CHIEF COMPLAINT: abnormal ETT

PRESENT ILLNESS: 68 year old male has a history of hypertension, hyperlipidemia
and cerebrovascular disease s/p stroke and left carotid
endarterectomy in [**2104**]. He also has a history of CAD s/p bare
metal RCA stenting in [**2123-9-5**]. He
presented back to [**Hospital1 18**] in [**2124-1-5**] where he was found
to have ISR of the RCA. This was treated with a drug eluting
stent. He continues on full strength Aspirin and Plavix. He has
recently undergone surveillance stress testing. This was
positive for apical and inferior ischemia. In terms of symptoms,
the patient reports feeling well without any complaints of chest
discomfort, shortness of breath, fatigue or any change in
activity tolerance. He was referred for left heart
catheterization to further evaluate. He is now being referred to
cardiac surgery for revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Coronary Artery Disease s/p NSTEMI, s/p RCA stenting in [**2123**]
[**2104**] CVA with residual mild slurred speech, mild numbness of
some
of the fingers on the right hand
[**2104**] Carotid artery disease s/p left CEA ([**Location (un) **] Hospital)

MEDICATION ON ADMISSION: ATORVASTATIN 20 mg daily
FUROSEMIDE 40 mg daily
MINOXIDIL 10 mg twice a day
NADOLOL 120 mg each evening
NITROGLYCERIN 0.4 mg Sublingual prn CP
ASPIRIN 325 mg daily
MULTIVITAMIN daily

ALLERGIES: Ticlopidine / Penicillins

PHYSICAL EXAM: Pulse: 60 Resp: 16  O2 sat: 96/RA
B/P  Right: 163/59   Left: 129/71
Height: 5'4"     Weight: 145 lbs

FAMILY HISTORY: father died from an MI in his 60's, and grandfather died from an
MI

SOCIAL HISTORY: Lives with:Wife
Occupation:Retired production line mechanic at [**Company 22916**]. He
works
part time as a custodian at a skating rink.
Tobacco:Quit 20 years ago at the time of a stroke, history of
smoking for 30 years
ETOH:occasional beer
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Other specified retention of urine,Old myocardial infarction,Late effects of cerebrovascular disease, other speech and language deficits,Iron deficiency anemia secondary to blood loss (chronic)
Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Status-post ptca,Oth spcf retention urine,Old myocardial infarct,Late ef-spch/lang df NEC,Chr blood loss anemia
Admission Date:  [**2124-7-11**]              Discharge Date:   [**2124-7-18**]

Date of Birth:  [**2055-10-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ticlopidine / Penicillins

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
abnormal ETT

Major Surgical or Invasive Procedure:
[**2124-7-11**] Coronary artery bypass graft surgery x3 (Left internal
mammary artery > left anterior descending, saphenous vein graft
> obtuse marginal, saphenous vein graft > posterior descending
artery)

History of Present Illness:
68 year old male has a history of hypertension, hyperlipidemia
and cerebrovascular disease s/p stroke and left carotid
endarterectomy in [**2104**]. He also has a history of CAD s/p bare
metal RCA stenting in [**2123-9-5**]. He
presented back to [**Hospital1 18**] in [**2124-1-5**] where he was found
to have ISR of the RCA. This was treated with a drug eluting
stent. He continues on full strength Aspirin and Plavix. He has
recently undergone surveillance stress testing. This was
positive for apical and inferior ischemia. In terms of symptoms,
the patient reports feeling well without any complaints of chest
discomfort, shortness of breath, fatigue or any change in
activity tolerance. He was referred for left heart
catheterization to further evaluate. He is now being referred to
cardiac surgery for revascularization.

Past Medical History:
Hypertension
Hyperlipidemia
Coronary Artery Disease s/p NSTEMI, s/p RCA stenting in [**2123**]
[**2104**] CVA with residual mild slurred speech, mild numbness of
some
of the fingers on the right hand
[**2104**] Carotid artery disease s/p left CEA ([**Location (un) **] Hospital)

Social History:
Lives with:Wife
Occupation:Retired production line mechanic at [**Company 22916**]. He
works
part time as a custodian at a skating rink.
Tobacco:Quit 20 years ago at the time of a stroke, history of
smoking for 30 years
ETOH:occasional beer

Family History:
father died from an MI in his 60's, and grandfather died from an
MI

Physical Exam:
Pulse: 60 Resp: 16  O2 sat: 96/RA
B/P  Right: 163/59   Left: 129/71
Height: 5'4"     Weight: 145 lbs

General: NAD, alert and cooperative
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck: Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x] Irregular [] III/VI systolic Murmur across
precordium
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
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      Right/Left: murmur radiates into both
carotids

Pertinent Results:
[**2124-7-11**] Echo: PREBYPASS: 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. There
are complex (mobile) atheroma in the descending aorta. The
aortic valve leaflets (3) are mildly thickened. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Trivial mitral regurgitation is seen.
POSTBYPASS: There is preserved biventricular systolic function.
The study is otherwise unchanged from prebypass.

[**2124-7-16**] CXR: There are median sternotomy wires identified. The
cardiac silhouette and mediastinum is normal. Lungs are clear.
There are no signs for focal consolidation or pneumothoraces or
pulmonary edema. On the lateral view, there is blunting of
bilateral CP angles suggestive for small pleural effusions.

[**2124-7-11**] 03:19PM BLOOD WBC-7.8 RBC-2.67*# Hgb-8.3*# Hct-22.9*#
MCV-86 MCH-31.1 MCHC-36.3* RDW-14.1 Plt Ct-164
[**2124-7-18**] 06:08AM BLOOD WBC-8.5 RBC-3.18* Hgb-9.7* Hct-27.6*
MCV-87 MCH-30.4 MCHC-35.0 RDW-13.9 Plt Ct-344
[**2124-7-11**] 03:19PM BLOOD PT-16.3* PTT-37.5* INR(PT)-1.4*
[**2124-7-11**] 04:27PM BLOOD UreaN-17 Creat-0.7 Na-142 K-4.2 Cl-112*
HCO3-25 AnGap-9
[**2124-7-18**] 06:08AM BLOOD UreaN-21* Creat-0.8 Na-134 K-4.6 Cl-98
HCO3-26 AnGap-15
[**2124-7-12**] 03:14AM BLOOD Calcium-8.0* Phos-4.4 Mg-2.6

Brief Hospital Course:
On [**7-11**] Mr. [**Known lastname **] was admitted same day surgery and was brought
to operating room for coronary artery bypass graft surgery. He
received Cefazolin for perioperative antibiotics and was
transferred to the intensive care unit for post operative
management. That evening he was weaned off sedation, awoke
neurologically intact and was extubated without complications.
On post operative day one he was started on diuretics and
remained in intensive care requiring epicardial pacing. On post
operative day two he was started on Beta blockers/aspirin/statin
and diuresis. He continued to progress and was transferred to
the step down unit on [**7-15**]. Physical therapy was consulted for
evaluation of his strength and mobility. Chest tubes and
epicardial wires were removed per protocol. Mr.[**Known lastname **] failed to
void and a Foley catheter was replaced, narcotics were stopped,
and he was placed on Flomax. On the night of post-op day six he
again had a voiding trial, which was successful, and his Foley
was removed. On post-op day seven he was cleared for discharge
to home with VNA and the appropriate medications. All follow up
appointments were advised.

Medications on Admission:
ATORVASTATIN 20 mg daily
FUROSEMIDE 40 mg daily
MINOXIDIL 10 mg twice a day
NADOLOL 120 mg each evening
NITROGLYCERIN 0.4 mg Sublingual prn CP
ASPIRIN 325 mg daily
MULTIVITAMIN daily

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(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. 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*
4. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 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:*30 Capsule, Ext Release 24 hr(s)* Refills:*2*
9. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
2 weeks.
Disp:*14 Tablet(s)* Refills:*0*
10. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day for 2 weeks.
Disp:*14 Tablet, ER Particles/Crystals(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Coronary artery disease s/p Coronary artery bypass garft x 3
Past medical history:
Hypertension
Hyperlipidemia
s/p NSTEMI, s/p RCA stenting in [**2123**]
[**2104**] CVA with residual mild slurred speech, mild numbness of
some of the fingers on the right hand
[**2104**] Carotid artery disease s/p left CEA

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 Left - healing well, no erythema or drainage.
trace - 1+ Edema

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**]

**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) **] on [**8-2**] at 1:00pm
Cardiologist: Dr [**Last Name (STitle) **] on [**8-17**] at 1:30pm

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) 24862**] [**Telephone/Fax (1) 64296**] in [**5-9**] 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:[**2124-7-18**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Other specified retention of urine,Old myocardial infarction,Late effects of cerebrovascular disease, other speech and language deficits,Iron deficiency anemia secondary to blood loss (chronic)'}


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: abnormal ETT

PRESENT ILLNESS: 68 year old male has a history of hypertension, hyperlipidemia
and cerebrovascular disease s/p stroke and left carotid
endarterectomy in [**2104**]. He also has a history of CAD s/p bare
metal RCA stenting in [**2123-9-5**]. He
presented back to [**Hospital1 18**] in [**2124-1-5**] where he was found
to have ISR of the RCA. This was treated with a drug eluting
stent. He continues on full strength Aspirin and Plavix. He has
recently undergone surveillance stress testing. This was
positive for apical and inferior ischemia. In terms of symptoms,
the patient reports feeling well without any complaints of chest
discomfort, shortness of breath, fatigue or any change in
activity tolerance. He was referred for left heart
catheterization to further evaluate. He is now being referred to
cardiac surgery for revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Coronary Artery Disease s/p NSTEMI, s/p RCA stenting in [**2123**]
[**2104**] CVA with residual mild slurred speech, mild numbness of
some
of the fingers on the right hand
[**2104**] Carotid artery disease s/p left CEA ([**Location (un) **] Hospital)

MEDICATION ON ADMISSION: ATORVASTATIN 20 mg daily
FUROSEMIDE 40 mg daily
MINOXIDIL 10 mg twice a day
NADOLOL 120 mg each evening
NITROGLYCERIN 0.4 mg Sublingual prn CP
ASPIRIN 325 mg daily
MULTIVITAMIN daily

ALLERGIES: Ticlopidine / Penicillins

PHYSICAL EXAM: Pulse: 60 Resp: 16  O2 sat: 96/RA
B/P  Right: 163/59   Left: 129/71
Height: 5'4"     Weight: 145 lbs

FAMILY HISTORY: father died from an MI in his 60's, and grandfather died from an
MI

SOCIAL HISTORY: Lives with:Wife
Occupation:Retired production line mechanic at [**Company 22916**]. He
works
part time as a custodian at a skating rink.
Tobacco:Quit 20 years ago at the time of a stroke, history of
smoking for 30 years
ETOH:occasional beer 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Other specified retention of urine,Old myocardial infarction,Late effects of cerebrovascular disease, other speech and language deficits,Iron deficiency anemia secondary to blood loss (chronic)'}
