CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 81 yo M with PMH significant for HTN,hyperlipidemia,
claudication, and right CEA with complaints of chest pain with
moderate exertion relieved with rest. He states that it is
occasionally associated with nausea and vomiting. The patient
had an abnormal stress echo and was referred for cardiac
catheterization which showed LM and RCA disease. We are asked to
evaluate for surgical revascularization.

MEDICAL HISTORY: DM
peripheral neuropathy
intermittent claudication
hypercholestrol
Degenerative arthritis,

MEDICATION ON ADMISSION: Carvedilol 6.25mg po BID
Plavix 75mg po daily
Humalog 100 unit/ml Solution SS breakfast and evening
Lisinopril/Hydrochlorothiazide 20mg-25mg  1 tab po daily
Metformin 1000mg po BID
Crestor 10mg po daily
ASA 325mg po daily
Flaxseed Oil 1000mg po daily
Niacin 500mg po BID
NPH 100unit/ml Suspension 26 units qAM, 28 units qPM
Fish Oil 1200mg-144mg capsule  1 capsule po daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:72 Resp:16  O2 sat:99%RA
B/P  Right:199/90    Left:195/72
Height:5'[**32**]"     Weight:194 lbs
Admission Exam

FAMILY HISTORY: N/C

SOCIAL HISTORY: He is a retired tool and die [**First Name3 (LF) **]. Very physically active.
Nonsmoker and nondrinker. Married with 4 children and many
grandchildren.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Atherosclerosis of native arteries of the extremities with intermittent claudication,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin,Anemia, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Pleural effusion NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Ath ext ntv at w claudct,Atrial fibrillation,BPH w/o urinary obs/LUTS,Osteoarthros NOS-unspec,Long-term use of insulin,Anemia NOS
Name:  [**Known lastname 7350**],[**Known firstname **]                     Unit No:   [**Numeric Identifier 7351**]

Admission Date:  [**2132-7-18**]              Discharge Date:   [**2132-7-23**]

Date of Birth:  [**2051-4-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 135**]
Addendum:
Medication Addendum

Pt advised to resume Metformin at preoperative dose, and
checking FSBS ACHS

Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1082**] VNA

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

Completed by:[**2132-7-23**]

Admission Date:  [**2132-7-18**]              Discharge Date:   [**2132-7-23**]

Date of Birth:  [**2051-4-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Chest pain


Major Surgical or Invasive Procedure:
-status post Coronary artery bypass grafting x3 with the left
internal mammary artery to the left anterior descending
artery and reverse saphenous vein graft to the right coronary
artery and obtuse marginal artery.


History of Present Illness:
81 yo M with PMH significant for HTN,hyperlipidemia,
claudication, and right CEA with complaints of chest pain with
moderate exertion relieved with rest. He states that it is
occasionally associated with nausea and vomiting. The patient
had an abnormal stress echo and was referred for cardiac
catheterization which showed LM and RCA disease. We are asked to
evaluate for surgical revascularization.

Past Medical History:
DM
peripheral neuropathy
intermittent claudication
hypercholestrol
Degenerative arthritis,

Social History:
He is a retired tool and die [**First Name3 (LF) **]. Very physically active.
Nonsmoker and nondrinker. Married with 4 children and many
grandchildren.


Family History:
N/C

Physical Exam:
Pulse:72 Resp:16  O2 sat:99%RA
B/P  Right:199/90    Left:195/72
Height:5'[**32**]"     Weight:194 lbs
Admission Exam

General:
Skin: Dry [x] [**Year (2 digits) 5235**] [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x] R CEA incision
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ []
Extremities: Warm [x], well-perfused [x]  Edema +1
Varicosities:mild
Neuro: Grossly [**Year (2 digits) 5235**]
Pulses:
Femoral      Right: dressing  Left: +2
DP           Right: +1  Left: +1
PT           [**Name (NI) 167**]: +1  Left: +1
Radial       Right: +2  Left: +2

Carotid Bruit        Right:  0  Left: 0


Pertinent Results:
[**2132-7-23**] 05:30AM BLOOD WBC-7.6 RBC-3.36* Hgb-10.2* Hct-29.6*
MCV-88 MCH-30.5 MCHC-34.6 RDW-14.5 Plt Ct-232
[**2132-7-18**] 12:31PM BLOOD WBC-10.7# RBC-3.14* Hgb-9.2* Hct-27.5*
MCV-88 MCH-29.3 MCHC-33.4 RDW-14.5 Plt Ct-179
[**2132-7-23**] 05:30AM BLOOD PT-14.2* INR(PT)-1.2*
[**2132-7-18**] 12:31PM BLOOD PT-13.9* PTT-34.4 INR(PT)-1.2*
[**2132-7-23**] 05:30AM BLOOD Glucose-65* UreaN-26* Creat-1.0 Na-142
K-4.3 Cl-104 HCO3-28 AnGap-14
[**2132-7-19**] 03:43AM BLOOD Glucose-112* UreaN-18 Creat-1.0 Na-140
K-4.7 Cl-106 HCO3-28 AnGap-11


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 40822**] (Complete)
Done [**2132-7-18**] at 10:13:33 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]
[**Last Name (NamePattern4) 18**] - Department of Cardiac S
[**Last Name (NamePattern1) 439**], 2A
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2051-4-28**]
Age (years): 81 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: CABG
ICD-9 Codes: 786.05, 786.51, 424.1, 424.0
Test Information
Date/Time: [**2132-7-18**] at 10:13    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW1-: Machine: aw1
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55% to 60%  >= 55%
Aortic Valve - Peak Gradient:  8 mm Hg  < 20 mm Hg

Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

LEFT VENTRICLE: Overall normal LVEF (>55%).

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

[**Last Name (NamePattern4) **]: Normal ascending [**Last Name (NamePattern4) 5236**] diameter. Complex (>4mm) atheroma
in the descending thoracic [**Last Name (NamePattern4) 5236**].

AORTIC VALVE: Moderately thickened aortic valve leaflets.
Minimal AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Trivial
MR.

TRICUSPID VALVE: Mild [1+] TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) 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 TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Pre-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are complex (>4mm) atheroma in the descending thoracic
[**Last Name (NamePattern4) 5236**].
The aortic valve leaflets are moderately thickened. There is a
minimally increased gradient consistent with minimal aortic
valve stenosis. The left cusp is nearly immobile.
No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen.
There is no pericardial effusion.

Post-CPB:
The patient is AV-Paced, on no inotropes.
Preserved biventricular systolic fxn.
No AI. Trace MR. [**First Name (Titles) **] [**Last Name (Titles) 5235**].
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2132-7-18**] 11:52


?????? [**2125**] CareGroup IS. All rights reserved.


Brief Hospital Course:
On [**7-18**] Mr.[**Known lastname 36243**] was taken to the operating room and underwent
Coronary artery bypass grafting x3 with the left internal
mammary artery to the left anterior descending artery and
reverse saphenous vein graft to the right coronary artery and
obtuse marginal artery. Please refer to Dr[**Doctor Last Name **] operative
report for further details. He tolerated the procedure well and
was transferred to the CVICU in critical but stable condition.
He awoke neurologically [**Doctor Last Name 5235**] and was extubated without
difficulty. All lines and drains were removed in a timely
fashion. Beta-blocker/ASA/Statin and diuresis were initiated.
POD#1 he was transferred to the step down unit for further
monitoring. Physical Therapy was consulted for evaluation of
strength and mobility. Postoperative paroxysmal atrial
fibrillation was rate controlled with Beta-blockade.
Anticoagulation was started with Coumadin. Dr.[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **],
Cardiology, will follow INR/Coumadin dosing, INR goal=2-2.5 for
AFib. Mr.[**Known lastname 36243**]  continued to progress and he was cleared by
Dr.[**Last Name (STitle) **] for discharge to home with VNA on POD# 5. All follow up
appointments were advised.


Medications on Admission:
Carvedilol 6.25mg po BID
Plavix 75mg po daily
Humalog 100 unit/ml Solution SS breakfast and evening
Lisinopril/Hydrochlorothiazide 20mg-25mg  1 tab po daily
Metformin 1000mg po BID
Crestor 10mg po daily
ASA 325mg po daily
Flaxseed Oil 1000mg po daily
Niacin 500mg po BID
NPH 100unit/ml Suspension 26 units qAM, 28 units qPM
Fish Oil 1200mg-144mg capsule  1 capsule po daily

Plavix - last dose:300mg load +75 daily (LD [**2132-7-14**])


Discharge Medications:
1. Ranitidine HCl 150 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO BID (2
times a day).
Disp:*60 [**Month/Day/Year 8426**](s)* Refills:*2*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. Rosuvastatin 5 mg [**Month/Day/Year 8426**] Sig: Two (2) [**Month/Day/Year 8426**] PO DAILY
(Daily).
Disp:*60 [**Month/Day/Year 8426**](s)* Refills:*2*
4. Omega-3 Fatty Acids     Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*60 Capsule(s)* Refills:*2*
5. Niacin 500 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO BID (2 times a day).
Disp:*60 Capsule, Sustained Release(s)* Refills:*2*
6. Aspirin 81 mg [**Month/Day/Year 8426**], Delayed Release (E.C.) Sig: One (1)
[**Month/Day/Year 8426**], Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 [**Month/Day/Year 8426**], Delayed Release (E.C.)(s)* Refills:*2*
7. Hydromorphone 2 mg [**Month/Day/Year 8426**] Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*45 [**Month/Day/Year 8426**](s)* Refills:*0*
8. Lisinopril 10 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO DAILY (Daily).
Disp:*60 [**Month/Day/Year 8426**](s)* Refills:*2*
9. Metoprolol Tartrate 25 mg [**Month/Day/Year 8426**] Sig: One (1) [**Month/Day/Year 8426**] PO TID
(3 times a day).
Disp:*90 [**Month/Day/Year 8426**](s)* Refills:*2*
10. Warfarin 1 mg [**Month/Day/Year 8426**] Sig: Five (5) [**Month/Day/Year 8426**] PO Once Daily at 4
PM for 1 doses.
Disp:*1 [**Month/Day/Year 8426**](s)* Refills:*0*
11. Warfarin 1 mg [**Month/Day/Year 8426**] Sig: [**Name8 (MD) **] MD [**First Name (Titles) 8426**] [**Last Name (Titles) **] once a day: INR
goal=2-2.5 for postop Atrial Fibrillation.
Disp:*150 [**Last Name (Titles) 8426**](s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
-Coronary artery disease.
-status post Coronary artery bypass grafting x3 with the left
internal mammary artery to the left anterior descending
artery and reverse saphenous vein graft to the right coronary
artery and obtuse marginal artery.
Past Medical History:
Hypertension
Hyperlipidemia
IDDM
Peripheral Neuropathy
Intermittent claudication
Degnerative arthritis
Skin CA
BPH
Blind Left eye from traumatic accident as a teenager->steel
shrapnel in eye. Also with shrapnel in chest and leg

Past Surgical History:
s/p Right CEA [**6-/2131**]
s/p Bilateral hand surgery as a teenager, right index finger
amputation, left finger reattached 20 yrs ago
s/p Right eye surgery after traumatic accident as a teenager


Discharge Condition:
Alert and oriented x3, nonfocal.
Ambulating with  steady gait.

Incisional pain managed with oral analgesics

Incisions:

Sternal - healing well, no erythema or drainage

Leg Left - healing well, no erythema or drainage. Edema


Discharge Instructions:
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.

No lotions, cream, powder, or ointments to incisions.
Each morning you should weigh yourself and then in the evening
take your temperature, These should be written down on the chart
.
No driving for approximately one month, until follow up with
surgeon.
No lifting more than 10 pounds for 10 weeks.
Please call with any questions or concerns ([**Telephone/Fax (1) 170**]).
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge of sternal wound.



**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.[**Last Name (STitle) **] #[**Telephone/Fax (1) 170**], appointment arranged for Wed.,
[**8-27**] at 1pm
Please call to schedule appointments with your:
Primary Care: Dr.[**Last Name (STitle) **],[**First Name3 (LF) **] G. [**Telephone/Fax (1) 6699**] call for
appoinment in [**1-19**] weeks.
Cardiologist: Dr.[**Last Name (NamePattern4) 40823**] [**Last Name (NamePattern1) **] # [**Telephone/Fax (1) 8725**] call for appoinment
in [**1-19**] weeks.
***Cardiologist: Dr.[**Last Name (NamePattern4) 40823**] [**Last Name (NamePattern1) **] # [**Telephone/Fax (1) 8725**] will follow
INR/Coumadin dosing
**Please call cardiac surgery office with any questions or
concerns ([**Telephone/Fax (1) 170**]). Answering service will contact on call
person during off hours.**
Labs: PT/INR for Coumadin ?????? indication=postoperative Atrial
Fibrillation
Goal INR: 2-2.5

First draw:[**2132-7-24**]

Results to:***Cardiologist: Dr.[**Last Name (NamePattern4) 40823**] [**Last Name (NamePattern1) **] #
[**Telephone/Fax (1) 8725**] -




Completed by:[**2132-7-23**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Atherosclerosis of native arteries of the extremities with intermittent claudication,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin,Anemia, unspecified'}


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: Chest pain

PRESENT ILLNESS: 81 yo M with PMH significant for HTN,hyperlipidemia,
claudication, and right CEA with complaints of chest pain with
moderate exertion relieved with rest. He states that it is
occasionally associated with nausea and vomiting. The patient
had an abnormal stress echo and was referred for cardiac
catheterization which showed LM and RCA disease. We are asked to
evaluate for surgical revascularization.

MEDICAL HISTORY: DM
peripheral neuropathy
intermittent claudication
hypercholestrol
Degenerative arthritis,

MEDICATION ON ADMISSION: Carvedilol 6.25mg po BID
Plavix 75mg po daily
Humalog 100 unit/ml Solution SS breakfast and evening
Lisinopril/Hydrochlorothiazide 20mg-25mg  1 tab po daily
Metformin 1000mg po BID
Crestor 10mg po daily
ASA 325mg po daily
Flaxseed Oil 1000mg po daily
Niacin 500mg po BID
NPH 100unit/ml Suspension 26 units qAM, 28 units qPM
Fish Oil 1200mg-144mg capsule  1 capsule po daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:72 Resp:16  O2 sat:99%RA
B/P  Right:199/90    Left:195/72
Height:5'[**32**]"     Weight:194 lbs
Admission Exam

FAMILY HISTORY: N/C

SOCIAL HISTORY: He is a retired tool and die [**First Name3 (LF) **]. Very physically active.
Nonsmoker and nondrinker. Married with 4 children and many
grandchildren. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Atherosclerosis of native arteries of the extremities with intermittent claudication,Atrial fibrillation,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Long-term (current) use of insulin,Anemia, unspecified'}
