CHIEF COMPLAINT: CP / CAD

PRESENT ILLNESS: This is a 73-year-old male who had a history of
coronary artery disease and had underwent a left internal
mammary artery H grafted with a radial artery to the left
anterior descending artery through a left anterior
thoracotomy many years ago. He had progressive shortness of
breath and was found to have critical aortic stenosis with
aortic valve area of 0.8 cm squared and moderate mitral
regurgitation. His ejection fraction was estimated to be
about a 25%. He also underwent a cardiac catheterization
which demonstrated that his H graft to the left anterior
descending artery was patent. He had a totally occluded left
anterior descending artery proximally. He also had
significant stenosis of his left circumflex artery and right
coronary artery.

MEDICAL HISTORY: lisinopril 30', coreg 3.125", norvasc 5', lipitor 40', coumadin

MEDICATION ON ADMISSION: lisinopril 30', coreg 3.125", norvasc 5', lipitor 40', coumadin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: retired electrical engineer with 7 children
Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of native coronary artery,Atherosclerosis of native arteries of the extremities with intermittent claudication,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Aortocoronary bypass status,Old myocardial infarction,Personal history of tobacco use,Personal history of malignant neoplasm of bronchus and lung
Mitral insuf/aort stenos,Crnry athrscl natve vssl,Ath ext ntv at w claudct,Surg compl-heart,Cardiac dysrhythmias NEC,Hypertension NOS,Pure hypercholesterolem,Aortocoronary bypass,Old myocardial infarct,History of tobacco use,Hx-bronchogenic malignan
Admission Date:  [**2132-10-6**]              Discharge Date:   [**2132-10-12**]

Date of Birth:  [**2058-10-28**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 1283**]
Chief Complaint:
CP / CAD

Major Surgical or Invasive Procedure:
Iliac and aortic stent placement [**2132-10-6**]
Re-do CABG X 4, AVR(tissue) [**2132-10-7**]


History of Present Illness:
This is a 73-year-old male who had a history of
coronary artery disease and had underwent a left internal
mammary artery H grafted with a radial artery to the left
anterior descending artery through a left anterior
thoracotomy many years ago. He had progressive shortness of
breath and was found to have critical aortic stenosis with
aortic valve area of 0.8 cm squared and moderate mitral
regurgitation. His ejection fraction was estimated to be
about a 25%. He also underwent a cardiac catheterization
which demonstrated that his H graft to the left anterior
descending artery was patent. He had a totally occluded left
anterior descending artery proximally. He also had
significant stenosis of his left circumflex artery and right
coronary artery.

It was recommended that he undergo a coronary artery bypass
grafting, aortic valve replacement, and possible mitral valve
repair/replacement. After the risks and benefits were
explained to the patient he agreed to proceed.


Past Medical History:
lisinopril 30', coreg 3.125", norvasc 5', lipitor 40', coumadin

Social History:
retired electrical engineer with 7 children

Pertinent Results:
[**2132-10-7**] 01:37PM BLOOD WBC-9.7# RBC-2.61*# Hgb-8.1*# Hct-23.2*
MCV-89 MCH-31.1 MCHC-34.9 RDW-14.1 Plt Ct-95*#
[**2132-10-10**] 07:15AM BLOOD WBC-11.0 RBC-4.05* Hgb-12.9* Hct-37.0*
MCV-91 MCH-31.7 MCHC-34.7 RDW-13.9 Plt Ct-137*
[**2132-10-11**] 05:10AM BLOOD PT-11.5 INR(PT)-1.0
[**2132-10-10**] 07:15AM BLOOD Plt Ct-137*
[**2132-10-12**] 05:25AM BLOOD Glucose-111* UreaN-20 Creat-1.0 Na-140
K-4.5 Cl-102 HCO3-28 AnGap-15

Conclusions:
Pre-CPB: No spontaneous echo contrast is seen in the left atrial
appendage.
There is mild symmetric left ventricular hypertrophy. The left
ventricular
cavity size is normal. Resting regional wall motion
abnormalities include
hypokinesis of septum, anterior, posterior and lateral walls at
the bases, and
akinesis of all mid-segments and apex. There is moderate global
right
ventricular free wall hypokinesis. There are simple atheroma in
the descending
thoracic aorta. There are three thickened aortic valve leaflets.
There is
moderate aortic valve stenosis. Mild (1+) aortic regurgitation
is seen. The
mitral valve leaflets are mildly thickened. Mild to moderate
([**2-11**]+) mitral
regurgitation with a central jet is seen. There is no
pericardial effusion.

Post-CPB: A well-seated and functioning prosthetic aortic valve
is seen. There
are no leaks. No AI. MR is 1+. Aorta is intact. Both ventricles
show slight
improvement in global systolic fxn. (The patient is on low-dose
epinephrine.)
Other parameters as pre-bypass.


Brief Hospital Course:
Patient was admitted after cardiac cath overnight, then
underwent an uncomplicated AVR with 23mm pericardial valve and
redo cabgx3. Patient came of CPB in the OR without incident, and
was treansferred to the csru intubated. pressors were weaned
that nights, and patient was extubated on POD1 after ppf was
switched to precedex for agitation when weaning. CTs were dc'd
on POD1, bblocker and asa started. He was then transferred to
the floor on POD2 after doing very well. Lopressor was gradually
increased for sinus tachycardia but was then swtiched to
carvedalol (his home med) to better control his HR&BP. Patient
was tolerating a regular diet ambulating well when he was
discharged home on POD5.

Medications on Admission:
lisinopril 30', coreg 3.125", norvasc 5', lipitor 40', coumadin

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO twice a day for 7 days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
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 Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. 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*
7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
9. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
AS
CAD
MR
[**First Name (Titles) 3593**]
[**Last Name (Titles) **]
hypercholesterolemia


Discharge Condition:
good


Discharge Instructions:
may shower, no bathing or swimming for 1 month
no creams, lotions or powders to any incisions
no driving for 1 month
no lifting > 10# for 10 weeks


[**Last Name (NamePattern4) 2138**]p Instructions:
with Dr. [**Last Name (STitle) **] in [**3-14**] weeks
with Dr. [**Last Name (Prefixes) **] in 4 weeks



Completed by:[**2132-10-12**]
{'Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of native coronary artery,Atherosclerosis of native arteries of the extremities with intermittent claudication,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Aortocoronary bypass status,Old myocardial infarction,Personal history of tobacco use,Personal history of malignant neoplasm of bronchus and lung'}


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: CP / CAD

PRESENT ILLNESS: This is a 73-year-old male who had a history of
coronary artery disease and had underwent a left internal
mammary artery H grafted with a radial artery to the left
anterior descending artery through a left anterior
thoracotomy many years ago. He had progressive shortness of
breath and was found to have critical aortic stenosis with
aortic valve area of 0.8 cm squared and moderate mitral
regurgitation. His ejection fraction was estimated to be
about a 25%. He also underwent a cardiac catheterization
which demonstrated that his H graft to the left anterior
descending artery was patent. He had a totally occluded left
anterior descending artery proximally. He also had
significant stenosis of his left circumflex artery and right
coronary artery.

MEDICAL HISTORY: lisinopril 30', coreg 3.125", norvasc 5', lipitor 40', coumadin

MEDICATION ON ADMISSION: lisinopril 30', coreg 3.125", norvasc 5', lipitor 40', coumadin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: retired electrical engineer with 7 children 

### Response:
{'Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of native coronary artery,Atherosclerosis of native arteries of the extremities with intermittent claudication,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Aortocoronary bypass status,Old myocardial infarction,Personal history of tobacco use,Personal history of malignant neoplasm of bronchus and lung'}
