CHIEF COMPLAINT: unstable angina

PRESENT ILLNESS: Ths=is 71 yesar olfd white male underwent eluting stents/PCI to
mid circumflex vessel in [**2102**].  He recently had an abnormal
stress test  (surveillance) and was scheduled for
catheterization.  He, however, presented with the acute onset on
angina ti [**Hospital3 417**] Hospital on [**8-29**].  Enzymes were flat
and he was transferred for catheterization.  95% left main
stenosis was found and he had some pain in the lab, propmting a
balloon to be placed with stabilization.  Surgical evaluation
was requested for urgent revascularization.

MEDICAL HISTORY: Hypertension
hyperlipidemia
benign prostatic hypertrophy
right carpal tunnel surgery
noninsulin dependent diabetes
gastroesophageal reflux
hiatal hernia
paroxysmal atrial fibrillation
migraines

MEDICATION ON ADMISSION: Aspirin 325 mg daily
Finasteride 5 mg daily
Combivent 2 puffs 4X/daily
Lisinopril 5 mg daily
Prazosin 2 mg twice daily
Propanolol 160 mg daily
Zocor 80 mg daily.
Pantoprazole 40 mg daily
Hyoscyamine  0.125 mg at night

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History:Premature coronary artery disease- mother died at
age 57 from MI; brother CABG [**51**]
[**Name2 (NI) **]:Caucasian

SOCIAL HISTORY: Occupation:Retired HVAC mechanic for [**Company 22957**]
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: denies
Illicit drug use:denies
Last Dental Exam:a few months ago, see dentist every 6 months
Lives with:alone, but stays with girfriend most of the time
Contact: [**Name (NI) **] (girlfriend) Phone #[**Telephone/Fax (1) 84066**]
Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Thrombocytopenia, unspecified,Old myocardial infarction,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Migraine with aura, without mention of intractable migraine without mention of status migrainosus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Diaphragmatic hernia without mention of obstruction or gangrene,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Personal history of contact with and (suspected) exposure to asbestos,Family history of ischemic heart disease,Percutaneous transluminal coronary angioplasty status,Obstructive sleep apnea (adult)(pediatric)
Crnry athrscl natve vssl,Parox ventric tachycard,Thrombocytopenia NOS,Old myocardial infarct,Intermed coronary synd,DMII wo cmp nt st uncntr,Mgrn w aura wo ntrc mgrn,Hypertension NOS,Hyperlipidemia NEC/NOS,Iatrogenc hypotnsion NEC,Diaphragmatic hernia,BPH w/o urinary obs/LUTS,Esophageal reflux,Hx-contct/expos asbestos,Fam hx-ischem heart dis,Status-post ptca,Obstructive sleep apnea
Name:  [**Known lastname 13369**],[**Known firstname 126**] M               Unit No:   [**Numeric Identifier 13370**]

Admission Date:  [**2105-8-31**]              Discharge Date:   [**2105-9-6**]

Date of Birth:  [**2033-12-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 265**]
Addendum:
Revised med list:
aspirin  81 mg Tablet, Delayed Release (E.C.)  Sig:  One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
    amiodarone  200 mg Tablet  Sig:  Two (2) Tablet PO BID (2
times a day) for 4 days: then decrease to 400mg daily for 1
week, then 200mg daily until seen by cards.
    potassium chloride  10 mEq Tablet Extended Release  Sig:
Two (2) Tablet Extended Release PO Q12H (every 12 hours).
    docusate sodium  100 mg Capsule  Sig:  One (1) Capsule PO
BID (2 times a day).
    pantoprazole  40 mg Tablet, Delayed Release (E.C.)  Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

    finasteride  5 mg Tablet  Sig:  One (1) Tablet PO DAILY
(Daily).
    ipratropium-albuterol  18-103 mcg/Actuation Aerosol  Sig:
Two (2) Puff Inhalation Q6H (every 6 hours).
    hyoscyamine sulfate  0.125 mg Tablet, Sublingual  Sig:  One
(1) Tablet, Sublingual Sublingual HS (at bedtime).
    glucagon (human recombinant)  1 mg Recon Soln  Sig:  One (1)
Recon Soln Injection Q15MIN () as needed for hypoglycemia
protocol.
    simvastatin  10 mg Tablet  Sig:  One (1) Tablet PO DAILY
(Daily): increase once off amiodarne.
    prazosin  1 mg Capsule  Sig:  Two (2) Capsule PO BID (2
times a day).
    magnesium hydroxide  400 mg/5 mL Suspension  Sig:  Thirty
(30) ML PO HS (at bedtime) as needed for constipation.
    acetaminophen  325 mg Tablet  Sig:  Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.
    bisacodyl  10 mg Suppository  Sig:  One (1) Suppository
Rectal DAILY (Daily) as needed for constipation.
    aspirin  325 mg Tablet, Delayed Release (E.C.)  Sig:  One
(1) Tablet, Delayed Release (E.C.) PO DAILY (Daily).
    metoprolol tartrate  50 mg Tablet  Sig:  One (1) Tablet PO
BID (2 times a day).
    Lasix  40 mg Tablet  Sig:  One (1) Tablet PO twice a day for
1 weeks: then decrease to 40mg po daily x1 week then reevaluate.

Print Options


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location 2075**]

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**]

Completed by:[**2105-9-6**]

Admission Date:  [**2105-8-31**]              Discharge Date:   [**2105-9-6**]

Date of Birth:  [**2033-12-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
unstable angina

Major Surgical or Invasive Procedure:
left heart catheterization, coronary angiogram
insertion of intra aortic balloon
urgent coronary artery bypass grafting


History of Present Illness:
Ths=is 71 yesar olfd white male underwent eluting stents/PCI to
mid circumflex vessel in [**2102**].  He recently had an abnormal
stress test  (surveillance) and was scheduled for
catheterization.  He, however, presented with the acute onset on
angina ti [**Hospital3 417**] Hospital on [**8-29**].  Enzymes were flat
and he was transferred for catheterization.  95% left main
stenosis was found and he had some pain in the lab, propmting a
balloon to be placed with stabilization.  Surgical evaluation
was requested for urgent revascularization.

Past Medical History:
Hypertension
hyperlipidemia
benign prostatic hypertrophy
right carpal tunnel surgery
noninsulin dependent diabetes
gastroesophageal reflux
hiatal hernia
paroxysmal atrial fibrillation
migraines

Social History:
Occupation:Retired HVAC mechanic for [**Company 22957**]
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: denies
Illicit drug use:denies
Last Dental Exam:a few months ago, see dentist every 6 months
Lives with:alone, but stays with girfriend most of the time
Contact: [**Name (NI) **] (girlfriend) Phone #[**Telephone/Fax (1) 84066**]


Family History:
Family History:Premature coronary artery disease- mother died at
age 57 from MI; brother CABG [**51**]
[**Name2 (NI) **]:Caucasian


Physical Exam:
Physical Exam

Pulse:70 Resp:14  O2 sat:99/2L
B/P  174/68
Height:5'7"     Weight:158 lbs

General:
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 [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  Edema [] _____ IABP in
R groin Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: IABP  Left: 2+
DP           Right: 1+    Left: 1+
PT           [**Name (NI) 167**]: 1+    Left: 1+
Radial       Right: 2+    Left: 2+

Carotid Bruit        Right: no   Left: no


Pertinent Results:
[**2105-8-31**] 06:40PM BLOOD WBC-5.2 RBC-4.32* Hgb-13.3* Hct-37.6*
MCV-87 MCH-30.8 MCHC-35.3* RDW-12.6 Plt Ct-116*
[**2105-8-31**] 06:40PM BLOOD Glucose-162* UreaN-14 Creat-1.1 Na-137
K-3.7 Cl-104 HCO3-27 AnGap-10
[**2105-8-31**] 06:40PM BLOOD ALT-19 AST-32 LD(LDH)-156 AlkPhos-58
TotBili-0.5
[**2105-9-6**] 07:20AM BLOOD WBC-9.2 RBC-3.11* Hgb-9.3* Hct-28.0*
MCV-90 MCH-29.9 MCHC-33.2 RDW-13.6 Plt Ct-180
[**2105-9-6**] 07:20AM BLOOD UreaN-30* Creat-1.2 Na-136 K-4.1 Cl-99
CXR [**9-4**]
Since [**2105-9-2**], bilateral lower lung atelectasis, left
more than
right, has improved. Moderate left and minimal right pleural
effusions are
unchanged. No new lung opacities of concern.

Heart size is top normal. Patient is status post median
sternotomy with intact
sternal sutures for CABG. Mediastinal and hilar contours are
stable.
TTE:
PRE-BYPASS:
-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. The left
ventricular cavity size is normal.
-Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%).
-Doppler parameters are most consistent with Grade I (mild) left
ventricular diastolic dysfunction.
-There are three aortic valve leaflets. No aortic regurgitation
is seen.
-The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen.
-There is no pericardial effusion.
- IABP was in too far (in arch) it was repositioned (pulled back
to distal to 1-2 cm distal to left sc)
Dr. [**Last Name (STitle) **] was notified of the results.

POSTBYPASS:
-The patient is on no inotropic infusions.
-Biventricular function is unchanged.
-There is trace mitral regurgitation.
-No aortic regurgitation is seen
-The aorta is intact post-decannulation
-IABP in good position with tip 1-2 cm distal to left sc artery


Brief Hospital Course:
As noted in present illness section, left main stenosis was
found and an intra aortic balloon was placed.  The following day
([**9-1**]) he went to the Operating Room where revascularization was
performed.  The balloon was retained and he required low dose
Neo Synephrine.  The balloon was removed the evening of surgery
due to malposition (hemodynamics were stable).  He was extubated
the following morning, CTs were removed and Neo Synephrine was
weaned off. He transferred to the floor on POD #3. Beta blocker
and Lasix were begun as was Amiodarone for atrial ectopy and his
history of paroxysmal atrial fibrillation.  Physical Therapy was
consulted for strength and mobility. His creatinine bumped
slighly but is returning to baseline, he continues to need to be
diuresed. His lisinopril should be restarted when appropriate.
Wires were removed according to protocol.  The [**Location (un) 1661**]-[**Location (un) **]
drain was removed. On pod#5 he was ready for discharge to Life
Care Center rehab West-[**Location (un) **]. Follow-up instructions
reviewed. Of note his left upper thigh is very ecchymotic and
extends to just above left knee, it has not changed in 48 hrs
and his Hct has been stable.

Medications on Admission:
Aspirin 325 mg daily
Finasteride 5 mg daily
Combivent 2 puffs 4X/daily
Lisinopril 5 mg daily
Prazosin 2 mg twice daily
Propanolol 160 mg daily
Zocor 80 mg daily.
Pantoprazole 40 mg daily
Hyoscyamine  0.125 mg at night


Discharge Medications:
1. hyoscyamine sulfate 0.125 mg Tablet, Sublingual Sig: One (1)
Tablet, Sublingual Sublingual HS (at bedtime).
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
3. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily) as needed for constipation.
6. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
7. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
8. prazosin 2 mg Capsule Sig: One (1) Capsule PO twice a day.
9. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 4 days: then decrease to 400mg daily for 1 week, then
200mg daily until seen by cards.
10. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO Q12H (every 12 hours).
11. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
13. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
15. hyoscyamine sulfate 0.125 mg Tablet, Sublingual Sig: One (1)
Tablet, Sublingual Sublingual HS (at bedtime).
16. glucagon (human recombinant) 1 mg Recon Soln Sig: One (1)
Recon Soln Injection Q15MIN () as needed for hypoglycemia
protocol.
17. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): increase once off amiodarne.
18. prazosin 1 mg Capsule Sig: Two (2) Capsule PO BID (2 times a
day).
19. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
20. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain.
21. oxycodone-acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every six (6) hours as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
22. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
23. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
24. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
25. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 1
weeks: then decrease to 40mg po daily x1 week then reevaluate.


Discharge Disposition:
Extended Care

Facility:
Life Care Center of [**Location 15289**]

Discharge Diagnosis:
unstable angina
left main coronary artery disease
gastroesophageal reflux
benign prostatic hypertrophy
noninsulin dependent disabetes mellitus
hyperlipidemia
paroxysmal atrial fibrillation
s/p carpal tunnel release
hypertension
hyperlipidemia
s/p coronary stenting
s/p coronary artery bypass grafts


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. Left
thigh very ecchymotic extending to just above the knee
Edema +[**12-14**] generalized


Discharge Instructions:
Please 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
Please 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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**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:
You are scheduled for the following appointments
Surgeon:Dr. [**First Name (STitle) **] ([**Telephone/Fax (1) 170**]on [**10-5**] @1:15pm
Cardiologist:Dr. [**Last Name (STitle) 7047**] ([**Telephone/Fax (1) 8725**]office will call with
appt.
Wound Check [**9-15**] @ 11:00

Please call to schedule appointments with:
Primary Care Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 28095**]) in [**3-17**] 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**


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2105-9-6**]
{'Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Thrombocytopenia, unspecified,Old myocardial infarction,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Migraine with aura, without mention of intractable migraine without mention of status migrainosus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Diaphragmatic hernia without mention of obstruction or gangrene,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Personal history of contact with and (suspected) exposure to asbestos,Family history of ischemic heart disease,Percutaneous transluminal coronary angioplasty status,Obstructive sleep apnea (adult)(pediatric)'}


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: unstable angina

PRESENT ILLNESS: Ths=is 71 yesar olfd white male underwent eluting stents/PCI to
mid circumflex vessel in [**2102**].  He recently had an abnormal
stress test  (surveillance) and was scheduled for
catheterization.  He, however, presented with the acute onset on
angina ti [**Hospital3 417**] Hospital on [**8-29**].  Enzymes were flat
and he was transferred for catheterization.  95% left main
stenosis was found and he had some pain in the lab, propmting a
balloon to be placed with stabilization.  Surgical evaluation
was requested for urgent revascularization.

MEDICAL HISTORY: Hypertension
hyperlipidemia
benign prostatic hypertrophy
right carpal tunnel surgery
noninsulin dependent diabetes
gastroesophageal reflux
hiatal hernia
paroxysmal atrial fibrillation
migraines

MEDICATION ON ADMISSION: Aspirin 325 mg daily
Finasteride 5 mg daily
Combivent 2 puffs 4X/daily
Lisinopril 5 mg daily
Prazosin 2 mg twice daily
Propanolol 160 mg daily
Zocor 80 mg daily.
Pantoprazole 40 mg daily
Hyoscyamine  0.125 mg at night

ALLERGIES: Penicillins

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Family History:Premature coronary artery disease- mother died at
age 57 from MI; brother CABG [**51**]
[**Name2 (NI) **]:Caucasian

SOCIAL HISTORY: Occupation:Retired HVAC mechanic for [**Company 22957**]
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: denies
Illicit drug use:denies
Last Dental Exam:a few months ago, see dentist every 6 months
Lives with:alone, but stays with girfriend most of the time
Contact: [**Name (NI) **] (girlfriend) Phone #[**Telephone/Fax (1) 84066**] 

### Response:
{'Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Thrombocytopenia, unspecified,Old myocardial infarction,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Migraine with aura, without mention of intractable migraine without mention of status migrainosus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Diaphragmatic hernia without mention of obstruction or gangrene,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Personal history of contact with and (suspected) exposure to asbestos,Family history of ischemic heart disease,Percutaneous transluminal coronary angioplasty status,Obstructive sleep apnea (adult)(pediatric)'}
