CHIEF COMPLAINT: Old myocardial infarction by echo and low ejection fraction. No
symptoms.

PRESENT ILLNESS: This 44 year old white male with a history of hypertension,
hyperlipidemia and  recent stroke was referred for cardiac
catheterization due to low EF of 20-30%. The patient was
admitted to [**Hospital1 2025**] in [**4-28**] with left CVA where they discovered an
old anterior wall MI with a low EF. The etiology of his stroke
was undetermined and he was discharged wearing a defibrillator
harness with plans for ICD in future.  He has no cardiac
symptoms, but reports occasional parasthesias in arms and legs.

MEDICAL HISTORY: hypertension
Hyperlipidemia
h/o Anterior wall MI
Left Cerebellar CVA [**4-28**] without residual deficits
s/p orchiplexy age 4

MEDICATION ON ADMISSION: Warfarin 7', Simvastatin 40', Carvedilol 6.25mg 1.5mg tab/am and
1.5 tab/pm, Lisinopril 5', ASA 81', Citalopram 20'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Grandfather died of MI in his 50s

SOCIAL HISTORY: Last Dental Exam: 2 years ago
Lives with:wife and 4 kids
Occupation:Full time welder, has not worked since CVA [**4-28**] and
wears a defibrillator harness
Tobacco:quit [**4-/2195**], 70 pack year history
ETOH:denies
Illicit drug use: denies
Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Other primary cardiomyopathies,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Paroxysmal tachycardia, unspecified,Other and unspecified hyperlipidemia,Old myocardial infarction,Depressive disorder, not elsewhere classified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other postprocedural status,Personal history of tobacco use
Crnry athrscl natve vssl,Chr systolic hrt failure,Prim cardiomyopathy NEC,Secundum atrial sept def,Hypertension NOS,Parox tachycardia NOS,Hyperlipidemia NEC/NOS,Old myocardial infarct,Depressive disorder NEC,Hx TIA/stroke w/o resid,Post-proc states NEC,History of tobacco use
Admission Date:  [**2195-8-28**]              Discharge Date:   [**2195-9-5**]

Date of Birth:  [**2151-7-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Old myocardial infarction by echo and low ejection fraction. No
symptoms.

Major Surgical or Invasive Procedure:
[**2195-9-1**] - 1. Coronary artery bypass grafting
x3(LIMA-LAD,SVG-lPDA,SVG-rPDA)&  Patent foramen ovale closure.
left heart catheterization, coronary angiography


History of Present Illness:
This 44 year old white male with a history of hypertension,
hyperlipidemia and  recent stroke was referred for cardiac
catheterization due to low EF of 20-30%. The patient was
admitted to [**Hospital1 2025**] in [**4-28**] with left CVA where they discovered an
old anterior wall MI with a low EF. The etiology of his stroke
was undetermined and he was discharged wearing a defibrillator
harness with plans for ICD in future.  He has no cardiac
symptoms, but reports occasional parasthesias in arms and legs.



Past Medical History:
hypertension
Hyperlipidemia
h/o Anterior wall MI
Left Cerebellar CVA [**4-28**] without residual deficits
s/p orchiplexy age 4


Social History:
Last Dental Exam: 2 years ago
Lives with:wife and 4 kids
Occupation:Full time welder, has not worked since CVA [**4-28**] and
wears a defibrillator harness
Tobacco:quit [**4-/2195**], 70 pack year history
ETOH:denies
Illicit drug use: denies


Family History:
Grandfather died of MI in his 50s

Physical Exam:
Admission:

Pulse:71 Resp:16  O2 sat: 99%RA
B/P  Right:116/74    Left: 113/66
Height: 6'3"    Weight:250 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
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
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: no   Left: no

Dishcarge
T: 97.8  HR: 79 SR  BP: 124/70  Sats: 95% RA
General: walking in halls no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple, no lyphadenopathy
Card: RRR normal S1,S2 no murmur/gallop or rub
Resp: diminished breath sounds otherwise clear
GI: bowel sounds positive, abdomen soft non-tender/non-distended
Extr: warm 1+ edema bilateral
Incision: sternal incision clean, no erythema, no click
Neuro: non-focal


Pertinent Results:
[**2195-8-31**] ECHO
PREBYPASS
The interatrial septum is aneurysmal. A patent foramen ovale is
present with right to left flow demonstarted with agitated
saline comtrast and Valsalva/release.. Left ventricular wall
thicknesses are normal. The left ventricular cavity is
moderately dilated. There is severe regional left ventricular
systolic dysfunction with akinesis of the apex distal anterior,
inferior, lateral and septal walls and mid anterior,
anteroseptal and inferoseptal walls. The remaining wall are
hypokinetic. Overall left ventricular systolic function is
severely depressed (LVEF= <20 %). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened. There is no aortic valve stenosis. Trace
aortic regurgitation is seen. The mitral valve leaflets are
structurally normal. Physiologic mitral regurgitation is seen
(within normal limits).

POSTBYPASS
There is improvement of the inferolateral and anterolateral
walls.(LVEF 20-25%) Akinetic areas remain unchanged. RV systolic
function remains unchanged. No color flow Doppler is visualized
through the interatrial septum. No agitated saline contrast is
visualized across the septum and rest or with Valsalva/release.
MR remains trace.

[**2195-8-31**] Carotid U/S
No hemodynamically significant stenosis.

[**2195-8-28**] Cardiac Catheterization
1. Coronary angiography in this co-dominant system demonstrated
three
vessel disease. The LMCA was long with mild luminal
irregularities. The
proximal LAD had focal calcification and was totally occluded
after a
high 1st diagonal branch and 1st septal branch. The mid-distal
LAD
filled vial left-to-left collaterals. The 1st diagonal branch
had mild
luminal irregularities. The LCx had proximal-mid vessel tapering
that
culminated in a 60% stenosis before OM2. The OM2 had mild origin

stenosis. There were distal collaterals from the LCx to the
RPL/RPDA
system. The RCA had diffuse disease with a 70% proximal
stenosis, a 50%
mid stenosis, and a 80% distal stenosis with subsequent total
occlusion.
There was minimal filling iof the distal RCA, RPDA, and RPL.
2. Resting hemodynamics revealed mildly elevated right and left
sided
filling pressures with RVEDP of 14 mmHg and LVEDP of 18 mmHg.
The
pulmonary arterial systolic pressure was normal at 27 mmHg. The
cardiac
index was preserved at 2.8 L/min/m2. There was normal systemic
arterial
pressure with SBP of 101 mmHg and DBP of 61 mmHg.
3. There was no evidence of significant right-to-left or
left-to-right
shunting based on oxygen saturation.
CXR: [**2195-9-4**] FINDINGS: In comparison with study of [**9-2**], the
right IJ sheath has been removed. There is a persistent, though
apparent decreasing opacification at the left base, consistent
with effusion and atelectasis. Mild atelectatic changes are seen
at the right base medially.

[**2195-9-4**] WBC-9.8 RBC-3.61* Hgb-10.4* Hct-30.6* Plt Ct-181
[**2195-9-4**] Glucose-121* UreaN-15 Creat-0.9 Na-136 K-4.5 Cl-97
HCO3-29 Mg-2.1

Brief Hospital Course:
Mr. [**Known lastname 82897**] was admitted to the [**Hospital1 18**] on [**2195-8-28**]. He underwent a
cardiac catheterization which revealed severe three vessel.
Given the severity of his disease, the cardiac surgical service
was consulted for surgical revascularization. He was worked-up
in the usual preoperative manner including a carotid duplex
ultrasound which showed no hemodynamically significant disease.
On [**2195-9-1**] Mr. [**Known lastname 82897**] was taken to the operating room where he
underwent coronary artery bypass grafting to three vessels and
closure of a patent foramen ovale. Please see operative note for
details.

Postoperatively he was taken to the intensive care unit for
monitoring. Within 24 hours, he awoke neurologically intact and
was extubated. On [**2195-9-2**], Mr. [**Known lastname 82897**] was transferred to the
step down unit for further recovery. He was gently diuresed
towards his preoperative weight. His electrolytes were repleted
as needed.  The chest-tube and pacing wires were removed per
protocol.  He was followed by serial chest films which revealed
small left lower lobe effusion with atelectasis.  The foley was
removed and he voided without difficulty. The physical therapy
service was consulted for assistance with his postoperative
strength and mobility. He was started on coreg 3.125 which he
tolerated.  His home meds were restarted.  His pain was well
controlled with Dilaudid and motrin.  He tolerated a regular
diet. He made steady progress and was discharged to home on
[**2195-9-5**].  He will follow-up as an outpatient.

Medications on Admission:
Warfarin 7', Simvastatin 40', Carvedilol 6.25mg 1.5mg tab/am and
1.5 tab/pm, Lisinopril 5', ASA 81', Citalopram 20'

Discharge Medications:
1. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Motrin 600 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for pain: take with food and water.
Disp:*90 Tablet(s)* Refills:*0*
7. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
8. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
9. Potassium Chloride 10 mEq Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO once a day: take with lasix.
Disp:*30 Tablet Sustained Release(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **] Nursing Services

Discharge Diagnosis:
coronary artery disease
s/p coronary artery bypass grafts
hypertension
Hyperlipidemia
h/o Anterior wall mycardial infarction
s/p Left Cerebellar CVA [**4-28**] without residual deficits
s/p orchiplexy


Discharge Condition:
Good.


Discharge Instructions:
Weigh yourself daily, call if weight goes up more than 2 pounds
[**Last Name (un) 5490**] or 5 pounds a week.
Take medications as directed on discharge instructions.
Do not drive for 4 weeks and while taking narcotics.
Do not lift more than 10 lbs. for 10 weeks.
Shower daily, let water flow over wounds, pat dry with a towel.
Do not use lotions, creams, or powders on wounds.
Call our office for sternal drainage or temperature greater
than100.5.

Followup Instructions:
Dr. [**First Name11 (Name Pattern1) 1158**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 1159**] in [**11-21**] weeks ([**Telephone/Fax (1) 20587**]) .
Dr. [**First Name (STitle) **] [**Name (STitle) 1911**] in [**12-23**] weeks ([**Telephone/Fax (1) 62**]).
Dr. [**Last Name (STitle) **] for 4 weeks ([**Telephone/Fax (1) 170**])
[**Hospital Ward Name 121**] 6 wound clinic in 2 weeks.
please call for appointments



Completed by:[**2195-9-5**]
{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Other primary cardiomyopathies,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Paroxysmal tachycardia, unspecified,Other and unspecified hyperlipidemia,Old myocardial infarction,Depressive disorder, not elsewhere classified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other postprocedural status,Personal history of tobacco use'}


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: Old myocardial infarction by echo and low ejection fraction. No
symptoms.

PRESENT ILLNESS: This 44 year old white male with a history of hypertension,
hyperlipidemia and  recent stroke was referred for cardiac
catheterization due to low EF of 20-30%. The patient was
admitted to [**Hospital1 2025**] in [**4-28**] with left CVA where they discovered an
old anterior wall MI with a low EF. The etiology of his stroke
was undetermined and he was discharged wearing a defibrillator
harness with plans for ICD in future.  He has no cardiac
symptoms, but reports occasional parasthesias in arms and legs.

MEDICAL HISTORY: hypertension
Hyperlipidemia
h/o Anterior wall MI
Left Cerebellar CVA [**4-28**] without residual deficits
s/p orchiplexy age 4

MEDICATION ON ADMISSION: Warfarin 7', Simvastatin 40', Carvedilol 6.25mg 1.5mg tab/am and
1.5 tab/pm, Lisinopril 5', ASA 81', Citalopram 20'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: Grandfather died of MI in his 50s

SOCIAL HISTORY: Last Dental Exam: 2 years ago
Lives with:wife and 4 kids
Occupation:Full time welder, has not worked since CVA [**4-28**] and
wears a defibrillator harness
Tobacco:quit [**4-/2195**], 70 pack year history
ETOH:denies
Illicit drug use: denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Other primary cardiomyopathies,Ostium secundum type atrial septal defect,Unspecified essential hypertension,Paroxysmal tachycardia, unspecified,Other and unspecified hyperlipidemia,Old myocardial infarction,Depressive disorder, not elsewhere classified,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other postprocedural status,Personal history of tobacco use'}
