CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 4020**] is a 53 year-old gentleman who underwent a CABGx3
on [**7-28**] with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**] at [**Hospital1 18**].  He had an uneventful
post-op course and was discharged on [**Last Name (un) **]-operative day 4.  He
has been followed since for a superficial sternal wound
infection and peripheral edema requiring increased doses of
lasix.  He presented to the emergency department with shortness
of breath and chest pain that worsens with coughing.

MEDICAL HISTORY: CAD s/p MI ([**2175**]) and multiple overlapping DES to LCx ([**2176-8-5**])

MEDICATION ON ADMISSION: methadone 40 mg TID
diazepam 5mg TID PRN pain
aspirin 81mg daily
docusate sodium 100mg [**Hospital1 **]
clopidogrel 75mg daily
prilosec 20mg daily
ipratropium-albuterol 2 puffs Q6hours
dilaudid 2mg q6hours PRN pain
flomax 0.4mg daily
cymbalta 60mg daily
atorvastatin 20mg daily
insulin glargine 50 units SQ [**Hospital1 **]
rosiglitazone 4mg daily
humalog insulin sliding scale
toprol XL 50mg daily

ALLERGIES: Neurontin / Prozac

PHYSICAL EXAM: At the time of discharge, Mr. [**Known lastname 4020**] was awake, alert, and
oriented.  His heart was of regular rate and rhythm.  His lungs
were clear to ausculation bilaterally.  His abdomen was soft,
non-tender, and non-distended.  His mediastinal incision was
clean, dry, and intact and his sternum was stable.  His vein
harvest site at his knee was open but without erythema or pus.
His harvest sites were otherwise clean.  He had trace edema in
his extremities.

FAMILY HISTORY: There is a family history of premature coronary artery disease
in his grandmother and aunt.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use: he has smoked [**1-15**] PPD x "all my life". There is a
history of alcohol abuse in the past; he has been sober x 8
years. He admits to using 4 lines of cocaine 2 days ago.
Chronic systolic heart failure,Other postoperative infection,Unspecified pleural effusion,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Venous (peripheral) insufficiency, unspecified,Aortocoronary bypass status,Bipolar disorder, unspecified,Sedative, hypnotic or anxiolytic dependence, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Chr systolic hrt failure,Other postop infection,Pleural effusion NOS,Abn react-anastom/graft,Venous insufficiency NOS,Aortocoronary bypass,Bipolar disorder NOS,Sed,hyp,anxiolyt dep-NOS,Chr airway obstruct NEC,Chrnc hpt C wo hpat coma,DMII wo cmp nt st uncntr,Esophageal reflux,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2177-8-24**]              Discharge Date:   [**2177-8-30**]

Date of Birth:  [**2124-4-21**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Neurontin / Prozac

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
tube thoracostomy left


History of Present Illness:
Mr. [**Known lastname 4020**] is a 53 year-old gentleman who underwent a CABGx3
on [**7-28**] with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**] at [**Hospital1 18**].  He had an uneventful
post-op course and was discharged on [**Last Name (un) **]-operative day 4.  He
has been followed since for a superficial sternal wound
infection and peripheral edema requiring increased doses of
lasix.  He presented to the emergency department with shortness
of breath and chest pain that worsens with coughing.

Past Medical History:
CAD s/p MI ([**2175**]) and multiple overlapping DES to LCx ([**2176-8-5**])

HTN
Hyperlipidemia--no LDL, HDL available at [**Hospital1 18**]
GERD
DM2--no A1C available
Nocturia
Hepatitis C--no viral load available
Chronic back pain s/p laminectomies, rod placement d/t
injury--on chronic methadone
COPD--no PFTs available
Arthritis
Bipolar

Social History:
Social history is significant for the presence of current
tobacco use: he has smoked [**1-15**] PPD x "all my life". There is a
history of alcohol abuse in the past; he has been sober x 8
years. He admits to using 4 lines of cocaine 2 days ago.

Family History:
There is a family history of premature coronary artery disease
in his grandmother and aunt.

Physical Exam:
At the time of discharge, Mr. [**Known lastname 4020**] was awake, alert, and
oriented.  His heart was of regular rate and rhythm.  His lungs
were clear to ausculation bilaterally.  His abdomen was soft,
non-tender, and non-distended.  His mediastinal incision was
clean, dry, and intact and his sternum was stable.  His vein
harvest site at his knee was open but without erythema or pus.
His harvest sites were otherwise clean.  He had trace edema in
his extremities.

Pertinent Results:
[**2177-8-29**] 05:41AM BLOOD WBC-6.2 RBC-3.10* Hgb-8.9* Hct-27.5*
MCV-89 MCH-28.6 MCHC-32.2 RDW-15.9* Plt Ct-302
[**2177-8-29**] 05:41AM BLOOD Glucose-90 UreaN-23* Creat-0.9 Na-136
K-4.3 Cl-95* HCO3-35* AnGap-10
[**Known lastname **], [**Known firstname 7167**]       [**Hospital1 18**] [**Numeric Identifier 15114**]TTE (Focused
views) Done [**2177-8-25**] at 1:29:35 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
[**Street Address(2) 15115**]
[**Location (un) 15116**], [**Numeric Identifier 15117**]  Status: Inpatient DOB: [**2124-4-21**]
Age (years): 53 M  Hgt (in): 69
BP (mm Hg): 122/64  Wgt (lb): 250
HR (bpm): 72  BSA (m2): 2.27 m2
Indication: H/O cardiac surgery. ?Pericardial effusion.
ICD-9 Codes: 428.0, 786.05
Test Information
Date/Time: [**2177-8-25**] at 01:29    Interpret MD: [**Name6 (MD) **] [**Name8 (MD) 4082**], MD
Test Type: TTE (Focused views) Son[**Name (NI) 930**]: Cardiology Fellow
Doppler: Limited Doppler and color Doppler Test Location: West
Echo Lab
Contrast: None Tech Quality: Suboptimal
Tape #: 2008W058-0:00 Machine: Vivid [**7-22**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  3.7 cm  <= 4.0 cm
Left Ventricle - Septal Wall Thickness:  0.9 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  1.1 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  *6.4 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  35% to 40%  >= 55%

Findings
This study was compared to the prior study of [**2177-7-26**].
LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: RA not well visualized.

LEFT VENTRICLE: Normal LV wall thickness. Moderately dilated LV
cavity. Mild-moderate regional LV systolic dysfunction.

RIGHT VENTRICLE: RV not well seen.

AORTIC VALVE: Aortic valve not well seen. No AR.

MITRAL VALVE: Trivial MR.

TRICUSPID VALVE: Tricuspid valve not well visualized.

PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Suboptimal image quality - poor echo windows.
Left pleural effusion.

REGIONAL LEFT VENTRICULAR WALL MOTION:





     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
The left atrium is normal in size. Left ventricular wall
thicknesses are normal. The left ventricular cavity is
moderately dilated. There is mild to moderate regional left
ventricular systolic dysfunction with severe hypokinesis of the
basal half of the inferior and inferolateral walls. The
remaining segments contract normally (LVEF = 35-40 %). The
aortic valve is not well seen. No aortic regurgitation is seen.
Trivial mitral regurgitation is seen. There is no pericardial
effusion.

Compared with the prior study (images reviewed) of [**2177-7-26**],
the left ventricular cavity size is smaller and a large left
pleural effusion is now present. The other findings are similar.




Brief Hospital Course:
Upon admission, an CXR was taken of Mr. [**Known lastname **] chest,
revealing a large left pleural effusion.  A chest tube was
placed, which drained 2.5 liters of serosanguinous fluid.  He
was placed on IV lasix. Vancomycin was started for sternal
erythema. Left EVH site was found to be open with purulent
drainage.  This was cultured.  Abx therapy was broadened to
include cipro and flagyl.  His vein harvest site improved
greatly. Pt. has remained stable and is ready for discharge
home.  He should follow-up in the wound clinic in 1 week.

Medications on Admission:
methadone 40 mg TID
diazepam 5mg TID PRN pain
aspirin 81mg daily
docusate sodium 100mg [**Hospital1 **]
clopidogrel 75mg daily
prilosec 20mg daily
ipratropium-albuterol 2 puffs Q6hours
dilaudid 2mg q6hours PRN pain
flomax 0.4mg daily
cymbalta 60mg daily
atorvastatin 20mg daily
insulin glargine 50 units SQ [**Hospital1 **]
rosiglitazone 4mg daily
humalog insulin sliding scale
toprol XL 50mg daily

Discharge Medications:
1. 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:*0*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Sust. Release 24 hr(s)* Refills:*2*
4. Duloxetine 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Metoprolol Succinate 50 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*
7. Rosiglitazone 2 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
9. Omeprazole 20 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:*2*
10. Methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble
PO three times a day.
Disp:*90 Tablet, Soluble(s)* Refills:*0*
11. Diazepam 5 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed.
Disp:*60 Tablet(s)* Refills:*0*
12. Dilaudid 2 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
13. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
14. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
15. Insulin Glargine 100 unit/mL Solution Sig: as pre-hospital
Units Subcutaneous twice a day: Insulin as before re-admission
per Dr. [**First Name (STitle) **].
Disp:*1 vial* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Fluid overload
L Pleural effusion


Discharge Condition:
good


Discharge Instructions:
Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet


Followup Instructions:
Please see your primary care provider ([**First Name5 (NamePattern1) 8254**] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 15118**]) in
[**1-15**] weeks.
Dr. [**First Name (STitle) **] in [**3-18**] weeks

Wound check in 1 week


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

Completed by:[**2177-9-1**]
{'Chronic systolic heart failure,Other postoperative infection,Unspecified pleural effusion,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Venous (peripheral) insufficiency, unspecified,Aortocoronary bypass status,Bipolar disorder, unspecified,Sedative, hypnotic or anxiolytic dependence, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}


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: Mr. [**Known lastname 4020**] is a 53 year-old gentleman who underwent a CABGx3
on [**7-28**] with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 914**] at [**Hospital1 18**].  He had an uneventful
post-op course and was discharged on [**Last Name (un) **]-operative day 4.  He
has been followed since for a superficial sternal wound
infection and peripheral edema requiring increased doses of
lasix.  He presented to the emergency department with shortness
of breath and chest pain that worsens with coughing.

MEDICAL HISTORY: CAD s/p MI ([**2175**]) and multiple overlapping DES to LCx ([**2176-8-5**])

MEDICATION ON ADMISSION: methadone 40 mg TID
diazepam 5mg TID PRN pain
aspirin 81mg daily
docusate sodium 100mg [**Hospital1 **]
clopidogrel 75mg daily
prilosec 20mg daily
ipratropium-albuterol 2 puffs Q6hours
dilaudid 2mg q6hours PRN pain
flomax 0.4mg daily
cymbalta 60mg daily
atorvastatin 20mg daily
insulin glargine 50 units SQ [**Hospital1 **]
rosiglitazone 4mg daily
humalog insulin sliding scale
toprol XL 50mg daily

ALLERGIES: Neurontin / Prozac

PHYSICAL EXAM: At the time of discharge, Mr. [**Known lastname 4020**] was awake, alert, and
oriented.  His heart was of regular rate and rhythm.  His lungs
were clear to ausculation bilaterally.  His abdomen was soft,
non-tender, and non-distended.  His mediastinal incision was
clean, dry, and intact and his sternum was stable.  His vein
harvest site at his knee was open but without erythema or pus.
His harvest sites were otherwise clean.  He had trace edema in
his extremities.

FAMILY HISTORY: There is a family history of premature coronary artery disease
in his grandmother and aunt.

SOCIAL HISTORY: Social history is significant for the presence of current
tobacco use: he has smoked [**1-15**] PPD x "all my life". There is a
history of alcohol abuse in the past; he has been sober x 8
years. He admits to using 4 lines of cocaine 2 days ago. 

### Response:
{'Chronic systolic heart failure,Other postoperative infection,Unspecified pleural effusion,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Venous (peripheral) insufficiency, unspecified,Aortocoronary bypass status,Bipolar disorder, unspecified,Sedative, hypnotic or anxiolytic dependence, unspecified,Chronic airway obstruction, not elsewhere classified,Chronic hepatitis C without mention of hepatic coma,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
