CHIEF COMPLAINT: angina,NSTEMI

PRESENT ILLNESS: 78 yo female with mutiple cardiac risk factors. Recently
admiutted for angina and ruled in for NSTEMI. Cath revealed  LAD
70%, DIAG 70%, OM1 99% CX 70%, and small RCA without lesions.
PCI was unsuccessful at cath and now referred for CABG.

MEDICAL HISTORY: NSTEMI
CVA ([**8-16**]; MRI showing left internal capsular defect, little
residual effect)
ESRD still not on HD - Cr 3.0 (1.7-6.0) - followed by Dr. [**Last Name (STitle) **]

MEDICATION ON ADMISSION: ASA 325 mg daily
levothyroxine 88 mcg daily
sertraline 50 mg daily
lipitor 80 mg daily
calcium acetate 667mg TID
protonix 40 mg daily
calcitriol 0.25 mg every other day
metoprolol 12.5 mg TID
Vits. C/E

ALLERGIES: Gemfibrozil

PHYSICAL EXAM: 55.9 kg    58"
elderly female in NAD
mild erythema on abd.
neck supple with full ROM, no carotid bruits
CTAB
RRR, no murmur
soft, NT, ND, +BS
warm, well-perfused, no edema or varicosities
neuro grossly intact
fems bil. 2+
DP/PT/radials  1+ bil.

FAMILY HISTORY: Notable for diabetes and renal failure in a brother.

SOCIAL HISTORY: Former light smoker (ages 25-73); quit 4 yrs ago. No history of
Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Personal history of other diseases of circulatory system,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Osteoarthrosis, unspecified whether generalized or localized, other specified sites
Subendo infarct, initial,Hyp kid NOS w cr kid V,End stage renal disease,CHF NOS,Crnry athrscl natve vssl,Hx-circulatory dis NEC,Hypothyroidism NOS,Pure hypercholesterolem,Depressive disorder NEC,Osteoarthro NOS-oth site
Admission Date:  [**2152-4-6**]              Discharge Date:   [**2152-4-11**]

Date of Birth:  [**2073-11-29**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Gemfibrozil

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
angina,NSTEMI

Major Surgical or Invasive Procedure:
cabg x4  [**2152-4-6**]  (LIMA to LAD, SVG to DIAG, SVG to OM 1 and OM
2)


History of Present Illness:
78 yo female with mutiple cardiac risk factors. Recently
admiutted for angina and ruled in for NSTEMI. Cath revealed  LAD
70%, DIAG 70%, OM1 99% CX 70%, and small RCA without lesions.
PCI was unsuccessful at cath and now referred for CABG.

Past Medical History:
NSTEMI
CVA ([**8-16**]; MRI showing left internal capsular defect, little
residual effect)
ESRD still not on HD - Cr 3.0 (1.7-6.0) - followed by Dr. [**Last Name (STitle) **]

Congestive Heart Failure (ECHO [**9-27**] [**Hospital1 1474**], technically
limited showed mild concentric LVH with EF at 60%, ?pericardial

effusion (size unspecified)
s/p right renal artery stent ([**9-15**]) by Dr. [**Last Name (STitle) 911**]
Hypertension
Hypercholesterolemia,
Hypothyroidism
Depression
Degenerative Joint Disease
TAH-BSO/repair of umbilical hernia for benign ovarian mass
(path=fibroma [**4-14**])


Social History:
Former light smoker (ages 25-73); quit 4 yrs ago. No history of

EtOH or other drugs. Formerly worked as a paralegal. Now living

in public senior housing in [**Hospital1 1474**]. Mother of two--one
daughter lives nearby.


Family History:
Notable for diabetes and renal failure in a brother.


Physical Exam:
55.9 kg    58"
elderly female in NAD
mild erythema on abd.
neck supple with full ROM, no carotid bruits
CTAB
RRR, no murmur
soft, NT, ND, +BS
warm, well-perfused, no edema or varicosities
neuro grossly intact
fems bil. 2+
DP/PT/radials  1+ bil.

Pertinent Results:
[**2152-4-11**] 07:15AM BLOOD WBC-10.3 RBC-4.05* Hgb-13.2 Hct-38.3
MCV-94 MCH-32.5* MCHC-34.4 RDW-15.0 Plt Ct-111*
[**2152-4-11**] 07:15AM BLOOD Plt Ct-111*
[**2152-4-9**] 06:20AM BLOOD PT-14.9* PTT-28.1 INR(PT)-1.3*
[**2152-4-11**] 07:15AM BLOOD UreaN-44* Creat-2.7* K-3.8

Cardiology Report ECHO Study Date of [**2152-4-6**]



PATIENT/TEST INFORMATION:
Indication: Intraoperative TEE for CABG procedure
Height: (in) 58
Weight (lb): 123
BSA (m2): 1.48 m2
BP (mm Hg): 187/67
HR (bpm): 56
Status: Inpatient
Date/Time: [**2152-4-6**] at 10:51
Test: TEE (Complete)
Doppler: Limited Doppler and color Doppler
Contrast: None
Tape Number: 2007AW1-:
Test Location: Anesthesia West OR cardiac
Technical Quality: Suboptimal




REFERRING DOCTOR: DR. [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **]

MEASUREMENTS:
Left Ventricle - Septal Wall Thickness: *1.3 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Ejection Fraction: >= 55% (nl >=55%)
Aorta - Ascending: 3.4 cm (nl <= 3.4 cm)
Aortic Valve - Peak Velocity: 1.2 m/sec (nl <= 2.0 m/sec)
Aortic Valve - Peak Gradient: 6 mm Hg
Mitral Valve - E Wave: 0.8 m/sec
Mitral Valve - A Wave: 0.8 m/sec
Mitral Valve - E/A Ratio: 1.00
Mitral Valve - E Wave Deceleration Time: 311 msec
Pericardium - Effusion Size: 0.6 cm

INTERPRETATION:

Findings:

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA
and extending into the RV. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Mild symmetric LVH. Normal regional LV systolic
function.
Overall normal LVEF (>55%). No resting LVOT gradient.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta
diameter. Simple atheroma in ascending aorta. Normal aortic arch
diameter.
Complex (>4mm) atheroma in the aortic arch. Normal descending
aorta diameter.
Complex (>4mm) atheroma in the descending thoracic aorta.

AORTIC VALVE: Three aortic valve leaflets. Filamentous strands
on the aortic
leaflets c/with Lambl's excresences (normal variant). No AS. No
AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS.
Mild (1+) MR.

TRICUSPID VALVE: Mild [1+] TR.

PERICARDIUM: Small 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 patient was under general anesthesia
throughout the
procedure. The patient appears to be in sinus rhythm. Results
were personally

Conclusions:
Prebypass

1.No atrial septal defect is seen by 2D or color Doppler.

2.There is mild symmetric left ventricular hypertrophy. Regional
left
ventricular wall motion is normal. Overall left ventricular
systolic function
is normal (LVEF>55%).

3. Right ventricular chamber size and free wall motion are
normal.

4.There are simple atheroma in the ascending aorta. There are
complex (>4mm)
atheroma in the aortic arch. There are complex (>4mm) atheroma
in the
descending thoracic aorta.

5.There are three aortic valve leaflets. There are filamentous
strands on the
aortic leaflets consistent with Lambl's excresences (normal
variant). There is
no aortic valve stenosis. No aortic regurgitation is seen.

6. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral
regurgitation is seen.

7.There is a small pericardial effusion.

POSTBYPASS

1. Patient is being AV paced and receiving an infusion of
phenylephrine.

2. Biventricular systolic function is unchanged.

3. Mild mitral regurgitation persists.

4. Aorta is intact post decannulation.

Electronically signed by [**Name6 (MD) 1509**] [**Name8 (MD) 1510**], MD on [**2152-4-6**] 16:29.

[**Location (un) **] PHYSICIAN:



([**Numeric Identifier 2541**])


Brief Hospital Course:
Admitted [**4-6**] and underwent cabg x4 with Dr. [**Last Name (STitle) 914**].
Transferred to the CSRU in stable condition on titrated
propofol, phenylephrine and nitroglycerin drips. Extubated that
evening and remained in the CSRU for 2 days requiring titrated
antihypertensives as well as an insulin drip.Transferred to the
floor on POD #2. HIT screen sent for decreasing platelets, but
results were negative. Chest tubes removed without incident on
POD #3. Pacing wires removed on POD #5 and plavix restarted.
Cleared for discharge to rehab on POD #5. Pt. is to make all
follow-up appts. as per discharge instructions.

Medications on Admission:
ASA 325 mg daily
levothyroxine 88 mcg daily
sertraline 50 mg daily
lipitor 80 mg daily
calcium acetate 667mg TID
protonix 40 mg daily
calcitriol 0.25 mg every other day
metoprolol 12.5 mg TID
Vits. C/E

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 10 days.
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 10
days.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO EVERY
OTHER DAY (Every Other Day).
8. Calcium Acetate 667 mg Capsule Sig: One (1) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
9. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
12. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Sertraline 50 mg daily.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 2542**] - [**Hospital1 1474**]

Discharge Diagnosis:
s/p cabg x4
CAD
NSTEMI
CRF with ESRD
CVA
renal artery stent
CHF
HTN


Discharge Condition:
stable


Discharge Instructions:
no driving for one month
no lotions, creams, or powders on any incision
no lifting greater than 10 pounds for 10 weeks
may shower over incisions and pat dry
call for fever greater than 100.5, redness or drainage

Followup Instructions:
see Dr. [**Last Name (STitle) 2539**] in [**12-14**] weeks
See Dr. [**Last Name (STitle) 911**] in [**1-15**] weeks
See Dr. [**Last Name (STitle) 914**] in 4 weeks  [**Telephone/Fax (1) 170**]



Completed by:[**2152-4-11**]
{'Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Personal history of other diseases of circulatory system,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Osteoarthrosis, unspecified whether generalized or localized, other specified sites'}


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: angina,NSTEMI

PRESENT ILLNESS: 78 yo female with mutiple cardiac risk factors. Recently
admiutted for angina and ruled in for NSTEMI. Cath revealed  LAD
70%, DIAG 70%, OM1 99% CX 70%, and small RCA without lesions.
PCI was unsuccessful at cath and now referred for CABG.

MEDICAL HISTORY: NSTEMI
CVA ([**8-16**]; MRI showing left internal capsular defect, little
residual effect)
ESRD still not on HD - Cr 3.0 (1.7-6.0) - followed by Dr. [**Last Name (STitle) **]

MEDICATION ON ADMISSION: ASA 325 mg daily
levothyroxine 88 mcg daily
sertraline 50 mg daily
lipitor 80 mg daily
calcium acetate 667mg TID
protonix 40 mg daily
calcitriol 0.25 mg every other day
metoprolol 12.5 mg TID
Vits. C/E

ALLERGIES: Gemfibrozil

PHYSICAL EXAM: 55.9 kg    58"
elderly female in NAD
mild erythema on abd.
neck supple with full ROM, no carotid bruits
CTAB
RRR, no murmur
soft, NT, ND, +BS
warm, well-perfused, no edema or varicosities
neuro grossly intact
fems bil. 2+
DP/PT/radials  1+ bil.

FAMILY HISTORY: Notable for diabetes and renal failure in a brother.

SOCIAL HISTORY: Former light smoker (ages 25-73); quit 4 yrs ago. No history of 

### Response:
{'Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Personal history of other diseases of circulatory system,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Osteoarthrosis, unspecified whether generalized or localized, other specified sites'}
