harishnair04/mtsamples huggingface dataset:
Angiogram & StarClose Closure 
Medical specialty:  Cardiovascular / Pulmonary
 Left heart cath, selective coronary angiogram, right common femoral angiogram, and StarClose closure of right common femoral artery.

EXAM: , Left heart cath, selective coronary angiogram, right common femoral angiogram, and StarClose closure of right common femoral artery.,REASON FOR EXAM: , Abnormal stress test and episode of shortness of breath.,PROCEDURE: , Right common femoral artery, 6-French sheath, JL4, JR4, and pigtail catheters were used.,FINDINGS:,1.  Left main is a large-caliber vessel.  It is angiographically free of disease,,2.  LAD is a large-caliber vessel.  It gives rise to two diagonals and septal perforator.  It erupts around the apex.  LAD shows an area of 60% to 70% stenosis probably in its mid portion.  The lesion is a type A finishing before the takeoff of diagonal 1.  The rest of the vessel is angiographically free of disease.,3.  Diagonal 1 and diagonal 2 are angiographically free of disease.,4.  Left circumflex is a small-to-moderate caliber vessel, gives rise to 1 OM.  It is angiographically free of disease.,5.  OM-1 is angiographically free of disease.,6.  RCA is a large, dominant vessel, gives rise to conus, RV marginal, PDA and one PL.  RCA has a tortuous course and it has a 30% to 40% stenosis in its proximal portion.,7.  LVEDP is measured 40 mmHg.,8.  No gradient between LV and aorta is noted.,Due to contrast concern due to renal function, no LV gram was performed.,Following this, right common femoral angiogram was performed followed by StarClose closure of the right common femoral artery.,IMPRESSION:,1.  60% to 70% mid left anterior descending stenosis.,2.  Mild 30% to 40% stenosis of the proximal right coronary artery.,3.  Status post StarClose closure of the right common femoral artery.,PLAN:  ,Plan will be to perform elective PCI of the mid LAD.
Angina 
Medical specialty:  Cardiovascular / Pulmonary
 A sample note on Angina.

ANGINA, is chest pain due to a lack of oxygen to the heart most often occurring in men age 35 or older and postmenopausal women.  It is usually located right under the breast bone.  Physical and emotional stress, as well as eating heavy meals, can bring it on.  In a healthy person, these stresses are easily handled.  In a person with an underlying heart condition like coronary artery disease, heart valve problem, arrhythmias or high blood pressure, the heart doesn't get enough blood (i.e. not enough oxygen to the heart muscles).  Other causes could be due to a hyperactive thyroid disorder or anemia.  People more likely to have angina may also have diabetes mellitus, be overweight, smoke, have a poor diet with lots of salt and fat, fail to exercise, have a stressful workload or have a family history of coronary artery disease.,SIGNS AND SYMPTOMS:,*  Pain in chest described as tightness, heavy pressure, aching or squeezing.,*  The pain sometimes radiates to the jaw, left arm, teeth and/or outer ear.,*  Possibly a left-sided numbness, tingling, or pain in the arm, shoulder, elbow or chest.,*  Occasionally a sudden difficulty in breathing occurs.,*  Pain may be located between the shoulder blades.,TREATMENT:,*  Nitroglycerin relieves the immediate symptoms of angina in seconds.  Carry it with you at all times.,*  Other medications may be prescribed for the underlying heart problems.  It is important to take them as prescribed by your doctor.,*  Surgery may be necessary to open the blocked coronary arteries (balloon angioplasty) or to bypass them.,*  Correct the contributing factors you have control over.  Lose weight, don't smoke, eat a low-salt, low-fat diet and avoid physical and emotional stresses that cause angina.  Such stressors include anger, overworking, going between extremes in hot and cold, sudden physical exertion and high altitudes (pressurized airplanes aren't a risk).  Practice relaxation techniques.,*  Exercise! Discuss first what you are able to do with your doctor and then go do it.,*  Even with treatment, angina may result in a heart attack, congestive heart failure or a fatal abnormal heartbeat.  Treatment decreases the odds that these will occur.,*  Let your doctor know if your angina doesn't go away after 10 minutes, even when you have taken a nitroglycerin tablet.  Call if you have repeated chest pains that awaken you from sleep regardless if the nitroglycerin helps.  If your pain changes or feels different, call your doctor or call 911 if the pain is severe.
Adenosine Nuclear Scan 
Medical specialty:  Cardiovascular / Pulmonary
 Adenosine with nuclear scan as the patient unable to walk on a treadmill.  Nondiagnostic adenosine stress test.  Normal nuclear myocardial perfusion scan.

INDICATION: , Chest pain.,TYPE OF TEST: , Adenosine with nuclear scan as the patient unable to walk on a treadmill.,INTERPRETATION:, Resting heart rate of 67, blood pressure of 129/86.  EKG, normal sinus rhythm.  Post-Lexiscan 0.4 mg, heart rate was 83, blood pressure 142/74.  EKG remained the same.  No symptoms were noted.,SUMMARY:,1.  Nondiagnostic adenosine stress test.,2.  Nuclear interpretation as below.,NUCLEAR INTERPRETATION:,  Resting and stress images were obtained with 10.4, 33.1 mCi of tetrofosmin injected intravenously by standard protocol.  Nuclear myocardial perfusion scan demonstrates homogeneous and uniform distribution of the tracer uptake without any evidence of reversible or fixed defect.  Gated SPECT revealed normal wall motion, ejection fraction of 58%.  End-diastolic volume of 74, end-systolic volume of 31.,IMPRESSION:,1.  Normal nuclear myocardial perfusion scan.,2.  Ejection fraction 58% by gated SPECT.
Acute Inferior Myocardial Infarction 
Medical specialty:  Cardiovascular / Pulmonary
 Patient presents with a chief complaint of chest pain admitted to Coronary Care Unit due to acute inferior myocardial infarction.

CHIEF COMPLAINT: , Chest pain.,HISTORY OF PRESENT ILLNESS:,  The patient is a 40-year-old white male who presents with a chief complaint of "chest pain".,The patient is diabetic and has a prior history of coronary artery disease.  The patient presents today stating that his chest pain started yesterday evening and has been somewhat intermittent.  The severity of the pain has progressively increased.  He describes the pain as a sharp and heavy pain which radiates to his neck & left arm.  He ranks the pain a 7 on a scale of 1-10.  He admits some shortness of breath & diaphoresis.  He states that he has had nausea & 3 episodes of vomiting tonight.  He denies any fever or chills.  He admits prior episodes of similar pain prior to his PTCA in 1995.  He states the pain is somewhat worse with walking and seems to be relieved with rest.  There is no change in pain with positioning.  He states that he took 3 nitroglycerin tablets sublingually over the past 1 hour, which he states has partially relieved his pain.  The patient ranks his present pain a 4 on a scale of 1-10.  The most recent episode of pain has lasted one-hour.,The patient denies any history of recent surgery, head trauma, recent stroke, abnormal bleeding such as blood in urine or stool or nosebleed.,REVIEW OF SYSTEMS:,  All other systems reviewed & are negative.,PAST MEDICAL HISTORY:,  Diabetes mellitus type II, hypertension, coronary artery disease, atrial fibrillation, status post PTCA in 1995 by Dr. ABC.,SOCIAL HISTORY: , Denies alcohol or drugs.  Smokes 2 packs of cigarettes per day.  Works as a banker.,FAMILY HISTORY: , Positive for coronary artery disease (father & brother).,MEDICATIONS: , Aspirin 81 milligrams QDay.  Humulin N. insulin 50 units in a.m.  HCTZ 50 mg QDay.  Nitroglycerin 1/150 sublingually PRN chest pain.,ALLERGIES: , Penicillin.,PHYSICAL EXAM: , The patient is a 40-year-old white male.,General:  The patient is moderately obese but he is otherwise well developed & well nourished.  He appears in moderate discomfort but there is no evidence of distress.  He is alert, and oriented to person place and circumstance.  There is no evidence of respiratory distress.  The patient ambulates
Abnormal Stress Test 
Medical specialty:  Cardiovascular / Pulmonary
 Patient had a markedly abnormal stress test with severe chest pain after 5 minutes of exercise on the standard Bruce with horizontal ST depressions and moderate apical ischemia on stress imaging only.

HISTORY OF PRESENT ILLNESS: , Mr. ABC is a 60-year-old gentleman who had a markedly abnormal stress test earlier today in my office with severe chest pain after 5 minutes of exercise on the standard Bruce with horizontal ST depressions and moderate apical ischemia on stress imaging only.  He required 3 sublingual nitroglycerin in total (please see also admission history and physical for full details).,The patient underwent cardiac catheterization with myself today which showed mild-to-moderate left main distal disease of 30%, moderate proximal LAD with a severe mid-LAD lesion of 99%, and a mid-left circumflex lesion of 80% with normal LV function and some mild luminal irregularities in the right coronary artery with some moderate stenosis seen in the mid to distal right PDA.,I discussed these results with the patient, and he had been relating to me that he was having rest anginal symptoms, as well as nocturnal anginal symptoms, and especially given the severity of the mid left anterior descending lesion, with a markedly abnormal stress test, I felt he was best suited for transfer for PCI.  I discussed the case with Dr. X at Medical Center who has kindly accepted the patient in transfer.,CONDITION ON TRANSFER: , Stable but guarded.  The patient is pain-free at this time.,MEDICATIONS ON TRANSFER:,1.  Aspirin 325 mg once a day.,2.  Metoprolol 50 mg once a day, but we have had to hold it because of relative bradycardia which he apparently has a history of.,3.  Nexium 40 mg once a day.,4.  Zocor 40 mg once a day, and there is a fasting lipid profile pending at the time of this dictation.  I see that his LDL was 136 on May 3, 2002.,5.  Plavix 600 mg p.o. x1 which I am giving him tonight.,Other medical history is inclusive for obstructive sleep apnea for which he is unable to tolerate positive pressure ventilation, GERD, arthritis,DISPOSITION:  ,The patient and his wife have requested and are agreeable with transfer to Medical Center, and we are enclosing the CD ROM of his images.
Gastric Bypass - Preop Eval 
Medical specialty:  Bariatrics
 Preop evaluation regarding gastric bypass surgery.

REASON FOR VISIT:,  Preop evaluation regarding gastric bypass surgery.,The patient has gone through the evaluation process and has been cleared from psychological, nutritional, and cardiac standpoint, also had great success on the preop Medifast diet.,PHYSICAL EXAMINATION: , The patient is alert and oriented x3.  Temperature of 97.9, pulse of 76, blood pressure of 114/74, weight of 247.4 pounds.  Abdomen:  Soft, nontender, and nondistended.,ASSESSMENT AND PLAN:,  The patient is currently in stable condition with morbid obesity, scheduled for gastric bypass surgery in less than two weeks.  Risks and benefits of the procedure were reiterated with the patient and significant other and mother, which included but not limited to death, pulmonary embolism, anastomotic leak, reoperation, prolonged hospitalization, stricture, small bowel obstruction, bleeding, and infection.  Questions regarding hospital course and recovery were addressed.  We will continue on the Medifast diet until the time of surgery and cleared for surgery.
Gastric Bypass Discussion - 2 
Medical specialty:  Bariatrics
 Patient scheduled for laparoscopic gastric bypass. 

HISTORY: , The patient is scheduled for laparoscopic gastric bypass.  The patient has been earlier seen by Dr. X, her physician.  She has been referred to us from Family Practice.  In short, she is a 33-year-old lady with a BMI of 43, otherwise healthy with unsuccessful nonsurgical methods of weight loss. ,She was on laparoscopic gastric bypass for weight loss. ,She meets the National Institute of Health Criteria.  She is very well educated and motivated and has no major medical contraindications for the procedure.,PHYSICAL EXAMINATION:,  On physical examination today, she weighs 216 pounds with a BMI of 43.5, pulse is 96, temperature is 97.6, blood pressure is 122/80.  Lungs are clear.  Abdomen is soft, nontender.  There is stigmata for morbid obesity.  She has cesarean section scars in the lower abdomen with no herniation. ,DISCUSSION: , I had a long talk with the patient about laparoscopic gastric bypass, possible open including risks, benefits, alternatives, need for long-term followup, need to adhere to dietary and exercise guidelines.  I also explained to her complications including rare cases of death secondary to DVT, PE, leak , peritonitis, sepsis, shock, multisystem organ failure, need for re-operation including for leak or bleeding, gastrostomy or jejunostomy for feeding, rare case of respiratory failure requiring mechanical ventilation, etc., with myocardial infarction, pneumonia, atelectasis in the postoperative period were also discussed. ,Short-term complications of gastric bypass including gastrojejunal stricture requiring endoscopic dilatation, marginal ulcer secondary to smoking or anti-inflammatory drug intake which can progress on to perforation or bleeding, small bowel obstruction secondary to internal hernia or adhesions, signs and symptoms of which were discussed.  The patient would alert us for earlier intervention.  Symptomatic gallstone formation secondary to rapid weight loss were also discussed.  How to avoid it by taking ursodiol were also discussed.  Long-term complications of gastric bypass including hair loss, excess skin, multivitamin and mineral deficiencies, protein-calorie malnutrition, weight regain, weight plateauing, need for major lifestyle and exercise and habit changes, avoiding pregnancy in the first two years, etc., were all stressed.  The patient understands.  She wants to go to surgery. ,In preparation of surgery, she will undergo very low-calorie diet through Medifast to decrease the size of the liver to make laparoscopic approach more successful and also to optimize her cardiopulmonary and metabolic comorbidities.  She will also see a psychologist, nutritionist, and exercise physiologist for a multidisciplinary effort for short and long-term success for weight loss surgery.  I will see her two weeks before the plan of surgery for further discussion and any other questions at that point of time.
Bariatric Consult - Surgical Weight Loss - 1 
Medical specialty:  Bariatrics
 Evaluation for elective surgical weight loss via the gastric bypass as opposed to Lap-Band.

PAST MEDICAL HISTORY: , She has a history of hypertension and shortness of breath.,PAST SURGICAL HISTORY: , Pertinent for cholecystectomy.,PSYCHOLOGICAL HISTORY: , Negative.,SOCIAL HISTORY: , She is single.  She drinks alcohol once a week.  She does not smoke.,FAMILY HISTORY: , Pertinent for obesity and hypertension.,MEDICATIONS: , Include Topamax 100 mg twice daily, Zoloft 100 mg twice daily, Abilify 5 mg daily, Motrin 800 mg daily, and a multivitamin.,ALLERGIES: , She has no known drug allergies.,REVIEW OF SYSTEMS: , Negative.,PHYSICAL EXAM:  ,This is a pleasant female in no acute distress.  Alert and oriented x 3.  HEENT:  Normocephalic, atraumatic.  Extraocular muscles intact, nonicteric sclerae.  Chest is clear to auscultation bilaterally.  Cardiovascular is normal sinus rhythm.  Abdomen is obese, soft, nontender and nondistended.  Extremities show no edema, clubbing or cyanosis.,ASSESSMENT/PLAN:  ,This is a 34-year-old female with a BMI of 43 who is interested in surgical weight via the gastric bypass as opposed to Lap-Band.  ABC will be asking for a letter of medical necessity from Dr. XYZ.  She will also see my nutritionist and social worker and have an upper endoscopy.  Once this is completed, we will submit her to her insurance company for approval.
Bariatric Consult - Surgical Weight Loss - 3 
Medical specialty:  Bariatrics
 Evaluation for bariatric surgery.

PAST MEDICAL HISTORY: , Her medical conditions driving her toward surgery include hypercholesterolemia, hypertension, varicose veins, prior history of stroke.  She denies any history of cancer.  She does have a history of hepatitis which I will need to further investigate.  She complains of multiple joint pains, and heavy snoring.,PAST SURGICAL HISTORY: , Includes hysterectomy in 1995 for fibroids and varicose vein removal.  She had one ovary removed at the time of the hysterectomy as well.,SOCIAL HISTORY:,  She is a single mother of one adopted child.,FAMILY HISTORY:  ,There is a strong family history of heart disease and hypertension, as well as diabetes on both sides of her family.  Her mother is alive.  Her father is deceased from alcohol.  She has five siblings.,MEDICATIONS: , As you know she takes the following medications for her diabetes, insulin 70 units/6 units times four years, aspirin 81 mg a day, Actos 15 mg, Crestor 10 mg and CellCept 500 mg two times a day.,ALLERGIES: , She has no known drug allergies.,PHYSICAL EXAM: , She is a 54-year-old obese female.  She does not appear to have any significant residual deficits from her stroke.  There may be slight left arm weakness.,ASSESSMENT/PLAN:,  We will have her undergo routine nutritional and psychosocial assessment.  I suspect that we can significantly improve the situation with her insulin and oral hypoglycemia, as well as hypertension, with significant weight loss.  She is otherwise at increased risk for future complications given her history, and weight loss will be a good option.  We will see her back in the office once she completes her preliminary workup and submit her for approval to the insurance company.
Autopsy - 5 
Medical specialty:  Autopsy
 Autopsy - Homicide - evidence of exsanguination - multiple stab wounds.

MANNER OF DEATH: , Homicide.,CAUSE OF DEATH:,
Discharge Summary - Gastric Bypass 
Medical specialty:  Bariatrics
 Patient suffered from morbid obesity for many years and made multiple attempts at nonsurgical weight loss without success. 

ADMISSION DIAGNOSIS:,  Morbid obesity.  BMI is 51.,DISCHARGE DIAGNOSIS: , Morbid obesity.  BMI is 51.,PROCEDURE: , Laparoscopic gastric bypass.,SERVICE: , Surgery.,CONSULT: , Anesthesia and pain.,HISTORY OF PRESENT ILLNESS: , Ms. A is a 27-year-old woman, who suffered from morbid obesity for many years.  She has made multiple attempts at nonsurgical weight loss without success.  She underwent a preoperative workup and clearance for gastric bypass and was found to be an appropriate candidate.  She underwent her procedure.,HOSPITAL COURSE: , Ms. A underwent her procedure.  She tolerated without difficulty.  She was admitted to the floor post procedure.  Her postoperative course has been unremarkable.  On postoperative day 1, she was hemodynamically stable, afebrile, normal labs, and she was started on a clear liquid diet, which she has tolerated without difficulty.  She has ambulated and had no complaints.  Today, on postoperative day 2, the patient continues to do well.  Pain controlled with p.o. pain medicine, ambulating without difficulty, tolerating a liquid diet.  At this point, it is felt that she is stable for discharge.  Her drain was discontinued.,DISCHARGE INSTRUCTIONS:,  Liquid diet x1 week, then advance to pureed and soft as tolerated.  No heavy lifting, greater than 10 pounds x4 weeks.  The patient is instructed to not engage in any strenuous activity, but maintain mobility.  No driving for 1 to 2 weeks.  She must be able to stop in an emergency and be off narcotic pain medicine.  She may shower.  She needs to keep her wounds clean and dry.  She needs to follow up in my office in 1 week for postoperative evaluation.  She is instructed to call for any problems of shortness of breath, chest pain, calf pain, temperature greater than 101.5, any redness, swelling, or foul smelling drainage from her wounds, intractable nausea, vomiting, and abdominal pain.  She is instructed just to resume her discharge medications.,DISCHARGE MEDICATIONS:,  She was given a scripts for Lortab Elixir, Flexeril, ursodiol, and Colace.
Bariatric Consult - Surgical Weight Loss - 2 
Medical specialty:  Bariatrics
 Evaluation for elective surgical weight loss via the Lap-Band as opposed to gastric bypass.

PAST MEDICAL HISTORY:  ,She had a negative stress test four to five years ago.  She gets short of breath in walking about 30 steps.  She has had non-insulin dependent diabetes for about eight years now.  She has a left knee arthritis and history of hemorrhoids.,PAST SURGICAL HISTORY: , Pertinent for laparoscopic cholecystectomy, tonsillectomy, left knee surgery, and right breast lumpectomy.,PSYCHOLOGICAL HISTORY: , Negative except that she was rehabilitated for alcohol addiction in 1990.,SOCIAL HISTORY: , The patient is married.  She is an office manager for a gravel company.  Her spouse is also overweight.  She drinks on a weekly basis and she smokes,about two packs of cigarettes over a week's period of time.  She is doing this for about 35 years.,FAMILY HISTORY: , Diabetes and hypertension.,MEDICATIONS:,  Include Colestid 1 g daily, Actos 30 mg daily, Amaryl 2 mg daily, Soma, and meloxicam for her back pain.,ALLERGIES:,  She has no allergies; however, she does get tachycardic with caffeine, Sudafed, or phenylpropanolamine.,REVIEW OF SYSTEMS: , Otherwise, negative.,PHYSICAL EXAM: , This is a pleasant female in no acute distress.  Alert and oriented x 3.  HEENT:  Normocephalic, atraumatic.  Extraocular muscles intact, nonicteric sclerae.  Chest is clear.  Abdomen is obese, soft, nontender and nondistended.  Extremities show no edema, clubbing or cyanosis.,ASSESSMENT/PLAN: , This is a 51-year-old female with a BMI of 43 who is interested in the Lap-Band as opposed to gastric bypass.  ABC will be asking for a letter of medical necessity from XYZ.  She will also need an EKG and clearance for surgery.  She will also see my nutritionist and social worker and once this is completed, we will submit her to her insurance company for approval.
Evaluation of Allergies 
Medical specialty:  Allergy / Immunology
 Chronic glossitis, xerostomia, probable environmental inhalant allergies, probable food allergies, and history of asthma.

HISTORY:,  A 55-year-old female presents self-referred for the possibility of evaluation and treatment of allergies, diminished taste, xerostomia, gastroesophageal reflux disease, possible food allergies, chronic GI irritability, asthma, and environmental inhalant allergies.  Please refer to chart for history and physical and review of systems and detailed medical history.,IMPRESSION:  ,1.  Chronic glossitis/xerostomia/probable environmental inhalant allergies/probable food allergies/history of asthma.,2.  History of fibromyalgia.,3.  History of peptic ulcer disease, history of gastritis, history of gastroesophageal disease.,4.  History of chronic fatigue.,5.  History of hypothyroidism.,6.  History of depression.,7.  History of dysphagia.,RECOMMENDATIONS: , RAST allergy testing was ordered for food allergy evaluation.  The patient had previous allergy testing done less than one year ago iby Dr. X, which was requested.  The patient will follow up after RAST allergy testing for further treatment recommendations.  At this point, no changes in her medication were prescribed until her followup visit.