CHIEF COMPLAINT: Chest pain, shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 61502**] is a 65 year old man who
complains of increasing chest pain and dyspnea on exertion over
the past 10-14 days.

MEDICAL HISTORY: Diabetes with polyneuropathy
Hypertension
Hyperlipidemia
Obesity
Diverticulitis of the large intestine
Chronic renal insufficiency
Sleep apnea, CPAP of 10
Hyperthyroidism
GERD
Tubular edenoma w polypectomy, conoloscopy due [**2176**]
HOH

MEDICATION ON ADMISSION: Lopressor 25mg [**Hospital1 **]
Nitrostat 0.4 SL PRN
ASA 81mg daily
Norvasc 2.5mg daily
Vitamin C 500mg daily
Lisinopril 10mg daily
Pravachol 40mg HS
Gabapentin 600mg [**Hospital1 **]
Cymbalta 60mg QAM
Fish Oil 1200mg [**Hospital1 **]
Glucosamine Chondroitin 500mg [**Hospital1 **]
Omeprazole 20mg daily
Metformin 500mg daily
Cialia 20mg PRN

ALLERGIES: bee stings

PHYSICAL EXAM: On Admission
Pulse: 56 Resp:23  O2 sat: 93
B/P  133/81
Height:  5'8"   Weight:220 lbs

FAMILY HISTORY: brother w CAD s/p stenting in 40s, died of bladder
CA in 60s

SOCIAL HISTORY: Race:Caucasian
Last Dental Exam: 6 weeks ago, no infections at that time
Lives with:girlfriend (pt is divorced)
Occupation:barber
Tobacco:20 pack year history, quit 1 wk ago
ETOH:[**12-22**] drinks per week
Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Other and unspecified hyperlipidemia,Obesity, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Other and unspecified angina pectoris,Obstructive sleep apnea (adult)(pediatric)
Crnry athrscl natve vssl,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hyperlipidemia NEC/NOS,Obesity NOS,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Esophageal reflux,Angina pectoris NEC/NOS,Obstructive sleep apnea
Admission Date:  [**2174-11-3**]              Discharge Date:   [**2174-11-8**]

Date of Birth:  [**2109-3-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
bee stings

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Chest pain, shortness of breath

Major Surgical or Invasive Procedure:
[**2174-11-4**]
1. Coronary artery bypass grafting x2 with left internal
    mammary artery to left anterior descending coronary
    artery; reverse saphenous vein single graft from the
    aorta to the ramus intermedius coronary artery.
2. Endoscopic left greater saphenous vein harvesting.


History of Present Illness:
Mr. [**Known lastname 61502**] is a 65 year old man who
complains of increasing chest pain and dyspnea on exertion over
the past 10-14 days.

Cardiac Catheterization: Date:  [**2174-11-3**]   Place: [**Hospital 5279**]
Hospital
Severe LM ramus and PDA lesions.  Normal EF


Past Medical History:
Diabetes with polyneuropathy
Hypertension
Hyperlipidemia
Obesity
Diverticulitis of the large intestine
Chronic renal insufficiency
Sleep apnea, CPAP of 10
Hyperthyroidism
GERD
Tubular edenoma w polypectomy, conoloscopy due [**2176**]
HOH


Social History:
Race:Caucasian
Last Dental Exam: 6 weeks ago, no infections at that time
Lives with:girlfriend (pt is divorced)
Occupation:barber
Tobacco:20 pack year history, quit 1 wk ago
ETOH:[**12-22**] drinks per week


Family History:
brother w CAD s/p stenting in 40s, died of bladder
CA in 60s


Physical Exam:
On Admission
Pulse: 56 Resp:23  O2 sat: 93
B/P  133/81
Height:  5'8"   Weight:220 lbs

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact [x]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 1+  Left: 1+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right: -   Left: -


Pertinent Results:
Admission Labs:
[**2174-11-3**] 11:51PM   GLUCOSE-134* UREA N-23* CREAT-1.0 SODIUM-133
POTASSIUM-8.6* CHLORIDE-100 TOTAL CO2-25 ANION GAP-17
[**2174-11-3**] 11:51PM   CK-MB-2 cTropnT-<0.01
[**2174-11-3**] 11:51PM   WBC-7.8 RBC-5.28 HGB-15.0 HCT-43.2 MCV-82
MCH-28.4 MCHC-34.7 RDW-14.3
[**2174-11-3**] 11:51PM   PLT COUNT-177
[**2174-11-3**] 11:51PM   PT-12.8 PTT-25.3 INR(PT)-1.1
[**2174-11-3**] 04:19PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.018
[**2174-11-3**] 04:19PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2174-11-3**] 04:05PM   GLUCOSE-112* UREA N-22* CREAT-0.8 SODIUM-138
POTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-26 ANION GAP-13
[**2174-11-3**] 04:05PM   ALT(SGPT)-47* AST(SGOT)-32 LD(LDH)-132
CK(CPK)-57 ALK PHOS-55 AMYLASE-54 TOT BILI-0.8
[**2174-11-3**] 04:05PM   LIPASE-26
[**2174-11-3**] 04:05PM   CK-MB-3 cTropnT-<0.01
[**2174-11-3**] 04:05PM   TSH-3.4
[**2174-11-3**] 04:05PM   T4-7.5 T3-117
[**2174-11-3**] 04:05PM BLOOD %HbA1c-7.4* eAG-166*
Discharge LAbs:
[**2174-11-8**] 04:45AM BLOOD WBC-7.6 RBC-2.93* Hgb-8.4* Hct-24.4*
MCV-83 MCH-28.7 MCHC-34.4 RDW-14.7 Plt Ct-229#
[**2174-11-8**] 04:45AM BLOOD Plt Ct-229#
[**2174-11-4**] 07:50PM BLOOD PT-13.1 PTT-26.0 INR(PT)-1.1
[**2174-11-8**] 04:45AM BLOOD Glucose-134* UreaN-24* Creat-0.9 Na-135
K-4.3 Cl-99 HCO3-30 AnGap-10

Radiology Report CHEST (PA & LAT) Study Date of [**2174-11-6**] 1:46 PM

[**Hospital 93**] MEDICAL CONDITION: 65 year old man with s/p POD 2
CABG CT removal
Final Report
Two views. Comparison with [**2174-11-4**]. The patient is status post
CABG as
before. An endotracheal tube, nasogastric tube, chest tube,
mediastinal
drain, and Swan-Ganz catheter have been withdrawn. Lung volumes
are low.
There is bibasilar streaky density consistent with subsegmental
atelectasis or consolidation in the retrocardiac area as before.
There is interval blunting of the left costophrenic sulcus.
Mediastinal structures are unchanged.
IMPRESSION: Interval increase in left pleural fluid. There is no
other
significant change since removal of line and tubes.

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  40%  >= 55%
Aorta - Ascending:  *3.8 cm  <= 3.4 cm
Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. No ASD by 2D or color
Doppler.
LEFT VENTRICLE: Mild regional LV systolic dysfunction. Mildly
depressed LVEF.
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Normal aortic diameter at the sinus level. Mildly dilated
ascending aorta. Simple atheroma in descending aorta.
AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.
TRICUSPID VALVE: Mild [1+] TR.
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.
REGIONAL LEFT VENTRICULAR WALL MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
Prebypass
No atrial septal defect is seen by 2D or color Doppler. There is
mild regional left ventricular systolic dysfunction with
hypokinesia of the apex, apical and mid portions of the
anteroseptal walls. Overall left ventricular systolic function
is mildly depressed (LVEF= 40%). Right ventricular chamber size
and free wall motion are normal. The ascending 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 mildly
thickened. Mild (1+) mitral regurgitation is seen. Dr. [**Last Name (STitle) 914**]
was notified in person of the results on [**2174-11-4**] at 1530
Post bypass
Patient is in sinus rhythm. Biventricular systolic function is
unchanged. Mild mitral regurgitation persists. Aorta is intact
post decannulation.


Brief Hospital Course:
Mr. [**Known lastname 61502**] was transferred on [**2174-11-3**] from [**Hospital 9464**] Hospital
for management of his coronary artery disease. He was continued
on IV heparin.  Preoperative work-up was completed. He was
brought to the operating room on [**2174-11-4**] for coronary artery
bypass graft surgery.  See operative report for further details.
 He received cefazolin for perioperative antibiotics and was
transferred to the intensive care unit for postoperative
management.  In the first twenty four hours he was weaned from
sedation, awoke neurologically intact and was extubated without
complications.  On post operative day one he was started on beta
blockers and diuretics.  He continued to do well and was
transferred to the floor hemodynamically stable. The remainder
of his hospital coursewas uneventful. Exam below summaries
hospital events:

Respiratory: aggressive pulmonary toilet, nebs, incentive
spirometer he titrated off oxygen with saturations of XXXX on
room air.
Chest-tubes: Mediastinal and left pleural chest tubes were
removed on POD2.

Cardiac: beta-blockers were titrated as tolerated
hemodynamically.
He remained hemodynamically stable in sinus rhythm. ASA and
statin were continued.

GI: H2 Blocker and bowel regime throughout hospital stay.
Nutrition: cardiac healthy, diabetic diet was tolerated

Renal: renal function within normal limits with good urine
output.  His electrolytes were replete as needed. He was
diuresed to pre operative weight

Endocrine: maintained on insulin drip in CVICU and transition to
insulin sliding scale with blood sugars < 150.  He was started
on his home dose Metformin.  Gabapentin was restarted on
postoperative day 1

Neuro/Pain: No neurological events.  Antidepressant was
restarted.   Well controlled with percocet.

Disposition: He was seen by physical therapy and deemed safe for
home.  He was discharged home with visiting nurses on [**2174-11-8**].

Medications on Admission:
Lopressor 25mg [**Hospital1 **]
Nitrostat 0.4 SL PRN
ASA 81mg daily
Norvasc 2.5mg daily
Vitamin C 500mg daily
Lisinopril 10mg daily
Pravachol 40mg HS
Gabapentin 600mg [**Hospital1 **]
Cymbalta 60mg QAM
Fish Oil 1200mg [**Hospital1 **]
Glucosamine Chondroitin 500mg [**Hospital1 **]
Omeprazole 20mg daily
Metformin 500mg daily
Cialia 20mg PRN


Discharge Medications:
1. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO QAM (once a day (in the
morning)).
2. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
3. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
7. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
8. metformin 500 mg Tablet Sig: One (1) Tablet PO once a day.
9. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
11. potassium chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Home Health & Hospice Care

Discharge Diagnosis:
Coronary Artery Disease s/p cabg
Diabetes with polyneuropathy
Hypertension
Hyperlipidemia
Obesity
Diverticulitis of the large intestine
Chronic renal insufficiency
Sleep apnea, CPAP of 10
Hyperthyroidism
GERD
Tubular edenoma w polypectomy, conoloscopy due [**2176**]
HOH


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Right leg - healing well, no erythema or drainage. Trace Edema


Discharge Instructions:
-Shower daily including washing incisions gently with mild soap,
no baths or swimming until cleared by surgeon. Look at your
incisions daily for redness or drainage
-NO lotions, cream, powder, or ointments to incisions
-Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

-No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
-No lifting more than 10 pounds for 10 weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) 914**], Tuesday, [**2174-11-22**], 2pm
Cardiologist: none

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 76709**] [**Telephone/Fax (1) 76133**] in [**1-20**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2174-12-1**]
{'Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Other and unspecified hyperlipidemia,Obesity, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Other and unspecified angina pectoris,Obstructive sleep apnea (adult)(pediatric)'}


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, shortness of breath

PRESENT ILLNESS: Mr. [**Known lastname 61502**] is a 65 year old man who
complains of increasing chest pain and dyspnea on exertion over
the past 10-14 days.

MEDICAL HISTORY: Diabetes with polyneuropathy
Hypertension
Hyperlipidemia
Obesity
Diverticulitis of the large intestine
Chronic renal insufficiency
Sleep apnea, CPAP of 10
Hyperthyroidism
GERD
Tubular edenoma w polypectomy, conoloscopy due [**2176**]
HOH

MEDICATION ON ADMISSION: Lopressor 25mg [**Hospital1 **]
Nitrostat 0.4 SL PRN
ASA 81mg daily
Norvasc 2.5mg daily
Vitamin C 500mg daily
Lisinopril 10mg daily
Pravachol 40mg HS
Gabapentin 600mg [**Hospital1 **]
Cymbalta 60mg QAM
Fish Oil 1200mg [**Hospital1 **]
Glucosamine Chondroitin 500mg [**Hospital1 **]
Omeprazole 20mg daily
Metformin 500mg daily
Cialia 20mg PRN

ALLERGIES: bee stings

PHYSICAL EXAM: On Admission
Pulse: 56 Resp:23  O2 sat: 93
B/P  133/81
Height:  5'8"   Weight:220 lbs

FAMILY HISTORY: brother w CAD s/p stenting in 40s, died of bladder
CA in 60s

SOCIAL HISTORY: Race:Caucasian
Last Dental Exam: 6 weeks ago, no infections at that time
Lives with:girlfriend (pt is divorced)
Occupation:barber
Tobacco:20 pack year history, quit 1 wk ago
ETOH:[**12-22**] drinks per week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Other and unspecified hyperlipidemia,Obesity, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Esophageal reflux,Other and unspecified angina pectoris,Obstructive sleep apnea (adult)(pediatric)'}
