CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: 3month history of shortness of breath and orthopnea. Evaluated
at [**Hospital **] hospital , cardiac cath revealed multi-vessel disease
with global hypokinesis and EF 48%.

MEDICAL HISTORY: CAD
HTN
COPD
DM2
OSA
Gout
CVA(R hemiplegia)
B arthroscopy knee
Scrotal Hernia repair

MEDICATION ON ADMISSION: Lisinopril 40'
Lasix 20'
Labetelol 300'''
Naprosyn 500"-prn
KCL 10'
Metformin
Probenecid 500'
Plavix 75'
Advair

ALLERGIES: Ciprofloxacin / Sulfa (Sulfonamides)

PHYSICAL EXAM: Admission:
VS T 9.1  HR 72  BP 147/71  RR 20  O2sat 93% 2LNP
Ht 75"  Wt 122K
Gen NAD
Neuro grossly intact
Pulm CTA bilat
CV RRR, no murmur
Abdm soft, NT/ND/+BS
Ext warm well perfused, no varicosities

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with wife
Retired [**Name (NI) **]
Remote tobacco-quit [**2141**]
Occasional wine w/dinner
Coronary atherosclerosis of native coronary artery,Acidosis,Systolic heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Obesity, unspecified,Unspecified essential hypertension,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation
Crnry athrscl natve vssl,Acidosis,Systolic hrt failure NOS,Chr airway obstruct NEC,Obesity NOS,Hypertension NOS,Gout NOS,DMII wo cmp nt st uncntr,Obstructive sleep apnea,Atrial fibrillation
Name:  [**Known lastname 12563**],[**Known firstname **] G                Unit No:   [**Numeric Identifier 12564**]

Admission Date:  [**2196-3-2**]              Discharge Date:   [**2196-3-8**]

Date of Birth:  [**2120-11-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ciprofloxacin / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 741**]
Addendum:
The pt. had a positive UA on day of discharge and was started on
Macrodantin for a 10 day course.

Pertinent Results:
[**2196-3-7**] 05:27AM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.017
[**2196-3-7**] 05:27AM URINE Blood-LG Nitrite-POS Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-SM
[**2196-3-7**] 05:27AM URINE RBC-0-2 WBC-[**11-17**]* Bacteri-MANY
Yeast-NONE Epi-0-2

Discharge Disposition:
Home With Service

Facility:
community vna, [**Location (un) **]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2196-3-7**]

Admission Date:  [**2196-3-2**]              Discharge Date:   [**2196-3-8**]

Date of Birth:  [**2120-11-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ciprofloxacin / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
Off Pump CABG x2(LIMA-LAD,SVG-OM)[**3-3**]


History of Present Illness:
3month history of shortness of breath and orthopnea. Evaluated
at [**Hospital **] hospital , cardiac cath revealed multi-vessel disease
with global hypokinesis and EF 48%.

Past Medical History:
CAD
HTN
COPD
DM2
OSA
Gout
CVA(R hemiplegia)
B arthroscopy knee
Scrotal Hernia repair

Social History:
Lives with wife
Retired [**Name (NI) **]
Remote tobacco-quit [**2141**]
Occasional wine w/dinner

Family History:
non-contributory

Physical Exam:
Admission:
VS T 9.1  HR 72  BP 147/71  RR 20  O2sat 93% 2LNP
Ht 75"  Wt 122K
Gen NAD
Neuro grossly intact
Pulm CTA bilat
CV RRR, no murmur
Abdm soft, NT/ND/+BS
Ext warm well perfused, no varicosities


Pertinent Results:
[**2196-3-7**] 05:25AM BLOOD WBC-10.3
[**2196-3-6**] 06:55AM BLOOD WBC-14.9* RBC-3.79* Hgb-10.2* Hct-31.9*
MCV-84 MCH-27.1 MCHC-32.1 RDW-14.1 Plt Ct-186
[**2196-3-5**] 03:02AM BLOOD PT-15.9* PTT-34.2 INR(PT)-1.4*
[**2196-3-4**] 04:00AM BLOOD PT-15.3* PTT-33.5 INR(PT)-1.4*
[**2196-3-6**] 06:55AM BLOOD Glucose-140* UreaN-30* Creat-1.0 Na-139
K-4.9 Cl-98 HCO3-34* AnGap-12

RADIOLOGY  Final Report
CHEST (PORTABLE AP)  [**2196-3-5**] 11:15 AM
CHEST (PORTABLE AP)
Reason: eval interval change
[**Hospital 93**] MEDICAL CONDITION:
75yoM s/p OPCABGx2(LIMA-LAD,SVG-OM)[**3-3**]
REASON FOR THIS EXAMINATION:
eval interval change
STUDY: AP chest, [**2196-3-5**].
HISTORY: 75-year-old man status post CABG. Evaluate for interval
change.
FINDINGS: The sheath in the right IJ has been removed. There are
markedly low lung volumes which limits evaluation. There is
crowding of the pulmonary vascular markings at the lung bases.
There is a left retrocardiac opacity. There are no signs for
overt pulmonary edema.
DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname 77752**], [**Known firstname 412**]       [**Hospital1 18**] [**Numeric Identifier 77753**] (Complete)
Done [**2196-3-3**] at 1:07:52 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
Division of Cardiothoracic [**Doctor First Name **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2120-11-11**]
Age (years): 75 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Abnormal ECG. Chest pain. Coronary artery disease.
Hypertension. Left ventricular function. Shortness of breath.
ICD-9 Codes: 402.90, 786.05, 786.51, 440.0
Test Information
Date/Time: [**2196-3-3**] at 13:07    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 6507**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2008AW1-: Machine: aw1
Echocardiographic Measurements
Results  Measurements  Normal Range
Right Atrium - Four Chamber Length:  *8.2 cm  <= 5.0 cm
Left Ventricle - Ejection Fraction:  40% to 45%  >= 55%
Aorta - Sinus Level:  3.4 cm  <= 3.6 cm
Aorta - Ascending:  *3.7 cm  <= 3.4 cm
Findings
LEFT ATRIUM: Mild LA enlargement. Good (>20 cm/s) LAA ejection
velocity. No thrombus in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: Markedly dilated RA. No
spontaneous echo contrast in the body of the RA. A catheter or
pacing wire is seen in the RA and extending into the RV. No ASD
by 2D or color Doppler.
LEFT VENTRICLE: Normal LV wall thickness. Normal LV cavity size.
Mild regional LV systolic dysfunction. Mildly depressed LVEF.
Transmitral Doppler and TVI c/w Grade II (moderate) LV diastolic
dysfunction.
RIGHT VENTRICLE: RV hypertrophy. Moderately dilated RV cavity.
Mild global RV free wall hypokinesis.
AORTA: Normal aortic diameter at the sinus level. Mildly dilated
ascending aorta. Complex (>4mm) atheroma in the ascending aorta.
Normal aortic arch diameter. Simple atheroma in aortic arch.
Normal descending aorta diameter. Complex (>4mm) atheroma in the
descending thoracic aorta.
AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets. No AS. Trace AR.
MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS.
Trivial MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with physiologic PR.
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. The patient received antibiotic prophylaxis. The
TEE probe was passed with assistance from the anesthesioology
staff using a laryngoscope. No TEE related complications.
patient.
REGIONAL LEFT VENTRICULAR WALL MOTION:
     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic
Conclusions
PRE-CPB:1. The left atrium is mildly dilated. No thrombus is
seen in the left atrial appendage.
2. The right atrium is markedly dilated. No spontaneous echo
contrast is seen in the body of the right atrium. No atrial
septal defect is seen by 2D or color Doppler.
3. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. There is mild regional left
ventricular systolic dysfunction with antero and anteroseptal
hypokinesis.. Overall left ventricular systolic function is
mildly depressed (LVEF= 45 %). Transmitral Doppler and tissue
velocity imaging are consistent with Grade II (moderate) LV
diastolic dysfunction.
4. The right ventricular free wall is hypertrophied. The right
ventricular cavity is moderately dilated with mild global free
wall hypokinesis.
5. The ascending aorta is mildly dilated. There are complex
(>4mm) atheroma in the ascending aorta. There are simple
atheroma in the aortic arch. There are complex (>4mm) atheroma
in the descending thoracic aorta.
6. There are three aortic valve leaflets. The aortic valve
leaflets are mildly thickened. There is no aortic valve
stenosis. Trace aortic regurgitation is seen.
7. The mitral valve leaflets are mildly thickened. Trivial
mitral regurgitation is seen. Dr. [**Last Name (STitle) **] was notified in person
of the results.
8. The procedure was done off-pump. Transient regional changes
with OM, LAD occlusion. On infusions of phenylephrine, epi.
9. The aortic contour is normal postCABG.
I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2196-3-3**] 15:12


Brief Hospital Course:
Mr [**Known lastname **] was transferred from [**Hospital **] Hospital on [**3-2**] for
surgical evaluation for coronary bypass surgery. He was brought
to the operating room on [**3-3**] for coronary bypass grafting, see
OR report for details. In summary he had off pump CABG x2 with a
LIMA-LAD, SVG-OM. He tolerated the operation well and was
transferred to the cardiac surgery ICU in stable condition. He
was hemodynamically stable in the immediate post-op period but
given his COPD he was ventilated throughout the operative day.
On the morning of POD1 he was weaned and extubated without
difficulty. On POD2 he was transferred to the step down floor
for continued post-operative care. Over the next several days
his activity level was advanced by nursing and PT and on POD #4
he was ready for discharge home.

Medications on Admission:
Lisinopril 40'
Lasix 20'
Labetelol 300'''
Naprosyn 500"-prn
KCL 10'
Metformin
Probenecid 500'
Plavix 75'
Advair

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
7. Probenecid 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
community vna, [**Location (un) **]

Discharge Diagnosis:
s/p OP-CABG x2(LIMA-LAD,SVG-OM)[**3-3**]
PMH: CAD, DM2, HTN, COPD, Gout, s/p CVA(R hemiplegia), s/p
scrotal hernia repair, s/p B arthroscopy


Discharge Condition:
stable


Discharge Instructions:
Keep wounds clean and dry. OK to shower, no bathing or swimming.
Take all medications as prescribed.
Call for any fever,redness or drainage from wounds.

Followup Instructions:
[**Hospital 409**] clinic in 2 weeks
Dr [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1683**] in [**1-31**] weeks
Dr [**Last Name (STitle) 8579**] in 4 weeks
Dr [**Last Name (STitle) **] in 4 weeks
Pt to call for all appointments



Completed by:[**2196-3-7**]

Name:  [**Known lastname 12563**],[**Known firstname **] G                Unit No:   [**Numeric Identifier 12564**]

Admission Date:  [**2196-3-2**]              Discharge Date:   [**2196-3-8**]

Date of Birth:  [**2120-11-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Ciprofloxacin / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 741**]
Addendum:
THe pt. went into AF at 100 for 20 mins. on POD#4.  He was given
1 dose of IV Lopressor and magnesium and converted to SR. He was
discharged to home on POD#5.

Discharge Disposition:
Home With Service

Facility:
community vna, [**Location (un) **]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2196-3-8**]
{'Coronary atherosclerosis of native coronary artery,Acidosis,Systolic heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Obesity, unspecified,Unspecified essential hypertension,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation'}


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: shortness of breath

PRESENT ILLNESS: 3month history of shortness of breath and orthopnea. Evaluated
at [**Hospital **] hospital , cardiac cath revealed multi-vessel disease
with global hypokinesis and EF 48%.

MEDICAL HISTORY: CAD
HTN
COPD
DM2
OSA
Gout
CVA(R hemiplegia)
B arthroscopy knee
Scrotal Hernia repair

MEDICATION ON ADMISSION: Lisinopril 40'
Lasix 20'
Labetelol 300'''
Naprosyn 500"-prn
KCL 10'
Metformin
Probenecid 500'
Plavix 75'
Advair

ALLERGIES: Ciprofloxacin / Sulfa (Sulfonamides)

PHYSICAL EXAM: Admission:
VS T 9.1  HR 72  BP 147/71  RR 20  O2sat 93% 2LNP
Ht 75"  Wt 122K
Gen NAD
Neuro grossly intact
Pulm CTA bilat
CV RRR, no murmur
Abdm soft, NT/ND/+BS
Ext warm well perfused, no varicosities

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives with wife
Retired [**Name (NI) **]
Remote tobacco-quit [**2141**]
Occasional wine w/dinner 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acidosis,Systolic heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Obesity, unspecified,Unspecified essential hypertension,Gout, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation'}
