CHIEF COMPLAINT: fatigue, weakness, dyspnea on exertion

PRESENT ILLNESS: 56 year old male with known coronary artery disease status post
stents to right coronary artery and left anteriopr descending
artery who now has complaints of fatigue and weakness. Several
weeks ago he presented to [**Hospital **] Hospital with complaints of
chest pain, ruled out for myocardial infarction, and was sent
home for outpatient stress test which was abnormal. He presented
on [**9-7**] for cardiac catheterization which revealed three vessel
coronary artery disease. Now presents for surgical
revascularization.

MEDICAL HISTORY: Coronary Artery Disease s/p Cypher stents to RCA and LAD [**2164-5-31**],
s/p LAD stent in [**2165**]
Hypertension
Hyperlipidemia
COPD
Chronic cough/bronchitis
Bipolar disease
Diverticulitis
Recent "spot on liver"-found on imaging study for abdominal pain

MEDICATION ON ADMISSION: Albuterol 90mcg inhaler-2 puffs PRN
Plavix 75mg po daily
Diltiazem 120mg po q12 hrs
Advair Diskus 1 puff IH [**Hospital1 **]
Furosemide 20mg po daily
Atrovent 2 puffs IH four times a day
Risperidone 2mg po qHS
Sertraline 200mg po qHS
Simvastatin 80mg po daily
MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:83  Resp:16  O2 sat: 100%RA
B/P  Right:130/83    Left: 151/94
Height: 5'7"    Weight:260 lbs

FAMILY HISTORY: Father died of MI age 59

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: many years
Lives with: wife
Occupation: On disability
Tobacco: 1ppd x45 years
ETOH: Rare
Recreational drugs: Marijuana daily
Coronary atherosclerosis of native coronary artery,Acidosis,Other and unspecified angina pectoris,Obstructive chronic bronchitis without exacerbation,Obesity, unspecified,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Obstructive sleep apnea (adult)(pediatric),Bipolar disorder, unspecified,Other and unspecified hyperlipidemia
Crnry athrscl natve vssl,Acidosis,Angina pectoris NEC/NOS,Obst chr bronc w/o exac,Obesity NOS,Hypertension NOS,Status-post ptca,Fam hx-ischem heart dis,Obstructive sleep apnea,Bipolar disorder NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2167-9-15**]              Discharge Date:   [**2167-9-22**]

Date of Birth:  [**2111-3-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
fatigue, weakness, dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2167-9-15**] Coronary artery bypass grafting x3 with left internal
mammary artery to left anterior descending artery and reverse
saphenous vein grafts to the posterior left ventricular branch
artery and the obtuse marginal artery

History of Present Illness:
56 year old male with known coronary artery disease status post
stents to right coronary artery and left anteriopr descending
artery who now has complaints of fatigue and weakness. Several
weeks ago he presented to [**Hospital **] Hospital with complaints of
chest pain, ruled out for myocardial infarction, and was sent
home for outpatient stress test which was abnormal. He presented
on [**9-7**] for cardiac catheterization which revealed three vessel
coronary artery disease. Now presents for surgical
revascularization.

Past Medical History:
Coronary Artery Disease s/p Cypher stents to RCA and LAD [**2164-5-31**],
s/p LAD stent in [**2165**]
Hypertension
Hyperlipidemia
COPD
Chronic cough/bronchitis
Bipolar disease
Diverticulitis
Recent "spot on liver"-found on imaging study for abdominal pain

***Episodes of epistaxis. Stopped ASA but continued plavix and
epistaxis stopped.
[**2137**] left ankle bullet wound injury, s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
s/p tonsillectomy
ear surgery as child

Social History:
Race: Caucasian
Last Dental Exam: many years
Lives with: wife
Occupation: On disability
Tobacco: 1ppd x45 years
ETOH: Rare
Recreational drugs: Marijuana daily

Family History:
Father died of MI age 59

Physical Exam:
Pulse:83  Resp:16  O2 sat: 100%RA
B/P  Right:130/83    Left: 151/94
Height: 5'7"    Weight:260 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 +2 Varicosities:
None [x]
Neuro: Grossly intact
Pulses:
Femoral      Right: dressing  Left: +2
DP           Right: +1  Left: +1
PT           [**Name (NI) 167**]: +1  Left: +1
Radial       Right: +2  Left: +2

Carotid Bruit        Right:  0  Left:0

Pertinent Results:
[**9-15**] Echo: PRE BYPASS The left atrium is moderately dilated. The
left atrium is elongated. Mild spontaneous echo contrast is seen
in the body of the left atrium.. No thrombus is seen in the body
of the left atrium/left atrial appendage or the body of the
right atrium/right atrial appendage. The left atrial appendage
emptying velocity is depressed (<0.2m/s). No atrial septal
defect is seen by 2D or color Doppler. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. There is moderate global left ventricular hypokinesis.
In addition, the distal lateral, anterolateral, and anterior
walls seem more hypokinetic than the other segments. The overall
ejection fraction is about 35%. The right ventricle displays
borderline normal free wall function. The aortic root is mildly
dilated at the sinus level. There are simple atheroma in the
aortic arch. There are simple atheroma in the descending
thoracic aorta. 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. Trivial mitral regurgitation is seen. There is no
pericardial effusion. Dr. [**Last Name (STitle) **] was notified in person of the
results in the operating room at the time of the study.
POSTBYPASS The patient is atrially paced on a phenylephrine
infusion. Global left ventricular function is now slightly
improved (overall ejection fracture about 40-45%) although
global left ventricular hypokinesis persists. The distal
lateral, anterolateral, and anterior walls continue to be more
hypokinetic than the other segments. Valvular function is
essentially unchanged. Thoracic aorta is unchanged after
decannulation.

Brief Hospital Course:
Mr. [**Known lastname 73256**] was a same day admit after undergoing his cardiac
cath and pre-admission testing during previous hospital visit.
On [**9-15**] he was brought directly to the operating room where he
underwent a coronary artery bypass graft x 3. Please see
operative report for surgical details. Following surgery he was
transferred to the CVICU for invasive monitoring. Within 24
hours he was weaned from sedation, awoke neurologically intact
and extubated. On post-op day one his chest tubes were removed
and he was transferred to the telemetry floor for further care.
Beta blockers and diuretics were started and he was diuresed
towards his pre-op weight. The patient was evaluated by the
physical therapy service for assistance with strength and
mobility.  By the time of discharge on POD 7 the patient was
ambulating freely, the wound was healing well and his pain was
controlled with oral analgesics.  The patient was discharged to
home in good condition with appropriate follow up instructions.

Medications on Admission:
Albuterol 90mcg inhaler-2 puffs PRN
Plavix 75mg po daily
Diltiazem 120mg po q12 hrs
Advair Diskus 1 puff IH [**Hospital1 **]
Furosemide 20mg po daily
Atrovent 2 puffs IH four times a day
Risperidone 2mg po qHS
Sertraline 200mg po qHS
Simvastatin 80mg po daily
MVI

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:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Zocor 80 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*2*
5. Risperidone 2 mg Tablet Sig: One (1) Tablet PO at bedtime.
Disp:*30 Tablet(s)* Refills:*2*
6. Zoloft 100 mg Tablet Sig: Two (2) Tablet PO at bedtime.
Disp:*60 Tablet(s)* Refills:*2*
7. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
1 puff Disk with Device Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 Disk with Device(s)* Refills:*2*
9. Atrovent HFA 17 mcg/Actuation HFA Aerosol Inhaler Sig: Two
(2) Puffs Inhalation four times a day.
Disp:*1 MDI* Refills:*2*
10. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puffs Inhalation four times a day as needed for
shortness of breath or wheezing.
Disp:*1 MDI* Refills:*2*
11. Lasix 20 mg Tablet Sig: Take 2 tabs daily for 7 days, then
decrease dose to 20mg daily.  Tablet PO QAM: Take 2 tablets
(40mg) daily with 20mEq potassium for 7 days, then decrease dose
to 20mg daily without potassium supplement.
Disp:*30 Tablet(s)* Refills:*2*
12. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO QAM for 7 days:
Take for 7 days with lasix and then stop.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] VNA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary artery bypass graft x 3
Past medical history:
Hypertension
Hyperlipidemia
s/p Cypher stents to RCA and LAD [**2164-5-31**], s/p LAD stent in [**2165**]
COPD
Chronic cough/bronchitis
Bipolar disease
Diverticulitis
Recent "spot on liver"-found on imaging study for abdominal pain

***Episodes of epistaxis. Stopped ASA but continued plavix and
epistaxis stopped.
[**2137**] left ankle bullet wound injury, s/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
s/p tonsillectomy
ear surgery as child

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with percocet prn

Incisions:
Sternal - healing well, no erythema or drainage. No instability.

Leg Right/Left - healing well, no erythema or drainage.
Edema 1+ bilaterally


Discharge Instructions:
1. 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
2. Please NO lotions, cream, powder, or ointments to incisions
3. Each morning you should weigh yourself and then in the
evening take your temperature, these should be written down on
the chart
4. No driving for approximately one month until follow up with
surgeon
5. No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
6. Take lasix 40mg (2 - 20mg tablets) once daily in the morning
for 1 week, then decrease dose to 1 tablet (20mg) daily
thereafter as per prior to surgery. You will take a potassium
supplement 20mEq daily with your lasix dose of 40mg for for 1
week and then stop.
7. Please call with any questions or concerns.
**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) **] on Wednesday [**2167-10-14**] at 1:00PM

Please call to schedule appointments with your

Primary Care Dr. [**First Name8 (NamePattern2) 73257**] [**Name (STitle) 19772**] in [**1-31**] weeks [**Telephone/Fax (1) 8506**]
Cardiologist Dr. [**First Name8 (NamePattern2) 20069**] [**Last Name (NamePattern1) **] in [**1-31**] 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:[**2167-9-22**]
{'Coronary atherosclerosis of native coronary artery,Acidosis,Other and unspecified angina pectoris,Obstructive chronic bronchitis without exacerbation,Obesity, unspecified,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Obstructive sleep apnea (adult)(pediatric),Bipolar disorder, unspecified,Other and unspecified hyperlipidemia'}


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: fatigue, weakness, dyspnea on exertion

PRESENT ILLNESS: 56 year old male with known coronary artery disease status post
stents to right coronary artery and left anteriopr descending
artery who now has complaints of fatigue and weakness. Several
weeks ago he presented to [**Hospital **] Hospital with complaints of
chest pain, ruled out for myocardial infarction, and was sent
home for outpatient stress test which was abnormal. He presented
on [**9-7**] for cardiac catheterization which revealed three vessel
coronary artery disease. Now presents for surgical
revascularization.

MEDICAL HISTORY: Coronary Artery Disease s/p Cypher stents to RCA and LAD [**2164-5-31**],
s/p LAD stent in [**2165**]
Hypertension
Hyperlipidemia
COPD
Chronic cough/bronchitis
Bipolar disease
Diverticulitis
Recent "spot on liver"-found on imaging study for abdominal pain

MEDICATION ON ADMISSION: Albuterol 90mcg inhaler-2 puffs PRN
Plavix 75mg po daily
Diltiazem 120mg po q12 hrs
Advair Diskus 1 puff IH [**Hospital1 **]
Furosemide 20mg po daily
Atrovent 2 puffs IH four times a day
Risperidone 2mg po qHS
Sertraline 200mg po qHS
Simvastatin 80mg po daily
MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pulse:83  Resp:16  O2 sat: 100%RA
B/P  Right:130/83    Left: 151/94
Height: 5'7"    Weight:260 lbs

FAMILY HISTORY: Father died of MI age 59

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: many years
Lives with: wife
Occupation: On disability
Tobacco: 1ppd x45 years
ETOH: Rare
Recreational drugs: Marijuana daily 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acidosis,Other and unspecified angina pectoris,Obstructive chronic bronchitis without exacerbation,Obesity, unspecified,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Family history of ischemic heart disease,Obstructive sleep apnea (adult)(pediatric),Bipolar disorder, unspecified,Other and unspecified hyperlipidemia'}
