CHIEF COMPLAINT: Palpitations/Chest pain

PRESENT ILLNESS: 70yo Spanish speaking only F with h/o HTN, med-noncompliance, R
carotid stent p/w chest pain/palpitations x 3 days. States has
been having episode of chest pain lasting about 15 mins which
are not related to exertion and resolve with drinking garlic
water. Presented to emergency department for further evaluation.

MEDICAL HISTORY: HTN
GERD
carotid stenosis s/p R carotid stent
Hyperlipidemia
Osteoarthritis
venous insufficiency

MEDICATION ON ADMISSION: Plavix 75 mg once daily
Fenlodapine 10 mg daily
Triamterene/HCTZ 50/25
Simvastatin 40 mg daily
Prilosec 20 mg daily

ALLERGIES: Ace Inhibitors / Nifedipine Er

PHYSICAL EXAM: Vitals 97.5 BP 132/76 HR 70 RR 16 O2 94%RA
.
Gen: elderly female in nad
HEENT: MMM, PERRL, EOMI, OP clear
Neck: supple, JVP ~8CM
Chest: CTAB, no crackles. Decreased BS at bases
CVR: RRR, nl s1, s2, no r/m/g
ABD: soft, nt, nd
EXT: no edema

FAMILY HISTORY: mother and sisters with HTN. Uncle with MI

SOCIAL HISTORY: Lives in [**Location **] with daughter denies smoking, etoh
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Venous (peripheral) insufficiency, unspecified
Subendo infarct, initial,Crnry athrscl natve vssl,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Obesity NOS,Hx of past noncompliance,Venous insufficiency NOS
Admission Date:  [**2187-11-18**]              Discharge Date:   [**2187-11-28**]

Date of Birth:  [**2117-7-13**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Ace Inhibitors / Nifedipine Er

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Palpitations/Chest pain

Major Surgical or Invasive Procedure:
Cardiac Catherization [**2187-11-19**]
s/p Coronary artery bypass graft x4 (Left internal mammary
artery>left anterior descending, Saphenous vein graft > obtuse
marginal, saphenous vein graft > RAMUS, saphenous vein graft >
diagonal) MAZE, Left atrial appendage ligation [**2187-11-23**]


History of Present Illness:
70yo Spanish speaking only F with h/o HTN, med-noncompliance, R
carotid stent p/w chest pain/palpitations x 3 days. States has
been having episode of chest pain lasting about 15 mins which
are not related to exertion and resolve with drinking garlic
water. Presented to emergency department for further evaluation.

Past Medical History:
HTN
GERD
carotid stenosis s/p R carotid stent
Hyperlipidemia
Osteoarthritis
venous insufficiency

Social History:
Lives in [**Location **] with daughter denies smoking, etoh

Family History:
mother and sisters with HTN. Uncle with MI

Physical Exam:
Vitals 97.5 BP 132/76 HR 70 RR 16 O2 94%RA
.
Gen: elderly female in nad
HEENT: MMM, PERRL, EOMI, OP clear
Neck: supple, JVP ~8CM
Chest: CTAB, no crackles. Decreased BS at bases
CVR: RRR, nl s1, s2, no r/m/g
ABD: soft, nt, nd
EXT: no edema


Pertinent Results:
[**2187-11-28**] 06:33AM BLOOD WBC-8.4 RBC-3.76* Hgb-11.2* Hct-32.5*
MCV-86 MCH-29.7 MCHC-34.4 RDW-14.7 Plt Ct-264#
[**2187-11-28**] 06:33AM BLOOD Plt Ct-264#
[**2187-11-23**] 12:41PM BLOOD PT-17.3* PTT-45.2* INR(PT)-1.6*
[**2187-11-28**] 06:33AM BLOOD Glucose-111* UreaN-12 Creat-0.7 Na-137
K-3.8 Cl-99 HCO3-30 AnGap-12

[**Known lastname 30941**], [**Known firstname 30942**]       [**Hospital1 18**] [**Numeric Identifier 30943**]
(Complete) Done [**2187-11-23**] at 9:20:12 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**]
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2117-7-13**]
Age (years): 70 F  Hgt (in): 60
BP (mm Hg): 135/78  Wgt (lb): 180
HR (bpm): 56  BSA (m2): 1.79 m2
Indication: Intraoperative TEE for CABG and MAZE procedure
ICD-9 Codes: 786.05, 786.51, 440.0, 424.0
Test Information
Date/Time: [**2187-11-23**] at 09:20    Interpret MD: [**Name6 (MD) 1509**] [**Name8 (MD) 1510**],
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: Suboptimal
Tape #: 2008AW1-: Machine: [**Pager number 14694**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Annulus:  1.7 cm  <= 3.0 cm
Aorta - Sinus Level:  3.3 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.6 cm  <= 3.0 cm
Aorta - Ascending:  2.8 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.1 m/sec  <= 2.0 m/sec
Mitral Valve - E Wave:  0.6 m/sec
Mitral Valve - A Wave:  0.3 m/sec
Mitral Valve - E/A ratio:  2.00

Findings
LEFT ATRIUM: Mild spontaneous echo contrast in the body of the
LA. No thrombus in the LAA.

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: Normal regional LV systolic function. Overall
normal LVEF (>55%). 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. Complex (>4mm) atheroma in the
descending thoracic aorta.

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

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild to
moderate ([**11-21**]+) MR.

TRICUSPID VALVE: Mild to moderate [[**11-21**]+] TR.

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 rhythm appears
to be atrial fibrillation. Results were personally reviewed with
the MD caring for the patient.
Conclusions
Prebypass

1. Mild spontaneous echo contrast is seen in the body of the
left atrium. No thrombus is seen in the left atrial appendage.
No atrial septal defect is seen by 2D or color Doppler.

2.Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%).

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

4.There are complex (>4mm) atheroma in the descending thoracic
aorta.

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

6.The mitral valve leaflets are mildly thickened. Mild to
moderate ([**11-21**]+) mitral regurgitation is seen.

Post Bypass

1. Patient is being A paced and receiving an infusion of
phenylephrine.

2. Biventricular systolic function is unchanged.

3. Aorta intact post decannulation.


Brief Hospital Course:
Admitted from ED ruling in for NSTEMI in atrial fibrillation.
Underwent cardiac catherization that revealed coronary artery
disease.  She was treated with medications to control atrial
fibrillation.  Cardiac surgery was consulted for surgical
evaluation.  She underwent preoperative workup and [**11-23**] went to
the operating room for coronary artery bypass graft, MAZE, and
LAA ligation surgery.  She received perioperative vancomycin as
she was inpatient preoperatively.  See operative report for
further details.  She was transferred to the ICU for hemodynamic
monitoring.  In the first 24 hours she was weaned from sedation,
awoke neurologically intact, and was extubated.  She was started
on betablockers and diuretics.  On post op day 2 she was
transferred to the floor.  Physical therapy worked with her for
strength and mobility.  She continued to make progress and was
ready for discharge home with services on post operative day 5.



Medications on Admission:
Plavix 75 mg once daily
Fenlodapine 10 mg daily
Triamterene/HCTZ 50/25
Simvastatin 40 mg daily
Prilosec 20 mg daily

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
2. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
3. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
Disp:*60 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
5. 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*
6. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*0*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO BID (2 times a day)
for 1 weeks.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary Artery Disease s/p CABG
Atrial Fibrillation s/p MAZE and LAA excision
NSTEMI
Hypertension
Gastric esophageal reflux disease
Carotid stenosis s/p right carotid stent
Hyperlipidemia
Osteoarthritis
Venous insufficiency


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) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment
Dr [**Last Name (STitle) **] in 2 weeks - please call for appointment
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1143**], MD Phone:[**Telephone/Fax (1) 1144**]
Date/Time:[**2187-12-17**] 4:00
Provider: [**Name10 (NameIs) 706**] Phone:[**Telephone/Fax (1) 9045**] Date/Time:[**2188-1-15**] 10:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1244**], MD Phone:[**Telephone/Fax (1) 1241**]
Date/Time:[**2188-1-30**] 1:00
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])



Completed by:[**2187-11-28**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Venous (peripheral) insufficiency, 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: Palpitations/Chest pain

PRESENT ILLNESS: 70yo Spanish speaking only F with h/o HTN, med-noncompliance, R
carotid stent p/w chest pain/palpitations x 3 days. States has
been having episode of chest pain lasting about 15 mins which
are not related to exertion and resolve with drinking garlic
water. Presented to emergency department for further evaluation.

MEDICAL HISTORY: HTN
GERD
carotid stenosis s/p R carotid stent
Hyperlipidemia
Osteoarthritis
venous insufficiency

MEDICATION ON ADMISSION: Plavix 75 mg once daily
Fenlodapine 10 mg daily
Triamterene/HCTZ 50/25
Simvastatin 40 mg daily
Prilosec 20 mg daily

ALLERGIES: Ace Inhibitors / Nifedipine Er

PHYSICAL EXAM: Vitals 97.5 BP 132/76 HR 70 RR 16 O2 94%RA
.
Gen: elderly female in nad
HEENT: MMM, PERRL, EOMI, OP clear
Neck: supple, JVP ~8CM
Chest: CTAB, no crackles. Decreased BS at bases
CVR: RRR, nl s1, s2, no r/m/g
ABD: soft, nt, nd
EXT: no edema

FAMILY HISTORY: mother and sisters with HTN. Uncle with MI

SOCIAL HISTORY: Lives in [**Location **] with daughter denies smoking, etoh 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Obesity, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Venous (peripheral) insufficiency, unspecified'}
