CHIEF COMPLAINT: chest pain, nausea, SOB

PRESENT ILLNESS: 86 F with no known CAD, h/o HTN and hyperlipidemia not
controlled by meds transferred for cardiac cath from NEBH.  2
days PTA pt developed [**10-2**] SSCP radiating to arms b/l
associated with SOB and nausea at rest.  Pain intermittent and
not relieved with antacids or [**Month/Year (2) **].

MEDICAL HISTORY: HTN
hyperlipidemia
glaucoma
s/p catarat surgery

MEDICATION ON ADMISSION: at home: Aspirin 325mg QD, Methazolamide 50 mg QD
at outside hospital: lipitor 80 mg QD, aspirin 325mg QD,
lopressor 25 mg [**Hospital1 **], IV heparin gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE  T   P 92  BP 111/87  RR 23  02 sat 95%(RA)
Gen: NAD, lying flat, pleasant
HEENT: mmm, eomi, o/p clear
Neck: JVD 10 cm,
CV: RRR, no m/r/g
Pulm: faint crackles at bases b/l
Abd: nt, nd, +bs
Ext: no c/c/e

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: no smoking, no ETOH, married, lives w/husband, very active
Cardiac arrest,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Cardiac rhythm regulators causing adverse effects in therapeutic use,Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Pneumonia, organism unspecified
Cardiac arrest,Mitral valve disorder,Crnry athrscl natve vssl,Hypertension NOS,Adv eff card rhyth regul,AMI anterior wall, init,CHF NOS,Pneumonia, organism NOS
Admission Date:  [**2140-12-1**]              Discharge Date:   [**2141-1-12**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
chest pain, nausea, SOB

Major Surgical or Invasive Procedure:
CABG  X 3
AICD/pacer placement


History of Present Illness:
86 F with no known CAD, h/o HTN and hyperlipidemia not
controlled by meds transferred for cardiac cath from NEBH.  2
days PTA pt developed [**10-2**] SSCP radiating to arms b/l
associated with SOB and nausea at rest.  Pain intermittent and
not relieved with antacids or [**Month/Year (2) **].

Pt presented to NEBH [**12-1**] with EKG showing ST elevations V1-V3
and CK 284, MB 26, and Trop I 8.54.  Pt started on [**Last Name (LF) 4532**], [**First Name3 (LF) **],
b-blocker, and heparin gtt and transfered to [**Hospital1 18**] for cath.  Of
note, bedside echo at OSH showed EF 20%.

Cath
CO 2.98
CI 1.96

PCWP 26
RA 8
AO 124/56
PA 52/22
LV 138/17
RV 56/5

LMCA 30%
LAD 90% ostial, mid 60%
LCX: 90% OM1
RCA: 100% prox --> fills via collaterals
LVEF 25% with anterior hypokinesis

ROS: - orthopnea, -PND, -lower ext edema. no F/C, emesis, cough,
diarrhea, constipation, HA, bleeding

SH
lives with husband in [**Name (NI) 1411**]
no smoking
no EtOH

FH
no CAD
no DM

PE  T   P 92  BP 111/87  RR 23  02 sat 95%(RA)
Gen: NAD, lying flat, pleasant
HEENT: mmm, eomi, o/p clear
Neck: JVD 10 cm,
CV: RRR, no m/r/g
Pulm: faint crackles at bases b/l
Abd: nt, nd, +bs
Ext: no c/c/e

EKG: NSR @ 100, N axis, ST elevation v1-v3, ST depression V4-V6,
I, II, and aVL


Past Medical History:
HTN
hyperlipidemia
glaucoma
s/p catarat surgery

Social History:
no smoking, no ETOH, married, lives w/husband, very active

Family History:
non-contributory

Physical Exam:
PE  T   P 92  BP 111/87  RR 23  02 sat 95%(RA)
Gen: NAD, lying flat, pleasant
HEENT: mmm, eomi, o/p clear
Neck: JVD 10 cm,
CV: RRR, no m/r/g
Pulm: faint crackles at bases b/l
Abd: nt, nd, +bs
Ext: no c/c/e


Pertinent Results:
[**2141-1-12**] 06:44AM BLOOD WBC-18.6* RBC-3.82* Hgb-11.4* Hct-34.8*
MCV-91 MCH-29.7 MCHC-32.6 RDW-15.9* Plt Ct-144*
[**2141-1-12**] 06:44AM BLOOD Plt Ct-144*
[**2141-1-12**] 06:44AM BLOOD Glucose-112* UreaN-37* Creat-1.0 Na-141
K-4.1 Cl-107 HCO3-30* AnGap-8

Brief Hospital Course:
Taken to OR on [**2140-12-5**], underwent CABG X 3 (LIMA>LAD, SVG>OM,
SVG>Ramus), post-op came off CPB on milrinone, epinephrine,
levophed, and IABP.  She remained sedated, on the ventilator,
pressors, and inotropes, for the first few post-op days.  She
had frequent ventricular tachycardia requiring emergent
cardioversion.  Her IABP was weaned and removed on post-op
day#2, but she had recurrent ventricular tachycardia with some
low cardiac output and hypotensive episodes.
She was taken to the cath lab on post-op day #4, where her LIMA
graft was found to be occluded, 2 stents were placed (mid, and
ostial LAD).  IABP was placed, and she returned to the ICU.  She
was then taken to the electrophysiology lab for temporary
coronary sinus pacer lead placement, and again returned to the
ICU.
She remained sedated, on the ventilator, with IABP in place over
the next few days, and improved hemodynamically.
IABP was subsequently removed on [**12-12**] (POD # 7), and she was
taken to the EP lab for removal of her temporary pacing leads,
and placement of an AICD/DDD pacer.
She was weaned from the ventilator, and extubated the following
morning.
She was weaned from her vasoactive gtts over the next 24 hours.
She was transferred from the ICU to the telemetry floor on [**12-15**]
(POD # 10), and she began physical therapy and cardiac rehab.
She was started on Captopril, but developed a dry cough.  This
was switched to lisinopril on [**12-22**].
WBC up to 19K (on [**12-21**]), afebrile, + u/a, started on
levofloxacin, cultures pending.
also w/erythematous rt. groin incision (no drainage).
Echo [**12-22**] revealed:significantly improved EF of 50%.  INR 1.5,
[**12-22**], heparin gtt d/c'd.
Patient was being screened for rehab when between [**12-22**] and [**12-26**]
she complained of SOB and dry cough.  With lungs ranging from
clear to rales throughout.  She was treated with diuresis,
aggressive chest PT, and neb treatments.  On [**12-27**] she was started
on a natracor drip fro diuresis with continued SOB and LE edema.
 CXR showed worsening of dissuse interstitial disease.  WBC
continued to climb to 22K on [**12-28**].  She was started on Zosyn on
[**12-24**], cipro on [**12-25**], and vanco [**12-28**] for suspected pneumonia.
ON [**12-29**] (POD 29), Mrs. [**Known lastname 59441**] was transferred back to the
intensive care unit for ongoing SOB and decreased oxygen
saturation with need for bipap in ICU.  Infectious disease and
interventional pumonary consults were obtained.  A diagnosis of
acute amiodarone toxicity and respiratory failure were
ultimately made.  Amiodarone was discontinued and patient was
continued on bipap.  (She was started on dilt instead.)  All of
the antibiotics were ultimately discontinued (by 1/13 per the
recommendation of the ID service) and she was also started on
steroids per ID on [**1-3**].  She rapidly improved and her oxygen
requirement quickly decreased.
On [**1-4**] (POD 30), Mrs. [**Known lastname 59441**] was weened from the face mask
for oxygen and was transferred back to the floor.
She had been restarted on coumadin with an INR of about 2 and it
was noticed on [**1-6**] that she had a drop in her HCT and dark
stools.  She was transfused 2units of PRBC, the coumadin was
discontinued and her HCT has remained stable since.  The
decision was made at this time that she receive no further
anticoagulation.
She was screened for rehab facilities and is awating discharge.

Medications on Admission:
at home: Aspirin 325mg QD, Methazolamide 50 mg QD
at outside hospital: lipitor 80 mg QD, aspirin 325mg QD,
lopressor 25 mg [**Hospital1 **], IV heparin gtt

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
2. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
3. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
4. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic  Q AM ().
5. Pilocarpine HCl 4 % Drops Sig: One (1) Drop Ophthalmic  Q8H
(every 8 hours).
6. Brimonidine Tartrate 0.2 % Drops Sig: One (1) Drop Ophthalmic
 [**Hospital1 **] (2 times a day).
7. Methazolamide 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours).
9. Docusate Sodium 150 mg/15 mL Liquid Sig: One Hundred (100) mg
PO BID (2 times a day).
10. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  QID
(4 times a day) as needed.
11. Isosorbide Mononitrate 10 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
12. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
13. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 4 days.
15. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12
hours).
17. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
18. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
19. Nystatin 100,000 unit/mL Suspension Sig: Ten (10) ML PO QID
(4 times a day).
20. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical  [**Hospital1 **]
(2 times a day).
21. Prednisone 10 mg Tablet Sig: Two (2) Tablet PO once a day
for 4 days: start [**1-16**] after LD 30mg prednisone.
22. Prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day
for 4 days: start [**1-21**] after LD 20mg prednisone
then d/c after last dose of 10 mg.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
CAD
atrial fibrillation
HTN
amiodarone pulmonary toxicity
post op pmeumonia


Discharge Condition:
good

Discharge Instructions:
may shower, no bathing for 1 onth
no creams, lotions or ointments to any incisions for 1 month
no lifting > 10 # for 1 month

Followup Instructions:
with Dr. [**Last Name (STitle) **] in [**1-26**] weeks
with Dr. [**Last Name (STitle) 5456**] in [**1-27**] weeks
with Dr. [**Last Name (STitle) **] in [**2-24**] weeks
She will need a PPD in 3 months time.



Completed by:[**2141-1-12**]
{'Cardiac arrest,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Cardiac rhythm regulators causing adverse effects in therapeutic use,Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Pneumonia, organism 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: chest pain, nausea, SOB

PRESENT ILLNESS: 86 F with no known CAD, h/o HTN and hyperlipidemia not
controlled by meds transferred for cardiac cath from NEBH.  2
days PTA pt developed [**10-2**] SSCP radiating to arms b/l
associated with SOB and nausea at rest.  Pain intermittent and
not relieved with antacids or [**Month/Year (2) **].

MEDICAL HISTORY: HTN
hyperlipidemia
glaucoma
s/p catarat surgery

MEDICATION ON ADMISSION: at home: Aspirin 325mg QD, Methazolamide 50 mg QD
at outside hospital: lipitor 80 mg QD, aspirin 325mg QD,
lopressor 25 mg [**Hospital1 **], IV heparin gtt

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE  T   P 92  BP 111/87  RR 23  02 sat 95%(RA)
Gen: NAD, lying flat, pleasant
HEENT: mmm, eomi, o/p clear
Neck: JVD 10 cm,
CV: RRR, no m/r/g
Pulm: faint crackles at bases b/l
Abd: nt, nd, +bs
Ext: no c/c/e

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: no smoking, no ETOH, married, lives w/husband, very active 

### Response:
{'Cardiac arrest,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Cardiac rhythm regulators causing adverse effects in therapeutic use,Acute myocardial infarction of other anterior wall, initial episode of care,Congestive heart failure, unspecified,Pneumonia, organism unspecified'}
