CHIEF COMPLAINT: chest pain and dyspnea, referred from PCP office to emergency
room

PRESENT ILLNESS: Seen by PCP in office, noted to be hypertensive and dyspnic. EKG
done that had new ST depressions. Referred to emergency room and
then to Cath lab, found to have left main disease. Intra-aortic
balloon pump placed in cath lab and then brought emergently to
operating room.

MEDICAL HISTORY: 1) CAD: s/p inferior infarction with catheterization documented
right coronary artery occlusion and moderate LAD and diagonal
branch disease in [**2098-6-1**]
2) CHF: [**8-6**]: EF 50% with akinesis of the base of the inferior
wall.
3) Crohn's Disease dx 20 years ago without medical management
4) Hypertension
5) Hyperlipidemia
6) Glucose intolerance
7) Moderate MR, AR [**8-6**]: [**12-4**]+ aortic and [**12-4**]+ mitral
regurgitation
osteoarthritis

MEDICATION ON ADMISSION: ASA 325', lopressor 50", univasc 15, norvasc 5', glyburide
[**9-6**]', metformin 500", HCTZ 25', asacol 2400", boniva 150qmo,
lipitor 40'

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VS T 98.1  HR 84  BP 97/59  RR 18  O2sat 97%-RA
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Patient currently lives alone. Leads active lifestyle, able to
walk and carry on daily activities. Non-smoker.
Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Regional enteritis of unspecified site,Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Unspecified essential hypertension
Subendo infarct, initial,Ac on chr syst hrt fail,Regional enteritis NOS,Crnry athrscl natve vssl,Mitral/aortic val insuff,Hypertension NOS
Admission Date:  [**2106-8-18**]              Discharge Date:   [**2106-8-24**]

Date of Birth:  [**2029-9-21**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
chest pain and dyspnea, referred from PCP office to emergency
room

Major Surgical or Invasive Procedure:
[**2106-8-18**] - Cardiac Catheterization with placement of an
Intra-Aortic Balloon Pump.
[**2106-8-18**] - CABGx4 (Left internal mammary artery->Left anterior
descending artery, Saphenous Vein Graft(SVG)->Diagonal Artery,
SVG->First Obtuse marginal artery, SVG->Second Obtuse marginal
artery).


History of Present Illness:
Seen by PCP in office, noted to be hypertensive and dyspnic. EKG
done that had new ST depressions. Referred to emergency room and
then to Cath lab, found to have left main disease. Intra-aortic
balloon pump placed in cath lab and then brought emergently to
operating room.

Past Medical History:
1) CAD: s/p inferior infarction with catheterization documented
right coronary artery occlusion and moderate LAD and diagonal
branch disease in [**2098-6-1**]
2) CHF: [**8-6**]: EF 50% with akinesis of the base of the inferior
wall.
3) Crohn's Disease dx 20 years ago without medical management
4) Hypertension
5) Hyperlipidemia
6) Glucose intolerance
7) Moderate MR, AR [**8-6**]: [**12-4**]+ aortic and [**12-4**]+ mitral
regurgitation
osteoarthritis

Social History:
Patient currently lives alone. Leads active lifestyle, able to
walk and carry on daily activities. Non-smoker.


Family History:
non contributory

Physical Exam:
VS T 98.1  HR 84  BP 97/59  RR 18  O2sat 97%-RA
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of *** cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
[**2106-8-18**] 12:50PM   PLT COUNT-279
[**2106-8-18**] 12:50PM   WBC-12.5* RBC-3.62* HGB-10.5* HCT-33.3*
MCV-92 MCH-29.1 MCHC-31.7 RDW-14.6
[**2106-8-18**] 12:50PM   CK-MB-31* MB INDX-9.1*
[**2106-8-18**] 12:50PM   cTropnT-0.76*
[**2106-8-18**] 12:50PM   GLUCOSE-204* UREA N-28* CREAT-1.1 SODIUM-138
POTASSIUM-4.8 CHLORIDE-101 TOTAL CO2-24 ANION GAP-18
[**2106-8-18**] 04:45PM   PT-12.3 PTT-22.0 INR(PT)-1.0
[**2106-8-18**] 04:45PM   WBC-15.5* RBC-3.62* HGB-11.0* HCT-32.8*
MCV-91 MCH-30.5 MCHC-33.6 RDW-14.6
[**2106-8-18**] 04:45PM   ALT(SGPT)-34 AST(SGOT)-70* ALK PHOS-74
AMYLASE-61 TOT BILI-0.7
[**2106-8-18**] 04:45PM   GLUCOSE-170* UREA N-25* CREAT-1.0 SODIUM-140
POTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-20* ANION GAP-21*
[**2106-8-23**] 06:05AM BLOOD WBC-8.5 RBC-3.91* Hgb-11.3* Hct-34.1*
MCV-87 MCH-28.8 MCHC-33.0 RDW-15.3 Plt Ct-286#
[**2106-8-23**] 06:05AM BLOOD Plt Ct-286#
[**2106-8-23**] 06:05AM BLOOD Glucose-129* UreaN-17 Creat-0.7 Na-141
K-4.5 Cl-102 HCO3-32 AnGap-12
Final Report
PA AND LATERAL CHEST ON [**2106-8-23**]
IMPRESSION: PA and lateral chest compared to [**8-21**],
preoperative chest radiograph:
Small bilateral pleural effusion is new. Severe cardiomegaly is
unchanged.  Atelectasis in the left mid lung is changed in
distribution but not in overall severity. No pulmonary edema or
pneumonia. No pneumothorax.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Conclusions
PRE-BYPASS: The left atrium is normal in size. No spontaneous
echo contrast or thrombus is seen in the body of the left atrium
or left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler. There is severe regional left ventricular
systolic dysfunction with severe anterior, inferior mid to
apical hypokinesis.. The remaining left ventricular segments are
hypokinetic. Right ventricular chamber size and free wall motion
are normal. There are simple atheroma in the descending thoracic
aorta. There are three aortic valve leaflets. The aortic valve
leaflets are moderately thickened. There is mild aortic valve
stenosis (valve area 1.2-1.9cm2). Mild (1+) aortic regurgitation
is seen. The mitral valve leaflets are mildly thickened. There
is moderate thickening of the mitral valve chordae. Mild to
moderate ([**12-4**]+) mitral regurgitation is seen. There is no
pericardial effusion.
IABP in good position.

POST CPB:
1. Mildly improved global and focal LV systolic function.
2. Preserved RV systolci function.
3. Mitral regurgitation is mild to moderate.
4. With improved cardiac output the [**First Name9 (NamePattern2) 19367**] [**Location (un) 109**] measured to
be 1.7 cm2
5. Persistent wall motion abnormalities (Inferior/anteroseptal
severe hypokinesis)
5. Persistent wall motion abnormalities.
  Interpretation assigned to [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting
physician



Brief Hospital Course:
Admitted for cardiac cath from ER [**8-18**] with NSTEMI. IABP placed
in the cath lab due to extensive coronary disease. Taken
emergently from cath lab to OR for surgery with Dr. [**First Name (STitle) **] that
evening. Transferred to the CVICU in fair condition on titrated
epinephrine, phenylephrine, and propofol drips. IABP removed and
extubated POD #1.Transferred to the floor on POD #2 Her activity
level was gradually advanced. Chest tubes and pacing wires
removed per protocol. Beta blockade titrated and gently diuresed
toward pre-op weight. Made excellent progress and cleared for
discharge to home on POD #6. Pt. is to make all follow-up appts.
as per discharge instructions.

Medications on Admission:
ASA 325', lopressor 50", univasc 15, norvasc 5', glyburide
[**9-6**]', metformin 500", HCTZ 25', asacol 2400", boniva 150qmo,
lipitor 40'

Discharge Medications:
1. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
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:*0*
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
Disp:*200 Tablet(s)* Refills:*0*
5. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
7. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
8. Mesalamine 400 mg Tablet, Delayed Release (E.C.) Sig: Three
(3) Tablet, Delayed Release (E.C.) PO TID (3 times a day).
Disp:*270 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
10. 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*
11. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
12. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: Three (3) Tablet Sustained Release 24 hr PO DAILY (Daily):
total dose 150 mg daily .
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*0*
13. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 10 days: for left leg .
Disp:*40 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Coronary artery disease s/p CABG with preoperative IABP
Non ST elevation myocardial infarction
Acute on chronic systolic heart failure
crohns
colonic polyps
hyperlipidemia
Hypertension
Diabetes mellitus type 2
aortic regurgitation
mitral regurgitation


Discharge Condition:
Good


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain. In the event that you have drainage
from your sternal wound, please contact the [**Name2 (NI) 5059**] at ([**Telephone/Fax (1) 4044**].
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry. Please shower daily. No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks from date of
surgery.
6) No driving for 1 month or while taking narcotics for pain.
7) Call with any questions or concerns. [**Telephone/Fax (1) 1504**]
8) Call with any questions or concerns. [**Telephone/Fax (1) 1504**]


Followup Instructions:
Wound Check Friday [**8-27**] with NP/PA on [**Hospital Ward Name **] 6 [**Telephone/Fax (1) 3071**]
Please follow-up with Dr. [**First Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
please follow-up with Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**1-5**] weeks.
[**Telephone/Fax (1) 62**]
Please follow-up with Dr [**Last Name (STitle) **] in 2 weeks. [**Telephone/Fax (1) 3329**]
Please call all providers for appointments

Scheduled appointments:
Provider: [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 62**]
Date/Time:[**2107-2-1**] 11:00
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 6925**] Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2107-2-2**]
11:00


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

Completed by:[**2106-8-24**]
{'Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Regional enteritis of unspecified site,Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Unspecified essential hypertension'}


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 and dyspnea, referred from PCP office to emergency
room

PRESENT ILLNESS: Seen by PCP in office, noted to be hypertensive and dyspnic. EKG
done that had new ST depressions. Referred to emergency room and
then to Cath lab, found to have left main disease. Intra-aortic
balloon pump placed in cath lab and then brought emergently to
operating room.

MEDICAL HISTORY: 1) CAD: s/p inferior infarction with catheterization documented
right coronary artery occlusion and moderate LAD and diagonal
branch disease in [**2098-6-1**]
2) CHF: [**8-6**]: EF 50% with akinesis of the base of the inferior
wall.
3) Crohn's Disease dx 20 years ago without medical management
4) Hypertension
5) Hyperlipidemia
6) Glucose intolerance
7) Moderate MR, AR [**8-6**]: [**12-4**]+ aortic and [**12-4**]+ mitral
regurgitation
osteoarthritis

MEDICATION ON ADMISSION: ASA 325', lopressor 50", univasc 15, norvasc 5', glyburide
[**9-6**]', metformin 500", HCTZ 25', asacol 2400", boniva 150qmo,
lipitor 40'

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: VS T 98.1  HR 84  BP 97/59  RR 18  O2sat 97%-RA
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Patient currently lives alone. Leads active lifestyle, able to
walk and carry on daily activities. Non-smoker. 

### Response:
{'Subendocardial infarction, initial episode of care,Acute on chronic systolic heart failure,Regional enteritis of unspecified site,Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Unspecified essential hypertension'}
