CHIEF COMPLAINT: Chest Pain

PRESENT ILLNESS: 68 y/o male with chest pain and positive stress test who was
referred for cardiac cath. Cath revealed three vessel coronary
artery disease and he was then referred for surgical
revascularization.

MEDICAL HISTORY: Hypertension, Hyperlipidemia, Prostate Cancer s/p XRT, Gout, s/p
Tonsillectomy, s/p Trigger finger release

MEDICATION ON ADMISSION: Atenolol 75mg qd

ALLERGIES: Mercury (Elemental) / Latex

PHYSICAL EXAM: VS: 62 16 194/81 5'9" 205#
Gen: WDWN male in NAD
Skin: Unremarkable
HEENT: EOMI PERRL
Neck: Supple, FROM -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused trace edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Brother with [**Name (NI) 5290**] in 50 and 60's. 1 s/p CABG.

SOCIAL HISTORY: Retired. Quit smoking 25 yrs ago after 1ppd x 20 yrs. Occ. ETOH
use.
Coronary atherosclerosis of native coronary artery,Precipitous drop in hematocrit,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension
Crnry athrscl natve vssl,Drop, hematocrit, precip,Hypertension NOS,Hyperlipidemia NEC/NOS,Gout NOS,Hx-prostatic malignancy,Iatrogenc hypotnsion NEC
Admission Date:  [**2122-6-2**]              Discharge Date:   [**2122-6-8**]

Date of Birth:  [**2053-7-24**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Mercury (Elemental) / Latex

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest Pain

Major Surgical or Invasive Procedure:
[**2122-6-2**] Coronary Artery Bypass Graft x 4 (LIMA to LAD, SVG to
Diag, SVG to OM, SVG to RCA)

History of Present Illness:
68 y/o male with chest pain and positive stress test who was
referred for cardiac cath. Cath revealed three vessel coronary
artery disease and he was then referred for surgical
revascularization.

Past Medical History:
Hypertension, Hyperlipidemia, Prostate Cancer s/p XRT, Gout, s/p
Tonsillectomy, s/p Trigger finger release

Social History:
Retired. Quit smoking 25 yrs ago after 1ppd x 20 yrs. Occ. ETOH
use.

Family History:
Brother with [**Name (NI) 5290**] in 50 and 60's. 1 s/p CABG.

Physical Exam:
VS: 62 16 194/81 5'9" 205#
Gen: WDWN male in NAD
Skin: Unremarkable
HEENT: EOMI PERRL
Neck: Supple, FROM -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused trace edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2122-6-6**] 07:30AM BLOOD WBC-5.3 RBC-3.19* Hgb-10.7* Hct-30.8*
MCV-97 MCH-33.5* MCHC-34.7 RDW-17.7* Plt Ct-172
[**2122-6-2**] 01:20PM BLOOD PT-13.9* PTT-35.4* INR(PT)-1.2*
[**2122-6-7**] 09:00AM BLOOD Glucose-128* UreaN-24* Creat-1.1 Na-140
K-3.5 Cl-96 HCO3-34* AnGap-14

CHEST (PA & LAT)  [**2122-6-7**] 2:36 PM

CHEST (PA & LAT)

Reason: interval change

[**Hospital 93**] MEDICAL CONDITION:
68 year old man with POD 5 CABG
REASON FOR THIS EXAMINATION:
interval change
PA AND LATERAL CHEST ON [**2122-6-7**] AT 1436

INDICATION: Postop CABG.

COMPARISON: [**2122-6-5**].

FINDINGS:

I do not see the previously demonstrated left pneumothorax.
There is persistent left pleural fluid, and retrocardiac area
appears better aerated. No new focal consolidations were seen.
Pulmonary vascular markings are within normal limits. The
cardiomediastinal silhouette is unchanged.

IMPRESSION:

Improving chest x-ray, left pleural effusion, and some basilar
atelectatic changes.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 78768**]
(Complete) Done [**2122-6-2**] at 9:15:14 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2053-7-24**]
Age (years): 68 M  Hgt (in): 69
BP (mm Hg): 140/60  Wgt (lb): 190
HR (bpm): 60  BSA (m2): 2.02 m2
Indication: Intraoperative TEE for CABG
ICD-9 Codes: 786.05, 786.51, 440.0, 413.9
Test Information
Date/Time: [**2122-6-2**] at 09:15    Interpret MD: [**Name6 (MD) 1509**] [**Name8 (MD) 1510**],
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 #: 2008AW1-: Machine: [**Pager number 5741**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  1.0 cm  0.6 - 1.1 cm

Left Ventricle - Ejection Fraction:  55% to 60%  >= 55%
Aorta - Annulus:  2.6 cm  <= 3.0 cm
Aorta - Sinus Level:  3.3 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.7 cm  <= 3.0 cm
Aorta - Ascending:  *3.6 cm  <= 3.4 cm
Aorta - Descending Thoracic:  *2.9 cm  <= 2.5 cm

Findings
LEFT ATRIUM: Normal LA and RA cavity sizes.

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. Mildly dilated
ascending aorta. Simple atheroma in aortic arch. Mildly dilated
descending aorta. Simple atheroma in descending aorta.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AR.


MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial
MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized.
No PS. 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. 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

Conclusions
PRE-BYPASS:

1. The left atrium and right atrium are normal in cavity 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. The ascending aorta is mildly dilated. There are simple
atheroma in the aortic arch. The descending thoracic aorta is
mildly dilated. There are simple atheroma in the descending
thoracic aorta.

5. The aortic valve leaflets (3) are mildly thickened. No aortic
regurgitation is seen.

6. The mitral valve leaflets are mildly thickened. Trivial
mitral regurgitation is seen.

7. There is no pericardial effusion.

POST-BYPASS:

For the post-bypass study, the patient was A paced

1. Regional and global left ventricular systolic function are
normal. Right ventricular systolic function is normal.

2. Aorta intact post decannulation.


Brief Hospital Course:
Mr. [**Known lastname 27636**] was a same day admit and brought directly to the
operating room on [**6-2**] where he underwent a coronary artery
bypass graft x 4. Please see operative report for surgical
details. Following surgery he was transferred to the CVICU for
invasive monitoring in stable condition. Within 24 hours he was
weaned from sedation, awoke neurologically intact and extubated.
On post-op day one beta blockers and diuretics were started and
he was gently diuresed towards his pre-op weight. Later on this
day he was transferred to the telemetry floor for further care.
Chest tubes and epicardial pacing wires were removed per
protocol. He was tranfused 2 units for HCT 22. He worked with
physical therapy during his post-op course for strength and
mobility. On post-op day #6 he was ready for discharge to rehab.


Medications on Admission:
Atenolol 75mg qd

Discharge Medications:
1. 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*
2. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 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:*2*
5. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*2*
6. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 5 days.
9. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for 5
days.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] Of [**Location (un) 620**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
PMH: Hypertension, Hyperlipidemia, Prostate Cancer s/p XRT,
Gout, s/p Tonsillectomy, s/p Trigger finger release

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Dr. [**First Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 10543**] in [**2-8**] weeks
Dr. [**Last Name (STitle) **] in [**1-7**] weeks

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2122-6-8**]
{'Coronary atherosclerosis of native coronary artery,Precipitous drop in hematocrit,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension'}


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

PRESENT ILLNESS: 68 y/o male with chest pain and positive stress test who was
referred for cardiac cath. Cath revealed three vessel coronary
artery disease and he was then referred for surgical
revascularization.

MEDICAL HISTORY: Hypertension, Hyperlipidemia, Prostate Cancer s/p XRT, Gout, s/p
Tonsillectomy, s/p Trigger finger release

MEDICATION ON ADMISSION: Atenolol 75mg qd

ALLERGIES: Mercury (Elemental) / Latex

PHYSICAL EXAM: VS: 62 16 194/81 5'9" 205#
Gen: WDWN male in NAD
Skin: Unremarkable
HEENT: EOMI PERRL
Neck: Supple, FROM -JVD, -carotid bruit
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused trace edema, -varicosities
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Brother with [**Name (NI) 5290**] in 50 and 60's. 1 s/p CABG.

SOCIAL HISTORY: Retired. Quit smoking 25 yrs ago after 1ppd x 20 yrs. Occ. ETOH
use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Precipitous drop in hematocrit,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Gout, unspecified,Personal history of malignant neoplasm of prostate,Other iatrogenic hypotension'}
