CHIEF COMPLAINT: coronary artery disease

PRESENT ILLNESS: This 60 year old white male presented at [**Hospital3 1280**] with known
coronary disease but worsening dyspnea with exertion and
fatigue.  A stress est was positive with LV dilatation on
stressing, and catheterization revealed triple vessel disease.
He was transferred for surgery.

MEDICAL HISTORY: hypercholesterolemia
R eye does not fully close resulting in dry eyes
s/p Left hip replacement
s/p multiple knee surgeries
s/p repair of torn/ruptured achillies tendon-bilat

MEDICATION ON ADMISSION: atenolol 25'
simvastatin 40'
ibuprofen 800'
thera tears eye gtts
aspirin 325'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: admission:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives with:wife and son
Occupation:owns own real estate management company
Tobacco:denies
ETOH:occasional
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Hip joint replacement
Crnry athrscl natve vssl,Intermed coronary synd,Pure hypercholesterolem,BPH w/o urinary obs/LUTS,Hypertension NOS,Joint replaced hip
Admission Date:  [**2151-5-4**]              Discharge Date:   [**2151-5-10**]

Date of Birth:  [**2090-12-5**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
coronary artery disease

Major Surgical or Invasive Procedure:
coronary artery bypass x 3(LIMA-LAD, SVG-Diag, SVG-PDA) [**2151-5-6**]


History of Present Illness:
This 60 year old white male presented at [**Hospital3 1280**] with known
coronary disease but worsening dyspnea with exertion and
fatigue.  A stress est was positive with LV dilatation on
stressing, and catheterization revealed triple vessel disease.
He was transferred for surgery.

Past Medical History:
hypercholesterolemia
R eye does not fully close resulting in dry eyes
s/p Left hip replacement
s/p multiple knee surgeries
s/p repair of torn/ruptured achillies tendon-bilat


Social History:
Lives with:wife and son
Occupation:owns own real estate management company
Tobacco:denies
ETOH:occasional

Family History:
noncontributory


Physical Exam:
admission:

Pulse:61Resp: 16 O2 sat: 96 on RA
B/P  Right:126/62    Left:
Height:     Weight:

General:
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 []  Murmur
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[x]
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: none   Left:none

Pertinent Results:
[**2151-5-10**] 04:30AM BLOOD WBC-9.8 RBC-4.46* Hgb-13.4* Hct-39.3*
MCV-88 MCH-30.1 MCHC-34.2 RDW-13.3 Plt Ct-216
[**2151-5-8**] 06:00AM BLOOD WBC-12.8* RBC-4.58* Hgb-13.9* Hct-41.0
MCV-89 MCH-30.3 MCHC-33.9 RDW-13.4 Plt Ct-147*
[**2151-5-6**] 04:27PM BLOOD PT-13.8* PTT-25.8 INR(PT)-1.2*
[**2151-5-9**] 04:15AM BLOOD Glucose-106* UreaN-17 Creat-1.1 Na-137
K-4.0 Cl-98 HCO3-27 AnGap-16
[**2151-5-8**] 06:00AM BLOOD Glucose-111* UreaN-18 Creat-1.4* Na-137
K-4.4 Cl-100 HCO3-30 AnGap-11
[**2151-5-9**] 04:15AM BLOOD Mg-2.2

Intra-op TEE
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 simple atheroma in
the descending thoracic aorta. The aortic valve leaflets (3) are
mildly thickened. No aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. Physiologic mitral
regurgitation is seen (within normal limits).

POSTBYPASS
Biventricular systolic function is preserved. The study is
otherwise unchanged from prebypass.

Brief Hospital Course:
The patient was admitted to the hospital and brought to the
operating room on [**2151-5-6**] where the patient underwent CABG x 3.
Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring.  Vancomycin was
used for surgical antibiotic prophylaxis given the preoperative
stay of greater than 24 hours.  POD 1 found the patient
extubated, alert and oriented and breathing comfortably.  The
patient was neurologically intact and hemodynamically stable on
no inotropic or vasopressor support.  Beta blocker was initiated
and the patient was gently diuresed toward the preoperative
weight.  The patient was transferred to the telemetry floor for
further recovery.  Chest tubes and pacing wires were
discontinued without complication.  The patient was evaluated by
the physical therapy service for assistance with strength and
mobility.  By the time of discharge on POD 4 the patient was
ambulating freely, the wound was healing and pain was controlled
with oral analgesics.  The patient was discharged to home in
good condition with appropriate follow up instructions.

Medications on Admission:
atenolol 25'
simvastatin 40'
ibuprofen 800'
thera tears eye gtts
aspirin 325'


Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain/fever.
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
8. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day
for 1 weeks.
Disp:*7 Tablet(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 1
weeks.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] Area VNA

Discharge Diagnosis:
coronary artery disease
s/p coronary artery bypass grafts
hyperlipidemia
s/p left total knee replacement
s/p knee surgeries
chronic dry eye- right
benign prostatic hypertrophy


Discharge Condition:
Alert and oriented x3, nonfocal.
Ambulating with  steady gait.

Incisional pain managed with ultram

Incisions:

Sternal - healing well, no erythema or drainage

Leg Right/Left - healing well, no erythema or drainage. Edema:


Discharge Instructions:
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.

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, until follow up with
surgeon.
No lifting more than 10 pounds for 10 weeks.
Please call with any questions or concerns ([**Telephone/Fax (1) 170**]).
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge of sternal wound.



**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. [**First Name (STitle) **] ([**Telephone/Fax (1) 170**]) on [**6-7**] at 1:30

 Please call to schedule appointments with:

Primary Care/Card.:  Dr. [**Last Name (STitle) **],AUROBINDO [**Telephone/Fax (1) 8058**] in
[**12-12**] 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.**


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2151-5-10**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Hip joint replacement'}


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: coronary artery disease

PRESENT ILLNESS: This 60 year old white male presented at [**Hospital3 1280**] with known
coronary disease but worsening dyspnea with exertion and
fatigue.  A stress est was positive with LV dilatation on
stressing, and catheterization revealed triple vessel disease.
He was transferred for surgery.

MEDICAL HISTORY: hypercholesterolemia
R eye does not fully close resulting in dry eyes
s/p Left hip replacement
s/p multiple knee surgeries
s/p repair of torn/ruptured achillies tendon-bilat

MEDICATION ON ADMISSION: atenolol 25'
simvastatin 40'
ibuprofen 800'
thera tears eye gtts
aspirin 325'

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: admission:

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Lives with:wife and son
Occupation:owns own real estate management company
Tobacco:denies
ETOH:occasional 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Hip joint replacement'}
