CHIEF COMPLAINT: Angina

PRESENT ILLNESS: 74 yo M with history of angina, diaphoresis that has progressed
to crescendo in the last 2 weeks.

MEDICAL HISTORY: CAD
bph, ^chol, HTN, Angina

MEDICATION ON ADMISSION: folate, finasteride 5', simvastatin 40', diltiazem ER 300',
Terazosin 10', ASA 325', NTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 56 RR 18 BP 142/58
WD elderly M in NAD
Upper and lower dentures
Lungs CTAB
RRR no murmur
Abdomen soft, NT, ND
Extrem warm, no edema, 2+ dp/pt pulses
No carotid bruits

FAMILY HISTORY: 2 brothers and sister with CABG at unknown age

SOCIAL HISTORY: retired
quit tob [**2115**] - 10 pack year history
3 etoh/week
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Pure hypercholesterolemia,Unspecified essential hypertension,Personal history of tobacco use,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,BPH w/o urinary obs/LUTS,Pure hypercholesterolem,Hypertension NOS,History of tobacco use,Atrial fibrillation,Abn react-anastom/graft
Admission Date:  [**2156-11-25**]              Discharge Date:   [**2156-12-1**]

Date of Birth:  [**2082-6-15**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Angina

Major Surgical or Invasive Procedure:
CABG X 6 ([**2156-11-26**]- LIMA to LAD, SVG to DIAG, SVG to PDA to PLV,
SVG to OM, with Y graft to RAMUS)


History of Present Illness:
74 yo M with history of angina, diaphoresis that has progressed
to crescendo in the last 2 weeks.

Past Medical History:
CAD
bph, ^chol, HTN, Angina

Social History:
retired
quit tob [**2115**] - 10 pack year history
3 etoh/week

Family History:
2 brothers and sister with CABG at unknown age

Physical Exam:
HR 56 RR 18 BP 142/58
WD elderly M in NAD
Upper and lower dentures
Lungs CTAB
RRR no murmur
Abdomen soft, NT, ND
Extrem warm, no edema, 2+ dp/pt pulses
No carotid bruits

Pertinent Results:
[**2156-11-30**] 06:40AM BLOOD WBC-8.2 RBC-3.31* Hgb-10.0* Hct-29.1*
MCV-88 MCH-30.3 MCHC-34.4 RDW-15.5 Plt Ct-171
[**2156-11-30**] 06:40AM BLOOD Plt Ct-171
[**2156-11-30**] 06:40AM BLOOD Plt Ct-171
[**2156-11-29**] 01:35AM BLOOD PT-13.5* PTT-29.4 INR(PT)-1.2*
[**2156-11-30**] 06:40AM BLOOD Glucose-133* UreaN-22* Creat-1.0 Na-140
K-4.0 Cl-103 HCO3-30 AnGap-11

RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2156-11-29**] 9:22 AM

CHEST (PORTABLE AP)

Reason: r/o ptx

[**Hospital 93**] MEDICAL CONDITION:
74 year old man s/p CABG and chest tubes removal
REASON FOR THIS EXAMINATION:
r/o ptx
CHEST PORTABLE AP.

CHEST PORTABLE AP [**2156-11-28**].

HISTORY: Evaluate for pneumothorax.

FINDINGS: There is poor inspiration with elevated
hemidiaphragms. There are sternotomy wires in place. There has
been interval removal of drains. There is no pneumothorax
identified. There are bilateral pleural effusions. There is a
sharpness to the right cardiophrenic angle, likely representing
a pleural reaction. The lung fields are otherwise clear.

IMPRESSION: No evidence of pneumothorax.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) 8648**] [**Name (STitle) 8649**]
DR. [**First Name8 (NamePattern2) **] [**Doctor Last Name **]
Approved: MON [**2156-11-29**] 8:45 PM

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 8032**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 74929**]
(Complete) Done [**2156-11-26**] at 1:51:59 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**]
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2082-6-15**]
Age (years): 74 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Aortic valve disease. Coronary artery disease. Left
ventricular function. Mitral valve disease. Right ventricular
function. Valvular heart disease.
ICD-9 Codes: 440.0, 424.1, 396.9, 424.0
Test Information
Date/Time: [**2156-11-26**] at 13:51    Interpret MD: [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**],
MD
Test Type: TEE (Complete)
3D imaging. Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 6507**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2007AW02-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Four Chamber Length:  *6.0 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  0.8 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  0.8 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *5.8 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  40% to 45%  >= 55%
Aorta - Annulus:  1.9 cm  <= 3.0 cm
Aorta - Sinus Level:  3.5 cm  <= 3.6 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm

Findings
Multiplanar reconstructions were generated and confirmed on an
independent workstation.

LEFT ATRIUM: Moderate LA enlargement. No spontaneous echo
contrast or thrombus in the body of the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **] LAA. All four
pulmonary veins identified and enter the left atrium.

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

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Mildly depressed LVEF.

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

AORTA: Normal aortic diameter at the sinus level. Normal
descending aorta diameter. Simple atheroma in descending aorta.

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

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
thickening of mitral valve chordae. Torn mitral chordae. [**Male First Name (un) **] of
the mitral chordae (normal variant). No resting LVOT gradient.
Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] 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. The patient was under general anesthesia throughout
the procedure. No TEE related complications.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-BYPASS: The left atrium is moderately dilated. 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 mildly 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. Trace aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Torn mitral chordae are present.
Mild (1+) mitral regurgitation is seen. There is no pericardial
effusion. IABP 5 cm. below the origin of the left subclavian
artery.

Post CPB:
Improved biventricular systolic function.
Trace MR/Trazce TR/+ chordal [**Male First Name (un) **].
IABP positioned under TEE guidance.
Electronically signed by [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting
physician


??????




Brief Hospital Course:
He was transferred from [**Hospital 9464**] Hospital  for CABG. He underwent
preop carotid ultrasound which showed < 40% stenosis
bilaterally. He had chest pain at rest, and A balloon pump was
placed in the cath lab preoperatively. He was taken to the
operating room urgently on [**11-26**] where he underwent a CABG x 6.
He was transferred to the ICU in critical but stable condition.
His IABP was dc'd and he was extuabted on POD #1. He was
transferred to the floor on POD #3. He had atrial fibrillation
for which he was started on amiodarone with conversion to SR.
Chest tubes and pacing wires removed without incident. Cleared
for discharge to rehab on POD #5. Pt. is to make all followup
appts. as per discharge instructions.

Medications on Admission:
folate, finasteride 5', simvastatin 40', diltiazem ER 300',
Terazosin 10', ASA 325', NTG prn

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*30 Capsule(s)* Refills:*0*
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*0*
5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
8. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) for 3 days: then 200 mg [**Hospital1 **] for 7 days until [**12-11**], then
200 mg daily ongoing.
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 10 days.
10. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
Two (2) Capsule, Sustained Release PO Q12H (every 12 hours) for
10 days: hold for K > 4.5.


Discharge Disposition:
Extended Care

Facility:
[**Doctor Last Name 74930**]Rehab

Discharge Diagnosis:
CAD
bph, ^chol, HTN, Angina
postop A Fib


Discharge Condition:
Good.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No lifting more than 10 pounds or driving until follow up with
surgeon.


Followup Instructions:
Dr. [**Last Name (STitle) 37217**] (PCP) 2 weeks
Dr. [**Last Name (STitle) 55499**] (Cardiologist) 2 weeks
Dr. [**Last Name (STitle) 914**] (Cardiac surgery) 2 weeks [**Telephone/Fax (1) 170**]
****[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] PA at VA Fax # [**Telephone/Fax (1) 74931**] - Fax all
prescriptions and d/c summary to him and pt will pick up at VA
pharmacy - we need to do this if he goes home.



Completed by:[**2156-12-1**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Pure hypercholesterolemia,Unspecified essential hypertension,Personal history of tobacco use,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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

PRESENT ILLNESS: 74 yo M with history of angina, diaphoresis that has progressed
to crescendo in the last 2 weeks.

MEDICAL HISTORY: CAD
bph, ^chol, HTN, Angina

MEDICATION ON ADMISSION: folate, finasteride 5', simvastatin 40', diltiazem ER 300',
Terazosin 10', ASA 325', NTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 56 RR 18 BP 142/58
WD elderly M in NAD
Upper and lower dentures
Lungs CTAB
RRR no murmur
Abdomen soft, NT, ND
Extrem warm, no edema, 2+ dp/pt pulses
No carotid bruits

FAMILY HISTORY: 2 brothers and sister with CABG at unknown age

SOCIAL HISTORY: retired
quit tob [**2115**] - 10 pack year history
3 etoh/week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Pure hypercholesterolemia,Unspecified essential hypertension,Personal history of tobacco use,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
