CHIEF COMPLAINT: Shortness of breath and chest heaviness

PRESENT ILLNESS: 81 year old male with history of end
stage renal disease. Left AV fistula placed on [**2163-11-16**]. Ever
since he has had the procedure he has been experiencing dyspnea
on exretion, there has never been a change in pattern and the
symptoms have never occured at rest. He is now transferred to
[**Hospital1 18**] for a cardiac catheterization which shows coronary artery
disease. He is now referred to cardiac surgery for possible
revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Coronary artery disease s/p 2 stents 15 years ago
Type 2 Diabetes Mellitus
End stage renal disease stage  IV
GERD
prostate carcinoma s/p total prostatectomy
Hyperparathyroidism
Osteoarthritis
Past Surgical History
[**2163-11-16**] PTFE graft from the brachial artery to the antecubital
vein
Left carotid endarterectomy
Left total knee replacement
total prostatctomy
Schatzki ring

MEDICATION ON ADMISSION: AMLODIPINE -  (Prescribed by Other Provider) - 5 mg Tablet - 1
(One) Tablet(s) by mouth once a day
CALCITRIOL -  (Prescribed by Other Provider) - 0.25 mcg Capsule
-
1 (One) Capsule(s) by mouth once a day
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 (One) Tablet(s) by mouth once a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 (One) Tablet(s) by mouth twice a day
OMEPRAZOLE -  (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
(One) Tablet(s) by mouth once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:63 Resp:14  O2 sat:97/RA
B/P  Right:157/59
Height:5'9.5"     Weight:233 lbs

FAMILY HISTORY: Mother died of heart disease

SOCIAL HISTORY: Lives with:alone, supportive family around
Occupation:retired
Tobacco:quit 40 years ago, [**2-16**] ppdx 15-20 years
ETOH:denies
Subendocardial infarction, initial episode of care,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Secondary hyperparathyroidism (of renal origin),Acidosis,Paralytic ileus,Acute posthemorrhagic anemia,Other iatrogenic hypotension,Bladder neck obstruction,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Stricture and stenosis of esophagus,Personal history of malignant neoplasm of prostate,Knee joint replacement,Personal history of tobacco use,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,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Subendo infarct, initial,End stage renal disease,Hyp kid NOS w cr kid V,Acute kidney failure NOS,Sec hyperparathyrd-renal,Acidosis,Paralytic ileus,Ac posthemorrhag anemia,Iatrogenc hypotnsion NEC,Bladder neck obstruction,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Status-post ptca,DMII wo cmp nt st uncntr,Esophageal stricture,Hx-prostatic malignancy,Joint replaced knee,History of tobacco use,Abn react-anastom/graft,Abn react-renal dialysis
Admission Date:  [**2163-12-12**]              Discharge Date:   [**2163-12-21**]

Date of Birth:  [**2082-2-22**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Shortness of breath and chest heaviness

Major Surgical or Invasive Procedure:
[**2163-12-14**]
1. Urgent coronary artery bypass graft x4 with left
    internal mammary artery to left anterior descending
    artery and saphenous vein grafts to diagonal, obtuse
    marginal and posterior descending arteries.
2. Endoscopic harvesting of the long saphenous vein.


History of Present Illness:
81 year old male with history of end
stage renal disease. Left AV fistula placed on [**2163-11-16**]. Ever
since he has had the procedure he has been experiencing dyspnea
on exretion, there has never been a change in pattern and the
symptoms have never occured at rest. He is now transferred to
[**Hospital1 18**] for a cardiac catheterization which shows coronary artery
disease. He is now referred to cardiac surgery for possible
revascularization.


Past Medical History:
Hypertension
Hyperlipidemia
Coronary artery disease s/p 2 stents 15 years ago
Type 2 Diabetes Mellitus
End stage renal disease stage  IV
GERD
prostate carcinoma s/p total prostatectomy
Hyperparathyroidism
Osteoarthritis
Past Surgical History
[**2163-11-16**] PTFE graft from the brachial artery to the antecubital
vein
Left carotid endarterectomy
Left total knee replacement
total prostatctomy
Schatzki ring


Social History:
Lives with:alone, supportive family around
Occupation:retired
Tobacco:quit 40 years ago, [**2-16**] ppdx 15-20 years
ETOH:denies


Family History:
Mother died of heart disease

Physical Exam:
Pulse:63 Resp:14  O2 sat:97/RA
B/P  Right:157/59
Height:5'9.5"     Weight:233 lbs

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft, non-distended, non-tender [x]
Extremities: Warm, well-perfused [x] No Edema or Varicosities
Neuro: Grossly intact
Pulses:
Femoral      Right: nd   Left: nd
DP           Right: dop  Left: dop
PT           [**Name (NI) 167**]: dop  Left: dop
Radial       Right: 2+   Left: 2+

Carotid Bruit [+] Left > Right


Pertinent Results:
Admission labs:
[**2163-12-12**] 04:00PM URINE  RBC-1 WBC-1 BACTERIA-FEW YEAST-NONE
EPI-0 TRANS EPI-<1
[**2163-12-12**] 04:00PM URINE  BLOOD-SM  NITRITE-NEG PROTEIN-100
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5
LEUK-NEG
[**2163-12-12**] 04:00PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.016
[**2163-12-12**] 05:26PM   CK-MB-14* MB INDX-6.8* cTropnT-0.44*
[**2163-12-12**] 05:26PM   CK(CPK)-206
[**2163-12-12**] 05:26PM   GLUCOSE-146* UREA N-80* CREAT-3.8* SODIUM-143
POTASSIUM-4.6 CHLORIDE-106 TOTAL CO2-24 ANION GAP-18
Discharge labs:
[**2163-12-21**] 07:05AM BLOOD WBC-12.2* RBC-3.10* Hgb-9.5* Hct-29.2*
MCV-94 MCH-30.6 MCHC-32.4 RDW-15.8* Plt Ct-311
[**2163-12-21**] 07:05AM BLOOD Plt Ct-311
[**2163-12-19**] 02:29AM BLOOD PT-14.4* PTT-31.4 INR(PT)-1.2*
[**2163-12-21**] 07:05AM BLOOD Glucose-127* UreaN-74* Creat-4.6* Na-139
K-4.1 Cl-101 HCO3-24 AnGap-18
[**2163-12-20**] 04:52AM BLOOD Glucose-99 UreaN-56* Creat-3.9* Na-139
K-4.3 Cl-101 HCO3-22 AnGap-20
[**2163-12-14**] 11:39PM BLOOD ALT-11 AST-29 LD(LDH)-267* AlkPhos-36*
Amylase-46 TotBili-0.1
[**2163-12-14**] 11:39PM BLOOD Lipase-64*
[**2163-12-13**] 03:15AM BLOOD %HbA1c-6.7* eAG-146*
[**2163-12-20**] 04:52AM BLOOD PTH-134*
[**2163-12-16**] 06:48AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE
HBcAb-NEGATIVE
[**2163-12-16**] 06:48AM BLOOD HCV Ab-NEGATIVE

Radiology Report CHEST (PA & LAT) Study Date of [**2163-12-20**] 8:40 AM

[**Hospital 93**] MEDICAL CONDITION: 81 year old man with s/p cabg
Final Report: Compared to [**2163-12-17**], the lung volumes are
improved. Small
bilateral pleural effusions, right greater than left, with
associated
atelectasis are stable to slightly improved from [**2163-12-16**].
There is no
pneumothorax. The cardiac and mediastinal silhouette are stable
in this
patient status post CABG with intact median sternotomy wires. A
right PICC
terminates in the upper-to-mid SVC. There has been interval
removal of the
right internal jugular catheter.
IMPRESSION: Small bilateral pleural effusions, right greater
than left, with associated atelectasis.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  *5.5 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  *6.3 cm  <= 5.2 cm
Left Atrium - Peak Pulm Vein S:  0.6 m/s
Left Atrium - Peak Pulm Vein D:  0.4 m/s
Left Atrium - Peak Pulm Vein A:  0.3 m/s  < 0.4 m/s
Right Atrium - Four Chamber Length:  *5.5 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.1 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  50%  >= 55%
Left Ventricle - Stroke Volume:  83 ml/beat
Left Ventricle - Cardiac Output:  4.57 L/min
Left Ventricle - Cardiac Index:  2.12  >= 2.0 L/min/M2
Left Ventricle - Lateral Peak E':  *0.08 m/s  > 0.08 m/s
Left Ventricle - Septal Peak E':  *0.07 m/s  > 0.08 m/s
Left Ventricle - Ratio E/E':  12  < 15
Aorta - Sinus Level:  3.6 cm  <= 3.6 cm
Aorta - Ascending:  *3.8 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.5 m/sec  <= 2.0 m/sec
Aortic Valve - LVOT pk vel:  1.00 m/sec
Aortic Valve - LVOT VTI:  20
Aortic Valve - LVOT diam:  2.3 cm
Mitral Valve - E Wave:  0.9 m/sec
Mitral Valve - A Wave:  1.1 m/sec
Mitral Valve - E/A ratio:  0.82
Mitral Valve - E Wave deceleration time:  210 ms  140-250 ms
Pulmonic Valve - Peak Velocity:  1.1 m/sec  <= 1.5 m/sec
Findings
LEFT ATRIUM: Moderate LA enlargement.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Mildly dilated RA. Normal
interatrial septum. No ASD by 2D or color Doppler.
LEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size. Mild
regional LV systolic dysfunction. No LV mass/thrombus. No
resting LVOT gradient. No VSD.
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal aortic diameter at the sinus level. Mildly dilated
ascending aorta.
AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP.
Mild mitral annular calcification. Mild thickening of mitral
valve chordae. No MS. Trivial MR.
TRICUSPID VALVE: Mildly thickened tricuspid valve leaflets. No
TS. Physiologic TR. Indeterminate PA systolic pressure.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.
PERICARDIUM: No pericardial effusion.
REGIONAL LEFT VENTRICULAR WALL MOTION:
    N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
The left atrium is moderately dilated. 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. There is mild regional left ventricular systolic
dysfunction with basal to mid inferior and infero-lateral
hypokinesis. No masses or thrombi are seen in the left
ventricle. There is no ventricular septal defect. 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 no aortic valve stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Trivial
mitral regurgitation is seen. The tricuspid valve leaflets are
mildly thickened. The pulmonary artery systolic pressure could
not be determined. There is no pericardial effusion.


Brief Hospital Course:
The patient was brought to the operating room on [**2163-12-14**] where
the patient underwent coronary bypass grafting(see operative
report for details). In summary he had:      1. Urgent coronary
artery bypass graft x4 with left internal mammary artery to left
anterior descending artery and saphenous vein grafts to
diagonal, obtuse marginal and posterior descending arteries.
2. Endoscopic harvesting of the long saphenous vein.
He tolerated the operation well and post-operatively was
transferred to the CVICU in stable condition on an inotrope and
pressor to support cardiac function. He was kept sedated
overnight, on the morning of POD1 he was extubated without
incident. His pressors were weaned. He was seen in consultation
by the renal service for his elevated creatinine in the setting
of end stage renal disease and was dialyzed to aid in diuresis.
His chest tubes and wires were removed.  By post-operative day 6
he was transferred to the step-down floor.  An ace-inhibitor was
initiated for better blood pressure control.  By post-operative
day [**Last Name (un) 87817**] he was ready for transfer to the long term acute care
rehab center at [**Hospital **] [**Hospital **] Hospital in [**Location (un) 701**].

Medications on Admission:
AMLODIPINE -  (Prescribed by Other Provider) - 5 mg Tablet - 1
(One) Tablet(s) by mouth once a day
CALCITRIOL -  (Prescribed by Other Provider) - 0.25 mcg Capsule
-
1 (One) Capsule(s) by mouth once a day
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 (One) Tablet(s) by mouth once a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 (One) Tablet(s) by mouth twice a day
OMEPRAZOLE -  (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
(One) Tablet(s) by mouth once a day

Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 325 mg Tablet - 1
(One) Tablet(s) by mouth once a day


Discharge Medications:
1. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
2. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for temperature >38.0.
3. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. calcium acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
9. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
10. ipratropium-albuterol 18-103 mcg/Actuation Aerosol Sig: [**1-15**]
Puffs Inhalation Q4H (every 4 hours) as needed for shortness of
breath or wheezing.
11. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
12. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. insulin lispro 100 unit/mL Solution Sig: sliding scale units
Subcutaneous QAC&HS.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] Northeast - [**Location (un) 701**]

Discharge Diagnosis:
Coronary Artery Disease
PMH:
Hypertension
Hyperlipidemia
Coronary artery disease s/p 2 stents 15 years ago
Type 2 Diabetes Mellitus
End stage renal disease stage  IV
GERD
prostate carcinoma s/p total prostatectomy
Hyperparathyroidism
Osteoarthritis
Past Surgical History
[**2163-11-16**] PTFE graft from the brachial artery to the antecubital
vein
Left carotid endarterectomy
Left total knee replacement
total prostatctomy
Schatzki ring


Discharge Condition:
Alert and oriented x3 nonfocal exam
Ambulating, gait steady
Sternal pain managed with Percocet
Sternal Incision - healing well, no erythema or drainage
Edema [**2-16**]+ bilat


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please 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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**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. [**Last Name (STitle) 7772**] on [**2164-1-16**] @1PM [**Telephone/Fax (1) 170**]
Cardiologist Dr. [**Last Name (STitle) **],[**First Name3 (LF) 488**] D. [**Telephone/Fax (1) 8725**]
Please call to schedule the following:
Primary Care Dr.[**Last Name (STitle) **],[**First Name3 (LF) **] C. [**Telephone/Fax (1) 25694**] in [**4-18**] 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:[**2163-12-21**]
{'Subendocardial infarction, initial episode of care,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Secondary hyperparathyroidism (of renal origin),Acidosis,Paralytic ileus,Acute posthemorrhagic anemia,Other iatrogenic hypotension,Bladder neck obstruction,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Stricture and stenosis of esophagus,Personal history of malignant neoplasm of prostate,Knee joint replacement,Personal history of tobacco use,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,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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 and chest heaviness

PRESENT ILLNESS: 81 year old male with history of end
stage renal disease. Left AV fistula placed on [**2163-11-16**]. Ever
since he has had the procedure he has been experiencing dyspnea
on exretion, there has never been a change in pattern and the
symptoms have never occured at rest. He is now transferred to
[**Hospital1 18**] for a cardiac catheterization which shows coronary artery
disease. He is now referred to cardiac surgery for possible
revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Coronary artery disease s/p 2 stents 15 years ago
Type 2 Diabetes Mellitus
End stage renal disease stage  IV
GERD
prostate carcinoma s/p total prostatectomy
Hyperparathyroidism
Osteoarthritis
Past Surgical History
[**2163-11-16**] PTFE graft from the brachial artery to the antecubital
vein
Left carotid endarterectomy
Left total knee replacement
total prostatctomy
Schatzki ring

MEDICATION ON ADMISSION: AMLODIPINE -  (Prescribed by Other Provider) - 5 mg Tablet - 1
(One) Tablet(s) by mouth once a day
CALCITRIOL -  (Prescribed by Other Provider) - 0.25 mcg Capsule
-
1 (One) Capsule(s) by mouth once a day
HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 (One) Tablet(s) by mouth once a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 25 mg
Tablet - 1 (One) Tablet(s) by mouth twice a day
OMEPRAZOLE -  (Prescribed by Other Provider) - 20 mg Capsule,
Delayed Release(E.C.) - 1 (One) Capsule(s) by mouth once a day
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
(One) Tablet(s) by mouth once a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:63 Resp:14  O2 sat:97/RA
B/P  Right:157/59
Height:5'9.5"     Weight:233 lbs

FAMILY HISTORY: Mother died of heart disease

SOCIAL HISTORY: Lives with:alone, supportive family around
Occupation:retired
Tobacco:quit 40 years ago, [**2-16**] ppdx 15-20 years
ETOH:denies 

### Response:
{'Subendocardial infarction, initial episode of care,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Secondary hyperparathyroidism (of renal origin),Acidosis,Paralytic ileus,Acute posthemorrhagic anemia,Other iatrogenic hypotension,Bladder neck obstruction,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Percutaneous transluminal coronary angioplasty status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Stricture and stenosis of esophagus,Personal history of malignant neoplasm of prostate,Knee joint replacement,Personal history of tobacco use,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,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
