CHIEF COMPLAINT: Chest pain/Dyspnea on exertion

PRESENT ILLNESS: 66 year old gentleman with known coronary artery disease who has
undergone stenting in the past who in Novemeber was admitted to
a hospital in [**State 108**] and treated for heart failure, severe
pulmonary hypertension and bilateral pneumonia. A cardiac
catheterization was performed which revealed severe left main
and two vessel disease. Given the severity of his disease, he
has been referred for surgical rvascularization. He has felt
significantly better with diuresis however continues to have
some chest pain and dypnea on exertion.

MEDICAL HISTORY: -CAD s/p PTCA and stenting in past (PTCA [**2077**], PTCA/Stent [**2085**],
Cypher stent [**2094**] Prox Lcx)
-Dyslipidemia
-Hypertension
-COPD
-CHF (Episode [**12-13**]) BNP up to 1369
-Recent Pneumonia
-Nephrolithiasis
-Pulmonary hyertension
-Barrett's esophagus
-s/p Cholescystectomy

MEDICATION ON ADMISSION: Lasix 40mg QD
Atenolol 25mg QD
Aspirin 325mg QD
Zocor 20mg QD
Omeprazole 20mg QD

ALLERGIES: Percocet / Vicodin

PHYSICAL EXAM: Pulse: 74 Resp: 20 O2 sat: 98%
B/P  Right: 109/61   Left: 117/79
Height: 5' 10.5"    Weight: 182lbs

FAMILY HISTORY: Brother with CABG at age 66

SOCIAL HISTORY: Lives with: Fiancee. Divorced with 4 children. Half the year is
spent living in [**State 108**] and the other half in [**State 350**].
Occupation: Retired
Tobacco: Former 35 pack year. Quit [**2092**].
ETOH: Occassional
Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Mitral valve disorders,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of aspirin
Crnry athrscl natve vssl,Ac on chr syst hrt fail,Mitral valve disorder,Hypertension NOS,Chr airway obstruct NEC,Hyperlipidemia NEC/NOS,Status-post ptca,Long-term use of aspirin
Admission Date:  [**2101-2-14**]              Discharge Date:   [**2101-2-22**]

Date of Birth:  [**2034-4-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Percocet / Vicodin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain/Dyspnea on exertion


Major Surgical or Invasive Procedure:
[**2101-2-14**] Mitral Valve Repair(28mm Annuloplasty Band) and Three
Vessel Coronary Artery Bypass Grafting utilizing the left
internal mammary artery to left anterior descending with
saphenous vein grafts to diagonal and obtuse marginal.


History of Present Illness:
66 year old gentleman with known coronary artery disease who has
undergone stenting in the past who in Novemeber was admitted to
a hospital in [**State 108**] and treated for heart failure, severe
pulmonary hypertension and bilateral pneumonia. A cardiac
catheterization was performed which revealed severe left main
and two vessel disease. Given the severity of his disease, he
has been referred for surgical rvascularization. He has felt
significantly better with diuresis however continues to have
some chest pain and dypnea on exertion.

Past Medical History:
-CAD s/p PTCA and stenting in past (PTCA [**2077**], PTCA/Stent [**2085**],
Cypher stent [**2094**] Prox Lcx)
-Dyslipidemia
-Hypertension
-COPD
-CHF (Episode [**12-13**]) BNP up to 1369
-Recent Pneumonia
-Nephrolithiasis
-Pulmonary hyertension
-Barrett's esophagus
-s/p Cholescystectomy


Social History:
Lives with: Fiancee. Divorced with 4 children. Half the year is
spent living in [**State 108**] and the other half in [**State 350**].
Occupation: Retired
Tobacco: Former 35 pack year. Quit [**2092**].
ETOH: Occassional


Family History:
Brother with CABG at age 66


Physical Exam:
Pulse: 74 Resp: 20 O2 sat: 98%
B/P  Right: 109/61   Left: 117/79
Height: 5' 10.5"    Weight: 182lbs

General: Well-developed, well-nourished male in no acute
distress
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/Varicosities:
None
[X]
Neuro: Grossly intact [X]
Pulses:
Femoral      Right/Left: 2+
DP           Right/Left: 2+
PT           [**Name (NI) 167**]/Left: 2+
Radial       Right/Left: 2+

Carotid Bruit    Right/Left: none


Pertinent Results:
[**2101-2-22**] 05:50AM BLOOD WBC-6.4 RBC-3.19* Hgb-9.7* Hct-28.8*
MCV-90 MCH-30.4 MCHC-33.7 RDW-15.2 Plt Ct-246
[**2101-2-14**] 12:18PM BLOOD WBC-14.5*# RBC-3.09*# Hgb-9.2*#
Hct-27.2*# MCV-88 MCH-29.6 MCHC-33.6 RDW-15.4 Plt Ct-155
[**2101-2-14**] 12:18PM BLOOD Neuts-77.5* Lymphs-18.9 Monos-2.5 Eos-0.7
Baso-0.5
[**2101-2-22**] 05:50AM BLOOD Plt Ct-246
[**2101-2-22**] 05:50AM BLOOD PT-13.6* INR(PT)-1.2*
[**2101-2-14**] 12:18PM BLOOD PT-16.1* PTT-42.4* INR(PT)-1.4*
[**2101-2-22**] 05:50AM BLOOD Glucose-95 UreaN-24* Creat-0.9 Na-142
K-4.3 Cl-104 HCO3-31 AnGap-11
[**2101-2-14**] 01:26PM BLOOD UreaN-11 Creat-0.8 Cl-120* HCO3-22
[**2101-2-22**] 05:50AM BLOOD Mg-2.4
[**2101-2-15**] 03:09AM BLOOD Calcium-8.5 Phos-3.3 Mg-2.6

[**Known lastname **],[**Known firstname **] [**Medical Record Number 110386**] M  66  [**2034-4-29**]

Radiology Report CHEST (PA & LAT) Study Date of [**2101-2-22**] 9:27 AM



[**Last Name (LF) **],[**First Name3 (LF) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 147**] FA6A [**2101-2-22**] 9:27 AM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 110387**]
Reason: evaluate left effusion



[**Hospital 93**] MEDICAL CONDITION:
   66 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
   evaluate left effusion



Final Report
PA AND LATERAL CHEST ON [**2-22**]

HISTORY: Status post CABG. Evaluate left pleural effusion.

IMPRESSION: PA and lateral chest compared to [**2101-2-20**]:

Small left pleural effusion is stable, and there is no
pneumothorax.
Mild-to-moderate enlargement of the cardiac silhouette is stable
but there has
been a decrease in vascular plethora consistent with improving
cardiac
function.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: [**First Name8 (NamePattern2) **] [**2101-2-22**] 1:36 PM

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 110388**] (Complete) Done
[**2101-2-14**] at 9:10:33 AM      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: [**2034-4-29**]
Age (years): 66 M  Hgt (in): 70
BP (mm Hg): 123/67  Wgt (lb): 185
HR (bpm): 78  BSA (m2): 2.02 m2
Indication: Intraoperative TEE for CABG and mitral valve repair.
Chest pain. Left ventricular function. Mitral valve disease.
Preoperative assessment. Pulmonary hypertension. Right
ventricular function.
ICD-9 Codes: 786.51, 424.0, 424.2
Test Information
Date/Time: [**2101-2-14**] at 09:10    Interpret MD: [**Name6 (MD) 1509**] [**Name8 (MD) 1510**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1510**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW2-: Machine: [**Doctor Last Name **]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Peak Pulm Vein S:  0.2 m/s
Left Atrium - Peak Pulm Vein D:  0.4 m/s
Left Ventricle - Ejection Fraction:  35%  >= 55%
Aorta - Ascending:  3.1 cm  <= 3.4 cm

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: Moderate regional LV systolic dysfunction.
Moderately depressed LVEF. No resting LVOT gradient.

RIGHT VENTRICLE: Mild global RV free wall hypokinesis.

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

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

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular calcification. No MS. Moderate (2+) MR.

TRICUSPID VALVE: Mild [1+] TR.

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.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Prebypass

No atrial septal defect is seen by 2D or color Doppler. There is
moderate regional left ventricular systolic dysfunction with
hypokinesia of the apical and mid portions of the inferior,
inferolateral and inferoseptal walls.. Overall left ventricular
systolic function is moderately depressed (LVEF= 35 %). with
mild global RV free wall hypokinesis. There are complex (>4mm)
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve leaflets
are mildly thickened. Moderate (2+) mitral regurgitation is
seen. There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified
in person of the results on [**2101-2-14**] at 900am

Post bypass

Patient is AV paced and receiving an infusion of phenylephrine
and epinephrine. Biventricular systolic function is unchanged.
Annuloplasty ring seen in the mitral position. Appears well
seated. Mild mitral regurgitation persists. Mean gradient across
the mitral valve is 4 mm Hg. Dr [**Last Name (STitle) **] aware. Aorta is intact
post decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 1509**] [**Name8 (MD) 1510**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2101-2-16**] 14:19




Brief Hospital Course:
Was admitted same day surgery and underwent coronary artery
bypass grafting and a mitral valve repair.  For surgical
details, please see operative note. Following the operation, he
was brought to the CVICU for invasive monitoring.  He took
several days to wean from inotropic support. On postoperative
day three, he transferred to the stepdown unit for ongoing
post-operative care. He was started on betablockers, statins and
diuresed toward his pre-operative weight. He was slow to wean
from supplemental oxygen due to persistent left effusion
requiring more aggressive diuresis.  He responded well to
additional IV Lasix and Zaroxolyn with oxygen saturation 93% on
room air at the time of discharge.  He was evaluated and treated
by physical therapy for strength and conditioning. He was
discharged to home on POD#8 in stable condition.

Medications on Admission:
Lasix 40mg QD
Atenolol 25mg QD
Aspirin 325mg QD
Zocor 20mg QD
Omeprazole 20mg QD

Discharge Medications:
1. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. 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*
4. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
5. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours).
Disp:*qs qs* Refills:*0*
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 2 weeks: please follow up with cardiologist prior to
completion .
Disp:*14 Tablet(s)* Refills:*0*
9. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*0*
10. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
One (1) Capsule, Sustained Release PO once a day for 2 weeks.
Disp:*14 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
Coronary Artery Disease, Mitral Valve Regurgitation
Chronic Systolic Congestive Heart Failure
Hypertension
Dyslipidemia
COPD


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with dilaudid prn


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Please call to schedule appointments
Surgeon Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**] [**3-17**] at 1:30 PM
Primary Care Dr. [**First Name (STitle) **] in [**2-5**] weeks
Cardiologist Dr. [**Last Name (STitle) 13175**] in [**2-5**] weeks
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will schedule



Completed by:[**2101-2-22**]
{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Mitral valve disorders,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of aspirin'}


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: Chest pain/Dyspnea on exertion

PRESENT ILLNESS: 66 year old gentleman with known coronary artery disease who has
undergone stenting in the past who in Novemeber was admitted to
a hospital in [**State 108**] and treated for heart failure, severe
pulmonary hypertension and bilateral pneumonia. A cardiac
catheterization was performed which revealed severe left main
and two vessel disease. Given the severity of his disease, he
has been referred for surgical rvascularization. He has felt
significantly better with diuresis however continues to have
some chest pain and dypnea on exertion.

MEDICAL HISTORY: -CAD s/p PTCA and stenting in past (PTCA [**2077**], PTCA/Stent [**2085**],
Cypher stent [**2094**] Prox Lcx)
-Dyslipidemia
-Hypertension
-COPD
-CHF (Episode [**12-13**]) BNP up to 1369
-Recent Pneumonia
-Nephrolithiasis
-Pulmonary hyertension
-Barrett's esophagus
-s/p Cholescystectomy

MEDICATION ON ADMISSION: Lasix 40mg QD
Atenolol 25mg QD
Aspirin 325mg QD
Zocor 20mg QD
Omeprazole 20mg QD

ALLERGIES: Percocet / Vicodin

PHYSICAL EXAM: Pulse: 74 Resp: 20 O2 sat: 98%
B/P  Right: 109/61   Left: 117/79
Height: 5' 10.5"    Weight: 182lbs

FAMILY HISTORY: Brother with CABG at age 66

SOCIAL HISTORY: Lives with: Fiancee. Divorced with 4 children. Half the year is
spent living in [**State 108**] and the other half in [**State 350**].
Occupation: Retired
Tobacco: Former 35 pack year. Quit [**2092**].
ETOH: Occassional 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Mitral valve disorders,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Long-term (current) use of aspirin'}
