CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: The patient is a 66-year-old
woman with a past medical history significant for coronary
artery disease, status post myocardial infarction in [**2122**],
diabetes mellitus, hypertension and tobacco use, who
presented with one month of shortness of breath.  The patient
first noticed the shortness of breath at night with
orthopnea.  The shortness of breath worsened, so that the
patient had dyspnea on exertion.  The patient also noticed
decreased exercise tolerance and, by the day of admission,
could only walk a half block without shortness of breath.
Previously, she had unlimited exercise tolerance.  She
currently had shortness of breath at rest.  The patient had
also complained of chest pressure which began several days
ago.  The chest pressure began with activity and was
alleviated by rest.

MEDICAL HISTORY: The past medical history was
significant for coronary artery disease, a myocardial
infarction in [**2122**], diabetes mellitus diagnosed in [**2122**], an
esophageal ulcer diagnosed in [**2138-4-27**] and hypertension.

MEDICATION ON ADMISSION: Zestril 20 mg p.o. q.d.
Glucophage 500 mg p.o. t.i.d.
Glyburide 5 mg p.o. b.i.d.
Prevacid 30 mg p.o. q.d.

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient had a mother with diabetes.
There was no family history of heart disease known to the
patient.

SOCIAL HISTORY: The patient had a remote smoking history of
two and a half packs per day times 34 years; she quit in
[**2122**].  She had no alcohol use.  She lived at home with her
son.
Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Abdominal aneurysm without mention of rupture,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
CHF NOS,Crnry athrscl natve vssl,Intermed coronary synd,Pleural effusion NOS,Abdom aortic aneurysm,Hyposmolality,DMII wo cmp nt st uncntr
Admission Date:  [**2138-10-6**]       Discharge Date:  [**2138-10-22**]

Date of Birth:   [**2072-12-5**]       Sex:  F

Service:  CARDIOTHORACIC

CHIEF COMPLAINT:  Shortness of breath.

HISTORY OF PRESENT ILLNESS:  The patient is a 66-year-old
woman with a past medical history significant for coronary
artery disease, status post myocardial infarction in [**2122**],
diabetes mellitus, hypertension and tobacco use, who
presented with one month of shortness of breath.  The patient
first noticed the shortness of breath at night with
orthopnea.  The shortness of breath worsened, so that the
patient had dyspnea on exertion.  The patient also noticed
decreased exercise tolerance and, by the day of admission,
could only walk a half block without shortness of breath.
Previously, she had unlimited exercise tolerance.  She
currently had shortness of breath at rest.  The patient had
also complained of chest pressure which began several days
ago.  The chest pressure began with activity and was
alleviated by rest.

In the emergency department, her chest x-ray was positive for
congestive heart failure.  The patient was given Lasix 40 mg
intravenous push, nitroglycerin paste one inch and albuterol
and Atrovent nebulizers.  Her blood pressure was 165/93.  Her
oxygen saturation was 85% on room air, increasing to 92% on
two liters by nasal cannula.

PAST MEDICAL HISTORY:  The past medical history was
significant for coronary artery disease, a myocardial
infarction in [**2122**], diabetes mellitus diagnosed in [**2122**], an
esophageal ulcer diagnosed in [**2138-4-27**] and hypertension.

MEDICATIONS ON ADMISSION:
Zestril 20 mg p.o. q.d.
Glucophage 500 mg p.o. t.i.d.
Glyburide 5 mg p.o. b.i.d.
Prevacid 30 mg p.o. q.d.

ALLERGIES:  The patient had no known drug allergies.

PHYSICAL EXAMINATION:  At the time of admission, the patient
had a temperature of 98.3??????F, a heart rate of 91, a blood
pressure of 165/93, a respiratory rate of 20 and an oxygen
saturation of 85% on room air, increasing to 92% on two
liters by nasal prongs.  In general, this was a middle aged
woman, sitting, in no acute distress.  On head, eyes, ears,
nose and throat examination, there was no jugular venous
distention.  The mucous membranes were moist.  The oropharynx
was clear.  The heart had an S1 and S2 with no murmurs, rubs
or gallops. The lungs had bilateral crackles half way up.
The abdomen was soft and nontender with positive bowel
sounds.  The extremities had 1+ pitting edema bilaterally.
The rectal examination was guaiac negative.

FAMILY HISTORY:  The patient had a mother with diabetes.
There was no family history of heart disease known to the
patient.

SOCIAL HISTORY:  The patient had a remote smoking history of
two and a half packs per day times 34 years; she quit in
[**2122**].  She had no alcohol use.  She lived at home with her
son.

ELECTROCARDIOGRAM:  The electrocardiogram showed sinus
tachycardia at 105 beats per minute with 1 mm ST segment
elevations in leads III an aVF, a new left bundle branch
block and flat T waves in V5 and V6.

RADIOLOGY DATA:  A chest x-ray showed positive congestive
heart failure with small bilateral effusions.

LABORATORY DATA:  The patient had a white blood cell count of
4700 with a hematocrit of 38.4 and platelet count of 136,000.
Prothrombin time was 12.7, partial thromboplastin time was
26.3 and INR was 1.1.  There was a sodium of 139, potassium
of 4.3, chloride of 103, bicarbonate of 23, BUN of 15,
creatinine of 0.8 and glucose of 215.  CK was 92 with a
troponin of 1.8.

HOSPITAL COURSE:  The patient was admitted to the hospital
for a rule out myocardial infarction and for a possible
cardiac catheterization.  On [**2138-10-8**], the patient was
brought to the cardiac catheterization laboratory, where she
underwent cardiac catheterization.  Please see the
catheterization report for full details.  In summary, the
catheterization showed 30% left main coronary artery, 60-70%
left anterior descending artery, total occlusion of the left
circumflex coronary artery with left to right collaterals and
70-90% right coronary artery with an ejection fraction of 35%
and mild mitral regurgitation.

The patient was then referred to the cardiothoracic surgery
service and, on [**2138-10-10**], she was brought to the operating
room where she underwent coronary artery bypass grafting
times three.  Please see the operative report for full
details.  In summary, she had coronary artery bypass grafting
times three with a left internal mammary artery graft to the
left anterior descending artery, a vein graft to the obtuse
marginal artery and a vein graft to the right posterolateral
artery.  She tolerated the operation well and was brought
from the operating room to the cardiac surgery recovery unit.
At that time, she had an arterial line, a Swan-Ganz catheter,
two atrial pacing wires, two mediastinal chest tubes and a
left pleural chest tube.  She also had milrinone, Levophed
and insulin infusing.

The patient did well in the immediate postoperative period.
Her anesthetics were reversed and she was taken off her
sedatives.  She was weaned from the ventilator and extubated
on the day of the surgery.  Her milrinone was weaned to off.
Her Levophed was titrated to a mean arterial blood pressure
of 60 and her insulin drip continued to infuse.  She remained
in the intensive care unit overnight on the first
postoperative day, as her oxygenation levels remained
relatively low.

On the night of postoperative day #1, the patient experienced
several episodes of ventricular tachycardia and was begun on
a lidocaine drip.  The patient continued to have difficulty
with oxygenation and she continued to be vigorously diuresed.
On postoperative day #3, the lidocaine was weaned to off and
the patient was begun on low dose beta blockers without
recurrence of her ventricular ectopy.

On postoperative day #4, the patient was noted to have a
right pleural effusion.  She was sent to the interventional
radiology department, where she underwent a therapeutic
thoracentesis.  At that time, 350 cc of clear, blood-tinged
fluid were removed from the right pleural space under
ultrasound guidance.

Over the next several days, the patient remained
hemodynamically stable.  She did, however, remain in the
intensive care unit because of difficulty oxygenating.  She
continued to be vigorously diuresed throughout that time.  On
postoperative day #6, she was deemed stable and ready to be
transferred to the floor, where she underwent continued
recovery from her surgery and cardiac rehabilitation.

The patient remained on the cardiac stepdown unit for the
next five days, during which time she continued to be
diuresed.  Her activity level was gradually accelerated with
the assistance of physical therapy.  During this time, she
remained hemodynamically stable and her oxygenation continued
to gradually improve throughout that period of time.  On
postoperative day #8, it was noted again that the patient had
reaccumulated her pleural effusion; however, it was not felt
at that time that she needed to have an additional
thoracentesis and that the effusion would improve with
continued diuresis.

On postoperative day #12, it was deemed that the patient was
stable and ready for discharge to a rehabilitation center,
where she would undergo continued increases in her activity
with the goal being increased strength and endurance.

DISCHARGE STATUS:  At the time of discharge, the patient's
status is stable.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease, status post coronary artery
bypass grafting times three with a left internal mammary
artery graft to the left anterior descending artery and vein
grafts to the obtuse marginal artery and right posterolateral
artery.
2.  Diabetes mellitus type 2.
3.  Esophageal ulcer.
4.  Hypertension.

PHYSICAL EXAMINATION AT DISCHARGE:  Vital signs revealed a
temperature of 98.9??????F, a heart rate of 72 and sinus rhythm, a
blood pressure of 100/50, a respiratory rate of 20 and an
oxygen saturation of 94% on five liters by nasal prongs.  Her
preoperative weight was 70.1 kg; her discharge weight is 74.3
kg.  The patient was alert, oriented and conversant.  The
respiratory examination revealed diminished breath sounds
bilaterally at the bases with crackles two-thirds of the way
up on the right and crackles at the apex on the left.  The
heart sounds revealed a regular rate and rhythm with S1 and
S2.  The sternum was stable with no erythema.  The abdomen
was soft, nontender and nondistended with positive bowel
sounds.  The extremities were warm and well perfused with 1
to 2+ pedal edema.

LABORATORY DATA AT DISCHARGE:  The patient had a white blood
cell count of 7100 and hematocrit of 25.5.  There was a
sodium of 134 (up from 127 on [**2138-10-21**]), potassium of 4.2,
chloride of 95, bicarbonate of 30, BUN of 27, creatinine of
1.1 and glucose of 202.

DISCHARGE MEDICATIONS:
Glyburide 5 mg p.o. b.i.d.
Glucophage 500 mg p.o. t.i.d.
Protonix 40 mg p.o. q.d.
Lopressor 25 mg p.o. b.i.d.
Colace 100 mg p.o. b.i.d.
Aspirin 81 mg p.o. q.d.
Lasix 100 mg p.o. b.i.d.
Atrovent and albuterol nebulizers every four to six hours
p.r.n.
Potassium chloride 20 mEq p.o. q.d.
Sodium chloride one tablet p.o. b.i.d.
NPH insulin 10 units subcutaneously q.p.m.
Regular insulin sliding scale every six hours p.r.n.
Ibuprofen 400 mg p.o. every six hours p.r.n.
Percocet 5/325 mg one to two tablets p.o. every four hours
p.r.n.
Serax 50 mg p.o. h.s. p.r.n.

DISPOSITION:  The patient is to be discharged to
rehabilitation.

FO[**Last Name (STitle) 996**]P:  The patient is to have follow up in the wound
clinic in two weeks, follow up in Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] office in
one month and follow up with her primary care physician in
three to four weeks.




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2138-10-22**]  14:57
T:  [**2138-10-22**]  15:15
JOB#:  [**Job Number 2547**]
{'Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Abdominal aneurysm without mention of rupture,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: The patient is a 66-year-old
woman with a past medical history significant for coronary
artery disease, status post myocardial infarction in [**2122**],
diabetes mellitus, hypertension and tobacco use, who
presented with one month of shortness of breath.  The patient
first noticed the shortness of breath at night with
orthopnea.  The shortness of breath worsened, so that the
patient had dyspnea on exertion.  The patient also noticed
decreased exercise tolerance and, by the day of admission,
could only walk a half block without shortness of breath.
Previously, she had unlimited exercise tolerance.  She
currently had shortness of breath at rest.  The patient had
also complained of chest pressure which began several days
ago.  The chest pressure began with activity and was
alleviated by rest.

MEDICAL HISTORY: The past medical history was
significant for coronary artery disease, a myocardial
infarction in [**2122**], diabetes mellitus diagnosed in [**2122**], an
esophageal ulcer diagnosed in [**2138-4-27**] and hypertension.

MEDICATION ON ADMISSION: Zestril 20 mg p.o. q.d.
Glucophage 500 mg p.o. t.i.d.
Glyburide 5 mg p.o. b.i.d.
Prevacid 30 mg p.o. q.d.

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient had a mother with diabetes.
There was no family history of heart disease known to the
patient.

SOCIAL HISTORY: The patient had a remote smoking history of
two and a half packs per day times 34 years; she quit in
[**2122**].  She had no alcohol use.  She lived at home with her
son. 

### Response:
{'Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Abdominal aneurysm without mention of rupture,Hyposmolality and/or hyponatremia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
