CHIEF COMPLAINT: Myocardial infarction

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 87482**] is a 56 year old man who presented to [**Hospital3 **] with upper back pain. He is without a
significant past medical history but has not seen a physician in
twenty years.  He ruled in for a inferoposterior/lateral
myocardial infarction and a cath revealed three vessel coronary
artery disease.  He was transferred to [**Hospital1 18**] for evaluation for
cadiac surgery.

MEDICAL HISTORY: Coronary artery disease
Myocardial infaction

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 70 Resp: 16 O2 sat: 97
B/P  Right:138/93
Height:  55   Weight:99 kg

FAMILY HISTORY: Mother with congestive failure

SOCIAL HISTORY: Lives with:alone
Occupation:on disability for 21 yrs for depression/anxiety
Tobacco:2-2.5 packs per day, smokes marijuana frequently
ETOH:less than weekly
Acute myocardial infarction of inferoposterior wall, initial episode of care,Candidiasis of mouth,Coronary atherosclerosis of native coronary artery,Dysthymic disorder,Tobacco use disorder,Other iatrogenic hypotension
AMI inferopost, initial,Thrush,Crnry athrscl natve vssl,Dysthymic disorder,Tobacco use disorder,Iatrogenc hypotnsion NEC
Admission Date:  [**2136-9-14**]              Discharge Date:   [**2136-9-21**]

Date of Birth:  [**2080-5-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Myocardial infarction

Major Surgical or Invasive Procedure:
[**2136-9-17**] - Coronary bypass grafting x4 with left internal mammary
artery to left anterior descending artery and reverse saphenous
vein grafts to the posterior descending artery, obtuse marginal
artery and first diagonal artery.


History of Present Illness:
[**Known firstname **] [**Known lastname 87482**] is a 56 year old man who presented to [**Hospital3 **] with upper back pain. He is without a
significant past medical history but has not seen a physician in
twenty years.  He ruled in for a inferoposterior/lateral
myocardial infarction and a cath revealed three vessel coronary
artery disease.  He was transferred to [**Hospital1 18**] for evaluation for
cadiac surgery.


Past Medical History:
Coronary artery disease
Myocardial infaction

Social History:
Lives with:alone
Occupation:on disability for 21 yrs for depression/anxiety
Tobacco:2-2.5 packs per day, smokes marijuana frequently
ETOH:less than weekly


Family History:
Mother with congestive failure

Physical Exam:
Pulse: 70 Resp: 16 O2 sat: 97
B/P  Right:138/93
Height:  55   Weight:99 kg

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]Distant breath sounds
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
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right:    Left:


Pertinent Results:
[**2136-9-17**] ECHO
Pre CPB:
No mass/thrombus is seen in the left atrium or left atrial
appendage.
No atrial septal defect is seen by 2D or color Doppler.
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is mildly depressed (LVEF= 50%) with a thinned
and akinetic inferiobasal wall.
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) appear mildly thickened with good
leaflet excursion and no aortic regurgitation. Trivial mitral
regurgitation is seen.
Post CPB:
Aortic contours intact
The MR is now mild(slightly increased compared to prebypass)
There is preserved RV systolic function
The LVEF is now 35%; There is hypokinesis of the inferior,
inferolateral and inferoseptal wall.

Pre-op labs
[**2136-9-14**] 03:02PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2136-9-14**] 05:04PM   PT-13.3 PTT-24.3 INR(PT)-1.1
[**2136-9-14**] 05:04PM   PLT COUNT-204
[**2136-9-14**] 05:04PM   WBC-14.8* RBC-5.52 HGB-17.0 HCT-51.2 MCV-93
MCH-30.7 MCHC-33.1 RDW-13.5
[**2136-9-14**] 05:04PM   %HbA1c-5.9 eAG-123
[**2136-9-14**] 05:04PM   ALBUMIN-4.7 MAGNESIUM-2.0
[**2136-9-14**] 05:04PM   CK-MB-58* MB INDX-5.0 cTropnT-1.08*
[**2136-9-14**] 05:04PM   LIPASE-18
[**2136-9-14**] 05:04PM   ALT(SGPT)-71* AST(SGOT)-140* LD(LDH)-819*
CK(CPK)-1170* ALK PHOS-76 AMYLASE-47 TOT BILI-0.6
[**2136-9-14**] 05:04PM   GLUCOSE-163* UREA N-13 CREAT-1.0 SODIUM-137
POTASSIUM-4.1 CHLORIDE-102 TOTAL CO2-23 ANION GAP-16
[**2136-9-14**] 05:04PM BLOOD CK-MB-58* MB Indx-5.0 cTropnT-1.08*
[**2136-9-15**] 12:16AM BLOOD CK-MB-37* MB Indx-4.8 cTropnT-1.01*
[**2136-9-15**] 09:25AM BLOOD CK-MB-27* MB Indx-4.5 cTropnT-1.22*
Discharge labs:
[**2136-9-19**] 05:00AM BLOOD WBC-10.9 RBC-3.53* Hgb-11.3* Hct-32.2*
MCV-91 MCH-32.1* MCHC-35.2* RDW-13.6 Plt Ct-112*
[**2136-9-19**] 05:00AM BLOOD Plt Ct-112*
[**2136-9-19**] 05:00AM BLOOD Glucose-111* UreaN-17 Creat-1.0 Na-138
K-4.0 Cl-103 HCO3-27 AnGap-12

[**2136-9-21**] 05:20AM BLOOD WBC-11.0 RBC-4.01* Hgb-13.0* Hct-36.5*
MCV-91 MCH-32.3* MCHC-35.5* RDW-13.9 Plt Ct-265#
[**2136-9-21**] 05:20AM BLOOD Glucose-104* UreaN-23* Creat-1.0 Na-140
K-4.0 Cl-101 HCO3-26 AnGap-17

Brief Hospital Course:
Mr. [**Known lastname 87482**] was admitted to the [**Hospital1 18**] on [**2136-9-14**] via transfer
from [**Hospital3 **] for surgical management of his coronary
artery disease. He was worked-up by the cardiac surgical service
in the routine preoperative manner. Plavix was stopped and
allowed to washout. On [**2136-9-17**], he was taken to the operating
room where he underwent coronary artery bypass grafting. Please
see operative note for details, in summary he had: Coronary
bypass grafting x4 with left internal mammary artery to left
anterior descending artery and reverse saphenous vein grafts to
the posterior descending artery, obtuse marginal artery and
first diagonal artery. His bypass time was 139 minutes, with a
crossclamp time of 104 minutes. He tolerated the procedure well
and postoperatively he was taken to the intensive care unit for
monitoring and recovery. Over the next several hours, he awoke
neurologically intact and was extubated. Beta blockade, aspirin
and a statin were resumed. On postoperative day one, he was
transferred to the step down unit for further recovery. All
tubes lines and drains were removed per cardiac surgery
protocol. He was gently diuresed towards his preoperative
weight. The physical therapy service was consulted for
assistance with his postoperative strength an mobility. The
remainder of his post-operative course was uneventful. By
post-operative day #4 he was ready for discharge to [**Location (un) **]
House rehab. All follow-up appointments were advised.Pt. needs a
PCP and has been instructed to see this provider in [**Name Initial (PRE) **] few weeks.

Medications on Admission:
None

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. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
Disp:*270 Tablet(s)* Refills:*2*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*2*
5. Bupropion HCl 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO BID (2 times a day).
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
6. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) for 5 days: please dispense 5 day supply.
Disp:*100 ML(s)* Refills:*0*
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 2 weeks.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] House Nursing Home - [**Location 9583**]

Discharge Diagnosis:
Coronary artery disease s/p Coronary bypass grafting x4
Myocardial infarction


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with percocet
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
1) Please shower daily including washing incisions gently with
mild soap, no baths or swimming until cleared by surgeon. Look
at your incisions daily for redness or drainage
2) Please NO lotions, cream, powder, or ointments to incisions
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart
4) No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
5) No lifting more than 10 pounds for 10 weeks
6) Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Wednesday [**10-17**], 1:15PM, [**Hospital Ward Name **] 2A
Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 171**] on [**11-15**] at 12:40pm.

Please obtain a primary care provider and see him or her in [**4-9**]
weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2136-9-21**]

Name:  [**Known lastname 13881**],[**Known firstname **] L                 Unit No:   [**Numeric Identifier 13882**]

Admission Date:  [**2136-9-14**]              Discharge Date:   [**2136-9-21**]

Date of Birth:  [**2080-5-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 135**]
Addendum:
[**Known firstname **] [**Known lastname **] was discharged to [**Location (un) 2785**] House.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 2785**] House Nursing Home - [**Location 2786**]

                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern4) 137**] MD [**MD Number(2) 138**]

Completed by:[**2136-9-21**]
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Candidiasis of mouth,Coronary atherosclerosis of native coronary artery,Dysthymic disorder,Tobacco use disorder,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: Myocardial infarction

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 87482**] is a 56 year old man who presented to [**Hospital3 **] with upper back pain. He is without a
significant past medical history but has not seen a physician in
twenty years.  He ruled in for a inferoposterior/lateral
myocardial infarction and a cath revealed three vessel coronary
artery disease.  He was transferred to [**Hospital1 18**] for evaluation for
cadiac surgery.

MEDICAL HISTORY: Coronary artery disease
Myocardial infaction

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 70 Resp: 16 O2 sat: 97
B/P  Right:138/93
Height:  55   Weight:99 kg

FAMILY HISTORY: Mother with congestive failure

SOCIAL HISTORY: Lives with:alone
Occupation:on disability for 21 yrs for depression/anxiety
Tobacco:2-2.5 packs per day, smokes marijuana frequently
ETOH:less than weekly 

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Candidiasis of mouth,Coronary atherosclerosis of native coronary artery,Dysthymic disorder,Tobacco use disorder,Other iatrogenic hypotension'}
