CHIEF COMPLAINT: DOE/ angina

PRESENT ILLNESS: 63 yo male with multiple cardiac risk factor including CHF. He
has had DOE and angina for 4-5 months. Had + ETT and this led to
cath which revealed 3VD. Referred for surgery.

MEDICAL HISTORY: IDDM
HTN
Hypercholesterolemia
CHF
Obesity
Peripheral Neuropathy
Chronic renal insufficiency ( baseline creat 2.2)

MEDICATION ON ADMISSION: Lasix 120mg twice a day
lisinopril 40mg daily
diltiazem ER 240mg daily
simvastatin 40mg daily
Fenobriate 54mg daily
ASA 325mg daily
Lantus 200 units in am 276 units in PM
sliding scale Novolog 40 units per 100pts
MVI daily
Vit C 1000mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:88  Resp: 18 O2 sat: 94% RA
B/P  Right:171/61    Left:186/60
Height:69 inches     Weight:323 lbs

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.  Mother died at 69 of colon CA, Father died at
72 of CVA

SOCIAL HISTORY: Employed as facilities manager, married 30+ years.  No
smoking/drinking/IVDU.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Hyperpotassemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Obesity, unspecified,Anemia, unspecified,Chronic kidney disease, unspecified,Long-term (current) use of insulin,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Chr systolic hrt failure,Hy kid NOS w cr kid I-IV,Hyperpotassemia,DMII wo cmp nt st uncntr,Idio periph neurpthy NOS,Obesity NOS,Anemia NOS,Chronic kidney dis NOS,Long-term use of insulin,Pure hypercholesterolem
Admission Date:  [**2187-5-30**]              Discharge Date:   [**2187-6-4**]

Date of Birth:  [**2123-12-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2187-5-30**]  CABG X 3 (LIMA to LAD, SVG to OM, SVG to RCA)

History of Present Illness:
63 yo male with multiple cardiac risk factor including CHF. He
has had DOE and angina for 4-5 months. Had + ETT and this led to
cath which revealed 3VD. Referred for surgery.

Past Medical History:
IDDM
HTN
Hypercholesterolemia
CHF
Obesity
Peripheral Neuropathy
Chronic renal insufficiency ( baseline creat 2.2)


Social History:
Employed as facilities manager, married 30+ years.  No
smoking/drinking/IVDU.


Family History:
There is no family history of premature coronary artery disease
or sudden death.  Mother died at 69 of colon CA, Father died at
72 of CVA

Physical Exam:
Pulse:88  Resp: 18 O2 sat: 94% RA
B/P  Right:171/61    Left:186/60
Height:69 inches     Weight:323 lbs

General:
Skin: Dry [x] intact [x] Well healed scar left forearm
HEENT: PERRLA [x] EOMI [x] teeth in poor repair
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x] Distant heart sounds
Heart: RRR [x]  Irregular []  Murmur Distant heart sounds
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x] Obese
Extremities: Warm [x], well-perfused [x]  2+ Edema Varicosities:
None [x] superficial veins bilateral thighs, erythema B/L lower
extremities with ~ 2 cm eschar on anterior LLE
Neuro: Grossly intact
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:1+   Left:1+
PT           [**Name (NI) 167**]:1+   Left:1+
Radial       Right:2+   Left:2+

Carotid Bruit        Right:none    Left:none


Pertinent Results:
Conclusions
PRE-BYPASS:
The left atrium is dilated. No spontaneous echo contrast or
thrombus is seen in the body of the left atrium/left atrial
appendage or the body of the right atrium/right atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler.
There is mild symmetric left ventricular hypertrophy with normal
cavity size and regional/global systolic function (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the aortic root. There are focal
calcifications in the aortic arch. There are simple atheroma in
the descending thoracic aorta.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. There is no pericardial effusion. Dr.
[**Last Name (STitle) **] was notified in person of the results on JG before
surgical incision.

POST-BYPASS:
Preserved biventricular systolic function.
LVEF 55%.
Trivial MR, TR and AI.
Intact thoracic aorta.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2187-5-30**] 14:18

[**2187-6-4**] 09:36AM BLOOD WBC-15.4*
[**2187-6-4**] 04:00AM BLOOD WBC-15.2* RBC-3.12* Hgb-8.9* Hct-26.2*
MCV-84 MCH-28.6 MCHC-34.1 RDW-15.3 Plt Ct-309
[**2187-6-4**] 04:00AM BLOOD Plt Ct-309
[**2187-6-2**] 03:52AM BLOOD PT-12.2 PTT-20.7* INR(PT)-1.0
[**2187-6-4**] 04:00AM BLOOD Glucose-77 UreaN-56* Creat-1.4* Na-138
K-4.0 Cl-103 HCO3-24 AnGap-15
[**2187-6-4**] 04:00AM BLOOD Mg-2.7*

Brief Hospital Course:
Admitted [**5-30**] and underwent surgery with Dr. [**Last Name (STitle) **]. Please
separately dictated op note. Transferred to the CVICU in stable
condition. Awoke neurologically intact and was extubated.
Transferred to floor on POD to begin increasing his activity
level. Beta blockade was titrated and he was gently diuresed
toward his pre-op weight. His creatinine slowly decreased to
1.4. Keflex for a 2 week course per Dr. [**Last Name (STitle) **] given his
significant risk factors for infection. Cleared for discharge to
home with VNA on POD #5. Pt. is to make all postop appts as per
discharge instructions.

Medications on Admission:
Lasix 120mg twice a day
lisinopril 40mg daily
diltiazem ER 240mg daily
simvastatin 40mg daily
Fenobriate 54mg daily
ASA 325mg daily
Lantus 200 units in am 276 units in PM
sliding scale Novolog 40 units per 100pts
MVI daily
Vit C 1000mg daily


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:*0*
2. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*30 Tablet(s)* Refills:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
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. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*0*
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
8. Fenofibrate 54 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
9. Multivitamins     Tablet, Chewable Sig: One (1) Tablet,
Chewable PO once a day.
10. Vitamin C 1,000 mg Tablet Sig: One (1) Tablet PO once a day.

11. Keflex 500 mg Capsule Sig: One (1) Capsule PO every six (6)
hours for 2 weeks.
Disp:*56 Capsule(s)* Refills:*0*
12. Lantus 100 unit/mL Solution Sig: 100  units  Subcutaneous
qam : dose below preop may need to be increased .
13. Lantus 100 unit/mL Solution Sig: Sixty (60) units
Subcutaneous at bedtime.
14. Humalog 100 unit/mL Solution Sig: per sliding scale
Subcutaneous four times a day.
15. sliding scale
Insulin SC Fixed Dose Orders
Breakfast Bedtime
Glargine      140  Units Glargine      60  Units
Insulin SC Sliding Scale
  Breakfast Lunch Dinner Bedtime
Humalog Humalog Humalog Humalog
Glucose Insulin Dose Insulin Dose Insulin Dose Insulin Dose
0-70   mg/dL Proceed with hypoglycemia protocol Proceed with
hypoglycemia protocol Proceed with hypoglycemia protocol Proceed
with hypoglycemia protocol
71-90   mg/dL 0   Units 0   Units 0   Units 0   Units
91-120   mg/dL 6   Units 6   Units 6   Units 0   Units
121-150   mg/dL 10   Units 10   Units 10   Units 0   Units
151-180   mg/dL 14   Units 14   Units 14   Units 0   Units
181-210   mg/dL 18   Units 18   Units 18   Units 4   Units
211-240   mg/dL 22   Units 22   Units 22   Units 6   Units


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
CAD s/p CABG
IDDM
HTN
Hypercholesterolemia
CHF
Obesity
Peripheral Neuropathy
Chronic renal insufficiency ( baseline creat 2.2)


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait with walker
Incisional pain managed with dilaudid prn
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema + 2 bilateral LE


Discharge Instructions:
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
Please 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**]

**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

[**First Name11 (Name Pattern1) 2053**] [**Last Name (NamePattern4) 2761**], MD Phone:[**Telephone/Fax (1) 8645**] Date/Time:[**2187-6-25**]
1:20
[**Name6 (MD) 1037**] [**Name8 (MD) 5647**], MD Phone:[**Telephone/Fax (1) 1971**] Date/Time:[**2187-9-27**] 10:15

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) **] in [**12-2**] weeks [**Telephone/Fax (1) 4775**]
Surgeon Dr [**Last Name (STitle) **] 3-4 weeks [**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**



Completed by:[**2187-6-5**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Hyperpotassemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Obesity, unspecified,Anemia, unspecified,Chronic kidney disease, unspecified,Long-term (current) use of insulin,Pure hypercholesterolemia'}


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: DOE/ angina

PRESENT ILLNESS: 63 yo male with multiple cardiac risk factor including CHF. He
has had DOE and angina for 4-5 months. Had + ETT and this led to
cath which revealed 3VD. Referred for surgery.

MEDICAL HISTORY: IDDM
HTN
Hypercholesterolemia
CHF
Obesity
Peripheral Neuropathy
Chronic renal insufficiency ( baseline creat 2.2)

MEDICATION ON ADMISSION: Lasix 120mg twice a day
lisinopril 40mg daily
diltiazem ER 240mg daily
simvastatin 40mg daily
Fenobriate 54mg daily
ASA 325mg daily
Lantus 200 units in am 276 units in PM
sliding scale Novolog 40 units per 100pts
MVI daily
Vit C 1000mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:88  Resp: 18 O2 sat: 94% RA
B/P  Right:171/61    Left:186/60
Height:69 inches     Weight:323 lbs

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.  Mother died at 69 of colon CA, Father died at
72 of CVA

SOCIAL HISTORY: Employed as facilities manager, married 30+ years.  No
smoking/drinking/IVDU. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Chronic systolic heart failure,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Hyperpotassemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified hereditary and idiopathic peripheral neuropathy,Obesity, unspecified,Anemia, unspecified,Chronic kidney disease, unspecified,Long-term (current) use of insulin,Pure hypercholesterolemia'}
