CHIEF COMPLAINT: Chest pain/Dyspnea on exertion

PRESENT ILLNESS: 51 y/o female who was hospitalized earlier this for for NSAID
induced GIB. During her admission, was found to have an elevated
troponin. An echo performed showed 2+ MR, depressed LV function
and wall abnormalities. Cardiac cath revealed 3 vessel disease.

MEDICAL HISTORY: Myocardial Infarction [**4-16**], Hyperlipidemia, Hypertension, GI
bleed, Peptic Ulcer Disease, Hypothyroidism, Elevated
cholesterol,Depression, Asthma, Herniated disc, Osteopenia, s/p
Thyroidectomy, s/p ex-lap, s/p appendectomy, s/p right elbow
surgery, s/p tubal ligation, s/p partial hysterectomy

MEDICATION ON ADMISSION: Aspirin 81mg qd, Prilosec 40mg qd, Toprol XL 50mg qd, Prozac
40mg and 80mg alt, Levoxyl 88mcg qd, Lipitor 80mg qd, Lisinopril
10mg qd, NTG prn, MVI, Ambien 5mg qd, Ativan 1mg qid,
Calcium/Vit D qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 74 152/84 67" 154#
Gen: WD/WN anxious female
Skin: W/D, unremarkable
HEENT: EOMI, PERRL, anicteric, OP benign
Neck: Supple, FROM, -JVD, -bruit
Chest: CTAB -w/r/r
Heart: RRR, faint SEM
Abd: Soft, NT/ND, +BS, well-healed midline scar
ExT: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, non-focal

FAMILY HISTORY: Father with h/o liver disease presumed [**3-14**] EtOH and upper GI
bleed. Brother with h/o liver disease presumed [**3-14**] EtOH.

SOCIAL HISTORY: Lives in [**Location 3146**], Mass. with boyfriend and 26yo daughter. [**Name (NI) 1403**]
as nurse [**First Name (Titles) **] [**Last Name (Titles) **] NH. + tobacco, 1/2ppd x 40y. + occ. EtOH
([**3-15**] drinks, 1x/wk). Denies IVDU.
Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Old myocardial infarction
Mitral valve disorder,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Hypothyroidism NOS,Depressive disorder NEC,Old myocardial infarct
Admission Date:  [**2160-7-17**]              Discharge Date:   [**2160-7-21**]

Date of Birth:  [**2108-10-11**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pain/Dyspnea on exertion

Major Surgical or Invasive Procedure:
s/p CABGx3(LIMA->LAD, SVG->OM, PDA)/MVR(29mm [**Company 1543**] Mosaic
porcine valve) [**2160-7-17**]

History of Present Illness:
51 y/o female who was hospitalized earlier this for for NSAID
induced GIB. During her admission, was found to have an elevated
troponin. An echo performed showed 2+ MR, depressed LV function
and wall abnormalities. Cardiac cath revealed 3 vessel disease.

Past Medical History:
Myocardial Infarction [**4-16**], Hyperlipidemia, Hypertension, GI
bleed, Peptic Ulcer Disease, Hypothyroidism, Elevated
cholesterol,Depression, Asthma, Herniated disc, Osteopenia, s/p
Thyroidectomy, s/p ex-lap, s/p appendectomy, s/p right elbow
surgery, s/p tubal ligation, s/p partial hysterectomy

Social History:
Lives in [**Location 3146**], Mass. with boyfriend and 26yo daughter. [**Name (NI) 1403**]
as nurse [**First Name (Titles) **] [**Last Name (Titles) **] NH. + tobacco, 1/2ppd x 40y. + occ. EtOH
([**3-15**] drinks, 1x/wk). Denies IVDU.

Family History:
Father with h/o liver disease presumed [**3-14**] EtOH and upper GI
bleed. Brother with h/o liver disease presumed [**3-14**] EtOH.

Physical Exam:
VS: 74 152/84 67" 154#
Gen: WD/WN anxious female
Skin: W/D, unremarkable
HEENT: EOMI, PERRL, anicteric, OP benign
Neck: Supple, FROM, -JVD, -bruit
Chest: CTAB -w/r/r
Heart: RRR, faint SEM
Abd: Soft, NT/ND, +BS, well-healed midline scar
ExT: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, non-focal

Pertinent Results:
[**2160-7-17**] Echo: Pre-CPB: 1. The left atrium is moderately dilated.
No spontaneous echo contrast is seen in the body of the left
atrium. No spontaneous echo contrast or thrombus is seen in the
body of the left atrium or left atrial appendage. 2. No atrial
septal defect is seen by 2D or color Doppler. 3. Left
ventricular wall thicknesses and cavity size are normal. Overall
left ventricular systolic function is mildly depressed. LVEF
45%. There is apical hypokinesis. 4. Right ventricular chamber
size and free wall motion are normal. 5. There are simple
atheroma in the ascending aorta. There are simple atheroma in
the aortic arch. There are focal calcifications in the aortic
arch. There are simple atheroma in the descending thoracic
aorta. 6. There are three aortic valve leaflets. The aortic
valve leaflets are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen. 7. The mitral valve
leaflets are moderately thickened. There is bilateral leaflet
retraction with a central jet of MR. [**First Name (Titles) **] [**Last Name (Titles) 71984**] size is normal.
There is no mitral valve prolapse. There is no systolic anterior
motion of the mitral valve leaflets. Moderate to severe (3+)
mitral regurgitation is seen. The pulmonary vein flow profile is
normal. POST-CPB: On infusion of phenylephrine. Bioprosthetic
valve seen in the mitral position, well seated and without
perivalvular leak. Trivial MR noted. Trivial valvular anterior
systolic motion. Remaining exam unchanged - mildly depressed LV
function with apical akinesis. Aortic contours unchanged.
[**2160-7-21**] CXR: Comparison with [**2160-7-20**]. Tiny left apical
pneumothorax, unchanged. Improving atelectasis at the left lung
base. Linear atelectasis at the right hilum and in the lateral
left lung, unchanged. Cardiac, mediastinal, and hilar contours
are unchanged. Bilateral tiny pleural effusions are similar in
appearance. Osseous structures are similar in appearance.
[**2160-7-17**] 01:02PM BLOOD WBC-17.3*# RBC-3.00*# Hgb-8.6*#
Hct-25.5*# MCV-85 MCH-28.8 MCHC-33.8 RDW-16.6* Plt Ct-175
[**2160-7-21**] 07:00AM BLOOD WBC-9.3 RBC-3.08* Hgb-9.1* Hct-26.5*
MCV-86 MCH-29.7 MCHC-34.5 RDW-17.2* Plt Ct-183#
[**2160-7-17**] 01:02PM BLOOD PT-16.7* PTT-34.7 INR(PT)-1.5*
[**2160-7-18**] 02:32AM BLOOD PT-11.6 PTT-26.8 INR(PT)-1.0
[**2160-7-17**] 01:27PM BLOOD UreaN-6 Creat-0.7 Cl-113* HCO3-25
[**2160-7-21**] 07:00AM BLOOD Glucose-106* UreaN-7 Creat-0.5 Na-141
K-4.2 Cl-103 HCO3-31 AnGap-11
[**2160-7-19**] 04:15AM BLOOD Calcium-8.1* Phos-3.2 Mg-1.8

Brief Hospital Course:
Ms. [**Known lastname **] was a same day admit after undergoing pre-operative
work-up as an outpatient. She was brought to the operating room
where she underwent a coronary artery bypass graft x 3 and
mitral valve replacement. Please see operative report for
details. Following surgery she was transferred to the CSRU for
invasive monitoring in stable condition. Within 24 hours she was
weaned from sedation, awoke neurologically intact and extubated.
On post-op day one beta blockers and diuretics were started and
she was transferred to the telemetry floor for further care. She
was gently diuresed towards her pre-op weight. On post-op day
two and three chest tubes were removed. Epicardial pacing wires
were removed per protocol. She worked with physical therapy for
strength and mobility. Over the next couple of days she improved
and appeared suitable for discharge home on post-op day four.

Medications on Admission:
Aspirin 81mg qd, Prilosec 40mg qd, Toprol XL 50mg qd, Prozac
40mg and 80mg alt, Levoxyl 88mcg qd, Lipitor 80mg qd, Lisinopril
10mg qd, NTG prn, MVI, Ambien 5mg qd, Ativan 1mg qid,
Calcium/Vit D qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. 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*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every six (6) hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
6. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO EVERY OTHER
DAY (Every Other Day).
Disp:*30 Capsule(s)* Refills:*0*
7. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days.
Disp:*10 Tablet(s)* Refills:*0*
8. Fluoxetine 20 mg Capsule Sig: Four (4) Capsule PO EVERY OTHER
DAY (Every Other Day).
Disp:*60 Capsule(s)* Refills:*0*
9. Levoxyl 88 mcg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
10. Prilosec 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
11. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day for 10
days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Coronary artery disease s/p Coronary Artery Bypass Graft x 3
Mitral regurgitation s/p Mitral Valve Replacement
PMH: Myocardial Infarction [**4-16**], Hyperlipidemia, Hypertension,
GI bleed, Peptic Ulcer Disease, Hypothyroidism, Elevated
cholesterol,Depression, Asthma, Herniated disc, Osteopenia, s/p
Thyroidectomy, s/p ex-lap, s/p appendectomy, s/p right elbow
surgery, s/p tubal ligation, s/p partial hysterectomy

Discharge Condition:
Good

Discharge Instructions:
Please shower daily, no baths or swimming
Monitor wounds for infection - redness, drainage, or increased
pain - please call if any occurs [**Telephone/Fax (1) 170**]
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Make an appointment with Dr. [**Name (NI) **] for [**2-12**]
weeks.[**Telephone/Fax (1) 1144**]
Make an appointment with Dr. [**Last Name (STitle) 914**] for 4 weeks. [**Telephone/Fax (1) 170**]
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 1989**] Date/Time:[**2160-8-20**]
2:40
Wound check appointment [**Hospital Ward Name **] 2 [**Telephone/Fax (1) 3633**]


Completed by:[**2160-7-21**]
{'Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Old myocardial infarction'}


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: Chest pain/Dyspnea on exertion

PRESENT ILLNESS: 51 y/o female who was hospitalized earlier this for for NSAID
induced GIB. During her admission, was found to have an elevated
troponin. An echo performed showed 2+ MR, depressed LV function
and wall abnormalities. Cardiac cath revealed 3 vessel disease.

MEDICAL HISTORY: Myocardial Infarction [**4-16**], Hyperlipidemia, Hypertension, GI
bleed, Peptic Ulcer Disease, Hypothyroidism, Elevated
cholesterol,Depression, Asthma, Herniated disc, Osteopenia, s/p
Thyroidectomy, s/p ex-lap, s/p appendectomy, s/p right elbow
surgery, s/p tubal ligation, s/p partial hysterectomy

MEDICATION ON ADMISSION: Aspirin 81mg qd, Prilosec 40mg qd, Toprol XL 50mg qd, Prozac
40mg and 80mg alt, Levoxyl 88mcg qd, Lipitor 80mg qd, Lisinopril
10mg qd, NTG prn, MVI, Ambien 5mg qd, Ativan 1mg qid,
Calcium/Vit D qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 74 152/84 67" 154#
Gen: WD/WN anxious female
Skin: W/D, unremarkable
HEENT: EOMI, PERRL, anicteric, OP benign
Neck: Supple, FROM, -JVD, -bruit
Chest: CTAB -w/r/r
Heart: RRR, faint SEM
Abd: Soft, NT/ND, +BS, well-healed midline scar
ExT: Warm, well-perfused, -edema, -varicosities
Neuro: A&O x 3, non-focal

FAMILY HISTORY: Father with h/o liver disease presumed [**3-14**] EtOH and upper GI
bleed. Brother with h/o liver disease presumed [**3-14**] EtOH.

SOCIAL HISTORY: Lives in [**Location 3146**], Mass. with boyfriend and 26yo daughter. [**Name (NI) 1403**]
as nurse [**First Name (Titles) **] [**Last Name (Titles) **] NH. + tobacco, 1/2ppd x 40y. + occ. EtOH
([**3-15**] drinks, 1x/wk). Denies IVDU. 

### Response:
{'Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Old myocardial infarction'}
