CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: This is a 79 year old male who presented to outside hospital
with worsening shortness of breath, dyspnea on exertion and
paroxsymal nocturnal dyspnea. He denied chest pain at that time.
He ruled in for a NSTEMI, with troponin peaking as high a 5.35.
Echocardiogram showed 2+ mitral regurgitation with reduced LV
ejection fraction and diastolic dysfunction. He subsequently
underwent cardiac catheterization which revealed severe three
vessel disease. He was [**Hospital **] transferred to the [**Hospital1 18**] for
cardiac surgical intervention.

MEDICAL HISTORY: Coronary artery disease
Diabetes Mellitus Type II
Hypercholesterolemia
Osteoarthritis
Spinal Stenosis
Benign Prostatic Hypertrophy
Peripheral Neuropathy
Claudication
s/p Vocal Cord Surgery
s/p Right Colectomy
s/p Left Knee Replacement

MEDICATION ON ADMISSION: Nifedical XL 60 qd
Doxazosin 4 qd
Triameterene 37.5 qd
Metoprolol 25 [**Hospital1 **]

ALLERGIES: Morphine / Conray

PHYSICAL EXAM: Vitals: BP 145/80, HR 72, RR 18, SAT  94% on room air
General: well appearing male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, trace edema, no varicosities
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: Brothers with CAD, s/p CABG.

SOCIAL HISTORY: Former smoker. Denies ETOH and recreational drugs
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Pure hypercholesterolemia
Subendo infarct, initial,CHF NOS,Mitral valve disorder,Surg compl-heart,Cardiac arrest,Crnry athrscl natve vssl,DMII neuro nt st uncntrl,Neuropathy in diabetes,Pure hypercholesterolem
Admission Date:  [**2129-8-3**]              Discharge Date:   [**2129-8-6**]

Date of Birth:  [**2050-4-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Morphine / Conray

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2129-8-5**] 1. Coronary Artery Bypass Grafting utilizing left
internal mammary to left anterior descending. 2. Mitral Valve
Replacement utilizing a 27 millimeter CE pericardial valve. 3.
Placement of Circumflex Marginal Stent.

History of Present Illness:
This is a 79 year old male who presented to outside hospital
with worsening shortness of breath, dyspnea on exertion and
paroxsymal nocturnal dyspnea. He denied chest pain at that time.
He ruled in for a NSTEMI, with troponin peaking as high a 5.35.
Echocardiogram showed 2+ mitral regurgitation with reduced LV
ejection fraction and diastolic dysfunction. He subsequently
underwent cardiac catheterization which revealed severe three
vessel disease. He was [**Hospital **] transferred to the [**Hospital1 18**] for
cardiac surgical intervention.

Past Medical History:
Coronary artery disease
Diabetes Mellitus Type II
Hypercholesterolemia
Osteoarthritis
Spinal Stenosis
Benign Prostatic Hypertrophy
Peripheral Neuropathy
Claudication
s/p Vocal Cord Surgery
s/p Right Colectomy
s/p Left Knee Replacement

Social History:
Former smoker. Denies ETOH and recreational drugs

Family History:
Brothers with CAD, s/p CABG.

Physical Exam:
Vitals: BP 145/80, HR 72, RR 18, SAT  94% on room air
General: well appearing male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, trace edema, no varicosities
Pulses: 2+ distally
Neuro: nonfocal


Pertinent Results:
[**8-3**] Chest X-ray: No acute cardiopulmonary abnormality
[**8-4**] Carotid Ultrasound: No evidence of stenosis in either
carotid artery.
[**8-4**] Echo: The left atrium is mildly dilated. Left ventricular
wall thicknesses are normal. The left ventricular cavity size is
normal. There is moderate global left ventricular hypokinesis
(ejection fraction 30-40 percent). Right ventricular chamber
size and free wall motion are normal. The ascending aorta is
mildly dilated. The aortic valve leaflets (3) are mildly
thickened. There is a minimally increased gradient consistent
with minimal aortic valve stenosis. The mitral valve leaflets
are mildly thickened. There is no mitral valve prolapse. Trivial
mitral regurgitation is seen. Moderate [2+] tricuspid
regurgitation is seen. There is moderate pulmonary artery
systolic hypertension. There is no pericardial effusion

[**2129-8-3**] 11:01PM BLOOD WBC-11.9* RBC-3.59* Hgb-12.1* Hct-32.6*
MCV-91 MCH-33.8* MCHC-37.2* RDW-12.9 Plt Ct-145*
[**2129-8-6**] 09:35AM BLOOD WBC-13.2* RBC-2.73* Hgb-8.4* Hct-23.6*
MCV-87 MCH-30.6 MCHC-35.4* RDW-15.1 Plt Ct-88*
[**2129-8-3**] 11:01PM BLOOD PT-13.4* PTT-26.8 INR(PT)-1.2*
[**2129-8-6**] 09:35AM BLOOD PT-17.5* PTT-85.8* INR(PT)-1.6*
[**2129-8-6**] 05:05AM BLOOD Glucose-443* UreaN-26* Creat-1.5* Na-146*
K-3.3 Cl-105 HCO3-18* AnGap-26*
[**2129-8-6**] 08:02AM BLOOD ALT-228* AST-181* LD(LDH)-524* AlkPhos-44
Amylase-319* TotBili-0.9
[**2129-8-6**] 09:51AM BLOOD Type-ART pO2-65* pCO2-45 pH-7.25*
calTCO2-21 Base XS--7

Brief Hospital Course:
Mr. [**Known lastname 68068**] was admitted to the cardiac surgical service and
underwent routine preoperative evaluation. He remained pain free
on medical therapy. Workup was essentially unremarkable except
for a positive urinalysis for which he was started on empiric
antibiotics for potential urinary tract infection. He was
otherwise cleared for surgery. Given his coronary anatomy, it
was agreed upon to performed a hybrid procedure of cornary
artery bypass grafting, mitral valve replacement with
concomitant percutaneous coronary intervention.

On [**8-5**], Dr. [**Last Name (STitle) 914**] performed single vessel coronary
artery bypass grafting and a mitral valve replacement.
Immediately following, Dr. [**Last Name (STitle) **] successfully placed two
Cypher DES to the mid and distal circumflex. His operative
course was notable for ventricular arrhythmias and hypotension.
He required multiple inotropes to wean from cardiopulmonary
bypass. Immediately following transfer to the CSRU, he
experienced wide complex tahcycardia and hypotension which did
not respond to pressors or defibrillation. He emergently
returned to the operating room where repeat cardiac
catheterization was performed. Amgiography revealed a widely
patent LIMA to LAD and widely patent circumflex stents. Given
his hemodynamic [**Last Name (LF) 68069**], [**First Name3 (LF) **] IABP was placed. He returned to
the CSRU in critical condition. Despite multiple pressors and
IABP support, he remained hypotensive and continued to
experience ventricular arrhythmias. He became acidotic,
coagulopathic with elevation in liver function tests. After
discusssion with the family, it was decided to withdraw medical
support and the patient expired on [**8-6**].

Medications on Admission:
Nifedical XL 60 qd
Doxazosin 4 qd
Triameterene 37.5 qd
Metoprolol 25 [**Hospital1 **]

Discharge Medications:
Not Applicable

Discharge Disposition:
Expired

Facility:
[**Hospital1 69**]

Discharge Diagnosis:
Postoperative Cardiogenic Shock, Postoperative Ventricular
arrhythmias, Congestive Heart Failure, Coronary Artery Disease,
Mitral Regurgitation, s/p Coronary Artery Bypass Grafting with
Mitral Valve Replacement and Placement of Stent to Circumflex
Marginal

Discharge Condition:
Expired

Discharge Instructions:
Not applicable

Followup Instructions:
Not appicable


Completed by:[**2129-8-25**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Pure hypercholesterolemia'}


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: Shortness of breath

PRESENT ILLNESS: This is a 79 year old male who presented to outside hospital
with worsening shortness of breath, dyspnea on exertion and
paroxsymal nocturnal dyspnea. He denied chest pain at that time.
He ruled in for a NSTEMI, with troponin peaking as high a 5.35.
Echocardiogram showed 2+ mitral regurgitation with reduced LV
ejection fraction and diastolic dysfunction. He subsequently
underwent cardiac catheterization which revealed severe three
vessel disease. He was [**Hospital **] transferred to the [**Hospital1 18**] for
cardiac surgical intervention.

MEDICAL HISTORY: Coronary artery disease
Diabetes Mellitus Type II
Hypercholesterolemia
Osteoarthritis
Spinal Stenosis
Benign Prostatic Hypertrophy
Peripheral Neuropathy
Claudication
s/p Vocal Cord Surgery
s/p Right Colectomy
s/p Left Knee Replacement

MEDICATION ON ADMISSION: Nifedical XL 60 qd
Doxazosin 4 qd
Triameterene 37.5 qd
Metoprolol 25 [**Hospital1 **]

ALLERGIES: Morphine / Conray

PHYSICAL EXAM: Vitals: BP 145/80, HR 72, RR 18, SAT  94% on room air
General: well appearing male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD, no carotid bruits
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, trace edema, no varicosities
Pulses: 2+ distally
Neuro: nonfocal

FAMILY HISTORY: Brothers with CAD, s/p CABG.

SOCIAL HISTORY: Former smoker. Denies ETOH and recreational drugs 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Mitral valve disorders,Cardiac complications, not elsewhere classified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Pure hypercholesterolemia'}
