CHIEF COMPLAINT: increasing OSB, CP

PRESENT ILLNESS: 72 yo M F who presented to [**Hospital3 417**] on [**6-1**] with SOB and
was found to have pulmonary edema. She was transferred to [**Hospital1 18**]
where cardiac catheterization showed 3VD and she was referred
for CABG.

MEDICAL HISTORY: hyperlipidemia
hypertension
Diabetes
CAD, s/p PCI to RCA in [**2092**], s/p PCI to LCx in [**2103**]
S/P pulmonary embolism [**11-4**]
Asthma
Degenerative joint disease of the back
COPD

MEDICATION ON ADMISSION: [**Last Name (LF) **], [**First Name3 (LF) **], lipitor 80', lisinopril 20'', zetia 10', imdur 60',
colace 100'', vicodin PRN, KCL 20', toprol 100', advair'',
lyrica 50'', serax 15', spiriva 18', lasix 80', humulin 70/30
60uQA/40uQP, coumadin 4'(PE)

ALLERGIES: Penicillins / Codeine

PHYSICAL EXAM: HR 78 RR 18 BP 128/53
NAD
Lungs with scattered crackles
Heart RRR
Abdomen Benign
Extrem warm
Superficial varicosities

FAMILY HISTORY: Brother with MI at 42, Other brothers with CAD in 60s.

SOCIAL HISTORY: Has 10 children, doesn't work, No smoking, No Etoh, No IVDU
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Chronic diastolic heart failure,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic obstructive asthma, unspecified,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Crnry athrscl natve vssl,Surg compl-heart,Chr diastolic hrt fail,Atrial fibrillation,DMII wo cmp nt st uncntr,Chronic obst asthma NOS,Hypertension NOS,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2106-6-14**]              Discharge Date:   [**2106-6-24**]

Date of Birth:  [**2033-6-25**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Codeine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
increasing OSB, CP

Major Surgical or Invasive Procedure:
CABG x3(Lima->LAD, SVG->PDA/OM)-[**6-15**]


History of Present Illness:
72 yo M F who presented to [**Hospital3 417**] on [**6-1**] with SOB and
was found to have pulmonary edema. She was transferred to [**Hospital1 18**]
where cardiac catheterization showed 3VD and she was referred
for CABG.

Past Medical History:
hyperlipidemia
hypertension
Diabetes
CAD, s/p PCI to RCA in [**2092**], s/p PCI to LCx in [**2103**]
S/P pulmonary embolism [**11-4**]
Asthma
Degenerative joint disease of the back
COPD

Social History:
Has 10 children, doesn't work, No smoking, No Etoh, No IVDU

Family History:
Brother with MI at 42, Other brothers with CAD in 60s.


Physical Exam:
HR 78 RR 18 BP 128/53
NAD
Lungs with scattered crackles
Heart RRR
Abdomen Benign
Extrem warm
Superficial varicosities

Pertinent Results:
[**2106-6-24**] 11:27AM BLOOD WBC-11.1* RBC-3.10* Hgb-9.0* Hct-27.1*
MCV-88 MCH-29.0 MCHC-33.1 RDW-15.7* Plt Ct-508*
[**2106-6-24**] 11:27AM BLOOD PT-27.3* PTT-32.6 INR(PT)-2.7*
[**2106-6-23**] 08:15PM BLOOD PT-36.0* INR(PT)-3.8*
[**2106-6-23**] 04:05PM BLOOD PT-36.4* INR(PT)-3.9*
[**2106-6-23**] 10:30AM BLOOD PT-32.3* INR(PT)-3.3*
[**2106-6-22**] 05:40AM BLOOD PT-20.2* INR(PT)-1.9*
[**2106-6-21**] 07:45AM BLOOD PT-18.9* PTT-28.9 INR(PT)-1.8*
[**2106-6-20**] 09:10AM BLOOD PT-19.5* PTT-31.4 INR(PT)-1.8*
[**2106-6-19**] 07:30AM BLOOD PT-16.7* INR(PT)-1.5*
[**2106-6-24**] 11:27AM BLOOD Glucose-116* UreaN-29* Creat-1.2* Na-137
K-3.6 Cl-91* HCO3-35* AnGap-15

Radiology Report CHEST (PORTABLE AP) Study Date of [**2106-6-22**]
12:30 PM


[**Last Name (LF) **],[**First Name3 (LF) **] R. CSURG FA6A [**2106-6-22**] SCHED
CHEST (PORTABLE AP)   Clip # [**Clip Number (Radiology) 68916**]
Reason: r/o effusion



[**Hospital 93**] MEDICAL CONDITION:
   72 year old woman with s/p CABG
REASON FOR THIS EXAMINATION:
   r/o effusion



Final Report
AP CHEST, 12:32 P.M., [**6-22**].

HISTORY: Status post CABG. Rule out effusion.

IMPRESSION: AP chest compared to [**6-16**] and 20:

Left lower lobe atelectasis and moderate left pleural effusion
have both
worsened since [**6-18**]. Right lung is clear. Large cardiac
silhouette is
essentially stable since [**6-15**]. No pneumothorax. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
was paged to
report these findings at the time of dictation.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname 10900**]       [**Hospital1 18**] [**Numeric Identifier 68917**] (Complete)
Done [**2106-6-15**] at 9:02:00 AM      FINAL
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: [**2033-6-25**]
Age (years): 72 F  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Abnormal ECG. Chest pain. Coronary artery disease.
Hypertension. Mitral valve disease.
ICD-9 Codes: 786.51, 440.0, 424.0
Test Information
Date/Time: [**2106-6-15**] at 09:02    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW3-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Four Chamber Length:  4.9 cm  <= 5.2 cm
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No spontaneous
echo contrast in the body of the RA. A catheter or pacing wire
is seen in the RA and extending into the RV. No ASD by 2D or
color Doppler.

LEFT VENTRICLE: Normal LV wall thickness and cavity size. Normal
LV wall thickness. Normal LV cavity size. Low normal LVEF.
Transmitral Doppler and TVI c/w Grade I (mild) LV diastolic
dysfunction.

RIGHT VENTRICLE: RV hypertrophy. Mildly dilated RV cavity.

AORTA: Normal aortic diameter at the sinus level. Simple
atheroma in aortic root. Normal ascending aorta diameter. Simple
atheroma in ascending aorta. Normal aortic arch diameter. Simple
atheroma in aortic arch. Normal descending aorta diameter.
Simple atheroma in descending aorta. Focal calcifications in
descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets. No AS. No AR.

MITRAL VALVE: Moderately thickened mitral valve leaflets.
Moderate mitral annular calcification. Calcified tips of
papillary muscles. No MS. The MR vena contracta is <0.3cm. Mild
(1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

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

PERICARDIUM: Trivial/physiologic 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 patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
patient.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-CPB:1. No spontaneous echo contrast is seen in the body of
the right atrium. No atrial septal defect is seen by 2D or color
Doppler.
2. Left ventricular wall thicknesses and cavity size are normal.
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is low normal (LVEF 50-55%). Transmitral
Doppler and tissue velocity imaging are consistent with Grade I
(mild) LV diastolic dysfunction.
3. The right ventricular free wall is hypertrophied. The right
ventricular cavity is mildly dilated
4. There are simple atheroma in the aortic root. There are
simple atheroma in the ascending aorta. There are simple
atheroma in the aortic arch. There are simple atheroma in the
descending thoracic aorta.
5. There are three aortic valve leaflets. The aortic valve
leaflets are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen.
6. The mitral valve leaflets are moderately thickened. Mild (1+)
mitral regurgitation is seen.
7. There is a trivial/physiologic pericardial effusion.
Dr. [**Last Name (STitle) **] was notified in person of the results.

POST-CPB: On infusion of phenylephrine. A pacing. Preserved
biventricular systolic function. MR is mild. Aortic contour is
normal post decannulation.


Brief Hospital Course:
She was admitted preoperatively for IV heparin. She was taken to
the operating room on [**2106-6-15**] where she underwent a CABG x 3.
She was transferred to the ICU in stable condition. She was
extubated later that day and transferred to the floor on POD #1.
Beta blockade was titrated and she was gently diuresed toward
her preop weight. Chest tubes and pacing wires removed without
incident. Coumadin restarted for history of PE. She went into
rapid atrial fibrillation, beta blockade was increased and she
was started on amio. Target INR 2.0-3.0 for prior PE and atrial
fibrillation. [**Last Name (un) **] consult done for better glucose management.
She was ready for discharge to rehab on POD #9.

Medications on Admission:
[**Last Name (LF) **], [**First Name3 (LF) **], lipitor 80', lisinopril 20'', zetia 10', imdur 60',
colace 100'', vicodin PRN, KCL 20', toprol 100', advair'',
lyrica 50'', serax 15', spiriva 18', lasix 80', humulin 70/30
60uQA/40uQP, coumadin 4'(PE)

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Pregabalin 25 mg Capsule Sig: Two (2) Capsule PO BID (2 times
a day).
7. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
8. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day): one
Inhalation [**Hospital1 **].
9. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
10. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.
11. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Forty (40) Units Subcutaneous with breakfast.
12. Lasix 80 mg Tablet Sig: One (1) Tablet PO once a day.
13. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Fifteen (15) units Subcutaneous with dinner.
14. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale
Subcutaneous four times a day.
15. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day) for 5 days: then 400 mg daily x 7 days then 200 mg daily
ongoing.
16. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
17. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
18. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
19. Warfarin 1 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for
1 doses: check INR [**6-25**], goal INR [**1-31**].


Discharge Disposition:
Extended Care

Facility:
tba

Discharge Diagnosis:
CAD s/p CABG
HTN, lipids, DM, CAD s/p PCI RCA [**2092**], Lcx [**2103**], asthma, PE (on
coumadin), COPD, DJD, anemia, TAH, tonsils


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

Followup Instructions:
Dr. [**Last Name (STitle) **],[**First Name3 (LF) **] M. [**Telephone/Fax (1) 6699**] 2 weeks
Dr. [**Last Name (STitle) **] 2 weeks
Dr. [**Last Name (STitle) **] 4 weeks [**Telephone/Fax (1) 170**]



Completed by:[**2106-6-24**]

Name:  [**Known lastname 1511**],[**Known firstname 6532**] F                 Unit No:   [**Numeric Identifier 11781**]

Admission Date:  [**2106-6-14**]              Discharge Date:   [**2106-6-24**]

Date of Birth:  [**2033-6-25**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Codeine

Attending:[**First Name3 (LF) 741**]
Addendum:
This patient had chronic diastolic CHF as evidenced by her
echocardiogram.

Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] center-[**Location (un) **]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2106-8-2**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Chronic diastolic heart failure,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic obstructive asthma, unspecified,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}


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: increasing OSB, CP

PRESENT ILLNESS: 72 yo M F who presented to [**Hospital3 417**] on [**6-1**] with SOB and
was found to have pulmonary edema. She was transferred to [**Hospital1 18**]
where cardiac catheterization showed 3VD and she was referred
for CABG.

MEDICAL HISTORY: hyperlipidemia
hypertension
Diabetes
CAD, s/p PCI to RCA in [**2092**], s/p PCI to LCx in [**2103**]
S/P pulmonary embolism [**11-4**]
Asthma
Degenerative joint disease of the back
COPD

MEDICATION ON ADMISSION: [**Last Name (LF) **], [**First Name3 (LF) **], lipitor 80', lisinopril 20'', zetia 10', imdur 60',
colace 100'', vicodin PRN, KCL 20', toprol 100', advair'',
lyrica 50'', serax 15', spiriva 18', lasix 80', humulin 70/30
60uQA/40uQP, coumadin 4'(PE)

ALLERGIES: Penicillins / Codeine

PHYSICAL EXAM: HR 78 RR 18 BP 128/53
NAD
Lungs with scattered crackles
Heart RRR
Abdomen Benign
Extrem warm
Superficial varicosities

FAMILY HISTORY: Brother with MI at 42, Other brothers with CAD in 60s.

SOCIAL HISTORY: Has 10 children, doesn't work, No smoking, No Etoh, No IVDU 

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Chronic diastolic heart failure,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Chronic obstructive asthma, unspecified,Unspecified essential hypertension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
