CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 75 y/o male with significant cardiac history since [**2122**]. Since
that time he has been followed for his mitral regurgitation and
coronary disease. He developed atrial fibrillation in [**8-28**] with
episodes of congestive heart failure requiring diuresis. His
most recent cath revealed three vessel coronary disease and echo
showed severe mitral regurgitation.

MEDICAL HISTORY: Coronary Artery Disease s/p Myocardial Infarction w/
stenting/PTCA [**1-23**], Mitral Regurgtation, Atrial Fibrillation s/p
Cardioversion [**12-28**], Hyperlipidemia, Hypertension, Diabetes
Mellitus, Congestive Heart failure, Chronic Obstructive
Pulmonary Disease, Stroke [**2114**], Renal Insufficiency, Back pain,
s/p ICD/PPM placement, s/p Lens implant OU [**3-27**], s/p bilaterala
inguinal hernia repair, s/p polypectomy

MEDICATION ON ADMISSION: Amiodarone 200mg qd, Norvasc 5mg qd, Aspirin 81mg qd, Calcium,
Combivent, Digoxin .125mg qd, Iron, Flovent, Folbic 2/2.5mg qd,
Humulin N, Humulin R, Lasix 80mg qd, Lipitor 80mg qd, Lisinopril
10mg qd, Lopressor 50mg TID, Omeprazole 40mg qd, Coumadin
(stopped prior to admission)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 60 16 98/50 70" 178#
General: WDWN pale appearing male in NAD
Skin: Pale, w/d intact
HEENT: Oropharynx benign, EOMI, NCAT
Neck: Supple, FROM, no JVD
Lungs: Diminished BS at bases, delayed exp
Heart: Regular rate and rhythm 1-2/6 late systolic murmur
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, trace to 1+ edema
Pulses: [**1-22**]+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: NC

SOCIAL HISTORY: Quit smoking 15 yrs ago after [**1-22**] ppd x 50 yrs. 1 ETOH drink/wk.
Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Urinary complications, not elsewhere classified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Acute kidney failure, unspecified,Atrioventricular block, complete,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Ostium secundum type atrial septal defect,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,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Chr systolic hrt failure,Surg compl-urinary tract,Ocl mlt bi art wo infrct,Acute kidney failure NOS,Atriovent block complete,Chronic kidney dis NOS,Chr airway obstruct NEC,Mitral valve disorder,Secundum atrial sept def,Atrial fibrillation,Abn react-anastom/graft,Old myocardial infarct,Hy kid NOS w cr kid I-IV,Hyperlipidemia NEC/NOS,Status cardiac pacemaker,Hx TIA/stroke w/o resid,DMII wo cmp nt st uncntr
Name:  [**Known lastname 12513**],[**Known firstname 947**] J              Unit No:   [**Numeric Identifier 12514**]

Admission Date:  [**2127-3-16**]              Discharge Date:   [**2127-3-28**]

Date of Birth:  [**2051-6-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 674**]
Addendum:
pt. has chronic systolic CHF as evidenced by echo.
Also, pt. had failed a voiding trial, requiring replacement of
his Foley.  He was subsequently started on flomax, and should
have his Foley removed within the next 24-48 hours for another
voiding trial.

Brief Hospital Course:


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] Convalescent

                             [**Doctor Last Name **] [**Last Name (Prefixes) **] MD [**MD Number(1) 681**]

Completed by:[**2127-3-24**]

Admission Date:  [**2127-3-16**]              Discharge Date:   [**2127-3-28**]

Date of Birth:  [**2051-6-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2127-3-19**] Coronary Artery Bypass Graft x 4 (LIMA to LAD, SVG to
Ramus, SVG to OM1 to OM2), Mitral Valve Replacement (31mm St.
[**Male First Name (un) 923**] Porcine Valve), Atrial Septal Defect Closure

History of Present Illness:
75 y/o male with significant cardiac history since [**2122**]. Since
that time he has been followed for his mitral regurgitation and
coronary disease. He developed atrial fibrillation in [**8-28**] with
episodes of congestive heart failure requiring diuresis. His
most recent cath revealed three vessel coronary disease and echo
showed severe mitral regurgitation.

Past Medical History:
Coronary Artery Disease s/p Myocardial Infarction w/
stenting/PTCA [**1-23**], Mitral Regurgtation, Atrial Fibrillation s/p
Cardioversion [**12-28**], Hyperlipidemia, Hypertension, Diabetes
Mellitus, Congestive Heart failure, Chronic Obstructive
Pulmonary Disease, Stroke [**2114**], Renal Insufficiency, Back pain,
s/p ICD/PPM placement, s/p Lens implant OU [**3-27**], s/p bilaterala
inguinal hernia repair, s/p polypectomy

Social History:
Quit smoking 15 yrs ago after [**1-22**] ppd x 50 yrs. 1 ETOH drink/wk.

Family History:
NC

Physical Exam:
Vitals: 60 16 98/50 70" 178#
General: WDWN pale appearing male in NAD
Skin: Pale, w/d intact
HEENT: Oropharynx benign, EOMI, NCAT
Neck: Supple, FROM, no JVD
Lungs: Diminished BS at bases, delayed exp
Heart: Regular rate and rhythm 1-2/6 late systolic murmur
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, trace to 1+ edema
Pulses: [**1-22**]+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

Pertinent Results:
[**2127-3-16**] 04:55PM BLOOD WBC-5.8 RBC-3.39* Hgb-9.8* Hct-30.4*
MCV-90 MCH-28.8 MCHC-32.1 RDW-18.6* Plt Ct-204
[**2127-3-16**] 04:55PM BLOOD PT-17.9* PTT-42.2* INR(PT)-1.6*
[**2127-3-16**] 04:55PM BLOOD Glucose-137* UreaN-67* Creat-2.4* Na-144
K-4.9 Cl-104 HCO3-30 AnGap-15
[**2127-3-16**] 04:55PM BLOOD ALT-30 AST-35 AlkPhos-115 Amylase-82
TotBili-0.4
[**2127-3-16**] 04:55PM BLOOD Albumin-3.9 Calcium-9.2 Phos-3.7 Mg-2.4
[**2127-3-16**] 04:55PM BLOOD %HbA1c-6.3*
[**2127-3-16**] Chest X-ray: Heart is mildly enlarged, pulmonary
vasculature is mildly engorged, and there is no pulmonary edema
or pleural effusion. Four transvenous leads represent right
atrial pacer, right ventricular pacer, left ventricular pacer
and right ventricular pacer defibrillator leads each terminating
in standard location, but continuity cannot be traced
equivocally to the left axillary pacemaker, except for the right
atrial lead because the lines are indistinguishable.
[**2127-3-17**] Carotid Ultrasound: Right ICA with 60% to 69% stenosis.
Left ICA with 40% to 59% stenosis.
[**2127-3-17**] Echocardiogram: The left atrium is elongated. The right
atrium is moderately dilated. No atrial septal defect is seen by
2D or color Doppler. The estimated right atrial pressure is
0-10mmHg. Left ventricular wall thicknesses are normal. The left
ventricular cavity is mildly dilated. There is mild regional
left ventricular systolic dysfunction with basal
inferior/infero-lateral hypokinesis. There is no ventricular
septal defect. with mild global free wall hypokinesis. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. An eccentric, posteriorly directed jet of at
least moderate (2+) mitral regurgitation is seen (ischemic MR is
suggested). The tricuspid valve leaflets are mildly thickened.
There is moderate pulmonary artery systolic hypertension. There
is no pericardial effusion.
[**2127-3-22**] Chest X-ray: 1. Stable bilateral pleural effusions left
greater than right. 2. New left infrahilar opacity may be
secondary to underlying fluid less likely reflects underlying
atelectasis and/or edema. Edema and associated atelectasis
cannot be entirely excluded.

Brief Hospital Course:
Mr. [**Name14 (STitle) 76853**] was admitted for heparinization and routine
preoperative evaluation. Carotid ultrasound was notable for mild
to moderate disease of both internal carotid arteries(see result
section). Preoperative echocardiogram revealed 2+ mitral
regurgitation and an LVEF of 50-55%(see result section). Surgery
was initially delayed secondary to elevated prothrombin time.
Vitamin K was given with improvement in coagulation. On [**3-19**], Dr. [**First Name (STitle) **] performed coronary artery bypass grafting along
with mitral valve replacement and atrial septal defect closure.
See operative note for additional surgical details. Following
the operation, he was brought to the CVICU for invasive
monitoring. Within 24 hours, he awoke neurologically intact and
was extubated without incident. On postoperative day one, he
transferred to the SDU for further care and recovery. He was
restarted on Warfarin and dosed for a goal INR between 2.0 -
3.0. He was transfused with PRBC to maintain hematocrit near
30%. Pacemaker interrogation showed complete heart block and he
remained v-paced. Over several days, he continued to make
clinical improvements with diuresis. He was eventually cleared
for discharge to rehab on postoperative day 5.


Medications on Admission:
Amiodarone 200mg qd, Norvasc 5mg qd, Aspirin 81mg qd, Calcium,
Combivent, Digoxin .125mg qd, Iron, Flovent, Folbic 2/2.5mg qd,
Humulin N, Humulin R, Lasix 80mg qd, Lipitor 80mg qd, Lisinopril
10mg qd, Lopressor 50mg TID, Omeprazole 40mg qd, Coumadin
(stopped prior to admission)

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
7. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
12. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed for pain.
13. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
14. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Thirty
(30) Units Subcutaneous once a day.
15. Humalog 100 unit/mL Solution Sig: sliding scale units
Subcutaneous AC & HS: BS 150-200 = 4U
201-250 = 6U
251-300 = 8U
301-350 = 10 U.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] Convalescent

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Mitral Regurgtation s/p mitral Valve Replacment
Atrial Septal Defect s/p Closure
Atrial Fibrillation
PMH: s/p Myocardial Infarction w/ stenting/PTCA [**1-23**],
Cardioversion [**12-28**], Hyperlipidemia, Hypertension, Diabetes
Mellitus, Congestive Heart failure, Chronic Obstructive
Pulmonary Disease, Stroke [**2114**], Renal Insufficiency, Back pain,
s/p ICD/PPM placement, s/p Lens implant OU [**3-27**], s/p bilaterala
inguinal hernia repair, s/p polypectomy

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
[**Hospital Ward Name 121**] 6 for wound check in 2 weeks
Dr. [**First Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 61691**] in [**2-23**] weeks
Dr. [**Last Name (STitle) **] in [**2-23**] weeks

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2127-3-24**]

Name:  [**Known lastname 12513**],[**Known firstname 947**] J              Unit No:   [**Numeric Identifier 12514**]

Admission Date:  [**2127-3-16**]              Discharge Date:   [**2127-3-28**]

Date of Birth:  [**2051-6-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 265**]
Addendum:
Mr. [**Known lastname 12515**]' discharge was delayed secondary to an acute
decline in renal function and supratherapeutic prothrombin time.


His postop creatinine peaked to 3.6. Renal ultrasound was
unremarkable and he did not experience oliguria. All medications
were titrated accordingly and by discharge, his renal function
improved. His renal function should continue to improve after
discharge.

He was also quite sensitive to Warfarin. His INR became
supratherapeutic, peaking to 6.1. Warfarin was held for several
days with improvement in prothrombin time. At discharge, his INR
was 3.6 and very low dose Warfarin was resumed. His goal INR is
between 2.0 - 3.0.

Pertinent Results:
[**2127-3-28**] 06:05AM BLOOD WBC-6.1 RBC-3.10* Hgb-9.0* Hct-27.4*
MCV-88 MCH-29.0 MCHC-32.8 RDW-18.3* Plt Ct-253
[**2127-3-27**] 05:45AM BLOOD WBC-6.6 RBC-3.01* Hgb-8.8* Hct-26.7*
MCV-89 MCH-29.3 MCHC-33.0 RDW-18.4* Plt Ct-254#
[**2127-3-23**] 07:30AM BLOOD WBC-7.3 RBC-3.14* Hgb-9.3* Hct-27.1*
MCV-86 MCH-29.7 MCHC-34.5 RDW-18.7* Plt Ct-124*
[**2127-3-22**] 07:10AM BLOOD WBC-8.8 RBC-2.55* Hgb-7.7* Hct-22.3*
MCV-88 MCH-30.0 MCHC-34.3 RDW-20.0* Plt Ct-107*
[**2127-3-28**] 06:05AM BLOOD PT-34.6* INR(PT)-3.6*
[**2127-3-27**] 05:45AM BLOOD PT-33.9* INR(PT)-3.6*
[**2127-3-26**] 08:45PM BLOOD PT-29.6* INR(PT)-3.0*
[**2127-3-26**] 01:25PM BLOOD PT-53.0* INR(PT)-6.1*
[**2127-3-26**] 05:35AM BLOOD PT-51.2* INR(PT)-5.9*
[**2127-3-25**] 07:14PM BLOOD PT-50.0* INR(PT)-5.7*
[**2127-3-25**] 11:00AM BLOOD PT-45.8* INR(PT)-5.1*
[**2127-3-24**] 09:15AM BLOOD PT-24.9* INR(PT)-2.4*
[**2127-3-23**] 07:30AM BLOOD PT-15.4* PTT-31.9 INR(PT)-1.4*
[**2127-3-22**] 07:10AM BLOOD PT-14.4* PTT-31.9 INR(PT)-1.3*
[**2127-3-28**] 06:05AM BLOOD Glucose-165* UreaN-77* Creat-2.3* Na-141
K-4.8 Cl-101 HCO3-31 AnGap-14
[**2127-3-27**] 05:45AM BLOOD Glucose-69* UreaN-82* Creat-2.9* Na-140
K-4.3 Cl-101 HCO3-27 AnGap-16
[**2127-3-26**] 05:35AM BLOOD UreaN-85* Creat-3.6* K-4.4
[**2127-3-24**] 05:35AM BLOOD UreaN-68* Creat-2.9* K-4.2
[**2127-3-23**] 07:30AM BLOOD Glucose-80 UreaN-65* Creat-2.9* Na-138
K-4.8 Cl-101 HCO3-26 AnGap-16
[**2127-3-22**] 07:10AM BLOOD Glucose-69* UreaN-59* Creat-2.9* Na-139
K-4.8 Cl-103 HCO3-27 AnGap-14
[**2127-3-21**] 06:45AM BLOOD Glucose-183* UreaN-48* Creat-2.3* Na-139
K-5.8* Cl-104 HCO3-28 AnGap-13
[**2127-3-20**] 03:35AM BLOOD Glucose-122* UreaN-40* Creat-1.7* Na-143
K-5.1 Cl-110* HCO3-27 AnGap-11
[**2127-3-16**] 04:55PM BLOOD Glucose-137* UreaN-67* Creat-2.4* Na-144
K-4.9 Cl-104 HCO3-30 AnGap-15
[**2127-3-27**] Discharge Chest x-ray: There has been interval decrease
in size in small right pleural effusion. Moderate left pleural
effusion is grossly unchanged. Bibasilar atelectasis greater on
the left side are persistent. There is no pneumothorax.
Cardiomediastinum is unchanged. Left transvenous pacemaker leads
terminate in standard positions. Patient is post median
sternotomy and CABG.


Brief Hospital Course:
See previous discharge summary. See addendums.

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q6H (every 6 hours).
7. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
11. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every 6-8 hours as needed for pain.
12. Furosemide 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
13. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Fifteen
(15) Units Subcutaneous once a day.
14. Humalog 100 unit/mL Solution Sig: sliding scale units
Subcutaneous AC & HS: 111-139 = 2U
140-159 = 4U
160-179 = 6U
180-199 = 8U
200-219 = 10U
220-239 = 12U
240-260 = 14U.
15. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
16. Warfarin 1 mg Tablet Sig: 0.5 Tablet PO qpm: Adjsut to
maintain INR between 2.0 - 3.0. Daily dose may vary.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] Convalescent

Discharge Diagnosis:
Chronic Systolic Congestive Heart Failure
Coronary Artery Disease, Mitral Regurgtation, Atrial Septal
Defect
Atrial Fibrillation
Postop Acute Renal Insufficiency, Chronic Renal Insufficiency
Hyperlipidemia
Hypertension
Diabetes Mellitus
Chronic Obstructive Pulmonary Disease
History of Stroke [**2114**]


Discharge Condition:
Good


Discharge Instructions:
- Please shower daily. No baths or swimming for at least one
month.
- Monitor wounds for infection - redness, drainage, or increased
pain
- Report any fever greater than 101
- Report any weight gain of greater than 2 pounds in 24 hours or
5 pounds in a week
- No creams, lotions, powders, or ointments to incisions
- No driving for approximately one month
- No lifting more than 10 pounds for 10 weeks
- Please call with any questions or concerns [**Telephone/Fax (1) 1477**]

Followup Instructions:
[**Hospital Ward Name **] 6 for wound check in 2 weeks
Dr. [**First Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 11152**] in [**2-23**] weeks
Dr. [**Last Name (STitle) 12516**] in [**2-23**] weeks


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 266**]

Completed by:[**2127-3-28**]
{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Urinary complications, not elsewhere classified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Acute kidney failure, unspecified,Atrioventricular block, complete,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Ostium secundum type atrial septal defect,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,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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

PRESENT ILLNESS: 75 y/o male with significant cardiac history since [**2122**]. Since
that time he has been followed for his mitral regurgitation and
coronary disease. He developed atrial fibrillation in [**8-28**] with
episodes of congestive heart failure requiring diuresis. His
most recent cath revealed three vessel coronary disease and echo
showed severe mitral regurgitation.

MEDICAL HISTORY: Coronary Artery Disease s/p Myocardial Infarction w/
stenting/PTCA [**1-23**], Mitral Regurgtation, Atrial Fibrillation s/p
Cardioversion [**12-28**], Hyperlipidemia, Hypertension, Diabetes
Mellitus, Congestive Heart failure, Chronic Obstructive
Pulmonary Disease, Stroke [**2114**], Renal Insufficiency, Back pain,
s/p ICD/PPM placement, s/p Lens implant OU [**3-27**], s/p bilaterala
inguinal hernia repair, s/p polypectomy

MEDICATION ON ADMISSION: Amiodarone 200mg qd, Norvasc 5mg qd, Aspirin 81mg qd, Calcium,
Combivent, Digoxin .125mg qd, Iron, Flovent, Folbic 2/2.5mg qd,
Humulin N, Humulin R, Lasix 80mg qd, Lipitor 80mg qd, Lisinopril
10mg qd, Lopressor 50mg TID, Omeprazole 40mg qd, Coumadin
(stopped prior to admission)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 60 16 98/50 70" 178#
General: WDWN pale appearing male in NAD
Skin: Pale, w/d intact
HEENT: Oropharynx benign, EOMI, NCAT
Neck: Supple, FROM, no JVD
Lungs: Diminished BS at bases, delayed exp
Heart: Regular rate and rhythm 1-2/6 late systolic murmur
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, trace to 1+ edema
Pulses: [**1-22**]+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: NC

SOCIAL HISTORY: Quit smoking 15 yrs ago after [**1-22**] ppd x 50 yrs. 1 ETOH drink/wk. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic systolic heart failure,Urinary complications, not elsewhere classified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Acute kidney failure, unspecified,Atrioventricular block, complete,Chronic kidney disease, unspecified,Chronic airway obstruction, not elsewhere classified,Mitral valve disorders,Ostium secundum type atrial septal defect,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,Old myocardial infarction,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
