CHIEF COMPLAINT: exertional angina

PRESENT ILLNESS: 66 yo M with history of untreated prostate cancer x 11 years who
presented to ED with chest pain.

MEDICAL HISTORY: prostate ca x 11 years, hyperlipidemia

MEDICATION ON ADMISSION: ambien 5', [**First Name (STitle) **] 81', celebrex 200', diazepam 2.5', uroxatral 10',
viagra prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 61 BP 120/72
NAD, flat after cath
Lungs CTAB
Heart RRR, no murmur
Abdomen benign
Extrem warm, no edema
No varicose veins

FAMILY HISTORY: father with MI at ages 48, 53 and 58

SOCIAL HISTORY: works as film director
denies tobacco
5 glasses of wine/week
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Retention of urine, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified visual disturbances,Anemia, unspecified,Malignant neoplasm of prostate
Subendo infarct, initial,Crnry athrscl natve vssl,Retention urine NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Visual disturbances NEC,Anemia NOS,Malign neopl prostate
Admission Date:  [**2102-3-27**]              Discharge Date:   [**2102-4-8**]

Date of Birth:  [**2036-3-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
exertional angina

Major Surgical or Invasive Procedure:
[**4-3**] CABGx5 (LIMA>LAD,SVG>Diag,SVG>Ramus,SVG>OM,SVG>dRCA)


History of Present Illness:
66 yo M with history of untreated prostate cancer x 11 years who
presented to ED with chest pain.

Past Medical History:
 prostate ca x 11 years, hyperlipidemia

Social History:
works as film director
denies tobacco
5 glasses of wine/week


Family History:
father with MI at ages 48, 53 and 58

Physical Exam:
HR 61 BP 120/72
NAD, flat after cath
Lungs CTAB
Heart RRR, no murmur
Abdomen benign
Extrem warm, no edema
No varicose veins

Pertinent Results:
[**2102-4-8**] 06:50AM BLOOD WBC-6.6 RBC-3.30*# Hgb-10.1*# Hct-28.8*#
MCV-87 MCH-30.5 MCHC-34.9 RDW-14.0 Plt Ct-243
[**2102-4-3**] 12:40PM BLOOD PT-14.6* PTT-38.8* INR(PT)-1.3*
[**2102-4-8**] 06:50AM BLOOD Glucose-104 UreaN-21* Creat-1.2 Na-140
K-4.6 Cl-102 HCO3-31 AnGap-12
Neurophysiology Report EEG Study Date of [**2102-4-7**]



OBJECT: STATUS POST CABG, NOW WITH VISUAL DISTURBANCES, RULE OUT

SEIZURES.


REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 14691**]


FINDINGS:
BACKGROUND: A well-formed 8 Hz posterior dominant rhythm was
noted in
wakefulness which attenuated appropriately with eye opening. The

anterior to posterior voltage gradient was preserved.
HYPERVENTILATION: Could not be performed.
INTERMITTENT PHOTIC STIMULATION: Could not be performed.
SLEEP: The patient progressed from the waking to drowsy state
but did
not attain stage II sleep during the recording.
CARDIAC MONITOR: Showed a generally regular rhythm with an
average rate
of 84 beats per minute.
IMPRESSION: This is a normal routine EEG in the waking and
drowsy
state. There were no areas of prominent focal slowing. There
were no
epileptic features.
RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2102-4-6**] 8:02 AM

CHEST (PORTABLE AP)

Reason: eval for pleural effusions

[**Hospital 93**] MEDICAL CONDITION:
66 year old man s/p CABG
REASON FOR THIS EXAMINATION:
eval for pleural effusions
CHEST RADIOGRAPH

INDICATION: Followup.

COMPARISON: [**2102-4-4**].

As compared to the previous radiograph, the left-sided pleural
effusion has minimally increased. On the right, there is no
evidence of effusion. Unchanged retrocardiac atelectasis. No
newly occurred parenchymal opacities suggestive of pneumonia.

DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]
Approved: [**Doctor First Name **] [**2102-4-6**] 10:53 AM






INTERPRETED BY: [**Last Name (LF) **],[**First Name3 (LF) 7495**] B.
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 14692**], [**Known firstname 5445**]       [**Hospital1 18**] [**Numeric Identifier 14693**] (Complete)
Done [**2102-4-3**] at 9:10:54 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2036-3-22**]
Age (years): 66 M  Hgt (in): 66
BP (mm Hg): 120/70  Wgt (lb): 150
HR (bpm): 70  BSA (m2): 1.77 m2
Indication: Intraoperative TEE for CABG
ICD-9 Codes: 410.91, 786.05, 786.51, 440.0, 424.1
Test Information
Date/Time: [**2102-4-3**] at 09:10    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5740**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW3-: Machine: [**Pager number 14694**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.6 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Annulus:  *3.1 cm  <= 3.0 cm
Aorta - Sinus Level:  3.4 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.9 cm  <= 3.0 cm
Aorta - Ascending:  3.4 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm

Findings
LEFT ATRIUM: Normal LA size. Good (>20 cm/s) LAA ejection
velocity.

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

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Overall normal LVEF (>55%).

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 aortic arch. Normal
descending aorta diameter. Simple atheroma in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). Mildly thickened
aortic valve leaflets. Mildly thickened aortic valve leaflets
(3). Significant AR, but cannot be quantified. Eccentric AR jet
directed toward the anterior mitral leaflet.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Pulmonic valve not well seen.

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. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient. See Conclusions for post-bypass data
The post-bypass study was performed while the patient was
receiving vasoactive infusions (see Conclusions for listing of
medications).
Conclusions
PRE-BYPASS:
1. The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler.
2. Left ventricular wall thicknesses are normal. The left
ventricular cavity size 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 aortic arch. There are
simple atheroma in the descending thoracic aorta.
5. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. The aortic valve leaflets are mildly
thickened. The aortic valve leaflets (3) are mildly thickened.
Significant aortic regurgitation is present, but cannot be
quantified. The aortic regurgitation jet is eccentric, directed
toward the anterior mitral leaflet.
6. The mitral valve appears structurally normal with trivial
mitral regurgitation.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine and was
in normal sinus rhythm.
1. Regional and global left ventricular systolic function are
normal.
2. Right ventricular systolic function is normal.
3. Valves are the same as noted pre-bypass.
4. Aortic contours are intact post-decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**], MD, Interpreting
physician








Brief Hospital Course:
He was admitted to cardiology. He ruled in for an NSTEMI. He
refused cardiac catheterization and was started on heparin,
[**Last Name (LF) 4532**], [**First Name3 (LF) **], metoprolol, and ACE-I and a statin. He underwent
[**First Name3 (LF) **] test on [**3-29**] where he had ST changed with minimal
exercise. He agreed to cardiac cath which showed moderate left
main and severe 3 vessel disease. He was referred for cardiac
surgery. His [**Month/Day (4) 4532**] was dc'd and he was started on heparin. He
awaited [**Month/Day (4) 4532**] washout prior to being taken to the operating
room on [**4-3**] where he underwent a CABG x5. He was transferred to
the ICU in stable conditon. He was extubated post op. His chest
tubes were dc'd and he was transferred to the floor on POD #1.
Bladder scan post void showed 1 liter residual and foley was
reinserted. He had a fever for which he was pancultured. He was
evaluated by neurology for visual changes. Pacing wires removed
on POD #3. Oncology also consulted. Beta blockade titrated and
he was gently diuresed toward his preop weight. On POD#3 he
complained of visual changes, seeing frames in front of his
eyes, and neurology was consulted.  He had an EEG which was
negative and then underwent CTA of the head and neck as he did
not want to have an MRI/MRA.  The CTA was negative for CVA and
he was instructed to follow up with Dr. [**First Name (STitle) **] from neurology as
an outpatient.  The visual changes improved and he was dischared
to home on POD#5 in stable condition.

Medications on Admission:
ambien 5', [**First Name (STitle) **] 81', celebrex 200', diazepam 2.5', uroxatral 10',
viagra prn

Discharge Medications:
1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
2. 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*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
5. Uroxatral 10 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
6. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
8. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 5 days.
Disp:*10 Packet(s)* Refills:*0*
9. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days.
Disp:*10 Tablet(s)* Refills:*0*
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 3765**] Hospice Program

Discharge Diagnosis:
CAD s/p CABG
PMH: prostate ca x 11 years, hyperlipidemia


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 daily, no baths, no lotions, creams or powders to
incisions.
No lifting more than 10 pounds for 10 weeks or driving until
follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) **]  in 2 weeks
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 9834**] [**Telephone/Fax (1) 14695**] 2 weeks
Dr. [**Last Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]
Provider: [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 126**], M.D. Phone:[**Telephone/Fax (1) 127**]
Date/Time:[**2102-5-10**] 10:30
Provider: [**Name Initial (NameIs) 10081**]/EXERCISE LAB Phone:[**Telephone/Fax (1) 1566**]
Date/Time:[**2102-4-26**] 10:30



Completed by:[**2102-4-8**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Retention of urine, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified visual disturbances,Anemia, unspecified,Malignant neoplasm of prostate'}


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: exertional angina

PRESENT ILLNESS: 66 yo M with history of untreated prostate cancer x 11 years who
presented to ED with chest pain.

MEDICAL HISTORY: prostate ca x 11 years, hyperlipidemia

MEDICATION ON ADMISSION: ambien 5', [**First Name (STitle) **] 81', celebrex 200', diazepam 2.5', uroxatral 10',
viagra prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 61 BP 120/72
NAD, flat after cath
Lungs CTAB
Heart RRR, no murmur
Abdomen benign
Extrem warm, no edema
No varicose veins

FAMILY HISTORY: father with MI at ages 48, 53 and 58

SOCIAL HISTORY: works as film director
denies tobacco
5 glasses of wine/week 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Retention of urine, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other specified visual disturbances,Anemia, unspecified,Malignant neoplasm of prostate'}
