CHIEF COMPLAINT: congestive heart failure

PRESENT ILLNESS: This 60 year old white male presented to an outside hospital
with several weeks of exertional dyspnea.  He had shortness of
breath essentially at rest on [**2-3**] and called 911.  he received
oxygen, ASA,NTG and was in pulmonary edema on arrival to the ED.
 Enzymes were positive and he responded to therapy.

MEDICAL HISTORY: Untreated hypertension
untreated diabetes

MEDICATION ON ADMISSION: Heparin gtt

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: Resp:16  O2 sat:p
B/P  Right:122/77    Left: 122/77
Height: 68"    Weight:240#

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Last Dental Exam:6 months
Lives with:self
Occupation:painter
Tobacco:2-3pk/wk
ETOH:24 beers, 2bottles [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**]/wk
Subendocardial infarction, initial episode of care,Body Mass Index 40.0-44.9, adult,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Alcohol abuse, continuous,Obesity, unspecified,Atrial fibrillation
Subendo infarct, initial,BMI 40.0-44.9, adult,Crnry athrscl natve vssl,CHF NOS,Hypertension NOS,DMII wo cmp uncntrld,Alcohol abuse-continuous,Obesity NOS,Atrial fibrillation
Admission Date:  [**2118-2-4**]              Discharge Date:   [**2118-2-14**]

Date of Birth:  [**2057-11-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
congestive heart failure

Major Surgical or Invasive Procedure:
urgent coronary artery bypass graft
x4(LIMA-LAD,SVG-PDA,SVG-OM1-OM2) [**2118-2-5**]


History of Present Illness:
This 60 year old white male presented to an outside hospital
with several weeks of exertional dyspnea.  He had shortness of
breath essentially at rest on [**2-3**] and called 911.  he received
oxygen, ASA,NTG and was in pulmonary edema on arrival to the ED.
 Enzymes were positive and he responded to therapy.

Catheterization on [**2-4**] revealed triple vessel disease and 90%
left main disease  with EF of ~30%. He was transferred for
revascularization.

Past Medical History:
Untreated hypertension
untreated diabetes

Social History:
Last Dental Exam:6 months
Lives with:self
Occupation:painter
Tobacco:2-3pk/wk
ETOH:24 beers, 2bottles [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**]/wk


Family History:
Non-contributory

Physical Exam:
Pulse: Resp:16  O2 sat:p
B/P  Right:122/77    Left: 122/77
Height: 68"    Weight:240#

General:WDWN in NAD
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
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
Pulses:
Femoral      Right: 2  Left:2
DP           Right:2   Left:2
PT           [**Name (NI) 167**]:2   Left:2
Radial       Right:2   Left:2

Carotid Bruit        Right: n   Left:n


Pertinent Results:
[**2118-2-5**] ECHO
Pre-CPB:
No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is severely depressed
(LVEF= 15-20 %). with mild global free wall hypokinesis.
There are simple atheroma in the descending thoracic aorta.
The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic regurgitation. The mitral
valve leaflets are mildly thickened. Moderate (2+) mitral
regurgitation is seen.
There is no pericardial effusion.

Post-CPB:
The patient is in SR, on an infusion of epinephrine.
Improved biventricular systolic fxn. EF is now 35 - 40%.
MR is trace.
No AI. Aorta intact.

[**2118-2-13**] 07:00AM BLOOD WBC-11.8* RBC-3.39* Hgb-10.2* Hct-30.9*
MCV-91 MCH-30.0 MCHC-32.9 RDW-14.9 Plt Ct-298
[**2118-2-11**] 05:10AM BLOOD WBC-11.7* RBC-3.37* Hgb-10.5* Hct-30.5*
MCV-91 MCH-31.1 MCHC-34.3 RDW-14.0 Plt Ct-255
[**2118-2-8**] 02:02AM BLOOD PT-12.1 PTT-26.8 INR(PT)-1.0
[**2118-2-13**] 07:00AM BLOOD UreaN-22* Na-139 K-3.8 Cl-99
[**2118-2-11**] 05:10AM BLOOD Glucose-113* UreaN-25* Creat-1.0 Na-136
K-3.6 Cl-98 HCO3-28 AnGap-14

Brief Hospital Course:
Mr. [**Known lastname 4781**] was admitted to the [**Hospital1 18**] on [**2118-2-4**] for surgical
management of his coronary artery disease. He was worked-up in
the usual preoperative manner. Heparin and nitroglycerin were
continued. On [**2118-2-5**], Mr. [**Known lastname 4781**] was taken to the operating
room where he underwent coronary artery bypass grafting to four
vessels. Please see operative note for details. Postoperatively
he was taken to the intensive care unit for monitoring. He
remained intubated as he was quite lethargic on postoperative
day one. On postoperative day two, he was alert and successfully
extubated. Aspirin, a statin and beta blockade were started. On
postoperative day three 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. As
he had a myocardial infraction preoperatively, an ace inhibitor
was started.  He was seen in consultation by the [**Last Name (un) **]
Endocrinology service, who recommended placing him on lantus, a
humalog sliding scale, and metformin.  He received insulin
administration teaching, diabetes diet instruction, and glucose
testing education.

He continued to make steady progress and was discharged home on
postoperative day 9.

Medications on Admission:
Heparin gtt

Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*14 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*14 Tablet(s)* Refills:*2*
3. carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*28 Tablet(s)* Refills:*2*
4. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*28 Tablet(s)* Refills:*2*
5. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*14 Tablet(s)* Refills:*2*
6. amiodarone 200 mg Tablet Sig: Two (2) Tablet PO once a day:
take 400mg daily for one week, then taper to 200mg daily
ongoing.
Disp:*60 Tablet(s)* Refills:*2*
7. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*14 Tablet(s)* Refills:*2*
8. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
9. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 10
days.
Disp:*10 Tablet(s)* Refills:*2*
10. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO once a day for 10 days.
Disp:*10 Tablet, ER Particles/Crystals(s)* Refills:*2*
11. Lantus 100 unit/mL Solution Sig: One (1) 36 Subcutaneous at
bedtime.
Disp:*qs * Refills:*2*
12. Humalog 100 unit/mL Solution Sig: One (1) per sliding scale
Subcutaneous four times a day: per sliding scale.
Disp:*qs * Refills:*2*
13. syringes
qs packets insulin syringes with needles for 3 months, five
injections per day (lantus plus humalog), three refills
14. test strips
Freestyle Lite Test Strips, qs for testing four times per day,
three refills


Discharge Disposition:
Home with Service

Discharge Diagnosis:
s/p urgent coronary artery bypass
Unstable angina, left main coronary artery disease
congestive heart failure
non-ST segment myocardial infarction
diabetes mellitus
hypertension
alcohol abuse


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with steady gait
Incisional pain managed with percocet
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema: firm edema bilateral lower extremities


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**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 170**]on [**2118-3-16**] at 1:00pm

Please call to schedule appointments with your
Primary Care in [**3-22**] weeks
Endocrinologist as soon as possible
Cardiologist: Dr. [**Last Name (STitle) 5017**] in 3 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:[**2118-2-14**]
{'Subendocardial infarction, initial episode of care,Body Mass Index 40.0-44.9, adult,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Alcohol abuse, continuous,Obesity, unspecified,Atrial fibrillation'}


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: congestive heart failure

PRESENT ILLNESS: This 60 year old white male presented to an outside hospital
with several weeks of exertional dyspnea.  He had shortness of
breath essentially at rest on [**2-3**] and called 911.  he received
oxygen, ASA,NTG and was in pulmonary edema on arrival to the ED.
 Enzymes were positive and he responded to therapy.

MEDICAL HISTORY: Untreated hypertension
untreated diabetes

MEDICATION ON ADMISSION: Heparin gtt

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: Resp:16  O2 sat:p
B/P  Right:122/77    Left: 122/77
Height: 68"    Weight:240#

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Last Dental Exam:6 months
Lives with:self
Occupation:painter
Tobacco:2-3pk/wk
ETOH:24 beers, 2bottles [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5261**]/wk 

### Response:
{'Subendocardial infarction, initial episode of care,Body Mass Index 40.0-44.9, adult,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Alcohol abuse, continuous,Obesity, unspecified,Atrial fibrillation'}
