural effusion,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Dysphagia, unspecified,Other iatrogenic hypotension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Anemia, unspecified,Orthopnea,Oliguria and anuria,Alcohol abuse, unspecified,Nonspecific abnormal findings in stool contents,Atherosclerosis of aorta,Personal history of malignant neoplasm of prostate,Other postprocedural status'}
