CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Ms. [**Known lastname 83836**] is a 83 year old Arabic speaking woman with two
days of chest pain, brought to [**Hospital3 **] by her son. [**Name (NI) **]
initial troponin was elevated at 4.85 and she had minimal ST
depressions in lead I and AVL.  She was found to have
multi-vessel CAD and referred for CABG.

MEDICAL HISTORY: Coronary Artery Disease
Hypertension
Diabetes
Hyperlipidemia
DVT after knee surgery-on Coumadin
Chronic kidney disease-on Hemodialysis (x5weeks)
Congestive Heart Failure
Anemia
Enlarged appendix-?appendicitis

MEDICATION ON ADMISSION: Medications at home:
Renegal 1600mg TID
Coumadin 5mg daily   -last dose 9/19
Vit D2 1.25mg weekly
Clonidine 0.1mg [**Hospital1 **]
Doxazosin 2mg daily
Lisinopril 5mg daily
Fluoxetine 20mg daily
Furosemide 40mg daily
Pravastatin 40mg daily
Amlopidine 10mg daily
NPH 40AM/30PM
RISS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 97.6   Pulse: 66  Resp: 16  O2 sat: 96%-RA
B/P  Right: 140/64Left:
Height:     Weight: 187lbs

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: She lives with her son, [**Name (NI) **] [**Name (NI) 83837**].  She has never been a
smoker.
Coronary atherosclerosis of native coronary artery,End stage renal disease,Other primary cardiomyopathies,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Intermediate coronary syndrome,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Renal dialysis status,Anemia, unspecified,Unspecified psychosis,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Knee joint replacement
Crnry athrscl natve vssl,End stage renal disease,Prim cardiomyopathy NEC,CHF NOS,Hyp kid NOS w cr kid V,Urin tract infection NOS,Intermed coronary synd,DMII renal uncntrld,Renal dialysis status,Anemia NOS,Psychosis NOS,Hyperlipidemia NEC/NOS,Iatrogenc hypotnsion NEC,Hx-ven thrombosis/embols,Long-term use anticoagul,Joint replaced knee
Name:  [**Known lastname 13310**],[**Known firstname 13311**]                  Unit No:   [**Numeric Identifier 13312**]

Admission Date:  [**2200-9-23**]              Discharge Date:   [**2200-10-5**]

Date of Birth:  [**2117-1-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 741**]
Addendum:
Pt was not discharged until POD#9. She was unable to receive
rehab placement and did not qualify for home care services.
Therefore she remained in the hospital for continued medical
management. She continued with HD three times a week. [**Last Name (un) 616**]
continued to adjust her insulin due to persistent hypo and
hyperglycemia. Needed extensive physical therapy in order to
prepare her for home enviornment.  Physical therapy worked with
family to help transition to home and on POD#9 she was
discharged to home in stable condition. She will need to
continue to monitor her blood sugars closely and f/u with her
endocrinologists. She will continue with her regularly scheduled
outpatient dialysis.

Discharge Medications:
1. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
2. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
4. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
10. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
11. Coumadin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
12. NPH insulin human recomb 100 unit/mL Suspension Sig: One (1)
Subcutaneous twice a day: 25 Units at breakfast, 18 Units HS.
Disp:*qs * Refills:*2*
13. Humalog 100 unit/mL Solution Sig: per sliding scale units
Subcutaneous four times a day.
Disp:*qs * Refills:*2*
14. tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours)
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
15. Outpatient Lab Work
Serial PT/INR
Dx: DVT, goal INR [**2-6**]
Management per Dr. [**First Name (STitle) **] [**Telephone/Fax (1) 13313**]


Discharge Disposition:
Home With Service

Facility:
[**Company 720**]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2200-10-7**]

Admission Date:  [**2200-9-23**]              Discharge Date:   [**2200-10-5**]

Date of Birth:  [**2117-1-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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


Major Surgical or Invasive Procedure:
Coronary artery bypass grafting times three (Left interior
mammary artery to left anterior descending, saphenous vein graft
to posterior descending, and saphenous vein grafting to obtuse
marginal) [**2200-9-26**]


History of Present Illness:
Ms. [**Known lastname 83836**] is a 83 year old Arabic speaking woman with two
days of chest pain, brought to [**Hospital3 **] by her son. [**Name (NI) **]
initial troponin was elevated at 4.85 and she had minimal ST
depressions in lead I and AVL.  She was found to have
multi-vessel CAD and referred for CABG.

Past Medical History:
Coronary Artery Disease
Hypertension
Diabetes
Hyperlipidemia
DVT after knee surgery-on Coumadin
Chronic kidney disease-on Hemodialysis (x5weeks)
Congestive Heart Failure
Anemia
Enlarged appendix-?appendicitis


Social History:
She lives with her son, [**Name (NI) **] [**Name (NI) 83837**].  She has never been a
smoker.

Family History:
No premature coronary artery disease


Physical Exam:
T 97.6   Pulse: 66  Resp: 16  O2 sat: 96%-RA
B/P  Right: 140/64Left:
Height:     Weight: 187lbs

General: NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
tunneled permacath-HD catheter right SC/IJ
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x]
Extremities: Warm [x], well-perfused [x]
Edema: None     Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: cath site  Left: 2+

Carotid Bruit        Right:no    Left: no


Pertinent Results:
[**2200-9-26**] Intra-op TEE
Conclusions
PRE-BYPASS:
-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 symmetric left ventricular hypertrophy. Overall left
ventricular systolic function is normal (LVEF>55%).
-Doppler parameters are most consistent with Grade II (moderate)
left ventricular diastolic dysfunction. with normal free wall
contractility.
-There are simple atheroma in the aortic arch. There are simple
atheroma in the descending thoracic aorta.
-There are three aortic valve leaflets. There is no aortic valve
stenosis. No aortic regurgitation is seen.
-The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen. Pseudonormal diastolic
dysfunction.
Dr. [**Last Name (STitle) **] was notified of the results at the time of the
study.

POSTBYPASS:
Preserved LV systolic funciont LVEF > 55%, no swma, no
dissection seen after cannula removed. NO SWMA after chest
closed. Decreased SVR requiring phenylephrine indicated by
normal [**Female First Name (un) **] with reduced ESA in the setting of mildly decreased
BP. No other changes from prebypass.
\
[**2200-10-1**] 07:47AM BLOOD WBC-8.7 RBC-2.53* Hgb-7.9* Hct-23.5*
MCV-93 MCH-31.4 MCHC-33.8 RDW-15.4 Plt Ct-244
[**2200-10-1**] 07:47AM BLOOD PT-18.3* INR(PT)-1.6*
[**2200-10-1**] 07:47AM BLOOD Glucose-88 UreaN-42* Creat-4.9*# Na-133
K-4.1 Cl-95* HCO3-25 AnGap-17
[**2200-10-2**] 04:11AM BLOOD WBC-8.8 RBC-2.99* Hgb-9.2* Hct-27.3*
MCV-91 MCH-30.8 MCHC-33.7 RDW-15.4 Plt Ct-258
[**2200-10-1**] 07:47AM BLOOD WBC-8.7 RBC-2.53* Hgb-7.9* Hct-23.5*
MCV-93 MCH-31.4 MCHC-33.8 RDW-15.4 Plt Ct-244
[**2200-9-30**] 06:25AM BLOOD WBC-9.1 RBC-2.64* Hgb-8.1* Hct-24.0*
MCV-91 MCH-30.6 MCHC-33.7 RDW-15.4 Plt Ct-235
[**2200-10-2**] 04:11AM BLOOD PT-21.8* INR(PT)-2.0*
[**2200-10-1**] 07:47AM BLOOD PT-18.3* INR(PT)-1.6*
[**2200-9-30**] 06:25AM BLOOD PT-14.9* INR(PT)-1.3*
[**2200-9-29**] 02:13AM BLOOD PT-12.2 INR(PT)-1.0
[**2200-10-2**] 04:11AM BLOOD Glucose-71 UreaN-28* Creat-4.0* Na-135
K-4.2 Cl-97 HCO3-26 AnGap-16
[**2200-10-1**] 07:47AM BLOOD Glucose-88 UreaN-42* Creat-4.9*# Na-133
K-4.1 Cl-95* HCO3-25 AnGap-17
[**2200-9-30**] 06:25AM BLOOD Glucose-56* UreaN-27* Creat-3.5* Na-137
K-4.0 Cl-99 HCO3-29 AnGap-13

Brief Hospital Course:
Ms. [**Known lastname 83836**] was admitted for pre-operative work-up.  Renal was
consulted for hemodialysis recommendations.  She was found to
have a positive urinalysis and was started on Cipro.  The
patient was brought to the Operating Room on [**2200-9-26**] where the
he underwent coronary artery bypass grafting with Dr. [**Last Name (STitle) **].
Vancomycin was used for peri-operative antibiotics given her
pre-operative inpatient stay of greater than 24 hours.  Overall
the patient tolerated the procedure well and post-operatively
was transferred to the CVICU in stable condition for recovery
and invasive monitoring.
Post-operative day one found the patient extubated, alert and
oriented and breathing comfortably.  The patient was
neurologically intact and hemodynamically stable, weaned from
inotropic and vasopressor support.  Beta blocker was initiated
and the patient was gently diuresed toward her preoperative
weight.  [**Last Name (un) **] was consulted for assistance with post-operative
glucose management.  Coumadin was resumed for pre-operative deep
vein thrombosis.  The patient was transferred to the telemetry
floor for further recovery on post-operative day three.  Chest
tubes and pacing wires were discontinued without complication.
The patient was evaluated by the physical therapy service for
assistance with strength and mobility.  By the time of discharge
on post-operative day four the patient was ambulating freely,
the wound was healing and pain was controlled with oral
analgesics.  The patient was discharged to home on
post-operative day six.  All appropriate follow-up appointments
were advised.


Medications on Admission:
Medications at home:
Renegal 1600mg TID
Coumadin 5mg daily   -last dose 9/19
Vit D2 1.25mg weekly
Clonidine 0.1mg [**Hospital1 **]
Doxazosin 2mg daily
Lisinopril 5mg daily
Fluoxetine 20mg daily
Furosemide 40mg daily
Pravastatin 40mg daily
Amlopidine 10mg daily
NPH 40AM/30PM
RISS

Meds on Transfer:
Heparin Infusion- off
Metoprolol 50mg [**Hospital1 **]
ASA 325 daily
Fluoxetine 20mg daily
Furosemide 40mg daily
Lisinopril 20mg daily
Pravastatin 40mg daily
Nephrocaps 1cap daily
Amlopidine 10mg daily
Insulin SS
Tylenol prn
MOM prn
NTG sl/prn


Discharge Medications:
1. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
2. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
4. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
10. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
11. Coumadin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
12. NPH insulin human recomb 100 unit/mL Suspension Sig: One (1)
35 Units at Breakfast and 22 Units HS Subcutaneous as above.
Disp:*qs * Refills:*2*
13. Humalog 100 unit/mL Solution Sig: per sliding scale units
Subcutaneous four times a day.
Disp:*qs * Refills:*2*
14. tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours)
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
15. Outpatient Lab Work
Serial PT/INR
Dx: DVT, goal INR [**2-6**]
Management per Dr. [**First Name (STitle) **] [**Telephone/Fax (1) 25736**]


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Coronary Artery Disease
Hypertension
Diabetes
Hyperlipidemia
DVT after knee surgery-on Coumadin
Chronic kidney disease-on Hemodialysis (x5weeks)
Congestive Heart Failure
Anemia
Enlarged appendix-?appendicitis
s/p CABGx3

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
No edema


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**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**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:
Recommended Follow-up:
You are scheduled for the following appointments
Surgeon: [**Name6 (MD) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2200-10-29**] 1:45
Cardiologist: Dr. [**Last Name (STitle) 83838**] [**2200-10-27**] at 1PM

Please call to schedule appointments with your
Primary Care: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 7988**] [**Telephone/Fax (1) 18099**] in [**4-8**] 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**

Goal INR [**2-6**]
Dx: DVT
First draw [**2200-10-3**]
INR/Coumadin to be managed by Dr. [**First Name (STitle) **] [**Telephone/Fax (1) 25736**]



Completed by:[**2200-10-2**]

Name:  [**Known lastname 13310**],[**Known firstname 13311**]                  Unit No:   [**Numeric Identifier 13312**]

Admission Date:  [**2200-9-23**]              Discharge Date:   [**2200-10-5**]

Date of Birth:  [**2117-1-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 741**]
Addendum:
Insulin was changed.  See below.

Discharge Medications:
1. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
2. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
4. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
10. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
11. Coumadin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*60 Tablet(s)* Refills:*2*
12. NPH insulin human recomb 100 unit/mL Suspension Sig: One (1)
 Subcutaneous twice a day: 25 Units at breakfast, 18 Units HS.
Disp:*qs * Refills:*2*
13. Humalog 100 unit/mL Solution Sig: per sliding scale units
Subcutaneous four times a day.
Disp:*qs * Refills:*2*
14. tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours)
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
15. Outpatient Lab Work
Serial PT/INR
Dx: DVT, goal INR [**2-6**]
Management per Dr. [**First Name (STitle) **] [**Telephone/Fax (1) 13313**]


Discharge Disposition:
Home With Service

Facility:
[**Company 720**]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2200-10-2**]
{'Coronary atherosclerosis of native coronary artery,End stage renal disease,Other primary cardiomyopathies,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Intermediate coronary syndrome,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Renal dialysis status,Anemia, unspecified,Unspecified psychosis,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Knee joint replacement'}


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: Ms. [**Known lastname 83836**] is a 83 year old Arabic speaking woman with two
days of chest pain, brought to [**Hospital3 **] by her son. [**Name (NI) **]
initial troponin was elevated at 4.85 and she had minimal ST
depressions in lead I and AVL.  She was found to have
multi-vessel CAD and referred for CABG.

MEDICAL HISTORY: Coronary Artery Disease
Hypertension
Diabetes
Hyperlipidemia
DVT after knee surgery-on Coumadin
Chronic kidney disease-on Hemodialysis (x5weeks)
Congestive Heart Failure
Anemia
Enlarged appendix-?appendicitis

MEDICATION ON ADMISSION: Medications at home:
Renegal 1600mg TID
Coumadin 5mg daily   -last dose 9/19
Vit D2 1.25mg weekly
Clonidine 0.1mg [**Hospital1 **]
Doxazosin 2mg daily
Lisinopril 5mg daily
Fluoxetine 20mg daily
Furosemide 40mg daily
Pravastatin 40mg daily
Amlopidine 10mg daily
NPH 40AM/30PM
RISS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: T 97.6   Pulse: 66  Resp: 16  O2 sat: 96%-RA
B/P  Right: 140/64Left:
Height:     Weight: 187lbs

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: She lives with her son, [**Name (NI) **] [**Name (NI) 83837**].  She has never been a
smoker. 

### Response:
{'Coronary atherosclerosis of native coronary artery,End stage renal disease,Other primary cardiomyopathies,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Urinary tract infection, site not specified,Intermediate coronary syndrome,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,Renal dialysis status,Anemia, unspecified,Unspecified psychosis,Other and unspecified hyperlipidemia,Other iatrogenic hypotension,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants,Knee joint replacement'}
