CHIEF COMPLAINT: Dyspnea on exertion

PRESENT ILLNESS: 69 year old male who was hospitalized at [**Hospital3 3765**] in
[**Month (only) **] with a GI bleed. An endoscopy revealed gastric ulcers
which were attributed to NSAIDs and a positive H. pylori. He was
treated with cessation of NSAIDs antibiotics for the H. pylori.
A repeat endoscopy showed resolution of the ulcers. During this
admission a cardiac evaluation was done. A nuclear stress test
showed a moderate size, severe, partially reversible inferior
wall defect. A coronary CTA showed an elevated calcium score in
the territory of the left anterior descending artery. The
cardiac workup was done due to patient feeling shortness of
breath, chest tightness and weak while cycling at the gym. He
states he is in his normal state of health. He was referred for
a cardiac catheterization for furter evaluation and was found to
have three vessel coronary artery disease. He is now being
referred to cardiac surgery for revascularization.

MEDICAL HISTORY: Paroxysmal Atrial Fibrillation
Hyperlipidemia
Hypothyroidism
Peripheral neuropathy
GERD
H. pylori
Gastric Ulcer
Right eye optic nerve damage as a child

MEDICATION ON ADMISSION: ALENDRONATE 70 mg weekly Saturday morning
ATENOLOL  25 mg once a day
ATORVASTATIN 20 mg once a day
FLECAINIDE 100 mg three times a day
LEVOTHYROXINE 150 mcg once a day
OMEPRAZOLE 20 mg twice daily
ASPIRIN 81 mg daily
COENZYME Q10 [CO Q-10] [**Hospital1 **] 300 in am and 400 in pm
OMEGA-3 FATTY ACIDS-VITAMIN E [FISH OIL]  1000 Daily
Magnesium 500mg Daily
Vitamin C 500mg [**Hospital1 **]
Calcium 1000mg [**Hospital1 **]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:54 Resp:16  O2 sat:99/RA
B/P  Right:146/73    Left:137/73
Height:5'7"     Weight:150 lbs

FAMILY HISTORY: Family History:Premature coronary artery disease:
Father MI < 55 [x]x2          Mother < 65 []

SOCIAL HISTORY: Occupation:Video transfer work
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: < 1 drink/week [x]  [**1-21**] drinks/week [] >8 drinks/week []
Illicit drug use:denies
Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Hyposmolality and/or hyponatremia,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Esophageal reflux,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified
Crnry athrscl natve vssl,Secundum atrial sept def,Hyposmolality,Atrial fibrillation,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Esophageal reflux,Idio periph neurpthy NOS,Anemia NOS
Admission Date:  [**2109-10-21**]              Discharge Date:   [**2109-10-26**]

Date of Birth:  [**2040-6-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2109-10-21**]:
1. Coronary artery bypass grafting x3 with left internal mammary
artery to left anterior descending coronary artery; reverse
saphenous vein single graft from the aorta to the first obtuse
marginal coronary artery; reverse saphenous vein single graft
from the aorta to the posterior descending coronary artery.
2. Full left-sided Maze procedure with resection of left atrial
appendage using the Atricure synergy bipolar RF system and the
cryo cath.
3. Patent foramen ovale closure.
4. Epicardial LV lead x2.

History of Present Illness:
69 year old male who was hospitalized at [**Hospital3 3765**] in
[**Month (only) **] with a GI bleed. An endoscopy revealed gastric ulcers
which were attributed to NSAIDs and a positive H. pylori. He was
treated with cessation of NSAIDs antibiotics for the H. pylori.
A repeat endoscopy showed resolution of the ulcers. During this
admission a cardiac evaluation was done. A nuclear stress test
showed a moderate size, severe, partially reversible inferior
wall defect. A coronary CTA showed an elevated calcium score in
the territory of the left anterior descending artery. The
cardiac workup was done due to patient feeling shortness of
breath, chest tightness and weak while cycling at the gym. He
states he is in his normal state of health. He was referred for
a cardiac catheterization for furter evaluation and was found to
have three vessel coronary artery disease. He is now being
referred to cardiac surgery for revascularization.

Past Medical History:
Paroxysmal Atrial Fibrillation
Hyperlipidemia
Hypothyroidism
Peripheral neuropathy
GERD
H. pylori
Gastric Ulcer
Right eye optic nerve damage as a child


Social History:
Occupation:Video transfer work
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: < 1 drink/week [x]  [**1-21**] drinks/week [] >8 drinks/week []
Illicit drug use:denies


Family History:
Family History:Premature coronary artery disease:
Father MI < 55 [x]x2          Mother < 65 []


Physical Exam:
Pulse:54 Resp:16  O2 sat:99/RA
B/P  Right:146/73    Left:137/73
Height:5'7"     Weight:150 lbs

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema [] _____
Varicosities: None [x]
Neuro: Grossly intact [x]
Pulses: all palpable 2+

Carotid Bruit        Right: none    Left: none


Pertinent Results:
[**2109-10-21**] ECHO
PRE-CPB:1. The left atrium is mildly dilated. No thrombus is
seen in the left atrial appendage.
2. A patent foramen ovale is present.
3. Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal.
4. Right ventricular chamber size and free wall motion are
normal.
5. There are simple atheroma in the aortic arch. There are
simple atheroma in the descending thoracic aorta.
6. There are three aortic valve leaflets. The aortic valve
leaflets (3) are mildly thickened. There is no aortic valve
stenosis. Mild to moderate ([**12-16**]+) aortic regurgitation is seen.
There is a small central jet and a small jet between the left
and right coronary cusps.
7. Trivial mitral regurgitation is seen.
8. There is no pericardial effusion.
Dr. [**Last Name (STitle) 914**] was notified in person of the results.

POST-CPB: On infusion of phenylephrine. AV pacing. Preserved
biventricular systolic function post cpb. LVEF = 60%. 1+ AI,
trace MR. [**First Name (Titles) **] [**Last Name (Titles) 14205**] remnant is ligated. The pfo flow is trivial
post repair. Aortic contour is normal post decannulation.
[**2109-10-26**] 06:30AM BLOOD WBC-4.7 RBC-3.14* Hgb-9.8* Hct-29.1*
MCV-93 MCH-31.1 MCHC-33.6 RDW-13.1 Plt Ct-212#
[**2109-10-26**] 06:30AM BLOOD Glucose-101* UreaN-26* Creat-0.8 Na-136
K-3.7 Cl-98 HCO3-30 AnGap-12

Brief Hospital Course:
Mr. [**Known lastname 22325**] was admitted to the [**Hospital1 18**] on [**2109-10-21**] for
surgical management of his coronary artery disease. He was taken
directly to the operating room where he underwent coronary
artery bypass grafting to three vessels, a PFO closure,
placement of left ventricular leads and a MAZE procedure. Please
see operative note for details. Postoperatively he was taken to
the intensive care unit for monitoring. He later awoke
neurologically intact and was extubated. He was slowly weaned
from pressors. Free water was restricted due hyponatremia. He wa
transfused for postoperative anemia. On postoperative day two,
he was 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 with his
postoperative strength and mobility. Pradaxa was started for
anticoagulation for atrial fibrillation.

Mr. [**Name14 (STitle) 22326**] continued to make steady progress and was
discharged home on postoperative day 5. He is scheduled to
follow-up with Dr. [**Last Name (STitle) 914**], his cardiologist and his primary
care physician.

Medications on Admission:
ALENDRONATE 70 mg weekly Saturday morning
ATENOLOL  25 mg once a day
ATORVASTATIN 20 mg once a day
FLECAINIDE 100 mg three times a day
LEVOTHYROXINE 150 mcg once a day
OMEPRAZOLE 20 mg twice daily
ASPIRIN 81 mg daily
COENZYME Q10 [CO Q-10] [**Hospital1 **] 300 in am and 400 in pm
OMEGA-3 FATTY ACIDS-VITAMIN E [FISH OIL]  1000 Daily
Magnesium 500mg Daily
Vitamin C 500mg [**Hospital1 **]
Calcium 1000mg [**Hospital1 **]


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. levothyroxine 100 mcg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
Disp:*45 Tablet(s)* Refills:*2*
3. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
6. 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*
7. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain, fever.
Disp:*40 Tablet(s)* Refills:*0*
8. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 7
days.
Disp:*7 Tablet(s)* Refills:*0*
9. potassium chloride 20 mEq Packet Sig: Two (2)  PO once a day
for 7 days.
Disp:*14 20 mEq* Refills:*0*
10. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
Disp:*30 Suppository(s)* Refills:*0*


Discharge Disposition:
Home With Service

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

Discharge Diagnosis:
s/p coronary artery bypass grafts
coronary artery disease
Paroxysmal Atrial Fibrillation
Hyperlipidemia
Hypothyroidism
Peripheral neuropathy
gastroesophageal reflux
h/o Gastric Ulcer
Right eye optic nerve damage as a child
Spinal operation [**2106**], [**2107**] thoracic and lumbar
s/p cataract surgery


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with
Incisions:
Sternal - healing well, no erythema or drainage
Leg Right/Left - healing well, no erythema or drainage.
Edema



Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication
Goal INR
First draw
Results to phone fax


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) 914**] ([**Telephone/Fax (1) 170**]on [**2109-11-25**] at 1:30pm in the
[**Hospital **] Medical Office Building [**Last Name (NamePattern1) **] [**Hospital Unit Name **]. Wound
check in same locale on [**2109-10-31**] at 11am
Cardiologist:Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on [**2109-11-19**] at 1pm

Please call to schedule appointments with your
Primary Care Dr. [**Last Name (STitle) 22327**] [**Name (STitle) 22328**] ([**Telephone/Fax (1) 21640**]) in [**3-19**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**




Completed by:[**2109-10-26**]
{'Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Hyposmolality and/or hyponatremia,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Esophageal reflux,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, 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: Dyspnea on exertion

PRESENT ILLNESS: 69 year old male who was hospitalized at [**Hospital3 3765**] in
[**Month (only) **] with a GI bleed. An endoscopy revealed gastric ulcers
which were attributed to NSAIDs and a positive H. pylori. He was
treated with cessation of NSAIDs antibiotics for the H. pylori.
A repeat endoscopy showed resolution of the ulcers. During this
admission a cardiac evaluation was done. A nuclear stress test
showed a moderate size, severe, partially reversible inferior
wall defect. A coronary CTA showed an elevated calcium score in
the territory of the left anterior descending artery. The
cardiac workup was done due to patient feeling shortness of
breath, chest tightness and weak while cycling at the gym. He
states he is in his normal state of health. He was referred for
a cardiac catheterization for furter evaluation and was found to
have three vessel coronary artery disease. He is now being
referred to cardiac surgery for revascularization.

MEDICAL HISTORY: Paroxysmal Atrial Fibrillation
Hyperlipidemia
Hypothyroidism
Peripheral neuropathy
GERD
H. pylori
Gastric Ulcer
Right eye optic nerve damage as a child

MEDICATION ON ADMISSION: ALENDRONATE 70 mg weekly Saturday morning
ATENOLOL  25 mg once a day
ATORVASTATIN 20 mg once a day
FLECAINIDE 100 mg three times a day
LEVOTHYROXINE 150 mcg once a day
OMEPRAZOLE 20 mg twice daily
ASPIRIN 81 mg daily
COENZYME Q10 [CO Q-10] [**Hospital1 **] 300 in am and 400 in pm
OMEGA-3 FATTY ACIDS-VITAMIN E [FISH OIL]  1000 Daily
Magnesium 500mg Daily
Vitamin C 500mg [**Hospital1 **]
Calcium 1000mg [**Hospital1 **]

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse:54 Resp:16  O2 sat:99/RA
B/P  Right:146/73    Left:137/73
Height:5'7"     Weight:150 lbs

FAMILY HISTORY: Family History:Premature coronary artery disease:
Father MI < 55 [x]x2          Mother < 65 []

SOCIAL HISTORY: Occupation:Video transfer work
Cigarettes: Smoked no [x] yes []
Other Tobacco use:denies
ETOH: < 1 drink/week [x]  [**1-21**] drinks/week [] >8 drinks/week []
Illicit drug use:denies 

### Response:
{'Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Hyposmolality and/or hyponatremia,Atrial fibrillation,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Esophageal reflux,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified'}
