CHIEF COMPLAINT: Exertional chest pain

PRESENT ILLNESS: CC:  73 yo Hispanic man admitted to Holding Area from exercise
lab due to EKG changes and chest pain during outpt ETT today.

MEDICAL HISTORY: HTN
Hyperlipidemia
Headaches

MEDICATION ON ADMISSION: Medications as per [**Company 4916**] Pharmacy: [**Telephone/Fax (1) 38015**]. Patient
unable to identify meds. States takes 4 pills a day.
Aspirin 81 mg daily
Atenolol 50 mg daily
HCTZ 25 mg daily
Tylenol #3 daily for headache
Prazosin 1 mg daily (pt thinks this was stopped, unable to
verify)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Appears comfortable, stating no further episodes of chest pain.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Employed custodian. Lives with his son. [**Name (NI) **] his son is not
able to help with discharge to home due to work schedule. No
current tobacco (Quit 30 years ago) or ETOH use.
Coronary atherosclerosis of native coronary artery,Systolic heart failure, unspecified,Intermediate coronary syndrome,Mitral valve disorders,Pulmonary collapse,Unspecified essential hypertension,Pure hypercholesterolemia,Hydrocele, unspecified
Crnry athrscl natve vssl,Systolic hrt failure NOS,Intermed coronary synd,Mitral valve disorder,Pulmonary collapse,Hypertension NOS,Pure hypercholesterolem,Hydrocele NOS
Admission Date:  [**2107-8-3**]              Discharge Date:   [**2107-8-10**]

Date of Birth:  [**2033-8-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Exertional chest pain

Major Surgical or Invasive Procedure:
[**2107-8-5**] - Off Pump CABGx3 (Left internal mammary->left anterior
descending artery, Vein graft->Diagonal artery, Vein
graft->Posterior descending artery)
[**2107-8-3**] - Cardiac Catheterization


History of Present Illness:
CC:  73 yo Hispanic man admitted to Holding Area from exercise
lab due to EKG changes and chest pain during outpt ETT today.

HPI: Information obtained from pt. with assistance of
interpreter services. This 73 yo man with no known prior hx CAD,
reports overall good health. Approximately 3 months ago, he
noted the onset of chest pressure associated with physical
activity. He also had periods of DOE both with and without chest
pressure. He works as a janitor. Initially symptoms were
infrequent and relieved by rest. Over the past month he has had
2-3 episodes of chest pain per week. Symptoms relieved by rest.
He was referred for ETT today by PCP Dr [**Last Name (STitle) 1789**]. He completed
11.5 min of a modified [**Doctor First Name **] protocol. Stopped due to symptoms
of chest pressure and fatigue. EKG showed 2.25 mm ST segment
horizontal down sloping in the inferolateral leads. There were T
wave inversions leads V2-V5 noted during the recovery phase. Nuc
imaging revealed nl LV size, mild systolic dysfunction, and
distal anterior HK.

Past Medical History:
HTN
Hyperlipidemia
Headaches

Social History:
Employed custodian. Lives with his son. [**Name (NI) **] his son is not
able to help with discharge to home due to work schedule. No
current tobacco (Quit 30 years ago) or ETOH use.


Family History:
noncontributory

Physical Exam:
Appears comfortable, stating no further episodes of chest pain.

VS: tele SR 50??????s BP 180/80??????s
Lungs:  CTA ant/lat
Heart:  RRR -MRG
Abd: NT + BS
PV: fems 2+ no bruits. DPs 1+ bilaterally, no [**Location (un) **]. No
variocosties


Pertinent Results:
[**2107-8-10**] 07:10AM BLOOD WBC-8.1 RBC-3.48* Hgb-11.2* Hct-31.7*
MCV-91 MCH-32.1* MCHC-35.2* RDW-14.2 Plt Ct-246#
[**2107-8-3**] 01:15PM BLOOD WBC-5.7 RBC-5.06 Hgb-16.1 Hct-46.2 MCV-91
MCH-31.7 MCHC-34.8 RDW-13.9 Plt Ct-222
[**2107-8-10**] 07:10AM BLOOD Plt Ct-246#
[**2107-8-7**] 01:51AM BLOOD PT-14.1* PTT-33.1 INR(PT)-1.3*
[**2107-8-3**] 01:15PM BLOOD Plt Ct-222
[**2107-8-3**] 01:15PM BLOOD PT-10.9 INR(PT)-0.9
[**2107-8-10**] 07:10AM BLOOD Glucose-107* UreaN-16 Creat-0.8 Na-142
K-3.8 Cl-97 HCO3-32 AnGap-17
[**2107-8-3**] 01:15PM BLOOD Glucose-111* UreaN-21* Creat-1.1 Na-140
K-4.3 Cl-98 HCO3-32 AnGap-14
[**2107-8-6**] 02:46AM BLOOD ALT-9 AST-20 LD(LDH)-193 AlkPhos-35*
Amylase-27 TotBili-0.3
[**2107-8-3**] 04:15PM BLOOD VitB12-268
[**2107-8-3**] 04:15PM BLOOD %HbA1c-6.1*
[**2107-8-3**] 04:15PM BLOOD Triglyc-83 HDL-54 CHOL/HD-3.1 LDLcalc-98

   RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2107-8-9**] 2:27 PM

CHEST (PA & LAT)

Reason: evaluate ptx

[**Hospital 93**] MEDICAL CONDITION:
73 year old man s/p CABG
REASON FOR THIS EXAMINATION:
evaluate ptx
CXR, TWO FILMS

HISTORY: Status post CABG.

FINDINGS: Sternotomy noted. There are small bilateral pleural
effusions and thickening of the fissures. The bibasilar
atelectasis shows considerable improvement compared to the
previous examination of [**2107-8-7**]. No heart failure.

CONCLUSION: Status post CABG. Improving bilateral pleural
effusions and bibasilar atelectasis.

DR. [**First Name (STitle) 3934**] [**Name (STitle) 3935**]
Approved: TUE [**2107-8-9**] 10:14 PM

Cardiology Report ECHO Study Date of [**2107-8-5**]


*** Report not finalized ***
PRELIMINARY REPORT

PATIENT/TEST INFORMATION:
Indication: Abnormal ECG. Aortic valve disease. Coronary artery
disease. Left ventricular function. Mitral valve disease.
Valvular heart disease.
Status: Inpatient
Date/Time: [**2107-8-5**] at 13:59
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2007AW02-:
Test Location: Anesthesia West OR cardiac
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name (STitle) **] [**Name (STitle) **]

MEASUREMENTS:
Left Ventricle - Ejection Fraction: 30% to 40% (nl >=55%)

INTERPRETATION:

Findings:

Off Pump CABG
LEFT ATRIUM: Normal LA size. 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. A catheter or
pacing wire is
seen in the RA. Dynamic interatrial septum. No ASD or PFO by 2D,
color Doppler
or saline contrast with maneuvers.

LEFT VENTRICLE: Normal LV wall thickness and cavity size.
Moderately depressed
LVEF.

LV WALL MOTION: Regional LV wall motion abnormalities include:
basal anterior
- hypo; mid anterior - hypo; basal anteroseptal - hypo; mid
anteroseptal -
hypo; basal inferoseptal - hypo; mid inferoseptal - hypo; basal
inferior -
hypo; mid inferior - hypo; basal inferolateral - hypo; mid
inferolateral -
hypo; basal anterolateral - hypo; mid anterolateral - hypo;
anterior apex -
hypo; septal apex - hypo; inferior apex - hypo; lateral apex -
hypo; apex -
hypo;

RIGHT VENTRICLE: Mildly dilated RV cavity. Normal RV systolic
function.

AORTA: Normal ascending aorta diameter. Normal descending aorta
diameter.
Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve
leaflets. No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular
calcification. Mild thickening of mitral valve chordae.
Physiologic MR (within
normal limits).

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify
I was present in compliance with HCFA regulations. No TEE
related
complications. The TEE probe was passed with assistance from the

anesthesioology staff using a laryngoscope. The patient was
under general
anesthesia throughout the procedure. Suboptimal image quality -
poor echo
windows.

Conclusions:
The left atrium is normal in size. No spontaneous echo contrast
or thrombus is
seen in the body of the left atrium or left atrial appendage. No
atrial septal
defect or patent foramen ovale is seen by 2D, color Doppler or
saline contrast
with maneuvers. Left ventricular wall thicknesses and cavity
size are normal.
Overall left ventricular systolic function is moderately
depressed (LVEF= XX
%). The right ventricular cavity is mildly dilated. Right
ventricular systolic
function is normal. There are simple atheroma in the descending
thoracic
aorta. There are three aortic valve leaflets. The aortic valve
leaflets are
mildly thickened. There is no aortic valve stenosis. No aortic
regurgitation
is seen. The mitral valve leaflets are mildly thickened.
Physiologic mitral
regurgitation is seen (within normal limits). There is no
pericardial
effusion.
[**Location (un) **] PHYSICIAN:

 Cardiology Report ECG Study Date of [**2107-8-5**]  5:47:06 PM


Sinus rhythm with ventricular premature beat. Low limb lead QRS
voltage, is
non-specific. Modest right precordial lead/anterior T wave
changes are
non-specific and unstable baseline makes assessment difficult.
Clinical
correlation is suggested. Compared to the previous tracing of
[**2107-8-3**] sinus
bradycardia is absent, ventricular ectopy and precordial T wave
changes are now
seen.


Read by: [**Last Name (LF) **],[**First Name3 (LF) 177**] W.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
82 158 82 356/394 52 16 50






Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2107-8-3**] for further
management of his angina and positive stress test. He underwent
a cardiac catheterization which revealed severe three vessel
coronary artery disease. Given these findings, the cardiac
surgical service was consulted for surgical mananagement. Mr.
[**Known lastname **] was worked-up in the usual preoperative manner. On
[**2107-8-5**], Mr. [**Known lastname **] was taken to the operating room where he
underwent off pump coronary artery bypass grafting to three
vessels. Please see operative note for details. Postoperatively
he was taken to the cardiac surgical intensive care unit for
monitoring. On postoperative day one, Mr. [**Known lastname **] [**Last Name (Titles) 5058**]
neurologically intact and was extubated. Aspirin, beta blockade
and his statin were resumed. Plavix was started as his surgery
was performed off pump and should be continued for three months.
On postoperative day two, he was transferred to the step down
unit for further recovery. He was gently diuresed towards his
preoperative weight. The physical therapy service was consulted
for assistance with his postoperative strength and mobility. He
continued to progress and was ready for discharge to rehab on
POD 5.

Medications on Admission:
Medications as per [**Company 4916**] Pharmacy: [**Telephone/Fax (1) 38015**]. Patient
unable to identify meds. States takes 4 pills a day.
Aspirin 81 mg daily
Atenolol 50 mg daily
HCTZ 25 mg daily
Tylenol #3 daily for headache
Prazosin 1 mg daily (pt thinks this was stopped, unable to
verify)


Discharge Medications:
1. oxygen
Oxygen 2 L NC wean to room air for sats > 92%
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
6. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 3 months.
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day.
9. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
10. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: 1.5 Tablet Sustained Release 24 hrs PO DAILY (Daily).
11. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 11729**] Home - [**Location (un) 686**]

Discharge Diagnosis:
CAD s/p off pump CABG
Systolic heart failure EF 35-40%
Hyperlipidemia
HTN
Headaches


Discharge Condition:
Good


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Please shower daily.
No bathing or swimming for 1 month. Use sunscreen on incision if
exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns. [**Telephone/Fax (1) 170**]

Followup Instructions:
Please follow-up with Dr. [**First Name (STitle) **] in 1 month ([**Telephone/Fax (1) 1504**]
Please follow-up with Dr. [**Last Name (STitle) 1789**] (cardiologist/PCP) after
discharge from rehab [**Telephone/Fax (1) 1792**]


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

Completed by:[**2107-8-10**]
{'Coronary atherosclerosis of native coronary artery,Systolic heart failure, unspecified,Intermediate coronary syndrome,Mitral valve disorders,Pulmonary collapse,Unspecified essential hypertension,Pure hypercholesterolemia,Hydrocele, 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: Exertional chest pain

PRESENT ILLNESS: CC:  73 yo Hispanic man admitted to Holding Area from exercise
lab due to EKG changes and chest pain during outpt ETT today.

MEDICAL HISTORY: HTN
Hyperlipidemia
Headaches

MEDICATION ON ADMISSION: Medications as per [**Company 4916**] Pharmacy: [**Telephone/Fax (1) 38015**]. Patient
unable to identify meds. States takes 4 pills a day.
Aspirin 81 mg daily
Atenolol 50 mg daily
HCTZ 25 mg daily
Tylenol #3 daily for headache
Prazosin 1 mg daily (pt thinks this was stopped, unable to
verify)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Appears comfortable, stating no further episodes of chest pain.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Employed custodian. Lives with his son. [**Name (NI) **] his son is not
able to help with discharge to home due to work schedule. No
current tobacco (Quit 30 years ago) or ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Systolic heart failure, unspecified,Intermediate coronary syndrome,Mitral valve disorders,Pulmonary collapse,Unspecified essential hypertension,Pure hypercholesterolemia,Hydrocele, unspecified'}
