CHIEF COMPLAINT: 

PRESENT ILLNESS: This 47 year old male underwent
coronary bypass grafting times three in [**2118-6-9**], and now
has onset of shortness of breath and increasing fatigue since
[**2118-8-10**].  He had an echocardiogram which showed three
to four plus mitral regurgitation and he is now admitted, was
seen preoperatively by Dr. [**Last Name (Prefixes) **] for mitral valve
replacement.  Cardiac catheterization showed venous left
anterior descending coronary artery with 70 to 80 percent
stenosis, vein graft to the obtuse marginal two with 80
percent stenosis, patent vein graft to the posterior
descending coronary artery, ejection fraction 25 to 30
percent, occluded left coronary artery, global hypokinesis,
three to four plus mitral regurgitation, 100 percent native
left anterior descending coronary artery, 70 to 80 percent
native circumflex and obtuse marginal one 99 percent lesion.
Echocardiogram showed global hypokinesis, inferior akinesis,
ejection fraction 30 percent, three to four plus mitral
regurgitation and trace tricuspid regurgitation.

MEDICAL HISTORY: Status post coronary artery bypass
graft times three in [**2118-6-9**].

MEDICATION ON ADMISSION: 1. Aspirin 325 mg p.o. daily.
2. Lisinopril 10 mg p.o. daily.
3. Toprol 25 mg p.o. daily.
4. Lipitor 40 mg p.o. daily.
5. Plavix 75 mg p.o. daily.
6. Bupropion SR 150 mg p.o. twice a day for smoking
   cessation.
7. Vitamin B1 10 mg p.o. daily.

ALLERGIES: He had no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is currently unemployed.  He had
a thirty pack year history of smoking four to five cigarettes
a day right at this time although the patient admits that he
is cutting down.  He also admits to a couple of beers per
week.
Mitral valve disorders,Urinary complications, not elsewhere classified,Retention of urine, unspecified,Fitting and adjustment of automatic implantable cardiac defibrillator,Aortocoronary bypass status,Old myocardial infarction,Shortness of breath
Mitral valve disorder,Surg compl-urinary tract,Retention urine NOS,Ftng autmtc dfibrillator,Aortocoronary bypass,Old myocardial infarct,Shortness of breath
Admission Date: [**2118-11-14**]        Discharge Date: [**2118-11-20**]

Date of Birth:  [**2075-8-18**]        Sex:  M

Service:


HI[**Last Name (STitle) 2710**]OF PRESENT ILLNESS:  This 47 year old male underwent
coronary bypass grafting times three in [**2118-6-9**], and now
has onset of shortness of breath and increasing fatigue since
[**2118-8-10**].  He had an echocardiogram which showed three
to four plus mitral regurgitation and he is now admitted, was
seen preoperatively by Dr. [**Last Name (Prefixes) **] for mitral valve
replacement.  Cardiac catheterization showed venous left
anterior descending coronary artery with 70 to 80 percent
stenosis, vein graft to the obtuse marginal two with 80
percent stenosis, patent vein graft to the posterior
descending coronary artery, ejection fraction 25 to 30
percent, occluded left coronary artery, global hypokinesis,
three to four plus mitral regurgitation, 100 percent native
left anterior descending coronary artery, 70 to 80 percent
native circumflex and obtuse marginal one 99 percent lesion.
Echocardiogram showed global hypokinesis, inferior akinesis,
ejection fraction 30 percent, three to four plus mitral
regurgitation and trace tricuspid regurgitation.

PAST MEDICAL HISTORY:  Status post coronary artery bypass
graft times three in [**2118-6-9**].

Elevated lipids.

Hypertension.

Ankle surgery.

ICD placement 11/[**2117**].

Percutaneous transluminal coronary angioplasty with stents
times three in [**2118-8-10**].

MEDICATIONS ON ADMISSION:
1. Aspirin 325 mg p.o. daily.
2. Lisinopril 10 mg p.o. daily.
3. Toprol 25 mg p.o. daily.
4. Lipitor 40 mg p.o. daily.
5. Plavix 75 mg p.o. daily.
6. Bupropion SR 150 mg p.o. twice a day for smoking
   cessation.
7. Vitamin B1 10 mg p.o. daily.


ALLERGIES:  He had no known allergies.

SOCIAL HISTORY:  The patient is currently unemployed.  He had
a thirty pack year history of smoking four to five cigarettes
a day right at this time although the patient admits that he
is cutting down.  He also admits to a couple of beers per
week.

Cardiac MR performed [**2118-10-13**], showed a left ventricular
ejection fraction of 55 percent, a forward left ventricular
ejection fraction of 30 percent, right ventricular ejection
fraction of 59 percent, moderate to severe mitral
regurgitation, mild to moderate tricuspid regurgitation and
descending thoracic aorta diameter was 29 with global
hypokinesis.

Preoperative laboratories were as follows:  Urinalysis was
negative.  ALT 24, AST 23, alkaline phosphatase 112, total
bilirubin 0.5, total protein 8.5, albumin 4.9, globulin 3.6,
hemoglobin A1C 5.7 percent.  Prothrombin time 12.8, partial
thromboplastin time 28.2 and INR 1.0.  Sodium 137, potassium
4.5, chloride 99, bicarbonate 25, blood urea nitrogen 22,
creatinine 1.1 with a blood sugar of 78.  White blood cell
count 8.9, hematocrit 43.8.  Electrocardiogram showed sinus
bradycardia at 59 beats per minute.  Chest x-ray showed
interval placement of right ventricular ICD lead, as well as
decreasing left base lung atelectasis.

PHYSICAL EXAMINATION:  On examination, the patient is five
feet nine inches tall, 190 pounds, oxygen saturation 96
percent in room air, in sinus rhythm at 67 beats per minute
with a blood pressure of 133/86.  He came into the office in
no apparent distress.  His skin was warm and dry with normal
skin tone.  Extraocular movements were intact.  No jugular
venous distention or carotid bruits.  Lungs were clear
bilaterally.  His heart was regular rate and rhythm with S1
and S2 tones and grade II/VI systolic ejection murmur heard
best at the apex.  His abdomen was soft, round, nontender,
nondistended, with positive bowel sounds.  Extremities were
warm and well perfused with no edema.  He had no varicosities
apparent.  He was alert and oriented times three and
appropriate and grossly neurologically intact.  He had
bilateral two plus dorsalis pedis, posterior tibial and
radial pulses.  No carotid bruit was heard.

HO[**Last Name (STitle) **] COURSE:  The patient was seen preoperatively on
[**2118-11-11**], in the office and was admitted for his surgery on
[**2118-11-14**].  Dr. [**Last Name (Prefixes) **] performed a redo sternotomy with
mitral valve replacement with 27 millimeter [**Last Name (un) 3843**]-
[**Doctor Last Name **] bioprosthesis.  The patient was transferred to the
Cardiothoracic Intensive Care Unit in stable condition on a
Lidocaine drip of 2 mg a minute, Neo-Synephrine drip at 0.3
mcg/kg/minute, Epinephrine drip at 0.01 mcg/kg/minute and
titrated Propofol drip. On postoperative day number one, the
patient had a blood pressure of 109/65, remained ventilated
in sinus rhythm at 73 beats per minute on an Epinephrine drip
at 0.01, Neo-Synephrine drip at 0.6 and insulin drip at 2
units per hour and Lidocaine drip at 2.0.  Epinephrine was
discontinued during the day.  Swan remained in and the
patient remained intubated and sedated.  When he was off
sedation, he was moving all extremities.  He had coarse
breath sounds bilaterally with the plan to extubate him and
try and cut back on his drips in preparation for extubation.
He was also seen by electrophysiology service.  His ICD
detectors were turned off.  The patient was left on VVI.
They evaluated his pacer and then did postoperative
interrogation.  Detection was turned on and VVI was set at 40
and it was determined that the ICD single chamber was
normally functioning.  On postoperative day number two, the
patient had been extubated and an ejection fraction of
approximately 40 percent.  Blood pressure 103/60 and sinus
rhythm in the 70s, oxygen saturation 97 percent on nasal
cannula.  Started Aspirin and his oral Plavix as well as
Lasix diuresis.  Neo-Synephrine was weaned to off.  He
started on low dose beta blockers.  Chest tubes and Swan-Ganz
were discontinued and his Precedex was discontinued.  The
patient ask for a pain service consultation.  This was
determined by the team to be placed on the back burner at the
time.  The patient was making adequate urine.  His
postoperative hematocrit was 26, and a chest x-ray was
ordered.  On postoperative day number three, he continued
Plavix, Lopressor and Lasix and he was off all drips.  He was
changed over to Toprol.  His chest tubes were discontinued
and his pacing wires were discontinued.  The patient
continued to have a slight oxygen requirement and he was
transferred out to the floor.  He was also started on Flomax.
Foley was replaced for retention and was left in.  Repeat
chest x-ray showed a right lung base effusion.  The patient
had an oxygen requirement.  Beta blocker was changed over to
Toprol.  The patient was transferred out to the floor later
in the day.  The patient was transferred out to the floor and
began to work with physical therapy.  He was also seen by
case management in an effort to get him to improve his
pulmonary toilet and start increasing his activity level.
His creatinine remained stable at 0.9.  He was on Toprol XL
at 25 and continued with his Plavix.  His p.o. intake was
limited.  The patient was managed with p.o. pain medications
on the floor, continued to work with physical therapy, made
excellent progress on postoperative day number five.  He
continued with Flomax and he was encouraged to ambulate and
increase his p.o. intake.  His pacing wires were discontinued
without any incident and discharge planning was begun.  The
patient was also started on Thiamine and was receiving some
Dilaudid p.r.n. for pain, as well as starting on some Flovent
and Combivent to aid in his pulmonary status.  The patient
also was given a little bit of Ativan to help him with his
Dilaudid, to decrease his anxiety and increase his pain
relief.  He had some right basilar crackles and was getting
nebulizer treatments as previously stated.  He continued to
improve on the floor.  On postoperative day number six, his
weight was down to 87.2 kilograms and he was hemodynamically
stable.  He was doing very well and was discharged to home
with VNA services.  He was noted to have a small ridge noted
on his incision but this was not deemed to be necessary to
hold up his discharge and he was discharged to home on
[**2118-11-20**].

DISCHARGE DIAGNOSES:  Status post redo sternotomy and mitral
valve replacement.

Status post coronary artery disease [**2118-6-9**].

Elevated lipids.

Hypertension.

Ankle surgery.

ICD placed 11/[**2117**].

Percutaneous transluminal coronary angioplasty with three
stents 09/[**2117**].

DI[**Last Name (STitle) 408**]E INSTRUCTIONS:  The patient was instructed to follow-
up with Dr. [**Last Name (Prefixes) **] and see him in the office at
approximately four weeks postoperatively for his
postoperative surgical visit.  He was also instructed to
follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 12300**] for his postoperative visit
in one to two weeks, [**Telephone/Fax (1) 58104**].

MEDICATIONS ON DISCHARGE:
1. Lasix 20 mg p.o. twice a day for seven days.
2. Potassium Chloride 20 mEq p.o. twice a day for seven days.
3. Colace 100 mg p.o. twice a day.
4. Enteric Coated Aspirin 81 mg p.o. one daily.
5. Plavix 75 mg p.o. daily.
6. Dilaudid 2 mg tablets, dispense one to two tablets p.o.
   p.r.n. q4-6hours for pain as needed.
7. Albuterol/Ipratropium 103/118 mcg aerosol two puffs
   inhalation q6hours.
8. Fluticasone Propionate 110 mcg aerosol two puffs twice a
   day inhalation.
9. Ibuprofen 600 mg p.o. q6hours as needed for pain.
10.      Metoprolol 50 mg p.o. sustained release one daily.
11.      Tamsulosin Hydrochloride 0.4 mg sustained release
   p.o. daily at bedtime.
12.      Bupropion 150 mg sustained release p.o. twice a day
   for smoking cessation.


CONDITION ON DISCHARGE:  Again, the patient was discharged
home in stable condition on [**2118-11-20**].



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2119-1-31**] 16:47:43
T:  [**2119-1-31**] 20:25:44
Job#:  [**Job Number 58105**]
{'Mitral valve disorders,Urinary complications, not elsewhere classified,Retention of urine, unspecified,Fitting and adjustment of automatic implantable cardiac defibrillator,Aortocoronary bypass status,Old myocardial infarction,Shortness of breath'}


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: 

PRESENT ILLNESS: This 47 year old male underwent
coronary bypass grafting times three in [**2118-6-9**], and now
has onset of shortness of breath and increasing fatigue since
[**2118-8-10**].  He had an echocardiogram which showed three
to four plus mitral regurgitation and he is now admitted, was
seen preoperatively by Dr. [**Last Name (Prefixes) **] for mitral valve
replacement.  Cardiac catheterization showed venous left
anterior descending coronary artery with 70 to 80 percent
stenosis, vein graft to the obtuse marginal two with 80
percent stenosis, patent vein graft to the posterior
descending coronary artery, ejection fraction 25 to 30
percent, occluded left coronary artery, global hypokinesis,
three to four plus mitral regurgitation, 100 percent native
left anterior descending coronary artery, 70 to 80 percent
native circumflex and obtuse marginal one 99 percent lesion.
Echocardiogram showed global hypokinesis, inferior akinesis,
ejection fraction 30 percent, three to four plus mitral
regurgitation and trace tricuspid regurgitation.

MEDICAL HISTORY: Status post coronary artery bypass
graft times three in [**2118-6-9**].

MEDICATION ON ADMISSION: 1. Aspirin 325 mg p.o. daily.
2. Lisinopril 10 mg p.o. daily.
3. Toprol 25 mg p.o. daily.
4. Lipitor 40 mg p.o. daily.
5. Plavix 75 mg p.o. daily.
6. Bupropion SR 150 mg p.o. twice a day for smoking
   cessation.
7. Vitamin B1 10 mg p.o. daily.

ALLERGIES: He had no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is currently unemployed.  He had
a thirty pack year history of smoking four to five cigarettes
a day right at this time although the patient admits that he
is cutting down.  He also admits to a couple of beers per
week. 

### Response:
{'Mitral valve disorders,Urinary complications, not elsewhere classified,Retention of urine, unspecified,Fitting and adjustment of automatic implantable cardiac defibrillator,Aortocoronary bypass status,Old myocardial infarction,Shortness of breath'}
