CHIEF COMPLAINT: shortness of breath, respiratory distress

PRESENT ILLNESS: 58 y.o male with h/o DM, htn, hypercholesterolemia, with known
dz per cath in [**2114**] where pt had 95% mid RCA stenosis, 70% Lcx,
60% LAD and 40% L main with recent 4 vessel CABG on [**2123-3-4**] (LIMA
to LAD, SVG to OM, ramus, RCA), who presents with acute
SOB/respiratory distress.  He present to [**Hospital1 18**] [**Location (un) 620**] where he
was found to be acidemic (ABG 7.08/87/91), intubated for
hypercarbic respiratory failure.  He was started on a heparin
gtt and nitro gtt.  He also had ?Vtach on EKG and was started on
lidocaine drip. There was a question of t-wave changes on EKG,
and he was transferred here for cardiac catheterization and
further management.  Cath on arrival showed patent grafts (no
PTCA performed), and he was brought to CCU for further
management.

MEDICAL HISTORY: 1.  CAD, s/p recent CABG as above; TTE [**3-6**] showing dilated
LA/LAV, 1+ MR, EF=20-30%, with BiV pacer for ventricular
arrhythmias
2.  Prostatitis
3.  Melanoma s/p excisions
4.  DM x 2 years
5.  Recurrent PNA
6.  GERD
7.  gout
8.  Sleep apnea
9.  s/p hemorrhoidectomy
10.  bilateral Iliac artery anneurysm s/p repair
11.  Hypertensive cardiomyopathy
12.  Hypercholesterolemia
13.  Cervical radiculopathy

MEDICATION ON ADMISSION: Meds on Admission:
Lisinopril 10 mg
Coreg 3.125 mg [**Hospital1 **]
Dig 0.125 mcg
Ranitidine 150 mg daily
Amiodarone 200 mg daily
Glyburide 2.5 mg daily
Lasix 40 mg [**Hospital1 **]
Escitalopram 20 mg daily
Lipitor 80 mg daily
Klonopin 0.5 [**Hospital1 **]
Zetia 10 mg daily
Percocet PRN
KCL 20 meq daily

ALLERGIES: Hydrochlorothiazide / Demerol / Ambien

PHYSICAL EXAM: VS:   99.0   89/55   60   14  100% on AC, FiO2=100%, 700/14,
PEEP=10
Gen: in mild distress, intubated
HEENT:  PERRL, OP clear
Lungs: crackes at bases, no w/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs, no masses
Groin: right groin with sheath, left with triple lumen
Extr: no c/c/e, DP 2+ bilat
Neuro: moving all 4 extremities

FAMILY HISTORY: Father with MI in 50s

SOCIAL HISTORY: Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anxiety state, unspecified,Automatic implantable cardiac defibrillator in situ,Personal history of malignant melanoma of skin,Gout, unspecified,Unspecified sleep apnea,Pure hypercholesterolemia,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,CHF NOS,Aortocoronary bypass,Chr pulmon heart dis NEC,DMII wo cmp nt st uncntr,Anxiety state NOS,Status autm crd dfbrltr,Hx-malig skin melanoma,Gout NOS,Sleep apnea NOS,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2123-4-12**]              Discharge Date:   [**2123-4-15**]

Date of Birth:  [**2064-3-13**]             Sex:   M

Service: MEDICINE

Allergies:
Hydrochlorothiazide / Demerol / Ambien

Attending:[**First Name3 (LF) 7055**]
Chief Complaint:
shortness of breath, respiratory distress

Major Surgical or Invasive Procedure:
Endotracheal intubation
Cardiac Catheterization

History of Present Illness:
58 y.o male with h/o DM, htn, hypercholesterolemia, with known
dz per cath in [**2114**] where pt had 95% mid RCA stenosis, 70% Lcx,
60% LAD and 40% L main with recent 4 vessel CABG on [**2123-3-4**] (LIMA
to LAD, SVG to OM, ramus, RCA), who presents with acute
SOB/respiratory distress.  He present to [**Hospital1 18**] [**Location (un) 620**] where he
was found to be acidemic (ABG 7.08/87/91), intubated for
hypercarbic respiratory failure.  He was started on a heparin
gtt and nitro gtt.  He also had ?Vtach on EKG and was started on
lidocaine drip. There was a question of t-wave changes on EKG,
and he was transferred here for cardiac catheterization and
further management.  Cath on arrival showed patent grafts (no
PTCA performed), and he was brought to CCU for further
management.


Past Medical History:
1.  CAD, s/p recent CABG as above; TTE [**3-6**] showing dilated
LA/LAV, 1+ MR, EF=20-30%, with BiV pacer for ventricular
arrhythmias
2.  Prostatitis
3.  Melanoma s/p excisions
4.  DM x 2 years
5.  Recurrent PNA
6.  GERD
7.  gout
8.  Sleep apnea
9.  s/p hemorrhoidectomy
10.  bilateral Iliac artery anneurysm s/p repair
11.  Hypertensive cardiomyopathy
12.  Hypercholesterolemia
13.  Cervical radiculopathy


Social History:
Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption.

Family History:
Father with MI in 50s

Physical Exam:
VS:   99.0   89/55   60   14  100% on AC, FiO2=100%, 700/14,
PEEP=10
Gen: in mild distress, intubated
HEENT:  PERRL, OP clear
Lungs: crackes at bases, no w/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs, no masses
Groin: right groin with sheath, left with triple lumen
Extr: no c/c/e, DP 2+ bilat
Neuro: moving all 4 extremities

Pertinent Results:
EKG at OSH: Wide complex tachycardia, right axis, LBBB; rate=102

CXR: mild failure

Brief Hospital Course:
1. CAD; no anginal symptoms on admission, but cardiac
catheterization was performed to rule out ischemia as a cause of
his ?CHF flare and respiratory distress.  Catheterization
revealed patent vein grafts, and no intervention was performed.
He was continued on his Aspirin, Lipitor, Lisinopril, Coreg.
His dose of lisinopril was increased to 20 mg daily while the
Coreg was increased to 12.5 mg twice daily.  His lipid profile
was checked, and his LDL was found to be 50, so his dose of
Lipitor was decreased to 40 mg daily.  He had no anginal
symptoms or EKG changes, and he was discharged on his medical
regimen, to follow up with his PCP and cardiologist.

2. CHF: His chest X-ray and exam on admission was consistent
with congestive heart failure (likely the cause of his
respiratory distress on admission).  He was diuresed with good
success, 1-1.5 L each day with IV lasix.  TTE was repeated
showing EF=15-20% with worsening of systolic function from prior
TTE.  Although the cause of his current CHF flare was never
definitively determined, it was thought to be secondary to
dietary indiscretions (patient had apparently eaten ?salty
chinese food prior to presentation).  He was euvolemic at time
of discharge and will continue his home lasix/potassium regimen.
 He will weigh himself daily and have his creatinine/K checked
in [**3-5**] days after discharge.  He declined evaluation for heart
transplant at this time.

3. Rhythm: He had ?ventricular tachycardia at the outside
hospital. His pacemaker was interrogated by EP while in-house
who thought that his arrhythmia was sinus tachycardia.  NIPS
study was performed, and the pacemaker was found to be
functioning properly.  His amiodarone was continued at his
current dose, and he will follow up in device clinic.

4. Respiratory: intubated in [**Location (un) 620**] for hypercarbic respiratory
failure, and he was extubated at [**Hospital1 18**] on day of admission after
some diuresis.  He likely was in respiratory distress secondary
to pulmonary edema.  He remained stable after extubation and was
saturating adequately on room air at time of discharge.  He was
continued on his atrovent and advair while in-house.

5. Chronic RF; baseline 1.3-1.5; his creatinine remained below
his baseline but increased to 1.3 at time of discharge (likely
after diuresis).  He was instructed to have his Creatinine
rechecked 3-4 days after discharge.

6. Dispo: He was discharged in good condition and will follow up
with his PCP, [**Name10 (NameIs) 2085**], cardiac surgeon, and
electrophysiologist.


Medications on Admission:
Meds on Admission:
Lisinopril 10 mg
Coreg 3.125 mg [**Hospital1 **]
Dig 0.125 mcg
Ranitidine 150 mg daily
Amiodarone 200 mg daily
Glyburide 2.5 mg daily
Lasix 40 mg [**Hospital1 **]
Escitalopram 20 mg daily
Lipitor 80 mg daily
Klonopin 0.5 [**Hospital1 **]
Zetia 10 mg daily
Percocet PRN
KCL 20 meq daily

Discharge Medications:
1. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

4. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
5. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation Q4-6H (every 4 to 6 hours) as needed.
Disp:*qs * Refills:*3*
6. Amiodarone HCl 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Escitalopram Oxalate 10 mg Tablet Sig: Two (2) Tablet PO
DAILY (Daily).
8. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
9. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed.
10. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
11. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
12. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
13. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*
14. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
16. Outpatient Lab Work
Please check creatinine and potassium on [**2123-4-19**]


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnoses:
1.  Congestive Heart Failure
2.  Respiratory failure requiring intubation
3.  Coronary Heart Disease
Secondary Diagnoses:
1.  Hypertension
2.  Hypercholesterolemia
3.  Diabetes Mellitus

Discharge Condition:
Good

Discharge Instructions:
1.  Weigh yourself every morning, [**Name8 (MD) 138**] MD if weight > 3 lbs.
Adhere to 2 gm sodium diet
Fluid Restriction: 1.5 L daily

2.  Please take all your medications exactly as described in
this discharge paperwork.  We made the following changes to your
medication regimen:
   - We increased your Lisinopril to 20 mg daily
   - We increased your Coreg to 6.25 mg daily
   - We decreased your Lipitor to 40 mg daily

3.  Please follow up with your cardiologist, Dr. [**Last Name (STitle) **] as
described below.  Please call your PCP if you are experiencing
chest pain, shortness of breath, fever, chills, weight gain more
than 3 lb, or with any other concerns.

Followup Instructions:
1.  Follow up with Dr. [**Last Name (STitle) **] on [**2123-5-31**] ([**Telephone/Fax (1) 127**])

2.  Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) 7045**], MD Where: CARDIAC SURGERY LMOB 2A
Date/Time:[**2123-4-20**] 2:00

3.  Follow up with Dr. [**Last Name (STitle) 1407**] ([**Telephone/Fax (1) 100531**]) on [**2123-4-28**] as
already scheduled.  He may need to adjust your dose of glyburide
at this time.  You should also have your electrolytes checked on
Monday, [**2123-4-19**] to ensure that your potassium and creatinine are
under good control.

4. Follow up with Dr. [**Last Name (STitle) **] as scheduled for your pacemaker
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anxiety state, unspecified,Automatic implantable cardiac defibrillator in situ,Personal history of malignant melanoma of skin,Gout, unspecified,Unspecified sleep apnea,Pure hypercholesterolemia,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, respiratory distress

PRESENT ILLNESS: 58 y.o male with h/o DM, htn, hypercholesterolemia, with known
dz per cath in [**2114**] where pt had 95% mid RCA stenosis, 70% Lcx,
60% LAD and 40% L main with recent 4 vessel CABG on [**2123-3-4**] (LIMA
to LAD, SVG to OM, ramus, RCA), who presents with acute
SOB/respiratory distress.  He present to [**Hospital1 18**] [**Location (un) 620**] where he
was found to be acidemic (ABG 7.08/87/91), intubated for
hypercarbic respiratory failure.  He was started on a heparin
gtt and nitro gtt.  He also had ?Vtach on EKG and was started on
lidocaine drip. There was a question of t-wave changes on EKG,
and he was transferred here for cardiac catheterization and
further management.  Cath on arrival showed patent grafts (no
PTCA performed), and he was brought to CCU for further
management.

MEDICAL HISTORY: 1.  CAD, s/p recent CABG as above; TTE [**3-6**] showing dilated
LA/LAV, 1+ MR, EF=20-30%, with BiV pacer for ventricular
arrhythmias
2.  Prostatitis
3.  Melanoma s/p excisions
4.  DM x 2 years
5.  Recurrent PNA
6.  GERD
7.  gout
8.  Sleep apnea
9.  s/p hemorrhoidectomy
10.  bilateral Iliac artery anneurysm s/p repair
11.  Hypertensive cardiomyopathy
12.  Hypercholesterolemia
13.  Cervical radiculopathy

MEDICATION ON ADMISSION: Meds on Admission:
Lisinopril 10 mg
Coreg 3.125 mg [**Hospital1 **]
Dig 0.125 mcg
Ranitidine 150 mg daily
Amiodarone 200 mg daily
Glyburide 2.5 mg daily
Lasix 40 mg [**Hospital1 **]
Escitalopram 20 mg daily
Lipitor 80 mg daily
Klonopin 0.5 [**Hospital1 **]
Zetia 10 mg daily
Percocet PRN
KCL 20 meq daily

ALLERGIES: Hydrochlorothiazide / Demerol / Ambien

PHYSICAL EXAM: VS:   99.0   89/55   60   14  100% on AC, FiO2=100%, 700/14,
PEEP=10
Gen: in mild distress, intubated
HEENT:  PERRL, OP clear
Lungs: crackes at bases, no w/r
CV: RRR, nl s1/s2, no m/r/g
Abd: soft, nt/nd, nabs, no masses
Groin: right groin with sheath, left with triple lumen
Extr: no c/c/e, DP 2+ bilat
Neuro: moving all 4 extremities

FAMILY HISTORY: Father with MI in 50s

SOCIAL HISTORY: Ex-smoker, with 40 pack-year smoking history. He quit in [**2106**].
He lives with his wife. [**Name (NI) **] history of EtOH consumption. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Aortocoronary bypass status,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anxiety state, unspecified,Automatic implantable cardiac defibrillator in situ,Personal history of malignant melanoma of skin,Gout, unspecified,Unspecified sleep apnea,Pure hypercholesterolemia,Unspecified essential hypertension'}
