CHIEF COMPLAINT: dyspnea on exertion

PRESENT ILLNESS: This is a 61 year old male with exercise intolerance and dyspnea
on exertion. Nuclear stress testing showed inferolateral ST
depressions with exercise. SPECT revealed an LVEF of 59% with
reversible defects in the anterolateral, inferior and
inferolateral regions. Subsequent cardiac catheterization was
notable for severe three vessel disease and normal LV function.
Based upon the above results, he was referred for surgical
revascularization.

MEDICAL HISTORY: Coronary Artery Disease
Diabetes mellitus type II
Hypertension
Hypercholesterolemia
Chronic back pain
Carotid bruits
s/p Shoulder surgery

MEDICATION ON ADMISSION: Avapro 150 qd, Toprol XL 100 qd, Omeprazole 20 qd, Lipitor 80
qd, Tricor 145 qd,
Avandia 8 qd, Aspirin 81 qd, Coenzyme Q10

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 114/58, HR 54, RR 12, SAT  98 on room air
General: well developed male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD, bilateral carotid bruits noted
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, trace edema, no varicosities
Pulses: 1+ distally, bilateral femoral bruits noted
Neuro: nonfocal

FAMILY HISTORY: Denies premature CAD.

SOCIAL HISTORY: 45 pack year history of tobacco, quit approximately 1 month
prior to admission. Denies ETOH. He is a mechanic. Currently
lives with his wife.
Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Mitral valve disorders,Unspecified essential hypertension,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Backache, unspecified
Crnry athrscl natve vssl,Surg compl-urinary tract,Acute kidney failure NOS,Abn react-procedure NOS,Mitral valve disorder,Hypertension NOS,Atrial fibrillation,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Backache NOS
Admission Date:  [**2137-8-29**]              Discharge Date:   [**2137-9-7**]

Date of Birth:  [**2076-1-8**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
dyspnea on exertion

Major Surgical or Invasive Procedure:
[**2137-8-29**] - CABGx4 (Left internal mammary->left anterior
descending artery, vein graft to diagonal, vein graft to obtsue
marginal, vein graft to posterior descending artery)


History of Present Illness:
This is a 61 year old male with exercise intolerance and dyspnea
on exertion. Nuclear stress testing showed inferolateral ST
depressions with exercise. SPECT revealed an LVEF of 59% with
reversible defects in the anterolateral, inferior and
inferolateral regions. Subsequent cardiac catheterization was
notable for severe three vessel disease and normal LV function.
Based upon the above results, he was referred for surgical
revascularization.

Past Medical History:
Coronary Artery Disease
Diabetes mellitus type II
Hypertension
Hypercholesterolemia
Chronic back pain
Carotid bruits
s/p Shoulder surgery

Social History:
45 pack year history of tobacco, quit approximately 1 month
prior to admission. Denies ETOH. He is a mechanic. Currently
lives with his wife.

Family History:
Denies premature CAD.

Physical Exam:
Vitals: BP 114/58, HR 54, RR 12, SAT  98 on room air
General: well developed male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD, bilateral carotid bruits noted
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, trace edema, no varicosities
Pulses: 1+ distally, bilateral femoral bruits noted
Neuro: nonfocal


Pertinent Results:
[**2137-9-7**] 05:35AM BLOOD WBC-14.4* RBC-3.37* Hgb-10.6* Hct-31.0*
MCV-92 MCH-31.5 MCHC-34.2 RDW-15.5 Plt Ct-362
[**2137-9-7**] 05:35AM BLOOD Glucose-92 UreaN-40* Creat-1.8* Na-134
K-4.6 Cl-97 HCO3-24 AnGap-18

Brief Hospital Course:
Mr. [**Known lastname 69335**] was admitted and underwent coronary artery bypass
grafting by Dr. [**Last Name (STitle) **]. The operation was uneventful and he was
transferred to the CSRU in stable condition. For further
surgical details, please see seperate dictated operative note.
Within 24 hours, he awoke neurologically intact and was
extubated. Due to persistent secretions and hypoxia, he required
reintubation on postoperative day one. He concomitantly
experienced an acute decline in renal function and postoperative
leukocytosis. His creatinine peaked to 2.7. His white count
peaked to 21K and he was started on empiric antibiotics. A TEE
on postoperative day two was unremarkable. Over the next several
days, his renal and respiratory function improved. His white
count normalized. He was eventually extubated again on
postoperative day four. Sputum cultures showed only normal
flora. He continued to make clinical improvements and was
intermittently transfused to maintain hematocrit near 30%. He
stablized and transferred to the SDU on postoperative day six.
He experienced brief periods of paroxsymal atrial fibrillation
but remained mostly in a normal sinus rhythm. Beta blockade was
advanced as tolerated, and he has had no further AFib. He
remains hemodynamically stable and ready to be discharged home.

Medications on Admission:
Avapro 150 qd, Toprol XL 100 qd, Omeprazole 20 qd, Lipitor 80
qd, Tricor 145 qd,
Avandia 8 qd, Aspirin 81 qd, Coenzyme Q10

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:*2*
3. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
Disp:*1 MDI* Refills:*2*
4. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
Disp:*1 MDI* Refills:*2*
5. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO every [**4-18**]
hours as needed.
Disp:*40 Tablet(s)* Refills:*0*
6. Rosiglitazone 8 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. 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:*2*
9. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
Disp:*90 Tablet(s)* Refills:*2*
10. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 7
days.
Disp:*14 Tablet(s)* Refills:*0*
11. Potassium Chloride 10 mEq Tablet Sustained Release Sig: One
(1) Tablet Sustained Release PO twice a day for 7 days.
Disp:*14 Tablet Sustained Release(s)* Refills:*0*
12. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
VNA of So. eastern Ma

Discharge Diagnosis:
Coronary Artery Disease - s/p CABG
Postop Acute Renal Insufficiency
Postop Acute Respiratory Failure
Postop Leukocytosis
Hypercholesterolemia
HTN
Diabetes mellitus
Chronic back pain
Carotid bruits


Discharge Condition:
Stable


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
one week.
4) No lifting greater then 10 pounds for 10 weeks.
5) No driving for 1 month.


Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 4 weeks.
Follow-up with primary care physician [**Last Name (NamePattern4) **]. [**First Name (STitle) **] in 2 weeks.
Follow-up with cardiologist Dr. [**Last Name (STitle) 45555**] in [**1-14**] weeks.



Completed by:[**2137-9-7**]
{'Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Mitral valve disorders,Unspecified essential hypertension,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Backache, 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: This is a 61 year old male with exercise intolerance and dyspnea
on exertion. Nuclear stress testing showed inferolateral ST
depressions with exercise. SPECT revealed an LVEF of 59% with
reversible defects in the anterolateral, inferior and
inferolateral regions. Subsequent cardiac catheterization was
notable for severe three vessel disease and normal LV function.
Based upon the above results, he was referred for surgical
revascularization.

MEDICAL HISTORY: Coronary Artery Disease
Diabetes mellitus type II
Hypertension
Hypercholesterolemia
Chronic back pain
Carotid bruits
s/p Shoulder surgery

MEDICATION ON ADMISSION: Avapro 150 qd, Toprol XL 100 qd, Omeprazole 20 qd, Lipitor 80
qd, Tricor 145 qd,
Avandia 8 qd, Aspirin 81 qd, Coenzyme Q10

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 114/58, HR 54, RR 12, SAT  98 on room air
General: well developed male in no acute distress
HEENT: oropharynx benign,
Neck: supple, no JVD, bilateral carotid bruits noted
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds
Ext: warm, trace edema, no varicosities
Pulses: 1+ distally, bilateral femoral bruits noted
Neuro: nonfocal

FAMILY HISTORY: Denies premature CAD.

SOCIAL HISTORY: 45 pack year history of tobacco, quit approximately 1 month
prior to admission. Denies ETOH. He is a mechanic. Currently
lives with his wife. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Acute kidney failure, unspecified,Unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Mitral valve disorders,Unspecified essential hypertension,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Backache, unspecified'}
