CHIEF COMPLAINT: Dyspnea and chest pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 60 year old man with a history of silent MI,
hyperlipidemia, type 2 diabetes, and sleep apnea, who was
admitted to [**Hospital 1474**] Hospital on [**2103-1-16**] with shortness of
breath and exertional chest discomfort. He went to the [**Hospital1 1474**]
ED after an episode of "indigestion" which dissipated with a
sublingual dose of hyoscyamine; however, afterward, he noticed
slight difficulty breathing associated with cough productive of
pink phlegm. He was transferred to [**Hospital1 18**] for cardiac
catheterization after a positive persantine-MIBI stress test. He
noted symptoms of shortness of breath, indigestion, chest
congestion, and production of pink, frothy sputum. He was
admitted, and cardiac enzymes were <0.01 x 3, with CK's 132, 98,
and 84 respectively. CXR at the OSH reported mild pulmonary
congestion, for which the patient was diuresed with IV Lasix. He
underwent a pharmacologic stress test which exhibited an EF of
46% and moderate sized inferobasal hypokinesis. He was
transferred to [**Hospital1 18**] for cardiac catheterization. Prior to cath,
he was given a Plavix load. His cardiac catheterzation was
significant for severe three vessel disease. He is now referred
for surgical revascularization.

MEDICAL HISTORY: HTN
Hyperlipidemia
DM II
CAD, prior MI
Cardiomyopathy
Sleep Apnea--on CPAP
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension
Cardiac History: No history of CABG
Percutaneous coronary intervention: None
Pacemaker/ICD: None

MEDICATION ON ADMISSION: Lantus 33 units QHS
ASA 81mg Daily
Glyburide 10mg [**Hospital1 **]
Avandia 8mg Daily
Lasix 40mg Daily
Atenolol 100mg Daily
Prozac 40mg Daily
Zocor 80mg Daily
Nifedipine 60mg Daily
Lisinopril 40mg Daily
Flonase nasal spray
Advair IH
Travatan eye gtt QHS

ALLERGIES: Vicodin / Morphine / Percocet

PHYSICAL EXAM: Blood pressure was 141/74 mm Hg while seated. Pulse was 61
beats/min and regular, respiratory rate was 20 breaths/min.
Oxygen saturation was 92% on room air. Generally the patient was
well developed, well nourished and well groomed. The patient was
oriented to person, place and time. The patient's mood and
affect were not inappropriate.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. The neck was supple with
JVP at the level of the mandible at 30 degrees. The carotid
waveform was normal. There was no thyromegaly. The were no chest
wall deformities, scoliosis or kyphosis. The respirations were
not labored and there were no use of accessory muscles. The
lungs were clear to ascultation bilaterally anteriorly (as
patient required to lie flat after cath) with normal breath
sounds and no adventitial sounds or rubs.
.
Palpation of the heart revealed the PMI to be located in the 5th
intercostal space, mid clavicular line. There were no thrills,
lifts or palpable S3 or S4. The heart sounds revealed a normal
S1 and the S2 was normal. There were no rubs, murmurs, clicks or
gallops.
.
The abdominal aorta was not enlarged by palpation. There was no
hepatosplenomegaly or tenderness. The abdomen was soft nontender
and nondistended. The extremities had no pallor, cyanosis,
clubbing or edema. There were no abdominal, femoral or carotid
bruits. Inspection and/or palpation of skin and subcutaneous
tissue showed no stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: There is a family history of coronary artery disease (father and
mother with coronary disease in their 70's, brother with CAD in
his 50's, sister with CAD in her 60's). No history of sudden
death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is married, lives
with his wife, and has a business selling [**Location (un) **] seed.
Coronary atherosclerosis of native coronary artery,Systolic heart failure, unspecified,Other primary cardiomyopathies,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Obstructive sleep apnea (adult)(pediatric)
Crnry athrscl natve vssl,Systolic hrt failure NOS,Prim cardiomyopathy NEC,Intermed coronary synd,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Obstructive sleep apnea
Admission Date:  [**2103-1-22**]              Discharge Date:   [**2103-1-30**]

Date of Birth:  [**2042-10-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Vicodin / Morphine / Percocet

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Dyspnea and chest pain


Major Surgical or Invasive Procedure:
[**2103-1-25**] - CABGx5 (left internal mammary artery graft to left
anterior descending, reverse saphenous vein graft to the
posterior descending
artery, 2nd marginal branch, 1st marginal branch, diagonal
branch)
[**2103-1-22**] - Cardiac Catheterization


History of Present Illness:
Mr. [**Known lastname **] is a 60 year old man with a history of silent MI,
hyperlipidemia, type 2 diabetes, and sleep apnea, who was
admitted to [**Hospital 1474**] Hospital on [**2103-1-16**] with shortness of
breath and exertional chest discomfort. He went to the [**Hospital1 1474**]
ED after an episode of "indigestion" which dissipated with a
sublingual dose of hyoscyamine; however, afterward, he noticed
slight difficulty breathing associated with cough productive of
pink phlegm. He was transferred to [**Hospital1 18**] for cardiac
catheterization after a positive persantine-MIBI stress test. He
noted symptoms of shortness of breath, indigestion, chest
congestion, and production of pink, frothy sputum. He was
admitted, and cardiac enzymes were <0.01 x 3, with CK's 132, 98,
and 84 respectively. CXR at the OSH reported mild pulmonary
congestion, for which the patient was diuresed with IV Lasix. He
underwent a pharmacologic stress test which exhibited an EF of
46% and moderate sized inferobasal hypokinesis. He was
transferred to [**Hospital1 18**] for cardiac catheterization. Prior to cath,
he was given a Plavix load. His cardiac catheterzation was
significant for severe three vessel disease. He is now referred
for surgical revascularization.

Past Medical History:
HTN
Hyperlipidemia
DM II
CAD, prior MI
Cardiomyopathy
Sleep Apnea--on CPAP
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension
Cardiac History: No history of CABG
Percutaneous coronary intervention: None
Pacemaker/ICD: None


Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is married, lives
with his wife, and has a business selling [**Location (un) **] seed.

Family History:
There is a family history of coronary artery disease (father and
mother with coronary disease in their 70's, brother with CAD in
his 50's, sister with CAD in her 60's). No history of sudden
death.

Physical Exam:
Blood pressure was 141/74 mm Hg while seated. Pulse was 61
beats/min and regular, respiratory rate was 20 breaths/min.
Oxygen saturation was 92% on room air. Generally the patient was
well developed, well nourished and well groomed. The patient was
oriented to person, place and time. The patient's mood and
affect were not inappropriate.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. The neck was supple with
JVP at the level of the mandible at 30 degrees. The carotid
waveform was normal. There was no thyromegaly. The were no chest
wall deformities, scoliosis or kyphosis. The respirations were
not labored and there were no use of accessory muscles. The
lungs were clear to ascultation bilaterally anteriorly (as
patient required to lie flat after cath) with normal breath
sounds and no adventitial sounds or rubs.
.
Palpation of the heart revealed the PMI to be located in the 5th
intercostal space, mid clavicular line. There were no thrills,
lifts or palpable S3 or S4. The heart sounds revealed a normal
S1 and the S2 was normal. There were no rubs, murmurs, clicks or
gallops.
.
The abdominal aorta was not enlarged by palpation. There was no
hepatosplenomegaly or tenderness. The abdomen was soft nontender
and nondistended. The extremities had no pallor, cyanosis,
clubbing or edema. There were no abdominal, femoral or carotid
bruits. Inspection and/or palpation of skin and subcutaneous
tissue showed no stasis dermatitis, ulcers, scars, or xanthomas.

.
Pulses:
Right: Carotid 2+ Femoral 2+ DP 2+
Left: Carotid 2+ Femoral 2+ DP 2+


Pertinent Results:
[**2103-1-22**] 03:00PM   PT-13.8* PTT-30.4 INR(PT)-1.2*
[**2103-1-22**] 03:00PM   PLT COUNT-233
[**2103-1-22**] 03:00PM   NEUTS-68.5 LYMPHS-18.8 MONOS-9.2 EOS-2.0
BASOS-1.4
[**2103-1-22**] 03:00PM   WBC-4.9 RBC-4.61 HGB-14.2 HCT-40.9 MCV-89
MCH-30.9 MCHC-34.9 RDW-13.5
[**2103-1-22**] 03:00PM   TRIGLYCER-174* HDL CHOL-36 CHOL/HDL-4.7
LDL(CALC)-97
[**2103-1-22**] 03:00PM   VIT B12-503
[**2103-1-22**] 03:00PM   ALBUMIN-3.8 CHOLEST-168
[**2103-1-22**] 03:00PM   ALT(SGPT)-14 AST(SGOT)-14 CK(CPK)-42 ALK
PHOS-78 AMYLASE-70 TOT BILI-0.3
[**2103-1-22**] 03:00PM   estGFR-Using this
[**2103-1-22**] 03:00PM   GLUCOSE-129* UREA N-12 CREAT-0.8 SODIUM-140
POTASSIUM-3.9 CHLORIDE-108 TOTAL CO2-24 ANION GAP-12
.
Cardiac Cath [**1-22**]: 1) Initial coronary angiography revealed a
right dominant system with severe three vessel disease.  The
left main had a 10% distal lesion. The LAD had a diffuse 80% mid
vessel lesion before D2.  D1 had moderate proximal disease up to
40-50%.  The Cx had a 95% eccentric mid vessel stenosis after
OM1. The RCA was 100% occluded in the proximal vessel with the
distal vessel filling via collaterals. 2) Resting hemodynamics
revealed mildly elevated right sided filling pressures (RA
15mmhg, RVEDP 14 mmhg).  There was mild pulmonary artery
hypertension (PA 37/19) in the context of a significantly
elevated PCWP (22mmHg).  The left sided filling pressures were
severely elevated with a LVEDP of 32mmHg (post A wave).  There
was no evidence of aortic or mitral stenosis.  Cardiac output
was preserved (4.6 l/min).  There was no evidence of an
intracardiac shunt with limited SVC and PA saturations. FINAL
DIAGNOSIS:
1. Three vessel coronary artery disease. 2. Elevated right and
left sided filling pressures. 3. CT surgery referral.\
.
CXR [**2103-1-23**]: Two views. The lungs are clear. The heart is normal
in size. The aorta is calcified. Mediastinal structures are
unremarkable. The bony thorax is grossly intact. IMPRESSION: No
active disease.
.
Carotid Doppler [**2103-1-24**]: Bilateral less than 40% carotid stenosis
.
Echocardiogram [**2103-1-24**]: The left atrium is normal in size. No
atrial septal defect is seen by 2D or color Doppler. There is
mild symmetric left ventricular hypertrophy with normal cavity
size. There is basal inferior hypokinesis with preserved global
left ventricular systolic function (LVEF>55%). Transmitral
Doppler and tissue velocity imaging are consistent with Grade I
(mild) LV diastolic dysfunction. There is no ventricular septal
defect. Right ventricular chamber size and free wall motion are
normal. The ascending aorta is mildly dilated. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. The left
ventricular inflow pattern suggests impaired relaxation. The
estimated pulmonary artery systolic pressure is
normal. There is no pericardial effusion.


Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2103-1-22**] for a cardiac
catheterization. This was significant for severe three vessel
disease. Given the severity of his disease, the cardiac surgical
service was consulted for surgical evaluation. Mr. [**Known lastname **] was
worked-up in the usual preoperative manner including a carotid
duplex ultrasound which showed a less then 40% internal carotid
artery stenosis bilaterally. His surgery was delayed a couple of
days to allow washout of his plavix load from his
catheterization. On [**2103-1-25**], Mr. [**Known lastname **] was taken to the operating
room where he underwent coronary artery bypass grafting to five
vessels. Postoperatively he was taken to the cardiac surgical
intensive care unit for monitoring. By postoperative day one,
Mr. [**Known lastname **] had awoken neurologically intact and was extubated.
Beta blockade, aspirin and a statin were resumed. He was then
transferred to the step down unit for further recovery. He was
gently diuresed towards his preoperative weight. The physical
therapy service was consulted for assistance in his
postoperative strength and mobility. The [**Last Name (un) 387**] diabetes service
was consulted to assist with his diabetes medications
postoperatively.
Mr. [**Known lastname **] continued to make steady progress and was discharged
home on [**2103-1-30**]. He will follow-up with Dr. [**Last Name (STitle) **], his
cardiologist and his primary care physician as an outpatient.

Medications on Admission:
Lantus 33 units QHS
ASA 81mg Daily
Glyburide 10mg [**Hospital1 **]
Avandia 8mg Daily
Lasix 40mg Daily
Atenolol 100mg Daily
Prozac 40mg Daily
Zocor 80mg Daily
Nifedipine 60mg Daily
Lisinopril 40mg Daily
Flonase nasal spray
Advair IH
Travatan eye gtt QHS


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. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
3. 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:*0*
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
5. Glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*0*
6. Fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*0*
7. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
8. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
9. Travoprost 0.004 % Drops Sig: One (1)  Ophthalmic daily ().
10. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
11. Lantus 100 unit/mL Solution Sig: Thirty Three (33) units
Subcutaneous once a day.
Disp:*qs 1 month* Refills:*0*
12. Insulin Regular Human 300 unit/3 mL Insulin Pen Sig: sliding
scale  Subcutaneous four times a day.
Disp:*QS 1 month* Refills:*0*
13. Propoxyphene N-Acetaminophen 100-650 mg Tablet Sig: [**11-21**]
Tablets PO Q6H (every 6 hours) as needed.
Disp:*50 Tablet(s)* Refills:*0*
14. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
15. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
Disp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital **] Home Health Care

Discharge Diagnosis:
CAD s/p CABGx5
Diabetes
Obstructive Sleep Apnea
HTN
Hyperlipidemia
MI


Discharge Condition:
Good.


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. No bathing or swimming
for 1 month. Use sunscreen on incision if exposed to sun.
5)No lifting greater then 10 pounds for 10 weeks.
6)No driving for 1 month.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with cardiologist Dr. [**Last Name (STitle) **] in 2 weeks. ([**Telephone/Fax (1) 29561**]
Follow-up with PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1057**] in [**12-24**] weeks. ([**Telephone/Fax (1) 71877**]
Call all poviders for appointments.



Completed by:[**2103-2-2**]
{'Coronary atherosclerosis of native coronary artery,Systolic heart failure, unspecified,Other primary cardiomyopathies,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Obstructive sleep apnea (adult)(pediatric)'}


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 and chest pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 60 year old man with a history of silent MI,
hyperlipidemia, type 2 diabetes, and sleep apnea, who was
admitted to [**Hospital 1474**] Hospital on [**2103-1-16**] with shortness of
breath and exertional chest discomfort. He went to the [**Hospital1 1474**]
ED after an episode of "indigestion" which dissipated with a
sublingual dose of hyoscyamine; however, afterward, he noticed
slight difficulty breathing associated with cough productive of
pink phlegm. He was transferred to [**Hospital1 18**] for cardiac
catheterization after a positive persantine-MIBI stress test. He
noted symptoms of shortness of breath, indigestion, chest
congestion, and production of pink, frothy sputum. He was
admitted, and cardiac enzymes were <0.01 x 3, with CK's 132, 98,
and 84 respectively. CXR at the OSH reported mild pulmonary
congestion, for which the patient was diuresed with IV Lasix. He
underwent a pharmacologic stress test which exhibited an EF of
46% and moderate sized inferobasal hypokinesis. He was
transferred to [**Hospital1 18**] for cardiac catheterization. Prior to cath,
he was given a Plavix load. His cardiac catheterzation was
significant for severe three vessel disease. He is now referred
for surgical revascularization.

MEDICAL HISTORY: HTN
Hyperlipidemia
DM II
CAD, prior MI
Cardiomyopathy
Sleep Apnea--on CPAP
Cardiac Risk Factors: Diabetes, Dyslipidemia, Hypertension
Cardiac History: No history of CABG
Percutaneous coronary intervention: None
Pacemaker/ICD: None

MEDICATION ON ADMISSION: Lantus 33 units QHS
ASA 81mg Daily
Glyburide 10mg [**Hospital1 **]
Avandia 8mg Daily
Lasix 40mg Daily
Atenolol 100mg Daily
Prozac 40mg Daily
Zocor 80mg Daily
Nifedipine 60mg Daily
Lisinopril 40mg Daily
Flonase nasal spray
Advair IH
Travatan eye gtt QHS

ALLERGIES: Vicodin / Morphine / Percocet

PHYSICAL EXAM: Blood pressure was 141/74 mm Hg while seated. Pulse was 61
beats/min and regular, respiratory rate was 20 breaths/min.
Oxygen saturation was 92% on room air. Generally the patient was
well developed, well nourished and well groomed. The patient was
oriented to person, place and time. The patient's mood and
affect were not inappropriate.
.
There was no xanthalesma and conjunctiva were pink with no
pallor or cyanosis of the oral mucosa. The neck was supple with
JVP at the level of the mandible at 30 degrees. The carotid
waveform was normal. There was no thyromegaly. The were no chest
wall deformities, scoliosis or kyphosis. The respirations were
not labored and there were no use of accessory muscles. The
lungs were clear to ascultation bilaterally anteriorly (as
patient required to lie flat after cath) with normal breath
sounds and no adventitial sounds or rubs.
.
Palpation of the heart revealed the PMI to be located in the 5th
intercostal space, mid clavicular line. There were no thrills,
lifts or palpable S3 or S4. The heart sounds revealed a normal
S1 and the S2 was normal. There were no rubs, murmurs, clicks or
gallops.
.
The abdominal aorta was not enlarged by palpation. There was no
hepatosplenomegaly or tenderness. The abdomen was soft nontender
and nondistended. The extremities had no pallor, cyanosis,
clubbing or edema. There were no abdominal, femoral or carotid
bruits. Inspection and/or palpation of skin and subcutaneous
tissue showed no stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: There is a family history of coronary artery disease (father and
mother with coronary disease in their 70's, brother with CAD in
his 50's, sister with CAD in her 60's). No history of sudden
death.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. He is married, lives
with his wife, and has a business selling [**Location (un) **] seed. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Systolic heart failure, unspecified,Other primary cardiomyopathies,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Obstructive sleep apnea (adult)(pediatric)'}
