CHIEF COMPLAINT: Dizziness and weakness

PRESENT ILLNESS: This is a 73 year old male who has a history of multiple strokes
in the past, last in '[**75**] with minor defecit of left leg
weakness, DMII, hypercholesterolemia, and hypertension presents
to outside hospital reporting generalized weakness, inability to
ambulate with his cane due to fatigue, and a near syncopal
episode.He ruled in for NSTEMI and radiographic evidence of
heart failure. He was found to have acute anemia and transfused
packed red blood cells. He was admitted to the OSH ICU and later
was cathed. Cardiac cath revealed 3 vessel disease. He was
transferred to [**Hospital1 18**] for cardiac surgical evaluation of coronary
artery revascularization.

MEDICAL HISTORY: - History of CVA x 3 - last '[**75**] with (L)LE weakness
- Type II Diabetes Mellitus
- Hypertension
- Dyslipidemia

MEDICATION ON ADMISSION: Aggrenox 25/200(2), Metformin 1000(2), HCTZ 25(1), Quinipril
40(1), Glipizide 5(2), Clorazepate 7.5(1), Lipitor 20(1),
Atenolol 50(1)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Preop Exam:

FAMILY HISTORY: Father died at 57yo of heart failure. Mother died at 86 yo-"old
age". He has two brothers, both living - 1 with history of MI,
the other has high blood pressure.

SOCIAL HISTORY: Lives with: wife, has 5 children.
Occupation: Construction company owner
Tobacco: denies
ETOH: denies
Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified
Subendo infarct, initial,Urin tract infection NOS,CHF NOS,Crnry athrscl natve vssl,Vascular dementia,uncomp,Cerebral atherosclerosis,Late effect CV dis NEC,Muscskel sympt limb NEC,DMII wo cmp nt st uncntr,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Anemia NOS
Admission Date:  [**2177-8-7**]              Discharge Date:   [**2177-8-18**]

Date of Birth:  [**2103-11-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dizziness and weakness

Major Surgical or Invasive Procedure:
[**2177-8-12**] Urgent Four Vessel Coronary Artery Bypass Grafting(left
internal mammary artery to left anterior descending artery, with
vein grafts to ramus, obtuse marginal and posterior descending
artery)


History of Present Illness:
This is a 73 year old male who has a history of multiple strokes
in the past, last in '[**75**] with minor defecit of left leg
weakness, DMII, hypercholesterolemia, and hypertension presents
to outside hospital reporting generalized weakness, inability to
ambulate with his cane due to fatigue, and a near syncopal
episode.He ruled in for NSTEMI and radiographic evidence of
heart failure. He was found to have acute anemia and transfused
packed red blood cells. He was admitted to the OSH ICU and later
was cathed. Cardiac cath revealed 3 vessel disease. He was
transferred to [**Hospital1 18**] for cardiac surgical evaluation of coronary
artery revascularization.


Past Medical History:
- History of CVA x 3 - last '[**75**] with (L)LE weakness
- Type II Diabetes Mellitus
- Hypertension
- Dyslipidemia

Social History:
Lives with: wife, has 5 children.
Occupation: Construction company owner
Tobacco: denies
ETOH: denies

Family History:
Father died at 57yo of heart failure. Mother died at 86 yo-"old
age". He has two brothers, both living - 1 with history of MI,
the other has high blood pressure.


Physical Exam:
Preop Exam:

BP  Right:128/75   Pulse:80 Resp:18  O2 sat: 99% on RA
General: Elderly male in no acute distress
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR []  Irregular [x]  Murmur 2/6 SEM
Abd: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+[x]
Extremities: Warm [x], well-perfused [x]  Edema - trace
Varicosities: None
None[x]
Neuro: Grossly intact
Pulses:
Femoral      Right: 2+  Left:2+
DP           Right: 2+  Left:2+
PT           [**Name (NI) 167**]:2+   Left:2+
Radial       Right: 2+  Left:2+

Carotid Bruit        Right: none   Left:none


Pertinent Results:
[**2177-8-7**] WBC-11.6* RBC-3.67* Hgb-11.6* Hct-33.9*  Plt Ct-252
[**2177-8-7**] PT-12.9 PTT-23.4 INR(PT)-1.1
[**2177-8-7**] Glucose-289* UreaN-48* Creat-1.8* Na-138 K-3.9 Cl-98
HCO3-27
[**2177-8-7**] ALT-24 AST-54* LD(LDH)-432* AlkPhos-109 Amylase-89
TotBili-1.0
[**2177-8-7**] %HbA1c-6.8* eAG-148*
[**2177-8-8**] Echocardiogram:
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy with normal cavity size. There is
moderate regional left ventricular systolic dysfunction with
near akinesis of the distal half of the anterior septum and
anterior walls, distal inferior wall, and apex. The remaining
segments contract normally (LVEF = 35 %).There is an apical left
ventricular aneurysm. Mild spontaneous echo contrast but no
masses or thrombi are seen in the left ventricular apex. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. Mild to moderate
([**2-8**]+) mitral regurgitation is seen. The pulmonary artery
systolic pressure could not be determined. There is no
pericardial effusion.

[**2177-8-8**] Head CT Scan:
There is no evidence of acute major vascular territorial
infarct. There is no intra- or extra-axial hemorrhage, obvious
masses, mass effect, or shift of normally midline structures.
Moderate atrophy is seen causing prominence of ventricles and
sulci. Osseous and soft tissue structures are unremarkable.
IMPRESSION: 1. No acute intracranial pathology.  2. Left
parieto-occipital hypoattenuation likely from old infarct. 3.
Chronic small vessel ischemic disease, and moderately severe
atrophy.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted with NSTEMI and congestive heart
failure. Given recent Plavix, surgery was delayed and he
underwent extensive preoperative evaluation. He remained pain
free on intravenous Heparin. Preoperative antibiotics were given
for a positive urinalysis. Head CT scan showed no acute
pathology. Neurology evaluation was consistent with dementia,
most likely multiple infarct dementia. He was cleared for
surgery by the Neurology service but remained high risk for
stroke based on his risk factors and previous history of
strokes. After extensive evaluation, his family agreed and gave
surgical consent to proceed with surgical revascularization. The
remainder of his preoperative course was uneventful.

On [**8-12**], Dr. [**Last Name (STitle) **] performed urgent coronary artery bypass
grafting surgery. See operative note for details. Following
surgery, he was brought to the CVICU for invasive monitoring.
Within 24 hours, he awoke neurologically intact and was
extubated without incident. Given dementia, narcotics were
avoided. He otherwise maintained stable hemodynamics and
transferred to the SDU on postopertive day one.

Blood glucoses were initially elevated, but came under better
control on resuming home doses of metformin and glipizide, in
addition to Lantus and sliding scale insulin.  Lantus was
discontinued upon discharge.
BUN and Creatinine rose and were monitored closely. creatinine
peaked at 1.9 with baseline of 1.5.  Foley was maintained to
closely monitor urine output.  When the foley was removed, he
failed a void trial, despite a bladder scan for 800cc, foley was
replaced and Flomax was started.  he will need a repaet voding
trial at rehab.

The patient was evaluated by the physical therapy service for
assistance with strength and mobility and rehab was recommended
prior to return to home.

 By the time of discharge on POD #6 the patient was ambulating
with assistance, the wound was healing and pain was controlled
with oral analgesics.  The patient was discharged to [**Hospital **]
rehab in [**Location (un) 701**] in good condition with appropriate follow up
instructions.

Medications on Admission:
Aggrenox 25/200(2), Metformin 1000(2), HCTZ 25(1), Quinipril
40(1), Glipizide 5(2), Clorazepate 7.5(1), Lipitor 20(1),
Atenolol 50(1)


Discharge Medications:
1. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
2. Glipizide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
4. Dipyridamole-Aspirin 200-25 mg Cap, Multiphasic Release 12 hr
Sig: One (1) Cap PO BID (2 times a day).
5. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 10 days: or until at pre-op weight 169#'s.
10. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain/temp.
11. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
12. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
13. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours) for 10 days: while on lasix.


Discharge Disposition:
Extended Care

Facility:
[**Location (un) **] of [**Location (un) **]

Discharge Diagnosis:
Coronary Artery Disease, s/p CABG
NSTEMI
Congestive Heart Failure
Cerebrovascular Disease
Dementia
Hypertension
Dyslipidemia
Type II Diabetes Mellitus
Preoperative Urinary Tract Infection
Atrial Fibrillation


Discharge Condition:
Alert and oriented x1-2 nonfocal
Ambulating with assistance

Incisional pain managed with oral analgesics

Incisions:
Sternal - healing well, no erythema or drainage
Leg /Left - healing well, no erythema or drainage. Edema -trace


Discharge Instructions:
Please 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

Please 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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks

Repeat voiding trial in next one or two days.

Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**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:
Dr. [**Last Name (STitle) **] on [**2177-9-18**] @ 1PM
PCP: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 85044**] in [**2-8**] weeks, call for appt
Cardiologist: Dr. [**Last Name (STitle) **] in [**2-8**] weeks, call for appt



Completed by:[**2177-8-22**]
{'Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, 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: Dizziness and weakness

PRESENT ILLNESS: This is a 73 year old male who has a history of multiple strokes
in the past, last in '[**75**] with minor defecit of left leg
weakness, DMII, hypercholesterolemia, and hypertension presents
to outside hospital reporting generalized weakness, inability to
ambulate with his cane due to fatigue, and a near syncopal
episode.He ruled in for NSTEMI and radiographic evidence of
heart failure. He was found to have acute anemia and transfused
packed red blood cells. He was admitted to the OSH ICU and later
was cathed. Cardiac cath revealed 3 vessel disease. He was
transferred to [**Hospital1 18**] for cardiac surgical evaluation of coronary
artery revascularization.

MEDICAL HISTORY: - History of CVA x 3 - last '[**75**] with (L)LE weakness
- Type II Diabetes Mellitus
- Hypertension
- Dyslipidemia

MEDICATION ON ADMISSION: Aggrenox 25/200(2), Metformin 1000(2), HCTZ 25(1), Quinipril
40(1), Glipizide 5(2), Clorazepate 7.5(1), Lipitor 20(1),
Atenolol 50(1)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Preop Exam:

FAMILY HISTORY: Father died at 57yo of heart failure. Mother died at 86 yo-"old
age". He has two brothers, both living - 1 with history of MI,
the other has high blood pressure.

SOCIAL HISTORY: Lives with: wife, has 5 children.
Occupation: Construction company owner
Tobacco: denies
ETOH: denies 

### Response:
{'Subendocardial infarction, initial episode of care,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified'}
