CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 77 year old gentleman who presented to outside hospital with
hematuria.  During admission he developed chest pain and was
ruled out for myocardial infarction.  He underwent stress test
that was positive and he was referred for cardiac evaluation.

MEDICAL HISTORY: - Hypertension
- Hyperlipidemia
- Hypothyroidism
- Gout
- s/p lap CCY [**2100**]
- s/p colon polypectomy
- s/p b/l hernia repair [**4-19**]
- s/p hemorroidectomy
- s/p TURP [**2082**]

MEDICATION ON ADMISSION: 1. Amlodipine 5mg daily
2. Atenolol 50mg daily
3. Ciprofloxacin 500mg daily for 7 days (started [**7-23**])
4. Plavix 75 mg daily
5. Finasteride 5mg daily
6. Levothyroxine 88mcg daily
7. Lisinopril 5mg daily
8. Simvastatin 80mg daily
9. ASA 325mg daily
10. Docusate sodium 100mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=97.1 BP= 150/51 HR=52 RR=16 O2 sat= 98% on 2 L NC

FAMILY HISTORY: Brother died of aneurysm (unspecified type) at age 67.

SOCIAL HISTORY: lives with his wife in [**Name (NI) 1468**]
Retired data processor
Tobacco history: quit 20 yrs ago/ 30 pack-year smoking history
ETOH:  1 glass of wine w/ meals daily
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Urinary tract infection, site not specified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Gout, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Urin tract infection NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Iatrogenc hypotnsion NEC,Gout NOS
Admission Date:  [**2110-7-25**]              Discharge Date:   [**2110-8-4**]

Date of Birth:  [**2033-2-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
[**2110-7-25**] Cardiac catheterization
[**2110-7-29**] Coronary artery bypass grafting x3:
Left internal mammary artery graft to left anterior
descending, reverse saphenous vein graft to the first
marginal branch of the posterior descending artery


History of Present Illness:
77 year old gentleman who presented to outside hospital with
hematuria.  During admission he developed chest pain and was
ruled out for myocardial infarction.  He underwent stress test
that was positive and he was referred for cardiac evaluation.

Past Medical History:
- Hypertension
- Hyperlipidemia
- Hypothyroidism
- Gout
- s/p lap CCY [**2100**]
- s/p colon polypectomy
- s/p b/l hernia repair [**4-19**]
- s/p hemorroidectomy
- s/p TURP [**2082**]


Social History:
lives with his wife in [**Name (NI) 1468**]
Retired data processor
Tobacco history: quit 20 yrs ago/ 30 pack-year smoking history
ETOH:  1 glass of wine w/ meals daily


Family History:
Brother died of aneurysm (unspecified type) at age 67.

Physical Exam:
VS: T=97.1 BP= 150/51 HR=52 RR=16 O2 sat= 98% on 2 L NC

GENERAL: well-appearing elderly gentleman lying completely flat
in bed, after catheterization in NAD.
HEENT: anicteric sclerae. PERRL, EOMI. o/p clear
NECK: Supple with JVP of 7cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RRR normal S1, S2. No appreciable murmurs. No S3 or S4.
LUNGS: no chest wall deformities, CTAB/L, no crackles
ABDOMEN: +BS, Soft, NTND. No HSM
EXTREMITIES: No cyanosis, clubbing or edema
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
[**2110-8-3**] 08:31AM [**Month/Day/Year 3143**] WBC-9.8
[**2110-8-2**] 07:15AM [**Month/Day/Year 3143**] WBC-12.6* RBC-3.47* Hgb-9.6* Hct-29.7*
MCV-86 MCH-27.5 MCHC-32.2 RDW-15.7* Plt Ct-283
[**2110-7-25**] 09:05AM [**Month/Day/Year 3143**] WBC-6.9 RBC-2.79* Hgb-8.2* Hct-25.0*
MCV-90 MCH-29.3 MCHC-32.7 RDW-14.5 Plt Ct-258
[**2110-8-2**] 07:15AM [**Month/Day/Year 3143**] Plt Ct-283
[**2110-7-25**] 09:05AM [**Month/Day/Year 3143**] PT-14.4* PTT-31.2 INR(PT)-1.2*
[**2110-7-25**] 09:05AM [**Month/Day/Year 3143**] Plt Ct-258
[**2110-8-3**] 06:50AM [**Month/Day/Year 3143**] UreaN-13 Creat-1.0 K-3.5
[**2110-8-2**] 07:15AM [**Month/Day/Year 3143**] Glucose-96 UreaN-13 Creat-1.0 Na-135
K-3.8 Cl-100 HCO3-22 AnGap-17
[**2110-7-25**] 09:05AM [**Month/Day/Year 3143**] ALT-15 AST-18 AlkPhos-54 TotBili-0.9
[**2110-7-26**] 07:40AM [**Month/Day/Year 3143**] %HbA1c-5.4

[**2110-7-26**] 4:39 pm URINE      Source: CVS.

                            **FINAL REPORT [**2110-7-28**]**

   URINE CULTURE (Final [**2110-7-28**]):    NO GROWTH.

Radiology Report CHEST (PA & LAT) Study Date of [**2110-8-1**] 4:50 PM



[**Last Name (LF) **],[**First Name3 (LF) **] R. TSURG FA6A [**2110-8-1**] 4:50 PM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 82980**]
Reason: interval change



[**Hospital 93**] MEDICAL CONDITION:
   77 year old man with cabg
REASON FOR THIS EXAMINATION:
   interval change



Final Report
HISTORY: CABG.

FINDINGS: In comparison with study of [**7-30**], there is slight
improvement in
the left lower lung atelectasis as well as some decrease in the
pleural
effusion. Pulmonary vascularity is essentially within normal
limits and the
cardiomediastinal silhouette is unchanged. Intact sternal
sutures are again
seen. The right IJ sheath has been removed.


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Last Name (LF) 82981**], [**Known firstname 82982**]       [**Hospital1 18**] [**Numeric Identifier 82983**]
(Complete) Done [**2110-7-29**] at 1:25:32 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2033-2-17**]
Age (years): 77 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Aortic valve disease. Coronary artery disease. Left
ventricular function. Mitral valve disease. Valvular heart
disease.
ICD-9 Codes: 440.0, 424.1, 396.9, 424.0
Test Information
Date/Time: [**2110-7-29**] at 13:25    Interpret MD: [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**],
MD
Test Type: TEE (Complete)
3D imaging. Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 6507**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW4-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *6.4 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.4 cm  <= 5.2 cm
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Aorta - Sinus Level:  3.5 cm  <= 3.6 cm

Findings
Poor transgastric echo windows. LV function could be grossly
estimated and unable to measure wall thickness and LV cavity
size.
Multiplanar reconstructions were generated and confirmed on an
independent workstation.

LEFT ATRIUM: Marked LA enlargement. No spontaneous echo contrast
or thrombus in the LA/LAA or the RA/RAA. All four pulmonary
veins identified and enter the left atrium.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. A catheter or
pacing wire is seen in the RA.

LEFT VENTRICLE: Normal LV wall thickness and cavity size.

RIGHT VENTRICLE: Mildly dilated RV cavity. Normal RV systolic
function.

AORTA: Normal ascending aorta diameter. Mildly dilated
descending aorta. Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets (3). No AS. Mild (1+) AR.

MITRAL VALVE: Moderately thickened mitral valve leaflets. Mild
thickening of mitral valve chordae. Mild to moderate ([**12-13**]+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] 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 TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications. Suboptimal image quality - poor echo windows.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-BYPASS: The left atrium is markedly 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. Left ventricular wall thicknesses
and cavity size are normal. The right ventricular cavity is
mildly dilated with normal free wall contractility. The
descending thoracic aorta is mildly dilated. There are simple
atheroma in the descending thoracic aorta. There are three
aortic valve leaflets. The aortic valve leaflets (3) are mildly
thickened. There is no aortic valve stenosis. Mild (1+) aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened. Mild to moderate ([**12-13**]+) mitral regurgitation is seen.
There is no pericardial effusion.

POST-CPB:

1. Preserved biventricular systolci function (Possible
underestimated due to MR).
2. Moderate to severe mitral regurgitation
3. MR severity improved with initiation of inotropic therapy
(Epinephrine) and decreased to moderate MR.
4. NO change in TR or AI severity.
5. No other change.
  Electronically signed by [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2110-7-29**] 13:33

Cardiology Report ECG Study Date of [**2110-7-29**]  2:08:12 PM


Sinus rhythm. Low anterolateral lead T wave amplitude is
non-specific. Tracing
may be within normal limits but clinical correlation is
suggested. No previous
tracing available for comparison.


Read by: [**Last Name (LF) **],[**First Name3 (LF) 177**] W.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
74 142 82 404/428 47 -7 63



Brief Hospital Course:
Transferred from outside hospital for cardiac evaluation and
underwent cardiac catherization [**2110-7-25**] which revealed coronary
artery disease.  He was referred for surgical evaluation.  He
underwent preoperative work up and on [**2110-7-29**] was brought to the
operating room and underwent coronary artery bypass graft
surgery.  See operative report for details.  He received
vancomycin for perioperative antibiotics as he was in the
hospital preoperatively.  He was transferred to the intensive
care unit for hemodynamic management. Due to decreased
hematocrit he was transfused with packed red [**Date Range **] cells. He
continued his cipro course for urethral irrigation at outside
hospital.  In the first twenty four hours he was weaned from
sedation, awoke neurologically intact, and was extubated without
complications.  On post operative day one he was weaned off
epinephrine drip and remained in intensive care unit for
hemodynamic management.  On post operative day two he was
started on beta blockers and diuretics, and transferred to the
post operative floor for the remainder of his care.  He
developed sternal drainage so he was started on cefazolion,
dressing changes and increased diuresis.  Physical therapy
worked with him on strength and mobility. Sternal drainage
resolved and he was ready for discharge home with services on
post operative day six. Plan for follow up wound check in 3 days
on [**Wardname **].


Medications on Admission:
1. Amlodipine 5mg daily
2. Atenolol 50mg daily
3. Ciprofloxacin 500mg daily for 7 days (started [**7-23**])
4. Plavix 75 mg daily
5. Finasteride 5mg daily
6. Levothyroxine 88mcg daily
7. Lisinopril 5mg daily
8. Simvastatin 80mg daily
9. ASA 325mg daily
10. Docusate sodium 100mg [**Hospital1 **]


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
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. Levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Ultram 50 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 2 weeks.
Disp:*56 Capsule(s)* Refills:*0*
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO BID (2 times a
day) for 2 weeks.
Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary artery disease s/p CABG
Hematuria
Hypertension
Elevated Lipids
Hypothyroid
Gout


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, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
If you have any [**Telephone/Fax (1) **] in urine or difficulty passing urine
please contact Dr [**First Name8 (NamePattern2) **] [**Name (NI) 1356**] (urologist)  ([**Telephone/Fax (1) 52531**]

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**Last Name (STitle) **],[**First Name3 (LF) **]  in 1 week [**Telephone/Fax (1) 82984**]
Dr.  [**Last Name (STitle) **] in [**1-14**] weeks
Please call for appointments
Wound Check Thrusday [**8-7**] on [**Hospital Ward Name **] [**Telephone/Fax (1) 3071**]
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])
You have an appointment scheduled with Dr [**First Name (STitle) 1356**] (Urology) On
[**2110-9-3**] at 3:30 pm - if any problems with [**Name2 (NI) **] in
urine or difficulty passing urine please contact him



Completed by:[**2110-8-4**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Urinary tract infection, site not specified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Gout, 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: 77 year old gentleman who presented to outside hospital with
hematuria.  During admission he developed chest pain and was
ruled out for myocardial infarction.  He underwent stress test
that was positive and he was referred for cardiac evaluation.

MEDICAL HISTORY: - Hypertension
- Hyperlipidemia
- Hypothyroidism
- Gout
- s/p lap CCY [**2100**]
- s/p colon polypectomy
- s/p b/l hernia repair [**4-19**]
- s/p hemorroidectomy
- s/p TURP [**2082**]

MEDICATION ON ADMISSION: 1. Amlodipine 5mg daily
2. Atenolol 50mg daily
3. Ciprofloxacin 500mg daily for 7 days (started [**7-23**])
4. Plavix 75 mg daily
5. Finasteride 5mg daily
6. Levothyroxine 88mcg daily
7. Lisinopril 5mg daily
8. Simvastatin 80mg daily
9. ASA 325mg daily
10. Docusate sodium 100mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T=97.1 BP= 150/51 HR=52 RR=16 O2 sat= 98% on 2 L NC

FAMILY HISTORY: Brother died of aneurysm (unspecified type) at age 67.

SOCIAL HISTORY: lives with his wife in [**Name (NI) 1468**]
Retired data processor
Tobacco history: quit 20 yrs ago/ 30 pack-year smoking history
ETOH:  1 glass of wine w/ meals daily 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Urinary tract infection, site not specified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other iatrogenic hypotension,Gout, unspecified'}
