CHIEF COMPLAINT: dyspnea on exertion

PRESENT ILLNESS: 70 yo female with DOE and wheezing noted in early [**9-16**]. PCP rx
with [**Name9 (PRE) 621**], but no improvement. She worsened and ruled in for
NSTEMI in the ER. Cath revealed severe 3VD.

MEDICAL HISTORY: CAD s/p silent MI c/b LV mural thrombus (resolved, off warfarin)

MEDICATION ON ADMISSION: lipitor 80 mg daily
ASA 325 mg daily
isosorbide MN 30 mg daily
methimazole 10 mg daily
protonix 40 mg daily
lisinopril 20 mg daily
chlorazepate dipotassium 3.75 mg daily
toprol XL 50 mg daily
insulin levemir 32 units Q PM
novolog 8 units Q AM
novolog 14 units Q PM

ALLERGIES: Bactrim / Heparin Agents

PHYSICAL EXAM: at discharge:
VS: 97.4, 121/54, 80SR, 20, 97%RA
Gen: NAD, overweight WF
Lungs: crackles b/l bases, o/w clear
heart: RRR, no murmur or rub
abd: obese, NABS, soft, non-tender, non-distended
ext: warm, trace edema b/l
sternal wound: c/d/i, no erythema or drainage
EVH: c/d/i, no erythema or drainage

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: Denies tobacco, EtOH
lives with husband
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atherosclerosis of native arteries of the extremities, unspecified,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Subendocardial infarction, subsequent episode of care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified angina pectoris
Crnry athrscl natve vssl,Surg compl-heart,Atrial fibrillation,Abn react-anastom/graft,Athscl extrm ntv art NOS,Thyrotox NOS no crisis,Subendo infarct, subseq,Hypertension NOS,DMII wo cmp nt st uncntr,Angina pectoris NEC/NOS
Admission Date:  [**2116-10-12**]              Discharge Date:   [**2116-10-17**]

Date of Birth:  [**2045-10-30**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Bactrim / Heparin Agents

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
dyspnea on exertion

Major Surgical or Invasive Procedure:
CABG x4/repair LV aneurysm/CX endarterectomy  [**2116-10-12**]
(LIMA to LAD, SVG to OM, SVG to OM, SVG to PDA)


History of Present Illness:
70 yo female with DOE and wheezing noted in early [**9-16**]. PCP rx
with [**Name9 (PRE) 621**], but no improvement. She worsened and ruled in for
NSTEMI in the ER. Cath revealed severe 3VD.

Past Medical History:
CAD s/p silent MI c/b LV mural thrombus (resolved, off warfarin)

PAD s/p left SFA angioplasty and stent
DM2
HTN
OA
spinal stenosis
Hyperthyroidism
s/p cholecystectomy
s/p appendectomy
s/p TAH

Social History:
Denies tobacco, EtOH
lives with husband


Family History:
No family history of early MI, otherwise non-contributory.


Physical Exam:
at discharge:
VS: 97.4, 121/54, 80SR, 20, 97%RA
Gen: NAD, overweight WF
Lungs: crackles b/l bases, o/w clear
heart: RRR, no murmur or rub
abd: obese, NABS, soft, non-tender, non-distended
ext: warm, trace edema b/l
sternal wound: c/d/i, no erythema or drainage
EVH: c/d/i, no erythema or drainage

Pertinent Results:
PRE-CPB: 1. The left atrium is moderately dilated. No
spontaneous echo contrast is seen in the body of the left
atrium. No thrombus is seen in the left atrial appendage. No
atrial septal defect is seen by 2D or color Doppler.
2. Left ventricular wall thicknesses are normal. The left
ventricular cavity is mildly dilated. There is an antero-apical
left ventricular aneurysm. There is moderate regional left
ventricular systolic dysfunction with anteroseptal and
anteroapical hypokinesis. There is an inferoapical aneurysm with
no thrombus seen.. No masses or thrombi are seen in the left
ventricle. Overall left ventricular systolic function is
moderately depressed (LVEF= 35 %).
3. Right ventricular chamber size and free wall motion are
normal.
4. There are simple atheroma in the aortic root. There are
simple atheroma in the ascending aorta. There are simple
atheroma in the aortic arch. There are complex (>4mm) atheroma,
nonmobile, in the descending thoracic aorta.
5. There are three aortic valve leaflets. The aortic valve
leaflets are mildly thickened. There is no aortic valve
stenosis. No aortic regurgitation is seen.
6. The mitral valve leaflets are mildly thickened. Trivial
mitral regurgitation is seen.
7. The tricuspid valve leaflets are mildly thickened.
8. There is a trivial/physiologic pericardial effusion. Dr.
[**Last Name (STitle) **] was notified in person of the results.

POST-CPB: On infusions of epinephrine, phenylephrine. There is
improvement of global LV systolic function on inotropic support.
LVEF is now 40%. There is evidence of a suture-repair of the lv
apical aneurysm. MR remains trace. The aortic contour is normal
post-decannulation.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2116-10-13**] 08:38


?????? [**2110**] CareGroup IS. All rights reserved.

[**2116-10-16**] 05:45AM BLOOD WBC-8.8 RBC-3.53* Hgb-10.1* Hct-30.4*
MCV-86 MCH-28.6 MCHC-33.2 RDW-15.0 Plt Ct-189
[**2116-10-16**] 05:45AM BLOOD Glucose-91 UreaN-18 Creat-0.5 Na-138
K-4.5 Cl-105 HCO3-24 AnGap-14
[**2116-10-17**] 07:15AM BLOOD WBC-8.7 RBC-3.35* Hgb-10.0* Hct-29.0*
MCV-86 MCH-29.9 MCHC-34.6 RDW-15.1 Plt Ct-293#
[**2116-10-17**] 07:15AM BLOOD Glucose-267* UreaN-16 Creat-0.6 Na-134
K-4.1 Cl-97 HCO3-30 AnGap-11

Brief Hospital Course:
Admitted [**10-12**] and underwent surgery with Dr. [**Last Name (STitle) **]. transferred
to the CVICU in stable condition on epinephrine, insulin and
propofol drips. Extubated later that evening. Transferred to the
floor on POD #2, but went into rapid A Fib and was transferred
back to the CVICU for better IV access. Amiodarone was started.
Transferred back to the floor on POD #3 to begin increasing her
activity level.  [**Last Name (un) **] was consulted regarding glucose
management.  Gently diuresed toward her preop weight.  The
patient made excellent progress with physical therapy, showing
good strength and balance before discharge.  Chest tubes and
pacing wires were discontinued without complication.  By the
time of discharge on POD 5, the patient was ambulating freely,
the wound was healing and pain was controlled with oral
analgesics.

Medications on Admission:
lipitor 80 mg daily
ASA 325 mg daily
isosorbide MN 30 mg daily
methimazole 10 mg daily
protonix 40 mg daily
lisinopril 20 mg daily
chlorazepate dipotassium 3.75 mg daily
toprol XL 50 mg daily
insulin levemir 32 units Q PM
novolog 8 units Q AM
novolog 14 units Q PM

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 1 months.
Disp:*60 Capsule(s)* Refills:*0*
2. 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*
3. 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*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
5. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg 2x/day for 4 days, then 200mg 2x/day for 1 week,
then 200mg/day.
Disp:*120 Tablet(s)* Refills:*0*
8. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: Three (3)
Tablet Sustained Release 24 hr PO once a day.
Disp:*90 Tablet Sustained Release 24 hr(s)* Refills:*0*
9. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day) for 2 weeks.
Disp:*qs * Refills:*0*
10. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day
for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
11. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 1 weeks.
Disp:*14 Packet(s)* Refills:*0*
12. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed.
Disp:*60 Tablet(s)* Refills:*0*
13. Insulin Detemir 100 unit/mL Insulin Pen Sig: 40 units
Subcutaneous q am.
Disp:*30 * Refills:*0*
14. Novolog Flexpen 100 unit/mL Insulin Pen Sig: per scale
Subcutaneous ac, hs: dose to be determined by sliding scale.
Disp:*30 * Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
CAD/apical aneurysm
s/p CABG x4/rep. LV aneurysm
postop A Fib
MI
IDDM
hyperthyroidism
OA
spinal stenosis
retroperitoneal bleed s/p cath
PVD with L SFA stent/PTCA


Discharge Condition:
good


Discharge Instructions:
no lotions, creams or powders on any incision
shower daily and pat incisions dry
no driving for one month and until off all narcotics for pain
no lifting greater than 10 pounds for 10 weeks
call for fever greater than 100.5, redness or drainage
call for weight gain greater than 2 pounds in one day, or 5
pounds in a week

Followup Instructions:
Dr. [**Last Name (STitle) **] 1 week
see Dr. [**Last Name (STitle) 75782**] in [**12-11**] weeks
see Dr. [**Last Name (STitle) **] in [**1-12**] weeks
see Dr. [**Last Name (STitle) **] in 4 weeks  [**Telephone/Fax (1) 170**]
please call for all appts.



Completed by:[**2116-10-17**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atherosclerosis of native arteries of the extremities, unspecified,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Subendocardial infarction, subsequent episode of care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified angina pectoris'}


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: dyspnea on exertion

PRESENT ILLNESS: 70 yo female with DOE and wheezing noted in early [**9-16**]. PCP rx
with [**Name9 (PRE) 621**], but no improvement. She worsened and ruled in for
NSTEMI in the ER. Cath revealed severe 3VD.

MEDICAL HISTORY: CAD s/p silent MI c/b LV mural thrombus (resolved, off warfarin)

MEDICATION ON ADMISSION: lipitor 80 mg daily
ASA 325 mg daily
isosorbide MN 30 mg daily
methimazole 10 mg daily
protonix 40 mg daily
lisinopril 20 mg daily
chlorazepate dipotassium 3.75 mg daily
toprol XL 50 mg daily
insulin levemir 32 units Q PM
novolog 8 units Q AM
novolog 14 units Q PM

ALLERGIES: Bactrim / Heparin Agents

PHYSICAL EXAM: at discharge:
VS: 97.4, 121/54, 80SR, 20, 97%RA
Gen: NAD, overweight WF
Lungs: crackles b/l bases, o/w clear
heart: RRR, no murmur or rub
abd: obese, NABS, soft, non-tender, non-distended
ext: warm, trace edema b/l
sternal wound: c/d/i, no erythema or drainage
EVH: c/d/i, no erythema or drainage

FAMILY HISTORY: No family history of early MI, otherwise non-contributory.

SOCIAL HISTORY: Denies tobacco, EtOH
lives with husband 

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Atherosclerosis of native arteries of the extremities, unspecified,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Subendocardial infarction, subsequent episode of care,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified angina pectoris'}
