CHIEF COMPLAINT: Chest pain and shortness of breath

PRESENT ILLNESS: This is a 59 year old male with known coronary artery disease
and
prior silent myocardial infarction. Cardiac catheterization
revealed 3 vessel CAD and his Dobutamine stress test showed
ainferior hypokinesis at rest with recruitment indicating
viablmyocardium. Currently, he reports no exertional or rest
angina. CABG was recommended in [**2132-3-21**] but patient declined
surgery at that time. He complains of occasional leg pain with
walking about [**3-26**] blocks. He had not been exerting himself much.
He can climb one flight of stairs without symptoms. There is no
history of lightheadedness, palpitations, syncope, orthopnea,
PND or increasing lower
extremity edema.

MEDICAL HISTORY: - CAD s/p remote silent myocardial infarction likely [**2124**]
- Diabetes mellitus Type II
- Dyslipidemia
- History of stroke [**2125**], s/p ?thrombolytics, no residual
symptoms
- Hypertension
- Prostatism
- ?Intermittent claudication?

MEDICATION ON ADMISSION: Clonidine 0.3mg twice daily, Niaspan 500 mg daily, Lipitor 80 mg
daily, Plavix 75 mg daily, Norvasc 10 mg daily, Imdur 90 mg
daily, Lisinopril 40 mg daily, ASA 325 mg daily, Toprol 200 mg
daily , Pletal 100 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam  Pulse: 75  Resp: 20  O2 sat: 95%
BP  Right:  142/89  Left: 132/87

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social History: Denies tobacco. There is no history of alcohol
abuse. Currently divorced, lives alone. Occupation: student.
Coronary atherosclerosis of native coronary artery,Toxic encephalopathy,Acute posthemorrhagic anemia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Other nervous system complications,Ventricular fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Acute sinusitis, unspecified,Physical restraints status,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Crnry athrscl natve vssl,Toxic encephalopathy,Ac posthemorrhag anemia,Late ef-hemplga side NOS,Surg comp nerv systm NEC,Ventricular fibrillation,DMII wo cmp nt st uncntr,Old myocardial infarct,Acute sinusitis NOS,Physical restrain status,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2133-9-10**]              Discharge Date:   [**2133-9-19**]

Date of Birth:  [**2073-11-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Chest pain and shortness of breath


Major Surgical or Invasive Procedure:
[**2133-9-11**] - Coronary artery bypass grafting x5 with reverse
saphenous vein grafts to the posterior descending artery, left
anterior descending artery, ramus intermedius artery and
sequential reverse saphenous vein graft to the first and second
obtuse marginal artery.


History of Present Illness:
This is a 59 year old male with known coronary artery disease
and
prior silent myocardial infarction. Cardiac catheterization
revealed 3 vessel CAD and his Dobutamine stress test showed
ainferior hypokinesis at rest with recruitment indicating
viablmyocardium. Currently, he reports no exertional or rest
angina. CABG was recommended in [**2132-3-21**] but patient declined
surgery at that time. He complains of occasional leg pain with
walking about [**3-26**] blocks. He had not been exerting himself much.
He can climb one flight of stairs without symptoms. There is no
history of lightheadedness, palpitations, syncope, orthopnea,
PND or increasing lower
extremity edema.


Past Medical History:
- CAD s/p remote silent myocardial infarction likely [**2124**]
- Diabetes mellitus Type II
- Dyslipidemia
- History of stroke [**2125**], s/p ?thrombolytics, no residual
symptoms
- Hypertension
- Prostatism
- ?Intermittent claudication?


Social History:
Social History: Denies tobacco. There is no history of alcohol
abuse. Currently divorced, lives alone. Occupation: student.


Family History:
There is no family history of premature coronary artery disease
or sudden death.


Physical Exam:
Physical Exam  Pulse: 75  Resp: 20  O2 sat: 95%
BP  Right:  142/89  Left: 132/87

General: WDWN male in no acute distress
Skin: Warm[x] Dry [x] intact [x]
HEENT: NCAT[x] PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular [x]  Murmur - none
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema: none
Varicosities: None [x]
Neuro: Grossly intact

Pulses:
Femoral      Right: 2  Left: 2
DP           Right: 1  Left: 1
PT           [**Name (NI) 167**]: 1  Left: 1
Radial       Right: 2  Left: 2

Carotid Bruit        Right: none   Left: none


Pertinent Results:
[**2133-9-10**] Cardiac catheterization
1. Selective coronary angiography in this right domiinant system

demonstrated three vessel coronary artery disease.  The LMCA had
no
angiographically-apparent disease.  The LAD had moderate diffuse
disease
with a proximal 80% stenosis.  The LCx had moderate diffuse
disease with
a 40-50% proximal stenosis, there was a 60% stenosis of OM1 and
80%
proximal stenosis of OM2.  The mid AV groove circumflex was
occluded
with bridging collaterals into the OM2.  There was an 80%
stenosis of
the ramus intermedius proximally.  The RCA had a proximal 50%
stenosis.
There was a 90% stenosis in the mid-RCA and a 70% stenosis
proximal to
the PDA/PL bifurcation.  The RPL was occluded but filled faintly
wiht
right to right collaterals.
2. Limited resting hemodynamics revealed normotension.

[**2133-9-11**] ECHO
Pre bypass: The left atrium is mildly dilated. Overall left
ventricular systolic function is low normal (LVEF 50-55%). The
right ventricular cavity is mildly dilated with focal basal free
wall hypokinesis. There are simple atheroma in the aortic arch.
There are complex (>4mm) atheroma in the descending thoracic
aorta. The aortic valve leaflets (3) appear structurally normal
with good leaflet excursion and no aortic regurgitation. There
is no aortic valve stenosis. No aortic regurgitation is seen.
The mitral valve appears structurally normal with trivial mitral
regurgitation. There is no pericardial effusion.

Post bypass: Paitent on epinepherine,milirinone, pheynlepherine,
AV, then A paced, and finally sinus. LV function unchanged or
slightly improved motion in inferior basal wall, LVEF 50-55%. RV
function unchanged with basal free wall hypokinesis after
bypass. MR mild on initial seperation from bypass, later
moderate, ultimately trace to mild. TR unchanged mild to
moderate. Aortic contorus intact. Remaining exam is unchanged.
All findings discussed with surgeons at time of the exam.

Brief Hospital Course:
Mr. [**Known lastname 85034**] was admitted to the [**Hospital1 18**] on [**2133-9-10**] for surgical
management of his coronary artery disease. He underwent a
diagnostic cardiac catheterization which revealed severe three
vessel coronary artery disease. He was worked up in the usual
preoperative manner. On [**2133-9-12**], Mr. [**Known lastname 85034**] was taken to the
operating room where he underwent coronary artery bypass
grafting to five vessels. Please see operative note for details.
Postoperatively he was taken to the intensive care unit for
monitoring. He remained intubated due to severe aggitation and
inability to follow commands. Extubation was attempted on
[**2133-9-14**] but he was reintubated shortly after due to tachypnea,
hypertension and agitation. A head CT scan revealed evidence of
prior infarctions but no acute process was identified. Mr.
[**Known lastname 85034**] spiked a fever and was found to have gram positive
cocci and gram negative rods in his sputum. Cefepime and
vancomycin were started after he was pancultured. An infectious
disease consult was obtained. He continued gentle diuresis
towards his preoperative weight.

Neurology followed the pt as thought he had a metabolic
encephalopathy. He continued to slowly improve and was
eventually moving all his extremities and following commands. On
[**2133-9-19**] a decision was made to extubate him and this was done
at 13:30. At 14:04, he showed signs of resp. distress and
anesthesia came immediately to bedside. Oral intubation was not
successful and surgical consult was obtained for a surgical
airway. Please refer to Dr.[**Name (NI) 1745**] note and the event note by
Dr. [**Last Name (STitle) 35981**] that outlines his death. Airway was unable to be
secured and subsequently went into cardiac arrest. He was not
able to be resuscitated and he was pronounced at 15:20 despite
ACLS /CPR.


Medications on Admission:
Clonidine 0.3mg twice daily, Niaspan 500 mg daily, Lipitor 80 mg
daily, Plavix 75 mg daily, Norvasc 10 mg daily, Imdur 90 mg
daily, Lisinopril 40 mg daily, ASA 325 mg daily, Toprol 200 mg
daily , Pletal 100 mg daily


Discharge Disposition:
Expired

Discharge Diagnosis:
Coronary artery disease s/p cabg x5
CAD s/p remote silent myocardial infarction likely [**2124**]
Diabetes mellitus Type II
Dyslipidemia
History of stroke [**2125**], s/p ?thrombolytics, no residual
symptoms
Hypertension
Prostatism
?Intermittent claudication?
respiratory arrest


Discharge Condition:
Deceased


Discharge Instructions:
Deceased

Followup Instructions:
Deceased



Completed by:[**2133-10-9**]
{'Coronary atherosclerosis of native coronary artery,Toxic encephalopathy,Acute posthemorrhagic anemia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Other nervous system complications,Ventricular fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Acute sinusitis, unspecified,Physical restraints status,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: Chest pain and shortness of breath

PRESENT ILLNESS: This is a 59 year old male with known coronary artery disease
and
prior silent myocardial infarction. Cardiac catheterization
revealed 3 vessel CAD and his Dobutamine stress test showed
ainferior hypokinesis at rest with recruitment indicating
viablmyocardium. Currently, he reports no exertional or rest
angina. CABG was recommended in [**2132-3-21**] but patient declined
surgery at that time. He complains of occasional leg pain with
walking about [**3-26**] blocks. He had not been exerting himself much.
He can climb one flight of stairs without symptoms. There is no
history of lightheadedness, palpitations, syncope, orthopnea,
PND or increasing lower
extremity edema.

MEDICAL HISTORY: - CAD s/p remote silent myocardial infarction likely [**2124**]
- Diabetes mellitus Type II
- Dyslipidemia
- History of stroke [**2125**], s/p ?thrombolytics, no residual
symptoms
- Hypertension
- Prostatism
- ?Intermittent claudication?

MEDICATION ON ADMISSION: Clonidine 0.3mg twice daily, Niaspan 500 mg daily, Lipitor 80 mg
daily, Plavix 75 mg daily, Norvasc 10 mg daily, Imdur 90 mg
daily, Lisinopril 40 mg daily, ASA 325 mg daily, Toprol 200 mg
daily , Pletal 100 mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam  Pulse: 75  Resp: 20  O2 sat: 95%
BP  Right:  142/89  Left: 132/87

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social History: Denies tobacco. There is no history of alcohol
abuse. Currently divorced, lives alone. Occupation: student. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Toxic encephalopathy,Acute posthemorrhagic anemia,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Other nervous system complications,Ventricular fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Acute sinusitis, unspecified,Physical restraints status,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
