CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 60 year old man has a history of Type II diabetes and
hyperlipidemia. He reports that around late summer he had at
least 24 hours of persistent chest burning or "heartburn". He
recalls at the time that he was involved in heavy exertion. In
addition to these symptoms, he also noticed bilateral shoulder
discomfort and shortness of breath that would resolve with rest.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Type II DM
Hyperthyroidism s/p radioactive iodine
Depression
Remote knee surgery
T&A (remote)

MEDICATION ON ADMISSION: GLYBURIDE 10 mg twice a day
LEVOTHYROXINE 75 mcg Daily
METFORMIN 1,000 mg twice a day
METOPROLOL TARTRATE 25 mg twice a day
PIOGLITAZONE 30 mg daily
SERTRALINE 50 mg daily
SILDENAFIL prn
SIMVASTATIN 20 mg Daily
ASPIRIN 81 mg Daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 63 Resp: 14 O2 sat: 99
B/P  Right:  149/71
Height: 5'6"    Weight:171 pounds

FAMILY HISTORY: Mother died from an MI at age 73

SOCIAL HISTORY: Lives with: spouse
Occupation:[**Name2 (NI) **] is employed as a manager for a racetrack.
Tobacco:Quit in [**2115**]
ETOH:several beers every [**1-27**] nights
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Depressive disorder, not elsewhere classified
Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Thyrotox NOS no crisis,Depressive disorder NEC
Admission Date:  [**2146-11-9**]              Discharge Date:   [**2146-11-13**]

Date of Birth:  [**2086-2-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2146-11-9**] Coronary artery bypass graft x5, left internal mammary
  artery to left anterior descending artery, saphenous vein
graft to distal left anterior descending artery and right
coronary artery, and sequential saphenous vein grafts to obtuse
marginal 1 and 2.  Endoscopic harvesting of the long saphenous
vein.


History of Present Illness:
60 year old man has a history of Type II diabetes and
hyperlipidemia. He reports that around late summer he had at
least 24 hours of persistent chest burning or "heartburn". He
recalls at the time that he was involved in heavy exertion. In
addition to these symptoms, he also noticed bilateral shoulder
discomfort and shortness of breath that would resolve with rest.

Since that time he has noticed continued fatigue and shortness
of breath with exertion, although he has remained fairly
sedentary over the past months. Upon evaluation in [**Month (only) **]
[**2145**], he was found to have new EKG changes as compared
to his EKG from [**Month (only) 958**]. He has since undergone both echo and
stress testing as noted below and cardiac catheterization that
revealed coronary artery disease.

Past Medical History:
Hypertension
Hyperlipidemia
Type II DM
Hyperthyroidism s/p radioactive iodine
Depression
Remote knee surgery
T&A (remote)


Social History:
Lives with: spouse
Occupation:[**Name2 (NI) **] is employed as a manager for a racetrack.
Tobacco:Quit in [**2115**]
ETOH:several beers every [**1-27**] nights


Family History:
Mother died from an MI at age 73


Physical Exam:
Pulse: 63 Resp: 14 O2 sat: 99
B/P  Right:  149/71
Height: 5'6"    Weight:171 pounds

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
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:
Femoral      Right: 1+  Left: 1+
DP           Right: 1+  Left: 1+
PT           [**Name (NI) 167**]: 1+  Left: 1+
Radial       Right: 1+  Left: 1+

Carotid Bruit        Right: -   Left:-

Discharge Exam:
VS: T: 99.2  HR        BP:     Sats: 96% RA
General: 60 year-old male in no apparent distress
HEENT: normocephalic, muscus membranes moist
Neck: supple,
Card: RRR normal S1,S2 no murmur
Resp:
GI: benign
Extr: warm 1+ edema
Incision: sternal clean, dry intact,
Neuro: awake, alert moves all extremities


Pertinent Results:
[**2146-11-13**] WBC-9.9 RBC-3.11* Hgb-9.5* Hct-26.9* MCV-86 MCH-30.5
MCHC-35.2* RDW-13.4 Plt Ct-156
[**2146-11-9**] WBC-19.6*# RBC-3.16* Hgb-9.8*# Hct-28.3* MCV-90
MCH-31.0 MCHC-34.7 RDW-13.2 Plt Ct-176
[**2146-11-13**] Glucose-144* UreaN-12 Creat-0.9 Na-138 K-3.9 Cl-101
HCO3-32
[**2146-11-9**] UreaN-14 Creat-0.8 Na-144 K-4.0 Cl-116* HCO3-23 AnGap-9
[**2146-11-13**] Mg-2.0

CXR:
[**2146-11-13**]: Small posterior pleural effusions which may not have
been visible on the  previous AP chest x-ray. Evaluation of the
right hemidiaphragm unchanged.  Subsegmental atelectasis or
scarring, unchanged.
[**2146-11-9**]: The ET tube tip is 4 cm above the carina. The left
chest tube, the right internal jugular line, and the NG tube are
in expected location as well as the mediastinal drain.
Cardiomediastinal silhouette is unremarkable in the patient
immediately after surgery as well as there is no abnormality
seen with sternal wires. Left mid lung linear opacity is most
likely consistent with atelectasis as well as the opacity in the
right upper lung. There is no evidence of pneumothorax or
appreciable pleural effusion seen.

Echo
[**2146-11-9**]: Prebypass
No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thicknesses are normal. There is mild regional
left ventricular systolic dysfunction with hypokinesia of the
apex, apical and mid portions of the lateral, anterolateral and
anteroseptal walls. Overall left ventricular systolic function
is mildly depressed (LVEF= 40 %).
Right ventricular chamber size and free wall motion are normal.
There are simple atheroma in the descending thoracic aorta. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Trace aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen.

Post bypass
Patient is A paced and receiving an infusion of phenylephrine.
Biventricular systolic function is unchanged. Mild mitral
regurgitation persists. Aorta is intact post decannulation.
  I


Brief Hospital Course:
Admitted same day surgery and was brought to the operating room
for coronary artery bypass graft surgery.  See operative report
for further details.  He received cefazolin for perioperative
antibiotics and was transferred to the intensive care unit for
postoperative management.  In first twenty four hours he was
weaned from sedation, awoke neurologically intact and was
extubated without complications.  On post operative day one he
was started on beta blockers and diuretics.  He continued to do
well and was transferred to the floor hemodynamically stable.

Respiratory: aggressive incentive spirometer, nebs and
ambulation he titrated off oxygen with room oxygen saturations
of 96%

Chest tubes: 2 mediastinal and left pleural chest tubes were
removed on POD2

Cardiac: beta-blockers were started POD1 and titrated for sinus
tachycardia.  Blood pressure was stable.

GI: benign.  H2 blockers and bowel regime were given

Nutrition: diabetic diet was started on POD1 and he tolerated

Renal: gentle diuresis was titrated as needed.  Foley was
removed and he voided.  Electrolytes were repleted.  Renal
function remained within normal limits Cre 0.9

Endocrine: BS 96-200's.  While in the SICU he was on an insulin
drip and transitioned to insulin SS and his home dose of
Glyburide and metformin.

Neuro: awake, alert and oriented.  Pain was control with opioids
and NSAIDS with good control.

Disposition: he was seen by physical therapy and deemed safe for
home.  He was discharged on xxx.


Medications on Admission:
GLYBURIDE 10 mg twice a day
LEVOTHYROXINE 75 mcg Daily
METFORMIN 1,000 mg twice a day
METOPROLOL TARTRATE 25 mg twice a day
PIOGLITAZONE 30 mg daily
SERTRALINE 50 mg daily
SILDENAFIL prn
SIMVASTATIN 20 mg Daily
ASPIRIN 81 mg Daily

Discharge Medications:
1. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for fever/pain.
3. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
6. glyburide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
7. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
8. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
9. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): take early AM & 3PM until weight < 170 pounds.
Disp:*60 Tablet(s)* Refills:*2*
10. potassium chloride 8 mEq Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO once a day: take in am with
lasix.
Disp:*30 Tablet Sustained Release(s)* Refills:*2*
11. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
12. Sennalax-S 8.6-50 mg Tablet Sig: One (1) Tablet PO twice a
day: take while taking narcotics.
Disp:*60 Tablet(s)* Refills:*2*
13. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
Disp:*120 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 2203**] VNA

Discharge Diagnosis:
Coronary artery disease s/p CABG
Hypertension
Hyperlipidemia
Diabetes mellitus type 2
Hyperthyroidism
Depression


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


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr [**First Name (STitle) **] [**Telephone/Fax (1) 170**] Monday [**2146-11-28**] at 2:30 pm
Cardiologist: Dr [**Last Name (STitle) 34547**] [**Telephone/Fax (1) 84953**] Monday [**12-5**] at 11:15 am

Please call to schedule appointments with your
Primary Care Dr [**First Name (STitle) 916**] in [**2-28**] weeks [**Telephone/Fax (1) 17663**]

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


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2146-11-13**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Depressive disorder, not elsewhere classified'}


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: 60 year old man has a history of Type II diabetes and
hyperlipidemia. He reports that around late summer he had at
least 24 hours of persistent chest burning or "heartburn". He
recalls at the time that he was involved in heavy exertion. In
addition to these symptoms, he also noticed bilateral shoulder
discomfort and shortness of breath that would resolve with rest.

MEDICAL HISTORY: Hypertension
Hyperlipidemia
Type II DM
Hyperthyroidism s/p radioactive iodine
Depression
Remote knee surgery
T&A (remote)

MEDICATION ON ADMISSION: GLYBURIDE 10 mg twice a day
LEVOTHYROXINE 75 mcg Daily
METFORMIN 1,000 mg twice a day
METOPROLOL TARTRATE 25 mg twice a day
PIOGLITAZONE 30 mg daily
SERTRALINE 50 mg daily
SILDENAFIL prn
SIMVASTATIN 20 mg Daily
ASPIRIN 81 mg Daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pulse: 63 Resp: 14 O2 sat: 99
B/P  Right:  149/71
Height: 5'6"    Weight:171 pounds

FAMILY HISTORY: Mother died from an MI at age 73

SOCIAL HISTORY: Lives with: spouse
Occupation:[**Name2 (NI) **] is employed as a manager for a racetrack.
Tobacco:Quit in [**2115**]
ETOH:several beers every [**1-27**] nights 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm,Depressive disorder, not elsewhere classified'}
