CHIEF COMPLAINT: Dyspnea/Diminished exercise tolerance

PRESENT ILLNESS: This is a 73 year old male who has noted gradual decline in
exercise tolerance in the setting of hypertension,
hyperlipidemia and bradycardia. He complains of dyspnea with
moderate exertion and first nted these symptoms with playing
tennis. His dyspnea improves with rest. He denies chest pain,
palpitations, lightheadedness, syncope, orthopnea, PND and pedal
edema. He continues to exercise on a regular basis. A stress
echo was performed which was normal however a cardiac CT scan
showed his calcium score to be very high at 3962. He was
subsequently sent for a cardiac catheterization which revealed
severe three vessel disease. Given the severity of his disease,
he was referred for surgical management.

MEDICAL HISTORY: Hypertensin
Dyslipidemia
First Degree AV Block with Bradycardia
Prostate Cancer
Prostatectomy
Spine Surgery
Hernia Repair
Right rotator cuff repair
Bilateral Inguinal hernia repair
Deviated Septum Repair

MEDICATION ON ADMISSION: Norvasc 5mg daily
Aspirin 81mg daily
Renexa 500mg twice daily
Lipitor 80mg daily
Fish Oil 1000mg twice daily
MVI
Glucosamine
Aleve 220mg QHS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vital Signs sheet entries for [**2144-6-3**]:
BP: (L) 130/78. (R) 134/80 Heart Rate: 70. Resp. Rate: 16. Pain
Score: 0. O2 Saturation%: 99.

FAMILY HISTORY: Mother sudden death at age 53. Father died at age 89. Has 3
brothers, 2 sisters - one sibling diagnosed with CAD.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months0
Lives with: Wife
Contact:                      Phone #
Occupation: Retired, engineering/construction
Cigarettes: Denies
ETOH: Social
Illicit drug use: Denies
Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other secondary thrombocytopenia,Paralytic ileus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of prostate,Other specified retention of urine,Anemia, unspecified,Other iatrogenic hypotension
Crnry athrscl natve vssl,Atrial fibrillation,Sec thrombocytpenia NEC,Paralytic ileus,Hypertension NOS,Hyperlipidemia NEC/NOS,Hx-prostatic malignancy,Oth spcf retention urine,Anemia NOS,Iatrogenc hypotnsion NEC
Admission Date:  [**2144-6-22**]              Discharge Date:   [**2144-6-29**]

Date of Birth:  [**2070-10-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea/Diminished exercise tolerance

Major Surgical or Invasive Procedure:
[**2144-6-22**] Coronary artery bypass graft x 4
Left internal mammary artery grafted to left anterior descending
artery/ saphenous vein grafted to ramus intermedius/ PLV

History of Present Illness:
This is a 73 year old male who has noted gradual decline in
exercise tolerance in the setting of hypertension,
hyperlipidemia and bradycardia. He complains of dyspnea with
moderate exertion and first nted these symptoms with playing
tennis. His dyspnea improves with rest. He denies chest pain,
palpitations, lightheadedness, syncope, orthopnea, PND and pedal
edema. He continues to exercise on a regular basis. A stress
echo was performed which was normal however a cardiac CT scan
showed his calcium score to be very high at 3962. He was
subsequently sent for a cardiac catheterization which revealed
severe three vessel disease. Given the severity of his disease,
he was referred for surgical management.

Past Medical History:
Hypertensin
Dyslipidemia
First Degree AV Block with Bradycardia
Prostate Cancer
Prostatectomy
Spine Surgery
Hernia Repair
Right rotator cuff repair
Bilateral Inguinal hernia repair
Deviated Septum Repair

Social History:
Race: Caucasian
Last Dental Exam: Every 6 months0
Lives with: Wife
Contact:                      Phone #
Occupation: Retired, engineering/construction
Cigarettes: Denies
ETOH: Social
Illicit drug use: Denies

Family History:
Mother sudden death at age 53. Father died at age 89. Has 3
brothers, 2 sisters - one sibling diagnosed with CAD.

Physical Exam:
Vital Signs sheet entries for [**2144-6-3**]:
BP: (L) 130/78. (R) 134/80 Heart Rate: 70. Resp. Rate: 16. Pain
Score: 0. O2 Saturation%: 99.

Height: 65"     Weight: 163

General: WDWN in NAD
Skin: Warm, Dry and intact.
HEENT: NCAT, PERRLA, EOMI, sclera anicteric, OP benign. Teeth in
good repair.
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR, No M/R/G
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+[X]
Extremities: Warm [X], well-perfused [X]  No edema
Varicosities: Rith thigh and lower leg with superficial
varicosities. Left leg appears suitable.
Neuro: Grossly intact [X]
Pulses:
Femoral      Right:2   Left:2
DP           Right:2   Left:2
PT           [**Name (NI) 167**]:2   Left:2
Radial       Right:2   Left:2

Carotid Bruit        None

Pertinent Results:
[**2144-6-22**] Echo: PRE_BYPASS The left atrium is normal in size. No
spontaneous echo contrast or thrombus is seen in the body of the
left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. No atrial septal defect is seen
by 2D or color Doppler. There is mild symmetric left ventricular
hypertrophy. The left ventricular cavity size is normal.
Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic root is mildly dilated at the sinus level. There are
complex (>4mm) atheroma in the aortic arch. There are simple
atheroma in the descending thoracic aorta. The aortic valve
leaflets (3) are mildly thickened but aortic stenosis is not
present. Mild (1+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. There is no pericardial effusion. Dr.
[**Last Name (STitle) **] was notified in person of the results in the operating
room at the time of the study.
POST-BYPASS The patient is AV paced. There is normal
biventricular systolic function. The mitral regurgitation was
initially somewhat worse after separation from bypass (mild to
moderate) but decreased back to mild later on. The rest of
valvular function was unchanged. The thoracic aorta was intact
after decannulation.
[**2144-6-29**] 04:57AM BLOOD WBC-12.5* RBC-3.80* Hgb-11.0* Hct-33.5*
MCV-88 MCH-28.8 MCHC-32.7 RDW-13.4 Plt Ct-272
[**2144-6-22**] 02:12PM BLOOD WBC-13.6*# RBC-3.50*# Hgb-10.0*#
Hct-30.6*# MCV-87 MCH-28.7 MCHC-32.9 RDW-12.9 Plt Ct-148*
[**2144-6-29**] 04:57AM BLOOD PT-12.3 INR(PT)-1.1
[**2144-6-22**] 02:12PM BLOOD PT-16.9* PTT-27.0 INR(PT)-1.6*
[**2144-6-29**] 04:57AM BLOOD Glucose-93 UreaN-21* Creat-1.0 Na-138
K-4.1 Cl-104 HCO3-27 AnGap-11
[**2144-6-22**] 03:30PM BLOOD UreaN-17 Creat-0.8 Na-143 K-3.5 Cl-110*
HCO3-23 AnGap-14
[**2144-6-24**] 04:29AM BLOOD ALT-13 AST-46* LD(LDH)-226 AlkPhos-79
Amylase-51 TotBili-0.6

Brief Hospital Course:
Mr. [**Known lastname 40046**] was a same day admit and brought directly to the
operating room where he underwent a coronary artery bypass graft
x 4 (Left internal mammary artery graft to left anterior
descending, reverse saphenous vein graft to the posterior
left ventricular branch, ramus intermedius, diagonal branch)
with Dr.[**Last Name (STitle) **]. Please see operative note for surgical details.
Following surgery he was transferred to the CVICU for invasive
monitoring in stable condition. Later this day he was weaned
from sedation, awoke neurologically intact and extubated.
Beta-blockers, Statin, aspirin, and diuresis was initiated.
Post-operatively he developed an ileus, which resolved with an
aggresive bowel regimen. POD#1  He was transferred to the
surgical step down floor for further monitoring. His chest tubes
and wires were removed.  Physical therapy was consulted for
evaluation of strength and mobility. Mr.[**Known lastname 40046**] had failure to
void x 2. The foley catheter was reinserted and  urology was
consulted. He had some postoperative hypoxia that improved with
diuresis and increased ambulation. POD#6 he had a brief episode
of postoperative atrial fibrillation that resolved with
beta-blocker and electrolyte replacement. No further episodes
occurred.  By post-operative day #7 he was ready for discharge
to home with a leg bag and VNA services.  Appropriate follow-up
appointments were advised.

Medications on Admission:
Norvasc 5mg daily
Aspirin 81mg daily
Renexa 500mg twice daily
Lipitor 80mg daily
Fish Oil 1000mg twice daily
MVI
Glucosamine
Aleve 220mg QHS

Discharge Medications:
1. omega-3 fatty acids     Capsule Sig: One (1) Capsule PO BID
(2 times a day).
2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*80 Tablet(s)* Refills:*2*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. ranitidine HCl 150 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
8. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
Disp:*60 Capsule, Ext Release 24 hr(s)* Refills:*2*
9. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
10. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
11. potassium chloride 10 mEq Capsule, Extended Release Sig: One
(1) Capsule, Extended Release PO once a day for 10 days.
Disp:*10 Capsule, Extended Release(s)* Refills:*0*
12. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
Disp:*180 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Corornary artery disease s/p Coronary artery bypass graft x 4
Past medical history:
Hypertensin
Dyslipidemia
First Degree AV Block with Bradycardia
Prostate Cancer
Prostatectomy
Spine Surgery
Hernia Repair
Right rotator cuff repair
Bilateral Inguinal hernia repair
Deviated Septum Repair

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesia
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema trace


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **] [**2144-8-5**] at 1:00p
Cardiologist: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2912**] [**2144-7-16**] at 1:45
Wound Check [**2144-7-7**] at 10:30a
Please follow up with Urology for urinary retention
Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) 4457**] [**Last Name (NamePattern1) 3100**] in [**4-23**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2144-6-29**]
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other secondary thrombocytopenia,Paralytic ileus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of prostate,Other specified retention of urine,Anemia, unspecified,Other iatrogenic hypotension'}


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: Dyspnea/Diminished exercise tolerance

PRESENT ILLNESS: This is a 73 year old male who has noted gradual decline in
exercise tolerance in the setting of hypertension,
hyperlipidemia and bradycardia. He complains of dyspnea with
moderate exertion and first nted these symptoms with playing
tennis. His dyspnea improves with rest. He denies chest pain,
palpitations, lightheadedness, syncope, orthopnea, PND and pedal
edema. He continues to exercise on a regular basis. A stress
echo was performed which was normal however a cardiac CT scan
showed his calcium score to be very high at 3962. He was
subsequently sent for a cardiac catheterization which revealed
severe three vessel disease. Given the severity of his disease,
he was referred for surgical management.

MEDICAL HISTORY: Hypertensin
Dyslipidemia
First Degree AV Block with Bradycardia
Prostate Cancer
Prostatectomy
Spine Surgery
Hernia Repair
Right rotator cuff repair
Bilateral Inguinal hernia repair
Deviated Septum Repair

MEDICATION ON ADMISSION: Norvasc 5mg daily
Aspirin 81mg daily
Renexa 500mg twice daily
Lipitor 80mg daily
Fish Oil 1000mg twice daily
MVI
Glucosamine
Aleve 220mg QHS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vital Signs sheet entries for [**2144-6-3**]:
BP: (L) 130/78. (R) 134/80 Heart Rate: 70. Resp. Rate: 16. Pain
Score: 0. O2 Saturation%: 99.

FAMILY HISTORY: Mother sudden death at age 53. Father died at age 89. Has 3
brothers, 2 sisters - one sibling diagnosed with CAD.

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: Every 6 months0
Lives with: Wife
Contact:                      Phone #
Occupation: Retired, engineering/construction
Cigarettes: Denies
ETOH: Social
Illicit drug use: Denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Other secondary thrombocytopenia,Paralytic ileus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Personal history of malignant neoplasm of prostate,Other specified retention of urine,Anemia, unspecified,Other iatrogenic hypotension'}
