CHIEF COMPLAINT: Fatigue with decreased activity

PRESENT ILLNESS: 67 y/o male with positive ETT. Underwent cath which revealed
severe three vessel disease. Referred for surgical intervention.

MEDICAL HISTORY: Hypertension, Diabetes Mellitus, Hypercholesterolemia,
Peripheral Vascular Disease, ?TIA, s/p C-section

MEDICATION ON ADMISSION: Avapro 300mg qd, Atenolol 25mg qd, Felodipine 5mg qd, Crestor
20mg qd, Cilastalol 100mg [**Hospital1 **], Humulin, Aspirin 325mg qd

ALLERGIES: Lipitor / Codeine

PHYSICAL EXAM: VS: 70 14 188/70 62" 160lbs
Gen: 67 y/o obese female in NAD
Skin: W/D intact
HEENT: EOMI, PERRL NC/AT
Neck: Supple, FROM -JVD, -bruit
Lungs: CTAB -w/r/r
Heart: RRR 1/6 early systolic
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 1+ edema
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies tobacco and ETOH use.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Hemorrhage complicating a procedure,Atrial fibrillation,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,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,Atherosclerosis of native arteries of the extremities with intermittent claudication,Unspecified essential hypertension,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Osteoporosis, unspecified,Pure hypercholesterolemia
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Hemorrhage complic proc,Atrial fibrillation,Surg compl-heart,Urin tract infection NOS,Abn react-anastom/graft,Ath ext ntv at w claudct,Hypertension NOS,DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Osteoporosis NOS,Pure hypercholesterolem
Admission Date:  [**2103-9-21**]              Discharge Date:   [**2103-9-29**]

Date of Birth:  [**2035-10-24**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Lipitor / Codeine

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

Major Surgical or Invasive Procedure:
[**2103-9-25**] Coronary Artery Bypass Graft x 4 (LIMA to LAD, SVG to
OM, SVG to PDA to PLB)

History of Present Illness:
67 y/o male with positive ETT. Underwent cath which revealed
severe three vessel disease. Referred for surgical intervention.

Past Medical History:
Hypertension, Diabetes Mellitus, Hypercholesterolemia,
Peripheral Vascular Disease, ?TIA, s/p C-section

Social History:
Denies tobacco and ETOH use.

Family History:
Non-contributory

Physical Exam:
VS: 70 14 188/70 62" 160lbs
Gen: 67 y/o obese female in NAD
Skin: W/D intact
HEENT: EOMI, PERRL NC/AT
Neck: Supple, FROM -JVD, -bruit
Lungs: CTAB -w/r/r
Heart: RRR 1/6 early systolic
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 1+ edema
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
[**2103-9-21**] Echo: PRE-BYPASS: 1. No atrial septal defect is seen by
2D or color Doppler. 2. There is mild symmetric left ventricular
hypertrophy. 3. Overall left ventricular systolic function is
normal (LVEF>55%). 4. There are simple atheroma in the aortic
root. There are simple atheroma in the ascending aorta. The
descending thoracic aorta is mildly dilated. There are simple
atheroma in the descending thoracic aorta. 5. There are three
aortic valve leaflets. The aortic valve leaflets are mildly
thickened. No aortic regurgitation is seen. 6. The mitral valve
leaflets are mildly thickened. 7. Trivial mitral regurgitation
is seen. 8. The tricuspid valve leaflets are mildly thickened.
There is mild tricuspid regurgitation. POST-BYPASS: 1. Preserved
biventricular function. 2. Aortic contours are intact.

Brief Hospital Course:
Ms. [**Known lastname **] was a same day admit after undergoing all pre-operative
work-up as an outpatient. On day of admission she was brought to
the operating room where she underwent a coronary artery bypass
graft x 4. Please see operative report for surgical details.
Following surgery she was transferred to the CSRU for invasive
monitoring in stable condition. She did require several blood
transfusions for post-op bleeding and low HCT. She was weaned
from sedation within 24 hours, awoke neurologically intact and
extubated. On post-op day one she was started on beta blockers
and diuretics and gently diuresed towards her pre-op weight. On
post-op day two her chest tubes were removed. On post-op day
three she was transferred to the SDU for further care. She had
episode of atrial fibrillation and was started on Amiodarone
with titration of beta blockers. She was also eventually started
on Coumadin and titrated to a therapeutic INR. On post-op day
four she had sternal drainage and was started on antibiotics.
Stopped [**9-26**]. She worked with physical therapy for strength and
mobility during his entire post-op course. On
post-op day eight she appeared suitable for discharge to home
with VNA services and the appropriate follow-up appointments.


Medications on Admission:
Avapro 300mg qd, Atenolol 25mg qd, Felodipine 5mg qd, Crestor
20mg qd, Cilastalol 100mg [**Hospital1 **], Humulin, Aspirin 325mg qd

Discharge Medications:
1. 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*
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
3. Rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*1*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*1*
5. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO TID
(3 times a day).
Disp:*270 Tablet(s)* Refills:*1*
6. Pletal 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*1*
7. Furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
8. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO once a day for 2 weeks.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
9. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO once a day
for 7 days: tapering dose to QD after 5 days of 400 [**Hospital1 **] dosing.
Disp:*7 Tablet(s)* Refills:*0*
10. Amiodarone 400 mg Tablet Sig: One (1) Tablet PO twice a day
for 5 days: take this dose first.
Disp:*10 Tablet(s)* Refills:*0*
11. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day:
this will be your final dose.
Disp:*30 Tablet(s)* Refills:*2*
12. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
13. Coumadin 2 mg Tablet Sig: One (1) Tablet PO at bedtime: take
this dose for [**9-30**] and [**10-1**].  Have INR checked and have results
sent to your cardiologist before resuming.
Disp:*30 Tablet(s)* Refills:*2*
14. Outpatient Lab Work
CBC, INR

Please fax results to your Cardiologist on Tuesday [**2103-10-2**]


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Coronary Artery Disease s/p Coronary Artery Bypass Graft x 4
Post-op Atrial Fibrillation
PMH: Hypertension, Diabetes Mellitus, Hypercholesterolemia,
Peripheral Vascular Disease, ?TIA, s/p C-section

Discharge Condition:
Good

Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increasing pain. Please contact surgeon ([**Telephone/Fax (1) 4044**] with all wound issues.
2) Please shower daily. You may wash incision and gently pat
dry. You may have steri-strips on incisions which should fall
off on their own. If still intact after 3 weeks, you mat remove
them. No lotions, creams or powders to incision until it has
healed. No swimming until wound has healed. Use sunscreen on
incision when out in sun after it has healed.
3) No lifting greater then 10 pounds for 10 weeks from the date
of surgery.
4) No driving for 1 month.
5) Report any fever greater then 100.5.
6) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
7) Call with any questions or concerns.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**Last Name (STitle) 29070**] in [**3-3**] weeks
Dr. [**Last Name (STitle) **] in [**1-30**] weeks


Completed by:[**2103-9-29**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Hemorrhage complicating a procedure,Atrial fibrillation,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,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,Atherosclerosis of native arteries of the extremities with intermittent claudication,Unspecified essential hypertension,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Osteoporosis, unspecified,Pure hypercholesterolemia'}


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 with decreased activity

PRESENT ILLNESS: 67 y/o male with positive ETT. Underwent cath which revealed
severe three vessel disease. Referred for surgical intervention.

MEDICAL HISTORY: Hypertension, Diabetes Mellitus, Hypercholesterolemia,
Peripheral Vascular Disease, ?TIA, s/p C-section

MEDICATION ON ADMISSION: Avapro 300mg qd, Atenolol 25mg qd, Felodipine 5mg qd, Crestor
20mg qd, Cilastalol 100mg [**Hospital1 **], Humulin, Aspirin 325mg qd

ALLERGIES: Lipitor / Codeine

PHYSICAL EXAM: VS: 70 14 188/70 62" 160lbs
Gen: 67 y/o obese female in NAD
Skin: W/D intact
HEENT: EOMI, PERRL NC/AT
Neck: Supple, FROM -JVD, -bruit
Lungs: CTAB -w/r/r
Heart: RRR 1/6 early systolic
Abd: Soft, NT/ND +BS
Ext: Warm, well-perfused, 1+ edema
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies tobacco and ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Hemorrhage complicating a procedure,Atrial fibrillation,Cardiac complications, not elsewhere classified,Urinary tract infection, site not specified,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,Atherosclerosis of native arteries of the extremities with intermittent claudication,Unspecified essential hypertension,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Osteoporosis, unspecified,Pure hypercholesterolemia'}
