CHIEF COMPLAINT: + Exercise Tolerance Test

PRESENT ILLNESS: The patient is 70-year-old man on renal dialysis who presents
with congestive heart failure. Positive stress echo on work-up
for kidney transplant. Catheterization showed severe 3-vessel
disease, ejection fraction of 32% with mild mitral
regurgitation. Transesophageal echocardiogram intraoperatively
showed moderate mitral regurgitation with ejection fraction of
35%.

MEDICAL HISTORY: Hyperlipidemia
HTN
PUD
ESRD on hemodialysis
DM type 2
Silent MI [**2109**]
Right arm AV fistula
Pacemaker [**7-31**]
s/p Burr holes to remove intracranial hemorrhage 51 years ago.
Right hemiplegia
Cataract removal

MEDICATION ON ADMISSION: Aspirin 325mg daily
Tegretol XR 200mg Twice daily
Atenolol 25mg daily
Lipitor 80mg daily
Glyburide 2.5mg daily
Tums

ALLERGIES: Methyldopa

PHYSICAL EXAM: Admission H+P
98.4 140/70 60
NEURO: Awake and alert.
CARD: RRR, systolic ejection mumur heard best at left sternal
border
LUNGS: Clear
ABD: Soft, nontender, nondistended.
EXT: Warm, no edema

FAMILY HISTORY: 

SOCIAL HISTORY: Occasional alcohol use. Quit smoking 35 years ago after a 10
pack year history.
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Old myocardial infarction,Cardiac pacemaker in situ
Crnry athrscl natve vssl,CHF NOS,Hyp kid NOS w cr kid V,DMII wo cmp nt st uncntr,Late ef-hemplga side NOS,Old myocardial infarct,Status cardiac pacemaker
Admission Date:  [**2121-8-4**]              Discharge Date:   [**2121-8-11**]

Date of Birth:  [**2050-8-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Methyldopa

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
+ Exercise Tolerance Test

Major Surgical or Invasive Procedure:
[**2121-8-5**] - Cardiac Catheterization
[**2121-8-6**] - CABG x 3(LIMA->LAD, SVG->OM2, SVG-PDA)


History of Present Illness:
The patient is 70-year-old man on renal dialysis who presents
with congestive heart failure. Positive stress echo on work-up
for kidney transplant. Catheterization showed severe 3-vessel
disease, ejection fraction of 32% with mild mitral
regurgitation. Transesophageal echocardiogram intraoperatively
showed moderate mitral regurgitation with ejection fraction of
35%.


Past Medical History:
Hyperlipidemia
HTN
PUD
ESRD on hemodialysis
DM type 2
Silent MI [**2109**]
Right arm AV fistula
Pacemaker [**7-31**]
s/p Burr holes to remove intracranial hemorrhage 51 years ago.
Right hemiplegia
Cataract removal

Social History:
Occasional alcohol use. Quit smoking 35 years ago after a 10
pack year history.

Physical Exam:
Admission H+P
98.4 140/70 60
NEURO: Awake and alert.
CARD: RRR, systolic ejection mumur heard best at left sternal
border
LUNGS: Clear
ABD: Soft, nontender, nondistended.
EXT: Warm, no edema

Pertinent Results:
[**2121-8-4**] 06:55PM   PT-12.7 PTT-24.8 INR(PT)-1.1
[**2121-8-4**] 06:55PM   PLT COUNT-145*
[**2121-8-4**] 06:55PM   WBC-5.8 RBC-3.69* HGB-12.4* HCT-39.1*
MCV-106*# MCH-33.6* MCHC-31.6 RDW-15.0
[**2121-8-4**] 06:55PM   GLUCOSE-139* UREA N-45* CREAT-5.0* SODIUM-144
POTASSIUM-4.2 CHLORIDE-99 TOTAL CO2-34* ANION GAP-15
[**2121-8-4**] 07:48PM URINE  RBC-0-2 WBC-0 BACTERIA-RARE YEAST-NONE
EPI-0-2
[**2121-8-4**] 07:48PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-NEG
[**2121-8-4**] 07:48PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.012
[**2121-8-9**] 10:27AM BLOOD WBC-10.6 RBC-3.10* Hgb-10.4* Hct-31.7*
MCV-102* MCH-33.6* MCHC-32.8 RDW-16.6* Plt Ct-120*
[**2121-8-9**] 10:27AM BLOOD Plt Ct-120*
[**2121-8-9**] 10:27AM BLOOD UreaN-45* Creat-4.4* Na-137 K-4.4 Cl-102
HCO3-24 AnGap-15

[**2121-8-5**] Cardiac Catheterization
1. Limited hemodynamics showed moderately elevated
central aortic pressure.
2. The left ventriculography at [**Doctor Last Name **] view showed severely reduced

systolic function  with predominantly anterolateral and apical
hypokinesia. The LVEDP was moderately elevated.
3. Coronary angiography revealed diffusely irregular coronary
vessels
with  the LAD and the RCA vessels showing significant
narrowings. The
LMCA had no significant lesions. The LAD was diffusely irregular
with
20-30% narrowings throughout the vessel. The mid vessel has a
70%
lesion. The diagonal branches are small calibre and short. The
LCx has
no hemodynamically significant lesions. The RCA is dominant.
There is a
proximal 70% lesion.  The vessel is subtotally occluded at the
origin of
the RV branch. There is TIMI I flow beyond. THe RV branch has an
ostial 90% lesion. The distal RCA, PDA and PLV are also
collateralised by the left system.

[**2121-8-8**] CXR
Sternal wires, skin staples, and pacemaker leads are unchanged.
There is mild enlargement of the cardiac silhouette, but no
overt CHF, pleural effusion, pneumothorax, or consolidation.

[**2121-8-6**] EKG
Initially rhythm is ventricular paced at rate 90 with large
ventricular pacer spikes followed by cessation of ventricular
pacing which is then followed by A-V paced rhythm with different
pacing morphologies
Since previous tracing of [**2121-8-5**], different pacing morphologies
as described .



Brief Hospital Course:
Mr. [**Known lastname 23054**] was admitted to the [**Hospital1 18**] for a cardiac
catheterization and surgical revascularization. His cardiac
catheterization revealed a 70% stenosed left anterior descending
artery, a 70% stenosed right coronary artery, a 90% stenosed RV
branch, 2+ mitral valve regurgitation and a severely impaired
left ventricular function. He was worked-up in the usual
preoperative manner. He underwent hemodialysis the day prior to
surgery. On [**2121-8-6**], Mr. [**Known lastname 23054**] was taken to the operating room
where he underwent coronary artery bypass grafting to three
vessels. Postoperatively he was taken to the cardiac surgical
intensive care unit for monitoring. On postoperative day one,
Mr. [**Known lastname 23054**] [**Last Name (Titles) 5058**] neurologically intact and was extubated.
Hemodialysis was performed. Aspirin and an ace inhibitor were
resumed. Later on postoperative day one, Mr. [**Known lastname 23054**] was
transferred to the cardiac surgical step down unit for further
recovery. His drains and pacing wires were removed per protocol.
The physical therapy service was consulted for assistance with
his postoperative strength and mobility. He resumed his routine
dialysis schedule. Mr. [**Known lastname 23054**] continued to make steady
progress and was discharged home on postoperative day five. He
will follow-up with Dr. [**Last Name (STitle) **], his cardiologist and his primary
care physician as an outpatient.

Medications on Admission:
Aspirin 325mg daily
Tegretol XR 200mg Twice daily
Atenolol 25mg daily
Lipitor 80mg daily
Glyburide 2.5mg daily
Tums

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*30 Capsule(s)* Refills:*0*
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Carbamazepine 200 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*0*
6. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*30 Tablet(s)* Refills:*0*
7. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 tabs* Refills:*0*
8. Trandolapril 2 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
10. Tums 500 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO twice a day.
Disp:*60 Tablet, Chewable(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
s/p CABG x 3(LIMA->LAD, SVG->OM2, SVG-PDA)
PMH:HTN,^chol,ESRD-HD,CAD s/p PCI '[**09**],DM2,PUD, Rt hemiplegia


Discharge Condition:
good


Discharge Instructions:
Keep wounds clean and  dry. Shower, no swimming or bathing, no
lotions creams or powders.
Take all medications as  prescribed.
Call for temperature more than 101.5, redness or drainage from
incisions.
Call for weight gain more than 2 pounds in one weeks or five in
one day.

Followup Instructions:
Dr [**Last Name (STitle) **] in [**1-2**] weeks
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 2 weeks
Resume Hemodialysis tuesday



Completed by:[**2121-8-25**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Old myocardial infarction,Cardiac pacemaker in situ'}


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: + Exercise Tolerance Test

PRESENT ILLNESS: The patient is 70-year-old man on renal dialysis who presents
with congestive heart failure. Positive stress echo on work-up
for kidney transplant. Catheterization showed severe 3-vessel
disease, ejection fraction of 32% with mild mitral
regurgitation. Transesophageal echocardiogram intraoperatively
showed moderate mitral regurgitation with ejection fraction of
35%.

MEDICAL HISTORY: Hyperlipidemia
HTN
PUD
ESRD on hemodialysis
DM type 2
Silent MI [**2109**]
Right arm AV fistula
Pacemaker [**7-31**]
s/p Burr holes to remove intracranial hemorrhage 51 years ago.
Right hemiplegia
Cataract removal

MEDICATION ON ADMISSION: Aspirin 325mg daily
Tegretol XR 200mg Twice daily
Atenolol 25mg daily
Lipitor 80mg daily
Glyburide 2.5mg daily
Tums

ALLERGIES: Methyldopa

PHYSICAL EXAM: Admission H+P
98.4 140/70 60
NEURO: Awake and alert.
CARD: RRR, systolic ejection mumur heard best at left sternal
border
LUNGS: Clear
ABD: Soft, nontender, nondistended.
EXT: Warm, no edema

FAMILY HISTORY: 

SOCIAL HISTORY: Occasional alcohol use. Quit smoking 35 years ago after a 10
pack year history. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Old myocardial infarction,Cardiac pacemaker in situ'}
