CHIEF COMPLAINT: See other DC summary completed for this stay.

PRESENT ILLNESS: Ms. [**Known lastname 1120**] is a 79-year-old woman
who presented to the [**Hospital6 1109**] on [**1-6**]
with complaint of chest pain which occurred following
vomiting coffee ground material.  She underwent a cardiac
catheterization which showed 40-50 percent left main,
proximal LAD, diagonal, circumflex, OM and PDA stenosis.
Unable to evaluate ejection fraction due to ectopy with
likely posterolateral hypokinesis.  She was transferred to [**Hospital1 **]
[**Hospital **] [**First Name (Titles) **] [**Last Name (Titles) **], on the day of admission to
[**Hospital1 **], for coronary artery bypass grafting, but had large
volume of hemoptysis.  She was transferred to the CCU and
underwent upper GI endoscopy which revealed duodenitis,
hiatal hernia, gastritis, with no active bleeding.  She was
placed on IV Protonix, anticoagulation was stopped, and she
had no further evidence of bleeding over the next two days.
She was then cleared by the GI service to proceed with
coronary artery bypass grafting.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Erythromycin Base / Promethazine

PHYSICAL EXAM: Neuro grossly intact.  No carotid bruits.
Pulmonary:  Clear to auscultation bilaterally.  Cardiac:
Regular rate and rhythm.  No murmur.  Abdomen is soft,
nontender and nondistended.  Extremities are warm, trace
pedal edema bilaterally with no varicosities.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified gastritis and gastroduodenitis, with hemorrhage,Mitral valve disorders,Subendocardial infarction, subsequent episode of care,Unspecified acquired hypothyroidism,Arthropathy, unspecified, shoulder region,Asthma, unspecified type, unspecified,Esophageal reflux,M?ni?re's disease, unspecified,Obesity, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Gstr/ddnts NOS w hmrhg,Mitral valve disorder,Subendo infarct, subseq,Hypothyroidism NOS,Arthropathy NOS-shlder,Asthma NOS,Esophageal reflux,Meniere's disease NOS,Obesity NOS
Admission Date:  [**2112-1-6**]              Discharge Date:   [**2112-1-14**]

Date of Birth:  [**2032-7-23**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Erythromycin Base / Promethazine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
See other DC summary completed for this stay.

Major Surgical or Invasive Procedure:
CABG


Brief Hospital Course:
FOr events during this hospitalization, see the other DC summary
completed

Discharge Disposition:
Extended Care

Facility:
TCU at [**Location (un) 47**] [**Hospital1 1281**]

Discharge Diagnosis:
s/p CABG x5 LIMA->Diag,SVG->LAD,SVG->Ramus,SVG->OM,SVG->PDA
hypothyroid,asthma,skin CA,Meniere's dz,GERD,arthritis,L ear
deafness


Discharge Condition:
good

Discharge Instructions:
keep wounds clean and dry. OK to shower, no swimming or bathing
Take all medications as prescribed
Call for any fever, redness or drainage from wounds

Followup Instructions:
Dr [**Last Name (STitle) 1159**] in [**3-17**] weeks
Dr [**Last Name (STitle) **] in 4 weeks





Admission Date: [**2112-1-6**]        Discharge Date: [**2112-1-14**]

Date of Birth:  [**2032-7-23**]        Sex:  F

Service:  CSU


HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 1120**] is a 79-year-old woman
who presented to the [**Hospital6 1109**] on [**1-6**]
with complaint of chest pain which occurred following
vomiting coffee ground material.  She underwent a cardiac
catheterization which showed 40-50 percent left main,
proximal LAD, diagonal, circumflex, OM and PDA stenosis.
Unable to evaluate ejection fraction due to ectopy with
likely posterolateral hypokinesis.  She was transferred to [**Hospital1 **]
[**Hospital **] [**First Name (Titles) **] [**Last Name (Titles) **], on the day of admission to
[**Hospital1 **], for coronary artery bypass grafting, but had large
volume of hemoptysis.  She was transferred to the CCU and
underwent upper GI endoscopy which revealed duodenitis,
hiatal hernia, gastritis, with no active bleeding.  She was
placed on IV Protonix, anticoagulation was stopped, and she
had no further evidence of bleeding over the next two days.
She was then cleared by the GI service to proceed with
coronary artery bypass grafting.

PAST MEDICAL HISTORY:  Coronary artery disease.

Hypothyroidism.

Asthma.

Skin CA.

Meniere's disease.

GERD.

Left ear deafness.

Left shoulder arthritis.

MEDS AT HOME:
1. Advair 250/50, 2 puffs [**Hospital1 **].
2. Synthroid 100 mcg once daily.
3. Hydrochlorothiazide.
4. Singulair 10 once daily.
5. Vistaril.


MEDS AT [**Hospital Ward Name **] MEDICAL CENTER:
1. Aspirin 325 once daily.
2. Protonix 40 IV bid.
3. Synthroid 88 once daily.
4. Singulair 10 once daily.
5. Lipitor 40 once daily.
6. Advair 250/50, 2 puffs [**Hospital1 **].
7. Subcu heparin.
8. Carafate 1 gm [**Hospital1 **].
9. Lopressor 25 mg [**Hospital1 **].


ALLERGIES:  Erythromycin.

REVIEW OF SYMPTOMS:  No TIA, CVA, seizure, or headaches.
Positive Meniere's.  Positive polio as a child.  Pulmonary:
Positive asthma with no sputum production.  Cardiac:
Positive dyspnea on exertion, occasional palpitations.  No
PND.  No orthopnea.  GI:  Positive GERD.  No previous
hemoptysis.  Positive hemorrhoids.  GU:  No frequency.  No
dysuria.  Heme, ID:  No issues.  Endocrine:  Hypothyroidism.
No diabetes.

PHYSICAL EXAM:  Neuro grossly intact.  No carotid bruits.
Pulmonary:  Clear to auscultation bilaterally.  Cardiac:
Regular rate and rhythm.  No murmur.  Abdomen is soft,
nontender and nondistended.  Extremities are warm, trace
pedal edema bilaterally with no varicosities.

LAB DATA:  White count 8.5, hematocrit 33.4, platelets 159,
sodium 140, potassium 3.9, chloride 109, CO2 27, BUN 10,
creatinine 0.7, glucose 121, PTT 32.1, INR 1.1.

The patient had carotid duplexes that showed no significant
hemodynamic lesions on either right or left.  Additionally,
she had an echocardiogram that showed an EF of 60 percent
with no AS, trace AR, 1 plus MR, and normal PA pressures.

HOSPITAL COURSE:  Ultimately, on [**1-11**] the patient was
brought to the operating room where she underwent coronary
artery bypass grafting.  Please see the OR report for full
details.  In summary, the patient had a CABG x 5 with a LIMA
to the diag, saphenous vein graft to the LAD, saphenous vein
graft to the ramus, saphenous vein graft to the OM, and
saphenous vein graft to the PDA.  Her bypass time was 97
minutes with a crossclamp time of 78 minutes.  She tolerated
the operation well and was transferred from the operating
room to the Cardiothoracic Intensive Care Unit.  At the time
of transfer, the patient had Levophed at 0.03 mcg/kg/min,
Nitroglycerin at 0.5 mcg/kg/min, lidocaine at 2 mg/min and
propofol at 20 mcg/kg/min.

The patient did well in the immediate postoperative period.
Her anesthesia was reversed.  She was weaned from the
ventilator and successfully extubated.  On the course of the
operative day, she was also weaned from her Levophed drip as
well, and her Nitroglycerin was titrated to control periods
of hypertension postoperatively.  The patient also remained
on a lidocaine drip overnight.

On postoperative day 1, the lidocaine drip was discontinued.
The patient was transitioned from IV Nitroglycerin to oral
beta blockers, following which the IV Nitroglycerin was
weaned off.

On postoperative day 2, the patient's central lines, Foley
catheter, and chest tubes were removed, and she was
transferred to the floor for continuing postoperative care
and cardiac rehabilitation.  Over the next two days, the
patient had an uneventful postoperative course.  Her activity
level was increased with the assistance of the nursing staff,
as well as physical therapy, and on postoperative day 3 the
patient was considered to be stable and ready to transfer to
rehabilitation at [**Hospital1 **] TCU.

At the time of this dictation, the patient's physical exam is
as follows:  Temperature 98, heart rate 87--sinus rhythm,
blood pressure 129/57, respiratory rate 20, O2 sat 98 percent
on 2 liters, weight preoperatively 68 kg, and at discharge
68.5 kg.

LAB DATA:  White count 12.3, hematocrit 32.5, platelets 201,
sodium 139, potassium 3.9, chloride 102, CO2 28, BUN 16,
creatinine 0.7, glucose 106.

Neuro:  Alert and oriented x 3, moves all extremities,
follows commands, nonfocal exam.  Pulmonary:  Clear to
auscultation bilaterally.  Cardiac:  Regular rate and rhythm,
S1 and S2.  Sternum was stable.  Incision with dry sterile
dressing.  No drainage or erythema.  Abdomen was soft,
nontender, nondistended with hypoactive bowel sounds.
Extremities were warm and well-perfused with 1 plus edema
bilaterally.  The patient had bilateral saphenous vein graft
site incisions with Steri-Strips, open to air.

CONDITION ON DISCHARGE:  Good.

FOLLOW UP:  Dr. [**Last Name (STitle) 1159**] in [**3-17**] weeks following discharge from
rehabilitation and with Dr. [**Last Name (STitle) **] in 4 weeks.

DISCHARGE MEDICATIONS:
1. Lopressor 25 mg [**Hospital1 **].
2. Lasix 20 mg [**Hospital1 **].
3. Colace 100 mg [**Hospital1 **].
4. Potassium chloride 20 mEq [**Hospital1 **].
5. Aspirin 81 mg once daily.
6. Tylenol 325-650 q 4 h prn.
7. Advair 250/50, 1-2 puffs [**Hospital1 **].
8. Synthroid 88 mcg once daily.
9. Singulair 10 mg once daily.
10.Pantoprazole 40 mg once daily.

DISCHARGE DIAGNOSES:  Coronary artery disease, status post
coronary artery bypass graft x 5 with a left internal mammary
artery to the diagonal, saphenous vein graft to the left
anterior descending, saphenous vein graft to ramus, saphenous
vein graft to obtuse marginal, and saphenous vein graft to
posterior descending artery.

Hypothyroid.

Asthma.

Skin cancer.

Meniere's.

Gastroesophageal reflux disease.

Status post upper gastrointestinal bleed.

Arthritis.

Left ear deafness.

DISPOSITION:  Again, the patient is to be discharged to
[**Hospital1 **] TCU.



                        [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2112-1-14**] 12:17:32
T:  [**2112-1-14**] 12:58:27
Job#:  [**Job Number 59703**]
{"Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified gastritis and gastroduodenitis, with hemorrhage,Mitral valve disorders,Subendocardial infarction, subsequent episode of care,Unspecified acquired hypothyroidism,Arthropathy, unspecified, shoulder region,Asthma, unspecified type, unspecified,Esophageal reflux,M?ni?re's disease, unspecified,Obesity, 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: See other DC summary completed for this stay.

PRESENT ILLNESS: Ms. [**Known lastname 1120**] is a 79-year-old woman
who presented to the [**Hospital6 1109**] on [**1-6**]
with complaint of chest pain which occurred following
vomiting coffee ground material.  She underwent a cardiac
catheterization which showed 40-50 percent left main,
proximal LAD, diagonal, circumflex, OM and PDA stenosis.
Unable to evaluate ejection fraction due to ectopy with
likely posterolateral hypokinesis.  She was transferred to [**Hospital1 **]
[**Hospital **] [**First Name (Titles) **] [**Last Name (Titles) **], on the day of admission to
[**Hospital1 **], for coronary artery bypass grafting, but had large
volume of hemoptysis.  She was transferred to the CCU and
underwent upper GI endoscopy which revealed duodenitis,
hiatal hernia, gastritis, with no active bleeding.  She was
placed on IV Protonix, anticoagulation was stopped, and she
had no further evidence of bleeding over the next two days.
She was then cleared by the GI service to proceed with
coronary artery bypass grafting.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 

ALLERGIES: Erythromycin Base / Promethazine

PHYSICAL EXAM: Neuro grossly intact.  No carotid bruits.
Pulmonary:  Clear to auscultation bilaterally.  Cardiac:
Regular rate and rhythm.  No murmur.  Abdomen is soft,
nontender and nondistended.  Extremities are warm, trace
pedal edema bilaterally with no varicosities.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{"Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified gastritis and gastroduodenitis, with hemorrhage,Mitral valve disorders,Subendocardial infarction, subsequent episode of care,Unspecified acquired hypothyroidism,Arthropathy, unspecified, shoulder region,Asthma, unspecified type, unspecified,Esophageal reflux,M?ni?re's disease, unspecified,Obesity, unspecified"}
