CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: This is a 61 year old Chinese male with a one month history of
shortness of breath and orthopnea. In early [**2108-8-3**], he
experienced new onset congestive heart failure. He was admitted
to [**Hospital1 336**] and underwent further evaluation. Echocardiogram was
notable for an LVEF of 15% with 2-3+ aortic insufficiency. SPECT
study found a severe inferior defect consistent with no
significant viability. There was also a moderate-severe
anteroapical defect that had some viability. Subsequent cardiac
catheterization revealed severe three vessel coronary artery
disease with severely depressed left ventricular function.
Coronary angiography showed total occlusion of the left anterior
descending and right coronary arteries while the circumflex had
a 60% lesion. Ventriculogram revealed an LVEF of 20% with 2+
mitral regurgitation. Based on the above results, he was
referred for cardiac surgical intervention.

MEDICAL HISTORY: Congestive heart failure, Ischemic cardiomyopathy, Hypertension,
Mitral regurgitation, History of cholelithiasis - s/p
cholecystectomy

MEDICATION ON ADMISSION: Lisinopril 10 qd, Coreg 3.125 [**Hospital1 **], ASA 325 qd, Lipitor 10 qd,
Iron 325 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP - 122/74, Pulse 57/min, Resp 14/min
Wt - 133 lbs
General - well developed, well nourished male in no acute
distress
Skin - no rashes or lesions, good turgor
HEENT - orpharynx benign
Neck - supple, no JVD
Chest - mostly clear, soft bibasilar rales noted
Heart - regular rate, normal s1s2, soft diastolic murmur noted
Abd - benign
Ext -  warm, no edema
Varicosities - none
Neuro - alert and oriented, cranial nerves grossly intact, FROM,
5/5 strength in all extremities, normal gait, good balance, no
focal deficits noted
Pulses - 1+ distally
Bruit - no carotid or femoral bruits noted

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Quit tobacco over 30 years ago. Denies ETOH. Lives with wife and
son. [**Name (NI) 1403**] at a chinese restaurant.
Mitral valve insufficiency and aortic valve insufficiency,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension
Mitral/aortic val insuff,CHF NOS,Crnry athrscl natve vssl,Hypertension NOS
Admission Date:  [**2108-9-3**]              Discharge Date:   [**2108-9-8**]

Date of Birth:  [**2047-5-31**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
[**2108-9-3**] Aortic valve replacement utilizing 21 millimeter
[**Company 1543**] mosaic porcine heart valve and three vessel coronary
artery bypass grafting(left internal mammary to left anterior
descending, vein graft to obtuse marginal, vein graft to
posterior descending artery).


History of Present Illness:
This is a 61 year old Chinese male with a one month history of
shortness of breath and orthopnea. In early [**2108-8-3**], he
experienced new onset congestive heart failure. He was admitted
to [**Hospital1 336**] and underwent further evaluation. Echocardiogram was
notable for an LVEF of 15% with 2-3+ aortic insufficiency. SPECT
study found a severe inferior defect consistent with no
significant viability. There was also a moderate-severe
anteroapical defect that had some viability. Subsequent cardiac
catheterization revealed severe three vessel coronary artery
disease with severely depressed left ventricular function.
Coronary angiography showed total occlusion of the left anterior
descending and right coronary arteries while the circumflex had
a 60% lesion. Ventriculogram revealed an LVEF of 20% with 2+
mitral regurgitation. Based on the above results, he was
referred for cardiac surgical intervention.

Past Medical History:
Congestive heart failure, Ischemic cardiomyopathy, Hypertension,
Mitral regurgitation, History of cholelithiasis - s/p
cholecystectomy

Social History:
Quit tobacco over 30 years ago. Denies ETOH. Lives with wife and
son. [**Name (NI) 1403**] at a chinese restaurant.

Family History:
No premature coronary artery disease

Physical Exam:
BP - 122/74, Pulse 57/min, Resp 14/min
Wt - 133 lbs
General - well developed, well nourished male in no acute
distress
Skin - no rashes or lesions, good turgor
HEENT - orpharynx benign
Neck - supple, no JVD
Chest - mostly clear, soft bibasilar rales noted
Heart - regular rate, normal s1s2, soft diastolic murmur noted
Abd - benign
Ext -  warm, no edema
Varicosities - none
Neuro - alert and oriented, cranial nerves grossly intact, FROM,
5/5 strength in all extremities, normal gait, good balance, no
focal deficits noted
Pulses - 1+ distally
Bruit - no carotid or femoral bruits noted

Pertinent Results:
[**2108-9-6**] 06:05AM BLOOD WBC-10.2 RBC-3.38* Hgb-10.1* Hct-30.3*
MCV-90 MCH-30.0 MCHC-33.4 RDW-14.5 Plt Ct-83*
[**2108-9-7**] 06:30AM BLOOD Glucose-126* UreaN-33* Creat-1.5* Na-137
K-4.2 Cl-102 HCO3-27 AnGap-12
[**2108-9-7**] 06:30AM BLOOD Mg-2.2

Brief Hospital Course:
Mr. [**Known lastname 724**] was admitted and underwent an aortic valve replacement
utilizing 21 millimeter [**Company 1543**] mosaic porcine heart valve and
three vessel coronary artery bypass grafting(left internal
mammary to left anterior descending, vein graft to obtuse
marginal, vein graft to posterior descending artery). Postop
transesophageal echocardiogram revealed no aortic insufficiency;
there was [**2-5**]+ mitral regurgitation and his jection fraction
continued to be 15%-20% after bypass. Cardiac output, however,
had increased to 3.7 liters per minute whereas it was 2.4 liters
per minute preoperatively. The operation was otherwise
uneventful and he transferred to the CSRU. Within 24 hours, he
awoke neurologically intact and was extubated. He weaned from
intravenous therapy without complication. He was then
transferred to the floor in stable condition and continued to
progress.  He was restarted on an ACE and Coreg and was d/c'd to
home on POD#5.

Medications on Admission:
Lisinopril 10 qd, Coreg 3.125 [**Hospital1 **], ASA 325 qd, Lipitor 10 qd,
Iron 325 qd

Discharge Medications:
1. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
2. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. 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*
5. Ferrous Gluconate 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
7. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 10
days.
Disp:*40 Capsule, Sustained Release(s)* Refills:*0*
8. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 10 days.
Disp:*20 Tablet(s)* Refills:*0*
9. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 1952**], [**Location (un) 86**]

Discharge Diagnosis:
Congestive Heart Failure, Ischemic Cardiomyopathy, Coronary
artery disease, Aortic insufficiency, Hypertension, s/p Aortic
valve replacement utilizing 21 millimeter [**Company 1543**] mosaic
porcine heart valve and three vessel coronary artery bypass
grafting(left internal mammary to left anterior descending, vein
graft to obtuse marginal, vein graft to posterior descending
artery).


Discharge Condition:
Stable, good.

Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for one month. Lift restrictions - no more
than 10 lbs for 10 weeks.

Followup Instructions:
Dr. [**Last Name (STitle) **] in 4 weeks
Dr. [**First Name (STitle) **] [**Name (STitle) **](PCP)in 2 weeks
Local cardiologist in 2 weeks



Completed by:[**2108-9-8**]
{'Mitral valve insufficiency and aortic valve insufficiency,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}


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: This is a 61 year old Chinese male with a one month history of
shortness of breath and orthopnea. In early [**2108-8-3**], he
experienced new onset congestive heart failure. He was admitted
to [**Hospital1 336**] and underwent further evaluation. Echocardiogram was
notable for an LVEF of 15% with 2-3+ aortic insufficiency. SPECT
study found a severe inferior defect consistent with no
significant viability. There was also a moderate-severe
anteroapical defect that had some viability. Subsequent cardiac
catheterization revealed severe three vessel coronary artery
disease with severely depressed left ventricular function.
Coronary angiography showed total occlusion of the left anterior
descending and right coronary arteries while the circumflex had
a 60% lesion. Ventriculogram revealed an LVEF of 20% with 2+
mitral regurgitation. Based on the above results, he was
referred for cardiac surgical intervention.

MEDICAL HISTORY: Congestive heart failure, Ischemic cardiomyopathy, Hypertension,
Mitral regurgitation, History of cholelithiasis - s/p
cholecystectomy

MEDICATION ON ADMISSION: Lisinopril 10 qd, Coreg 3.125 [**Hospital1 **], ASA 325 qd, Lipitor 10 qd,
Iron 325 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: BP - 122/74, Pulse 57/min, Resp 14/min
Wt - 133 lbs
General - well developed, well nourished male in no acute
distress
Skin - no rashes or lesions, good turgor
HEENT - orpharynx benign
Neck - supple, no JVD
Chest - mostly clear, soft bibasilar rales noted
Heart - regular rate, normal s1s2, soft diastolic murmur noted
Abd - benign
Ext -  warm, no edema
Varicosities - none
Neuro - alert and oriented, cranial nerves grossly intact, FROM,
5/5 strength in all extremities, normal gait, good balance, no
focal deficits noted
Pulses - 1+ distally
Bruit - no carotid or femoral bruits noted

FAMILY HISTORY: No premature coronary artery disease

SOCIAL HISTORY: Quit tobacco over 30 years ago. Denies ETOH. Lives with wife and
son. [**Name (NI) 1403**] at a chinese restaurant. 

### Response:
{'Mitral valve insufficiency and aortic valve insufficiency,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension'}
