CHIEF COMPLAINT: Shortness of breath, worsening fatigue

PRESENT ILLNESS: 61 year old man with a PMH notable for ischemic cardiomyopathy.
He has had two prior myocardial infarctions, the first in [**2092**]
and the second in [**2096**]. He also has undergone multiple PCI??????s,
the most recent being an angioplasty at [**Hospital1 756**]
and Women??????s Hospital in [**2106**]. He does complain of chest
discomfort. He does get significant shortness of breath with
mild to moderate exertion. This can occur with activities like
emptying the garbage. Given his degree of cardiomyopathy with an
ejection fraction of 26%, he has been referred for LV lead
placement with biventricular upgrade.

MEDICAL HISTORY: Past Medical History
- Coronary Artery Disease/Ischemic Cardiomyopahty
- History of Myocardial Infarctions
- Prior PCI's([**Hospital1 756**] and Women??????s)
- Hypertension
- Hyperlipidemia
- Diet controlled diabetes
- GERD
- History of Rheumatic fever as a child, Heart murmur
Past Surgical History
s/p PPM/AICD [**2109-2-27**]([**Company 1543**] Virtuoso DR)
s/p Resection of skin cancer on his face
s/p Back surgery
s/p Appendectomy

MEDICATION ON ADMISSION: Medications at home:
Lisinopril 5mg daily every morning
Isosorbide Mononitrate 60mg daily every morning
Coreg 12.5mg twice a day
Aspirin 325mg daily every morning
MVI one daily every morning
Omeprazole 20mg daily every evening
Ranexa 500mg twice daily
Turosemide 100mg tabs, 0.5 tabs prn
Simvastatin 40mg daily every evening
SL nitroglycerin as needed

ALLERGIES: Inderal La / Codeine / Morphine

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Notable for premature coronary disease on his paternal side.
Paternal uncles died in their 40's of "heart disease".

SOCIAL HISTORY: Patient is married and lives with his wife.
Occupation: Recently unable to work. Previously worked in auto
parts delivery.
ETOH:  occasional
Tobacco: Quit in [**2092**], 45+PYH
Chronic systolic heart failure,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Other specified forms of chronic ischemic heart disease,Other chronic pulmonary heart diseases,Percutaneous transluminal coronary angioplasty status,Mitral valve disorders,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified angina pectoris,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Old myocardial infarction,Other left bundle branch block
Chr systolic hrt failure,Parox ventric tachycard,Surg compl-heart,Chr ischemic hrt dis NEC,Chr pulmon heart dis NEC,Status-post ptca,Mitral valve disorder,Abn react-surg proc NEC,Angina pectoris NEC/NOS,Esophageal reflux,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS,Old myocardial infarct,Left bb block NEC
Admission Date:  [**2110-3-3**]              Discharge Date:   [**2110-3-8**]

Date of Birth:  [**2048-6-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Inderal La / Codeine / Morphine

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Shortness of breath, worsening fatigue


Major Surgical or Invasive Procedure:
s/p biventricular pacing/defibrillator system.


History of Present Illness:
61 year old man with a PMH notable for ischemic cardiomyopathy.
He has had two prior myocardial infarctions, the first in [**2092**]
and the second in [**2096**]. He also has undergone multiple PCI??????s,
the most recent being an angioplasty at [**Hospital1 756**]
and Women??????s Hospital in [**2106**]. He does complain of chest
discomfort. He does get significant shortness of breath with
mild to moderate exertion. This can occur with activities like
emptying the garbage. Given his degree of cardiomyopathy with an
ejection fraction of 26%, he has been referred for LV lead
placement with biventricular upgrade.


Past Medical History:
Past Medical History
- Coronary Artery Disease/Ischemic Cardiomyopahty
- History of Myocardial Infarctions
- Prior PCI's([**Hospital1 756**] and Women??????s)
- Hypertension
- Hyperlipidemia
- Diet controlled diabetes
- GERD
- History of Rheumatic fever as a child, Heart murmur
Past Surgical History
s/p PPM/AICD [**2109-2-27**]([**Company 1543**] Virtuoso DR)
s/p Resection of skin cancer on his face
s/p Back surgery
s/p Appendectomy


Social History:
Patient is married and lives with his wife.
Occupation: Recently unable to work. Previously worked in auto
parts delivery.
ETOH:  occasional
Tobacco: Quit in [**2092**], 45+PYH


Family History:
Notable for premature coronary disease on his paternal side.
Paternal uncles died in their 40's of "heart disease".


Physical Exam:
Physical Exam

Pulse: 94 Resp: 16 O2 sat: 97% RA
B/P  Right: 86/52   Left: 81/52
General: Middle ages male in NAD
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x] no JVD
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur - soft SEM
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
Pulses:
Femoral      Right: 1  Left: 1
Radial       Right: 2  Left: 2

Carotid Bruit        Right: none   Left: possible


Pertinent Results:
[**2110-3-6**] 05:20AM BLOOD WBC-6.8 RBC-3.04* Hgb-10.0* Hct-28.8*
MCV-95 MCH-32.8* MCHC-34.6 RDW-14.3 Plt Ct-157
[**2110-3-3**] 04:50PM BLOOD WBC-10.9 RBC-3.86* Hgb-12.2* Hct-35.9*
MCV-93 MCH-31.7 MCHC-34.1 RDW-14.4 Plt Ct-295
[**2110-3-4**] 02:08AM BLOOD PT-12.9 PTT-27.3 INR(PT)-1.1
[**2110-3-6**] 05:20AM BLOOD Glucose-106* UreaN-25* Creat-1.0 Na-137
K-4.4 Cl-99 HCO3-31 AnGap-11
[**2110-3-3**] 04:50PM BLOOD Glucose-144* UreaN-26* Creat-1.0 Na-134
K-4.2 Cl-101 HCO3-25 AnGap-12


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 82485**]Portable TTE
(Complete) Done [**2110-3-5**] at 3:36:27 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2048-6-29**]
Age (years): 61 M  Hgt (in): 64
BP (mm Hg): 85/55  Wgt (lb): 116
HR (bpm): 92  BSA (m2): 1.55 m2
Indication: Left ventricular function. Dilated cardiomyopathy.
ICD-9 Codes: 425.4, 414.8, 424.0, 424.2
Test Information
Date/Time: [**2110-3-5**] at 15:36    Interpret MD: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**],
MD
Test Type: Portable TTE (Complete) Son[**Name (NI) 930**]: [**First Name4 (NamePattern1) 1022**] [**Last Name (NamePattern1) **],
RDCS
Doppler: Full Doppler and color Doppler Test Location: [**Location 13333**]/[**Hospital Ward Name 121**] 6
Contrast: None Tech Quality: Adequate
Tape #: 2010W007-1:32 Machine: Vivid [**6-4**]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Atrium - Long Axis Dimension:  3.1 cm  <= 4.0 cm
Left Atrium - Four Chamber Length:  4.6 cm  <= 5.2 cm
Left Atrium - Peak Pulm Vein S:  0.4 m/s
Left Atrium - Peak Pulm Vein D:  0.8 m/s
Right Atrium - Four Chamber Length:  4.3 cm  <= 5.0 cm
Left Ventricle - Septal Wall Thickness:  *0.5 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  0.9 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  5.6 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  5.0 cm
Left Ventricle - Fractional Shortening:  *0.11  >= 0.29
Left Ventricle - Ejection Fraction:  <= 20%  >= 55%
Left Ventricle - Stroke Volume:  41 ml/beat
Left Ventricle - Cardiac Output:  3.75 L/min
Left Ventricle - Cardiac Index:  2.42  >= 2.0 L/min/M2
Left Ventricle - Lateral Peak E':  *0.07 m/s  > 0.08 m/s
Left Ventricle - Septal Peak E':  *0.05 m/s  > 0.08 m/s
Left Ventricle - Ratio E/E':  12  < 15
Aorta - Sinus Level:  3.0 cm  <= 3.6 cm
Aorta - Ascending:  2.4 cm  <= 3.4 cm
Aortic Valve - Peak Velocity:  1.2 m/sec  <= 2.0 m/sec
Aortic Valve - LVOT VTI:  16
Aortic Valve - LVOT diam:  1.8 cm
Mitral Valve - E Wave:  0.7 m/sec
Mitral Valve - A Wave:  0.7 m/sec
Mitral Valve - E/A ratio:  1.00
Mitral Valve - E Wave deceleration time:  *92 ms  140-250 ms
TR Gradient (+ RA = PASP):  *36 to 42 mm Hg  <= 25 mm Hg

Findings
LEFT ATRIUM: Normal LA and RA cavity sizes.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Normal IVC diameter
(<2.1cm) with <35% decrease during respiration (estimated RA
pressure indeterminate).

LEFT VENTRICLE: Normal LV wall thickness and cavity size. Severe
global LV hypokinesis. No LV mass/thrombus. No resting LVOT
gradient.

RIGHT VENTRICLE: Normal RV chamber size. Focal apical
hypokinesis of RV free wall.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS.
No AR.

MITRAL VALVE: Normal mitral valve leaflets. Mild to moderate
([**11-30**]+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. Mild [1+] TR.
Moderate PA systolic hypertension.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet.
No PS. Physiologic PR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: Left pleural effusion.
Conclusions
The left atrium and right atrium are normal in cavity size. The
right atrial pressure is indeterminate. Left ventricular wall
thicknesses and cavity size are normal. There is severe global
left ventricular hypokinesis (LVEF <20 %). The basal
inferolateral wall contracts best. No masses or thrombi are seen
in the left ventricle. Right ventricular chamber size is normal.
with focal severe hypokinesis of the apical half of the free
wall. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are structurally normal. Mild to
moderate ([**11-30**]+) mitral regurgitation is seen. There is moderate
pulmonary artery systolic hypertension. There is no pericardial
effusion.

IMPRESSION: Severe global left ventricular systolic dysfunction.
Mild-moderate mitral regurgitation. Moderate pulmonary artery
systolic hypertension. Right ventricular apical free wall
hypokinesis.

CLINICAL IMPLICATIONS:
The left ventricular ejection fraction is <40%, a threshold for
which the patient may benefit from a beta blocker and an ACE
inhibotor or [**Last Name (un) **].
Based on [**2106**] AHA endocarditis prophylaxis recommendations, the
echo findings indicate prophylaxis is NOT recommended. Clinical
decisions regarding the need for prophylaxis should be based on
clinical and echocardiographic data.
  Electronically signed by [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4083**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2110-3-5**] 16:03


?????? [**2102**] CareGroup IS. All rights reserved.


Brief Hospital Course:
[**3-3**] Mr.[**Known lastname **] went to the operating room and underwent left
epicardial ventricular lead placement for biventricular upgrade
via a left thoracotomy. He tolerated the procedure well. After
recovery in the post anesthesia unit he was transferred to the
CVICU for further monitoring. Chest tube inserted intraop
secondary to entering the  left pleural space. POD#1 he was
transferred to the step down unit. AN episode of VTach on [**3-5**]
triggered his AICD and he was defibrillated x 1. Ep was called.
The remainder of his admission he remained hemodynamically
stable with 1 further episode of VTach (without triggering a
shock.) EP recommended follow up with Dr.[**Last Name (STitle) 3321**] in 1 week
following discharge. On POD#5 he was cleared for discharge to
home by Dr. [**Last Name (STitle) 914**]. All follow up appointments were advised.


Medications on Admission:
Medications at home:
Lisinopril 5mg daily every morning
Isosorbide Mononitrate 60mg daily every morning
Coreg 12.5mg twice a day
Aspirin 325mg daily every morning
MVI one daily every morning
Omeprazole 20mg daily every evening
Ranexa 500mg twice daily
Turosemide 100mg tabs, 0.5 tabs prn
Simvastatin 40mg daily every evening
SL nitroglycerin as needed


Discharge Medications:
1. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Torsemide 100 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
5. Ranolazine 500 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO bid ().
Disp:*60 Tablet Sustained Release 12 hr(s)* Refills:*2*
6. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
9. Ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours) as needed for pain.
Disp:*120 Tablet(s)* Refills:*1*
10. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for pain.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
s/p biventricular pacing/defibrillator system.

Past medical history is remarkable for:
1. Coronary artery disease.
2. Ischemic cardiomyopathy.
3. History of multiple myocardial infarctions.
4. Prior history of multiple percutaneous coronary
angioplasties/stents.
5. Hypertension.
6. Hyperlipidemia.
7. Diet-controlled diabetes.
8. Gastroesophageal reflux disease.
9. History of rheumatic fever as a child.

Past surgical history:
1. Status post permanent pacemaker/AICD in [**2109-2-27**] ([**Company 1543**]
Virtuoso DR).
2. Status post resection of skin cancer on his face.
3. Status post back surgery.
4. Status post appendectomy.


Discharge Condition:
alert and oriented
ambulatory
pain controlled with motrin and tylenol


Discharge Instructions:
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving until cleared by Dr. [**Last Name (STitle) **]
[**Name (STitle) **] lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Please call for appointment in [**11-30**] weeks after discharge:
PCP: [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Telephone/Fax (1) 26647**]
Please call for appointment in 1 week with EP/Cardiologist:
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3321**]
Cardiac Surgeon: Dr [**Last Name (STitle) 914**] [**Telephone/Fax (1) 170**] [**4-8**] at 1:30 PM



Completed by:[**2110-3-8**]
{'Chronic systolic heart failure,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Other specified forms of chronic ischemic heart disease,Other chronic pulmonary heart diseases,Percutaneous transluminal coronary angioplasty status,Mitral valve disorders,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified angina pectoris,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Old myocardial infarction,Other left bundle branch block'}


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, worsening fatigue

PRESENT ILLNESS: 61 year old man with a PMH notable for ischemic cardiomyopathy.
He has had two prior myocardial infarctions, the first in [**2092**]
and the second in [**2096**]. He also has undergone multiple PCI??????s,
the most recent being an angioplasty at [**Hospital1 756**]
and Women??????s Hospital in [**2106**]. He does complain of chest
discomfort. He does get significant shortness of breath with
mild to moderate exertion. This can occur with activities like
emptying the garbage. Given his degree of cardiomyopathy with an
ejection fraction of 26%, he has been referred for LV lead
placement with biventricular upgrade.

MEDICAL HISTORY: Past Medical History
- Coronary Artery Disease/Ischemic Cardiomyopahty
- History of Myocardial Infarctions
- Prior PCI's([**Hospital1 756**] and Women??????s)
- Hypertension
- Hyperlipidemia
- Diet controlled diabetes
- GERD
- History of Rheumatic fever as a child, Heart murmur
Past Surgical History
s/p PPM/AICD [**2109-2-27**]([**Company 1543**] Virtuoso DR)
s/p Resection of skin cancer on his face
s/p Back surgery
s/p Appendectomy

MEDICATION ON ADMISSION: Medications at home:
Lisinopril 5mg daily every morning
Isosorbide Mononitrate 60mg daily every morning
Coreg 12.5mg twice a day
Aspirin 325mg daily every morning
MVI one daily every morning
Omeprazole 20mg daily every evening
Ranexa 500mg twice daily
Turosemide 100mg tabs, 0.5 tabs prn
Simvastatin 40mg daily every evening
SL nitroglycerin as needed

ALLERGIES: Inderal La / Codeine / Morphine

PHYSICAL EXAM: Physical Exam

FAMILY HISTORY: Notable for premature coronary disease on his paternal side.
Paternal uncles died in their 40's of "heart disease".

SOCIAL HISTORY: Patient is married and lives with his wife.
Occupation: Recently unable to work. Previously worked in auto
parts delivery.
ETOH:  occasional
Tobacco: Quit in [**2092**], 45+PYH 

### Response:
{'Chronic systolic heart failure,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Other specified forms of chronic ischemic heart disease,Other chronic pulmonary heart diseases,Percutaneous transluminal coronary angioplasty status,Mitral valve disorders,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified angina pectoris,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Old myocardial infarction,Other left bundle branch block'}
