CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 67 year old female with dyspnea on exertion and abnormal stress
test referred for cardiac catheterization. Cath showed severe
3vCAD and now asked to
evaluate for surgical revascularization.

MEDICAL HISTORY: Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing

MEDICATION ON ADMISSION: Furosemide 20 mg Tablet daily as needed
Insulin Glargine [Lantus] 100 unit/mL Cartridge 12 Units twice a
day
nr Insulin Lispro [Humalog] 100 unit/mL Cartridge 10 Units in
am,
13  units at lunch, and 12 Units at supper
Isosorbide Mononitrate 60 mg daily
Levothyroxine 200 mcg daily
Lisinopril 40 mg daily
Metoprolol Succinate 50 mg daily
Simvastatin 20 mg daily
Aspirin 81 mg daily, chewable

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 77   Resp:  20   O2 sat: 97 on RA
B/P  159/72
Height: 5'3"     Weight: 185 lbs

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Occupation: Retired from BJ Wholesalers
Lives with: daughter; pt is divorced and has 3 grown daughters
[**Name (NI) 1139**]: quit [**11-30**], 1ppd x >30yrs
ETOH: Rare
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Osteoporosis, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Pleural effusion NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Osteoporosis NOS
Admission Date:  [**2145-8-17**]              Discharge Date:   [**2145-8-26**]

Date of Birth:  [**2078-1-1**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2145-8-17**] Coronary artery bypass grafting x4: Left internal
mammary artery grafted to left anterior descending, reverse
saphenous vein graft to the marginal branch, diagonal branch,
posterior descending artery

History of Present Illness:
67 year old female with dyspnea on exertion and abnormal stress
test referred for cardiac catheterization. Cath showed severe
3vCAD and now asked to
evaluate for surgical revascularization.

Past Medical History:
Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing

Social History:
Occupation: Retired from BJ Wholesalers
Lives with: daughter; pt is divorced and has 3 grown daughters
[**Name (NI) 1139**]: quit [**11-30**], 1ppd x >30yrs
ETOH: Rare

Family History:
Non-contributory

Physical Exam:
Pulse: 77   Resp:  20   O2 sat: 97 on RA
B/P  159/72
Height: 5'3"     Weight: 185 lbs

General: Obese female in no acute distress
Skin: Dry [x] intact [x] - well healed left knee scar
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 - trace
Varicosities: None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right: 1+   Left: 1+
DP/PT           [**Name (NI) 167**]: decreased  Left: decreased
Radial       Right: 2  Left: 2

Carotid Bruit        Right: ++   Left: none

Pertinent Results:
[**2145-8-17**] Echo: Pre-bypass: No mass/thrombus is seen in the left
atrium or left atrial appendage. No atrial septal defect is seen
by 2D or color Doppler. Left ventricular wall thicknesses are
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. There are simple atheroma in the descending thoracic
aorta. The aortic valve leaflets (3) are mildly thickened. There
is mild aortic valve stenosis (valve area 1.2-1.9cm2). No aortic
regurgitation is seen. Mild (1+) mitral regurgitation is seen.
There is no pericardial effusion. Post-bypass: The patient is
not receiving any inotropic support post-bypass. All findings
are consistent with pre-bypass findings. Overall left
ventricular systolic function remains normal. The aorta is
intact post-decannulation. All findings communicated with
surgeon.

Labs:
[**2145-8-21**] WBC-12.0* RBC-3.37* Hgb-8.3* Hct-27.2 Plt Ct-307
[**2145-8-20**] WBC-15.1* RBC-3.44* Hgb-8.3* Hct-27.1* Plt Ct-285
[**2145-8-17**] WBC-16.0*# RBC-3.85* Hgb-9.4* Hct-29.5* Plt Ct-283
[**2145-8-22**] Glucose-56* UreaN-17 Creat-0.4 Na-148* K-3.9 Cl-110*
HCO3-33*
[**2145-8-19**] Glucose-205* UreaN-19 Creat-0.7 Na-146* K-3.4 Cl-108
HCO3-27
[**2145-8-18**] Glucose-140* UreaN-11 Creat-0.5 Na-144 K-4.3 Cl-116*
HCO3-21*
[**2145-8-19**] ALT-10 AST-22 LD(LDH)-253* AlkPhos-70 Amylase-23
TotBili-0.3

Cultures: C. diff negative, Urine culture negative, Blood
cultures negative to date

CXR: [**2145-8-19**] New partial atelectasis of the left lower lobe is
noted. Left chest tube and mediastinal tube have been removed.
New moderate left pleural effusion and small left apical
pneumothorax are visualized. Linear atelectasis of the right
lung, and small right effusion are new.



Brief Hospital Course:
She was admitted same day surgery and was brought to the
operating room.  She underwent coronary artery bypass graft
surgery.  See operative report for further details.  She
received cefazolin for perioperative antibiotics.  Post
operatively she was transferred to the intensive care unit for
hemodynamic managment.  In the first twenty four hours she was
weaned from sedation, awoke, and was extubated without
complications.  Her narcotic pain medications were discontinued
due to disorientation.  She continued to progress slowly,
physical therapy worked with her on strength and mobility.  Her
foley was reinserted for failure to void however it was removed
[**8-22**] and she voided without difficulty.  Her synthroid was
stopped [**8-20**] due to low TSH level, level was rechecked, along
with T3 and T4 levels.  Her insulin was adjusted and she had
episodes hypoglycemia and hyperglycemia, [**Last Name (un) 387**] was consulted
for blood glucose management and thyroid levels.  They
recommended resuming her synthroid and rechecking a level in 6
weeks. She was noted to have a small amount of serous drainage
and two pin hole openings at the distal aspect of her sternal
incision. she was treated with IV cefazolin and dressing
changes. She reamined afebrile with a normal WBC. Sternal
incision with distal 1 inch area with incision not approximated
and fibrinoous tissue mild erythema.  On post operative day nine
to rehab with plan for follow up wound check [**2145-8-31**].


Medications on Admission:
Furosemide 20 mg Tablet daily as needed
Insulin Glargine [Lantus] 100 unit/mL Cartridge 12 Units twice a
day
nr Insulin Lispro [Humalog] 100 unit/mL Cartridge 10 Units in
am,
13  units at lunch, and 12 Units at supper
Isosorbide Mononitrate 60 mg daily
Levothyroxine 200 mcg daily
Lisinopril 40 mg daily
Metoprolol Succinate 50 mg daily
Simvastatin 20 mg daily
Aspirin 81 mg daily, chewable

Discharge Medications:
1. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
2. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Levothyroxine 200 mcg Tablet Sig: One (1) Tablet PO once a
day.
6. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): will evaluate lasix at wound check follow up 9/8.
8. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
9. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours): call surgeon for fevers, change in wound [**Telephone/Fax (1) 170**].

10. Wound care
Midline sternal incision with distal end scant serous drainage,
small amount of erythema distal 1 inch open with fibrinous
tissues - wash daily with soap and water in shower then cover
with dry dressing and place bra on with bottom open to prevent
rubbung on distal incision - follow up with wound check tuesday
[**8-31**] at [**Hospital1 18**] [**Hospital Ward Name **] 6 [**Telephone/Fax (1) 170**] call if any questions or
concerns
11. Lantus 100 unit/mL Solution Sig: Twelve (12) units
Subcutaneous twice a day.
12. sliding scale insulin
Insulin SC Fixed Dose Orders
Breakfast Lunch Dinner Bedtime
Glargine      12  Units
Humalog      14  Units Humalog      14  Units Humalog      14
Units Glargine      12  Units
Insulin SC Sliding Scale
Breakfast   Lunch          Dinner       Bedtime



71-100   mg/dL 0   Units 0   Units 0   Units 0   Units
101-150   mg/dL 0   Units 0   Units 0   Units 0   Units
151-200   mg/dL 2   Units 2   Units 2   Units 2   Units
201-250   mg/dL 4   Units 4   Units 4   Units 4   Units
251-300   mg/dL 6   Units 6   Units 6   Units 6   Units
301-350   mg/dL 8   Units 8   Units 8   Units 8   Units
351-400   mg/dL 10   Units 10   Units 10   Units 10   Units

13. Humalog 100 unit/mL Solution Sig: Fourteen (14) units
Subcutaneous ac: to receive 14 units humalog and then additional
insulin based on BNG per sliding scale .


Discharge Disposition:
Extended Care

Facility:
TBA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft
Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing


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**]
Please check blood glucose Ac and HS and prn - goal BG < 150, on
sliding scale insulin and lantus

Followup Instructions:
Please call to schedule all apointments
Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) 5314**] in [**12-25**] weeks
Dr. [**Last Name (STitle) 5686**] in [**12-25**] weeks
Wound check Tuesday [**8-31**] on [**Hospital Ward Name **] 6 at 10 am with NP/PA
[**Telephone/Fax (1) 170**]
Needs repeat TSH 6 weeks after surgery.



Completed by:[**2145-8-26**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Osteoporosis, unspecified'}


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: Dyspnea on exertion

PRESENT ILLNESS: 67 year old female with dyspnea on exertion and abnormal stress
test referred for cardiac catheterization. Cath showed severe
3vCAD and now asked to
evaluate for surgical revascularization.

MEDICAL HISTORY: Diabetes mellitus type 2
Lower Extremity Neuropathy
Hypertension
Hyperlipidemia
Obesity
Osteoporosis
Arthritis
Hypothyroidism
Hard of Hearing

MEDICATION ON ADMISSION: Furosemide 20 mg Tablet daily as needed
Insulin Glargine [Lantus] 100 unit/mL Cartridge 12 Units twice a
day
nr Insulin Lispro [Humalog] 100 unit/mL Cartridge 10 Units in
am,
13  units at lunch, and 12 Units at supper
Isosorbide Mononitrate 60 mg daily
Levothyroxine 200 mcg daily
Lisinopril 40 mg daily
Metoprolol Succinate 50 mg daily
Simvastatin 20 mg daily
Aspirin 81 mg daily, chewable

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse: 77   Resp:  20   O2 sat: 97 on RA
B/P  159/72
Height: 5'3"     Weight: 185 lbs

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Occupation: Retired from BJ Wholesalers
Lives with: daughter; pt is divorced and has 3 grown daughters
[**Name (NI) 1139**]: quit [**11-30**], 1ppd x >30yrs
ETOH: Rare 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified pleural effusion,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Osteoporosis, unspecified'}
