CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 64 year old presented to his cardiologist with 2 weeks of
increasing anginal symptoms at rest. He also reports having 2
prior negative stress tests a few years ago. His recent anginal
episode have occured at rest with chest pressure, jaw pain, and
sweats lasting up to 30 minutes. He denies any recent DOE,
lightheadedness, lower extremity edema, orthopnea, PND, or
claudication symptoms. He was seen by Dr. [**Last Name (STitle) 1911**] on
[**2132-1-17**] who has recommended immediate catheterization.

MEDICAL HISTORY: Dyslipidemia
Hypertension
Prior Cholecystectomy
Left Inguinal Hernia, not repaired

MEDICATION ON ADMISSION: Crestor 5mg daily in the evening
Toprol xl 100mg daily in the am
Imdur 30mg daily (new med, only taken once
Aspirin 325mg daily (new, only took x3)
Ntg prn (not taking)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.1 118/60 55 16 98% on RA
GEN: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
No JVD. No carotid bruit.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
PULM: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABD: BS+, soft, NTND. No HSM or tenderness.
LIMBS: No c/c/e. No femoral bruits. No stasis dermatitis,
ulcers, scars, or xanthomas. Cath site in R groin with no
bleeding, hematoma, pain, or bruit.
Pulses:
Right: Radial 2+ carotid 2+ DP 2+ PT 2+
Left: Radial 2+ carotid 2+ DP 2+ PT 2+

FAMILY HISTORY: No coronary artery disease, no heart failure or arrhythmias. His
mother had breast cancer and his father died of a brain tumor

SOCIAL HISTORY: He lives in [**Location 745**] for the last year and half, previously lived
in [**Location (un) 5622**] and spent some time in [**Country 19828**]. He is retired
physician (pathologist by training), who was working for
AstraZeneca as the head of Hypertension and Heart Failure
Research. He denies smoking history. He has rare alcohol.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other iatrogenic hypotension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)
Crnry athrscl natve vssl,Intermed coronary synd,Iatrogenc hypotnsion NEC,Abn react-anastom/graft,Anemia NOS,Cardiac dysrhythmias NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Unilat inguinal hernia
Admission Date:  [**2132-1-18**]              Discharge Date:   [**2132-1-28**]

Date of Birth:  [**2067-3-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
s/p Coronary Artery Bypass Graft Surgery (Left internal mammary
artery>left anterior descending, Saphenous vein graft>RAMUS,
saphenous vein graft>obtuse marginal, saphenous vein
graft>distal right coronary artery) [**2132-1-22**]
Cardiac catherization [**2132-1-18**]


History of Present Illness:
64 year old presented to his cardiologist with 2 weeks of
increasing anginal symptoms at rest. He also reports having 2
prior negative stress tests a few years ago. His recent anginal
episode have occured at rest with chest pressure, jaw pain, and
sweats lasting up to 30 minutes. He denies any recent DOE,
lightheadedness, lower extremity edema, orthopnea, PND, or
claudication symptoms. He was seen by Dr. [**Last Name (STitle) 1911**] on
[**2132-1-17**] who has recommended immediate catheterization.


Past Medical History:
Dyslipidemia
Hypertension
Prior Cholecystectomy
Left Inguinal Hernia, not repaired


Social History:
He lives in [**Location 745**] for the last year and half, previously lived
in [**Location (un) 5622**] and spent some time in [**Country 19828**]. He is retired
physician (pathologist by training), who was working for
AstraZeneca as the head of Hypertension and Heart Failure
Research. He denies smoking history. He has rare alcohol.

Family History:
No coronary artery disease, no heart failure or arrhythmias. His
mother had breast cancer and his father died of a brain tumor

Physical Exam:
VS: 97.1 118/60 55 16 98% on RA
GEN: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
No JVD. No carotid bruit.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
PULM: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABD: BS+, soft, NTND. No HSM or tenderness.
LIMBS: No c/c/e. No femoral bruits. No stasis dermatitis,
ulcers, scars, or xanthomas. Cath site in R groin with no
bleeding, hematoma, pain, or bruit.
Pulses:
Right: Radial 2+ carotid 2+ DP 2+ PT 2+
Left: Radial 2+ carotid 2+ DP 2+ PT 2+


Pertinent Results:
[**2132-1-28**] 07:00AM BLOOD WBC-10.0 RBC-2.94* Hgb-9.0* Hct-25.3*#
MCV-86 MCH-30.54 MCHC-35.4* RDW-15.5 Plt Ct-292
[**2132-1-27**] 06:25AM BLOOD Hct-20.2*
[**2132-1-18**] 10:15AM BLOOD WBC-9.4 RBC-4.75 Hgb-14.5 Hct-40.6 MCV-85
MCH-30.6 MCHC-35.8* RDW-13.3 Plt Ct-186
[**2132-1-22**] 11:51AM BLOOD Neuts-78.3* Lymphs-19.0 Monos-1.8*
Eos-0.8 Baso-0.1
[**2132-1-28**] 07:00AM BLOOD Plt Ct-292
[**2132-1-23**] 02:03AM BLOOD PT-14.5* PTT-39.5* INR(PT)-1.3*
[**2132-1-18**] 10:15AM BLOOD Plt Ct-186
[**2132-1-18**] 10:15AM BLOOD PT-13.8* PTT-27.5 INR(PT)-1.2*
[**2132-1-23**] 02:03AM BLOOD Fibrino-243
[**2132-1-28**] 07:00AM BLOOD Glucose-104 UreaN-21* Creat-1.1 Na-140
K-4.2 Cl-101 HCO3-32 AnGap-11
[**2132-1-18**] 10:15AM BLOOD Glucose-91 UreaN-16 Creat-1.2 Na-142
K-4.2 Cl-106 HCO3-22 AnGap-18
[**2132-1-22**] 07:25PM BLOOD ALT-55* AST-83* AlkPhos-55 Amylase-46
TotBili-1.7*
[**2132-1-18**] 12:20PM BLOOD ALT-28 AST-26 CK(CPK)-65 AlkPhos-64
Amylase-75 TotBili-1.2
[**2132-1-22**] 07:25PM BLOOD Lipase-24
[**2132-1-21**] 06:40AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2132-1-26**] 08:25AM BLOOD Mg-2.2
[**2132-1-18**] 12:20PM BLOOD VitB12-503
[**2132-1-18**] 12:20PM BLOOD %HbA1c-5.5
[**2132-1-19**] 06:00AM BLOOD Triglyc-71 HDL-37 CHOL/HD-3.6 LDLcalc-83

[**Known lastname 104725**],[**Known firstname **] [**Medical Record Number 104726**] M  64  [**2067-3-5**]

Radiology Report CHEST (PA & LAT) Study Date of [**2132-1-27**] 10:43
AM


[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2132-1-27**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 104727**]
Reason: evaluate pneumothorax



[**Hospital 93**] MEDICAL CONDITION:
   64 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
   evaluate pneumothorax



Final Report
PA AND LATERAL CHEST ON [**1-27**]

HISTORY: Status post CABG. Evaluate pneumothorax.

IMPRESSION: PA and lateral chest compared to [**1-24**] through
24:

Moderate size left hydropneumothorax has changed in distribution
but not in
overall size since [**1-24**], following removal of left pleural
drains.
Postoperative enlargement of the cardiomediastinal silhouette is
stable since
[**1-23**], suggesting persistence of some mediastinal fluid.
Right lung is
grossly clear, small right pleural effusion is stable.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 3891**]
Approved: [**First Name8 (NamePattern2) **] [**2132-1-27**] 4:46 PM

[**Known lastname 104725**],[**Known firstname **] [**Medical Record Number 104726**] M  64  [**2067-3-5**]

Cardiology Report ECG Study Date of [**2132-1-22**]  1:01:00 PM


Sinus rhythm. Low amplitude T waves. Compared to the previous
tracing
of [**2132-1-18**] there is a generalized diminution of voltage. The T
waves are
less prominent. The rate has increased. Otherwise, no diagnostic
interim
change.


Read by: [**Last Name (LF) 578**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 579**]

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
76 122 86 [**Telephone/Fax (2) 104728**] 28

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 104725**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 104729**]
(Complete) Done [**2132-1-22**] at 10:43:43 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2067-3-5**]
Age (years): 64 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Coronary artery disease, for intraoperative
management
ICD-9 Codes: 440.0, 424.1, 424.0
Test Information
Date/Time: [**2132-1-22**] at 10:43    Interpret MD: [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**],
MD
Test Type: TEE (Complete) 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 #: 2009AW2-: Machine: 2
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  0.8 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *4.9 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  3.8 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Annulus:  2.0 cm  <= 3.0 cm
Aorta - Sinus Level:  3.4 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  2.5 cm  <= 3.0 cm
Aorta - Ascending:  2.7 cm  <= 3.4 cm
Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  1.6 m/sec  <= 2.0 m/sec

Findings
LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

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

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

AORTA: Simple atheroma in descending aorta.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Trace AR.
AR vena contracta is <0.3cm.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.

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. No TEE related complications. Results were

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PREBYPASS
1. The left atrium is normal in size.

2. Left ventricular wall thicknesses and cavity size are normal.
Overall left ventricular systolic function is normal (LVEF>55%)
with hypokinesis of the anterior and lateral apical segments.

3. Right ventricular chamber size and free wall motion are
normal.

4. There are simple atheroma in the descending thoracic aorta.

5. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion. Trace aortic regurgitation is seen with
jets seen at the base of the non coronary/right commisure and
right/left coronary commisures..

6.The mitral valve appears structurally normal with trivial
mitral regurgitation.

POST CPB:

1. Preserved [**Hospital1 **]-ventricular systolci function

2. No change in valve structure and function
POST CPB:

Preserved [**Hospital1 **]-ventrucular systolic function.

No change in valve structure and function

7. There is no pericardial effusion. Dr. [**Last Name (STitle) 914**] was notified in
person of the results during the surgery.

POSTBYPASS
1. Patient is on phenylephrine infusion

2. Left ventricular ejection fraction remains similar at 55-60%.

3. Trace MR [**First Name (Titles) **] [**Last Name (Titles) **] are still seen

4. Aortic contours are smooth after decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) 6506**] [**Name8 (MD) 6507**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2132-1-25**] 07:13





Brief Hospital Course:
Admitted for cardiac catherization that revealed coronary artery
disease.  He was admitted and underwent preoperative workup.  He
was cleared for surgery and went to the operating [**2132-1-23**]
for coronary artery bypass graft surgery.  See operative report
for further details.  He received vancomycin for perioperative
antibiotics because in was in the hospital preoperatively.  He
was transfered to the intensive care unit for hemodynamic
monitoring.  He received fluids, packed red blood cells and
started on pressors and inotropes for hemodynamic instability.
He improved and was weaned from inotropes, sedation, and
pressors.  He awoke neurologically intact on post operative day
one and was extubated without complications.  He was transfered
to the floor for the remainder of his care.  Physical therapy
worked with him on strength and mobility.  On post operative day
five his hematocrit was 20 down from 22, chest radiology with no
evidence of mediastinal widening.  He was transfused with packed
red blood cells with hematocrit increased to 25.  His beta
blockers were titrated for heart rate control and he was ready
for discharge home with services post operative day six. He has
follow up wound check appointment to evaluate sternum but also
left leg which is ecchymotic but no erythema or warmth.

Medications on Admission:
Crestor 5mg daily in the evening
Toprol xl 100mg daily in the am
Imdur 30mg daily (new med, only taken once
Aspirin 325mg daily (new, only took x3)
Ntg prn (not taking)


Discharge Medications:
1. 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*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
8. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO twice
a day.
Disp:*60 Tablet(s)* Refills:*0*
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
10. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
11. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
One (1) Capsule, Sustained Release PO once a day for 10 days.
Disp:*10 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Coronary Artery Disease - s/p CABG
Hypertension
Dyslipidemia
Hernia


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
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Please call to schedule all appointments
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**Last Name (STitle) 1911**] in 2 weeks
Dr. [**Last Name (STitle) 2472**] in 1 week
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2132-1-28**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other iatrogenic hypotension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)'}


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: 64 year old presented to his cardiologist with 2 weeks of
increasing anginal symptoms at rest. He also reports having 2
prior negative stress tests a few years ago. His recent anginal
episode have occured at rest with chest pressure, jaw pain, and
sweats lasting up to 30 minutes. He denies any recent DOE,
lightheadedness, lower extremity edema, orthopnea, PND, or
claudication symptoms. He was seen by Dr. [**Last Name (STitle) 1911**] on
[**2132-1-17**] who has recommended immediate catheterization.

MEDICAL HISTORY: Dyslipidemia
Hypertension
Prior Cholecystectomy
Left Inguinal Hernia, not repaired

MEDICATION ON ADMISSION: Crestor 5mg daily in the evening
Toprol xl 100mg daily in the am
Imdur 30mg daily (new med, only taken once
Aspirin 325mg daily (new, only took x3)
Ntg prn (not taking)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.1 118/60 55 16 98% on RA
GEN: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
No JVD. No carotid bruit.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
PULM: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABD: BS+, soft, NTND. No HSM or tenderness.
LIMBS: No c/c/e. No femoral bruits. No stasis dermatitis,
ulcers, scars, or xanthomas. Cath site in R groin with no
bleeding, hematoma, pain, or bruit.
Pulses:
Right: Radial 2+ carotid 2+ DP 2+ PT 2+
Left: Radial 2+ carotid 2+ DP 2+ PT 2+

FAMILY HISTORY: No coronary artery disease, no heart failure or arrhythmias. His
mother had breast cancer and his father died of a brain tumor

SOCIAL HISTORY: He lives in [**Location 745**] for the last year and half, previously lived
in [**Location (un) 5622**] and spent some time in [**Country 19828**]. He is retired
physician (pathologist by training), who was working for
AstraZeneca as the head of Hypertension and Heart Failure
Research. He denies smoking history. He has rare alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other iatrogenic hypotension,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Anemia, unspecified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)'}
