CHIEF COMPLAINT: Sternal click

PRESENT ILLNESS: Mr. [**Known lastname 27218**] is a 69 year old male who recently [**Known lastname 1834**] CABG
on [**2131-5-4**] by Dr. [**Last Name (STitle) 914**]. His postoperative course was
relatively uneventful. Since discharge, he has been concerned
about his chest incision. Patient stated he felt a "click" when
he coughed. He also noted a small amount of erythema and serous
drainage. His temperature at home has been at most, 100 F. He
has been short of breath with increasing fatigue and unable to
do his daily chores. Given the above complaints, he presented to
the ED and was subsequently admitted for further evaluation and
treatment.

MEDICAL HISTORY: Coronary Artery Disease - s/p recent CABG on [**2131-5-4**]
Chronic Obstructive Pulmonary Disease
Hypertension
History of Syncope
Depression
Benign Prostatic hypertrophy
GERD
Anxiety
Chronic Back Issues
History of Bladder Cancer - s/p Excision and BCG treatment

MEDICATION ON ADMISSION: lasix 20 [**Hospital1 **]
aspirin 81 qd
plavix 75 qd
lipitor 20 qd
lisinopril 5 qd
lopressor 25 [**Hospital1 **]
detrol 4 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 98.3, BP 128/74, HR 94, RR 22, SAT 97 on 3L
General: well developed male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: bibasilar crackles noted
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, 1+ edema,
Pulses: palpable distally
Neuro: nonfocal
Sternum: positive click, no drainage, minimal erythema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married, lives with his wife, 5 children.  He is a retired truck
driver and currently helps out in his son??????s restaurant.
+tobacco 1ppd x 55 years.  Occasional ETOH.
Disruption of internal operation (surgical) wound,Iatrogenic pulmonary embolism and infarction,Other complications due to other cardiac device, implant, and graft,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Personal history of malignant neoplasm of bladder
Disrup internal op wound,Iatrogen pulm emb/infarc,Comp-oth cardiac device,Chr airway obstruct NEC,Crnry athrscl natve vssl,Aortocoronary bypass,Hypertension NOS,BPH w/o urinary obs/LUTS,Esophageal reflux,Hx of bladder malignancy
Admission Date:  [**2131-5-12**]              Discharge Date:   [**2131-5-25**]

Date of Birth:  [**2061-8-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Sternal click

Major Surgical or Invasive Procedure:
[**2131-5-15**] Sternal Debridement with Re-wiring
[**2131-5-17**] Emergency resternotomy for cardiac tamponade
[**2131-5-18**] Mediastinal washout/sternal plating/bil. pectoralis
flaps
[**2131-5-24**] PICC line placement

History of Present Illness:
Mr. [**Known lastname 27218**] is a 69 year old male who recently [**Known lastname 1834**] CABG
on [**2131-5-4**] by Dr. [**Last Name (STitle) 914**]. His postoperative course was
relatively uneventful. Since discharge, he has been concerned
about his chest incision. Patient stated he felt a "click" when
he coughed. He also noted a small amount of erythema and serous
drainage. His temperature at home has been at most, 100 F. He
has been short of breath with increasing fatigue and unable to
do his daily chores. Given the above complaints, he presented to
the ED and was subsequently admitted for further evaluation and
treatment.

Past Medical History:
Coronary Artery Disease - s/p recent CABG on [**2131-5-4**]
Chronic Obstructive Pulmonary Disease
Hypertension
History of Syncope
Depression
Benign Prostatic hypertrophy
GERD
Anxiety
Chronic Back Issues
History of Bladder Cancer - s/p Excision and BCG treatment

Social History:
Married, lives with his wife, 5 children.  He is a retired truck
driver and currently helps out in his son??????s restaurant.
+tobacco 1ppd x 55 years.  Occasional ETOH.

Family History:
Noncontributory

Physical Exam:
Vitals: T 98.3, BP 128/74, HR 94, RR 22, SAT 97 on 3L
General: well developed male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: bibasilar crackles noted
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, 1+ edema,
Pulses: palpable distally
Neuro: nonfocal
Sternum: positive click, no drainage, minimal erythema


Pertinent Results:
[**2131-5-13**] Chest CT Scan: Sternal dehiscence with an extensive
fluid collection extending along the entire length of the
sternum. While this measures simple fluid density, infection
cannot be excluded. Bilateral pleural effusions measuring simple
fluid density.
[**2131-5-17**] Echo: There is a moderate sized pericardial effusion.
The effusion appears circumferential. There are no
echocardiographic signs of tamponade.
[**2131-5-18**] LE U/S: 1. RIGHT LOWER EXTREMITY: Extensive thrombosis
of the right femoral vein along its entire length and no
significant internal flow. 2. LEFT LOWER EXTREMITY: No evidence
for DVT.
[**2131-5-18**] Echo: The right atrium is moderately dilated. A
mass/thrombus associated with a catheter/pacing wire is seen in
the right atrium and/or right ventricle. This mass disappeared
later in the exam. No atrial septal defect or patent foramen
ovale is seen by 2D, color Doppler or saline contrast with
maneuvers. The left ventricular cavity is unusually small and
hyperdynamic. There is mild LVH. 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. Right ventricular systolic function is
borderline normal. There are simple atheroma in the aortic arch
and the descending thoracic aorta. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. The mitral valve appears structurally
normal with trivial mitral regurgitation. Moderate to severe
[3+] tricuspid regurgitation is seen. All findings discussed
with surgeons at the time of the exam.
[**2131-5-24**] UE U/S: Persistent areas of intraluminal thrombus in the
left IJ, and within the superficial veins of the left and right
cephalic veins, and new thrombus in the superficial left basilic
vein.
[**2131-5-12**] 05:45PM BLOOD WBC-12.8*# RBC-3.59* Hgb-10.4* Hct-30.1*
MCV-84 MCH-28.9 MCHC-34.5 RDW-15.5 Plt Ct-578*#
[**2131-5-17**] 01:06AM BLOOD WBC-20.1* RBC-2.50* Hgb-7.1* Hct-20.6*
MCV-83 MCH-28.6 MCHC-34.7 RDW-16.0* Plt Ct-601*
[**2131-5-19**] 03:02AM BLOOD WBC-30.5* RBC-3.08* Hgb-9.6* Hct-27.8*
MCV-90 MCH-31.2 MCHC-34.6 RDW-16.2* Plt Ct-188
[**2131-5-25**] 05:18AM BLOOD WBC-11.5* RBC-2.97* Hgb-8.8* Hct-26.3*
MCV-89 MCH-29.5 MCHC-33.3 RDW-15.6* Plt Ct-446*
[**2131-5-12**] 05:45PM BLOOD PT-12.3 PTT-30.4 INR(PT)-1.1
[**2131-5-18**] 10:56PM BLOOD PT-28.1* PTT-80.3* INR(PT)-2.9*
[**2131-5-25**] 05:18AM BLOOD PT-25.2* PTT-30.9 INR(PT)-2.5*
[**2131-5-12**] 05:45PM BLOOD Glucose-102 UreaN-23* Creat-1.5* Na-133
K-4.9 Cl-99 HCO3-26 AnGap-13
[**2131-5-20**] 03:20AM BLOOD Glucose-115* UreaN-21* Creat-1.4* Na-136
K-4.0 Cl-106 HCO3-22 AnGap-12
[**2131-5-25**] 05:18AM BLOOD Glucose-103 UreaN-23* Creat-1.3* Na-136
K-3.5 Cl-99 HCO3-28 AnGap-13
[**2131-5-18**] 06:00PM BLOOD HEPARIN DEPENDENT ANTIBODIES-Negative

Brief Hospital Course:
Mr. [**Known lastname 27218**] was admitted [**5-12**] with sternal instability and
[**Month/Day (1) 1834**] chest CT scan which confirmed sternal dehiscence. It
was also notable for an extensive fluid collection extending
along the entire length of the sternum. He was empirically
started on antibiotics and taken to the operating room on [**5-15**]
for sternal re-wiring. There was no evidence of sternal wound
infection. Postoperatively, he was maintained on antibiotics and
wound irrigation. On [**5-17**] in the early AM, he became acutely
hypotensive and increased his chest tube drainage. Transferred
to the CSRU, Swan placed, and transfused one unit. Emergent Echo
revealed a moderate sized pericardial effusion that appeared
circumferential. His chest was ultimately opened emergently in
the unit for washout, and returned to the OR for complete
washout and a hole in the vein graft was sutured closed. Please
see op reports for surgical details. Following surgery he was
transferred to the with open chest and plastic surgery was
consulted regarding sternal plating. The following day he was
brought back to the operating room for chest closure. Echo done
at that time revealed an acute Pulmonary Embolism/Thrombus in
the RA/RV. This mass/thrombus disappeared later on exam. He then
[**Month/Year (2) 1834**] sternal plating closure/bil. pectoralis flaps done by
plastic surgery. Following surgery he was again transferred back
to the CSRU for invasive monitoring. Argatroban started for
presumed HIT (eventually came back negative) and Hematology
consulted. On [**5-21**] he was weaned from sedation, awoke
neurologically intact and extubated. Following extubation a
bedside swallow study was done, which he initially failed, but
repeated [**5-23**] with improvement. Also on [**5-23**] he was transferred
to the SDU for further care. Extremity U/S revealed thrombus in
his right femoral vein, left IJ, superficial veins of the left
and right cephalic veins, and in the superficial left basilic
vein. On [**5-24**] a PICC line was placed. Although operative wound
cultures were eventually negative, per ID, he will receive 4
weeks of vancomycin for high risk of sternal contamination. He
continued to improve and worked with physical therapy during his
post-op course for strength and mobility. On [**5-25**] he was
discharged to rehab facility with the appropriate follow-up
appointments. Of note, he will remain on Coumadin for DVT/PE for
minimum of 6 months.

Medications on Admission:
lasix 20 [**Hospital1 **]
aspirin 81 qd
plavix 75 qd
lipitor 20 qd
lisinopril 5 qd
lopressor 25 [**Hospital1 **]
detrol 4 qd

Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
2. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day).
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. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
7. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
12. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
13. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

14. Zinc Sulfate 220 (50) mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
15. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
17. Vancomycin in Dextrose 1 g/200 mL Piggyback Sig: One (1)
Intravenous Q12H (every 12 hours) for 1 months: via PICC line.
18. Haloperidol 0.5 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
19. Furosemide 20 mg Tablet Sig: One (1) Tablet PO twice a day
for 7 days.
20. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 7
days.
21. Warfarin 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
Please adjust for an INR [**2-10**] (for DVT/PE).

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 700**] - [**Location (un) 701**]

Discharge Diagnosis:
Sternal Instability/Dehiscence - s/p Sternal Re-wiring
Pulmonary Embolism
DVTs of LIJ, Right superficial femoral
PMH: Coronary Artery Disease - s/p recent CABG on [**2131-5-4**],
Chronic Obstructive Pulmonary Disease, Hypertension,
Gastroesophageal Reflux Disease, Anxiety, History of Bladder
Cancer - s/p Excision and BCG treatment


Discharge Condition:
Good

Discharge Instructions:
Patient may shower, no baths. PLEASE SHOWER DAILY. No creams,
lotions or ointments to incisions. No driving for at least one
month. No lifting more than 10 lbs for at least 10 weeks from
the date of surgery. Monitor wounds for signs of infection.
Please call with any concerns or questions.

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in [**4-12**] weeks, call for appt [**Social Security Number 27220**]
Dr. [**Last Name (un) **] in [**2-10**] weeks, call for appt
Dr. [**First Name (STitle) **] in [**7-17**] days, call for appt [**Telephone/Fax (1) 1416**]


Completed by:[**2131-5-25**]
{'Disruption of internal operation (surgical) wound,Iatrogenic pulmonary embolism and infarction,Other complications due to other cardiac device, implant, and graft,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Personal history of malignant neoplasm of bladder'}


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: Sternal click

PRESENT ILLNESS: Mr. [**Known lastname 27218**] is a 69 year old male who recently [**Known lastname 1834**] CABG
on [**2131-5-4**] by Dr. [**Last Name (STitle) 914**]. His postoperative course was
relatively uneventful. Since discharge, he has been concerned
about his chest incision. Patient stated he felt a "click" when
he coughed. He also noted a small amount of erythema and serous
drainage. His temperature at home has been at most, 100 F. He
has been short of breath with increasing fatigue and unable to
do his daily chores. Given the above complaints, he presented to
the ED and was subsequently admitted for further evaluation and
treatment.

MEDICAL HISTORY: Coronary Artery Disease - s/p recent CABG on [**2131-5-4**]
Chronic Obstructive Pulmonary Disease
Hypertension
History of Syncope
Depression
Benign Prostatic hypertrophy
GERD
Anxiety
Chronic Back Issues
History of Bladder Cancer - s/p Excision and BCG treatment

MEDICATION ON ADMISSION: lasix 20 [**Hospital1 **]
aspirin 81 qd
plavix 75 qd
lipitor 20 qd
lisinopril 5 qd
lopressor 25 [**Hospital1 **]
detrol 4 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T 98.3, BP 128/74, HR 94, RR 22, SAT 97 on 3L
General: well developed male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: bibasilar crackles noted
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, 1+ edema,
Pulses: palpable distally
Neuro: nonfocal
Sternum: positive click, no drainage, minimal erythema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Married, lives with his wife, 5 children.  He is a retired truck
driver and currently helps out in his son??????s restaurant.
+tobacco 1ppd x 55 years.  Occasional ETOH. 

### Response:
{'Disruption of internal operation (surgical) wound,Iatrogenic pulmonary embolism and infarction,Other complications due to other cardiac device, implant, and graft,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Esophageal reflux,Personal history of malignant neoplasm of bladder'}
