CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 59 yo M with exertional chest pain and dyspnea with abnormal
stress test, referred for cardiac catheterization which showed
TO LAD. He was referred for surgery.

MEDICAL HISTORY: Coronary artery disease
Hypertension
Elevated lipids
ORIF/foot
Eye surgery

MEDICATION ON ADMISSION: asa 81', lopressor 25', lipitor', chantix 0.5''

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 72 RR 12 BP 160/78
NAD
Lungs CTAB
Heart RRR
Abdomen benign
Extrem warm, no edema

FAMILY HISTORY: Mother with [**Name (NI) 77601**] older age

SOCIAL HISTORY: recently layed off from construction job
quit tobacco late [**2177-2-15**], 2 ppd x 40 years
denies etoh
Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Crnry athrscl natve vssl,Ac on chr syst hrt fail,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2177-4-11**]              Discharge Date:   [**2177-4-15**]

Date of Birth:  [**2117-5-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Endoscopic Off Pump CABGx1(LIMA>LAD)


History of Present Illness:
59 yo M with exertional chest pain and dyspnea with abnormal
stress test, referred for cardiac catheterization which showed
TO LAD. He was referred for surgery.

Past Medical History:
Coronary artery disease
Hypertension
Elevated lipids
ORIF/foot
Eye surgery

Social History:
recently layed off from construction job
quit tobacco late [**2177-2-15**], 2 ppd x 40 years
denies etoh

Family History:
Mother with [**Name (NI) 77601**] older age


Physical Exam:
HR 72 RR 12 BP 160/78
NAD
Lungs CTAB
Heart RRR
Abdomen benign
Extrem warm, no edema


Pertinent Results:
[**2177-4-15**] 05:10AM BLOOD WBC-8.4 RBC-3.48* Hgb-11.7* Hct-33.1*
MCV-95 MCH-33.5* MCHC-35.3* RDW-14.3 Plt Ct-214
[**2177-4-11**] 11:44AM BLOOD WBC-11.0 RBC-3.64* Hgb-12.0*# Hct-34.3*
MCV-94 MCH-33.1* MCHC-35.1* RDW-14.0 Plt Ct-169
[**2177-4-15**] 05:10AM BLOOD Plt Ct-214
[**2177-4-11**] 11:44AM BLOOD Plt Ct-169
[**2177-4-11**] 11:44AM BLOOD PT-13.6* PTT-36.1* INR(PT)-1.2*
[**2177-4-11**] 11:44AM BLOOD Fibrino-303
[**2177-4-15**] 05:10AM BLOOD Glucose-127* UreaN-7 Creat-0.7 Na-142
K-3.8 Cl-108 HCO3-25 AnGap-13
[**2177-4-11**] 01:04PM BLOOD UreaN-14 Creat-0.8 Cl-110* HCO3-24
[**2177-4-15**] 05:10AM BLOOD Mg-2.0

CHEST (PA & LAT)  [**2177-4-14**] 8:53 AM

CHEST (PA & LAT)

Reason: evaluate effusion

[**Hospital 93**] MEDICAL CONDITION:
59 year old man with s/p min inv cabg
REASON FOR THIS EXAMINATION:
evaluate effusion
INDICATION: Evaluate effusion.

COMPARISON: [**2177-4-12**].

FRONTAL AND LATERAL CHEST RADIOGRAPHS: Cardiac silhouette
appears enlarged, with persistent cardiomegaly, not
significantly changed in appearance from prior. Small bilateral
pleural effusions are present. Basilar a plate-like atelectasis
is seen. No definite focal consolidations.

IMPRESSION: Small bilateral pleural effusions with basilar
atelectasis bilaterally.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]. [**Last Name (NamePattern1) **]
DR. [**First Name (STitle) 3901**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3902**]
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 4130**]

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 77602**] (Complete)
Done [**2177-4-11**] at 9:44:43 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
[**Street Address(2) 15115**]
[**Location (un) 15116**], [**Numeric Identifier 15117**]  Status: Inpatient DOB: [**2117-5-5**]
Age (years): 59 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: OP-CAB
ICD-9 Codes: 786.05, 786.51, 799.02, 440.0, 424.1, 424.0
Test Information
Date/Time: [**2177-4-11**] at 09:44    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW1-: Machine: AW3
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.8 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  35% to 40%  >= 55%
Aorta - Ascending:  *3.5 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.0 cm  <= 2.5 cm

Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal ascending aorta diameter. Complex (>4mm) atheroma
in the descending thoracic aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets (3). Trace AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Mild [1+] TR.

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 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-procedure: No spontaneous echo contrast is seen in the left
atrial appendage. Right ventricular chamber size and free wall
motion are normal. There are complex (>4mm) atheroma in the
descending thoracic aorta. There are three aortic valve
leaflets. The aortic valve leaflets (3) are mildly thickened.
Trace aortic regurgitation is seen. The mitral valve leaflets
are moderately thickened. Mild (1+) mitral regurgitation is
seen. There is no pericardial effusion.
The LV has moderate systolic dysfxn of the mid and distal walls
globally. Basal segments function well.

Post- LIMA-LAD: Patient is in NSR with no pressors or inotropes
running.
Improved LV systolic fxn. EF now 45 - 50%. Trace MR, Trace AI.
Aorta intact.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2177-4-11**] 11:38


Brief Hospital Course:
He was taken to the operating room on [**4-11**] where he  underwent a
thoracoscopic [**Female First Name (un) 899**] harvest and off pump CABG x 1 via a keyhole
incision. He was transferred to the ICU in stable condition. He
was extubated later that same day. He was transferred to the
floor on POD #1. He was tachycardic and his beta blocker was
progressively increased. He continued to progress and was ready
for discharge home post op day 4.

Medications on Admission:
asa 81', lopressor 25', lipitor', chantix 0.5''

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. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
4. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 3 months.
Disp:*90 Tablet(s)* Refills:*0*
6. Chantix 0.5 mg Tablet Sig: One (1) Tablet PO twice a day:
please resume previous treatment as prescribed by your Primary
care physician.
7. 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*
8. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 3 weeks.
Disp:*64 Tablet(s)* Refills:*0*
9. Lopressor 100 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Coronary artery disease s/p OPCABG
Hypertension
Elevated cholesterol
ORIF/foot
Eye surgery


Discharge Condition:
Good.


Discharge Instructions:
Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths, no lotions, creams or powders to incisions.
No driving while taking narcotic pain medicine.
Please change dressing on left chest tube site daily, please
call for increased drainage
Please call with any questions or concerns ([**Telephone/Fax (1) 170**])

Followup Instructions:
Please call to schedule appointments
Dr. [**First Name (STitle) **] 4 weeks [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) 15942**] 2 weeks [**Telephone/Fax (1) 60570**]
Dr. [**Last Name (STitle) 10543**] 2 weeks
Wound check [**Hospital Ward Name **] 6, please schedule with RN [**Telephone/Fax (1) 3071**]


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

Completed by:[**2177-4-15**]
{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: 59 yo M with exertional chest pain and dyspnea with abnormal
stress test, referred for cardiac catheterization which showed
TO LAD. He was referred for surgery.

MEDICAL HISTORY: Coronary artery disease
Hypertension
Elevated lipids
ORIF/foot
Eye surgery

MEDICATION ON ADMISSION: asa 81', lopressor 25', lipitor', chantix 0.5''

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 72 RR 12 BP 160/78
NAD
Lungs CTAB
Heart RRR
Abdomen benign
Extrem warm, no edema

FAMILY HISTORY: Mother with [**Name (NI) 77601**] older age

SOCIAL HISTORY: recently layed off from construction job
quit tobacco late [**2177-2-15**], 2 ppd x 40 years
denies etoh 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute on chronic systolic heart failure,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
