CHIEF COMPLAINT: angina

PRESENT ILLNESS: 65 year old female with known coronary artery disease, status
post LAD bare metal stent in [**5-6**], hypertension,
hypercholesterolemia, and diabetes mellitus requiring insulin,
reports intermittent chest pain, lasting approximately 20
minutes, radiating to back, that improves with rest.Pain located
in precordial
area with no exacerbating factors. Cardiac work up at OSH
revealed in stent stenosis.

MEDICAL HISTORY: CAD s/p stent [**4-/2113**] - LAD bare metal
Diabetes type 2
Hypertension
Hypercholesterolemia
Cervical Cancer stage 3 (squamous cell)
Cardiomyopathy  EF 45-50%
Anemia

MEDICATION ON ADMISSION: Coreg 6.25 mg twice daily
Norvasc 5 mg daily
Aspirin 325 mg daily
Metoprolol 25 mg daily
Lisinopril 40 mg daily
Lipitor 80 mg daily
Iron 325 mg daily
Lantus 45 units daily
Novolog 8 units premeals

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:80 SR Resp:18  O2 sat: 100% on 2Lpm
B/P  Right: 114/68   Left:
Height:     Weight:156LBs

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: receptionist in laundry
Lives with: Alone
Tobacco: 2 pack year history, quit 50 years ago
ETOH: denies
Other complications due to other cardiac device, implant, and graft,Other primary cardiomyopathies,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Malignant neoplasm of cervix uteri, unspecified site,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Anemia, unspecified,Long-term (current) use of insulin,Percutaneous transluminal coronary angioplasty status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Comp-oth cardiac device,Prim cardiomyopathy NEC,Urin tract infection NOS,Crnry athrscl natve vssl,Mal neo cervix uteri NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Anemia NOS,Long-term use of insulin,Status-post ptca,Abn react-cardiac cath
Admission Date:  [**2113-8-2**]              Discharge Date:   [**2113-8-8**]

Date of Birth:  [**2047-10-30**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Endoscopic coronary artery bypass graft x1: Left
internal mammary artery to left anterior descending artery.


History of Present Illness:
65 year old female with known coronary artery disease, status
post LAD bare metal stent in [**5-6**], hypertension,
hypercholesterolemia, and diabetes mellitus requiring insulin,
reports intermittent chest pain, lasting approximately 20
minutes, radiating to back, that improves with rest.Pain located
in precordial
area with no exacerbating factors. Cardiac work up at OSH
revealed in stent stenosis.

Past Medical History:
CAD s/p stent [**4-/2113**] - LAD bare metal
Diabetes type 2
Hypertension
Hypercholesterolemia
Cervical Cancer stage 3 (squamous cell)
Cardiomyopathy  EF 45-50%
Anemia


Social History:
Occupation: receptionist in laundry
Lives with: Alone
Tobacco: 2 pack year history, quit 50 years ago
ETOH: denies


Family History:
noncontributory

Physical Exam:
Pulse:80 SR Resp:18  O2 sat: 100% on 2Lpm
B/P  Right: 114/68   Left:
Height:     Weight:156LBs

General:A&Ox3
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Varicosities: LLE varicosities noted
Neuro: Grossly intact
Pulses:
Femoral  (R) groin -cath site=C/D/I, no hematoma noted, soft
Right:   Left:
DP           Right:2+   Left:2+
PT           [**Name (NI) 167**]:   Left:
Radial       Right:   Left:

Carotid Bruit :none       Right: 2+   Left:2+


Pertinent Results:
[**2113-8-2**] 09:20PM BLOOD WBC-12.9* RBC-4.65 Hgb-12.6 Hct-36.8
MCV-79* MCH-27.0 MCHC-34.2 RDW-14.6 Plt Ct-298
[**2113-8-6**] 03:01AM BLOOD WBC-16.2* RBC-3.55* Hgb-9.2* Hct-29.0*
MCV-82 MCH-25.9* MCHC-31.7 RDW-14.0 Plt Ct-201
[**2113-8-2**] 09:20PM BLOOD PT-12.2 PTT-25.2 INR(PT)-1.0
[**2113-8-5**] 02:51AM BLOOD PT-13.2 PTT-26.0 INR(PT)-1.1
[**2113-8-2**] 09:20PM BLOOD Glucose-157* UreaN-10 Creat-0.7 Na-141
K-3.5 Cl-104 HCO3-28 AnGap-13
[**2113-8-6**] 03:01AM BLOOD Glucose-130* UreaN-14 Creat-0.8 Na-135
K-4.1 Cl-105 HCO3-22 AnGap-12


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 83207**] (Complete)
Done [**2113-8-4**] at 11:13:35 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: [**2047-10-30**]
Age (years): 65 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: 402.90, 786.51, 440.0, 424.0
Test Information
Date/Time: [**2113-8-4**] at 11:13    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 #: 2009AW1-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Ascending:  3.0 cm  <= 3.4 cm

Findings
LEFT ATRIUM: Mild LA enlargement. Good (>20 cm/s) LAA ejection
velocity. No thrombus in the LAA.

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

LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Mild regional LV systolic dysfunction.

LV WALL MOTION: Regional left ventricular wall motion findings
as shown below; remaining LV segments contract normally.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. 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.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets (?#). No AS. Trace AR.

MITRAL VALVE: No MS. Trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
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. 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
Off-Pump CABG planned:
1. The left atrium is mildly dilated. No thrombus is seen in the
left atrial appendage. No thrombus is seen in the right atrial
appendage 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. There is mild regional left
ventricular systolic dysfunction with anterior hypokinesis.. The
remaining left ventricular segments contract normally. LVEF is
50%.
3. Right ventricular chamber size and free wall motion are
normal.
4. 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. Trace aortic regurgitation is seen between the LCC and
NCC.
6. . Trivial mitral regurgitation is seen.
7. There is no pericardial effusion.
Dr. [**Last Name (STitle) **] was notified in person of the results.
After off-pump LIMA-LAD, there is improvement of the anterior
wall motion and global improvement of the LVEF to 60%.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2113-8-4**] 13:01


?????? [**2106**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Transferred from outside hospital for surgical evaluation.
Underwent preoperative workup and management of chest pain
requiring heparin and nitroglycerin drips preoperatively.  On
[**2113-8-4**] she was taken to the operating room and underwent
endoscopic coronary artery bypass graft surgery.  See operative
report for further details.  She received vancomycin for
perioperative antibiotics because she was in the hospital prior
to surgery.  Post operatively she was taken to the intensive
care unit for hemodynamic management requiring vasoactive
medications for hypertension.  She was weaned from sedation,
awoke neurologically intact, and was extubated without
complications.  [**Last Name (un) **] was consulted for diabetes management
since on insulin regimen preoperatively and hgba1c 10.  She
continued to do well and was transferred to the floor.  Physical
therapy worked with her on strength and mobility.  She was
provided diabetes education.  She continued to do well and was
ready for discharge home with services on post operative day
four.

Medications on Admission:
Coreg 6.25 mg twice daily
Norvasc 5 mg daily
Aspirin 325 mg daily
Metoprolol 25 mg daily
Lisinopril 40 mg daily
Lipitor 80 mg daily
Iron 325 mg daily
Lantus 45 units daily
Novolog 8 units premeals

Plavix - last dose: stopped 1 month ago


Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 3 months.
Disp:*30 Tablet(s)* Refills:*3*
2. 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:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 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:*0*
5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
7. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
8. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for PAIN.
Disp:*40 Tablet(s)* Refills:*0*
9. Motrin 400 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours for 2 weeks.
Disp:*42 Tablet(s)* Refills:*0*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 5 days.
Disp:*5 Tablet(s)* Refills:*0*
11. Lopressor 100 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours.
Disp:*90 Tablet(s)* Refills:*0*
12. Humalog 100 unit/mL Solution Sig: Six (6) units Subcutaneous
before each meal .
Disp:*qs qs* Refills:*2*
13. Lantus 100 unit/mL Solution Sig: Thirty Five (35) units
Subcutaneous once a day: please take everyday at the same time .
Disp:*qs qs* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
Coronary artery disease s/p Endoscopic CABG
hypertension
hyperlipidemia
Diabetes Mellitus
cervical cancer
anemia


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 4 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Blood glucose monitoring before meals and bedtime - please call
PCP if blood glucose greater than 200

Followup Instructions:
Please call to schedule appointments
Dr [**First Name8 (NamePattern2) **] [**Name (STitle) **] - [**Hospital3 **] clinic in [**12-30**] weeks
[**Telephone/Fax (1) 24107**]
Dr. [**Last Name (STitle) 14334**] in [**1-31**] weeks
Dr [**First Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]


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

Completed by:[**2113-8-8**]
{'Other complications due to other cardiac device, implant, and graft,Other primary cardiomyopathies,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Malignant neoplasm of cervix uteri, unspecified site,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Anemia, unspecified,Long-term (current) use of insulin,Percutaneous transluminal coronary angioplasty status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: angina

PRESENT ILLNESS: 65 year old female with known coronary artery disease, status
post LAD bare metal stent in [**5-6**], hypertension,
hypercholesterolemia, and diabetes mellitus requiring insulin,
reports intermittent chest pain, lasting approximately 20
minutes, radiating to back, that improves with rest.Pain located
in precordial
area with no exacerbating factors. Cardiac work up at OSH
revealed in stent stenosis.

MEDICAL HISTORY: CAD s/p stent [**4-/2113**] - LAD bare metal
Diabetes type 2
Hypertension
Hypercholesterolemia
Cervical Cancer stage 3 (squamous cell)
Cardiomyopathy  EF 45-50%
Anemia

MEDICATION ON ADMISSION: Coreg 6.25 mg twice daily
Norvasc 5 mg daily
Aspirin 325 mg daily
Metoprolol 25 mg daily
Lisinopril 40 mg daily
Lipitor 80 mg daily
Iron 325 mg daily
Lantus 45 units daily
Novolog 8 units premeals

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:80 SR Resp:18  O2 sat: 100% on 2Lpm
B/P  Right: 114/68   Left:
Height:     Weight:156LBs

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Occupation: receptionist in laundry
Lives with: Alone
Tobacco: 2 pack year history, quit 50 years ago
ETOH: denies 

### Response:
{'Other complications due to other cardiac device, implant, and graft,Other primary cardiomyopathies,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Malignant neoplasm of cervix uteri, unspecified site,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Anemia, unspecified,Long-term (current) use of insulin,Percutaneous transluminal coronary angioplasty status,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
