CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 69 year old male seen by his PCP for worsening dyspnea on
exertion. Stress test showed ST depressions in the inferolateral
leads. He was referred to MWMC for cardiac cath. Cath revealed
multivessel severe coronary artery disease. He was transferred
to the [**Hospital1 18**] for evaluation of coronary revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
MV prolapse
TIA '[**09**]-no residual
Psoriatic arthritis
Shingles
Lyme disease
RBBB/LAFB
Heartburn

MEDICATION ON ADMISSION: ASA 81mg daily
Lisinopril-Hydrochlorothiazide 20/12.5mg daily
Cyclobenzaprine HCL 5mg daily
Doxazosin 2mg daily

ALLERGIES: Sulfa(Sulfonamide Antibiotics) / Methotrexate

PHYSICAL EXAM: Pulse: 85 Resp: 20 O2 sat:100%RA
B/P  137/92
Height: 5'7.5"    Weight:198LB

FAMILY HISTORY: Brother (+)CABG at age 69yo. father (+)MI 40s.

SOCIAL HISTORY: Last Dental Exam:edentulous
Lives with:wife
Contact:                      Phone #
Occupation:works as supervisor in credit collections dept.
Cigarettes: Smoked no [] yes [x] last cigarette >10yo Hx:
Other Tobacco use:
ETOH: < 1 drink/week []  [**2-18**] drinks/week [x] >8 drinks/week []
Illicit drug use
Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic diastolic heart failure,Right bundle branch block and left anterior fascicular block,Other iatrogenic hypotension,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Mitral valve disorders,Other and unspecified hyperlipidemia,Anemia, unspecified,Psoriatic arthropathy,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other acquired absence of organ,Personal history of tobacco use,Family history of ischemic heart disease,Personal history of colonic polyps
Crnry athrscl natve vssl,Hy kid NOS w cr kid I-IV,Chr diastolic hrt fail,Rt bbb/lft ant fasc blk,Iatrogenc hypotnsion NEC,Chr airway obstruct NEC,Chronic kidney dis NOS,Mitral valve disorder,Hyperlipidemia NEC/NOS,Anemia NOS,Psoriatic arthropathy,Loc osteoarth NOS-l/leg,Hx TIA/stroke w/o resid,Acq absence of organ NEC,History of tobacco use,Fam hx-ischem heart dis,Prsnl hst colonic polyps
Admission Date:  [**2110-3-4**]              Discharge Date:   [**2110-3-10**]

Date of Birth:  [**2041-1-1**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa(Sulfonamide Antibiotics) / Methotrexate

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2110-3-6**] - Coronary artery bypass grafting to four vessels. Left
internal mammary artery to left anterior descending artery,
Saphenous vein graft (SVG) to left posterior descending artery,
SVG->Diagonal artery, SVG->Obtuse marginal artery)

History of Present Illness:
69 year old male seen by his PCP for worsening dyspnea on
exertion. Stress test showed ST depressions in the inferolateral
leads. He was referred to MWMC for cardiac cath. Cath revealed
multivessel severe coronary artery disease. He was transferred
to the [**Hospital1 18**] for evaluation of coronary revascularization.

Past Medical History:
Hypertension
Hyperlipidemia
MV prolapse
TIA '[**09**]-no residual
Psoriatic arthritis
Shingles
Lyme disease
RBBB/LAFB
Heartburn

Social History:
Last Dental Exam:edentulous
Lives with:wife
Contact:                      Phone #
Occupation:works as supervisor in credit collections dept.
Cigarettes: Smoked no [] yes [x] last cigarette >10yo Hx:
Other Tobacco use:
ETOH: < 1 drink/week []  [**2-18**] drinks/week [x] >8 drinks/week []
Illicit drug use

Family History:
Brother (+)CABG at age 69yo. father (+)MI 40s.

Physical Exam:
Pulse: 85 Resp: 20 O2 sat:100%RA
B/P  137/92
Height: 5'7.5"    Weight:198LB

General:A&Ox3, NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema [] _____
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:  Left:
PT           [**Name (NI) 167**]: 2+  Left:
Radial       Right: 2+  Left:2+

Carotid Bruit -none   Right:2+    Left:2+

Pertinent Results:
[**2110-3-4**] Carotid U/S: There is mild homogeneous calcified plaque
at the carotid bifurcations bilaterally, but no evidence of a
hemodynamically significant stenosis. Flow in the vertebral
arteries is prograde.
.
[**2110-3-6**] ECHO PRE-CPB: The left atrium is mildly dilated. No
spontaneous echo contrast is seen in the left 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. Overall left ventricular
systolic function is normal (LVEF>55%). The right ventricular
cavity is mildly dilated with normal free wall contractility.
The ascending aorta is mildly dilated. There are simple atheroma
in the descending thoracic aorta. No thoracic aortic dissection
is seen. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Mild to moderate ([**1-13**]+) mitral regurgitation
is seen. Dr. [**Last Name (STitle) **] was notified in person of the results at
time of study.
POST-CPB: The left ventricular systolic function remains normal,
estimated EF>55%. The RV systolic function remains normal. The
mitral regurgitation remains mild to moderate. Other valve
function remains unchanged. There is no evidence of dissection.
.
[**2110-3-9**] Chest X-ray: A tiny pneumothorax suggested on the films
dated [**2110-3-8**] at 10 a.m. is not distinctly visualized on the
current exam and has likely resolved. No other evidence for
pneumothorax is identified. There are small bilateral effusions
seen posteriorly and slight blunting of the right costophrenic
angle. There is minimal plate-like atelectasis and some patchy
retrocardiac density, which has improved in the interim. Minimal
plate-like atelectasis at the left base is new.
Cardiomediastinal silhouette is prominent, but slightly
improved.  Sternotomy wires and mediastinal clips noted. There
is upper zone re-distribution, without other evidence of CHF.
.
[**2110-3-4**] 05:43PM BLOOD WBC-5.9 RBC-4.30* Hgb-13.6* Hct-37.7*
MCV-88 MCH-31.7 MCHC-36.1* RDW-12.9 Plt Ct-192
[**2110-3-9**] 06:30AM BLOOD WBC-8.2 RBC-3.26* Hgb-10.4* Hct-29.1*
MCV-89 MCH-31.9 MCHC-35.7* RDW-13.4 Plt Ct-131*
[**2110-3-4**] 05:43PM BLOOD PT-11.5 PTT-31.2 INR(PT)-1.1
[**2110-3-6**] 02:59PM BLOOD PT-12.4 PTT-33.8 INR(PT)-1.1
[**2110-3-4**] 05:43PM BLOOD Glucose-114* UreaN-19 Creat-0.9 Na-137
K-3.8 Cl-103 HCO3-24 AnGap-14
[**2110-3-10**] 04:30AM BLOOD Glucose-103* UreaN-22* Creat-0.9 Na-137
K-3.9 Cl-100 HCO3-29 AnGap-12
[**2110-3-4**] 05:43PM BLOOD ALT-21 AST-24 LD(LDH)-149 AlkPhos-51
Amylase-53 TotBili-0.4
[**2110-3-4**] 05:43PM BLOOD %HbA1c-5.8 eAG-120

Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2110-3-4**] for further
management of his coronary artery disease. He was worked-up in
the usual preoperative manner including a carotid ultrasound
which showed no evidence of a hemodynamically significant
stenosis. Heparin was started given his significant disease and
coronary anatomy. On [**2110-3-6**] Mr. [**Known lastname **] was taken to the
operating room where he underwent coronary artery bypass
grafting to four vessels. Please see operative note for details.
Postoperatively he was taken to the intensive care unit for
monitoring. Over the next several hours, he awoke neurologically
intact and was extubated. He remained on Neo through POD #1 this
was weaned off by POD#2 and he was started on low dose
lopressor. He transferred to floor for further care. Chest tubes
and epicardial pacing wires were removed per protocol. While on
the telemetry floor he continued to make good progress and
worked with physical therapy for strength and mobility. On
post-op day four he was discharged home with VNA services with
the appropriate medications and follow-up appointments.

Medications on Admission:
ASA 81mg daily
Lisinopril-Hydrochlorothiazide 20/12.5mg daily
Cyclobenzaprine HCL 5mg daily
Doxazosin 2mg daily

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:*2*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
3. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
4. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
5. furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
6. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO Q12H (every 12 hours)
for 2 weeks.
Disp:*28 Tablet, ER Particles/Crystals(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
Coronary artery disease s/p Coronary artery bypass graft x 4
Past medical history:
Hypertension
Hyperlipidemia
MV prolapse
TIA '[**09**]-no residual
Psoriatic arthritis
Shingles
Lyme disease
RBBB/LAFB
Heartburn

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema +1


Discharge Instructions:
1) 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.
2) Please NO lotions, cream, powder, or ointments to incisions.
3) Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart provided.
4) No driving for approximately one month and while taking
narcotics. Driving will be discussed at follow up appointment
with surgeon when you will likely be cleared to drive.
5) No lifting more than 10 pounds for 10 weeks
6) Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**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) **] [**2110-4-9**] @1pm
Cardiologist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 31888**] [**2110-3-31**] 11:30am
Wound check : [**2110-3-18**] @ 10am
Please call to schedule appointments with your
Primary Care Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **] in [**4-17**] 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:[**2110-3-10**]
{'Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic diastolic heart failure,Right bundle branch block and left anterior fascicular block,Other iatrogenic hypotension,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Mitral valve disorders,Other and unspecified hyperlipidemia,Anemia, unspecified,Psoriatic arthropathy,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other acquired absence of organ,Personal history of tobacco use,Family history of ischemic heart disease,Personal history of colonic polyps'}


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 on exertion

PRESENT ILLNESS: 69 year old male seen by his PCP for worsening dyspnea on
exertion. Stress test showed ST depressions in the inferolateral
leads. He was referred to MWMC for cardiac cath. Cath revealed
multivessel severe coronary artery disease. He was transferred
to the [**Hospital1 18**] for evaluation of coronary revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
MV prolapse
TIA '[**09**]-no residual
Psoriatic arthritis
Shingles
Lyme disease
RBBB/LAFB
Heartburn

MEDICATION ON ADMISSION: ASA 81mg daily
Lisinopril-Hydrochlorothiazide 20/12.5mg daily
Cyclobenzaprine HCL 5mg daily
Doxazosin 2mg daily

ALLERGIES: Sulfa(Sulfonamide Antibiotics) / Methotrexate

PHYSICAL EXAM: Pulse: 85 Resp: 20 O2 sat:100%RA
B/P  137/92
Height: 5'7.5"    Weight:198LB

FAMILY HISTORY: Brother (+)CABG at age 69yo. father (+)MI 40s.

SOCIAL HISTORY: Last Dental Exam:edentulous
Lives with:wife
Contact:                      Phone #
Occupation:works as supervisor in credit collections dept.
Cigarettes: Smoked no [] yes [x] last cigarette >10yo Hx:
Other Tobacco use:
ETOH: < 1 drink/week []  [**2-18**] drinks/week [x] >8 drinks/week []
Illicit drug use 

### Response:
{'Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic diastolic heart failure,Right bundle branch block and left anterior fascicular block,Other iatrogenic hypotension,Chronic airway obstruction, not elsewhere classified,Chronic kidney disease, unspecified,Mitral valve disorders,Other and unspecified hyperlipidemia,Anemia, unspecified,Psoriatic arthropathy,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Other acquired absence of organ,Personal history of tobacco use,Family history of ischemic heart disease,Personal history of colonic polyps'}
