CHIEF COMPLAINT: coronary artery disease

PRESENT ILLNESS: This 56 year old white male underwent stress testing for a 5
year history of exertional angina, especially in the cold.  This
was positive and a cardiac catheterization demonstrated triple
vessel disease with preserved ventricular function.  He was
referred for surgical revascularization.

MEDICAL HISTORY: appendectomy
wrist ganglionectomies
hypertension
hyperlipidemia

MEDICATION ON ADMISSION: ATENOLOL -  (Prescribed by Other Provider) - 25 mg Tablet - 1
Tablet(s) by mouth once daily
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth once daily
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth once daily
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once every evening

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: admission:
Pulse:58 Resp:16  O2 sat: 100/RA
B/P  Right: 121/80   Left: 118/70
Height:5'[**15**]"     Weight:215 lbs

FAMILY HISTORY: Family History: father had an MI at age 50, brother had an MI at
age 37

SOCIAL HISTORY: Race:caucasian
Lives with:wife
Occupation:Homicide detective for the City of [**Location (un) 86**]
Tobacco:denies - quit 30 years ago
ETOH:2 drinks per month
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of tobacco use,Family history of ischemic heart disease
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Pure hypercholesterolem,History of tobacco use,Fam hx-ischem heart dis
Admission Date:  [**2116-1-6**]              Discharge Date:   [**2116-1-9**]

Date of Birth:  [**2059-9-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
coronary artery disease

Major Surgical or Invasive Procedure:
Coronary artery bypass grafts x 3(LIMA-LAD,SVG-OM,SVG-PDA)
[**2116-1-6**]


History of Present Illness:
This 56 year old white male underwent stress testing for a 5
year history of exertional angina, especially in the cold.  This
was positive and a cardiac catheterization demonstrated triple
vessel disease with preserved ventricular function.  He was
referred for surgical revascularization.

Past Medical History:
appendectomy
wrist ganglionectomies
hypertension
hyperlipidemia

Social History:
Race:caucasian
Lives with:wife
Occupation:Homicide detective for the City of [**Location (un) 86**]
Tobacco:denies - quit 30 years ago
ETOH:2 drinks per month


Family History:
Family History: father had an MI at age 50, brother had an MI at
age 37


Physical Exam:
admission:
Pulse:58 Resp:16  O2 sat: 100/RA
B/P  Right: 121/80   Left: 118/70
Height:5'[**15**]"     Weight:215 lbs

General:
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  0
Varicosities: +1
Neuro: Grossly intact
Pulses:
Femoral      Right:  +2 Left: +2
DP           Right:  +2 Left: +2
PT           [**Name (NI) 167**]:  +2 Left: +2
Radial       Right:  +2 Left: +2

Carotid Bruit        Right:   0 Left: 0


Pertinent Results:
Admission labs:
[**2116-1-6**] 09:20AM   HGB-14.2 calcHCT-43
[**2116-1-6**] 09:20AM   GLUCOSE-108* LACTATE-1.0 NA+-137 K+-3.5
CL--100
[**2116-1-6**] 12:50PM   FIBRINOGE-187
[**2116-1-6**] 12:50PM   PT-15.0* PTT-28.1 INR(PT)-1.3*
[**2116-1-6**] 12:50PM   PLT COUNT-140*
[**2116-1-6**] 12:50PM   WBC-12.4*# RBC-3.30*# HGB-10.6*# HCT-28.9*#
MCV-87 MCH-32.0 MCHC-36.6* RDW-12.7
[**2116-1-6**] 01:56PM   UREA N-14 CREAT-1.0 SODIUM-141 POTASSIUM-3.2*
CHLORIDE-109* TOTAL CO2-25 ANION GAP-10
Discharge Labs:
[**2116-1-9**] 09:39AM BLOOD WBC-8.2 RBC-3.41* Hgb-10.8* Hct-30.1*
MCV-88 MCH-31.8 MCHC-36.0* RDW-12.4 Plt Ct-113*
[**2116-1-9**] 09:39AM BLOOD Plt Ct-113*
[**2116-1-6**] 01:56PM BLOOD PT-14.3* PTT-29.2 INR(PT)-1.2*
[**2116-1-9**] 09:39AM BLOOD UreaN-13 Creat-1.1 Na-140 K-3.7 Cl-101
[**2116-1-9**] 09:39AM BLOOD Mg-2.1

Radiology Report CHEST (PORTABLE AP) Study Date of [**2116-1-7**] 9:05
AM
[**Hospital 93**] MEDICAL CONDITION: 56 year old man with s/p CABG, CTs
d/c'd
Final Report
Left pleural effusion is tiny, if any. No pneumothorax.
Postoperative
widening of the mediastinum, particularly in the anterior
compartment at the level of the aortic arch is stable. Heart
size top normal, unchanged. Right lung clear.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *4.7 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  5.0 cm  <= 5.2 cm
Left Ventricle - Septal Wall Thickness:  1.1 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Ejection Fraction:  55% to 65%  >= 55%
Aorta - Annulus:  2.1 cm  <= 3.0 cm
Aorta - Sinus Level:  2.7 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.5 cm  <= 3.0 cm
Aorta - Ascending:  3.1 cm  <= 3.4 cm
Aortic Valve - LVOT diam:  1.9 cm
Findings
LEFT ATRIUM: Mild LA enlargement. Depressed LAA emptying
velocity (<0.2m/s) No thrombus in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. No ASD by 2D or color
Doppler.
LEFT VENTRICLE: Normal LV wall thickness. Mildly depressed LVEF.

RIGHT VENTRICLE: Mildly dilated RV cavity. Normal RV systolic
function.
AORTA: Normal ascending aorta diameter. Focal calcifications in
aortic arch. Simple atheroma in descending aorta. No thoracic
aortic dissection.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
MITRAL VALVE: Normal mitral valve leaflets. Trivial MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
Physiologic (normal) PR.
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:
The left atrium is mildly dilated. No thrombus is seen in the
left atrial appendage. No atrial septal defect is seen by 2D or
color Doppler.
Left ventricular wall thicknesses are normal. Overall left
ventricular systolic function is mildly depressed, estimated EF
= 45-50%.
The right ventricular cavity is mildly dilated with normal free
wall contractility.
There are focal calcifications in the distal aortic arch. There
is intimal thickening in the descending thoracic aorta. No
thoracic aortic dissection is seen.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis. No aortic
regurgitation is seen.
The mitral valve leaflets appear normal. Trivial mitral
regurgitation is seen.
POST-CPB:
The overal LV systolic function appears improved, estimated EF =
60%. There remains trivial MR, trivial TR, and trace PI. No AI.
No evidence of dissection.


Brief Hospital Course:
56 year old patient of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] and Dr. [**First Name (STitle) **]
[**Name (STitle) 2257**] with exertional chest pain, dyspnea and a positive
stress test had a cardiac catheterization that revealed 3 vessel
coronary disease. Post catheterization he was referred for
revascularization.

He was admitted for revascularization on [**1-6**] and taken to the
Operating Room where coronary bypass grafting please see
operative report for details, in summary he had:
1. Coronary bypass grafting x3 with left internal mammary
artery, left anterior descending coronary; reverse saphenous
vein single graft from aorta to first obtuse
marginal coronary artery; reverse saphenous vein single graft
from aorta to the distal right coronary artery. His
cardiopulmonary bypass time was 36 minutes and crossclamp time
was 56 minutes. He tolerated the operation well and
post-operatively was transferred to the cardiac surgery ICU in
stable condition. He reamined hemodynamically satble, weaned
from the ventilator and was extubated the evening of surgery. On
POD1 he was transferred to the stepdown floor for continued
post-operative care and recovery. All tubes lines and drains
were removed per cardiac surgery protocol. He was diuresed
towards his preoperative weight, beta blockade was begun as
well.  Physical Therapy worked with him for mobility and
strength. The remainder of his hospital stay was uneventful.
He was cleared for discharge on POD3 and sent home with visiting
nurses. He is to follow-up with Dr [**Last Name (STitle) 914**] in 3 weeks

Medications on Admission:
ATENOLOL -  (Prescribed by Other Provider) - 25 mg Tablet - 1
Tablet(s) by mouth once daily
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth once daily
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth once daily
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once every evening

Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 325 mg Tablet - 1
Tablet(s) by mouth once daily
MULTIVITAMIN -  (Prescribed by Other Provider) - Dosage
uncertain
OMEGA-3 FATTY ACIDS-VITAMIN E [OMEGA-3 FISH OIL] -  (Prescribed
by Other Provider) - Dosage uncertain


Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever or pain.
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. potassium chloride 10 mEq Tablet Sustained Release Sig: Two
(2) Tablet Sustained Release PO once a day for 10 days.
Disp:*20 Tablet Sustained Release(s)* Refills:*0*
8. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 10
days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
coronary artery disease s/p Coronary artery bypass grafts x 3
s/p appendectomy
hypertension
hyperlipidemia


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with Percocet
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema- none


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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
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
Surgeon: Dr. [**Last Name (STitle) 914**] ([**Telephone/Fax (1) 170**]) on [**2-4**] @ 1pm [**Hospital Unit Name **]
[**Hospital Unit Name **]
Cardiologist: Dr.[**First Name (STitle) **] [**Name (STitle) 2257**] on [**1-30**] @11:10AM/[**Location (un) **]
Office

Please call to schedule appointments with:
Primary Care Dr. [**Last Name (STitle) 12782**],[**First Name3 (LF) **] [**Telephone/Fax (1) 6803**] in [**4-15**] weeks

**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:[**2116-1-9**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of tobacco use,Family history of ischemic heart disease'}


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: coronary artery disease

PRESENT ILLNESS: This 56 year old white male underwent stress testing for a 5
year history of exertional angina, especially in the cold.  This
was positive and a cardiac catheterization demonstrated triple
vessel disease with preserved ventricular function.  He was
referred for surgical revascularization.

MEDICAL HISTORY: appendectomy
wrist ganglionectomies
hypertension
hyperlipidemia

MEDICATION ON ADMISSION: ATENOLOL -  (Prescribed by Other Provider) - 25 mg Tablet - 1
Tablet(s) by mouth once daily
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth once daily
LISINOPRIL -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth once daily
SIMVASTATIN -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once every evening

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: admission:
Pulse:58 Resp:16  O2 sat: 100/RA
B/P  Right: 121/80   Left: 118/70
Height:5'[**15**]"     Weight:215 lbs

FAMILY HISTORY: Family History: father had an MI at age 50, brother had an MI at
age 37

SOCIAL HISTORY: Race:caucasian
Lives with:wife
Occupation:Homicide detective for the City of [**Location (un) 86**]
Tobacco:denies - quit 30 years ago
ETOH:2 drinks per month 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of tobacco use,Family history of ischemic heart disease'}
