CHIEF COMPLAINT: Shortness of breath times two days.

PRESENT ILLNESS: A 75-year-old man with a history
of coronary artery disease status post a myocardial
infarction in [**2095**] as well as hypertension,
hypercholesterolemia, diabetes mellitus with shortness of
breath times two days.  The patient reports he has had chest
pains four to five times a year.  Can only walk about a half
a block at a time before he gets short of breath.  Has two
pillow orthopnea and a history of lower extremity edema in
the past.  He also reports fever and chills with cough
although it is nonproductive.  Two days prior to admission at
the outside hospital, patient ruled in for a myocardial
infarction with a peak CK of 520 and troponin-I of 15.4.  He
was started on aspirin, beta blocker, heparin and a statin.
Treated for pneumonia with Levaquin and ceftriaxone.  Patient
transferred to [**Hospital1 69**] for
cardiac catheterization with an EKG that showed lateral ST
depressions.  Catheterization revealed severe three vessel
disease.  Following cardiac catheterization the patient was
to be evaluated for coronary artery bypass grafting by
Cardiothoracic Surgery.

MEDICAL HISTORY: 1.  Coronary artery disease status post myocardial infarction
in [**2095**].
2.  Chronic obstructive pulmonary disease.
3.  Insulin-dependent diabetes mellitus.
4.  Bladder cancer.
5.  Hypertension.
6.  Hypercholesterolemia.

MEDICATION ON ADMISSION: Include:
1.  Aspirin 325 q. day.
2.  NPH 35 q. a.m. and 15 q. p.m.
3.  Lisinopril no dose provided.
4.  Neurontin 300 q. hs.
5.  Prednisone 40 q. day which was started the day prior to
admission.
6.  Protonix 40 q. day.
7.  Lovenox 80 b.i.d.
8.  Lopressor 50 b.i.d.
9.  Lovastatin 40 q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother died at 75 of heart disease.  Father
died at 66 also of heart disease as well as emphysema.

SOCIAL HISTORY: The patient lives with his wife.  His son
lives nearby.  Remote tobacco history.  Quit in [**2095**].  Prior
to that he had a 150 pack years.  Occasional EToH use.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Primary pulmonary hypertension,Atrial fibrillation,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension
Subendo infarct, initial,Crnry athrscl natve vssl,Mitral valve disorder,Prim pulm hypertension,Atrial fibrillation,Urin tract infection NOS,DMI wo cmp nt st uncntrl,Chr airway obstruct NEC,Hypertension NOS
Admission Date:  [**2121-1-20**]       Discharge Date:  [**2121-2-1**]

Date of Birth:   [**2046-1-13**]       Sex:  M

Service:  CARDTHORAC

CHIEF COMPLAINT:  Shortness of breath times two days.

HISTORY OF PRESENT ILLNESS:  A 75-year-old man with a history
of coronary artery disease status post a myocardial
infarction in [**2095**] as well as hypertension,
hypercholesterolemia, diabetes mellitus with shortness of
breath times two days.  The patient reports he has had chest
pains four to five times a year.  Can only walk about a half
a block at a time before he gets short of breath.  Has two
pillow orthopnea and a history of lower extremity edema in
the past.  He also reports fever and chills with cough
although it is nonproductive.  Two days prior to admission at
the outside hospital, patient ruled in for a myocardial
infarction with a peak CK of 520 and troponin-I of 15.4.  He
was started on aspirin, beta blocker, heparin and a statin.
Treated for pneumonia with Levaquin and ceftriaxone.  Patient
transferred to [**Hospital1 69**] for
cardiac catheterization with an EKG that showed lateral ST
depressions.  Catheterization revealed severe three vessel
disease.  Following cardiac catheterization the patient was
to be evaluated for coronary artery bypass grafting by
Cardiothoracic Surgery.

PAST MEDICAL HISTORY:
1.  Coronary artery disease status post myocardial infarction
in [**2095**].
2.  Chronic obstructive pulmonary disease.
3.  Insulin-dependent diabetes mellitus.
4.  Bladder cancer.
5.  Hypertension.
6.  Hypercholesterolemia.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Include:
1.  Aspirin 325 q. day.
2.  NPH 35 q. a.m. and 15 q. p.m.
3.  Lisinopril no dose provided.
4.  Neurontin 300 q. hs.
5.  Prednisone 40 q. day which was started the day prior to
admission.
6.  Protonix 40 q. day.
7.  Lovenox 80 b.i.d.
8.  Lopressor 50 b.i.d.
9.  Lovastatin 40 q. day.

SOCIAL HISTORY:  The patient lives with his wife.  His son
lives nearby.  Remote tobacco history.  Quit in [**2095**].  Prior
to that he had a 150 pack years.  Occasional EToH use.

FAMILY HISTORY:  Mother died at 75 of heart disease.  Father
died at 66 also of heart disease as well as emphysema.

PHYSICAL EXAMINATION:  Temperature 97.9, heart rate 80, blood
pressure 110/47, respiratory rate 20, oxygen saturation 95%
on three liters.  General:  No acute distress, alert and
oriented times three.  HEENT:  Mucus membranes are moist.
Jugular venous distention is at 12.  Cardiovascular:  Regular
rate and rhythm, no murmurs, rubs or gallops.  Pulmonary:
Bibasilar crackles.  Abdomen is soft, non-tender,
non-distended with positive bowel sounds.  Extremities with
no edema.  One plus pulses bilaterally and no bruits.

LABORATORY DATA:  White count 17.9, hematocrit 32, platelet
count 309,000.  Sodium 129, potassium 4.3, chloride 98, CO2
23, BUN 27, creatinine 1.3, glucose 195.

RADIOLOGY:  Chest x-ray was consistent with mild congestive
heart failure.

CATHETERIZATION:  His catheterization showed a wedge of 21,
cardiac output of 6, left main 60% ostial stenosis, 80%
distal stenosis, left anterior descending artery with
proximal occlusion, circumflex large OM1 with 50% proximal
disease, right coronary artery with 90% mid disease and a
small vessel.  No ventriculogram was done due to severe
pulmonary hypertension.

ECHOCARDIOGRAM:   the day following [**Hospital 228**] transfer to
[**Hospital1 69**] he underwent an
echocardiogram which showed an ejection fraction of 30% with
mild to moderate mitral regurgitation and moderate tricuspid
regurgitation as well as moderate pulmonary hypertension.

CAROTID ULTRASOUND:  Additionally, patient had carotid
ultrasound which showed no significant lesions in right or
left carotids.

HOSPITAL COURSE:  The patient was seen by Cardiac Surgery and
accepted for surgery once his potential Infectious Disease
issues were fully sorted out.  The patient was followed by
the Medical Service while these issues were resolved and on
[**1-24**] he was brought to the Operating Room where he
underwent coronary artery bypass grafting.  Please see the
Operating Room report for full details.  In summary, the
patient had coronary artery bypass grafting times two with
the left internal mammary artery to the left anterior
descending artery and a saphenous vein graft to the obtuse
marginal.  His bypass time was 59 minutes with a crossclamp
time of 39 minutes.  He tolerated the operation well and was
transferred from the Operating Room to the Cardiothoracic
Intensive Care Unit.  At the time of transfer the patient was
AV paced at a rate of 87 beats per minute.  His mean arterial
pressure was 69 and CVP was 11.  He had epinephrine at 0.2
mcg/kg/min, nitroglycerin at 0.3 mcg/kg/min and propofol at
10 mcg/kg/min.  The patient did well in the immediate
postoperative period.  His anesthesia was reversed.  He was
weaned from the ventilator and successfully extubated over
the course of postoperative day.  His propofol, epinephrine
and nitroglycerin were all weaned to off.  He was, however,
started on a Neo-Synephrine drip to maintain an adequate
blood pressure.  On postoperative day one the patient
remained hemodynamically stable, however, he was noted to
have some heart block with occasional episodes of Wenckebach,
therefore, he remained in the Intensive Care Unit.
Additionally, the patient continued to require low dose
Neo-Synephrine to maintain an adequate blood pressure.  On
postoperative day two the patient continued to be
hemodynamically stable.  His heart rhythm was a first degree
AV block.  His chest tubes were discontinued.  He was weaned
from his Neo-Synephrine drip and diuresis was begun.  On
postoperative day three the patient continued to be
hemodynamically stable.  He was noted to have episodes of
atrial fibrillation that were rate controlled with a
ventricular response in the 90-100 range.  He was begun on
beta blockers, did not convert to a sinus rhythm until after
receiving amiodarone.  Following conversion to sinus rhythm,
the patient's amiodarone was discontinued given his history
of heart block.  On postoperative day four the patient
continued to progress slowly.  He remained hemodynamically
stable and he was transferred to [**Hospital Ward Name 121**] Two for continuing
postoperative care and cardiac rehabilitation.  Over the next
several days the [**Hospital 228**] hospital course was uneventful.
He remained on [**Hospital Ward Name 121**] Two where he worked with the nursing
staff and Physical Therapy to increase his level of activity.
His Foley catheter was discontinued on postoperative day four
and he failed to void and, therefore, his Foley catheter was
reinserted.  A review of the patient's past history indicated
that he had had bladder surgery in [**2120-11-11**] and had been
straight cathing himself daily since that time.  On
postoperative day seven it was decided that the patient would
most likely be stable and ready to be transferred to
rehabilitation on the following day.

PHYSICAL EXAMINATION AT DISCHARGE:  Vital signs:  Temperature
98.1, heart rate 79 sinus rhythm, blood pressure 126/40,
respiratory rate 20, oxygen saturation 100% on room air.
Weight preoperatively 81.6 kilos, at discharge 78 kilos.

LABORATORY DATA:  Hematocrit 30.2, sodium 137, potassium 3.9,
chloride 102, CO2 24, BUN 16, creatinine 1.0, glucose 110.

Alert and oriented times three.  Moves all extremities.
Follows commands.  Respiratory:  Clear to auscultation
bilaterally.  Cardiac:  Regular rate and rhythm, S1, S2,
sternum is stable.  Incision with Steri-Strips open to air,
clean and dry.  Abdomen is soft, non-tender, non-distended
with positive bowel sounds.  Extremities are warm and
well-perfused.  Right saphenous vein graft site with
Steri-Strips open to air, clean and dry.

DISCHARGE MEDICATIONS:  Include:
1.  Metoprolol 25 mg b.i.d.
2.  Lasix 20 mg q. day times ten days.
3.  Potassium chloride 20 mEq q. day times ten days.
4.  Enteric coated aspirin 325 mg q. day.
5.  Plavix 75 mg q. day.
6.  Pantoprazole 40 mg q. day.
7.  Atorvastatin 40 mg q. day.
8.  _____________ 0.4 mg q. hs.
9.  Flagyl 500 mg t.i.d. times seven days.
10. Insulin NPH 20 units q. a.m., 8 units q. p.m.
11. Regular insulin sliding scale.  Blood sugar 120 to 140, 3
units; 141 to 160, 4 units; 161 to 180, 5 units; 181 to 200,
6 units; 201 to 220, 7 units; 221 to 240, 8 units.  Greater
than 240 [**Name8 (MD) 138**] M.D.
12.  Percocet 5/325 one to two tabs q. 4h. p.r.n.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease status post coronary artery
bypass grafting times two with the left internal mammary
artery to the left anterior descending artery and a saphenous
vein graft to obtuse marginal.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Diabetes mellitus.
5.  Chronic obstructive pulmonary disease.
6.  Bladder cancer status post bladder surgery [**2120-11-11**].

DISPOSITION:  The patient is to be discharged to
rehabilitation.

CONDITION AT DISCHARGE:  Good.

FOLLOW UP:  He is to have follow up with his primary care
physician three to four weeks following his discharge from
rehabilitation.  Follow up with Dr. [**Last Name (STitle) 7047**] in three to four
weeks.  Follow up with Dr. [**Last Name (STitle) 70**] in six weeks.





                            [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

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

D:  [**2121-1-31**]  15:55
T:  [**2121-1-31**]  16:48
JOB#:  [**Job Number 52960**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Primary pulmonary hypertension,Atrial fibrillation,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,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 times two days.

PRESENT ILLNESS: A 75-year-old man with a history
of coronary artery disease status post a myocardial
infarction in [**2095**] as well as hypertension,
hypercholesterolemia, diabetes mellitus with shortness of
breath times two days.  The patient reports he has had chest
pains four to five times a year.  Can only walk about a half
a block at a time before he gets short of breath.  Has two
pillow orthopnea and a history of lower extremity edema in
the past.  He also reports fever and chills with cough
although it is nonproductive.  Two days prior to admission at
the outside hospital, patient ruled in for a myocardial
infarction with a peak CK of 520 and troponin-I of 15.4.  He
was started on aspirin, beta blocker, heparin and a statin.
Treated for pneumonia with Levaquin and ceftriaxone.  Patient
transferred to [**Hospital1 69**] for
cardiac catheterization with an EKG that showed lateral ST
depressions.  Catheterization revealed severe three vessel
disease.  Following cardiac catheterization the patient was
to be evaluated for coronary artery bypass grafting by
Cardiothoracic Surgery.

MEDICAL HISTORY: 1.  Coronary artery disease status post myocardial infarction
in [**2095**].
2.  Chronic obstructive pulmonary disease.
3.  Insulin-dependent diabetes mellitus.
4.  Bladder cancer.
5.  Hypertension.
6.  Hypercholesterolemia.

MEDICATION ON ADMISSION: Include:
1.  Aspirin 325 q. day.
2.  NPH 35 q. a.m. and 15 q. p.m.
3.  Lisinopril no dose provided.
4.  Neurontin 300 q. hs.
5.  Prednisone 40 q. day which was started the day prior to
admission.
6.  Protonix 40 q. day.
7.  Lovenox 80 b.i.d.
8.  Lopressor 50 b.i.d.
9.  Lovastatin 40 q. day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Mother died at 75 of heart disease.  Father
died at 66 also of heart disease as well as emphysema.

SOCIAL HISTORY: The patient lives with his wife.  His son
lives nearby.  Remote tobacco history.  Quit in [**2095**].  Prior
to that he had a 150 pack years.  Occasional EToH use. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Primary pulmonary hypertension,Atrial fibrillation,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension'}
