CHIEF COMPLAINT: Chest discomfort

PRESENT ILLNESS: 71 y/o male with increasing chest discomfort and b/l arm pain
with activity. He underwent a cardiac cath which revealed severe
three vessel coronary artery disease. Then referred for bypass
surgery.

MEDICAL HISTORY: Coronary Artery Disease and Myocardial Infarction s/p PTCA to
RCA [**2157**], Hypertension, Hypercholesterolemia, Obesity, Diabetes
Mellitus
PSH: Left eye surgery, Parotid Cyst surgery

MEDICATION ON ADMISSION: Aspirin 325mg qd, Lopressor 75mg [**Hospital1 **], Zocor 80mg qd, Lisinopril
10mg qd, Metformin 500mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: V: 68 18 126/83 5'8" 195lbs
Gen: WDWN male in NAD
Skin: Unremarkable
Neck: Supple, FROM, -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, +varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: NC

SOCIAL HISTORY: Quit smoking [**2156**] after 1ppd x 45 yrs. Drinks 1 beer/day.
Lives with spouse
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Other and unspecified angina pectoris
Crnry athrscl natve vssl,Surg compl-heart,Atrial fibrillation,Abn react-anastom/graft,Hypertension NOS,Old myocardial infarct,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Angina pectoris NEC/NOS
Admission Date:  [**2170-3-30**]              Discharge Date:   [**2170-4-6**]

Date of Birth:  [**2099-1-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest discomfort

Major Surgical or Invasive Procedure:
[**2170-4-2**] Coronary Artery Bypass Graft x 3 (LIMA to LAD, SVG to OM,
SVG to PDA)

History of Present Illness:
71 y/o male with increasing chest discomfort and b/l arm pain
with activity. He underwent a cardiac cath which revealed severe
three vessel coronary artery disease. Then referred for bypass
surgery.

Past Medical History:
Coronary Artery Disease and Myocardial Infarction s/p PTCA to
RCA [**2157**], Hypertension, Hypercholesterolemia, Obesity, Diabetes
Mellitus
PSH: Left eye surgery, Parotid Cyst surgery

Social History:
Quit smoking [**2156**] after 1ppd x 45 yrs. Drinks 1 beer/day.
Lives with spouse

Family History:
NC

Physical Exam:
V: 68 18 126/83 5'8" 195lbs
Gen: WDWN male in NAD
Skin: Unremarkable
Neck: Supple, FROM, -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, +varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2170-4-6**] 05:25AM BLOOD WBC-9.2 RBC-3.52* Hgb-10.7* Hct-31.3*
MCV-89 MCH-30.3 MCHC-34.1 RDW-13.6 Plt Ct-196
[**2170-3-30**] 08:49PM BLOOD WBC-6.9 RBC-4.89 Hgb-15.1 Hct-41.9 MCV-86
MCH-31.0 MCHC-36.1* RDW-12.9 Plt Ct-156
[**2170-4-6**] 05:25AM BLOOD Plt Ct-196
[**2170-3-30**] 08:49PM BLOOD PT-12.5 PTT-25.0 INR(PT)-1.1
[**2170-4-6**] 05:25AM BLOOD Glucose-101 UreaN-16 Creat-0.8 Na-141
K-4.3 Cl-104 HCO3-28 AnGap-13
[**2170-3-30**] 08:49PM BLOOD Glucose-178* UreaN-14 Creat-1.0 Na-141
K-3.9 Cl-105 HCO3-26 AnGap-14
[**2170-3-30**] 08:49PM BLOOD ALT-23 AST-18 LD(LDH)-176 AlkPhos-60
Amylase-82 TotBili-0.7
[**2170-3-30**] 08:49PM BLOOD Lipase-41
[**2170-4-6**] 05:25AM BLOOD Mg-2.4
[**2170-3-30**] 08:49PM BLOOD %HbA1c-6.7*

CHEST (PORTABLE AP)  [**2170-4-4**] 5:05 PM

CHEST (PORTABLE AP)

Reason: eval for effusions

[**Hospital 93**] MEDICAL CONDITION:
71 year old man s/p CABG
REASON FOR THIS EXAMINATION:
eval for effusions
CHEST RADIOGRAPH

INDICATION: Followup.

COMPARISON: [**2170-4-3**].

FINDINGS: As compared to the previous radiograph, there is no
major change. Status post CABG. Unchanged cardiomegaly with no
obvious signs of hyperhydration or cardiac failure. The minimal
pleural effusion left has slightly increased in extent and
causes moderate retrocardiac atelectasis. Otherwise, no focal
parenchymal opacities.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name8 (NamePattern2) 5206**] [**Name (STitle) **]
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]
Approved: FRI [**2170-4-6**] 12:18 AM

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 78059**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 78060**]
(Complete) Done [**2170-4-2**] at 12:28:47 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2099-1-26**]
Age (years): 71 M  Hgt (in): 68
BP (mm Hg): 123/67  Wgt (lb): 196
HR (bpm): 72  BSA (m2): 2.03 m2
Indication: Intraoperative TEE for CABG procedure
ICD-9 Codes: 786.05, 786.51, 440.0, 424.0
Test Information
Date/Time: [**2170-4-2**] at 12:28    Interpret MD: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1510**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW3-: Machine: AW3
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Peak Pulm Vein S:  0.6 m/s
Left Atrium - Peak Pulm Vein D:  0.3 m/s
Left Ventricle - Septal Wall Thickness:  1.1 cm  0.6 - 1.1 cm
Left Ventricle - Diastolic Dimension:  *6.1 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  5.2 cm
Left Ventricle - Fractional Shortening:  *0.15  >= 0.29
Left Ventricle - Ejection Fraction:  40%  >= 55%
Aorta - Annulus:  2.1 cm  <= 3.0 cm
Aorta - Ascending:  3.2 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.4 m/sec  <= 2.0 m/sec
Aortic Valve - Peak Gradient:  9 mm Hg  < 20 mm Hg
Aortic Valve - Mean Gradient:  5 mm Hg
Mitral Valve - E Wave:  0.5 m/sec
Mitral Valve - A Wave:  0.7 m/sec
Mitral Valve - E/A ratio:  0.71

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. No ASD by 2D or color
Doppler.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Normal LV wall thickness. Moderately
dilated LV cavity. Mild-moderate regional LV systolic
dysfunction. Mildly depressed LVEF. No resting LVOT gradient.

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

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal descending aorta diameter.
Simple atheroma in descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

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. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Prebypass

1. No atrial septal defect is seen by 2D or color Doppler.

2. Left ventricular wall thicknesses are normal. The left
ventricular cavity is moderately dilated.

3. There is mild to moderate regional left ventricular systolic
dysfunction with hypokinesia of the apex, apical and mid
portions of the anterior septum and anterior wall. Mid portion
of the inferior wall is also hypokinetic. . Overall left
ventricular systolic function is mildly depressed (LVEF= 40 %).

4.Right ventricular chamber size and free wall motion are
normal.

5.There are simple atheroma in the descending thoracic aorta.

6.The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen.

7. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen.

8.There is a trivial/physiologic pericardial effusion.

9.Dr. [**Last Name (STitle) **] was notified in person of the results on [**2170-4-2**]
during the operative procedure.

POST CPB Normal right ventricular systolic function. Left
ventricle with continued apical, distal anterior, and
anteroseptal hypokinesis. Overall left ventricular ejection
fraction is slightly improved from pre-CPB study, now 45-50%.
Mild mitral regurgitation remains. No other significant change
from pre-CPB study.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4901**], MD, Interpreting physician
[**Last Name (NamePattern4) **] [**2170-4-2**] 15:35



Brief Hospital Course:
Mr. [**Known lastname **] was transferred from outside hospital following
his cardiac catherization which showed severe three vessel
coronary artery disease. Upon admission he underwent
pre-operative work-up which included a cardiac echocardiogram.
On [**4-2**] he was brought to the operating room where he underwent a
coronary artery bypass graft x 3. Please see operative report
for surgical details. Following surgery he was transferred to
the CVICU for invasive monitoring.  Within 24 hours he was
weaned from sedation, awoke neurologically intact and extubated.
On post-op day one his chest tubes were removed and he was
transferred to the telemetry floor for further care. Beta
blockers and diuretics were started and he was gently diuresed
towards his pre-op weight. Late on post-op day one his heart
rhythm went into rapid atrial fibrillation and he was started on
amiodarone. He converted back to normal sinus rhythm with beta
blockers and amiodarone.  Physical therapy worked with him for
strength and mobility.  He continued to progress and was ready
for discharge home POD 4 with VNA services.

Medications on Admission:
Aspirin 325mg qd, Lopressor 75mg [**Hospital1 **], Zocor 80mg qd, Lisinopril
10mg qd, Metformin 500mg qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. 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*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
5. Metformin 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO ONCE (Once) for 7
doses.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
8. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every four (4)
hours as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
9. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
10. Metoprolol Tartrate 100 mg Tablet Sig: One (1) Tablet PO
three times a day.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Home Health and Hospice

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 3
Post-operative Atrial Fibrillation
PMH: Myocardial Infarction s/p PTCA to RCA [**2157**], Hypertension,
Hypercholesterolemia, Obesity, Diabetes Mellitus
PSH: Left eye surgery, Parotid Cyst surgery

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:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 70025**] in [**1-28**] weeks
Dr. [**First Name (STitle) **] in [**12-27**] weeks


Completed by:[**2170-4-6**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Other and unspecified angina pectoris'}


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 discomfort

PRESENT ILLNESS: 71 y/o male with increasing chest discomfort and b/l arm pain
with activity. He underwent a cardiac cath which revealed severe
three vessel coronary artery disease. Then referred for bypass
surgery.

MEDICAL HISTORY: Coronary Artery Disease and Myocardial Infarction s/p PTCA to
RCA [**2157**], Hypertension, Hypercholesterolemia, Obesity, Diabetes
Mellitus
PSH: Left eye surgery, Parotid Cyst surgery

MEDICATION ON ADMISSION: Aspirin 325mg qd, Lopressor 75mg [**Hospital1 **], Zocor 80mg qd, Lisinopril
10mg qd, Metformin 500mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: V: 68 18 126/83 5'8" 195lbs
Gen: WDWN male in NAD
Skin: Unremarkable
Neck: Supple, FROM, -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, -edema, +varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: NC

SOCIAL HISTORY: Quit smoking [**2156**] after 1ppd x 45 yrs. Drinks 1 beer/day.
Lives with spouse 

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Other and unspecified angina pectoris'}
