CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 72M h/o sCHF (EF 35%); CAD s/p CABG x2; LCx stent [**2110**]; 4+MR;
s/p BiV ICD; recurrent pAF w/ RVR s/p AV node ablation; DM2,
presented to the ED with SOBx 2 days, as well as with one
recorded temperature at home to T 100.  Of note, pt had been
discharged on [**2116-1-11**] after undergoing AV node ablation, and had
denied respiratory distress during [**1-23**] EP outpatient follow-up;
at that time, ICD had been interrogated and found to be WNL.
(On this presentation, however, pt stated that he had been SOB
since his latest discharge.)
.
Pt also reported that he had been coughing x3 days, producing
white phelgm, and had been in contact with a granddaughter
recently [**Name2 (NI) **] with influenza.
.
ROS: Positive for SOB, increased peripheral edema x1day,
decreased ability to sleep given SOB, and decreased exercise
tolerance.  Negative for chest pain, abd pain, N/V, changes in
urinary/bowel habits, myalgias/arthralgias.
.
ED course:
# Vitals: O2sat 91 on RA, mid 80s on RA with conversation, 96 on
2L
# Meds: Furosemide 40mg IV (excreted 400cc urine), levofloxacin

MEDICAL HISTORY: # CAD s/p inferior MI, CABG x2 ([**2080**], [**2100**]: SVG to OM, SVG to
LAD, patent in [**2110**]), LCx stent [**2110**]
# Systolic CHF [**12-28**] ischemic CM (EF 35%) s/p BiV ICD [**2110**],
replaced [**2114**]
# HTN
# 4+ MR
# h/o paroxysmal atrial fibrillation s/p cardioversion [**2114**], s/p
AV node ablation [**2115**]
# COPD: No home O2
# DM2
# Hypercholesterolemia
# Chronic renal insufficiency
# GERD

MEDICATION ON ADMISSION: Atorvastatin (Lipitor) 20 mg daily
Furosemide 60 mg [**Hospital1 **]
Glyburide 5 mg [**Hospital1 **]
Ranitidine (Zantac) 150 mg [**Hospital1 **]
Warfarin 2 mg daily
ASA 81mg daily
Clopidogrel 75 mg daily
Toprol XL 150 mg daily
Imdur 30 mg daily
Spironolactone 25 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS:  T 96.8, BP 100/50, HR 70, RR 20, O2sat 95 on 2L, FS 245
HEENT: NCAT, OP clear, MMM, no LAD
NECK:  JVP elevated to ear.  No carotid bruits.
CHEST:  Bilateral rales 3/4 up.  Apices clear.  No rhonchi,
wheezes.
CARDIAC:  RRR, S1S2, 2/6 SEM @ apex.
ABDOMEN:  Soft, NT/ND, BS+, no HSM
EXT:  BLE to ankles, 1+ B DP.
NEURO: A&Ox3

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: # Personal: Lives with wife, has 2 sons.  [**Name (NI) 24075**]-speaking only.
# Professional: Retired construction worker.
# Tobacco: Smoked maximum 4ppd
# Alcohol: Social
# Recreational drugs: None
Mitral valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic periodontitis, unspecified,Atrial fibrillation,Other chronic pulmonary heart diseases,Other and unspecified angina pectoris,Aortocoronary bypass status,Automatic implantable cardiac defibrillator in situ,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Benign neoplasm of rectum and anal canal,Diverticulosis of colon (without mention of hemorrhage),Iron deficiency anemia, unspecified
Mitral valve disorder,Ac on chr syst hrt fail,Crnry athrscl natve vssl,Chr airway obstruct NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Chronc periodontitis NOS,Atrial fibrillation,Chr pulmon heart dis NEC,Angina pectoris NEC/NOS,Aortocoronary bypass,Status autm crd dfbrltr,Gstr/ddnts NOS w/o hmrhg,Benign neopl rectum/anus,Dvrtclo colon w/o hmrhg,Iron defic anemia NOS
Admission Date:  [**2116-2-2**]              Discharge Date:   [**2116-2-28**]

Date of Birth:  [**2043-7-9**]             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:
mitral valve repair via right thoracotomy [**2-20**]
cardiac cath
colonoscopy
upper endoscopy
dental extraction

History of Present Illness:
72M h/o sCHF (EF 35%); CAD s/p CABG x2; LCx stent [**2110**]; 4+MR;
s/p BiV ICD; recurrent pAF w/ RVR s/p AV node ablation; DM2,
presented to the ED with SOBx 2 days, as well as with one
recorded temperature at home to T 100.  Of note, pt had been
discharged on [**2116-1-11**] after undergoing AV node ablation, and had
denied respiratory distress during [**1-23**] EP outpatient follow-up;
at that time, ICD had been interrogated and found to be WNL.
(On this presentation, however, pt stated that he had been SOB
since his latest discharge.)
.
Pt also reported that he had been coughing x3 days, producing
white phelgm, and had been in contact with a granddaughter
recently [**Name2 (NI) **] with influenza.
.
ROS: Positive for SOB, increased peripheral edema x1day,
decreased ability to sleep given SOB, and decreased exercise
tolerance.  Negative for chest pain, abd pain, N/V, changes in
urinary/bowel habits, myalgias/arthralgias.
.
ED course:
# Vitals: O2sat 91 on RA, mid 80s on RA with conversation, 96 on
2L
# Meds: Furosemide 40mg IV (excreted 400cc urine), levofloxacin

Past Medical History:
# CAD s/p inferior MI, CABG x2 ([**2080**], [**2100**]: SVG to OM, SVG to
LAD, patent in [**2110**]), LCx stent [**2110**]
# Systolic CHF [**12-28**] ischemic CM (EF 35%) s/p BiV ICD [**2110**],
replaced [**2114**]
# HTN
# 4+ MR
# h/o paroxysmal atrial fibrillation s/p cardioversion [**2114**], s/p
AV node ablation [**2115**]
# COPD: No home O2
# DM2
# Hypercholesterolemia
# Chronic renal insufficiency
# GERD

Social History:
# Personal: Lives with wife, has 2 sons.  [**Name (NI) 24075**]-speaking only.
# Professional: Retired construction worker.
# Tobacco: Smoked maximum 4ppd
# Alcohol: Social
# Recreational drugs: None

Family History:
Noncontributory

Physical Exam:
VITALS:  T 96.8, BP 100/50, HR 70, RR 20, O2sat 95 on 2L, FS 245
HEENT: NCAT, OP clear, MMM, no LAD
NECK:  JVP elevated to ear.  No carotid bruits.
CHEST:  Bilateral rales 3/4 up.  Apices clear.  No rhonchi,
wheezes.
CARDIAC:  RRR, S1S2, 2/6 SEM @ apex.
ABDOMEN:  Soft, NT/ND, BS+, no HSM
EXT:  BLE to ankles, 1+ B DP.
NEURO: A&Ox3

Pertinent Results:
Studies/imaging:
# EKG: V-paced at rate 69
# CXR:  Mild cardiogenic pulmonary edema although no definite
focal
infection is visualized.  Repeat radiography after appropriate
diuresis is helpful to assess for underlying infection.
.
ECHO [**2116-2-4**]:
Conclusions
The left atrium is moderately dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity is
moderately dilated. There is moderate regional left ventricular
systolic dysfunction with severe hypokinesis/akinesis of the
inferior, inferolateral and inferoseptal walls, and hypokinesis
of the apex, c/w multivessel CAD. [Intrinsic left ventricular
systolic function is likely more depressed given the severity of
valvular regurgitation.] Right ventricular chamber size is
normal. with mild global free wall hypokinesis. The aortic root
is mildly dilated at the sinus level. The ascending aorta is
mildly dilated. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. The mitral valve
leaflets are mildly thickened. A very eccentric, posteriorly
directed jet of [**Location (un) **] (4+) mitral regurgitation is seen, likely
on the basis of the posteromedial papillary muscle dysfunction.
Moderate [2+] tricuspid regurgitation is seen. There is moderate
pulmonary artery systolic hypertension. There is no pericardial
effusion.
IMPRESSION: Dilated left ventricle with moderate regional
systolic dysfunction, c/w multivessel CAD. Severe secondary
mitral regurgitation. Moderate tricuspid regurgitation. Moderate
pulmonary hypertension.
Compared with the prior study (images reviewed) of [**2115-12-25**],
mitral and tricuspid regurgitation are more severe and pulmonary
pressures are higher. The other findings are similar.
Findings disscussed with Dr. [**Last Name (STitle) 24076**] at 1140 hours on the day of
the study.
.
C.CATH Study Date of [**2116-2-11**]
COMMENTS:
1. Coronary angiography of this right dominant system revealed
three
vessel coronary disease. The LMCA had mild disease. The LAD was
totally
occluded proximally with the distal vessel filling via a patent
SVG. The
LCX had a widely patent stent supplying OM2 which filled by a
patent
SVG. The RCA was known to be totally occluded and therefore was
not
selectively engaged.
2. Venous conduit arteriography revealed widely patent SVG-LAD
and
SVG-OM1.
3. Resting hemodynamics revealed an RASP of 11 mm Hg, RVEDP of
18 mm Hg,
PASP of 43 mm Hg, and PCWP of 21 mm Hg. The cardiac output was
4.0 and
the index 2.3.
4. Left ventriculography was deferred.
FINAL DIAGNOSIS:
1. Three vessel coronary artery disease.
2. [**Hospital1 **]-ventricular diastolic dysfunction.
3. Patent SVG-LAD, SVG-OM1.
.
CHEST (PRE-OP PA & LAT)  [**2116-2-12**] 3:14 PM
FINDINGS: In comparison with study of [**2-2**], there is again
enlargement of the cardiac silhouette in this patient who has
undergone a previous CABG procedure with intact sternal sutures.
Defibrillator device remains in place. Prominence ill-defined
interstitial markings is consistent with the clinical diagnosis
of vascular congestion.
.
[**2116-2-2**] 12:05PM BLOOD WBC-8.3 RBC-3.61* Hgb-8.5* Hct-29.2*
MCV-81* MCH-23.5* MCHC-29.1* RDW-19.4* Plt Ct-232
[**2116-2-9**] 05:00AM BLOOD WBC-6.3 RBC-3.65* Hgb-9.2* Hct-29.8*
MCV-82 MCH-25.3* MCHC-30.9* RDW-20.0* Plt Ct-143*
[**2116-2-17**] 06:43AM BLOOD WBC-6.2 RBC-3.68* Hgb-9.2* Hct-30.3*
MCV-83 MCH-25.0* MCHC-30.3* RDW-19.4* Plt Ct-153
[**2116-2-28**] 05:20AM BLOOD WBC-6.6 RBC-3.30* Hgb-8.8* Hct-28.2*
MCV-85 MCH-26.7* MCHC-31.3 RDW-18.7* Plt Ct-162
[**2116-2-2**] 01:05PM BLOOD PT-36.2* PTT-32.7 INR(PT)-3.9*
[**2116-2-9**] 05:00AM BLOOD PT-14.4* PTT-26.5 INR(PT)-1.3*
[**2116-2-17**] 06:43AM BLOOD PT-14.1* PTT-59.0* INR(PT)-1.2*
[**2116-2-28**] 05:20AM BLOOD PT-30.1* PTT-33.9 INR(PT)-3.1*
[**2116-2-2**] 12:05PM BLOOD Glucose-193* UreaN-53* Creat-1.8* Na-134
K-5.5* Cl-97 HCO3-23 AnGap-20
[**2116-2-9**] 05:00AM BLOOD Glucose-151* UreaN-23* Creat-1.4* Na-141
K-3.7 Cl-103 HCO3-30 AnGap-12
[**2116-2-18**] 09:30AM BLOOD Glucose-263* UreaN-19 Creat-1.5* Na-135
K-4.1 Cl-102 HCO3-25 AnGap-12
[**2116-2-28**] 05:20AM BLOOD Glucose-145* UreaN-27* Creat-1.5* Na-138
K-5.6* Cl-102 HCO3-27 AnGap-15
[**2116-2-25**] 02:51AM BLOOD Calcium-8.4 Phos-3.9 Mg-2.2

Brief Hospital Course:
He was taken to cardiac cath and found to have three vessel
disease. He was Iron deficient by labs and given the concern for
GI bleed, though stool guaiac was documented as negative, he was
taken to colonoscopy and EGD, which showed no source of bleed.
His Plavix was held upon admission in anticipation for
cardiothoracic surgery. His Coumadin was discontinued and he was
maintained on heparin drip once GI bleed was ruled out until
surgery. On [**2-17**] he had three teeth extracted.  He was then
taken to the operating room on [**2-20**] where he underwent a mitral
valve repair via right thoracotomy. Please see operative report
for surgical details Following surgery he was transferred to the
CVICU for invasive monitoring in stable condition. He was given
48 hours of vancomycin as he was in the hospital preoperatively.
Later on op day he was weaned from sedation, awoke
neurologically intact and extubated. He was restarted on
Coumadin for his atrial fibrillation. Also started on beta
blockers and diuretics and gently diuresed towards his pre-op
weight. He remained in the ICU for pulmonary toilet. Chest tubes
and epicardial pacing wires were removed per protocol. On [**2-24**],
post-op day four, he underwent right thoracentesis for 250 cc.
He was transferred to the floor on post-op day five. He worked
with physical therapy for strength and mobility. He continued to
slowly recover and was discharged to home with vna services and
the appropriate medications and follow-up appointments. Dr.
[**Last Name (STitle) 1911**] will follow his INR and adjust Coumadin
accordingly.

Medications on Admission:
Atorvastatin (Lipitor) 20 mg daily
Furosemide 60 mg [**Hospital1 **]
Glyburide 5 mg [**Hospital1 **]
Ranitidine (Zantac) 150 mg [**Hospital1 **]
Warfarin 2 mg daily
ASA 81mg daily
Clopidogrel 75 mg daily
Toprol XL 150 mg daily
Imdur 30 mg daily
Spironolactone 25 mg daily

Discharge Medications:
1. Glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*1*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*1*
4. 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:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*1*
7. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
8. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
9. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
Disp:*1 * Refills:*2*
10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 * Refills:*2*
11. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 4 weeks.
Disp:*65 Tablet(s)* Refills:*0*
12. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day for 1
doses: Titrate dose as directed by the office of Dr.
[**Last Name (STitle) 1911**].
Disp:*40 Tablet(s)* Refills:*1*
13. Outpatient Lab Work
INR to be drawn Saturday with results faxed to [**First Name4 (NamePattern1) 2808**]
[**Location (un) 24077**], RN in the office of Dr. [**Last Name (STitle) 1911**]
[**Telephone/Fax (1) 14926**].
14. Furosemide 40 mg Tablet Sig: One (1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*1*

Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Primary:
severe mitral regurgitaion now s/p Mitral Valve Repair
coronary artery disease
chronic systolic heart failure
anemia
.
Secondary:
# h/o paroxysmal atrial fibrillation
- s/p cardioversion [**3-2**]
- s/p AVJ ablation [**2116-1-10**]
# COPD
# amio lung toxicity
# HTN
# Diabetes type 2
# Hypercholesterolemia
# Chronic renal insufficiency
# GERD

Discharge Condition:
Stable

Discharge Instructions:
1)Call with fever, redness or drainage from incision or weight
gain more than 2 pounds in one day or five in one week.
2)Please shower daily. No baths. Pat dry incisions, do not rub.
3)Avoid creams and lotions to surgical incisions.
4)Call cardiac surgeon if there is concern for wound infection.
5)No driving for at least one month.

Followup Instructions:
Dr. [**First Name (STitle) 679**] 2 weeks
Dr. [**Last Name (STitle) 1911**] 2 weeks
Dr. [**First Name (STitle) **] 4 weeks
Please fax INR results to [**First Name4 (NamePattern1) 2808**] [**Location (un) 24077**], RN at the office
of Dr. [**Last Name (STitle) 1911**] [**Telephone/Fax (1) 14926**]. Confirmation e-mailed from
[**Doctor Last Name 2808**] on [**2116-2-27**]

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

Completed by:[**2116-2-28**]
{'Mitral valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic periodontitis, unspecified,Atrial fibrillation,Other chronic pulmonary heart diseases,Other and unspecified angina pectoris,Aortocoronary bypass status,Automatic implantable cardiac defibrillator in situ,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Benign neoplasm of rectum and anal canal,Diverticulosis of colon (without mention of hemorrhage),Iron deficiency anemia, unspecified'}


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: 72M h/o sCHF (EF 35%); CAD s/p CABG x2; LCx stent [**2110**]; 4+MR;
s/p BiV ICD; recurrent pAF w/ RVR s/p AV node ablation; DM2,
presented to the ED with SOBx 2 days, as well as with one
recorded temperature at home to T 100.  Of note, pt had been
discharged on [**2116-1-11**] after undergoing AV node ablation, and had
denied respiratory distress during [**1-23**] EP outpatient follow-up;
at that time, ICD had been interrogated and found to be WNL.
(On this presentation, however, pt stated that he had been SOB
since his latest discharge.)
.
Pt also reported that he had been coughing x3 days, producing
white phelgm, and had been in contact with a granddaughter
recently [**Name2 (NI) **] with influenza.
.
ROS: Positive for SOB, increased peripheral edema x1day,
decreased ability to sleep given SOB, and decreased exercise
tolerance.  Negative for chest pain, abd pain, N/V, changes in
urinary/bowel habits, myalgias/arthralgias.
.
ED course:
# Vitals: O2sat 91 on RA, mid 80s on RA with conversation, 96 on
2L
# Meds: Furosemide 40mg IV (excreted 400cc urine), levofloxacin

MEDICAL HISTORY: # CAD s/p inferior MI, CABG x2 ([**2080**], [**2100**]: SVG to OM, SVG to
LAD, patent in [**2110**]), LCx stent [**2110**]
# Systolic CHF [**12-28**] ischemic CM (EF 35%) s/p BiV ICD [**2110**],
replaced [**2114**]
# HTN
# 4+ MR
# h/o paroxysmal atrial fibrillation s/p cardioversion [**2114**], s/p
AV node ablation [**2115**]
# COPD: No home O2
# DM2
# Hypercholesterolemia
# Chronic renal insufficiency
# GERD

MEDICATION ON ADMISSION: Atorvastatin (Lipitor) 20 mg daily
Furosemide 60 mg [**Hospital1 **]
Glyburide 5 mg [**Hospital1 **]
Ranitidine (Zantac) 150 mg [**Hospital1 **]
Warfarin 2 mg daily
ASA 81mg daily
Clopidogrel 75 mg daily
Toprol XL 150 mg daily
Imdur 30 mg daily
Spironolactone 25 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS:  T 96.8, BP 100/50, HR 70, RR 20, O2sat 95 on 2L, FS 245
HEENT: NCAT, OP clear, MMM, no LAD
NECK:  JVP elevated to ear.  No carotid bruits.
CHEST:  Bilateral rales 3/4 up.  Apices clear.  No rhonchi,
wheezes.
CARDIAC:  RRR, S1S2, 2/6 SEM @ apex.
ABDOMEN:  Soft, NT/ND, BS+, no HSM
EXT:  BLE to ankles, 1+ B DP.
NEURO: A&Ox3

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: # Personal: Lives with wife, has 2 sons.  [**Name (NI) 24075**]-speaking only.
# Professional: Retired construction worker.
# Tobacco: Smoked maximum 4ppd
# Alcohol: Social
# Recreational drugs: None 

### Response:
{'Mitral valve disorders,Acute on chronic systolic heart failure,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Chronic periodontitis, unspecified,Atrial fibrillation,Other chronic pulmonary heart diseases,Other and unspecified angina pectoris,Aortocoronary bypass status,Automatic implantable cardiac defibrillator in situ,Unspecified gastritis and gastroduodenitis, without mention of hemorrhage,Benign neoplasm of rectum and anal canal,Diverticulosis of colon (without mention of hemorrhage),Iron deficiency anemia, unspecified'}
