CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 79 year old with known coronary artery disease and prior
myocardial infarction who presents with increased dyspnea on
exertion over last year. Recent stress test was positive and
cardiac cath revealed severe three vessel coronary artery
disease.

MEDICAL HISTORY: Coronary Artery Disease, history of Myocardial Infarction [**2124**]
Hypertension
Hyperlipidemia
Chronic renal insufficiency
Reactive airway disease
Osteoarthritis
Carotid Disease
Benign Prosatic Hypertrophy
Head Injury secondary to Motor vehicle accident

MEDICATION ON ADMISSION: Simvastatin 40mg daily, Benicar 20mg daily, Aspirin 81mg daily,
Metoprolol 25mg daily, Avodart 0.5mg daily, Advair 250/50mg [**Hospital1 **],
Methotrexate 10 every sunday, Alendronate 70 every wekk,
Calcium, Folate

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 80 16 131/71
General: Elderly male in no acute distress
Skin: Warm, dry, +Vitiligo
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear to auscultation bilaterally
Heart: Regular rate and rhythm with no murmurs
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired. 40 pack year smoking history. Denies alcohol use.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Chronic obstructive asthma, unspecified,Chronic kidney disease, unspecified,Mitral valve disorders,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Vitiligo
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,Chronic obst asthma NOS,Chronic kidney dis NOS,Mitral valve disorder,Ocl crtd art wo infrct,BPH w/o urinary obs/LUTS,Hyperlipidemia NEC/NOS,Hy kid NOS w cr kid I-IV,Vitiligo
Admission Date:  [**2155-6-6**]              Discharge Date:   [**2155-6-10**]

Date of Birth:  [**2075-8-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
Dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2155-6-6**] Coronary Artery Bypas Graft x 3 (Left internal mammary
artery to left anterior descending, Saphenous vein graft to
obtuse marginal, Saphenous vein graft to posterior descending
artery)

History of Present Illness:
79 year old with known coronary artery disease and prior
myocardial infarction who presents with increased dyspnea on
exertion over last year. Recent stress test was positive and
cardiac cath revealed severe three vessel coronary artery
disease.

Past Medical History:
Coronary Artery Disease, history of Myocardial Infarction [**2124**]
Hypertension
Hyperlipidemia
Chronic renal insufficiency
Reactive airway disease
Osteoarthritis
Carotid Disease
Benign Prosatic Hypertrophy
Head Injury secondary to Motor vehicle accident

Social History:
Retired. 40 pack year smoking history. Denies alcohol use.

Family History:
Non-contributory

Physical Exam:
Vitals: 80 16 131/71
General: Elderly male in no acute distress
Skin: Warm, dry, +Vitiligo
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear to auscultation bilaterally
Heart: Regular rate and rhythm with no murmurs
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

Pertinent Results:
                      UreaN Creat    K
[**2155-6-10**] 05:45AM      31* 1.7*   4.9

[**6-6**] Echo: PRE-BYPASS: 1. No mass/thrombus is seen in the left
atrium or left atrial appendage. 2. No atrial septal defect is
seen by 2D or color Doppler. 3. There is mild regional
anteroseptal, septal, inferoseptal, and apical wall hypokinesis,
in the presence of global left ventricular hypokinesis (LVEF =
40-45 %). 4. Right ventricular chamber size and free wall motion
are normal. 5. The diameters of aorta at the sinus, ascending
and arch levels are normal. 6. There are simple atheroma in the
ascending aorta. There are simple atheroma in the aortic arch.
There are complex (>4mm) atheroma in the descending thoracic
aorta. 7. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
There is no aortic valve stenosis. The mitral valve leaflets are
mildly thickened. Mild to moderate ([**2-14**]+) mitral regurgitation
is seen. POST-BYPASS: 1. For the post-bypass study, the patient
was receiving vasoactive infusions including phenylephrine. AV
pacing initially. 2. Preserved biventricular systolic function
from pre cpb. Inferior hypokinesis. LVEF is now 45%. 3. Aortic
contour is normal post decannulation.

Brief Hospital Course:
Mr. [**Known lastname **]. [**Known lastname 17862**] was a same day admit after undergoing
preoperative work-up prior to admission. On [**6-6**] he was brought
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 in stable condition. Within 24 hours he was
weaned from sedation, awoke neurologically intact and extubated.
On post-operative day one he was transferred to the telemetry
floor for further care. He had a short run of atrial
fibrillation which converted to sinus rhythm with beta blockers.
Chest tubes and epicardial pacing wires were removed per
protocol. He continued to slowly improve and worked with
physical therapy for strength and mobility. Mr. [**Known lastname **]. [**Known lastname 17862**] did
c/o difficulty swallowing- a speech and swallow consult and
video swallow was done and no abnormality was detected. He had
no further complaints of swallowing difficulty. On
post-operative day #4 he was discharged to home with VNA.

Medications on Admission:
Simvastatin 40mg daily, Benicar 20mg daily, Aspirin 81mg daily,
Metoprolol 25mg daily, Avodart 0.5mg daily, Advair 250/50mg [**Hospital1 **],
Methotrexate 10 every sunday, Alendronate 70 every wekk,
Calcium, Folate

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*65 Tablet(s)* Refills:*0*
5. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO daily ().
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 7 days.
Disp:*7 Tablet(s)* Refills:*0*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for
7 days.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
12. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
start on [**2155-6-18**].
Disp:*30 Tablet(s)* Refills:*2*
13. methotrexate


Discharge Disposition:
Home With Service

Facility:
Home Health and Hospice [**Location (un) 8117**], NH

Discharge Diagnosis:
Coronary Artery Disease
Hypertension
Hyperlipidemia
Chronic renal insufficiency
Reactive airway disease
Osteoarthritis
Carotid Disease
Benign Prosatic Hypertrophy
Head Injury secondary to Motor vehicle accident

Discharge Condition:
Good

Discharge Instructions:
Please shower daily including washing incisions, 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, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 2 weeks
Dr. [**Last Name (STitle) 31087**] in [**2-14**] weeks
Dr. [**Last Name (STitle) 82599**] in 2 weeks



Completed by:[**2155-6-10**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Chronic obstructive asthma, unspecified,Chronic kidney disease, unspecified,Mitral valve disorders,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Vitiligo'}


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: 79 year old with known coronary artery disease and prior
myocardial infarction who presents with increased dyspnea on
exertion over last year. Recent stress test was positive and
cardiac cath revealed severe three vessel coronary artery
disease.

MEDICAL HISTORY: Coronary Artery Disease, history of Myocardial Infarction [**2124**]
Hypertension
Hyperlipidemia
Chronic renal insufficiency
Reactive airway disease
Osteoarthritis
Carotid Disease
Benign Prosatic Hypertrophy
Head Injury secondary to Motor vehicle accident

MEDICATION ON ADMISSION: Simvastatin 40mg daily, Benicar 20mg daily, Aspirin 81mg daily,
Metoprolol 25mg daily, Avodart 0.5mg daily, Advair 250/50mg [**Hospital1 **],
Methotrexate 10 every sunday, Alendronate 70 every wekk,
Calcium, Folate

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: 80 16 131/71
General: Elderly male in no acute distress
Skin: Warm, dry, +Vitiligo
HEENT: Unremarkable
Neck: Supple, full range of motion
Chest: Clear to auscultation bilaterally
Heart: Regular rate and rhythm with no murmurs
Abd: Soft, non-tender, non-distended, +bowel sounds
Ext: Warm, well-perfused, -edema
Neuro: Grossly intact

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired. 40 pack year smoking history. Denies alcohol use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Chronic obstructive asthma, unspecified,Chronic kidney disease, unspecified,Mitral valve disorders,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other and unspecified hyperlipidemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Vitiligo'}
