CHIEF COMPLAINT: Chest pain, Dyspnea on exertion

PRESENT ILLNESS: 60 y/o male adm. to OSH w/CP, found to have elev. troponin and
pulmonary edema. Transferred to [**Hospital1 18**] for cardiac
catheterization.

MEDICAL HISTORY: Congestive Heart Failure, Diabetes Mellitus, Hypertension,
Chronic Renal Insufficiency newly started on hemodialysis
[**2182-7-29**], Anemia, Fournier's gangrene s/p scrotal surgery, s/p
appendectomy and tonsillectomy

MEDICATION ON ADMISSION: Toprol 50 mg PO daily, Glyburide 1.25 mg PO daily, Norvasc 20 mg
PO daily, Albuterol, Doxazosin 2 mg PO daily, Nephrocaps, ASA
325 mg PO daily, Plavix 75 mg PO daily, Lasix 20 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 87 20 155/66 5'0" 84kg
General: Well-appearing w/ SOB
HEENT: NCAT, EOMI, perrl
Neck: Supple, FROM -JVD
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft NT/ND, +BS
Ext: Warm, well-perfused with 1 +edema, -varicosities
Neuro: MAE, non-focal, A&O x 3

FAMILY HISTORY: non-contrib.

SOCIAL HISTORY: retired, smoked X 30 years, quit 5 years ago, rare ETOH
Coronary atherosclerosis of native coronary artery,Acute myocardial infarction of unspecified site, initial episode of care,Systolic heart failure, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,End stage renal disease,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Postinflammatory pulmonary fibrosis,Duodenitis, with hemorrhage,Acute posthemorrhagic anemia,Hyperpotassemia,Benign neoplasm of colon,Abnormal coagulation profile,Proliferative diabetic retinopathy,Hypotension of hemodialysis,Disorders of phosphorus metabolism,Legal blindness, as defined in U.S.A.,Vitreous hemorrhage
Crnry athrscl natve vssl,AMI NOS, initial,Systolic hrt failure NOS,DMII renal uncntrld,End stage renal disease,Atrial fibrillation,Hyp kid NOS w cr kid V,Acute kidney failure NOS,Postinflam pulm fibrosis,Duodenitis w hmrhg,Ac posthemorrhag anemia,Hyperpotassemia,Benign neoplasm lg bowel,Abnrml coagultion prfile,Prolif diab retinopathy,Hemododialysis hypotensn,Dis phosphorus metabol,Legal blindness-usa def,Vitreous hemorrhage
Admission Date:  [**2182-8-2**]              Discharge Date:   [**2182-8-28**]

Date of Birth:  [**2122-5-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pain, Dyspnea on exertion

Major Surgical or Invasive Procedure:
Coronary Artery Bypass Graft x 4(LIMA->LAD, SVG->RCA, OM)
[**2182-8-9**]

History of Present Illness:
60 y/o male adm. to OSH w/CP, found to have elev. troponin and
pulmonary edema. Transferred to [**Hospital1 18**] for cardiac
catheterization.

Past Medical History:
Congestive Heart Failure, Diabetes Mellitus, Hypertension,
Chronic Renal Insufficiency newly started on hemodialysis
[**2182-7-29**], Anemia, Fournier's gangrene s/p scrotal surgery, s/p
appendectomy and tonsillectomy

Social History:
retired, smoked X 30 years, quit 5 years ago, rare ETOH

Family History:
non-contrib.

Physical Exam:
VS: 87 20 155/66 5'0" 84kg
General: Well-appearing w/ SOB
HEENT: NCAT, EOMI, perrl
Neck: Supple, FROM -JVD
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft NT/ND, +BS
Ext: Warm, well-perfused with 1 +edema, -varicosities
Neuro: MAE, non-focal, A&O x 3

Pertinent Results:
Cath [**8-2**]: Selective coronary angiography of this right dominant
system demonstrated severe 3 vessel disease. The LMCA was short
but normal. The LAD was subtotally occluded after S1, remainder
of the LAD was small with diffuse irregularities filling
antegrade and via RCA acute marginal collaterals. The LCX had
diffuse disease and the OM2 was occluded and filled via
collaterals. The RCA was occluded at mid vessel after the acute
marginal which filled the distal LAD. There was mild pulmonary
hypertension with PAP 40/16 mmHg). Left ventriculography
revealed severe global hypokinesis with LVEF 29%. No significant
mitral regurgitation was evident.
CNIS [**8-5**]: Bilateral less than 40% carotid stenosis. Likely left
subclavian stenosis.
Chest CT [**8-6**]: Moderate emphysema. Widespread interstitial
pulmonary abnormality including fibrosis and interstitial
pneumonitis, consistent with IPF.
Echo [**8-8**]: PreBypass: The left atrium is moderately dilated.
There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity is mildly dilated. There is moderate regional
left ventricular systolic dysfunction with LVEF 30-40%. Resting
regional wall motion abnormalities include septal hypokinesis at
the base, septal akinesis from mid basal region to apex,
inferior wall hypokinesis at the base and inferior wall akinesis
at the apex. A prominent thrombus is seen in the left ventricle,
adherent to the ventricular wall near the apex. There are simple
atheroma in the aortic arch. There are complex (mobile) atheroma
in the descending aorta. There is no aortic valve stenosis. No
aortic regurgitation is seen.
Trivial mitral regurgitation is seen. Post Bypass: No new
regional wall motion or valvular abnormalities observed. LVEF
30-40%.  No new aortic abnormalities observed.
CXR [**8-25**]: Right IJ line is unchanged with tip in the right
atrium. Compared to [**2182-8-21**], there has been no significant change
in the lower lobe volume loss, prominent interstitial markings
versus scarring in the left lateral lung, mild cardiomegaly.
[**2182-8-3**] 10:55AM BLOOD WBC-8.5 RBC-4.10* Hgb-12.3* Hct-36.2*
MCV-88 MCH-30.1 MCHC-34.0 RDW-15.6* Plt Ct-170
[**2182-8-15**] 04:34AM BLOOD WBC-6.9 RBC-1.69* Hgb-4.9* Hct-14.4*
MCV-85 MCH-28.8 MCHC-33.8 RDW-16.9* Plt Ct-205
[**2182-8-28**] 08:15AM BLOOD WBC-6.3 RBC-3.55* Hgb-10.6* Hct-32.1*
MCV-90 MCH-29.7 MCHC-32.9 RDW-16.6* Plt Ct-247
[**2182-8-2**] 02:46PM BLOOD PT-16.6* INR(PT)-1.5*
[**2182-8-13**] 06:25AM BLOOD PT-30.1* INR(PT)-3.2*
[**2182-8-14**] 01:23PM BLOOD PT-70.2* PTT-45.4* INR(PT)-9.0*
[**2182-8-28**] 10:15AM BLOOD PT-19.5* PTT-30.2 INR(PT)-1.9*
[**2182-8-2**] 02:46PM BLOOD Glucose-149* UreaN-37* Creat-3.2* Na-142
K-3.7 Cl-106 HCO3-22 AnGap-18
[**2182-8-12**] 08:40AM BLOOD Glucose-135* UreaN-47* Creat-4.7* Na-134
K-4.3 Cl-99 HCO3-27 AnGap-12
[**2182-8-28**] 08:15AM BLOOD Glucose-174* UreaN-21* Creat-3.6* Na-140
K-3.9 Cl-99 HCO3-32 AnGap-13
[**2182-8-28**] 08:15AM BLOOD Calcium-7.4* Phos-3.7 Mg-1.5*
[**2182-8-6**] 05:46AM URINE Blood-SM Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2182-8-6**] 08:23PM URINE RBC-[**5-25**]* WBC-[**2-17**] Bacteri-MOD Yeast-NONE
Epi-[**2-17**]

Brief Hospital Course:
Pt. was admitted to the medical service, medical management was
optimized, he received regular hemodialysis treatments, and was
taken to the OR on [**2182-8-8**] with Dr. [**Last Name (STitle) 914**]. He underwent a CABG
X 4 (LIMA > LAD, SVG>Diag>OM, SVG>PDA). Please see operative
note for details of surgical procedure. Pt. was transported to
the cardiac surgical recovery unit for invasive monitoring in
stable condition. Later on op day he was weaned from sedation,
awoke neurologically intact and was extubated. His epicardial
wires and chest tubes were removed on POD # 1, and warfarin was
initiated(due to finding of LV thrombus in the OR). He remained
hemodynamically stable and was transferred to the telemetry unit
on POD # 2. He continued on regular dialysis, was being
anticoagulated, and had remained stable until early am on [**8-15**].
At that time, he had a bloody BM, was lightheaded, and
diaphoretic. He was transferred to the ICU.  His INR which had
been in the 3's had rapidly increased to 6, then to 9 just prior
to this incident. His hematocrit dropped to the mid-teens. He
was transfused RBC's & plasma, received vitamin K. GI was
consulted, and he underwent UGI endoscopy (on [**8-15**])which showed
gastritis (not actively bleeding). EGD was repeated on [**8-16**] which
showed gastritis & duodenitis. He remained hemodynamically
stable after his anticoagulation was reversed, and he was again
transferred to the telemetry floor. He underwent a colonoscopy
on [**2182-8-21**], which revealed polyps, and normal mucosa.
Anticoagulation was again initiated (for post-op AF, as well as
the LV thrombus noted in the OR) with warfarin and IV heparin
was given while waiting for the INR to become therapeutic. On
[**2182-8-26**], he was noted to have some bleeding in his left eye,
ophthalmalogy was consulted (pt. has long-standing history of
retinopathy, prev. vitreous hemmorhage, legally blind). He was
found to have vitreous hemmorhage, and eye drops were initiated
as recommended. His eye was patched, and anticoagulation was
stopped. Throughout post-op course he received regular
hemodialysis treatments and worked with physical therapy for
strength and mobility. He appeared stable and suitable for
discharge home on post-op day 20. He was not restarted on
coumadin seoncadry to the his sensitivity and bleeding
complications. He was discharged home with VNA services and the
appropriate follow-up appointments.

Medications on Admission:
Toprol 50 mg PO daily, Glyburide 1.25 mg PO daily, Norvasc 20 mg
PO daily, Albuterol, Doxazosin 2 mg PO daily, Nephrocaps, ASA
325 mg PO daily, Plavix 75 mg PO daily, Lasix 20 mg PO daily

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. 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*
3. 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*
4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID (3 times a day).
Disp:*90 Tablet, Chewable(s)* Refills:*2*
7. Norvasc 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
8. 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:*2*
9. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 Cap(s)* Refills:*2*
10. Scopolamine HBr 0.25 % Drops Sig: One (1) Drop Ophthalmic
[**Hospital1 **] (2 times a day).
Disp:*1 vial* Refills:*2*
11. Prednisolone Acetate 1 % Drops, Suspension Sig: One (1) Drop
Ophthalmic  QID (4 times a day).
Disp:*1 vial* Refills:*2*
12. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).
Disp:*270 Tablet(s)* Refills:*2*
14. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
Disp:*30 Tablet(s)* Refills:*2*
15. Enalapril Maleate 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
16. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic  [**Hospital1 **] (2 times a day).
Disp:*1 vial* Refills:*2*
17. Glyburide 1.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*

Discharge Disposition:
Home With Service

Facility:
Home Health and Hospice Care, [**Location (un) 686**]

Discharge Diagnosis:
Coronary artery disease s/p Coronary Artery Bypass Graft x 4
PMH: Congestive Heart Failure, Diabetes Mellitus, Hypertension,
Chronic Renal Insufficiency newly started on hemodialysis
[**2182-7-29**], Anemia, Fournier's gangrene s/p scrotal surgery, s/p
appendectomy and tonsillectomy

Discharge Condition:
Good

Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs. for 2 months.
Shower daily, let water flow over wounds, pat dry with a towel.
Do not use creams, powders, or lotions on wounds.
Call our office with sternal drainage, temp>101.5

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) 12816**] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) 914**] for 4 weeks.


Completed by:[**2182-9-12**]
{'Coronary atherosclerosis of native coronary artery,Acute myocardial infarction of unspecified site, initial episode of care,Systolic heart failure, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,End stage renal disease,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Postinflammatory pulmonary fibrosis,Duodenitis, with hemorrhage,Acute posthemorrhagic anemia,Hyperpotassemia,Benign neoplasm of colon,Abnormal coagulation profile,Proliferative diabetic retinopathy,Hypotension of hemodialysis,Disorders of phosphorus metabolism,Legal blindness, as defined in U.S.A.,Vitreous hemorrhage'}


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: Chest pain, Dyspnea on exertion

PRESENT ILLNESS: 60 y/o male adm. to OSH w/CP, found to have elev. troponin and
pulmonary edema. Transferred to [**Hospital1 18**] for cardiac
catheterization.

MEDICAL HISTORY: Congestive Heart Failure, Diabetes Mellitus, Hypertension,
Chronic Renal Insufficiency newly started on hemodialysis
[**2182-7-29**], Anemia, Fournier's gangrene s/p scrotal surgery, s/p
appendectomy and tonsillectomy

MEDICATION ON ADMISSION: Toprol 50 mg PO daily, Glyburide 1.25 mg PO daily, Norvasc 20 mg
PO daily, Albuterol, Doxazosin 2 mg PO daily, Nephrocaps, ASA
325 mg PO daily, Plavix 75 mg PO daily, Lasix 20 mg PO daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 87 20 155/66 5'0" 84kg
General: Well-appearing w/ SOB
HEENT: NCAT, EOMI, perrl
Neck: Supple, FROM -JVD
Chest: CTAB -w/r/r
Heart: RRR -c/r/m/g
Abd: Soft NT/ND, +BS
Ext: Warm, well-perfused with 1 +edema, -varicosities
Neuro: MAE, non-focal, A&O x 3

FAMILY HISTORY: non-contrib.

SOCIAL HISTORY: retired, smoked X 30 years, quit 5 years ago, rare ETOH 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute myocardial infarction of unspecified site, initial episode of care,Systolic heart failure, unspecified,Diabetes with renal manifestations, type II or unspecified type, uncontrolled,End stage renal disease,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acute kidney failure, unspecified,Postinflammatory pulmonary fibrosis,Duodenitis, with hemorrhage,Acute posthemorrhagic anemia,Hyperpotassemia,Benign neoplasm of colon,Abnormal coagulation profile,Proliferative diabetic retinopathy,Hypotension of hemodialysis,Disorders of phosphorus metabolism,Legal blindness, as defined in U.S.A.,Vitreous hemorrhage'}
