CHIEF COMPLAINT: exertional angina

PRESENT ILLNESS: 70 yo female with exertional angina and + stress echo revealing
anterior ischemia. Cath revealed severe 3 vessel CAD. Referred
for surgery.

MEDICAL HISTORY: Coronary artery disease
obesity
prior inferior myocardial infarction
Insulin-dependent diabetes mellitus
Hypertension
diabetic retinopathy
hypothyroidism
gastroesophageal reflux disease
hyperlipidemia

MEDICATION ON ADMISSION: plavix 75 mg daily (LD [**11-16**])
humalog 50 units q AM; 28 units QHS
HCTZ 25 mg daily
levothyroxine 150 mcg daily
ECASA 81 mg daily
lisinopril 40 mg daily
zetia 10 mg daily
niaspan 100 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Ht 61"  Wt 94.3K
discharge exam:
VS T98.7  BP 156/80   HR 73SR   RR 20   O2sat 95%RA  Wt 94.4K
Gen NAD
Neuro A&Ox3, nonfocal exam
Pulm scattered rhonchi
CV RRR, no murmur. Sternum stable, incision CDI
Abdm soft, NT/+BS
Ext warm well perfused. 1+ pedal edema bilat

FAMILY HISTORY: father died of MI at 65;mother died of MI at 61

SOCIAL HISTORY: retired teacher and librarian
lives with son
4 pk-yr hx/ quit 48 years ago
no ETOH
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Background diabetic retinopathy,Atrial fibrillation,Pure hypercholesterolemia,Esophageal reflux,Unspecified acquired hypothyroidism,Obesity, unspecified,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Long-term (current) use of insulin
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,DMII ophth nt st uncntrl,Hypertension NOS,Diabetic retinopathy NOS,Atrial fibrillation,Pure hypercholesterolem,Esophageal reflux,Hypothyroidism NOS,Obesity NOS,Obstructive sleep apnea,Old myocardial infarct,Long-term use of insulin
Admission Date:  [**2107-12-5**]              Discharge Date:   [**2107-12-9**]

Date of Birth:  [**2037-12-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
exertional angina

Major Surgical or Invasive Procedure:
[**2107-12-5**] cabg x4 (LIMA to LAD, SVG to RAMUS, SVG to OM, SVG to
PDA)


History of Present Illness:
70 yo female with exertional angina and + stress echo revealing
anterior ischemia. Cath revealed severe 3 vessel CAD. Referred
for surgery.

Past Medical History:
Coronary artery disease
obesity
prior inferior myocardial infarction
Insulin-dependent diabetes mellitus
Hypertension
diabetic retinopathy
hypothyroidism
gastroesophageal reflux disease
hyperlipidemia


Social History:
retired teacher and librarian
lives with son
4 pk-yr hx/ quit 48 years ago
no ETOH


Family History:
father died of MI at 65;mother died of MI at 61

Physical Exam:
Ht 61"  Wt 94.3K
discharge exam:
VS T98.7  BP 156/80   HR 73SR   RR 20   O2sat 95%RA  Wt 94.4K
Gen NAD
Neuro A&Ox3, nonfocal exam
Pulm scattered rhonchi
CV RRR, no murmur. Sternum stable, incision CDI
Abdm soft, NT/+BS
Ext warm well perfused. 1+ pedal edema bilat

Pertinent Results:
Conclusions
PRE-BYPASS:
1. The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler.
2. Left ventricular wall thicknesses and cavity size are normal.
There is moderate regional left ventricular systolic dysfunction
with anterior, septal and antero-lateral hypokinesis from the
mid to apex segments. Overall left ventricular systolic function
is moderately depressed (LVEF= 35 %).
3. Right ventricular chamber size and free wall motion are
normal.
4. There are three aortic valve leaflets. The aortic valve
leaflets are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen.
5. The mitral valve leaflets are mildly thickened. Mild to
moderate ([**1-5**]+) mitral regurgitation is seen.
6. There is no pericardial effusion.

Dr. [**Last Name (STitle) **] was notified in person of the results.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine and was
initially AV paced.
1. Bi ventricular function is unchanged.
2. MR initially severe with AV pacing, improved to mild with A
pacing.
3. Aorta is intact post decannulation.
4. Other findings are unchanged.




Radiology Report CHEST (PORTABLE AP) Study Date of [**2107-12-6**] 3:33
PM
[**Hospital 93**] MEDICAL CONDITION:
   70 year old woman s/p cabg
REASON FOR THIS EXAMINATION:
   please eval for pneumo now s/p left pleural chest tube
removal
Provisional Findings Impression: SP TUE [**2107-12-6**] 7:07 PM
PFI: No pneumothorax after chest tube removal, stable chest
findings.
Final Report
FINDINGS: AP single view of the chest obtained with patient in
semi-erect
position is analyzed in direct comparison with a preceding
similar study
obtained approximately four hours earlier during the same day.
During the
interval, the left-sided chest tube has been removed. No
pneumothorax has
developed. There is no evidence of increased density in the
lower pleural
space in comparison with the preceding study and no new
pulmonary parenchymal infiltrates have developed.
IMPRESSION: Stable chest findings, no pneumothorax after
left-sided chest
tube removal.
DR. [**First Name (STitle) **] [**Initials (NamePattern5) 3250**] [**Last Name (NamePattern5) 3251**]
Approved: TUE [**2107-12-6**] 9:01 PM


[**2107-12-5**] 03:11PM   UREA N-19 CREAT-0.8 CHLORIDE-110* TOTAL
CO2-26
[**2107-12-5**] 03:11PM   WBC-25.0*# RBC-3.41* HGB-9.9* HCT-29.6*
MCV-87 MCH-29.2 MCHC-33.6 RDW-13.6
[**2107-12-5**] 03:11PM   PLT COUNT-312
[**2107-12-5**] 03:11PM   PT-13.8* PTT-47.0* INR(PT)-1.2*
[**2107-12-5**] 01:45PM   GLUCOSE-202* LACTATE-3.6* NA+-133* K+-5.5*
CL--105

[**2107-12-8**] 05:22AM BLOOD WBC-13.6* RBC-2.77* Hgb-8.1* Hct-24.4*
MCV-88 MCH-29.1 MCHC-33.1 RDW-14.1 Plt Ct-282
[**2107-12-5**] 01:40PM BLOOD WBC-14.7*# RBC-2.86*# Hgb-8.2*# Hct-24.8*
MCV-87 MCH-28.8 MCHC-33.3 RDW-13.7 Plt Ct-297
[**2107-12-8**] 05:22AM BLOOD Glucose-103 UreaN-44* Creat-1.1 Na-135
K-5.1 Cl-101 HCO3-27 AnGap-12
[**2107-12-6**] 04:00AM BLOOD Glucose-80 UreaN-24* Creat-1.1 Na-138
K-5.3* Cl-109* HCO3-23 AnGap-11

Brief Hospital Course:
Same day admission to operating room for CABG. Admitted on [**12-5**]
and underwent surgery with Dr. [**Last Name (STitle) **]. Please refer to
Dr[**Last Name (STitle) **] operative report for details. In summary she had
coronary artery bypass grafting x4 with LIMA-LAD, SVG-OM,
SVG-Ramus, SVG-PDA. She tolerated the operation well and and
following surgery was  transferred to the CVICU in stable
condition. She remained hemodynamically stable in the immediate
post-op period was titrated off phenylephrine, propofol and
insulin drips, and extubated later that evening. All lines and
drains were discontinued per protocol. On POD#2 she transferred
to Step down unit for further monitoring and telemetry. Her
Creatinine was mildly elevated but returned to baseline over the
next several days.  Beta-blockers and ACE were initiated and
plavix restarted. Her activity level continued to progress and
on POD #4 she was discharged to rehab at [**Location (un) 582**] [**Location (un) **]. All
follow up appointments are oulined on discharge paperwork.

Medications on Admission:
plavix 75 mg daily (LD [**11-16**])
humalog 50 units q AM; 28 units QHS
HCTZ 25 mg daily
levothyroxine 150 mcg daily
ECASA 81 mg daily
lisinopril 40 mg daily
zetia 10 mg daily
niaspan 100 mg daily

Discharge Medications:
1. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two
(2) Tablet Sustained Release PO once a day for 2 weeks.
Disp:*28 Tablet Sustained Release(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
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:*2*
4. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*2*
5. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Niacin 1,000 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO once a day.
Disp:*30 Tablet Sustained Release(s)* Refills:*2*
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
8. Insulin Lispro 100 unit/mL Solution Sig: as directed
Subcutaneous twice a day: 50 units QAM
28 units QPM.
9. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
11. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO
twice a day.
Disp:*60 Tablet(s)* Refills:*2*
12. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day
for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
14. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] - [**Location (un) **]

Discharge Diagnosis:
CAD s/p cabg x4
obesity
prior inferior myocardial infarction
Insulin-dependent diabetes mellitus
Hypertension
diabetic retinopathy
hypothyroidism
gastroesophageal reflux disease
hyperlipidemia


Discharge Condition:
good


Discharge Instructions:
no lotions, creams or powders on any incision
shower daily and pat incisions dry
no lifting greater than 10 pounds for 10 weeks
no driving for one month AND until off all narcotics
call for fever greater than 100.5, redness or drainage


Followup Instructions:
see Dr. [**Last Name (STitle) 51334**] in [**1-5**] weeks
see Dr. [**Last Name (STitle) **] in [**2-6**] weeks
see Dr. [**Last Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]
please call for appts.



Completed by:[**2107-12-9**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Background diabetic retinopathy,Atrial fibrillation,Pure hypercholesterolemia,Esophageal reflux,Unspecified acquired hypothyroidism,Obesity, unspecified,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Long-term (current) use of insulin'}


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: exertional angina

PRESENT ILLNESS: 70 yo female with exertional angina and + stress echo revealing
anterior ischemia. Cath revealed severe 3 vessel CAD. Referred
for surgery.

MEDICAL HISTORY: Coronary artery disease
obesity
prior inferior myocardial infarction
Insulin-dependent diabetes mellitus
Hypertension
diabetic retinopathy
hypothyroidism
gastroesophageal reflux disease
hyperlipidemia

MEDICATION ON ADMISSION: plavix 75 mg daily (LD [**11-16**])
humalog 50 units q AM; 28 units QHS
HCTZ 25 mg daily
levothyroxine 150 mcg daily
ECASA 81 mg daily
lisinopril 40 mg daily
zetia 10 mg daily
niaspan 100 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Ht 61"  Wt 94.3K
discharge exam:
VS T98.7  BP 156/80   HR 73SR   RR 20   O2sat 95%RA  Wt 94.4K
Gen NAD
Neuro A&Ox3, nonfocal exam
Pulm scattered rhonchi
CV RRR, no murmur. Sternum stable, incision CDI
Abdm soft, NT/+BS
Ext warm well perfused. 1+ pedal edema bilat

FAMILY HISTORY: father died of MI at 65;mother died of MI at 61

SOCIAL HISTORY: retired teacher and librarian
lives with son
4 pk-yr hx/ quit 48 years ago
no ETOH 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Background diabetic retinopathy,Atrial fibrillation,Pure hypercholesterolemia,Esophageal reflux,Unspecified acquired hypothyroidism,Obesity, unspecified,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Long-term (current) use of insulin'}
