CHIEF COMPLAINT: asymptomatic

PRESENT ILLNESS: 77 yo male admitted to OSH in [**10-7**] for back pain, anemia, and +
troponins. Transferred to [**Hospital1 18**] where cath showed severe 3VD.
Workup also revealed a colon cancer and he underwent right
hemicolectomy . He now presents for CABG with Dr. [**Last Name (STitle) **].

MEDICAL HISTORY: 1. NIDDM, not on meds
2. Low back pain
3. BPH
4. CHF
5. colon Ca/ colectomy

MEDICATION ON ADMISSION: ASA 81 mg daily
lopressor 25 mg [**Hospital1 **]
lipitor 40 mg daily
flomax 0.4 mg daily
metformin 850 mg [**Hospital1 **]
colace 100 mg [**Hospital1 **]
prevacid 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 66  right 126/70  left 131/64
70"   135#
elderly, pale -appearing
warm, very thin
PERRL, anicteric sclera, oropharynx benign
no JVD, loud left carotid bruit, ? soft left bruit
RRR grade [**1-4**]/ 6 SEM
lungs CTAB with varicosities traversing thin chest wall
well-healed RLQ scar + BS, soft, NT, ND
extrems warm, well-perfused, 1+ LE edema, no obvious
varicosities
2+ fem/DP pulses; 1+ PT pulses
neuro grossly nonfocal, walks with walker, gait poor, [**4-7**] Bil.
strengths

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives alone, has lots of stairs at home, falls often. Drinks at
least [**3-6**] drinks per day. Smoked heavily until 20 years ago. No
illicits.
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atherosclerosis of aorta,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of large intestine,Personal history of tobacco use,Cardiac pacemaker in situ
Crnry athrscl natve vssl,CHF NOS,Aortic atherosclerosis,DMII wo cmp nt st uncntr,BPH w urinary obs/LUTS,Hypertension NOS,Pure hypercholesterolem,Hx of colonic malignancy,History of tobacco use,Status cardiac pacemaker
Name:  [**Known lastname 11249**],[**Known firstname **] J                    Unit No:   [**Numeric Identifier 11250**]

Admission Date:  [**2123-3-15**]              Discharge Date:   [**2123-3-19**]

Date of Birth:  [**2045-5-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4551**]
Addendum:
PMH also includes :

pacer placement [**10-7**] with hx of type 2 HB/bradycardia

elev. chol.
HTN

Discharge Disposition:
Extended Care

Facility:
[**Hospital 4426**] Rehab & Nursing Center - [**Hospital1 3983**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 358**] MD [**MD Number(1) 359**]

Completed by:[**2123-3-19**]

Admission Date:  [**2123-3-15**]              Discharge Date:   [**2123-3-19**]

Date of Birth:  [**2045-5-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
asymptomatic

Major Surgical or Invasive Procedure:
CABG x3/ placement of epicardial leads [**2123-3-15**]


History of Present Illness:
77 yo male admitted to OSH in [**10-7**] for back pain, anemia, and +
troponins. Transferred to [**Hospital1 18**] where cath showed severe 3VD.
Workup also revealed a colon cancer and he underwent right
hemicolectomy . He now presents for CABG with Dr. [**Last Name (STitle) **].

Past Medical History:
1. NIDDM, not on meds
2. Low back pain
3. BPH
4. CHF
5. colon Ca/ colectomy


Social History:
lives alone, has lots of stairs at home, falls often. Drinks at
least [**3-6**] drinks per day. Smoked heavily until 20 years ago. No
illicits.


Family History:
Noncontributory

Physical Exam:
HR 66  right 126/70  left 131/64
70"   135#
elderly, pale -appearing
warm, very thin
PERRL, anicteric sclera, oropharynx benign
no JVD, loud left carotid bruit, ? soft left bruit
RRR grade [**1-4**]/ 6 SEM
lungs CTAB with varicosities traversing thin chest wall
well-healed RLQ scar + BS, soft, NT, ND
extrems warm, well-perfused, 1+ LE edema, no obvious
varicosities
2+ fem/DP pulses; 1+ PT pulses
neuro grossly nonfocal, walks with walker, gait poor, [**4-7**] Bil.
strengths

Pertinent Results:
[**2123-3-18**] 06:10AM BLOOD WBC-9.1 RBC-3.43* Hgb-10.6* Hct-30.8*
MCV-90 MCH-31.0 MCHC-34.5 RDW-15.3 Plt Ct-160
[**2123-3-18**] 06:10AM BLOOD Plt Ct-160
[**2123-3-18**] 06:10AM BLOOD Glucose-143* UreaN-22* Creat-0.9 Na-141
K-4.7 Cl-108 HCO3-25 AnGap-13

[**Known lastname **],[**Known firstname **] J: [**Hospital1 18**] Cath Detail - CCC Record #[**Numeric Identifier 62308**]
[**Numeric Identifier 62309**] - CCC
PROCEDURE DATE: [**2122-11-3**]
INDICATIONS FOR CATHETERIZATION: Coronary artery disease, aortic
stenosis, left ventricular systolic dysfunction, preop for
colectomy.
FINAL DIAGNOSIS:
1. Low normal filling right- and left-sided filling pressures.
COMMENTS:
Right heart catheterization demonstrated reduced filling
pressures
consistent with hypovolemia. The right atrial and PCW filling
pressures
were low normal (4 and 6 mmHg), respectively. There was no
pulmonary
arterial hypertension. Using an assumed oxygen consumption, the
cardiac
index (based on finger oximetry) was slightly depressed at 2.3
L/min/m2.
The PA catheter was secured in place with a protective sleeve.
There
was no evidence of pneumothorax on fluoroscopy.
TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 30 minutes.
Arterial time = 0 minutes.
Fluoro time = 2 minutes.
Contrast:
Non-ionic low osmolar (isovue, optiray...), vol 0 ml
Premedications:
Versed 0.5 mg IV
Fentanyl 25 mcg IV
Anesthesia:
1% Lidocaine subq.
Anticoagulation: none

[**Known lastname **],[**Known firstname **] J:[**Hospital1 18**] Radiology Detail - CCC Record #[**Numeric Identifier 62308**]
FINAL REPORT


CAROTID SERIES COMPLETE

REASON: Bruit.

FINDINGS: Duplex evaluation _____ both carotid arteries.
Moderate plaque was
identified on the left. This is homogeneous.

On the right, peak systolic velocities are 86, 58, 103 in the
ICA, CCA, ECA
respectively. The ICA to CCA ratio is 1.5. This is consistent
with less than
40% stenosis.

On the left, peak systolic velocities are 180, 68, 270 in the
ICA, CCA, ECA
respectively. The ICA to CCA ratio is 2.6. This is consistent
with a 60-69%
stenosis.

There is antegrade flow in both vertebral arteries.

IMPRESSION: Moderate left-sided plaque with a 60-69% carotid
stenosis. On
the right, there is a less than 40% stenosis.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]


Approved: SAT [**2123-3-13**] 2:00 PM
Procedure Date:[**2123-3-8**]




Brief Hospital Course:
Admitted [**3-15**] and underwent cabg x3 (LIMA to LAD, SVG to OM, SVG
to PDA)/ and LV lead placement with Dr. [**Last Name (STitle) **]. Transferred to
the CSRU in stable condition on epinephrine, nitroglycerin, and
propofol drips. Extubated that evening, and remained on insulin
and neo drips. These were weaned off and he was transferred to
the floor that evening. He began gentle diuresis and beta
blockade. Chest tubes were removed on POD #2. He failed to void
on POD #3 and his foley was reinserted ( leg bag). He was
followed by Dr.[**Name (NI) 10529**] urology service, and will need to see him
when discharged from rehab. The patient must also see Dr. [**Last Name (STitle) **]
from the EP service in a couple of weeks to schedule device
placement. Pacing wires were removed and he continued to make
good progress on the floor. He was cleared for discharge to
rehab on POD #4 in stable condition.


Medications on Admission:
ASA 81 mg daily
lopressor 25 mg [**Hospital1 **]
lipitor 40 mg daily
flomax 0.4 mg daily
metformin 850 mg [**Hospital1 **]
colace 100 mg [**Hospital1 **]
prevacid 20 mg daily

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
1 months.
2. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
3. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 2 weeks.
4. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 2
weeks.
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
9. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
10. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
11. Metformin 850 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital 66**] Rehab & Nursing Center - [**Hospital1 392**]

Discharge Diagnosis:
s/p cabg x3/placement of epicardial leads on [**3-15**]
CHF
colon CA/s/p hemicolectomy
BPH/urinary retention


Discharge Condition:
stable


Discharge Instructions:
may shower over incision and pat dry
no driving for one month
no lotions, creams, or pwders on any incision
no lifting greater than 10 pounds for 10 weeks
call for fever, redness, or drainage

Followup Instructions:
follow up with Dr. [**Last Name (STitle) **] in [**1-4**] weeks
follow up with Dr. [**Last Name (STitle) **] in [**2-5**] weeks
follow up with Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
follow up with Dr. [**Last Name (STitle) **] ( urology) [**Telephone/Fax (1) 921**] when discharged
from rehab



Completed by:[**2123-3-19**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atherosclerosis of aorta,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of large intestine,Personal history of tobacco use,Cardiac pacemaker in situ'}


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: asymptomatic

PRESENT ILLNESS: 77 yo male admitted to OSH in [**10-7**] for back pain, anemia, and +
troponins. Transferred to [**Hospital1 18**] where cath showed severe 3VD.
Workup also revealed a colon cancer and he underwent right
hemicolectomy . He now presents for CABG with Dr. [**Last Name (STitle) **].

MEDICAL HISTORY: 1. NIDDM, not on meds
2. Low back pain
3. BPH
4. CHF
5. colon Ca/ colectomy

MEDICATION ON ADMISSION: ASA 81 mg daily
lopressor 25 mg [**Hospital1 **]
lipitor 40 mg daily
flomax 0.4 mg daily
metformin 850 mg [**Hospital1 **]
colace 100 mg [**Hospital1 **]
prevacid 20 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 66  right 126/70  left 131/64
70"   135#
elderly, pale -appearing
warm, very thin
PERRL, anicteric sclera, oropharynx benign
no JVD, loud left carotid bruit, ? soft left bruit
RRR grade [**1-4**]/ 6 SEM
lungs CTAB with varicosities traversing thin chest wall
well-healed RLQ scar + BS, soft, NT, ND
extrems warm, well-perfused, 1+ LE edema, no obvious
varicosities
2+ fem/DP pulses; 1+ PT pulses
neuro grossly nonfocal, walks with walker, gait poor, [**4-7**] Bil.
strengths

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: lives alone, has lots of stairs at home, falls often. Drinks at
least [**3-6**] drinks per day. Smoked heavily until 20 years ago. No
illicits. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atherosclerosis of aorta,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS),Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of large intestine,Personal history of tobacco use,Cardiac pacemaker in situ'}
