CHIEF COMPLAINT: CP
SOB

PRESENT ILLNESS: Pt is a 51 yo man w/ no PMH but does not see doctors, presented
to [**Hospital3 1443**] Hospital on [**2103-3-8**] w/ c/o CP, SOB. Pt
states he has been having SOB symptoms over the past week, which
he describes as DOE, for example when walking in the cold, or
walking up stairs. This has been relieved by rest. He also has
some orthopnea, as he notes SOB is worse with lying flat, and
he's been sleeping on 2 pillows at night. He attributed these
symptoms to a cold, as he was having some sinus drainage over
this time. Then, night of admission, pt states that he was lying
down resting before work when he developed some SSCP, which he
describes as pressure, moderate ([**5-10**]), no radiation, no
associated N/V, diaphoresis. Otherwise denies any f/c, change in
bowel or bladder habits, LE edema, any other complaints. He
therefore went to [**Hospital 487**] Hospital ED.
At OSH, pt was noted to be hypertensive w/ SBP 162. EKG
demonstrated LBBB (unknown duration, as pt w/ no PCP f/u). Labs
notable for r/i MI with Trop I mildly elevated at 1.5, MB 24, CK
600. Pt was given ASA, plavix, labetalol, nitropaste, started on
hep gtt and transferred to [**Hospital1 18**] ER for admission for cath. Pt
was CP free on transfer.
In [**Hospital1 18**] [**Name (NI) **], pt was afebrile, SBP 190, other VSS. Labs drawn =
pending. Pt was given lopressor 5mg IV x 1, and started on NTG
gtt, hep gtt, and integrillin gtt.
Currently pt CP free, no other symptoms.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen - obese man, awake, alert, NAD, pleasant.
HEENT - PERRL, EOMI, MMM
CVS - RRR, nl S1 S2 no m/r/g
Lungs - CTA b/l
Abd - obese, soft, nt/nd
Ext - no LE edema b/l
Pulses - 2+ femoral pulses b/l, no bruits, 2+ DP pulses b/l

FAMILY HISTORY: Father died of lung ca at age 50, mother alive and healthy at
age 80, maternal grandmother with some sort of [**Last Name **] problem.

SOCIAL HISTORY: No tobacco, etoh, drug use. Lives with wife and son.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension
Subendo infarct, initial,CHF NOS,Crnry athrscl natve vssl,Hypertension NOS
Admission Date:  [**2103-3-9**]              Discharge Date:   [**2103-3-20**]

Date of Birth:  [**2052-1-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2103-3-9**] Cardiac Catheterization
[**2103-3-13**] CABG x 4 (LIMA->LAD, SVG->Diag, SVG->OM, SVG->PLV)


History of Present Illness:
Pt is a 51 yo man w/ no PMH but does not see doctors, presented
to [**Hospital3 1443**] Hospital on [**2103-3-8**] w/ c/o CP, SOB. Pt
states he has been having SOB symptoms over the past week, which
he describes as DOE, for example when walking in the cold, or
walking up stairs. This has been relieved by rest. He also has
some orthopnea, as he notes SOB is worse with lying flat, and
he's been sleeping on 2 pillows at night. He attributed these
symptoms to a cold, as he was having some sinus drainage over
this time. Then, night of admission, pt states that he was lying
down resting before work when he developed some SSCP, which he
describes as pressure, moderate ([**5-10**]), no radiation, no
associated N/V, diaphoresis. Otherwise denies any f/c, change in
bowel or bladder habits, LE edema, any other complaints. He
therefore went to [**Hospital 487**] Hospital ED.
At OSH, pt was noted to be hypertensive w/ SBP 162. EKG
demonstrated LBBB (unknown duration, as pt w/ no PCP f/u). Labs
notable for r/i MI with Trop I mildly elevated at 1.5, MB 24, CK
600. Pt was given ASA, plavix, labetalol, nitropaste, started on
hep gtt and transferred to [**Hospital1 18**] ER for admission for cath. Pt
was CP free on transfer.
In [**Hospital1 18**] [**Name (NI) **], pt was afebrile, SBP 190, other VSS. Labs drawn =
pending. Pt was given lopressor 5mg IV x 1, and started on NTG
gtt, hep gtt, and integrillin gtt.
Currently pt CP free, no other symptoms.


Past Medical History:
none


Social History:
No tobacco, etoh, drug use. Lives with wife and son.

Family History:
Father died of lung ca at age 50, mother alive and healthy at
age 80, maternal grandmother with some sort of [**Last Name **] problem.

Physical Exam:
Gen - obese man, awake, alert, NAD, pleasant.
HEENT - PERRL, EOMI, MMM
CVS - RRR, nl S1 S2 no m/r/g
Lungs - CTA b/l
Abd - obese, soft, nt/nd
Ext - no LE edema b/l
Pulses - 2+ femoral pulses b/l, no bruits, 2+ DP pulses b/l

Pertinent Results:
[**2103-3-9**] - Cardiac Cath
1. Selective coronary angiography of this right dominant system
demonstrated 3 vessel coronary artery disease. The LMCA was
normal. The
LAD had80% stenosis after D1, 70% stenosis after D2; and a 60%
proximal
D1 stenosis. The LCX had 90% proximal stenosis and there is a
long mid
disease to 90%. The RCA had 80% mid vessel stenosis asnd 70%
stenosis
before bifurcation and ostium of PDA. A ramus artery  was small
and had
70% ostial lesion.
2. Resting hemodynamics were performed. The right sided filling
pressures were elevated (mean RA pressure was 12mmHg and RVEDP
was
20mmHg). The pulmonary artery pressures were elevated measuring
52/28mmHg. The left sided filling pressures were elevated (mean
PCW
pressure was 28mmHg and LVEDP was 33mmHg). The systemic arterial

pressures were elevated measuring 160/94mmHg. There was no
significant
gradient across the aortic valve upon pull back of the catheter
from the
left ventricle to the ascending aorta. The cardiac index was
mildly
depressed measuring 2.2l/min/m2.
3. Contrast ventriculography revealed an ejection fraction of
35% with
global hypokinesis. There was no mitral regurgitation noted.

[**2103-3-9**] ECHO
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is moderate global left ventricular hypokinesis.
Right ventricular chamber size and free wall motion are normal.
The aortic root is mildly dilated at the sinus level. The
ascending aorta is mildly dilated. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic regurgitation. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is moderate
pulmonary artery systolic hypertension. There is no pericardial
effusion.

[**2103-3-19**] CXR
Stable small bilateral pleural effusions; improving areas of
atelectasis, and resolution of loculated component of pleural
effusion in the left upper hemithorax.


Brief Hospital Course:
A Cardiac catheterization on [**2103-3-9**] revealed three vessel
disease and moderately severe LV dysfunction. Cardiac surgery
was consulted. Preop workup included echocardiogram and normal
carotid u/s. He was diuresed for his SOB and systolic CHF and
awaited plavix washout prior to surgery. He was taken to the
operating room on [**2103-3-13**] where he underwent a four vessel
coronary artery bypass grafting. He was transferred to the CSRU
in critical but stable condition on epi, neo and propofol. He
was extubated and weaned from his vasoactive drips later that
same day. He was transferred to the floor on postoperative day
one for further recovery. He was gently diuresed towards his
preoperative weight. The [**Last Name (un) **] diabetes service was consulted
for assistance with his diabetes medication management. He
worked with the physical therapy service daily for assistance
with his postoperative strength and mobility. He was  transfused
with red blood cells for postoperative anemia. Mild sternal
drainage was noted and followed closely. Cultures of the
drainage were negative. Mr. [**Known lastname **] continued to make steady
progress and was discharged home on postoperative day 7. He will
follow-up with Dr. [**Last Name (STitle) 914**], his cardiologist and his primary
care physician as an outpatient.

Medications on Admission:
none

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:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
3. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. 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*
5. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*
6. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day for
7 days.
Disp:*7 Tablet(s)* Refills:*0*
8. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO once a day for 7 days.
Disp:*14 Capsule, Sustained Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 **] VNA

Discharge Diagnosis:
Coronary Artery Disease s/p CABG
Myocaridal infarction
Obesity
Hypertension


Discharge Condition:
Good.


Discharge Instructions:
[**Month (only) 116**] shower, 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

Followup Instructions:
Dr [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**]) please call for appointment

Dr [**First Name (STitle) 437**] or local cardiologist in [**2-3**] weeks - please call for
appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3633**])
PCP (Please call us if you are unable to set up PCP followup in
[**Name9 (PRE) 41179**] as discussed) 2 weeks



Completed by:[**2103-4-5**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}


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: CP
SOB

PRESENT ILLNESS: Pt is a 51 yo man w/ no PMH but does not see doctors, presented
to [**Hospital3 1443**] Hospital on [**2103-3-8**] w/ c/o CP, SOB. Pt
states he has been having SOB symptoms over the past week, which
he describes as DOE, for example when walking in the cold, or
walking up stairs. This has been relieved by rest. He also has
some orthopnea, as he notes SOB is worse with lying flat, and
he's been sleeping on 2 pillows at night. He attributed these
symptoms to a cold, as he was having some sinus drainage over
this time. Then, night of admission, pt states that he was lying
down resting before work when he developed some SSCP, which he
describes as pressure, moderate ([**5-10**]), no radiation, no
associated N/V, diaphoresis. Otherwise denies any f/c, change in
bowel or bladder habits, LE edema, any other complaints. He
therefore went to [**Hospital 487**] Hospital ED.
At OSH, pt was noted to be hypertensive w/ SBP 162. EKG
demonstrated LBBB (unknown duration, as pt w/ no PCP f/u). Labs
notable for r/i MI with Trop I mildly elevated at 1.5, MB 24, CK
600. Pt was given ASA, plavix, labetalol, nitropaste, started on
hep gtt and transferred to [**Hospital1 18**] ER for admission for cath. Pt
was CP free on transfer.
In [**Hospital1 18**] [**Name (NI) **], pt was afebrile, SBP 190, other VSS. Labs drawn =
pending. Pt was given lopressor 5mg IV x 1, and started on NTG
gtt, hep gtt, and integrillin gtt.
Currently pt CP free, no other symptoms.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen - obese man, awake, alert, NAD, pleasant.
HEENT - PERRL, EOMI, MMM
CVS - RRR, nl S1 S2 no m/r/g
Lungs - CTA b/l
Abd - obese, soft, nt/nd
Ext - no LE edema b/l
Pulses - 2+ femoral pulses b/l, no bruits, 2+ DP pulses b/l

FAMILY HISTORY: Father died of lung ca at age 50, mother alive and healthy at
age 80, maternal grandmother with some sort of [**Last Name **] problem.

SOCIAL HISTORY: No tobacco, etoh, drug use. Lives with wife and son. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}
