CHIEF COMPLAINT: DOE

PRESENT ILLNESS: 82 y/o male with doe and +ETT. He was referred for a cardiac
cath which revealed severe coronary artery disease. He was thus
referred for surgical revascularization.

MEDICAL HISTORY: CAD
Hyperlipidemia
HTN
AF
MR
[**First Name (Titles) 21593**]
[**Last Name (Titles) 74596**] degeneration
[**Last Name (Titles) 74597**]
PTSD

MEDICATION ON ADMISSION: Toprol XL 100'
Zocor 20'
Coumadin
Proscar 5'
Terazosin 10'
Cosopt
Aplhagan

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 70 af    bp: 150/90
Gen: Pleasant elderly man in NAD
SKIN: Mild bruising
HEENT: NCAT, PERRL, Anicteric sclera, OP benign. No cartoid
bruit
LUNGS:CTA
HEART: Irreg, ireeg, no M/R/G
ABD: Benign
EXT: Warm, well perfused, no edema. No Varicosities. Pulses [**11-15**]+
NEURO: Nonfocal

FAMILY HISTORY: None noted

SOCIAL HISTORY: Sales who lives with his wife. Quit smoking cigars 30 years ago.
Drinks 1 glass of wine daily.
Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Atrial fibrillation,Retention of urine, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified glaucoma,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Anemia, unspecified,Cardiomegaly
Crnry athrscl natve vssl,Mitral valve disorder,Atrial fibrillation,Retention urine NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Glaucoma NOS,BPH NOS w/o ur obs/LUTS,Anemia NOS,Cardiomegaly
Name:  [**Known lastname 12291**],[**Known firstname **]                  Unit No:   [**Numeric Identifier 12292**]

Admission Date:  [**2141-8-7**]              Discharge Date:   [**2141-8-11**]

Date of Birth:  [**2059-5-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1543**]
Addendum:
Pt. was also sent on Coumadon 5 mg PO daily for INR goal of
[**12-16**].5.  Pt. will have INR daily until INR goal is reached.

Discharge Disposition:
Extended Care

Facility:
mapleleaf

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2141-8-11**]

Admission Date:  [**2141-8-7**]              Discharge Date:   [**2141-8-11**]

Date of Birth:  [**2059-5-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
DOE

Major Surgical or Invasive Procedure:
[**2141-8-7**] - CABGx3 (left internal mammary artery to the left
anterior descending coronary artery; reverse saphenous vein
single graft from aorta to the first obtuse marginal coronary
artery; reverse saphenous
vein single graft from the aorta to the posterior). Left atrial
appendage ligation.


History of Present Illness:
82 y/o male with doe and +ETT. He was referred for a cardiac
cath which revealed severe coronary artery disease. He was thus
referred for surgical revascularization.

Past Medical History:
CAD
Hyperlipidemia
HTN
AF
MR
[**First Name (Titles) 21593**]
[**Last Name (Titles) 74596**] degeneration
[**Last Name (Titles) 74597**]
PTSD

Social History:
Sales who lives with his wife. Quit smoking cigars 30 years ago.
Drinks 1 glass of wine daily.

Family History:
None noted

Physical Exam:
70 af    bp: 150/90
Gen: Pleasant elderly man in NAD
SKIN: Mild bruising
HEENT: NCAT, PERRL, Anicteric sclera, OP benign. No cartoid
bruit
LUNGS:CTA
HEART: Irreg, ireeg, no M/R/G
ABD: Benign
EXT: Warm, well perfused, no edema. No Varicosities. Pulses [**11-15**]+
NEURO: Nonfocal

Pertinent Results:
[**2141-8-7**] ECHO
PRE-BYPASS:
1. The left atrium is markedly dilated. Mild spontaneous echo
contrast is seen in the body of the left atrium. The left atrial
appendage emptying velocity is depressed (<0.2m/s). No thrombus
is seen in the left atrial appendage. No atrial septal defect is
seen by 2D or color Doppler. The coronary sinus is dilated
(diameter >15mm).
2. Left ventricular wall thicknesses and cavity size are normal.
Overall left ventricular systolic function is normal (LVEF>55%).

3. Right ventricular chamber size and free wall motion are
normal.
4. There are simple atheroma in the aortic arch. The descending
thoracic aorta is mildly dilated. There are simple atheroma in
the descending thoracic aorta.
5. There are three aortic valve leaflets. There is no aortic
valve stenosis. Mild aortic regurgitation is seen.
6. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral central regurgitation is seen.
7. There is no pericardial effusion.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine and AV
pacing.
1. LV systolic function is improved.
2. RV function is mildly depressed
3. MR [**First Name (Titles) **] [**Last Name (Titles) 1506**]
4. Aorta is intact post decannulation
5. Other findings are [**Last Name (Titles) 1506**]

[**2141-8-8**] CXR
In comparison with the study of [**8-7**], there has been removal of
the endotracheal and nasogastric tubes. The Swan-Ganz catheter
appears to be pulled back to the right atrium. Enlargement of
the cardiac silhouette persists with minimal fullness of the
pulmonary vessels. Increased opacification is again seen in the
retrocardiac area with a thick band of atelectatic change
adjacent.

[**2141-8-10**] 09:35AM BLOOD WBC-15.7* RBC-3.51* Hgb-11.2* Hct-32.0*
MCV-91 MCH-32.0 MCHC-35.1* RDW-13.8 Plt Ct-221
[**2141-8-10**] 09:35AM BLOOD PT-13.5* PTT-30.1 INR(PT)-1.2*
[**2141-8-10**] 09:35AM BLOOD Glucose-130* UreaN-23* Creat-0.9 Na-134
K-4.5 Cl-98 HCO3-28 AnGap-13

Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2141-8-7**] for surgical
management of his coronary artery disease. He was taken to the
operating room where he underwent coronary artery bypass
grafting to three vessels and a left atrial appendage ligation.
Postoperatively he was taken to the cardiac surgical intensive
care unit for monitoring. By postoperative day one, Mr. [**Known lastname **]
had awoken neurologically intact and had been extubated. His
pressors were slowly weaned. Later on postoperative day one, he
was transferred to the step down unit for further recovery. He
was gently diuresed towards his preoperative weight. The
physical therapy service was consulted for assistance with his
postoperative strength and mobility. His foley was replaced for
urinary retention. His foley was d/c'd and he voided well.  He
was discharged to rehab in stable condition on POD#4.

Medications on Admission:
Toprol XL 100'
Zocor 20'
Coumadin
Proscar 5'
Terazosin 10'
Cosopt
Aplhagan

Discharge Medications:
1. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 5 days.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Dorzolamide-Timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
7. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q12H
(every 12 hours).
8. Proscar 5 mg Tablet Sig: One (1) Tablet PO once a day.
9. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed.
11. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.


Discharge Disposition:
Extended Care

Facility:
mapleleaf

Discharge Diagnosis:
CAD s/p CABG
AF
Hyperlipidemia
MR
[**First Name (Titles) 21593**]
[**Last Name (Titles) **]
[**Last Name (Titles) 74596**] degeneration
PTSD


Discharge Condition:
Stable


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Gently pat the wound
dry.  Please shower daily.  No bathing or swimming for 1 month.
Use sunscreen on incision if exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) 914**] in 1 month ([**Telephone/Fax (1) 1504**]
Follow-up with Dr. [**Last Name (STitle) 39975**] in [**11-15**] weeks.
Follow-up with [**Doctor Last Name **] in 2 weeks.  [**Telephone/Fax (1) 74598**]
Please call all providers for appointments.



Completed by:[**2141-8-11**]
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Atrial fibrillation,Retention of urine, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified glaucoma,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Anemia, unspecified,Cardiomegaly'}


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: DOE

PRESENT ILLNESS: 82 y/o male with doe and +ETT. He was referred for a cardiac
cath which revealed severe coronary artery disease. He was thus
referred for surgical revascularization.

MEDICAL HISTORY: CAD
Hyperlipidemia
HTN
AF
MR
[**First Name (Titles) 21593**]
[**Last Name (Titles) 74596**] degeneration
[**Last Name (Titles) 74597**]
PTSD

MEDICATION ON ADMISSION: Toprol XL 100'
Zocor 20'
Coumadin
Proscar 5'
Terazosin 10'
Cosopt
Aplhagan

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 70 af    bp: 150/90
Gen: Pleasant elderly man in NAD
SKIN: Mild bruising
HEENT: NCAT, PERRL, Anicteric sclera, OP benign. No cartoid
bruit
LUNGS:CTA
HEART: Irreg, ireeg, no M/R/G
ABD: Benign
EXT: Warm, well perfused, no edema. No Varicosities. Pulses [**11-15**]+
NEURO: Nonfocal

FAMILY HISTORY: None noted

SOCIAL HISTORY: Sales who lives with his wife. Quit smoking cigars 30 years ago.
Drinks 1 glass of wine daily. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Atrial fibrillation,Retention of urine, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified glaucoma,Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS),Anemia, unspecified,Cardiomegaly'}
