CHIEF COMPLAINT: Right neck and mid scapula pain

PRESENT ILLNESS: 79 yo F with known CAD now with recurrent symptoms and abnormal
stress test, referred for cath which showed 3VD. Referred for
CABG.

MEDICAL HISTORY: Hyperlipidemia, GERD, arthritis, Osteoporosis, CAD s/p IMI,
Urethral stricture > tx w/ dilation q6month, Hysterectomy,
Chronic yeast infection, Psoriasis

MEDICATION ON ADMISSION: Plavix 75', Lisinopril 5', Toprol XL 50', Crestor 10', ASA
325', Zantac 150', Isosorbide 30', Actonel 35 qwk, Diflucan qwk,
Taclonex ointment to feet, Lotrisone vaginal cream

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD 65 18 124/41
CV RRR distant S1S2
Lungs CTAB ant/lat
Abdomen benign
Extrem warm, trace BLE edema
Extensive BLE varicose veins

FAMILY HISTORY: Family history: No CAD history

SOCIAL HISTORY: Lives alone, son and his family live nearby, non-smoker, no EtOH
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other and unspecified hyperlipidemia,Esophageal reflux,Osteoporosis, unspecified,Arthropathy, unspecified, site unspecified,Old myocardial infarction,Other psoriasis,Other specified causes of urethral stricture,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Osteoporosis NOS,Arthropathy NOS-unspec,Old myocardial infarct,Other psoriasis,Urethral stricture NEC,Status-post ptca
Admission Date:  [**2197-12-26**]              Discharge Date:   [**2198-1-5**]

Date of Birth:  [**2118-5-3**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Right neck and mid scapula pain

Major Surgical or Invasive Procedure:
[**1-1**] CABG x4 (LIMA>LAD, SVG>OM, SVG>Diag, SVG>PDA)


History of Present Illness:
79 yo F with known CAD now with recurrent symptoms and abnormal
stress test, referred for cath which showed 3VD. Referred for
CABG.

Past Medical History:
Hyperlipidemia, GERD, arthritis, Osteoporosis, CAD s/p IMI,
Urethral stricture > tx w/ dilation q6month, Hysterectomy,
Chronic yeast infection, Psoriasis

Social History:
Lives alone, son and his family live nearby, non-smoker, no EtOH


Family History:
Family history: No CAD history


Physical Exam:
NAD 65 18 124/41
CV RRR distant S1S2
Lungs CTAB ant/lat
Abdomen benign
Extrem warm, trace BLE edema
Extensive BLE varicose veins


Pertinent Results:

[**2198-1-4**] 08:00AM BLOOD WBC-9.1 RBC-3.22* Hgb-10.1* Hct-29.3*
MCV-91 MCH-31.5 MCHC-34.6 RDW-14.4 Plt Ct-106*
[**2198-1-4**] 08:00AM BLOOD Plt Ct-106*
[**2198-1-4**] 08:00AM BLOOD Glucose-87 UreaN-27* Creat-1.0 Na-136
K-4.4 Cl-102 HCO3-24 AnGap-14

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 68868**] (Complete)
Done [**2198-1-1**] at 10:57:40 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2118-5-3**]
Age (years): 79 F  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Coronary artery disease. Left ventricular function.
Preoperative assessment.
ICD-9 Codes: 440.0
Test Information
Date/Time: [**2198-1-1**] at 10:57    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 168**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 168**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2007AW5-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Diastolic Dimension:  4.0 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  >= 55%  >= 55%
Aorta - Annulus:  1.7 cm  <= 3.0 cm
Aorta - Sinus Level:  2.9 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  1.9 cm  <= 3.0 cm
Aorta - Ascending:  2.8 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD by 2D or
color Doppler.

LEFT VENTRICLE: Normal LV wall thickness and cavity size.
Overall normal LVEF (>55%).

LV WALL MOTION: Regional left ventricular wall motion findings
as shown below; remaining LV segments contract normally.

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

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular calcification. Trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

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. No TEE related complications.
Conclusions
PRE BYPASS
No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thicknesses and cavity size are normal. Overall
left ventricular systolic function is normal (LVEF>55%).Right
ventricular chamber size and free wall motion are normal. There
are complex (>4mm) atheroma in the descending thoracic aorta. An
epiaortic scan was performed. Focal calcifications in the
ascending aorta are visualized but not at the canullation or
cross clamp sight. The aortic valve leaflets (3) are mildly
thickened. Trace aortic regurgitation is seen. The mitral valve
leaflets are mildly thickened. Trivial mitral regurgitation is
seen.

POST BYPASS
Biventricular systolic function remains preserved. Study is
unchanged from prebypass.


Brief Hospital Course:
She underwent preoperaive workup and on [**1-1**] was taken to the
operatin room where she underwent a CABG x 4. She was
transferred to the ICU in critical but stable condition. She was
extubated later that same day. She was transferred to the floor
on POD #1. Her chest tubes and epicardial wires were removed,
she was started on lopressor & lasix.  She has remained
hemodynamically stable, but slow to progress from an ambulation
standpoint.  For this reason, she is being transferred to rehab
to progress with physical therapy, mobility and independence.

Medications on Admission:
 Plavix 75', Lisinopril 5', Toprol XL 50', Crestor 10', ASA
325', Zantac 150', Isosorbide 30', Actonel 35 qwk, Diflucan qwk,
Taclonex ointment to feet, Lotrisone vaginal cream

Discharge Medications:
1. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO once a
day.
3. Clotrimazole 1 % Cream Sig: One (1) Appl Topical QHS (once a
day (at bedtime)).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
7. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days: then re-evaluate need for continued diuresis.
8. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 7 days: while on lasix.
9. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.


Discharge Disposition:
Extended Care

Facility:
Hellenic - [**Location (un) 2624**]

Discharge Diagnosis:
CAD now s/p CABG
Hyperlipidemia, GERD, arthritis, Osteoporosis, CAD s/p IMI,
Urethral stricture > tx w/ dilation q6month, Hysterectomy,
Chronic yeast infection, Psoriasis


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 lifting more than 10 pounds or driving until follow up with
surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) 4469**] 2 weeks
Dr. [**Last Name (STitle) **] 4 weeks



Completed by:[**2198-1-5**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other and unspecified hyperlipidemia,Esophageal reflux,Osteoporosis, unspecified,Arthropathy, unspecified, site unspecified,Old myocardial infarction,Other psoriasis,Other specified causes of urethral stricture,Percutaneous transluminal coronary angioplasty status'}


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: Right neck and mid scapula pain

PRESENT ILLNESS: 79 yo F with known CAD now with recurrent symptoms and abnormal
stress test, referred for cath which showed 3VD. Referred for
CABG.

MEDICAL HISTORY: Hyperlipidemia, GERD, arthritis, Osteoporosis, CAD s/p IMI,
Urethral stricture > tx w/ dilation q6month, Hysterectomy,
Chronic yeast infection, Psoriasis

MEDICATION ON ADMISSION: Plavix 75', Lisinopril 5', Toprol XL 50', Crestor 10', ASA
325', Zantac 150', Isosorbide 30', Actonel 35 qwk, Diflucan qwk,
Taclonex ointment to feet, Lotrisone vaginal cream

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: NAD 65 18 124/41
CV RRR distant S1S2
Lungs CTAB ant/lat
Abdomen benign
Extrem warm, trace BLE edema
Extensive BLE varicose veins

FAMILY HISTORY: Family history: No CAD history

SOCIAL HISTORY: Lives alone, son and his family live nearby, non-smoker, no EtOH 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other and unspecified hyperlipidemia,Esophageal reflux,Osteoporosis, unspecified,Arthropathy, unspecified, site unspecified,Old myocardial infarction,Other psoriasis,Other specified causes of urethral stricture,Percutaneous transluminal coronary angioplasty status'}
