CHIEF COMPLAINT: Exertional Symptoms

PRESENT ILLNESS: 58 y/o male with exertional symptoms. Cardiac cath revealed 3
vessel disease (LM 50%, LAD 80%, OM 80-90%, RCA 95%) with a
45-50% EF. He was then referred for cardiac surgery.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Arthritis
Kidney Stones
s/p Right hand surgery
s/p ruptured achilles

MEDICATION ON ADMISSION: ASA 325mg qd
Imdur 30mg qd
Lipitor 10mg qd
Metoprolol 25mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 55 17 110/70 100%on RA
Neuro: NAD, A&O x 3
CV: RRR, +S1S2 -c/r/m/g
Lungs: CTAB -w/r/r
Abd: Obese, spft NT/ND
Ext: Warm, -edema/varicosities
HEENT: EOMI/PERRL
Neck: -Carotid Bruits

FAMILY HISTORY: Mother had MI in 50;s

SOCIAL HISTORY: Quit smoking in [**2178**]. Occ. ETOH
Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Cardiac complications, not elsewhere classified,Other and unspecified angina pectoris,Other specified cardiac dysrhythmias,Unspecified essential hypertension,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,Other and unspecified hyperlipidemia,Personal history of tobacco use
Crnry athrscl natve vssl,Iatrogenic pneumothorax,Surg compl-heart,Angina pectoris NEC/NOS,Cardiac dysrhythmias NEC,Hypertension NOS,Abn react-anastom/graft,Hyperlipidemia NEC/NOS,History of tobacco use
Admission Date:  [**2196-1-14**]              Discharge Date:   [**2196-1-20**]

Date of Birth:  [**2137-8-31**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Coronary Artery Bypass Graft x 4 ([**2196-1-14**])

History of Present Illness:
58 y/o male with exertional symptoms. Cardiac cath revealed 3
vessel disease (LM 50%, LAD 80%, OM 80-90%, RCA 95%) with a
45-50% EF. He was then referred for cardiac surgery.

Past Medical History:
Hypertension
Hyperlipidemia
Arthritis
Kidney Stones
s/p Right hand surgery
s/p ruptured achilles

Social History:
Quit smoking in [**2178**]. Occ. ETOH

Family History:
Mother had MI in 50;s

Physical Exam:
VS: 55 17 110/70 100%on RA
Neuro: NAD, A&O x 3
CV: RRR, +S1S2 -c/r/m/g
Lungs: CTAB -w/r/r
Abd: Obese, spft NT/ND
Ext: Warm, -edema/varicosities
HEENT: EOMI/PERRL
Neck: -Carotid Bruits

Pertinent Results:
CXR [**1-18**]:  Decreased size of right pneumothorax following chest
tube
placement.

[**2196-1-16**] 06:00AM BLOOD WBC-12.5* RBC-3.49* Hgb-11.4* Hct-30.6*
MCV-88 MCH-32.6* MCHC-37.2* RDW-13.5 Plt Ct-107*
[**2196-1-15**] 01:47AM BLOOD PT-13.0 PTT-29.7 INR(PT)-1.1
[**2196-1-18**] 07:30AM BLOOD Glucose-115* UreaN-12 Creat-1.0 Na-138
K-3.9 Cl-97 HCO3-33* AnGap-12
[**2196-1-19**] 07:05AM BLOOD UreaN-14 Creat-1.0 K-3.8

Brief Hospital Course:
Patient was a same day admit and brought directly to the
operating room where she underwent a coronary artery bypass
graft x 4. Please see op note for full surgical details. Pt
tolerated the procedure well and was transferred to the CSRU in
stable condition. Later on op day he was weaned from mechanical
ventilation and sedation and extubated. He was neurologically
intact. He was also weaned from all Inotropes by post op day
one. Diuretics and B blockers were started per protocol and he
was transferred to the telemetry floor on post op day one. Chest
tubes were removed on post op day two. Post chest tube pull
chest x-ray revealed a small-to-moderate right pneumothorax.
Epicardial pacing wires were removed on post op day three. On
post op day four he continued to have a persistent pneumothorax
and a right chest tube was reinserted. Following chest tube
placement chest x-ray revealed a decrease in size of his right
pneumothorax. On post op day five his chest tube was removed and
final chest x-ray showed stable-appearing small right apical
pneumothorax. The rest of his hospital course was uneventful. He
remained in a normal sinus rhythm and tolerated beta blockade.
He reponded well to diuresis and continued to make clinical
improvements. He was discharged home with VNA services and the
appropriate follow-up appointments on post op six. At discharge,
his BP was 106/64 with a HR of 84 in sinus. His room air
saturations were 99%. All surgical incisions were clean, dry and
intact without evidence of infection. He had adequate pain
control with Dilaudid.

Medications on Admission:
ASA 325mg qd
Imdur 30mg qd
Lipitor 10mg qd
Metoprolol 25mg [**Hospital1 **]

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:*1*
3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4
to 6 hours) as needed.
Disp:*40 Tablet(s)* Refills:*0*
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*1*
5. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day for
5 days.
Disp:*5 Tablet(s)* Refills:*0*
7. Potassium Chloride 10 mEq Tablet Sustained Release Sig: Two
(2) Tablet Sustained Release PO once a day for 5 days.
Disp:*10 Tablet Sustained Release(s)* Refills:*0*
8. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
TBA

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Hypertension
Hyperlipidemia
Postoperative Pneumothorax - small, stable

Discharge Condition:
good

Discharge Instructions:
[**Month (only) 116**] take shower. Wash incisions with water and gentle soap.
Gently pat dry. Do not bath.
Do not apply lotions, creams, ointments, or powders to
incisions.
Do not drive for 1 month.
Do not lift greater than 10 pounds for 2 months.
Take all medications and make follow-up appointments.
If you notice any redness, drainage from incisions or develop
fever greater than 101, please contact office.

Followup Instructions:
Dr. [**Last Name (STitle) 28946**] in 4 weeks
Dr. [**Last Name (STitle) 1911**] in [**2-12**] weeks
Dr. [**Last Name (STitle) 1159**] in [**1-11**] weeks


Completed by:[**2196-2-10**]
{'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Cardiac complications, not elsewhere classified,Other and unspecified angina pectoris,Other specified cardiac dysrhythmias,Unspecified essential hypertension,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,Other and unspecified hyperlipidemia,Personal history of tobacco use'}


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: Exertional Symptoms

PRESENT ILLNESS: 58 y/o male with exertional symptoms. Cardiac cath revealed 3
vessel disease (LM 50%, LAD 80%, OM 80-90%, RCA 95%) with a
45-50% EF. He was then referred for cardiac surgery.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Arthritis
Kidney Stones
s/p Right hand surgery
s/p ruptured achilles

MEDICATION ON ADMISSION: ASA 325mg qd
Imdur 30mg qd
Lipitor 10mg qd
Metoprolol 25mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 55 17 110/70 100%on RA
Neuro: NAD, A&O x 3
CV: RRR, +S1S2 -c/r/m/g
Lungs: CTAB -w/r/r
Abd: Obese, spft NT/ND
Ext: Warm, -edema/varicosities
HEENT: EOMI/PERRL
Neck: -Carotid Bruits

FAMILY HISTORY: Mother had MI in 50;s

SOCIAL HISTORY: Quit smoking in [**2178**]. Occ. ETOH 

### Response:
{'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Cardiac complications, not elsewhere classified,Other and unspecified angina pectoris,Other specified cardiac dysrhythmias,Unspecified essential hypertension,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,Other and unspecified hyperlipidemia,Personal history of tobacco use'}
