CHIEF COMPLAINT: Dyspnea on Exertion

PRESENT ILLNESS: 65 y/o female with progressive dyspnea on exertion (SOB after 1
flight of stairs) who had a positive ETT. She then underwent a
cardiac catheterization which showed Left main and two vessel
disease. She was then referred for surgical revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Hypothyroidism
s/p Left Knee Arthroscopy

MEDICATION ON ADMISSION: Aspirin 325mg qd, Levoxyl 150mcg qd, HCTZ 25mg qd, Atenolol 50mg
qd, Vytorin 10/40mg qd, Imdur 30mg qd, MVI, NTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 127/76 62 12 98%
General: 65 y/o female WDWN in NAD
HEENT: PERRL, EOMI, NC/AT
NECK: Supple, FROM - JVD
Chest: CTAB -w/r/r
Heart: RRR +S1S2 -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Spider veins/varicosities bilaterally, -edema
Neuro: Non-focal, MAE, A&O x 3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking 40 yrs ago after 5 pack yr history.
ETOH: 1 drink/day (vodka). -IVDA
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,Pleural effusion NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Hypothyroidism NOS
Admission Date:  [**2158-3-3**]              Discharge Date:   [**2158-3-10**]

Date of Birth:  [**2092-2-27**]             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:
Coronary Artery Bypass Graft x 3, LIMA->LAD, SVG->OM, SVG->PDA
[**2158-3-3**]

History of Present Illness:
65 y/o female with progressive dyspnea on exertion (SOB after 1
flight of stairs) who had a positive ETT. She then underwent a
cardiac catheterization which showed Left main and two vessel
disease. She was then referred for surgical revascularization.

Past Medical History:
Hypertension
Hyperlipidemia
Hypothyroidism
s/p Left Knee Arthroscopy

Social History:
Quit smoking 40 yrs ago after 5 pack yr history.
ETOH: 1 drink/day (vodka). -IVDA

Family History:
Non-contributory

Physical Exam:
VS: 127/76 62 12 98%
General: 65 y/o female WDWN in NAD
HEENT: PERRL, EOMI, NC/AT
NECK: Supple, FROM - JVD
Chest: CTAB -w/r/r
Heart: RRR +S1S2 -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Spider veins/varicosities bilaterally, -edema
Neuro: Non-focal, MAE, A&O x 3

Pertinent Results:
[**2158-3-3**] 12:10PM BLOOD WBC-11.3*# RBC-3.35* Hgb-11.1* Hct-31.0*
MCV-92 MCH-33.0* MCHC-35.8* RDW-13.4 Plt Ct-198
[**2158-3-10**] 06:50AM BLOOD Hct-25.5*
[**2158-3-3**] 11:17AM BLOOD PT-14.9* PTT-28.1 INR(PT)-1.3*
[**2158-3-5**] 03:50AM BLOOD PT-11.3 PTT-22.6 INR(PT)-1.0
[**2158-3-3**] 12:10PM BLOOD UreaN-14 Creat-0.7 Cl-108 HCO3-25
[**2158-3-10**] 06:50AM BLOOD UreaN-14 Creat-0.8 K-5.6*
[**2158-3-10**] 06:50AM BLOOD Mg-2.1
[**2158-3-4**] 10:17AM BLOOD freeCa-1.20

Echo: [**2158-3-3**]: Pre bypass: LV EF 50%. There is mild global left
ventricular hypokinesis. There is no aortic valve stenosis. No
aortic  regurgitation is seen. The mitral valve appears
structurally normal with
trivial mitral regurgitation. There are small nonmobile plaques
seen in the descending thoracic aorta and distal arch. Post
Bypass: Preserved biventricular systolic function. Study
otherwise unchanged from pre-bypass.
CXR [**2158-3-9**]: Resolving left basilar atelectasis. Persistent small
left pleural effusion.

Brief Hospital Course:
Ms. [**Known lastname **] was originally seen one week prior to admission for
surgery following her cardiac catheterization. She consented for
surgery and was brought directly to the operating room on [**3-3**]
where she underwent a coronary artery bypass graft x 3. Please
see operative note for surgical details. She was transferred to
CSRU in stable condition. Later on op day patient was weaned
from sedation and awoke neurologically intact. She was then
extubated. Chest tubes were removed on post op day one.
Inotropes were weaned off by post op day two. B blockers and
diuretics were initiated. She was gently diuresed towards he
pre-operative weight. Over the next several days patient was
recovering well but then had several short bursts of Atrial
Fibrillation. Amiodarone was given and she will be discharged
with a weaning dose. Rhythm at time of discharge was normal
sinus with freq. PAC's. Physical therapy followed patient during
her entire post-op course for strength and mobility. She was at
level five by post-op day seven and appeared to be doing well.
Physical exam and labs were stable and she was discharged to
home with VNA services and the appropriate follow-up
appointments on post-op day eight.

Medications on Admission:
Aspirin 325mg qd, Levoxyl 150mcg qd, HCTZ 25mg qd, Atenolol 50mg
qd, Vytorin 10/40mg qd, Imdur 30mg qd, MVI, NTG prn

Discharge Medications:
1. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. 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*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
6. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*135 Tablet(s)* Refills:*2*
8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): Take 400mg twice a day for 1 week. Then 400mg once a day
for 1 week. Then 200mg once a day until stopped by Cardiologist.
Disp:*60 Tablet(s)* Refills:*0*
9. Vytorin 10/40 10-40 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*

Discharge Disposition:
Home With Service

Facility:
[**Hospital1 3894**] Health VNA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Byapss Graft x 3
Hypertension
Hyperlipidemia
Hypothyroidism

Discharge Condition:
Good

Discharge Instructions:
Shower, wash incisions with mild soap and water and pat dry. No
lotions, creams or powders to incisions.
Call with fever >101, redness or drainage from incision, or
weight gain more than 2 pounds in one day or five pounds in one
week.
No lifting more than 10 pounds for 10 weeks.
No driving until follow up with surgeon.

Followup Instructions:
Dr. [**Last Name (STitle) **] in four weeks, [**Telephone/Fax (1) 170**]
Dr. [**Last Name (STitle) **] in [**1-9**] weeks, [**Telephone/Fax (1) 31895**]
Dr. [**Last Name (STitle) 5686**] in [**1-9**] weeks, [**Telephone/Fax (1) 65828**]


Completed by:[**2158-3-10**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism'}


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: 65 y/o female with progressive dyspnea on exertion (SOB after 1
flight of stairs) who had a positive ETT. She then underwent a
cardiac catheterization which showed Left main and two vessel
disease. She was then referred for surgical revascularization.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Hypothyroidism
s/p Left Knee Arthroscopy

MEDICATION ON ADMISSION: Aspirin 325mg qd, Levoxyl 150mcg qd, HCTZ 25mg qd, Atenolol 50mg
qd, Vytorin 10/40mg qd, Imdur 30mg qd, MVI, NTG prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 127/76 62 12 98%
General: 65 y/o female WDWN in NAD
HEENT: PERRL, EOMI, NC/AT
NECK: Supple, FROM - JVD
Chest: CTAB -w/r/r
Heart: RRR +S1S2 -c/r/m/g
Abd: Soft, NT/ND +BS
Ext: Spider veins/varicosities bilaterally, -edema
Neuro: Non-focal, MAE, A&O x 3

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Quit smoking 40 yrs ago after 5 pack yr history.
ETOH: 1 drink/day (vodka). -IVDA 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Unspecified pleural effusion,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism'}
