CHIEF COMPLAINT: Rare dyspnea on exertion

PRESENT ILLNESS: This is an 80-year-old patient with a recent episode of left arm
weakness who was investigated further and was found to have a
positive stress test. Further angiogram showed severe
triple-vessel disease with 80% left anterior descending and 90%
circumflex and 100% right coronary artery. The LV function was
well maintained with an ejection fraction of 60%, and he was
electively admitted for coronary artery bypass grafting.

MEDICAL HISTORY: Hypercholesterolemia
HTN
DJD
BPH
CRI
Chronic periodontal disease
AAA s/p endovascular stent [**2-28**]

MEDICATION ON ADMISSION: Lipitor 10mg QD
Aspirin 81mg QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN: WDWN man in NAD
HEENT: Unremarkable
NECK: Supple, no JVD
LUNGS: Clear
HEART: RRR, Nl S1-S2
ABD: Benign
EXT: Warm, well perfused, no edema, no varicosities.
NEURO: Nonfocal

FAMILY HISTORY: Brother with MI at age 50

SOCIAL HISTORY: Retired teacher. Lives with wife. Remote smoking history. Denies
alochol use.
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2120-2-26**]              Discharge Date:   [**2120-3-1**]

Date of Birth:  [**2040-3-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Rare dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2120-2-26**] Three Vessel CABG (LIMA-LAD, SVG-OM, SVG-> PDA)


History of Present Illness:
This is an 80-year-old patient with a recent episode of left arm
weakness who was investigated further and was found to have a
positive stress test. Further angiogram showed severe
triple-vessel disease with 80% left anterior descending and 90%
circumflex and 100% right coronary artery. The LV function was
well maintained with an ejection fraction of 60%, and he was
electively admitted for coronary artery bypass grafting.


Past Medical History:
Hypercholesterolemia
HTN
DJD
BPH
CRI
Chronic periodontal disease
AAA s/p endovascular stent [**2-28**]

Social History:
Retired teacher. Lives with wife. Remote smoking history. Denies
alochol use.

Family History:
Brother with MI at age 50

Physical Exam:
GEN: WDWN man in NAD
HEENT: Unremarkable
NECK: Supple, no JVD
LUNGS: Clear
HEART: RRR, Nl S1-S2
ABD: Benign
EXT: Warm, well perfused, no edema, no varicosities.
NEURO: Nonfocal

Pertinent Results:
[**2120-3-1**] 07:50AM BLOOD Hct-29.6*
[**2120-2-29**] 08:05AM BLOOD WBC-9.4 RBC-3.20* Hgb-10.0* Hct-28.7*
MCV-90 MCH-31.2 MCHC-34.9 RDW-13.9 Plt Ct-190
[**2120-3-1**] 07:50AM BLOOD UreaN-24* Creat-1.2 K-3.9
[**2120-2-29**] 08:05AM BLOOD Calcium-9.2 Phos-2.1* Mg-1.8

Brief Hospital Course:
Mr. [**Known lastname 65882**] was admitted to the [**Hospital1 18**] on [**2120-2-26**] for elective
surgical management of his coronary artery disease. He was taken
directly to the operating room where he underwent coronary
artery bypass grafting to three vessels. Please see operative
note for detail. Postoperatively he was taken to the cardiac
surgical intensive care unit for monitoring. On postoperative
day one, Mr. [**Known lastname 65882**] [**Last Name (Titles) 5058**] neurologically intact and was
extubated. He was then transferred to the step down unit for
further recovery. Mr. [**Known lastname 65882**] was gently diuresed towards his
preoperative weight. His drains and pacing wires were removed
per protocol without complication. He remained in a normal sinus
rhythm without atrial or ventricular arrhythmias. The physical
therapy service was consulted for assistance with his
postoperative strength and mobility. Beta blockade, aspirin and
a statin were resumed. As his blood pressure remained elevated,
an ace inhibitor was eventually started and titrated for optimal
blood pressure control. Over several days, Mr. [**Known lastname 65882**]
continued to make steady progress and clinical improvements. He
was discharged to home on postoperative day four. His blood
pressure ranged between 110-140/60-70's on discharge and he was
in a normal sinus rhythm, rate in the 60's to 80's with first
degree AV block. His incisions were clean, dry and intact
without drainage. He will continue to require gentle diuresis as
he remained about 10 pounds above his preoperative weight.

Medications on Admission:
Lipitor 10mg QD
Aspirin 81mg QD

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days: please take with KCL.
Disp:*14 Tablet(s)* Refills:*0*
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days: please take with Lasix.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*100 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 6-8 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
1 months.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Hospice and VNA

Discharge Diagnosis:
CAD - s/p CABG
Hypercholesterolemia
HTN
DJD
BPH
CRI
Chronic periodontal disease
AAA s/p endovascular aortic stent


Discharge Condition:
Good


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
one week.
4) No driving for 1 month or while on narcotics.
5) No lifting greater then 10 pounds for 10 weeks.
6) You may wash incision and pat dry. No swimming of bathing
until wound has healed.
7) No lotions, creams or powders to wound until it has healed.
8) Take lasix for one week as directed
9) Please call with any questions or concerns.

[**Last Name (NamePattern4) 2138**]p Instructions:
Follow-up with Dr. [**Last Name (Prefixes) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with Dr. [**First Name (STitle) **] in [**11-27**] weeks.
Follow-up with Dr. [**First Name (STitle) **] in 2 weeks. ([**Telephone/Fax (1) 65883**].
Please call all providers for appointments.



Completed by:[**2120-3-1**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: Rare dyspnea on exertion

PRESENT ILLNESS: This is an 80-year-old patient with a recent episode of left arm
weakness who was investigated further and was found to have a
positive stress test. Further angiogram showed severe
triple-vessel disease with 80% left anterior descending and 90%
circumflex and 100% right coronary artery. The LV function was
well maintained with an ejection fraction of 60%, and he was
electively admitted for coronary artery bypass grafting.

MEDICAL HISTORY: Hypercholesterolemia
HTN
DJD
BPH
CRI
Chronic periodontal disease
AAA s/p endovascular stent [**2-28**]

MEDICATION ON ADMISSION: Lipitor 10mg QD
Aspirin 81mg QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN: WDWN man in NAD
HEENT: Unremarkable
NECK: Supple, no JVD
LUNGS: Clear
HEART: RRR, Nl S1-S2
ABD: Benign
EXT: Warm, well perfused, no edema, no varicosities.
NEURO: Nonfocal

FAMILY HISTORY: Brother with MI at age 50

SOCIAL HISTORY: Retired teacher. Lives with wife. Remote smoking history. Denies
alochol use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia'}
