CHIEF COMPLAINT: Coronary Artery Disease

PRESENT ILLNESS: 57 year old woman with hyperlipidemia has recently been
evaluated for intermittent chest pressure/squeezing that has
been occurring over the past several months. These symptoms are
occurring both at rest and with activity, but do not
consistently occur with exertion. She was found to have tight
left main coronary artery disease on cardiac catheterization
today, now referred for cardiac surgery.

MEDICAL HISTORY: Past Medical History
Hyperlipidemia
Remote diagnosis of mitral valve prolapse. No evidence on most
recent echo
Osteoporosis

MEDICATION ON ADMISSION: Metoprolol succinate 25 mg daily
Simvastatin 10 mg daily
Aspirin 81 mg daily
Calcium Carbonatee-Vitamin D3 600 mg-200 mg 2 tablets daily
Multivitamin
Estradiol 10 mcg 3 x week

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:57 Resp:17  O2 sat: 95
B/P  Right: 113/62
Height:  5 feet 5 inches
Weight:  150 pounds

FAMILY HISTORY: Mother with cardiac history

SOCIAL HISTORY: Married with two children.
Occupation:She is employed as an assistant manager for an
independent living facility.
Tobacco: Remote, quit [**2088**]
ETOH: 6 drinks per weekend
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Anemia, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Hyperlipidemia NEC/NOS,Osteoporosis NOS,Anemia NOS
Admission Date:  [**2119-5-25**]              Discharge Date:   [**2119-5-30**]

Date of Birth:  [**2061-9-29**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Coronary Artery Disease

Major Surgical or Invasive Procedure:
[**2119-5-26**]: Coronary Artery ByPass Grafting x 2, (LIMA->LAD, free
RIMA to circumflex)


History of Present Illness:
57 year old woman with hyperlipidemia has recently been
evaluated for intermittent chest pressure/squeezing that has
been occurring over the past several months. These symptoms are
occurring both at rest and with activity, but do not
consistently occur with exertion. She was found to have tight
left main coronary artery disease on cardiac catheterization
today, now referred for cardiac surgery.


Past Medical History:
Past Medical History
Hyperlipidemia
Remote diagnosis of mitral valve prolapse. No evidence on most
recent echo
Osteoporosis

Past Surgical History
s/p resection of benign colon polyps
Appendectomy
C-section x 2


Social History:
Married with two children.
Occupation:She is employed as an assistant manager for an
independent living facility.
Tobacco: Remote, quit [**2088**]
ETOH: 6 drinks per weekend


Family History:
Mother with cardiac history

Physical Exam:
Pulse:57 Resp:17  O2 sat: 95
B/P  Right: 113/62
Height:  5 feet 5 inches
Weight:  150 pounds

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

Carotid Bruit        Right: -   Left:-


Pertinent Results:
Echo: [**2119-5-26**]
Conclusions
PRE-BYPASS: 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 is seen by 2D
or color Doppler. Overall left ventricular systolic function is
low normal (LVEF 50-55%). The right ventricular cavity is mildly
dilated with normal free wall contractility. The ascending,
transverse and descending thoracic aorta are normal in diameter
and free of atherosclerotic plaque to XX cm from the incisors.
The diameters of aorta at the sinus, ascending and arch levels
are normal. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion. There are three aortic valve
leaflets. There is no aortic valve stenosis. Trace aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is mild posterior leaflet mitral valve
prolapse. Trivial mitral regurgitation is seen. There is a
trivial/physiologic pericardial effusion.
POST CPB:
1. Preserved [**Hospital1 **]-venytricular systolcio function
2. No change in valve structure and function
3. Intact aorta

[**2119-5-29**] 04:30AM BLOOD WBC-7.9 RBC-2.78* Hgb-8.6* Hct-26.2*
MCV-94 MCH-30.8 MCHC-32.7 RDW-13.4 Plt Ct-112*
[**2119-5-28**] 06:30AM BLOOD WBC-9.9 RBC-2.93* Hgb-9.0* Hct-26.8*
MCV-92 MCH-30.6 MCHC-33.4 RDW-13.3 Plt Ct-105*
[**2119-5-29**] 04:30AM BLOOD Glucose-108* UreaN-17 Creat-0.7 Na-137
K-4.4 Cl-102 HCO3-29 AnGap-10
[**2119-5-28**] 06:30AM BLOOD Glucose-113* UreaN-12 Creat-0.7 Na-135
K-4.0 Cl-101 HCO3-28 AnGap-10
[**2119-5-30**] 04:45AM BLOOD WBC-7.2 RBC-2.87* Hgb-9.0* Hct-26.1*
MCV-91 MCH-31.2 MCHC-34.3 RDW-13.7 Plt Ct-175#
[**2119-5-30**] 04:45AM BLOOD Glucose-103* UreaN-12 Creat-0.6 Na-138
K-4.2 Cl-104 HCO3-27 AnGap-11

Brief Hospital Course:
 The patient was brought to the operating room on [**2119-5-26**] where
the patient underwent Coronary Artery Bypass Grafting x 2,
(LIMA->LAD, free RIMA to circ). Overall the patient tolerated
the procedure well and post-operatively was transferred to the
CVICU in stable condition for recovery and invasive monitoring.
She was extubated, weaned from inotropic and vasopressor
support. POD 1 the patient was alert and oriented and breathing
comfortably.  The patient was neurologically intact and
hemodynamically stable.  Beta blocker was initiated and the
patient was gently diuresed toward the preoperative weight. The
patient was transferred to the telemetry floor for further
recovery.  Chest tubes and pacing wires were discontinued
without complication. Cardiazem was started for free RIMA and is
to continue for 3 months. The patient was evaluated by the
physical therapy service for assistance with strength and
mobility.  By the time of discharge on POD 4 the patient was
ambulating freely, the wound was healing and pain was controlled
with oral analgesics.  The patient was discharged home with VNA
services in good condition with appropriate follow up
instructions.

Medications on Admission:
Metoprolol succinate 25 mg daily
Simvastatin 10 mg daily
Aspirin 81 mg daily
Calcium Carbonatee-Vitamin D3 600 mg-200 mg 2 tablets daily
Multivitamin
Estradiol 10 mcg 3 x week

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. diltiazem HCl 30 mg Tablet Sig: One (1) Tablet PO QID (4
times a day) as needed for Free RIMA for 3 months.
Disp:*120 Tablet(s)* Refills:*2*
5. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
6. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
5 days.
Disp:*5 Tablet(s)* Refills:*0*
7. potassium chloride 10 mEq Tablet Extended Release Sig: Two
(2) Tablet Extended Release PO once a day for 5 days.
Disp:*10 Tablet Extended Release(s)* Refills:*0*
8. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Coronary Artery Disease
Hyperlipidemia
Osteoporosis

PSH
Resection of benign colon polys
Appendectomy
C-Section x2


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
Edema: trace


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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**
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge


Followup Instructions:
You are scheduled for the following appointments:
Wound Check at Cardiac Surgery Office [**Telephone/Fax (1) 170**], [**2119-6-7**]
10:45
Surgeon Dr. [**First Name (STitle) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2119-6-22**] 1:15

Please call to schedule the following:
Primary Care Dr. [**Last Name (STitle) 68409**],[**First Name3 (LF) 20**] B. [**Telephone/Fax (1) 68410**] in [**4-11**] weeks
Cardiologist Dr. [**Last Name (STitle) **],[**First Name3 (LF) 2801**] I. [**Telephone/Fax (1) 2258**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2119-5-30**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Anemia, 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: Coronary Artery Disease

PRESENT ILLNESS: 57 year old woman with hyperlipidemia has recently been
evaluated for intermittent chest pressure/squeezing that has
been occurring over the past several months. These symptoms are
occurring both at rest and with activity, but do not
consistently occur with exertion. She was found to have tight
left main coronary artery disease on cardiac catheterization
today, now referred for cardiac surgery.

MEDICAL HISTORY: Past Medical History
Hyperlipidemia
Remote diagnosis of mitral valve prolapse. No evidence on most
recent echo
Osteoporosis

MEDICATION ON ADMISSION: Metoprolol succinate 25 mg daily
Simvastatin 10 mg daily
Aspirin 81 mg daily
Calcium Carbonatee-Vitamin D3 600 mg-200 mg 2 tablets daily
Multivitamin
Estradiol 10 mcg 3 x week

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:57 Resp:17  O2 sat: 95
B/P  Right: 113/62
Height:  5 feet 5 inches
Weight:  150 pounds

FAMILY HISTORY: Mother with cardiac history

SOCIAL HISTORY: Married with two children.
Occupation:She is employed as an assistant manager for an
independent living facility.
Tobacco: Remote, quit [**2088**]
ETOH: 6 drinks per weekend 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other and unspecified hyperlipidemia,Osteoporosis, unspecified,Anemia, unspecified'}
