CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 66 year old male with alzheimers dementia and history of
coronary artery disease, silent myocardial infarctions with
multiple interventions.

MEDICAL HISTORY: Coronary artery disease s/p CABG
Hypercholesterolemia
Hypertension
Venous insufficiency
GERD
Mitral Regurgitation
Dementia
Depression
Obstruction sleep apnea
Pseudogout
Hyperuricemia
Arthritis

MEDICATION ON ADMISSION: Atenolol 50 mg daily
Lipitor 70 mg daily
Citalopram 60mg daily
Plavix 75mg daily
Colchicine 0.6 mg daily
Donepezil 10 mg daily
Zetia 10 mg daily
Felodipine 10 mg daily
Fluticasone 50 mcg 2 sprays each nostril daily
HCTZ 25 mg daily
Lisinopril 20 mg daily
Prilosec 20 mg daily
Aspirin 325 mg daily
Tylenol 1000mg twice a day
NTG SL prn

ALLERGIES: Naproxen

PHYSICAL EXAM: General Comfortable HR 59, RR 19, b/p 173/94 rt, 183/88 lt
Skin unremarkable
HEENT unremarkable
Neck Supple full ROM
Chest Lungs CTA bilateral
Heart RRR
Abdomen soft, nondistended, nontender, + bowel sounds
Extremeties warm well perfused
Varicosities none
Neuro grossly intact
Pulses palpable

FAMILY HISTORY: Father deceased at 54 yo from myocardial infarction

SOCIAL HISTORY: Retired
Lives with spouse who is primary caretaker
[**Name (NI) 1139**] 50 pack year history quit 25 years ago
Alcohol rare
Coronary atherosclerosis of native coronary artery,Obstructive chronic bronchitis with (acute) exacerbation,Emphysematous bleb,Delirium due to conditions classified elsewhere,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Pure hypercholesterolemia,Benign essential hypertension,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Mitral valve disorders,Venous (peripheral) insufficiency, unspecified,Arthropathy, unspecified, site unspecified,Other disorders of calcium metabolism,Chondrocalcinosis, unspecified, lower leg,Depressive disorder, not elsewhere classified,Anemia, unspecified,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Personal history of poliomyelitis
Crnry athrscl natve vssl,Obs chr bronc w(ac) exac,Emphysematous bleb,Delirium d/t other cond,Alzheimer's disease,Dementia w/o behav dist,Pure hypercholesterolem,Benign hypertension,Obstructive sleep apnea,Esophageal reflux,Mitral valve disorder,Venous insufficiency NOS,Arthropathy NOS-unspec,Dis calcium metablsm NEC,Chondrocalcin NOS-l/leg,Depressive disorder NEC,Anemia NOS,Old myocardial infarct,Status-post ptca,Fam hx-ischem heart dis,Prsnl hst poliomyelitis
Admission Date:  [**2173-2-25**]              Discharge Date:   [**2173-3-4**]

Date of Birth:  [**2106-8-23**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Naproxen

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

Major Surgical or Invasive Procedure:
s/p Coronary artery bypass graft (Left internal mammary artery >
left anterior descending, saphenous vein graft > diagonal,
saphenous vein graft > obtuse marginal 1, saphenous vein graft >
obtuse marginal 2) [**2173-2-25**]


History of Present Illness:
66 year old male with alzheimers dementia and history of
coronary artery disease, silent myocardial infarctions with
multiple interventions.

Past Medical History:
Coronary artery disease s/p CABG
Hypercholesterolemia
Hypertension
Venous insufficiency
GERD
Mitral Regurgitation
Dementia
Depression
Obstruction sleep apnea
Pseudogout
Hyperuricemia
Arthritis

Social History:
Retired
Lives with spouse who is primary caretaker
[**Name (NI) 1139**] 50 pack year history quit 25 years ago
Alcohol rare

Family History:
Father deceased at 54 yo from myocardial infarction

Physical Exam:
General Comfortable HR 59, RR 19, b/p 173/94 rt, 183/88 lt
Skin unremarkable
HEENT unremarkable
Neck Supple full ROM
Chest Lungs CTA bilateral
Heart RRR
Abdomen soft, nondistended, nontender, + bowel sounds
Extremeties warm well perfused
Varicosities none
Neuro grossly intact
Pulses palpable

Pertinent Results:
[**2173-3-3**] 04:15PM BLOOD WBC-8.7 RBC-3.56* Hgb-10.5* Hct-28.7*
MCV-81* MCH-29.5 MCHC-36.6* RDW-15.1 Plt Ct-241
[**2173-2-25**] 12:19PM BLOOD WBC-13.6*# RBC-3.49*# Hgb-10.0*#
Hct-28.0* MCV-80* MCH-28.6 MCHC-35.7* RDW-14.1 Plt Ct-160
[**2173-3-3**] 04:15PM BLOOD Plt Ct-241
[**2173-3-1**] 12:01AM BLOOD PT-14.0* PTT-32.4 INR(PT)-1.2*
[**2173-2-25**] 12:19PM BLOOD Plt Ct-160
[**2173-2-25**] 12:02PM BLOOD PT-35.8* PTT-150* INR(PT)-3.80*
[**2173-2-25**] 12:02PM BLOOD Fibrino-52.5*
[**2173-3-3**] 11:10AM BLOOD Glucose-79 UreaN-19 Creat-0.9 Na-143
K-4.4 Cl-111* HCO3-26 AnGap-10
[**2173-2-25**] 01:03PM BLOOD UreaN-13 Creat-0.8 Cl-115* HCO3-24
[**2173-3-1**] 12:01AM BLOOD ALT-21 AST-30 AlkPhos-41 TotBili-1.6*
[**2173-2-26**] 05:41PM BLOOD ALT-15 AST-28 LD(LDH)-269* AlkPhos-35*
TotBili-0.5
[**2173-3-1**] 09:29AM BLOOD Glucose-96 K-3.9

[**Known lastname 13640**],[**Known firstname **] SR [**Medical Record Number 13641**] M  66  [**2106-8-23**]

Radiology Report CHEST (PA & LAT) Study Date of [**2173-3-2**] 10:40
AM


[**Last Name (LF) **],[**First Name7 (NamePattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2173-3-2**] SCHED
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 13642**]
Reason: evaluate for effusion



[**Hospital 93**] MEDICAL CONDITION:
   66 year old man with s/p CABG - hx alzeiheimers with
confusion please limit
   time in radiology
REASON FOR THIS EXAMINATION:
   evaluate for effusion



Provisional Findings Impression: ARHb [**First Name8 (NamePattern2) **] [**2173-3-2**] 12:38 PM
Left lower lung opacity demonstrates interval improvement which
may represent
atelectasis. Small bilateral pleural effusions.


Final Report
INDICATION: History of Alzheimer's with confusion.

COMPARISON: CXR, [**2173-2-25**].

FRONTAL AND LATERAL CHEST: Patient is status post CABG and
median sternotomy.
The cardiomediastinal silhouette appears unchanged. The
pulmonary vascularity
appears stable. Left lower lung opacity, likely representing
atelectasis,
demonstrates mild improvement with small bilateral pleural
effusions noted.
The right lung appears clear and there is no pneumothorax.

IMPRESSION: Improved left lower lung opacity with small
bilateral pleural
effusions.

The study and the report were reviewed by the staff radiologist.


DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3904**]
DR. [**First Name8 (NamePattern2) 1569**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 11006**]
Approved: WED [**2173-3-3**] 9:20 AM

[**Known lastname 13640**],[**Known firstname **] SR [**Medical Record Number 13641**] M  66  [**2106-8-23**]

Cardiology Report ECG Study Date of [**2173-3-2**]  10:59:26 AM


Sinus rhythm
Prolonged QT interval
T wave abnormalities
Since previous tracing of [**2173-2-25**], ST segment elevation in the
lateral leads
are less


Read by: [**Last Name (LF) **],[**First Name3 (LF) 900**] A.

  Intervals Axes
Rate PR QRS QT/QTc P QRS T
70 140 104 458/475 28 8 61

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 13640**], [**Known firstname **] SR       [**Hospital1 18**] [**Numeric Identifier 13643**]
(Complete) Done [**2173-2-25**] at 9:08:48 AM      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: [**2106-8-23**]
Age (years): 66 M  Hgt (in): 70
BP (mm Hg): 140/70  Wgt (lb): 220
HR (bpm): 72  BSA (m2): 2.18 m2
Indication: Chest pain. Coronary artery disease. Left
ventricular function. Right ventricular function. Valvular heart
disease.
ICD-9 Codes: 440.0, 413.9, 414.8, 424.0
Test Information
Date/Time: [**2173-2-25**] at 09:08    Interpret MD: [**Name6 (MD) 3892**] [**Name8 (MD) 3893**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Last Name (NamePattern5) 9958**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW01-: Machine:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  *1.2 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  4.6 cm  <= 5.6 cm
Left Ventricle - Ejection Fraction:  55%  >= 55%
Aorta - Annulus:  2.3 cm  <= 3.0 cm
Aorta - Sinus Level:  *3.9 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.2 cm  <= 3.0 cm
Aorta - Ascending:  *3.7 cm  <= 3.4 cm
Aorta - Arch:  3.0 cm  <= 3.0 cm
Aorta - Descending Thoracic:  *2.9 cm  <= 2.5 cm
Aortic Valve - Peak Velocity:  1.2 m/sec  <= 2.0 m/sec
Mitral Valve - E Wave:  0.7 m/sec
Mitral Valve - A Wave:  0.6 m/sec
Mitral Valve - E/A ratio:  1.17

Findings
LEFT ATRIUM: No spontaneous echo contrast or thrombus in the
LA/LAA or the RA/RAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. Lipomatous hypertrophy
of the interatrial septum. No ASD by 2D or color Doppler.

LEFT VENTRICLE: Wall thickness and cavity dimensions were
obtained from 2D images. Mild symmetric LVH with normal cavity
size and global systolic function (LVEF>55%). Normal regional LV
systolic function.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Mildly dilated aortic sinus. Mildly dilated ascending
aorta. Normal aortic arch diameter. Mildly dilated descending
aorta. Simple atheroma in descending aorta.

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

MITRAL VALVE: Myxomatous mitral valve leaflets. Mild MVP.
Eccentric MR jet. Mild to moderate ([**2-5**]+) MR.

TRICUSPID VALVE: Physiologic TR.

PULMONIC VALVE/PULMONARY ARTERY: No PS. Physiologic (normal) PR.


PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient.
Conclusions
PRE-BYPASS:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium/left atrial appendage or the body of the right
atrium/right atrial appendage. No atrial septal defect is seen
by 2D or color Doppler.
There is mild symmetric left ventricular hypertrophy with normal
cavity size and global systolic function (LVEF>55%). Regional
left ventricular wall motion is normal.
Right ventricular chamber size and free wall motion are normal.
The aortic root is mildly dilated at the sinus level. The
ascending aorta is mildly dilated. The descending thoracic aorta
is mildly dilated. There are simple atheroma in the descending
thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis. No aortic
regurgitation is seen.
The mitral valve leaflets are myxomatous. There is mild mitral
valve prolapse of the P2 region. An eccentric, posteriorly
directed jet of Mild to moderate ([**2-5**]+) mitral regurgitation is
seen.
There is no pericardial effusion.
Dr. [**Last Name (STitle) 914**] was notified in person of the results on Mr
[**Known lastname **], P at 8AM before incision.

Post-Bypass:

Preserved biventricular systolic function.
Normal LVEF 55%,
Intact thoracic aorta.
Mild to moderate MR>
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**Name6 (MD) 3892**] [**Name8 (MD) 3893**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2173-2-25**] 16:13







Brief Hospital Course:
Admitted same day as surgery and underwent coronary artery
bypass graft surgery.  Received cefazolin for perioperative
antibiotics.  See operative report for further details.  He was
transferred to the intensive care unit for hemodynamic
monitoring.  In the first twenty four hours he was weaned from
sedation, awoke with confusion but has baseline dementia, and
was extubated without complications.  He remained in the
intensive care unit on nitroglycerin drip and management of
confusion receiving haldol. With his confusion at times he
became aggressive with staff.  On post operative day four he was
transferred to the floor for the remainder of his care.
Physical therapy worked with him on strength and mobility.  He
continued to progress but remained on haldol due to confusion
although no aggressive behavior toward staff.  He was confused
with environment, getting in and out of bed frequently,
forgetting were things were in the room which may be due to the
unfamiliar environment. He was ready for discharge home on post
operative day seven with services.

Sternal incision clean no erythema no drainage
Left leg EVH sites no erythema, no drainage
Lower extemeties with +1 edema which is progressively decreasing


Plan to follow up with Dr [**Last Name (STitle) 1683**] on [**3-10**], he has been prescribed
haldol for 1mg at bedtime with repeat dose of 0.5mg once if
needed, wife has been instructed to call Dr [**Last Name (STitle) 1683**] with any
concerns about confusion, agitation, and aggression.  Spoke with
Dr [**Last Name (STitle) 1683**] and she will monitor him and manage the haldol dosing,
prescription given for only 20 tablets of 0.5mg.

Social work meet with Wife [**Location (un) **] Elder services and
Alzheimers association were contact[**Name (NI) **] on Mr [**Name (NI) **] behalf.


Medications on Admission:
Atenolol 50 mg daily
Lipitor 70 mg daily
Citalopram 60mg daily
Plavix 75mg daily
Colchicine 0.6 mg daily
Donepezil 10 mg daily
Zetia 10 mg daily
Felodipine 10 mg daily
Fluticasone 50 mcg 2 sprays each nostril daily
HCTZ 25 mg daily
Lisinopril 20 mg daily
Prilosec 20 mg daily
Aspirin 325 mg daily
Tylenol 1000mg twice a day
NTG SL prn

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
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:*0*
3. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily): to each nostril.
Disp:*qs qs* Refills:*0*
4. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
6. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
Disp:*30 Capsule(s)* Refills:*0*
7. Haloperidol 0.5 mg Tablet Sig: Two (2) Tablet PO at bedtime:
1 mg at bedtime, if needed may repeat with 0.5mg one time
no more than 1.5 mg in 24 hours.
Disp:*20 Tablet(s)* Refills:*0*
8. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
9. Donepezil 10 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*0*
10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
11. Citalopram 20 mg Tablet Sig: Three (3) Tablet PO once a day:
total dose 60mg .
Disp:*90 Tablet(s)* Refills:*0*
12. Lipitor 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
13. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
Disp:*180 Tablet(s)* Refills:*0*
14. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
15. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) for 5 days.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Coronary artery disease s/p CABG
Acute Delirium
Hypercholesterolemia
Hypertension
Venous insufficiency
GERD
Mitral Regurgitation
Dementia
Depression
Obstruction sleep apnea
Pseudogout
Hyperuricemia
Arthritis


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:
Please call to schedule all appointments
Dr [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in [**3-9**] weeks
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])

Provider: [**Name10 (NameIs) 13644**],NURSE [**First Name (Titles) 13644**] [**Last Name (Titles) **] Date/Time:[**2173-3-4**] 2:15
Provider: [**Name10 (NameIs) **],[**First Name8 (NamePattern2) 2352**] [**Last Name (NamePattern1) 2352**] - ADULT MEDICINE (SB)
Phone:[**Telephone/Fax (1) 1144**] Date/Time:[**2173-3-10**] 11:15
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8384**], MD Phone:[**Telephone/Fax (1) 1690**]
Date/Time:[**2173-3-17**] 2:00



Completed by:[**2173-3-4**]
{"Coronary atherosclerosis of native coronary artery,Obstructive chronic bronchitis with (acute) exacerbation,Emphysematous bleb,Delirium due to conditions classified elsewhere,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Pure hypercholesterolemia,Benign essential hypertension,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Mitral valve disorders,Venous (peripheral) insufficiency, unspecified,Arthropathy, unspecified, site unspecified,Other disorders of calcium metabolism,Chondrocalcinosis, unspecified, lower leg,Depressive disorder, not elsewhere classified,Anemia, unspecified,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Personal history of poliomyelitis"}


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: 66 year old male with alzheimers dementia and history of
coronary artery disease, silent myocardial infarctions with
multiple interventions.

MEDICAL HISTORY: Coronary artery disease s/p CABG
Hypercholesterolemia
Hypertension
Venous insufficiency
GERD
Mitral Regurgitation
Dementia
Depression
Obstruction sleep apnea
Pseudogout
Hyperuricemia
Arthritis

MEDICATION ON ADMISSION: Atenolol 50 mg daily
Lipitor 70 mg daily
Citalopram 60mg daily
Plavix 75mg daily
Colchicine 0.6 mg daily
Donepezil 10 mg daily
Zetia 10 mg daily
Felodipine 10 mg daily
Fluticasone 50 mcg 2 sprays each nostril daily
HCTZ 25 mg daily
Lisinopril 20 mg daily
Prilosec 20 mg daily
Aspirin 325 mg daily
Tylenol 1000mg twice a day
NTG SL prn

ALLERGIES: Naproxen

PHYSICAL EXAM: General Comfortable HR 59, RR 19, b/p 173/94 rt, 183/88 lt
Skin unremarkable
HEENT unremarkable
Neck Supple full ROM
Chest Lungs CTA bilateral
Heart RRR
Abdomen soft, nondistended, nontender, + bowel sounds
Extremeties warm well perfused
Varicosities none
Neuro grossly intact
Pulses palpable

FAMILY HISTORY: Father deceased at 54 yo from myocardial infarction

SOCIAL HISTORY: Retired
Lives with spouse who is primary caretaker
[**Name (NI) 1139**] 50 pack year history quit 25 years ago
Alcohol rare 

### Response:
{"Coronary atherosclerosis of native coronary artery,Obstructive chronic bronchitis with (acute) exacerbation,Emphysematous bleb,Delirium due to conditions classified elsewhere,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Pure hypercholesterolemia,Benign essential hypertension,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Mitral valve disorders,Venous (peripheral) insufficiency, unspecified,Arthropathy, unspecified, site unspecified,Other disorders of calcium metabolism,Chondrocalcinosis, unspecified, lower leg,Depressive disorder, not elsewhere classified,Anemia, unspecified,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Personal history of poliomyelitis"}
