CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 54-year-old man
who presented to the Emergency Room with complaint of
shortness of breath on exertion.  He had been having these
episodes since mid-[**Month (only) 216**], and they have been intermittent
since that time.  He describes an exertional component to his
shortness of breath, in that it occurs during walking and
when he is carrying heavy objects.  He also describes a mild
burning sensation in his upper chest that does not radiate,
along with tingling along the jaw line and under his ears.
He denies any palpitations, dizziness, diaphoresis.  He has
never used nitroglycerin.  Resting relieves all symptoms.  He
denies any previous occurrences prior to [**Month (only) 216**].  In [**Location (un) 86**]
from [**Location (un) 5622**] for a convention.  Medical staff at the
convention advised him to come to the Emergency Room after he
complained of shortness of breath.

MEDICAL HISTORY: GERD.

MEDICATION ON ADMISSION: 1. Zocor 40 q. h.s.
2. Ketoprofen 20 q.d.
3. Lexapro.

ALLERGIES: 

PHYSICAL EXAM: Temperature 99, heart rate 80, blood pressure
127/88, respiratory rate 16, O2 sat 97 percent on room air.
General:  Sitting in bed in no acute distress, pleasant,
obese man.  HEENT:  Anicteric.  Mucous membranes moist.
Neck:  Supple.  No lymphadenopathy.  Cardiovascular:  S1, S2.
No murmur.  Respiratory:  Clear to auscultation bilaterally.
GI:  Abdomen soft, nontender, nondistended.  Neuro:  Alert
and oriented x 3.  Moves all 4 extremities symmetrically.

FAMILY HISTORY: Father died of an MI at age 81.  He also had
a history of colon cancer.

SOCIAL HISTORY: He quit smoking in [**Month (only) 956**].  Up to that
point smoked one and a half packs x several decades.  Drinks
wine socially.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Esophageal reflux,Synovitis and tenosynovitis, unspecified
Crnry athrscl natve vssl,Intermed coronary synd,Pure hypercholesterolem,Esophageal reflux,Synovitis NOS
Admission Date: [**2110-10-13**]        Discharge Date: [**2110-10-20**]

Date of Birth:  [**2056-8-9**]        Sex:  M

Service:  [**Last Name (un) 7081**]


CHIEF COMPLAINT:  Shortness of breath.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 54-year-old man
who presented to the Emergency Room with complaint of
shortness of breath on exertion.  He had been having these
episodes since mid-[**Month (only) 216**], and they have been intermittent
since that time.  He describes an exertional component to his
shortness of breath, in that it occurs during walking and
when he is carrying heavy objects.  He also describes a mild
burning sensation in his upper chest that does not radiate,
along with tingling along the jaw line and under his ears.
He denies any palpitations, dizziness, diaphoresis.  He has
never used nitroglycerin.  Resting relieves all symptoms.  He
denies any previous occurrences prior to [**Month (only) 216**].  In [**Location (un) 86**]
from [**Location (un) 5622**] for a convention.  Medical staff at the
convention advised him to come to the Emergency Room after he
complained of shortness of breath.

PAST MEDICAL HISTORY:  GERD.

Hemorrhoids.

Hypercholesterolemia.

Tendinitis in the wrists.

Depression.

Trigger finger.

SOCIAL HISTORY:  He quit smoking in [**Month (only) 956**].  Up to that
point smoked one and a half packs x several decades.  Drinks
wine socially.

FAMILY HISTORY:  Father died of an MI at age 81.  He also had
a history of colon cancer.

PHYSICAL EXAM:  Temperature 99, heart rate 80, blood pressure
127/88, respiratory rate 16, O2 sat 97 percent on room air.
General:  Sitting in bed in no acute distress, pleasant,
obese man.  HEENT:  Anicteric.  Mucous membranes moist.
Neck:  Supple.  No lymphadenopathy.  Cardiovascular:  S1, S2.
No murmur.  Respiratory:  Clear to auscultation bilaterally.
GI:  Abdomen soft, nontender, nondistended.  Neuro:  Alert
and oriented x 3.  Moves all 4 extremities symmetrically.

LAB DATA:  Sodium 140, potassium 3.8, BUN 16, creatinine 0.9,
glucose 129, CK 127, troponin 0.04, white count 8.3,
hematocrit 39.5, platelets 236.

MEDICATIONS ON ADMISSION:
1. Zocor 40 q. h.s.
2. Ketoprofen 20 q.d.
3. Lexapro.


HOSPITAL COURSE:  Following admission, the patient went for
an exercise tolerance test that was stopped with 7/10 chest
pain, with 2-[**Street Address(2) 2051**] depressions, and hypotension.  Following
his positive stress test, the patient was brought to the
Cardiac Cath Lab where he was found to have an LAD that was
subtotally occluded, a left circumflex with a subtotally
occluded OM1, and an RCA that was totally occluded with
collaterals from the circumflex.  He also was reported to
have an EF of 45 percent.  Following cardiac catheterization,
the patient was seen by the cardiothoracic surgery service.
He was accepted for coronary artery bypass grafting, and on
[**10-15**] he was brought to the operating room for coronary
artery bypass grafting.  Please see the OR report for full
details.  In summary, he had a CABG x 4 with a LIMA to the
LAD, saphenous vein graft to the RCA, saphenous vein graft to
OM, and saphenous vein graft to the diagonal.  His bypass
time was 83 minutes with a crossclamp time of 46 minutes.  He
tolerated the operation well and was transferred from the
operating room to the Cardiothoracic Intensive Care Unit.  At
the time of transfer, the patient was in a sinus rhythm at 70
beats per minute with a mean arterial pressure of 71, and a
CVP of 13.  He had Neo-Synephrine at 0.4 mcg/kg/min and
propofol at 20 mcg/kg/min.

The patient did well in the immediate postoperative period.
He remained hemodynamically stable.  His anesthesia was
reversed.  He was weaned from the ventilator and successfully
extubated.  He remained hemodynamically stable throughout
operative day.  On postoperative day 1, the patient continued
to be hemodynamically stable.  However, he required a Neo-
Synephrine drip to maintain an adequate blood pressure.
Several attempts were made to wean his Neo-Synephrine drip
throughout the day of postoperative day 1.  All were
unsuccessful following which, his PA catheter was removed, as
was his arterial line.

On postoperative day 2, the patient again remained
hemodynamically stable, continuing to require Neo-Synephrine
infusion to maintain an adequate blood pressure.  His chest
tubes were discontinued, as was his Foley catheter, and he
remained in the Intensive Care Unit because of the need for
his Neo-Synephrine infusion.

On postoperative day 3, the patient was finally weaned from
his Neo-Synephrine infusion.  He was begun on beta blockade
and was transferred to the floor for continuing postoperative
care and cardiac rehabilitation.

The remainder of the patient's postoperative course was
uneventful.  On the floor, with the assistance of the nursing
staff and physical therapy, the patient's activity level was
advanced.  On postoperative day 5, it was decided that the
patient was stable and ready to be discharged.

At the time of this dictation, the patient's physical exam is
as follows:
Vital signs:  Temperature 98.9, heart rate 73 sinus rhythm
blood pressure 110/70, respiratory rate 18, O2 sat 96 percent
on room air.  Physical exam - Neuro:  Alert and oriented x 3,
moves all extremities, follows commands.  Respiratory:  Clear
to auscultation bilaterally.  Cardiac:  Regular rate and
rhythm, S1, S2, with no  murmurs.  Sternum is stable.
Incision with Steri-Strips, open to air, clean and dry.
Abdomen:  Soft, nontender, nondistended with positive bowel
sounds.
Extremities:  Warm and well-perfused with trace edema.  Left
leg saphenous vein graft harvest site with Steri-Strips, open
to air, clean and dry.

LAB DATA:  White count 9.0 hematocrit 27.4, platelets 193,
sodium 137, potassium 4.2, chloride 101, CO2 27, BUN 23,
creatinine 1.1, glucose 98.

CONDITION AT DISCHARGE:  Good.

DISCHARGE DIAGNOSES:  Coronary artery disease, status post
coronary artery bypass grafting x 4 with a left internal
mammary artery to the left anterior descending, saphenous
vein graft to right coronary artery, saphenous vein graft to
obtuse margin, and saphenous vein graft to diagonal.

Hypercholesterolemia.

Gastroesophageal reflux disease.

Depression.

Tendinitis of the wrist.

Trigger finger.

FOLLOW UP:  The patient is to be discharged initially to a
hotel with visiting nurses.  He is to have follow-up on Far-2
in 1 week with Dr. [**Last Name (STitle) 70**].  He is to have follow-up in [**4-10**]
weeks in [**Location (un) 5622**] with Dr. [**Last Name (STitle) 2903**].

DISCHARGE MEDICATIONS:
1. Aspirin 325 qd.
2. Simvastatin 40 qd.
3. Metoprolol 25 [**Hospital1 **].
4. Percocet 5/325, 1-2 tabs q 4-6 h prn.
5. Colace 100 [**Hospital1 **].
6. Lexapro 10 qd.
7. Plavix 75 qd x 3 months.
8. Ascorbic acid 500 [**Hospital1 **] x 1 month.
9.
   Ferrous gluconate 240 qd x 1 month.
10.      Multivitamin 1 capsule qd x 1 month.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2110-10-20**] 10:57:55
T:  [**2110-10-20**] 12:45:43
Job#:  [**Job Number 57019**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Esophageal reflux,Synovitis and tenosynovitis, unspecified'}


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: Shortness of breath.

PRESENT ILLNESS: Mr. [**Known lastname **] is a 54-year-old man
who presented to the Emergency Room with complaint of
shortness of breath on exertion.  He had been having these
episodes since mid-[**Month (only) 216**], and they have been intermittent
since that time.  He describes an exertional component to his
shortness of breath, in that it occurs during walking and
when he is carrying heavy objects.  He also describes a mild
burning sensation in his upper chest that does not radiate,
along with tingling along the jaw line and under his ears.
He denies any palpitations, dizziness, diaphoresis.  He has
never used nitroglycerin.  Resting relieves all symptoms.  He
denies any previous occurrences prior to [**Month (only) 216**].  In [**Location (un) 86**]
from [**Location (un) 5622**] for a convention.  Medical staff at the
convention advised him to come to the Emergency Room after he
complained of shortness of breath.

MEDICAL HISTORY: GERD.

MEDICATION ON ADMISSION: 1. Zocor 40 q. h.s.
2. Ketoprofen 20 q.d.
3. Lexapro.

ALLERGIES: 

PHYSICAL EXAM: Temperature 99, heart rate 80, blood pressure
127/88, respiratory rate 16, O2 sat 97 percent on room air.
General:  Sitting in bed in no acute distress, pleasant,
obese man.  HEENT:  Anicteric.  Mucous membranes moist.
Neck:  Supple.  No lymphadenopathy.  Cardiovascular:  S1, S2.
No murmur.  Respiratory:  Clear to auscultation bilaterally.
GI:  Abdomen soft, nontender, nondistended.  Neuro:  Alert
and oriented x 3.  Moves all 4 extremities symmetrically.

FAMILY HISTORY: Father died of an MI at age 81.  He also had
a history of colon cancer.

SOCIAL HISTORY: He quit smoking in [**Month (only) 956**].  Up to that
point smoked one and a half packs x several decades.  Drinks
wine socially. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Esophageal reflux,Synovitis and tenosynovitis, unspecified'}
