CHIEF COMPLAINT: Fatigue

PRESENT ILLNESS: This is a 53 year old male with known coronary artery disease.
Cardiac catheterization dating back to [**2145**] showed total
occlusion of right coronary and left anterior descending
arteries. Currently, he remains relatively
asymptomatic and has a decent functional status. He performs
routine ADLs without difficulty, and remains very active. He
denies history of chest pain, dyspnea, orthopnea, PND, pedal
edema and syncope. Recent SPECT showed viable myocardium with
normal LV function. He is now referred for surgical
revascularization but has yet to undergo repeat cardiac
catheterization.

MEDICAL HISTORY: - Coronary Artery Disease
- Hypertension
- Dyslipidemia
- Diabetes Mellitus Type II
- Fatty Liver
- History of Pyelonephritis
- GE reflux disease

MEDICATION ON ADMISSION: ATORVASTATIN - (Prescribed by Other Provider) - 10 mg Tablet - 1

ALLERGIES: Hytrin / niaspan

PHYSICAL EXAM: Pulse: 100 Resp: 16  O2 sat: 98% room air
B/P  Right: 180/104   Left: 147/100

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: SOCIAL HISTORY : Lives with: Wife in [**Location (un) 110799**]
Occupation: Glass Industry
Cigarettes: Denies
Other Tobacco use: Quit cigars over 6 yrs ago, smoked a cigar a
day for 25 yrs
ETOH: Quit [**2153-12-9**], previously [**1-15**] drinks/week
Coronary atherosclerosis of native coronary artery,Other chronic nonalcoholic liver disease,Iatrogenic pneumothorax,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Personal history, urinary (tract) infection,Personal history of tobacco use,Long-term (current) use of aspirin,Examination of participant in clinical trial,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Crnry athrscl natve vssl,Chronic liver dis NEC,Iatrogenic pneumothorax,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Obstructive sleep apnea,Esophageal reflux,Personal history UTI,History of tobacco use,Long-term use of aspirin,Exam-clincal trial,Abn react-anastom/graft
Admission Date:  [**2154-4-16**]              Discharge Date:   [**2154-4-23**]

Date of Birth:  [**2100-4-6**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Hytrin / niaspan

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Fatigue

Major Surgical or Invasive Procedure:
CABG x 4(LIMA-LAD; SVG to diag; SVG to OM; SVG to RCA)[**2154-4-16**]


History of Present Illness:
This is a 53 year old male with known coronary artery disease.
Cardiac catheterization dating back to [**2145**] showed total
occlusion of right coronary and left anterior descending
arteries. Currently, he remains relatively
asymptomatic and has a decent functional status. He performs
routine ADLs without difficulty, and remains very active. He
denies history of chest pain, dyspnea, orthopnea, PND, pedal
edema and syncope. Recent SPECT showed viable myocardium with
normal LV function. He is now referred for surgical
revascularization but has yet to undergo repeat cardiac
catheterization.


Past Medical History:
- Coronary Artery Disease
- Hypertension
- Dyslipidemia
- Diabetes Mellitus Type II
- Fatty Liver
- History of Pyelonephritis
- GE reflux disease


Social History:
SOCIAL HISTORY : Lives with: Wife in [**Location (un) 110799**]
Occupation: Glass Industry
Cigarettes: Denies
Other Tobacco use: Quit cigars over 6 yrs ago, smoked a cigar a
day for 25 yrs
ETOH: Quit [**2153-12-9**], previously [**1-15**] drinks/week


Family History:
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

Physical Exam:
Pulse: 100 Resp: 16  O2 sat: 98% room air
B/P  Right: 180/104   Left: 147/100

General: WDWN 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 [x] Irregular [] Murmur - none. Normal s1s2
Abdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds
+
[x], small ventral hernia noted
Extremities: Warm [x], well-perfused [x]
Edema: None
Varicosities: None
Neuro: Grossly intact [x]
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: None bilaterally


Pertinent Results:
Imaging

Cardiac Cath [**4-16**]:
1. Selective coronary angiography of this right dominant system
demonstrated two vessel and left main coronary artery disease.
The LMCA
had an 80% distal stenosis. The LAD had a total occlusion at the

mid-vessel. The LCx is a large vessel without angiographically
apparent
flow-limiting stenosis. The RCA is occluded.
2. Limited resting hemodynamics revealed systemic arterial
normotension
with a central aortic pressure of 105/67 mmHg. Left-sided
filling
pressures are mildly elevated with LVEDP of 15mmHg.

FINAL DIAGNOSIS:
1. Two vessel and left main coronary artery disease.
2. Aspirin daily.
3. Start heparin drip.
4. Cardiac surgery evaluation, email sent and Dr. [**Last Name (STitle) **] is
aware.

Carotid Series [**4-16**]:
Findings: Duplex evaluation was performed of bilateral carotid
arteries. On the right there is no plaque seen in the ICA . On
the left there is mild heterogeneous plaque seen in the ICA.

On the right systolic/end diastolic velocities of the ICA
proximal, mid and distal respectively are 65/21, 68/24, 76/29,
cm/sec. CCA peak systolic velocity is 106 cm/sec. ECA peak
systolic velocity is 148 cm/sec. The ICA/CCA ratio is .71 These
findings are consistent with no stenosis.

On the left systolic/end diastolic velocities of the ICA
proximal, mid and distal respectively are 65/26, 77/35, 54/24,
cm/sec. CCA peak systolic velocity is 109 cm/sec. ECA peak
systolic velocity is 163 cm/sec. The ICA/CCA ratio is .70. These
findings are consistent <40% stenosis.

There is antegrade right vertebral artery flow.
There is antegrade left vertebral artery flow.

Impression: Right ICA no stenosis.
Left ICA <40% stenosis.

CXR [**4-17**]: FINDINGS: There is no focal consolidation, pleural
effusion, or pneumothorax. The cardiomediastinal silhouette is
normal. There is no evidence of pulmonary edema. There are no
acute skeletal abnormalities.

IMPRESSION: No acute cardiopulmonary process.
.
[**2154-4-18**] Intra-op TEE
Conclusions
PRE-CPB:
The left atrium is moderately dilated. No thrombus is seen in
the left atrial appendage. No atrial septal defect is seen by 2D
or color Doppler.

Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is low normal (LVEF 50-55%). Right ventricular
chamber size and free wall motion are normal.

No thoracic aortic dissection is seen. The aortic valve leaflets
(3) appear structurally normal with good leaflet excursion and
no aortic stenosis. Trace aortic regurgitation is seen.

The mitral valve leaflets are structurally normal. Mild to
moderate ([**12-10**]+) mitral regurgitation is seen. Moderate [2+]
tricuspid regurgitation is seen.

[**2154-4-23**] 04:51AM BLOOD WBC-9.2 RBC-3.48* Hgb-9.8* Hct-30.8*
MCV-88 MCH-28.1 MCHC-31.7 RDW-13.5 Plt Ct-320#
[**2154-4-21**] 07:00AM BLOOD WBC-10.9 RBC-3.59* Hgb-10.2* Hct-31.7*
MCV-88 MCH-28.4 MCHC-32.1 RDW-13.6 Plt Ct-202
[**2154-4-23**] 04:51AM BLOOD UreaN-16 Creat-0.7 Na-136 K-4.5 Cl-97
[**2154-4-20**] 06:55AM BLOOD Glucose-145* UreaN-12 Creat-0.7 Na-138
K-4.1 Cl-99 HCO3-30 AnGap-13

Brief Hospital Course:
The patient was brought to the Operating Room on [**2154-4-18**] where
the patient underwent CABG x 4 LIMA-LAD; SVG to diag; SVG to OM;
SVG to RCA)[**2154-4-16**] with Dr. [**Last Name (STitle) **].  See operative note for full
details. Overall the patient tolerated the procedure well and
post-operatively was transferred to the CVICU in stable
condition for recovery and invasive monitoring. POD 1 found the
patient extubated, alert and oriented and breathing comfortably.
 The patient was neurologically intact and hemodynamically
stable, weaned from inotropic and vasopressor support.  Beta
blocker was initiated and the patient was gently diuresed toward
the preoperative weight. The patient was transferred to the
telemetry floor for further recovery.  Chest tubes and pacing
wires were discontinued. He did develop a tiny left apical
pneumothorax which remained stable on CXR. The patient was
evaluated by the physical therapy service for assistance with
strength and mobility. By the time of discharge on POD 5 the
patient was ambulating freely, the wound was healing and pain
was controlled with oral analgesics. He did have some minimal
erythema surrounding left knee saphenectomy site without
associated pain or drainage. He was afebrile and WBC count was
normal at the time of discharge. He was instructed to call with
any increasing erythema, pain, drainage or temperature >100.4.
The patient was discharged home in good condition with
appropriate follow up instructions.

Medications on Admission:
ATORVASTATIN - (Prescribed by Other Provider) - 10 mg Tablet - 1

Tablet(s) by mouth once a day
EZETIMIBE [ZETIA] - (Prescribed by Other Provider) - 10 mg
Tablet - 1 Tablet(s) by mouth once a day
HYDROCHLOROTHIAZIDE - (Prescribed by Other Provider) - 25 mg
Tablet - 1 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] - (Prescribed by Other Provider) - 100

unit/mL Solution - 8 units bedtime
METFORMIN - (Prescribed by Other Provider) - 1,000 mg Tablet - 1

Tablet(s) by mouth twice a day
METOPROLOL SUCCINATE - (Prescribed by Other Provider) - 100 mg
Tablet Extended Release 24 hr - 1 Tablet(s) by mouth once a day

NICOTINE [NICOTROL] - (Prescribed by Other Provider) - 10 mg
Cartridge - 1 puff inh prn
QUINAPRIL - (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day
RANITIDINE HCL - (Prescribed by Other Provider) - 300 mg Capsule

- 1 Capsule(s) by mouth as needed for prn
SITAGLIPTIN [JANUVIA] - (Prescribed by Other Provider) - 100 mg

Tablet - 1 Tablet(s) by mouth once a day
VITAMIN D - (Prescribed by Other Provider) - Dosage uncertain
ASCORBIC ACID [VITAMIN C] - (Prescribed by Other Provider) -
Dosage uncertain
ASPIRIN - (Prescribed by Other Provider) - 81 mg Tablet, Delayed

Release (E.C.) - 1 Tablet(s) by mouth once a day
B COMPLEX VITAMINS - (Prescribed by Other Provider) - Capsule
- 1 Capsule(s) by mouth once a day
CINNAMON BARK [CINNAMON] - (Prescribed by Other Provider) - 500

mg Capsule - 2 Capsule(s) by mouth twice a day
FLAXSEED OIL - (Prescribed by Other Provider) - 1,000 mg Capsule

- 1 Capsule(s) by mouth twice a day
GLUCOSAMINE-CHONDROIT-VIT C-MN [GLUCOSAMINE 1500 COMPLEX] -
(Prescribed by Other Provider) - 500 mg-400 mg Capsule - 1
Capsule(s) by mouth twice a day
MULTIVITAMIN - (Prescribed by Other Provider) - Dosage uncertain

NICOTINE (POLACRILEX) - (Prescribed by Other Provider) - 4 mg
Gum - as needed


Discharge Medications:
1. nicotine (polacrilex) 2 mg Gum Sig: One (1) Gum Buccal Q2H
(every 2 hours) as needed for cravings.
Disp:*qs Gum(s)* Refills:*0*
2. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
7. sitagliptin 100 mg Tablet Sig: One (1) Tablet PO daily ().
8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain, fever.
9. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
10. metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
Disp:*135 Tablet(s)* Refills:*2*
11. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
12. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
13. potassium chloride 10 mEq Tablet Extended Release Sig: One
(1) Tablet Extended Release PO once a day for 7 days.
Disp:*7 Tablet Extended Release(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Coronary Artery Disease, Hypertension, Dyslipidemia, Diabetes
Mellitus Type II, Fatty Liver, History of Pyelonephritis, GE
reflux disease


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema 1+ Bilaterally

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 and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
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:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] Date/Time:[**2154-5-29**] 1:00pm in
the [**Hospital **] Medical office building, [**Doctor First Name **] [**Hospital Unit Name **]

WOUND CARE NURSE Phone:[**Telephone/Fax (1) 170**] Date/Time:[**2154-5-2**] 10:00
[**Hospital **] Medical office building, [**Doctor First Name **] [**Hospital Unit Name **]

Cardiologist: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**2154-5-7**] 11:15a

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 104406**] in [**3-14**] 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:[**2154-4-23**]
{'Coronary atherosclerosis of native coronary artery,Other chronic nonalcoholic liver disease,Iatrogenic pneumothorax,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Personal history, urinary (tract) infection,Personal history of tobacco use,Long-term (current) use of aspirin,Examination of participant in clinical trial,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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

PRESENT ILLNESS: This is a 53 year old male with known coronary artery disease.
Cardiac catheterization dating back to [**2145**] showed total
occlusion of right coronary and left anterior descending
arteries. Currently, he remains relatively
asymptomatic and has a decent functional status. He performs
routine ADLs without difficulty, and remains very active. He
denies history of chest pain, dyspnea, orthopnea, PND, pedal
edema and syncope. Recent SPECT showed viable myocardium with
normal LV function. He is now referred for surgical
revascularization but has yet to undergo repeat cardiac
catheterization.

MEDICAL HISTORY: - Coronary Artery Disease
- Hypertension
- Dyslipidemia
- Diabetes Mellitus Type II
- Fatty Liver
- History of Pyelonephritis
- GE reflux disease

MEDICATION ON ADMISSION: ATORVASTATIN - (Prescribed by Other Provider) - 10 mg Tablet - 1

ALLERGIES: Hytrin / niaspan

PHYSICAL EXAM: Pulse: 100 Resp: 16  O2 sat: 98% room air
B/P  Right: 180/104   Left: 147/100

FAMILY HISTORY: No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: SOCIAL HISTORY : Lives with: Wife in [**Location (un) 110799**]
Occupation: Glass Industry
Cigarettes: Denies
Other Tobacco use: Quit cigars over 6 yrs ago, smoked a cigar a
day for 25 yrs
ETOH: Quit [**2153-12-9**], previously [**1-15**] drinks/week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other chronic nonalcoholic liver disease,Iatrogenic pneumothorax,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Personal history, urinary (tract) infection,Personal history of tobacco use,Long-term (current) use of aspirin,Examination of participant in clinical trial,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
