CHIEF COMPLAINT: dyspnea on exertion

PRESENT ILLNESS: The patient is a 63 year old white male with multiple risk
factors for coronary disease.  In [**2192-6-3**] he developed dyspnea
on exertion.  Echo at the time revealed EF 35-40%.  He delayed
follow up.  In [**2193-3-3**], Cardiolite ETT revealed a moderate
sized, severe inferobasilar predominantly fixed defect with a
small edge of peri-infarct ischemia.  Cardiac catheterization
and coronary angiography on [**2193-4-18**] revealed 2 vessel disease.
He was referred for surgical revascularization.

MEDICAL HISTORY: cardiomyopathy (LVEF 35-40%)
hypertension
hyperlipidemia
diabetes mellitus
chronic obstructive pulmonary disease
pneumonia [**2183**]
persistent epistaxis, s/p surgical clipping
cervical and lumbar disc disease s/p fall [**2176**]

MEDICATION ON ADMISSION: methocarbamol 750''''
glipizide 10''
furosemide 20'
KCl 10'
lisinopril 20'
avandia 4'
doxazosin 1'
diazepam 10prn
metformin 1000''
vicodin prn
advair 100/50 one puff ''
proair 90, 2 puffs ''''prn
ECASA 325'
simvastatin 40'
vitamin c 500'

ALLERGIES: Keflex / Cleocin Hcl

PHYSICAL EXAM: VS: 82, 16, 93%RA, 137/80
Wt: 270lb  ht: 6'1"
Skin: dry, intact
HEENT: PERRL, EOMI
Neck: supple with full ROM
Chest: lungs CTAB with distant breath sounds throughout
Heart: RRR, no murmur
Abd: soft, non-tender, non-distended, +bowel sounds
Ext: warm, well-perfused, no varicosities
Neuro: grossly intact
pulses: 2+ bilaterally throughout
Carotid Bruits: none

FAMILY HISTORY: brother with possible congenital heart disorder- died at 55 in
military service

SOCIAL HISTORY: worked as computer software designer
currently disabled
married with 2 grown children
lives with wife
[**Name (NI) 1139**]: 2.5ppd x 40 yrs., quit [**2183**]
EtOH: 2 drinks per week
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other primary cardiomyopathies,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Intermed coronary synd,Prim cardiomyopathy NEC,Chr airway obstruct NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2193-4-26**]              Discharge Date:   [**2193-5-1**]

Date of Birth:  [**2129-8-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Keflex / Cleocin Hcl

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
dyspnea on exertion

Major Surgical or Invasive Procedure:
coronary artery bypass x3 (LIMA-LAD, SVG-diag, SVG-Cx)


History of Present Illness:
The patient is a 63 year old white male with multiple risk
factors for coronary disease.  In [**2192-6-3**] he developed dyspnea
on exertion.  Echo at the time revealed EF 35-40%.  He delayed
follow up.  In [**2193-3-3**], Cardiolite ETT revealed a moderate
sized, severe inferobasilar predominantly fixed defect with a
small edge of peri-infarct ischemia.  Cardiac catheterization
and coronary angiography on [**2193-4-18**] revealed 2 vessel disease.
He was referred for surgical revascularization.

Past Medical History:
cardiomyopathy (LVEF 35-40%)
hypertension
hyperlipidemia
diabetes mellitus
chronic obstructive pulmonary disease
pneumonia [**2183**]
persistent epistaxis, s/p surgical clipping
cervical and lumbar disc disease s/p fall [**2176**]

Social History:
worked as computer software designer
currently disabled
married with 2 grown children
lives with wife
[**Name (NI) 1139**]: 2.5ppd x 40 yrs., quit [**2183**]
EtOH: 2 drinks per week

Family History:
brother with possible congenital heart disorder- died at 55 in
military service


Physical Exam:
VS: 82, 16, 93%RA, 137/80
Wt: 270lb  ht: 6'1"
Skin: dry, intact
HEENT: PERRL, EOMI
Neck: supple with full ROM
Chest: lungs CTAB with distant breath sounds throughout
Heart: RRR, no murmur
Abd: soft, non-tender, non-distended, +bowel sounds
Ext: warm, well-perfused, no varicosities
Neuro: grossly intact
pulses: 2+ bilaterally throughout
Carotid Bruits: none

Pertinent Results:
[**2193-4-26**] 11:18AM BLOOD WBC-11.9*# RBC-3.76* Hgb-10.7* Hct-31.7*
MCV-84 MCH-28.4 MCHC-33.7 RDW-14.1 Plt Ct-210
[**2193-4-27**] 04:00AM BLOOD Glucose-82 UreaN-14 Creat-0.9 Na-142
K-4.3 Cl-112* HCO3-24 AnGap-10



[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname 82543**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 82544**]
(Complete) Done [**2193-4-26**] at 9:07:44 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2129-8-30**]
Age (years): 63 M  Hgt (in): 73
BP (mm Hg): 124/65  Wgt (lb): 266
HR (bpm): 71  BSA (m2): 2.43 m2
Indication: Left ventricular function. Intraop TEE for elective
CABG. Abnormal ECG. Chest pain. Coronary artery disease.
Hypertension. Left ventricular function.
ICD-9 Codes: 414.8, 424.0, 424.2
Test Information
Date/Time: [**2193-4-26**] at 09:07    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5209**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW33-: Machine: [**Doctor Last Name **]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Ascending:  *3.5 cm  <= 3.4 cm

Findings
LEFT ATRIUM: LA not well visualized. No spontaneous echo
contrast in the body of the LA. No mass/thrombus in the [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]
LAA. No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: PFO is present. Left-to-right
shunt across the interatrial septum at rest.

LEFT VENTRICLE: Normal LV wall thickness, cavity size, and
global systolic function (LVEF>55%). Normal regional LV systolic
function.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Mildly dilated ascending aorta. Simple atheroma in aortic
arch. Simple atheroma in descending aorta.

AORTIC VALVE: Three aortic valve leaflets. Mildly thickened
aortic valve leaflets (3). No AS. No AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. No MS.
Mild (1+) MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR.

GENERAL COMMENTS: The patient was under general anesthesia
throughout the procedure. The patient received antibiotic
prophylaxis. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications. The patient appears to be in sinus rhythm.
Houseofficer caring for the patient was notified of the results
by e-mail. See Conclusions for post-bypass data The post-bypass
study was performed while the patient was receiving vasoactive
infusions (see Conclusions for listing of medications).
Conclusions
No spontaneous echo contrast is seen in the body of the left
atrium. No mass/thrombus is seen in the left atrium or left
atrial appendage. No spontaneous echo contrast is seen in the
left atrial appendage. A patent foramen ovale is present. A
left-to-right shunt across the interatrial septum is seen at
rest. Left ventricular wall thickness, cavity size, and global
systolic function are normal (LVEF>55%). Regional left
ventricular wall motion is normal. Right ventricular chamber
size and free wall motion are normal. The ascending aorta is
mildly dilated. There are simple atheroma in the aortic arch.
There are simple atheroma in the descending thoracic aorta.
There are three aortic valve leaflets. The aortic valve leaflets
(3) are mildly thickened. There is no aortic valve stenosis. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. Mild (1+) mitral regurgitation is seen.

POST-BYPASS: For the post-bypass study, the patient was
receiving vasoactive infusions including phenylephrine.
Preserved biventricular systolic function post cpb. Anterior
wall is improved. Aortic contour is normal post decannulation..

  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 5209**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2193-4-26**] 16:15


?????? [**2187**] CareGroup IS. All rights reserved.


Brief Hospital Course:
The patient was admitted to the hospital and brought to the
operating room on [**2193-4-26**] where he underwent coronary artery
bypass x 3.  Overall the patient tolerated the procedure well
and post-operatively was transferred to CVICU in good condition
for invasive monitoring and recovery.  POD 1 found the patient
extubated, alert and oriented and breathing comfortably.  He was
neurologically intact and hemodynamically stable on no inotropic
or vasopressor support at this time.  Chest tubes and pacing
wires were discontinued in the usual fashion without
complication.  The patient was transferred to the telemetry
floor on POD 1.  Beta blocker was started and the patient was
gently diuresed toward his preoperative weight.  The physical
therapy service was consulted for assistance with post-operative
strength and mobility.  Hospital course was uneventful and the
patient was discharged home in good condition on POD #4.  By the
time of discharge he was ambulating freely, the wound was
healing and pain was controlled with oral analgesics.  He was
given appropriate follow up instructions.

Medications on Admission:
methocarbamol 750''''
glipizide 10''
furosemide 20'
KCl 10'
lisinopril 20'
avandia 4'
doxazosin 1'
diazepam 10prn
metformin 1000''
vicodin prn
advair 100/50 one puff ''
proair 90, 2 puffs ''''prn
ECASA 325'
simvastatin 40'
vitamin c 500'

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 7 days: then decrease to 20mg daily ongoing.
Disp:*44 Tablet(s)* Refills:*1*
2. Glipizide 5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
3. Rosiglitazone 2 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Methocarbamol 500 mg Tablet Sig: 1.5 Tablets PO QID (4 times
a day) as needed.
5. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed.
Disp:*65 Tablet(s)* Refills:*0*
6. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Doxazosin 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

8. 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*
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Potassium Chloride 10 mEq Capsule, Sustained Release Sig:
One (1) Capsule, Sustained Release PO once a day: start on
[**2193-5-8**].
13. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a
day.
14. ProAir HFA 90 mcg/Actuation HFA Aerosol Inhaler Sig: Two (2)
puffs Inhalation four times a day.
15. Fluticasone-Salmeterol 100-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
coronary artery disease
PMH: hypertension
hyperlipidemia
diabetes mellitus
chronic obstructive pulmonary disease
cervical and lumbar disc disease- s/p fall
persistent epistaxis s/p surgical clipping


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month, and while taking
narcotics
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr. [**Last Name (STitle) 914**] in 4 weeks ([**Telephone/Fax (1) 170**])
Dr. [**Last Name (STitle) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 275**] [**Telephone/Fax (1) 6699**] in 1 week
Dr. [**Last Name (STitle) **] in [**2-5**] weeks
Please call for appointments
Wound check appointment [**Hospital Ward Name 121**] 6 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2193-4-30**]

Name:  [**Known lastname 13203**],[**Known firstname 1340**]                Unit No:   [**Numeric Identifier 13204**]

Admission Date:  [**2193-4-26**]              Discharge Date:   [**2193-5-1**]

Date of Birth:  [**2129-8-30**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Keflex / Cleocin Hcl

Attending:[**First Name3 (LF) 1543**]
Addendum:
Prior to discharge on [**4-30**], evidence of minimal , serous
drainage from Mr. [**Known lastname 13205**] sternotomy incision was observed. He
was kept in hospital for observation x 24hours. [**5-1**] on physical
exam no drainage could be expressed, incision was
clean/dry/intact, no erythema was evident. Dr.[**Last Name (STitle) **] cleared
him for discharge to home with VNA. Mr.[**Known lastname **] was instructed to
contact [**Name (NI) **] 6 or Dr[**Last Name (STitle) 13206**] office if any signs or symptoms
of worsening sternal drainage/infection evident. All follow up
appointments were instructed.

Major Surgical or Invasive Procedure:
coronary artery bypass x3 (LIMA-LAD, SVG-diag, SVG-Cx)


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 328**] VNA

                             [**First Name11 (Name Pattern1) 33**] [**Last Name (NamePattern4) 1544**] MD [**MD Number(2) 1545**]

Completed by:[**2193-5-1**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other primary cardiomyopathies,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: The patient is a 63 year old white male with multiple risk
factors for coronary disease.  In [**2192-6-3**] he developed dyspnea
on exertion.  Echo at the time revealed EF 35-40%.  He delayed
follow up.  In [**2193-3-3**], Cardiolite ETT revealed a moderate
sized, severe inferobasilar predominantly fixed defect with a
small edge of peri-infarct ischemia.  Cardiac catheterization
and coronary angiography on [**2193-4-18**] revealed 2 vessel disease.
He was referred for surgical revascularization.

MEDICAL HISTORY: cardiomyopathy (LVEF 35-40%)
hypertension
hyperlipidemia
diabetes mellitus
chronic obstructive pulmonary disease
pneumonia [**2183**]
persistent epistaxis, s/p surgical clipping
cervical and lumbar disc disease s/p fall [**2176**]

MEDICATION ON ADMISSION: methocarbamol 750''''
glipizide 10''
furosemide 20'
KCl 10'
lisinopril 20'
avandia 4'
doxazosin 1'
diazepam 10prn
metformin 1000''
vicodin prn
advair 100/50 one puff ''
proair 90, 2 puffs ''''prn
ECASA 325'
simvastatin 40'
vitamin c 500'

ALLERGIES: Keflex / Cleocin Hcl

PHYSICAL EXAM: VS: 82, 16, 93%RA, 137/80
Wt: 270lb  ht: 6'1"
Skin: dry, intact
HEENT: PERRL, EOMI
Neck: supple with full ROM
Chest: lungs CTAB with distant breath sounds throughout
Heart: RRR, no murmur
Abd: soft, non-tender, non-distended, +bowel sounds
Ext: warm, well-perfused, no varicosities
Neuro: grossly intact
pulses: 2+ bilaterally throughout
Carotid Bruits: none

FAMILY HISTORY: brother with possible congenital heart disorder- died at 55 in
military service

SOCIAL HISTORY: worked as computer software designer
currently disabled
married with 2 grown children
lives with wife
[**Name (NI) 1139**]: 2.5ppd x 40 yrs., quit [**2183**]
EtOH: 2 drinks per week 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other primary cardiomyopathies,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
