CHIEF COMPLAINT: Mild dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 45068**] is a 78 year old male found to have abnormal ECG on
routine exam. Subsequent ETT in [**2198-2-8**] was notable for
1.0-1.5mm ST depression in V4-V6 at peak exercise. Imaging
revealed inferoapical and septal ischemia. Cardiac
catheterization in [**2198-3-8**] showed severe three vessel disease
and normal LV function. Based upon the above results, he was
referred for cardiac surgical intervention.

MEDICAL HISTORY: Coronary Artery Disease, Hypertension, Hypercholesterolemia,
Osteoarthritis, Depression

MEDICATION ON ADMISSION: HCTZ 50 qd, Simvastatin 80 qd, Atenolol 50 qd, Aspirin 325 qd,
Ativan prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 176/94, HR 81, RR 12
General: elderly male in no acute distress
HEENT: oropharynx benign, sclera red without discharge
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub, distant
heart sounds
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Brother and sister with CABG in their 80's. Denies premature
CAD.

SOCIAL HISTORY: 40 pack year history of tobacco, quit approximately 38 years
ago. Admits to drinking several glasses of wine per day.
Retired. Married with one child.
Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Acute posthemorrhagic anemia,Atrial fibrillation,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, other specified sites,Depressive disorder, not elsewhere classified
Crnry athrscl natve vssl,Thoracic aortic aneurysm,Ac posthemorrhag anemia,Atrial fibrillation,Hypertension NOS,Delirium d/t other cond,Pure hypercholesterolem,Osteoarthro NOS-oth site,Depressive disorder NEC
Admission Date:  [**2198-3-23**]              Discharge Date:   [**2198-4-1**]

Date of Birth:  [**2119-7-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Mild dyspnea

Major Surgical or Invasive Procedure:
[**2198-3-23**] Three Vessel Coronary Artery Bypass Grafting utilizing
the left internal mammary artery to left anterior descending,
with vein grafts to the ramus intermedius and PLV. Replacement
of Ascending Aorta utilizing a 26mm Gelweave Dacron Graft.


History of Present Illness:
Mr. [**Known lastname 45068**] is a 78 year old male found to have abnormal ECG on
routine exam. Subsequent ETT in [**2198-2-8**] was notable for
1.0-1.5mm ST depression in V4-V6 at peak exercise. Imaging
revealed inferoapical and septal ischemia. Cardiac
catheterization in [**2198-3-8**] showed severe three vessel disease
and normal LV function. Based upon the above results, he was
referred for cardiac surgical intervention.

Past Medical History:
Coronary Artery Disease, Hypertension, Hypercholesterolemia,
Osteoarthritis, Depression


Social History:
40 pack year history of tobacco, quit approximately 38 years
ago. Admits to drinking several glasses of wine per day.
Retired. Married with one child.

Family History:
Brother and sister with CABG in their 80's. Denies premature
CAD.

Physical Exam:
Vitals: BP 176/94, HR 81, RR 12
General: elderly male in no acute distress
HEENT: oropharynx benign, sclera red without discharge
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub, distant
heart sounds
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 1+ distally
Neuro: nonfocal


Pertinent Results:
[**2198-3-23**] Intraoperative TEE:

MEASUREMENTS:
Left Ventricle - Inferolateral Thickness: *1.2 cm (nl 0.6 - 1.1
cm)
Left Ventricle - Ejection Fraction: 50% to 55% (nl >=55%)
Aorta - Ascending: *4.5 cm (nl <= 3.4 cm)
Aorta - Arch: 2.6 cm (nl <= 3.0 cm)
Aorta - Descending Thoracic: *2.7 cm (nl <= 2.5 cm)

INTERPRETATION:
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.

LEFT VENTRICLE: Mild symmetric LVH. Normal regional LV systolic
function. Low normal LVEF.
LV WALL MOTION: basal anterior - normal; mid anterior - normal;
basal anteroseptal - normal; mid anteroseptal - normal; basal
inferoseptal - normal; mid inferoseptal - normal; basal inferior
- normal; mid inferior - normal; basal inferolateral - normal;
mid inferolateral - normal; basal anterolateral - normal; mid
anterolateral - normal; anterior apex - normal; septal apex
-normal; inferior apex - normal; lateral apex normal
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Moderately dilated ascending aorta. Simple atheroma in
ascending aorta. Focal calcifications in ascending aorta. Normal
aortic arch diameter. Simple atheroma in aortic arch. Focal
calcifications in aortic arch. Mildly dilated descending aorta.
There are complex (>4mm) atheroma in the descending thoracic
aorta.
AORTIC VALVE: Mildly thickened aortic valve leaflets. No AS.
Trace AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild
mitral annular
calcification. Mild (1+) MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets. Physiologic
TR.
PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.



Brief Hospital Course:
Mr. [**Known lastname 45068**] was admitted and underwent coronary artery bypass
grafting surgery. Given intraoperative findings of an ascending
aortic aneurysm, he required replacement of his ascending aorta
as well. For surgical details, please see seperate dictated
operative note. Following the operation, he was brought to the
CSRU for invasive monitoring. Within 24 hours, he awoke
neurologically intact and was extubated without incident. He
maintained stable hemodynamics and weaned from Neosynephrine
without difficulty. His CSRU course was uneventful, and he
transferred to the SDU on postopertive day two. He initially
required a 1:1 sitter for some postoperative delirium/confusion.
Haldol was intermittently utilized for agitation. Bursts of
paroxsymal atrial fibrillation were noted which resolved with an
increase in beta blockade. Beta blockade was advanced as
tolerated while K and Mg levels were monitored and repleted per
protocol. He also required several units of packed red blood
cells for a postoperative anemia. Over several days, his mental
status improved. Sternal drainage was also noted but there was
no clinical evidence of infection. stop [**3-27**]

Medications on Admission:
HCTZ 50 qd, Simvastatin 80 qd, Atenolol 50 qd, Aspirin 325 qd,
Ativan prn

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet 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. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 7 days.
Disp:*28 Capsule(s)* Refills:*0*
7. Potassium Chloride 20 mEq Packet Sig: One (1)  PO once a day
for 7 days.
Disp:*7 packets* Refills:*0*
8. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 50 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
Disp:*270 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary Artery Disease and Ascending Aortic Aneursym - s/p
Coronary Artery Bypass Grafting and Replacement of Ascending
Aorta, Postoperative Atrial Fibrillation, Postoperative Anemia,
Postoperative Altered Mental Status, Hypertension,
Hypercholesterolemia, Osteoarthritis, Depression


Discharge Condition:
Good


Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions.

Followup Instructions:
Cardiac surgeon, Dr. [**First Name (STitle) **] in [**4-12**] weeks.
Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in [**2-10**] weeks.
Local cardiologist, Dr. [**First Name (STitle) **] in [**2-10**] weeks.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]
{'Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Acute posthemorrhagic anemia,Atrial fibrillation,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, other specified sites,Depressive disorder, not elsewhere classified'}


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: Mild dyspnea

PRESENT ILLNESS: Mr. [**Known lastname 45068**] is a 78 year old male found to have abnormal ECG on
routine exam. Subsequent ETT in [**2198-2-8**] was notable for
1.0-1.5mm ST depression in V4-V6 at peak exercise. Imaging
revealed inferoapical and septal ischemia. Cardiac
catheterization in [**2198-3-8**] showed severe three vessel disease
and normal LV function. Based upon the above results, he was
referred for cardiac surgical intervention.

MEDICAL HISTORY: Coronary Artery Disease, Hypertension, Hypercholesterolemia,
Osteoarthritis, Depression

MEDICATION ON ADMISSION: HCTZ 50 qd, Simvastatin 80 qd, Atenolol 50 qd, Aspirin 325 qd,
Ativan prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 176/94, HR 81, RR 12
General: elderly male in no acute distress
HEENT: oropharynx benign, sclera red without discharge
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub, distant
heart sounds
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, no edema, no varicosities
Pulses: 1+ distally
Neuro: nonfocal

FAMILY HISTORY: Brother and sister with CABG in their 80's. Denies premature
CAD.

SOCIAL HISTORY: 40 pack year history of tobacco, quit approximately 38 years
ago. Admits to drinking several glasses of wine per day.
Retired. Married with one child. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Thoracic aneurysm without mention of rupture,Acute posthemorrhagic anemia,Atrial fibrillation,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Pure hypercholesterolemia,Osteoarthrosis, unspecified whether generalized or localized, other specified sites,Depressive disorder, not elsewhere classified'}
