CHIEF COMPLAINT: 58 year old white male with CHF.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 58 year-old male with known 3-vessel CAD, severe
systolic dysfunction with EF 18% on ventriculogram in [**1-/2123**],
DM type 2, and [**Hospital 15134**] transferred from [**Hospital 4068**] hospital for
management of fever, CHF and NSTEMI. He was recently discharged
from [**Hospital1 18**] on [**2123-1-28**] after a 3-week admission for pulmonary
edema, and pneumonia. During that admission, a cardiac
catheterization revealed diffuse 3-vessel CAD with 60% LMCA
disease, serial LAD lesions as well as diffuse disease of LCx
and TO of RCA with collaterals. He had a BiV pacer placed during
that admission (for polymorphic VT). Per report, medical
management of his CAD was advised.

MEDICAL HISTORY: Coronary artery disease with severe 3-vessel disease
Congestive heart failure with EF 18% on ventriculogram in [**1-/2123**]
Hypercholesterolemia
Diabetes mellitus type 2
Hypertension
Infrarenal AAA of 3 cm status post repair [**2119**]
Bilateral iliac artery aneurysms
Anxiety disorder
Gastroesophageal reflux disease
S/p excision of melanoma of the lower back in [**2088**]
S/p septoplasty surgery and tonsillectomy

MEDICATION ON ADMISSION: Lipitor 80 mg PO QD
Amiodarone 400 mg PO QD
Lopressor 12.5 mg PO BID
Klonopin 0/5 mg PO TID
Lasix 40 mg PO BID
Glyburide 15 mg PO QD
Escitalopram 20 mg PO QD
ASA 325 mg PO QD
Zetia 10 mg PO QD
Folate

ALLERGIES: Hydrochlorothiazide / Demerol / Ambien

PHYSICAL EXAM: Physical examination prior to admission to CCU:
VITALS: T 100, BP 105/50 on Dopamine 2.5, Levophed 0.03, HR 83
Vent: AC 600 X 12, PEEP 5, FiO2 100%, Sat 100%
GEN: Intubated, alert, not sedated.
HEENT: ETT in place, OGT in place.
NECK: JVP to jaw.
RESP: ICD in place left anterior chest. Ronchorous breath sounds
bilaterally, with inspiratory crackles.
CVS: Normal S1, S2. No S3, S4. No murmur or rub appreciated.
GI: Obese abdomen. BS normoactive. Abdomen soft and non-tender.
Reported guaiac negative in ED.
EXT: No femoral bruits. Trace bilateral pedal edema. Strong
peripheral pulses.

FAMILY HISTORY: Father with MI in 50s

SOCIAL HISTORY: Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other primary cardiomyopathies,Pressure ulcer, lower back,Paroxysmal ventricular tachycardia,Mechanical complication of automatic implantable cardiac defibrillator,Unspecified septicemia,Sepsis,Acute respiratory failure,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Unspecified disorder of kidney and ureter,Esophageal reflux,Unspecified sleep apnea,Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Unspecified essential hypertension
Subendo infarct, initial,CHF NOS,Prim cardiomyopathy NEC,Pressure ulcer, low back,Parox ventric tachycard,Mch cmp autm mplnt dfbrl,Septicemia NOS,Sepsis,Acute respiratry failure,Pneumonia, organism NOS,Crnry athrscl natve vssl,Renal & ureteral dis NOS,Esophageal reflux,Sleep apnea NOS,DMII circ nt st uncntrld,Athscl extrm ntv art NOS,Abn react-procedure NEC,Other staphylococcus,Hypertension NOS
Admission Date:  [**2123-2-22**]              Discharge Date:   [**2123-3-13**]

Date of Birth:  [**2064-3-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Hydrochlorothiazide / Demerol / Ambien

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
58 year old white male with CHF.

Major Surgical or Invasive Procedure:
Cardiac catheterization [**2123-2-22**]
Endotracheal intubation (outside hospital)
Central venous line placement
CABGx4(LIMA->LAD, SVG->OM, ramus, RCA) [**2123-3-4**]


History of Present Illness:
Mr. [**Known lastname **] is a 58 year-old male with known 3-vessel CAD, severe
systolic dysfunction with EF 18% on ventriculogram in [**1-/2123**],
DM type 2, and [**Hospital 15134**] transferred from [**Hospital 4068**] hospital for
management of fever, CHF and NSTEMI. He was recently discharged
from [**Hospital1 18**] on [**2123-1-28**] after a 3-week admission for pulmonary
edema, and pneumonia. During that admission, a cardiac
catheterization revealed diffuse 3-vessel CAD with 60% LMCA
disease, serial LAD lesions as well as diffuse disease of LCx
and TO of RCA with collaterals. He had a BiV pacer placed during
that admission (for polymorphic VT). Per report, medical
management of his CAD was advised.

He had been managing well as home for 3 weeks, with ongoing
treatment of a sacral decubitus ulcer. Over the past 2 days, he
developed anorexia, fatigue and "cold symptoms". He denies C/P.
He subsequently developed a low-grade fever and progressive
shortness of breath, with dry heaves during the night prior to
admission. He was taken to [**Hospital 4068**] hospital, where he was found
to have a temperature of 101, leukocytosis (WBC 13), positive
cardiac enzymes (CK 492/MB 26), EKG A-sensed, BiV paced. He was
started on NTG drip, and given Levaquin/Zosyn and Lasix 40. CXR
was consistent with CHF. At the outside hospital, he developed
worsening respiratory distress, ABG 7.18/84/89 and he was
intubated. En route to [**Hospital1 18**], he became hypotensive with SBP in
70s, and was started on a Dopamine drip.

In [**Hospital1 18**] ED, Mr. [**Known lastname **] was started on Heparin and Integrillin
IV. He had a 20-beat run, then a 2-minute run of WCT at 120-130
while on Dopa, BP approximately 100. Lidocaine was started at 2
mg/min for presumed VT, Dopa changed to Levophed. Zosyn and
Vancomycin given in the ED.

Past Medical History:
Coronary artery disease with severe 3-vessel disease
Congestive heart failure with EF 18% on ventriculogram in [**1-/2123**]
Hypercholesterolemia
Diabetes mellitus type 2
Hypertension
Infrarenal AAA of 3 cm status post repair [**2119**]
Bilateral iliac artery aneurysms
Anxiety disorder
Gastroesophageal reflux disease
S/p excision of melanoma of the lower back in [**2088**]
S/p septoplasty surgery and tonsillectomy

Social History:
Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption.

Family History:
Father with MI in 50s

Physical Exam:
Physical examination prior to admission to CCU:
VITALS: T 100, BP 105/50 on Dopamine 2.5, Levophed 0.03, HR 83
Vent: AC 600 X 12, PEEP 5, FiO2 100%, Sat 100%
GEN: Intubated, alert, not sedated.
HEENT: ETT in place, OGT in place.
NECK: JVP to jaw.
RESP: ICD in place left anterior chest. Ronchorous breath sounds
bilaterally, with inspiratory crackles.
CVS: Normal S1, S2. No S3, S4. No murmur or rub appreciated.
GI: Obese abdomen. BS normoactive. Abdomen soft and non-tender.
Reported guaiac negative in ED.
EXT: No femoral bruits. Trace bilateral pedal edema. Strong
peripheral pulses.

Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2123-3-13**] 06:45AM    5.7 3.54* 9.8* 30.8* 87 27.7 31.9 15.2
239#
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2123-3-13**] 06:45AM        239#

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2123-3-13**] 06:45AM    90 24* 1.4* 143 4.4 107 29 11
  CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron

[**2123-3-13**] 06:45AM              2.1
Cardiology Report ECHO Study Date of [**2123-3-11**]



PATIENT/TEST INFORMATION:
Indication: H/O cardiac surgery. Left ventricular function.
Height: (in) 69
Weight (lb): 237
BSA (m2): 2.22 m2
BP (mm Hg): 120/70
Status: Inpatient
Date/Time: [**2123-3-11**] at 10:02
Test: TTE (Complete)
Doppler: Full doppler and color doppler
Contrast: None
Tape Number: 2005W054-0:30
Test Location: West Echo Lab
Technical Quality: Suboptimal




REFERRING DOCTOR: DR. [**First Name (STitle) **] R. [**Doctor Last Name **]

MEASUREMENTS:
Left Atrium - Long Axis Dimension: *5.6 cm (nl <= 4.0 cm)
Left Atrium - Four Chamber Length: *5.9 cm (nl <= 5.2 cm)
Right Atrium - Four Chamber Length: *5.9 cm (nl <= 5.0 cm)
Left Ventricle - Septal Wall Thickness: 1.1 cm (nl 0.6 - 1.1 cm)

Left Ventricle - Inferolateral Thickness: 1.1 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Diastolic Dimension: *7.1 cm (nl <= 5.6 cm)
Left Ventricle - Ejection Fraction: 20% to 30% (nl >=55%)
Aorta - Valve Level: *3.9 cm (nl <= 3.6 cm)
Aortic Valve - Peak Velocity: *2.1 m/sec (nl <= 2.0 m/sec)
Mitral Valve - E Wave: 1.1 m/sec
Mitral Valve - A Wave: 1.1 m/sec
Mitral Valve - E/A Ratio: 1.00
Mitral Valve - E Wave Deceleration Time: 250 msec
TR Gradient (+ RA = PASP): *28 mm Hg (nl <= 25 mm Hg)

INTERPRETATION:

Findings:

LEFT ATRIUM: Moderate LA enlargement.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. A catheter
or pacing wire
is seen in the RA.

LEFT VENTRICLE: Normal LV wall thickness. Severely dilated LV
cavity. Severely
depressed LVEF. No resting LVOT gradient.

RIGHT VENTRICLE: Normal RV wall thickness. Normal RV chamber
size. RV function
depressed.

AORTA: Mildly dilated aortic root. Focal calcifications in
aortic root.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
Trace AR.

MITRAL VALVE: Normal mitral valve leaflets. No MVP. Normal
mitral valve
supporting structures. Mild (1+) MR. Normal LV inflow pattern
for age.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR. Normal
tricuspid valve supporting structures. Borderline PA systolic
hypertension.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
physiologic PR. Normal main PA. No Doppler evidence for PDA

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Suboptimal
image quality - poor parasternal views. Suboptimal image quality
- poor apical
views.

Conclusions:
The left atrium is moderately dilated. Left ventricular wall
thicknesses are
normal. The left ventricular cavity is severely dilated. Overall
left
ventricular systolic function is severely depressed (ejection
fraction 20-30
percent). Right ventricular chamber size is normal. Right
ventricular systolic
function appears depressed. The aortic root is mildly dilated.
The aortic
valve leaflets (3) are mildly thickened but aortic stenosis is
not present.
Trace aortic regurgitation is seen. The mitral valve leaflets
are structurally
normal. There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is
seen. There is borderline pulmonary artery systolic
hypertension.

Compared with the findings of the prior study (tape reviewed) of
[**2123-2-22**], the left ventricular ejection fraction, while still
significantly
impaired, is increased, and the end-diastolic dimension has
decreased.

Electronically signed by [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **], MD on [**2123-3-11**] 10:58.

[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].


([**Numeric Identifier 100530**])





Brief Hospital Course:
58 year-old male with diffuse 3-vessel CAD with 60% LMCA disease
on last cath in [**2123-1-2**], also with DM and HTN, admitted
with fever, hypotension, CHF, and NSTEMI.
In the ED, Mr. [**Known lastname **] was started on Heparin IV, and
Integrillin. Decision was made to perform LHC and RHC to
reevaluate the LMCA lesion and assess intracardiac pressures. He
was taken to the cath lab on [**2123-2-22**], where coronary
angiography revealed critical 70% LMCA, proximal and mid 80% LAD
lesions, moderate diffuse disease in Lcx and proximal RCA
occlusion. He was admitted to the CCU post-procedure. His peak
cardiac enzymes were CK 421, MB 24 and troponin T 2.77 on
admission. EKG without ST elevations.
Given the above cath results, cardiac surgery was consulted. Per
cardiac surgery, a viability study at rest was obtained to
evaluate for viable myocardium. The latter was performed on
[**2123-2-24**] and revealed a moderate, medium sized perfusion defect
in the LAD territory which showed partial reversibility in the
24 hour images, as well as a severe, medium distal inferior wall
perfusion defect, also reversible at 24 hours. Per CT surgery, a
CHF/Transplant consult was also requested to evaluate for LVAD
back-up/transplant candidacy prior to taking a decision re:
CABG.
As part of the work-up, carotid series were obtained which
showed no significant disease.  After aggressive diuresis he was
extubated on HD#2.  He came in with a large sacral decubitus
ulcer which was fully evaluated and treated.  He the had an
increased creatinine with a high of 2.6.
His creatinine came down to 1.9 and on [**2123-3-4**] he underwent a
CABGx4 with LIMA->LAD, SVG->OM, ramus, and RCA.  Cross clamp
time was 68 mins., and total bypass time was 88 mins.  He
tolerated the procedure well and was transferred to the CSRU on
Neo, Milrinone, Epi, Vasopressin, and Amiodorone.
POD#1 the Epi was weaned and he was extubated and his chest
tubes were d/c'd on POD#3.  The Milrinone and Neo were gradually
weaned. POD#5 he was transferred to the floor in stable
condition.  He continued to progress well and was discharged to
rehab on POD#9 in stable condition.  Plastic surgery followed
his sacral decubitus throughout his stay and general surgery
ruled out a peri-rectal abcess.



Medications on Admission:
Lipitor 80 mg PO QD
Amiodarone 400 mg PO QD
Lopressor 12.5 mg PO BID
Klonopin 0/5 mg PO TID
Lasix 40 mg PO BID
Glyburide 15 mg PO QD
Escitalopram 20 mg PO QD
ASA 325 mg PO QD
Zetia 10 mg PO QD
Folate

Discharge Medications:
1. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO once a day. Capsule, Sustained
Release(s)
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
6. Atorvastatin Calcium 40 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
7. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
8. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily) for 4 weeks.
11. Escitalopram Oxalate 10 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
12. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
13. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

15. Glyburide 5 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
16. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 7 days.
17. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Tablet(s)


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 582**] Of [**Location (un) 620**]

Discharge Diagnosis:
Coronary artery disease.
NIDDM
GERD
CHF
Decubitis ulcer
Sleep apnea
PVD
HTN
Cardiomyopathy
^chol.
Ventricular arrythmias


Discharge Condition:
Good.

Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Follow medications on discharge instructions.
You may not drive for 6 weeks.
You may not lift more than 10 lbs. for 3 months.
You should shower, let water flow over wounds, pat dry with a
towel.

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) 1407**] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) **] for 2-3 weeks.
Make an appointment with Dr. [**Last Name (STitle) 284**] for 4 weeks.
Make an appointment with Dr. [**Last Name (STitle) **] for 4 weeks.
Follow up with Dr. [**First Name (STitle) **] of plastic surgey as needed.



Completed by:[**2123-3-13**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other primary cardiomyopathies,Pressure ulcer, lower back,Paroxysmal ventricular tachycardia,Mechanical complication of automatic implantable cardiac defibrillator,Unspecified septicemia,Sepsis,Acute respiratory failure,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Unspecified disorder of kidney and ureter,Esophageal reflux,Unspecified sleep apnea,Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Unspecified essential hypertension'}


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: 58 year old white male with CHF.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 58 year-old male with known 3-vessel CAD, severe
systolic dysfunction with EF 18% on ventriculogram in [**1-/2123**],
DM type 2, and [**Hospital 15134**] transferred from [**Hospital 4068**] hospital for
management of fever, CHF and NSTEMI. He was recently discharged
from [**Hospital1 18**] on [**2123-1-28**] after a 3-week admission for pulmonary
edema, and pneumonia. During that admission, a cardiac
catheterization revealed diffuse 3-vessel CAD with 60% LMCA
disease, serial LAD lesions as well as diffuse disease of LCx
and TO of RCA with collaterals. He had a BiV pacer placed during
that admission (for polymorphic VT). Per report, medical
management of his CAD was advised.

MEDICAL HISTORY: Coronary artery disease with severe 3-vessel disease
Congestive heart failure with EF 18% on ventriculogram in [**1-/2123**]
Hypercholesterolemia
Diabetes mellitus type 2
Hypertension
Infrarenal AAA of 3 cm status post repair [**2119**]
Bilateral iliac artery aneurysms
Anxiety disorder
Gastroesophageal reflux disease
S/p excision of melanoma of the lower back in [**2088**]
S/p septoplasty surgery and tonsillectomy

MEDICATION ON ADMISSION: Lipitor 80 mg PO QD
Amiodarone 400 mg PO QD
Lopressor 12.5 mg PO BID
Klonopin 0/5 mg PO TID
Lasix 40 mg PO BID
Glyburide 15 mg PO QD
Escitalopram 20 mg PO QD
ASA 325 mg PO QD
Zetia 10 mg PO QD
Folate

ALLERGIES: Hydrochlorothiazide / Demerol / Ambien

PHYSICAL EXAM: Physical examination prior to admission to CCU:
VITALS: T 100, BP 105/50 on Dopamine 2.5, Levophed 0.03, HR 83
Vent: AC 600 X 12, PEEP 5, FiO2 100%, Sat 100%
GEN: Intubated, alert, not sedated.
HEENT: ETT in place, OGT in place.
NECK: JVP to jaw.
RESP: ICD in place left anterior chest. Ronchorous breath sounds
bilaterally, with inspiratory crackles.
CVS: Normal S1, S2. No S3, S4. No murmur or rub appreciated.
GI: Obese abdomen. BS normoactive. Abdomen soft and non-tender.
Reported guaiac negative in ED.
EXT: No femoral bruits. Trace bilateral pedal edema. Strong
peripheral pulses.

FAMILY HISTORY: Father with MI in 50s

SOCIAL HISTORY: Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Other primary cardiomyopathies,Pressure ulcer, lower back,Paroxysmal ventricular tachycardia,Mechanical complication of automatic implantable cardiac defibrillator,Unspecified septicemia,Sepsis,Acute respiratory failure,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Unspecified disorder of kidney and ureter,Esophageal reflux,Unspecified sleep apnea,Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of native arteries of the extremities, unspecified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus,Unspecified essential hypertension'}
