CHIEF COMPLAINT: Left arm numbness and +ETT after Coronary stenting(BMS)

PRESENT ILLNESS: s/p Inferior Myocardial Infarction([**6-/2126**]) during which he
presented with syncope and high grade AV block. Had cardiac cath
and angioplasty(BMS) of RCA at that time. Complained again
during ETT of arm numbness and chest discomfort and was referred
for bypass grafting.

MEDICAL HISTORY: Coronary Artery Disease s/p AMI/angioplasty(BMS)[**6-/2126**],
Hypertension, Dyslipidemia, Right Bundle branch block, ? Seizure
disorder([**2125**]), Rectal prolapse, Benign prostatic hypertrophy

MEDICATION ON ADMISSION: Diovan 80', Metoprolol SR 200', Lipitor 80', Plavix 75'(last
dose 6/25), Aspirin 325', Keppra 500"-stopped, Omeprazole 20',
Colace 100"
On transfer add Maxair Inhaler 2 puffs TID, Nitropaste [**2-16**]"
Q6hrs, Zofran 4mg Q8hrs

ALLERGIES: Ciprofloxacin Hcl / Lisinopril

PHYSICAL EXAM: On Admission
Temp 98  Pulse: 66  Resp: 16  O2 sat: 95%-RA
B/P  Right: 127/68    Left:
Height: 5'6"    Weight:144 lbs

FAMILY HISTORY: no cardiac disease- father CVA

SOCIAL HISTORY: Lives with: wife
Occupation: semi retired engineer/former missioary minister
Tobacco: quit 40 yrs ago
ETOH: none
Coronary atherosclerosis of native coronary artery,Hyposmolality and/or hyponatremia,Unspecified pleural effusion,Acute myocardial infarction of other inferior wall, subsequent episode of care,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Right bundle branch block,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Rectal prolapse,Anemia, unspecified
Crnry athrscl natve vssl,Hyposmolality,Pleural effusion NOS,AMI inferior wall,subseq,Status-post ptca,Hypertension NOS,Hyperlipidemia NEC/NOS,Rt bundle branch block,BPH w/o urinary obs/LUTS,Rectal prolapse,Anemia NOS
Admission Date:  [**2126-8-11**]              Discharge Date:   [**2126-8-21**]

Date of Birth:  [**2041-4-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ciprofloxacin Hcl / Lisinopril

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Left arm numbness and +ETT after Coronary stenting(BMS)


Major Surgical or Invasive Procedure:
[**2126-8-13**] Coronary artery bypass grafting x4 with a left
internal mammary artery to the left anterior descending
artery and reverse saphenous vein grafts to the posterior
descending artery, the right posterior left ventricular
branch artery, second diagonal artery.


History of Present Illness:
s/p Inferior Myocardial Infarction([**6-/2126**]) during which he
presented with syncope and high grade AV block. Had cardiac cath
and angioplasty(BMS) of RCA at that time. Complained again
during ETT of arm numbness and chest discomfort and was referred
for bypass grafting.


Past Medical History:
Coronary Artery Disease s/p AMI/angioplasty(BMS)[**6-/2126**],
Hypertension, Dyslipidemia, Right Bundle branch block, ? Seizure
disorder([**2125**]), Rectal prolapse, Benign prostatic hypertrophy


Social History:
Lives with: wife
Occupation: semi retired engineer/former missioary minister
Tobacco: quit 40 yrs ago
ETOH: none


Family History:
 no cardiac disease- father CVA


Physical Exam:
On Admission
Temp 98  Pulse: 66  Resp: 16  O2 sat: 95%-RA
B/P  Right: 127/68    Left:
Height: 5'6"    Weight:144 lbs

General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Varicosities: None [x]
Neuro: Grossly intact, non-focal exam
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit  no      Right: 2+   Left:
2+


Pertinent Results:
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**2126-8-13**] at 12:01:48 PM
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  60% to 65%  >= 55%
Findings
LEFT ATRIUM: Mild LA enlargement. No spontaneous echo contrast
or thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. Normal
interatrial septum. No ASD by 2D or color Doppler.
LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
global systolic function (LVEF>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Simple atheroma in descending aorta.
AORTIC VALVE: Three aortic valve leaflets. No AS. Mild (1+) AR.
Eccentric AR jet directed toward the anterior mitral leaflet.
MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS.
Moderate (2+) MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets. Physiologic
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) PR.
PERICARDIUM: Trivial/physiologic 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.
Conclusions
Pre-bypass: The left atrium is mildly dilated. No spontaneous
echo contrast or thrombus is seen in the body of the left atrium
or left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler. Left ventricular wall thickness, cavity size,
and global systolic function are normal (LVEF>55%). 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. There are three
aortic valve leaflets. There is no aortic valve stenosis. Mild
(1+) aortic regurgitation is seen. The aortic regurgitation jet
is eccentric, directed toward the anterior mitral leaflet. The
mitral valve leaflets are mildly thickened. Moderate (2+) mitral
regurgitation is seen. There is a trivial/physiologic
pericardial effusion.
Post-bypass: The patient is receiving no inotropic support
post-CPB. Biventricular systolic function is preserved and all
findings are consistent with pre-bypass findings. The aorta is
intact post-decannulation. All findings communicated to the
surgeon intraoperatively.
PRELIMINARY REPORT developed by a Cardiology Fellow. Not
reviewed/approved by the Attending Echo Physician.
[**Name10 (NameIs) 55496**] assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD, Interpreting
physician
[**Name Initial (PRE) **]:
[**2126-8-11**] 12:35PM   PT-13.9* PTT-32.4 INR(PT)-1.2*
[**2126-8-11**] 12:35PM   PLT COUNT-255
[**2126-8-11**] 12:35PM   WBC-6.2 RBC-2.98* HGB-9.3* HCT-26.5* MCV-89
MCH-31.1 MCHC-34.9 RDW-13.8
[**2126-8-11**] 12:35PM   %HbA1c-6.1* eAG-128*
[**2126-8-11**] 12:35PM   ALBUMIN-3.6 CALCIUM-8.5 PHOSPHATE-3.0
MAGNESIUM-1.9 IRON-66
[**2126-8-11**] 12:35PM   CK-MB-2 cTropnT-<0.01
[**2126-8-11**] 12:35PM   LIPASE-28
[**2126-8-11**] 12:35PM   ALT(SGPT)-32 AST(SGOT)-26 LD(LDH)-128
CK(CPK)-51 ALK PHOS-103 AMYLASE-60 TOT BILI-0.4
[**2126-8-11**] 12:35PM   GLUCOSE-112* UREA N-18 CREAT-0.6 SODIUM-128*
POTASSIUM-4.6 CHLORIDE-95* TOTAL CO2-27 ANION GAP-11
[**2126-8-11**] 12:53PM   freeCa-1.09*
[**2126-8-11**] 05:12PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-7.0
LEUK-NEG
[**2126-8-11**] 05:12PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.014
[**2126-8-11**] 06:27PM   HCT-32.3*
Discharge:
[**2126-8-20**] 04:15AM BLOOD WBC-9.3 RBC-2.86* Hgb-8.6* Hct-24.9*
MCV-87 MCH-30.2 MCHC-34.6 RDW-14.9 Plt Ct-340
[**2126-8-20**] 04:15AM BLOOD Plt Ct-340
[**2126-8-15**] 03:05AM BLOOD PT-13.3 PTT-37.2* INR(PT)-1.1
[**2126-8-20**] 04:15AM BLOOD Glucose-96 UreaN-20 Creat-0.5 Na-127*
K-4.5 Cl-94* HCO3-27 AnGap-11
Radiology Report CHEST (PA & LAT) Study Date of [**2126-8-18**] 9:58 AM

[**Hospital 93**] MEDICAL CONDITION: 85 year old man s/p CABG
REASON FOR THIS EXAMINATION: eval for pleural effusions
Final Report
In comparison with the study of [**8-16**], moderate enlargement of the

cardiac silhouette persists in this patient with intact sternal
sutures
following CABG procedure. Left pleural effusion is again seen
and may be
slightly more prominent. Mild basilar atelectatic changes are
again seen. No definite vascular congestion or acute pneumonia.
DR. [**First Name11 (Name Pattern1) 1569**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 11006**]


Brief Hospital Course:
85yo man s/p IMI wBMS of RCA in [**2126-6-15**], admitted to MWMC [**8-9**]
after episode of arm tingling(anginal equivelant)during ETT. He
was placed on Heparin and Integrillin infusion. Did well over
next 2 days however had guiac + stool and recurrance of arm
tingling on [**8-11**]. He was transferred to [**Hospital1 18**] for further
treatment including planned coronary bypass grafting after
preoperative admission testing was completed.

On [**8-13**] Mr.[**Known lastname 85600**] was taken urgently to the operating room and
underwent coronary artery bypass grafting x4. Please refer to
Dr[**Doctor Last Name **] operative report for details, in summary he had:
Coronary artery bypass grafting x4 with a left internal mammary
artery to the left anterior descending artery and reverse
saphenous vein grafts to the posterior descending artery, the
right posterior left ventricular branch artery, second diagonal
artery. His bypass time was 83 minutes with a crossclamp of 76
minutes.
He tolerated the procedure well and was transferred to the CVICU
in stable but critical condition. He awoke neurologically intact
and was extubated without incident. He was weaned off cardiac
drips and Beta-blocker/Statin/Aspirin  and diuresis was
initiated. All lines and drains were discontinued according to
cardiac surgery protocol. On POD# 2 he was transferred to the
step down unit for further monitoring. Physical therapy was
consulted for evaluation of strength and mobility. The remainder
of his hospital course was uneventful. He continued to progress
and on POD#8 he was cleared by Dr.[**Last Name (STitle) **] for discharge to
rehabilitation atSudbury Pines in [**Location (un) 5176**], MA


Medications on Admission:
Diovan 80', Metoprolol SR 200', Lipitor 80', Plavix 75'(last
dose 6/25), Aspirin 325', Keppra 500"-stopped, Omeprazole 20',
Colace 100"
On transfer add Maxair Inhaler 2 puffs TID, Nitropaste [**2-16**]"
Q6hrs, Zofran 4mg Q8hrs

Plavix - last dose:[**8-9**]


Discharge Medications:
1. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours):
[**Hospital1 **] x 10days then QD until at pre-op weight(144lbs).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
9. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every six (6) hours as needed for pain.
10. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
2-4 Puffs Inhalation Q6H (every 6 hours) as needed for sob
wheezing.
11. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
12. Ferrous Sulfate 300  mg (60 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
13. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Furosemide 10 mg/mL Solution Sig: Forty (40) mg Injection
twice a day: IV BID x7 days then convert to PO and continue
until at preop weight(144lbs).
15. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
16. Sodium Chloride 0.9 % 0.9 % Parenteral Solution Sig: Three
(3) ML Intravenous DAILY (Daily) as needed for line flush:  0.9%
Flush 3 ml IV DAILY:PRN line flush Peripheral IV - Inspect site
every shift  .


Discharge Disposition:
Extended Care

Facility:
TBD

Discharge Diagnosis:
Coronary Artery Disease s/p AMI/angioplasty(BMS)[**6-/2126**],
[**2126-8-13**] Coronary artery bypass grafting x4
Hypertension, Dyslipidemia, Right
Bundle branch block, Seizure disorder([**2125**]), Rectal prolapse,
Benign prostatic hypertrophy


Discharge Condition:
Alert and oriented x3, nonfocal.
Ambulating with  steady gait.

Incisional pain managed with ****

Incisions:

Sternal - healing well, no erythema or drainage

Leg Right/Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
Shower daily including washing incisions gently with mild soap,
no baths or swimming until cleared by surgeon. Look at your
incisions daily for redness or drainage.

No lotions, cream, powder, or ointments to incisions.
Each morning you should weigh yourself and then in the evening
take your temperature, These should be written down on the chart
.
No driving for approximately one month, until follow up with
surgeon.
No lifting more than 10 pounds for 10 weeks.
Please call with any questions or concerns ([**Telephone/Fax (1) 170**]).
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge of sternal wound.



**Please call cardiac surgery office with any questions or
concerns ([**Telephone/Fax (1) 170**]). Answering service will contact on call
person during off hours.**






Followup Instructions:
are scheduled for the following appointments:
Surgeon:Dr.[**Last Name (STitle) **] #[**Telephone/Fax (1) 170**] appointment arranged for [**2126-9-11**] at 1:30 pm
Please call to schedule appointments with your

Primary Care:  Dr.[**Last Name (STitle) **],[**First Name3 (LF) **] P. [**Telephone/Fax (1) 83273**] in [**2-16**] weeks
Cardiologist:    Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 1295**] in [**2-16**] weeks

**Please call cardiac surgery office with any questions or
concerns ([**Telephone/Fax (1) 170**]). Answering service will contact on call
person during off hours.**





Completed by:[**2126-8-21**]

Name:  [**Known lastname 13566**],[**Known firstname **]                     Unit No:   [**Numeric Identifier 13567**]

Admission Date:  [**2126-8-11**]              Discharge Date:   [**2126-8-21**]

Date of Birth:  [**2041-4-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ciprofloxacin Hcl / Lisinopril

Attending:[**First Name3 (LF) 135**]
Addendum:
Medication Addendum:
Rehab called re: inability to administer IV medication.
Lasix was ordered: 80 mg (2) x 7 days, then decrease to 80 mg
(1) or until preoperative weight obtained: 144 LBS

Discharge Disposition:
Extended Care

Facility:
[**Location (un) 13063**] Pines Extended Care - Facility (Spec)

                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern4) 137**] MD [**MD Number(2) 138**]

Completed by:[**2126-8-21**]
{'Coronary atherosclerosis of native coronary artery,Hyposmolality and/or hyponatremia,Unspecified pleural effusion,Acute myocardial infarction of other inferior wall, subsequent episode of care,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Right bundle branch block,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Rectal prolapse,Anemia, unspecified'}


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: Left arm numbness and +ETT after Coronary stenting(BMS)

PRESENT ILLNESS: s/p Inferior Myocardial Infarction([**6-/2126**]) during which he
presented with syncope and high grade AV block. Had cardiac cath
and angioplasty(BMS) of RCA at that time. Complained again
during ETT of arm numbness and chest discomfort and was referred
for bypass grafting.

MEDICAL HISTORY: Coronary Artery Disease s/p AMI/angioplasty(BMS)[**6-/2126**],
Hypertension, Dyslipidemia, Right Bundle branch block, ? Seizure
disorder([**2125**]), Rectal prolapse, Benign prostatic hypertrophy

MEDICATION ON ADMISSION: Diovan 80', Metoprolol SR 200', Lipitor 80', Plavix 75'(last
dose 6/25), Aspirin 325', Keppra 500"-stopped, Omeprazole 20',
Colace 100"
On transfer add Maxair Inhaler 2 puffs TID, Nitropaste [**2-16**]"
Q6hrs, Zofran 4mg Q8hrs

ALLERGIES: Ciprofloxacin Hcl / Lisinopril

PHYSICAL EXAM: On Admission
Temp 98  Pulse: 66  Resp: 16  O2 sat: 95%-RA
B/P  Right: 127/68    Left:
Height: 5'6"    Weight:144 lbs

FAMILY HISTORY: no cardiac disease- father CVA

SOCIAL HISTORY: Lives with: wife
Occupation: semi retired engineer/former missioary minister
Tobacco: quit 40 yrs ago
ETOH: none 

### Response:
{'Coronary atherosclerosis of native coronary artery,Hyposmolality and/or hyponatremia,Unspecified pleural effusion,Acute myocardial infarction of other inferior wall, subsequent episode of care,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Right bundle branch block,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Rectal prolapse,Anemia, unspecified'}
