CHIEF COMPLAINT: SOB

PRESENT ILLNESS: 63 yo M s/p motorcycle MVC 10 days ago, treated for road rash
and bruising as well as dehydration and dc'd home. One week
later was found ashen, SOB, nauseas and weak, went to see PCP
who sent him to ED. Troponin 0.25, transferred for cath which
showed 90% LM. IABP inserted and patient referred for surgery.

MEDICAL HISTORY: Hyperlipidemia, DM, OSA (CPAP), Obesity, s/p motorcycle MVC- 10d
ago, Cerebellar atrophy, GERD, s/p bil knee repl, s/p nasal
septum repair after trauma

MEDICATION ON ADMISSION: prilosec, crestor, prozac, motrin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 66 RR 18 BP 118/69
NAD
multiple abrasions both arms; multiple ecchymosis groin, back
lungs CTAB
heart RRR, distant, IABP
Abdomen Benign, obese
Extrem warm, no edema, 2+ pulses t/o

FAMILY HISTORY: NC

SOCIAL HISTORY: cemetary/farm worker
denies tobacco, etoh
Subendocardial infarction, initial episode of care,Pulmonary collapse,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Anemia, unspecified,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places
Subendo infarct, initial,Pulmonary collapse,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Obstructive sleep apnea,Atrial fibrillation,Anemia NOS,Iatrogenc hypotnsion NEC,Abn react-surg proc NEC,Accident in place NEC
Admission Date:  [**2132-6-11**]              Discharge Date:   [**2132-6-17**]

Date of Birth:  [**2069-3-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**6-11**] cardiac catherization and intra aortic balloon insertion
[**6-12**] Coronary artery bypass graft x2 (left internal mammary
artery >  anterior descending, saphenous vein graft > obtuse
marginal)


History of Present Illness:
63 yo M s/p motorcycle MVC 10 days ago, treated for road rash
and bruising as well as dehydration and dc'd home. One week
later was found ashen, SOB, nauseas and weak, went to see PCP
who sent him to ED. Troponin 0.25, transferred for cath which
showed 90% LM. IABP inserted and patient referred for surgery.

Past Medical History:
Hyperlipidemia, DM, OSA (CPAP), Obesity, s/p motorcycle MVC- 10d
ago, Cerebellar atrophy, GERD, s/p bil knee repl, s/p nasal
septum repair after trauma

Social History:
cemetary/farm worker
denies tobacco, etoh

Family History:
NC

Physical Exam:
HR 66 RR 18 BP 118/69
NAD
multiple abrasions both arms; multiple ecchymosis groin, back
lungs CTAB
heart RRR, distant, IABP
Abdomen Benign, obese
Extrem warm, no edema, 2+ pulses t/o


Pertinent Results:
[**2132-6-16**] 05:19AM BLOOD WBC-10.4 RBC-2.77* Hgb-7.9* Hct-24.1*
MCV-87 MCH-28.5 MCHC-32.7 RDW-15.4 Plt Ct-280
[**2132-6-11**] 03:08PM BLOOD WBC-6.8 RBC-3.77* Hgb-10.6* Hct-31.7*
MCV-84 MCH-28.1 MCHC-33.4 RDW-14.0 Plt Ct-269
[**2132-6-11**] 03:08PM BLOOD Neuts-67.4 Lymphs-25.8 Monos-4.0 Eos-2.3
Baso-0.5
[**2132-6-16**] 05:19AM BLOOD Plt Ct-280
[**2132-6-16**] 05:19AM BLOOD PT-11.7 INR(PT)-1.0
[**2132-6-12**] 11:29AM BLOOD Fibrino-407*
[**2132-6-16**] 05:19AM BLOOD Glucose-109* UreaN-19 Creat-0.9 Na-136
K-4.0 Cl-101 HCO3-29 AnGap-10
[**2132-6-11**] 03:08PM BLOOD Glucose-118* UreaN-14 Creat-0.9 Na-140
K-4.1 Cl-105 HCO3-28 AnGap-11
[**2132-6-11**] 03:08PM BLOOD ALT-52* AST-31 CK(CPK)-102 AlkPhos-94
TotBili-0.8
[**2132-6-11**] 03:08PM BLOOD CK-MB-3 cTropnT-0.04*
[**2132-6-15**] 02:55AM BLOOD Calcium-7.8* Phos-3.3 Mg-2.0
[**2132-6-11**] 04:35PM BLOOD %HbA1c-6.4*

CHEST (PA & LAT)  [**2132-6-16**] 3:53 PM

CHEST (PA & LAT)

Reason: evaluate effusion

[**Hospital 93**] MEDICAL CONDITION:
63 year old man with s/p cabg
REASON FOR THIS EXAMINATION:
evaluate effusion
STUDY: PA and lateral chest radiograph.

INDICATION: Status post CABG. Please evaluate size of effusion.

COMPARISON: [**2132-6-15**].

FINDINGS: Right internal jugular central venous catheter tip
terminates at the cavoatrial junction. There is mild bibasilar
discoid atelectasis. Small bilateral effusions remain. There is
mild cardiomegaly. Median sternotomy wires remain intact. No
focal consolidation or evidence of acute pulmonary edema
detected.

IMPRESSION:
1. Mild bibasilar discoid atelectasis.
2. Cardiomegaly and small bilateral pleural effusions. No acute
pulmonary edema detected.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name (STitle) **] [**Doctor Last Name 4391**]
DR. [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1508**]Approved: MON [**2132-6-16**] 5:00 PM

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 78222**] (Complete)
Done [**2132-6-12**] at 11:25:38 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**]
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2069-3-9**]
Age (years): 63 M  Hgt (in): 72
BP (mm Hg): 119/53  Wgt (lb): 300
HR (bpm): 76  BSA (m2): 2.53 m2
Indication: Intra-op TEE for CABG
ICD-9 Codes: 410.91, 786.51
Test Information
Date/Time: [**2132-6-12**] at 11:25    Interpret MD: [**Name6 (MD) 928**]
[**Name8 (MD) 929**], MD, MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 929**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW02-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55%  >= 55%

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

LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
global systolic function (LVEF>55%).

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

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter. Normal aortic arch diameter. Normal
descending aorta diameter.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Normal mitral valve leaflets with 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. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient. See Conclusions for post-bypass data
The post-bypass study was performed while the patient was
receiving vasoactive infusions (see Conclusions for listing of
medications).
Conclusions
PRE-BYPASS:
1. No atrial septal defect is seen by 2D or color Doppler.
2. Left ventricular wall thickness, cavity size, and global
systolic function are normal (LVEF>55%).
3. Right ventricular chamber size and free wall motion are
normal.
4. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. 5. The
mitral valve appears structurally normal with trivial mitral
regurgitation.
Dr. [**Last Name (STitle) 914**] was notified in person of the results

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine and is in
Sinus rhythm
1. Biventricular function is preserved.
2. Aorta is intact post decannulation
3. IABP appears appropriately positioned 2-3 cm below take-off
of left subclavian artery
3. Other findings are unchanged
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 928**] [**Name8 (MD) 929**], MD, MD,
Interpreting physician [**Last Name (NamePattern4) **] [**2132-6-12**] 16:05



Brief Hospital Course:
He was admitted to the CCU after cardiac catherization that
revealed coronary artery disease. He was seen by cardiac surgery
and was taken to the operating room on [**6-12**] where he underwent a
CABG x 2. He was transferred to the ICU in stable condition.
IABP was dc'd post op. He was extubated on POD #1. He was seen
by skin care for his multiple abrasions. He was started on
amiodarone for afib. He was transferred to the floor on POD #3.
He did well postoperatively and was seen by physical therapy and
was cleared for discharge home. He was ready for discharge on
POD #5.

Medications on Admission:
prilosec, crestor, prozac, motrin

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. 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*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Crestor 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
5. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
6. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*0*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
8. Ferrous Gluconate 325 mg (37.5 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily) for 1 months.
Disp:*30 Tablet(s)* Refills:*0*
9. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) for 1 months.
Disp:*60 Tablet(s)* Refills:*0*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 2
weeks.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
please take 400mg daily for 10 days then decrease to 200mg once
daily and follow up with cardiologist.
Disp:*60 Tablet(s)* Refills:*0*
12. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Coronary artery disease s/p cabg
Post operative atrial fibrillation
Unstable angina
Elevated cholesterol
Diabetes mellitus
Obstructive sleep apnea
Gastroesophageal reflux disease


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:
Dr [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**First Name (STitle) 1356**] in 1 week ([**Telephone/Fax (1) 40833**]) please call for appointment
Dr [**Last Name (STitle) 10543**] in [**2-10**] weeks ([**Telephone/Fax (1) 4475**]) please call for appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])



Completed by:[**2132-6-17**]
{'Subendocardial infarction, initial episode of care,Pulmonary collapse,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Anemia, unspecified,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places'}


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: SOB

PRESENT ILLNESS: 63 yo M s/p motorcycle MVC 10 days ago, treated for road rash
and bruising as well as dehydration and dc'd home. One week
later was found ashen, SOB, nauseas and weak, went to see PCP
who sent him to ED. Troponin 0.25, transferred for cath which
showed 90% LM. IABP inserted and patient referred for surgery.

MEDICAL HISTORY: Hyperlipidemia, DM, OSA (CPAP), Obesity, s/p motorcycle MVC- 10d
ago, Cerebellar atrophy, GERD, s/p bil knee repl, s/p nasal
septum repair after trauma

MEDICATION ON ADMISSION: prilosec, crestor, prozac, motrin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: HR 66 RR 18 BP 118/69
NAD
multiple abrasions both arms; multiple ecchymosis groin, back
lungs CTAB
heart RRR, distant, IABP
Abdomen Benign, obese
Extrem warm, no edema, 2+ pulses t/o

FAMILY HISTORY: NC

SOCIAL HISTORY: cemetary/farm worker
denies tobacco, etoh 

### Response:
{'Subendocardial infarction, initial episode of care,Pulmonary collapse,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Anemia, unspecified,Other iatrogenic hypotension,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places'}
