CHIEF COMPLAINT: ANGINA, POSITIVE STRESS TEST

PRESENT ILLNESS: This 69 year old Russian speaking male had a myocardial
infarction in2005 and [**2169**] while in [**Country 532**].  He had no specific
intervention then.  He recently came to the US and has had
angina after a short walk, stair climbing or carrying groceries
and a positive stress test at a low level.

MEDICAL HISTORY: hypertension
myocardial infarctions [**2165**], [**2169**]

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] - 20 mg Tablet - 1 Tablet(s) by mouth
daily
LISINOPRIL - 20 mg Tablet - 1 Tablet(s) by mouth daily
METOPROLOL SUCCINATE - 50 mg Tablet Extended Release 24 hr - 1
Tablet(s) by mouth daily
NITROGLYCERIN -  (Prescribed by Other Provider) - 0.4 mg Tablet,
Sublingual - 1 Tablet(s) sub lingually Q 5 minutes x3 as needed
for chest pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:61 Resp:18  O2 sat:96/RA
B/P  Right:148/90    Left:146/74
Height:5'7"     Weight:163 lbs

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: lives with wife and daughter
retired
non smoker
denies ETOH
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Crnry athrscl natve vssl,Intermed coronary synd,Old myocardial infarct,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2172-5-5**]              Discharge Date:   [**2172-5-10**]

Date of Birth:  [**2102-9-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
ANGINA, POSITIVE STRESS TEST

Major Surgical or Invasive Procedure:
Coronary artery bypass grafts x3 (LIMA-LAD,SVG-PDA,SVG-PLV)
[**2172-5-6**]


History of Present Illness:
This 69 year old Russian speaking male had a myocardial
infarction in2005 and [**2169**] while in [**Country 532**].  He had no specific
intervention then.  He recently came to the US and has had
angina after a short walk, stair climbing or carrying groceries
and a positive stress test at a low level.

 He was admitted to the Cardiology Service on [**5-5**] and a
catheterization was done. This revealed three vessel disease and
was referred for revascularization.


Past Medical History:
hypertension
myocardial infarctions [**2165**], [**2169**]

Social History:
lives with wife and daughter
retired
non smoker
denies ETOH

Family History:
noncontributory

Physical Exam:
Pulse:61 Resp:18  O2 sat:96/RA
B/P  Right:148/90    Left:146/74
Height:5'7"     Weight:163 lbs

General: NAD, WGWN
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- none
Varicosities: slight
Neuro: Grossly intact x
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:    Left:
no bruits


Pertinent Results:
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname 8152**]       [**Hospital1 18**] [**Numeric Identifier 89326**] (Complete)
Done [**2172-5-6**] at 12:39:28 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2102-9-5**]
Age (years): 69 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: CABG
ICD-9 Codes: 786.05, 786.51
Test Information
Date/Time: [**2172-5-6**] at 12:39    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2011AW1-: Machine: us6
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  0.9 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.1 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aortic Valve - Peak Gradient:  7 mm Hg  < 20 mm Hg
Mitral Valve - MVA (P [**11-17**] T):  3.8 cm2

Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

LEFT VENTRICLE: Low normal LVEF.

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

AORTA: Normal ascending aorta diameter. Simple atheroma in
descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Mild to moderate ([**11-17**]+) MR.

TRICUSPID VALVE: Physiologic TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) 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. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Prer-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is low normal (LVEF
50-55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis or aortic
regurgitation.
Mild to moderate ([**11-17**]+) mitral regurgitation is seen.
There is no pericardial effusion.

Post-CPB:
The patient is A-Paced, on no inotropes.
Preserved biventricular systolic fxn.
MR remains 1 - 2+.
No AI. Aorta intact.
[**2172-5-7**] 03:25AM BLOOD WBC-9.8 RBC-3.49* Hgb-11.3* Hct-31.1*
MCV-89 MCH-32.4* MCHC-36.4* RDW-12.7 Plt Ct-156
[**2172-5-5**] 12:00PM BLOOD WBC-4.9 RBC-4.23* Hgb-14.2 Hct-39.4*
MCV-93 MCH-33.5* MCHC-35.9* RDW-13.0 Plt Ct-174
[**2172-5-5**] 12:00PM BLOOD Glucose-181* UreaN-12 Creat-0.8 Na-141
K-4.2 Cl-106 HCO3-32 AnGap-7*
[**2172-5-7**] 03:25AM BLOOD Glucose-107* UreaN-14 Creat-0.8 Na-137
K-4.2 Cl-106 HCO3-24 AnGap-11

Brief Hospital Course:
Following catheterization Mr. [**Known lastname 71328**] [**Last Name (Titles) 1834**] a preoperative
work up. He was brought to the operating room on [**2172-5-6**] where
the patient [**Date Range 1834**] coronary artery bypass grafting x3:Left
internal mammary artery graft to left anterior descending,
reverse saphenous vein graft to the posterior descending artery
and the posterior left ventricular branch. Overall the patient
tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring.  On post-operative day one he was
successfully extubated, alert and breathing comfortably.  The
patient was somewhat disoriented and pulling at lines and
therefore was given ultram only for pain. A Russian interpreter
was consulted to help with recovery instructions and confusion
resolved.  The patient was neurologically intact and
hemodynamically stable, weaned from inotropic and vasopressor
support.  Beta blocker was initiated and the patient was gently
diuresed toward the preoperative weight.  The patient was
transferred to the telemetry floor for further recovery.  Chest
tubes and pacing wires were discontinued without complication.
The patient was evaluated by the physical therapy service for
assistance with strength and mobility.  By the time of discharge
on post-operative day four the patient was ambulating freely,
the wound was healing, and his pain was controlled with oral
analgesics.  The patient was discharged to home with appropriate
follow up instructions.

Medications on Admission:
ATORVASTATIN [LIPITOR] - 20 mg Tablet - 1 Tablet(s) by mouth
daily
LISINOPRIL - 20 mg Tablet - 1 Tablet(s) by mouth daily
METOPROLOL SUCCINATE - 50 mg Tablet Extended Release 24 hr - 1
Tablet(s) by mouth daily
NITROGLYCERIN -  (Prescribed by Other Provider) - 0.4 mg Tablet,
Sublingual - 1 Tablet(s) sub lingually Q 5 minutes x3 as needed
for chest pain

Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Chewable - 1 (One) Tablet(s) by mouth once a day not currently
taking


Discharge Medications:
1. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
3. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO DAILY (Daily) as needed for constipation.
4. 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:*2*
5. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
7. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*2*
8. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day for 7 days.
Disp:*7 Tablet, ER Particles/Crystals(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
art of care

Discharge Diagnosis:
hypertension
coronary artery disease
hemorrhoids
s/p coronary artery bypass grafts


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
No Edema


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]on [**2172-6-4**] at 1:00 PM [**Last Name (un) 2577**]
Building [**Last Name (NamePattern1) **]
Cardiologist:Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 171**] ([**Telephone/Fax (1) 62**]) on [**2172-6-8**] at
2:40 PM

Please call to schedule appointments with your
Primary Care Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]([**Telephone/Fax (1) 250**])  in [**2-18**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2172-5-10**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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, POSITIVE STRESS TEST

PRESENT ILLNESS: This 69 year old Russian speaking male had a myocardial
infarction in2005 and [**2169**] while in [**Country 532**].  He had no specific
intervention then.  He recently came to the US and has had
angina after a short walk, stair climbing or carrying groceries
and a positive stress test at a low level.

MEDICAL HISTORY: hypertension
myocardial infarctions [**2165**], [**2169**]

MEDICATION ON ADMISSION: ATORVASTATIN [LIPITOR] - 20 mg Tablet - 1 Tablet(s) by mouth
daily
LISINOPRIL - 20 mg Tablet - 1 Tablet(s) by mouth daily
METOPROLOL SUCCINATE - 50 mg Tablet Extended Release 24 hr - 1
Tablet(s) by mouth daily
NITROGLYCERIN -  (Prescribed by Other Provider) - 0.4 mg Tablet,
Sublingual - 1 Tablet(s) sub lingually Q 5 minutes x3 as needed
for chest pain

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:61 Resp:18  O2 sat:96/RA
B/P  Right:148/90    Left:146/74
Height:5'7"     Weight:163 lbs

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: lives with wife and daughter
retired
non smoker
denies ETOH 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Old myocardial infarction,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
