CHIEF COMPLAINT: Mild fatigue

PRESENT ILLNESS: 66 year old male with hyperlipidemia and GERD/spastic colon has
a history of an MI in [**2165**] s/p LAD stenting at [**Hospital3 **]
Center. At the time of his MI, his symptoms were atypical with
epigastric discomfort and an overall feeling of being unwell.
Through the years he has been feeling fairly well without any
significant symptoms. He does notice some mild fatigue which he
believes might be related to lack of sleep due to personal
stressors. On [**2180-2-11**] he underwent a surveillance stress echo.
This was positive for ST depressions and apical ischemia on
imaging. He does describe occasional palpitations. He reports
that a recent 24 hour Holter monitor has revealed an occasional
skipped beat but no significant arrhythmia. He was referred for
left heart catheterization. He was found to have significant
coronary artery disease and is now being referred to cardiac
surgery for revascularization.

MEDICAL HISTORY: Coronary Artery Disease with NSTEMI [**2165**] s/p LAD stenting at [**Hospital1 2177**]
GERD/PUD
Spastic colon
BPH per referring records (patient denies knowledge)
Allergic rhinitis
Left renal cyst
Sciatica
Hematuria approximately five years ago- no source found
Gout
Anxiety
eye spasms (recieves botox treatments every 3 months)
Hemorrhoids
Past Surgical History:
[**2170**] appendectomy
Right shoulder rotator cuff repair x 2 ([**2172**] and [**2173**])
Hemorrhoid surgery
Past Cardiac Procedures:
s/p LAD stenting at [**Hospital1 2177**]

MEDICATION ON ADMISSION: CLONAZEPAM 1 mg Tablet - half Tablet by mouth every morning, 1
tablet every evening
HYOSCYAMINE SULFATE 0.375 mg Daily
ISOSORBIDE MONONITRATE 15 mg Daily
LANSOPRAZOLE 30 mg Daily
TOPROL XL 25 mg Daily
NITROGLYCERIN 0.4 mg Tablet- 1 Tablet sublingually every five
minutes for chest discomfort. Call 911 if pain persists longer
than 15 minutes
SIMVASTATIN 80 mg Daily
ACETAMINOPHEN 650 mg Daily
ASPIRIN 81 mg [**Hospital1 **]
CALCIUM CARBONATE 200 mg calcium (500 mg) Tablet, Chewable - [**12-6**]
Tablet by mouth q hs as needed for epigastric distress
MULTIVITAMIN 1 Capsule Daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:58 Resp:16  O2 sat:100/RA
B/P  Right:161/71    Left:177/93
Height: 6'2"     Weight: 202 lbs

FAMILY HISTORY: Premature coronary artery disease- Father with CAD in his mid
80's.  Paternal uncle died from an MI at age 51. Brother
diagnosed with an MI in his late 50's. He has CHF. Mother with
mitral valve disease.

SOCIAL HISTORY: Lives with:wife
Contact:[**Name (NI) 1154**] [**Name (NI) **] (wife)  [**Telephone/Fax (1) 110435**]
Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Pure hypercholesterolemia,Irritable bowel syndrome,Allergic rhinitis, cause unspecified,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Blepharospasm,Esophageal reflux
Crnry athrscl natve vssl,Old myocardial infarct,Pure hypercholesterolem,Irritable bowel syndrome,Allergic rhinitis NOS,Status-post ptca,Fam hx-ischem heart dis,Blepharospasm,Esophageal reflux
Admission Date:  [**2180-3-6**]              Discharge Date:   [**2180-3-10**]

Date of Birth:  [**2113-8-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Mild fatigue

Major Surgical or Invasive Procedure:
[**2180-3-6**] 1. Coronary artery bypass graft x4; left internal mammary
artery to left anterior descending artery and saphenous vein
grafts to distal right coronary artery, obtuse marginal and
diagonal arteries.
2. Endoscopic harvesting of the long saphenous vein.

History of Present Illness:
66 year old male with hyperlipidemia and GERD/spastic colon has
a history of an MI in [**2165**] s/p LAD stenting at [**Hospital3 **]
Center. At the time of his MI, his symptoms were atypical with
epigastric discomfort and an overall feeling of being unwell.
Through the years he has been feeling fairly well without any
significant symptoms. He does notice some mild fatigue which he
believes might be related to lack of sleep due to personal
stressors. On [**2180-2-11**] he underwent a surveillance stress echo.
This was positive for ST depressions and apical ischemia on
imaging. He does describe occasional palpitations. He reports
that a recent 24 hour Holter monitor has revealed an occasional
skipped beat but no significant arrhythmia. He was referred for
left heart catheterization. He was found to have significant
coronary artery disease and is now being referred to cardiac
surgery for revascularization.

Past Medical History:
Coronary Artery Disease with NSTEMI [**2165**] s/p LAD stenting at [**Hospital1 2177**]
GERD/PUD
Spastic colon
BPH per referring records (patient denies knowledge)
Allergic rhinitis
Left renal cyst
Sciatica
Hematuria approximately five years ago- no source found
Gout
Anxiety
eye spasms (recieves botox treatments every 3 months)
Hemorrhoids
Past Surgical History:
[**2170**] appendectomy
Right shoulder rotator cuff repair x 2 ([**2172**] and [**2173**])
Hemorrhoid surgery
Past Cardiac Procedures:
s/p LAD stenting at [**Hospital1 2177**]

Social History:
Lives with:wife
Contact:[**Name (NI) 1154**] [**Name (NI) **] (wife)  [**Telephone/Fax (1) 110435**]

Occupation:Retired engineer for GE
Cigarettes: Smoked no [x] yes []
Other Tobacco use:rare cigar
ETOH: 2 beers/night
Illicit drug use:denies

Family History:
Premature coronary artery disease- Father with CAD in his mid
80's.  Paternal uncle died from an MI at age 51. Brother
diagnosed with an MI in his late 50's. He has CHF. Mother with
mitral valve disease.

Physical Exam:
Pulse:58 Resp:16  O2 sat:100/RA
B/P  Right:161/71    Left:177/93
Height: 6'2"     Weight: 202 lbs

General:
Skin: Dry [] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck: Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x] Irregular [] Murmur [] grade ______
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 [x]
Pulses:
Femoral      Right: +2  Left:+2
DP           Right: +2  Left:+2
PT           [**Name (NI) 167**]: +2  Left:+2
Radial       Right: +2  Left:+2

Carotid Bruit      Right:None    Left:None

Pertinent Results:
[**2180-3-6**] Intra-op TEE: Prebypass: No atrial septal defect is seen
by 2D or color Doppler. Left ventricular wall thicknesses are
normal. Regional left ventricular wall motion is normal. Overall
left ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic stenosis. Trace aortic
regurgitation is seen. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is no
pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person
of the results on [**2180-3-6**] at 1215pm.
Post bypass: There is normal biventricular systolic function.
Valvular function is unchanged. The thoracic aorta is intact
after decannulation.
.
[**2180-3-6**] 03:43PM BLOOD WBC-17.6*# RBC-3.44* Hgb-11.0*# Hct-33.2*
MCV-97 MCH-32.1* MCHC-33.2 RDW-13.4 Plt Ct-195
[**2180-3-9**] 05:43AM BLOOD WBC-10.6 RBC-3.50* Hgb-11.0* Hct-33.9*
MCV-97 MCH-31.4 MCHC-32.4 RDW-13.6 Plt Ct-183
[**2180-3-6**] 03:43PM BLOOD PT-16.6* PTT-29.8 INR(PT)-1.6*
[**2180-3-7**] 02:30AM BLOOD PT-12.2 PTT-29.2 INR(PT)-1.1
[**2180-3-6**] 05:15PM BLOOD UreaN-18 Creat-1.0 Na-141 K-4.5 Cl-111*
HCO3-25 AnGap-10
[**2180-3-9**] 05:43AM BLOOD Glucose-99 UreaN-15 Creat-1.0 Na-141
K-4.2 Cl-104 HCO3-29 AnGap-12
[**2180-3-7**] 02:30AM BLOOD Calcium-8.3* Phos-4.0 Mg-2.1

Brief Hospital Course:
The patient was brought to the Operating Room on [**2180-3-6**] where
the patient underwent Coronary Artery Bypass with Dr. [**First Name (STitle) **].
Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring. POD 1 found the
patient extubated, alert and oriented and breathing comfortably.
The patient was neurologically intact and hemodynamically
stable, weaned from inotropic and vasopressor support. Beta
blocker was initiated and the patient was gently diuresed toward
the preoperative weight.  The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued without complication. The patient was
evaluated by the physical therapy service for assistance with
strength and mobility.  By the time of discharge on POD 4 the
patient was ambulating freely, the wound was healing and pain
was controlled with oral analgesics. The patient was discharged
home with VNA services in good condition with appropriate follow
up instructions.

Medications on Admission:
CLONAZEPAM 1 mg Tablet - half Tablet by mouth every morning, 1
tablet every evening
HYOSCYAMINE SULFATE 0.375 mg Daily
ISOSORBIDE MONONITRATE 15 mg Daily
LANSOPRAZOLE 30 mg Daily
TOPROL XL 25 mg Daily
NITROGLYCERIN 0.4 mg Tablet- 1 Tablet sublingually every five
minutes for chest discomfort. Call 911 if pain persists longer
than 15 minutes
SIMVASTATIN 80 mg Daily
ACETAMINOPHEN 650 mg Daily
ASPIRIN 81 mg [**Hospital1 **]
CALCIUM CARBONATE 200 mg calcium (500 mg) Tablet, Chewable - [**12-6**]
Tablet by mouth q hs as needed for epigastric distress
MULTIVITAMIN 1 Capsule Daily

Discharge Medications:
1. simvastatin 40 mg Tablet [**Month/Day (2) **]: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
2. clonazepam 0.5 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO DAILY
(Daily).
3. acetaminophen 325 mg Tablet [**Month/Day (2) **]: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain, fever.
4. clonazepam 1 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO QHS (once a day
(at bedtime)) as needed for anxiety.
5. magnesium hydroxide 400 mg/5 mL Suspension [**Month/Day (2) **]: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. hyoscyamine sulfate 0.375 mg Capsule,Extended Release 12 hr
[**Month/Day (2) **]: One (1) Capsule,Extended Release 12 hr PO DAILY (Daily).
7. polyvinyl alcohol-povidon(PF) 1.4-0.6 % Dropperette [**Month/Day (2) **]: [**12-6**]
Drops Ophthalmic PRN (as needed) as needed for xerophthalmia.
8. metoprolol tartrate 25 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
[**Month/Day (2) **]: One (1) Tablet, Chewable PO QID (4 times a day) as needed
for reflux.
10. aspirin 81 mg Tablet, Delayed Release (E.C.) [**Month/Day (2) **]: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
11. aspirin 81 mg Tablet, Delayed Release (E.C.) [**Month/Day (2) **]: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
12. tramadol 50 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
13. tramadol 50 mg Tablet [**Month/Day (2) **]: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
14. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
15. multivitamin     Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Coronary Artery Disease s/p coronary artery bypass graft x 4
Hyperlipidemia
NSTEMI, CAD s/p LAD stenting at [**Hospital1 2177**]
gastroesophageal reflux
Spastic colon
Allergic rhinitis
Left renal cyst
Sciatica
Hematuria
Gout
Anxiety
blepharospasm (recieves botox treatments every 3 months)
Hemorrhoids
s/p appendectomy
Right shoulder rotator cuff repair x 2 ([**2172**] and [**2173**])
Past Cardiac Procedures:
s/p LAD stenting at [**Hospital1 2177**]

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
Edema- none

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:
Wound Check at Cardiac Surgery Office ([**Telephone/Fax (1) 170**])
Surgeon Dr.[**First Name (STitle) **]([**Telephone/Fax (1) 170**]) on [**2180-4-11**] at 2pm
Wound check in surgery office on [**2180-3-16**] at 10am
Cardiologist:Dr.[**Last Name (STitle) 110436**] on [**2180-3-24**] at 11am

Please call to schedule the following:
Primary Care Dr.[**Last Name (STitle) 14879**]([**Telephone/Fax (1) 32949**]in [**3-9**] 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:[**2180-3-10**]
{'Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Pure hypercholesterolemia,Irritable bowel syndrome,Allergic rhinitis, cause unspecified,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Blepharospasm,Esophageal reflux'}


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: Mild fatigue

PRESENT ILLNESS: 66 year old male with hyperlipidemia and GERD/spastic colon has
a history of an MI in [**2165**] s/p LAD stenting at [**Hospital3 **]
Center. At the time of his MI, his symptoms were atypical with
epigastric discomfort and an overall feeling of being unwell.
Through the years he has been feeling fairly well without any
significant symptoms. He does notice some mild fatigue which he
believes might be related to lack of sleep due to personal
stressors. On [**2180-2-11**] he underwent a surveillance stress echo.
This was positive for ST depressions and apical ischemia on
imaging. He does describe occasional palpitations. He reports
that a recent 24 hour Holter monitor has revealed an occasional
skipped beat but no significant arrhythmia. He was referred for
left heart catheterization. He was found to have significant
coronary artery disease and is now being referred to cardiac
surgery for revascularization.

MEDICAL HISTORY: Coronary Artery Disease with NSTEMI [**2165**] s/p LAD stenting at [**Hospital1 2177**]
GERD/PUD
Spastic colon
BPH per referring records (patient denies knowledge)
Allergic rhinitis
Left renal cyst
Sciatica
Hematuria approximately five years ago- no source found
Gout
Anxiety
eye spasms (recieves botox treatments every 3 months)
Hemorrhoids
Past Surgical History:
[**2170**] appendectomy
Right shoulder rotator cuff repair x 2 ([**2172**] and [**2173**])
Hemorrhoid surgery
Past Cardiac Procedures:
s/p LAD stenting at [**Hospital1 2177**]

MEDICATION ON ADMISSION: CLONAZEPAM 1 mg Tablet - half Tablet by mouth every morning, 1
tablet every evening
HYOSCYAMINE SULFATE 0.375 mg Daily
ISOSORBIDE MONONITRATE 15 mg Daily
LANSOPRAZOLE 30 mg Daily
TOPROL XL 25 mg Daily
NITROGLYCERIN 0.4 mg Tablet- 1 Tablet sublingually every five
minutes for chest discomfort. Call 911 if pain persists longer
than 15 minutes
SIMVASTATIN 80 mg Daily
ACETAMINOPHEN 650 mg Daily
ASPIRIN 81 mg [**Hospital1 **]
CALCIUM CARBONATE 200 mg calcium (500 mg) Tablet, Chewable - [**12-6**]
Tablet by mouth q hs as needed for epigastric distress
MULTIVITAMIN 1 Capsule Daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:58 Resp:16  O2 sat:100/RA
B/P  Right:161/71    Left:177/93
Height: 6'2"     Weight: 202 lbs

FAMILY HISTORY: Premature coronary artery disease- Father with CAD in his mid
80's.  Paternal uncle died from an MI at age 51. Brother
diagnosed with an MI in his late 50's. He has CHF. Mother with
mitral valve disease.

SOCIAL HISTORY: Lives with:wife
Contact:[**Name (NI) 1154**] [**Name (NI) **] (wife)  [**Telephone/Fax (1) 110435**] 

### Response:
{'Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Pure hypercholesterolemia,Irritable bowel syndrome,Allergic rhinitis, cause unspecified,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Blepharospasm,Esophageal reflux'}
