CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 61-year-old female
with a history of exertional chest pain for six months.

MEDICAL HISTORY: 1.  Hypertension.
2.  Asthma.
3.  Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy.
4.  Status post cholecystectomy.
5.  Status post appendectomy.
6.  Status post bladder surgery.

MEDICATION ON ADMISSION: Medications at home included
Norvasc.

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a 45-pack-year smoker.  She
quit two month ago.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Personal history of tobacco use,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Atrial fibrillation,Hypertension NOS,Asthma NOS,History of tobacco use,Abn react-anastom/graft,Accid in resident instit
Admission Date:  [**2183-6-3**]     Discharge Date:  [**2183-6-10**]

Date of Birth:   [**2122-4-20**]     Sex:  F

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  This is a 61-year-old female
with a history of exertional chest pain for six months.

The patient had undergone a stress test on [**6-3**] which was
positive for 2-mm ST depressions in leads V4 and V5 and II,
III, and aVF.  The patient was sent to the Emergency
Department after describing 10/10 chest pain radiating to the
left shoulder.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Asthma.
3.  Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy.
4.  Status post cholecystectomy.
5.  Status post appendectomy.
6.  Status post bladder surgery.

MEDICATIONS ON ADMISSION: Medications at home included
Norvasc.

ALLERGIES:  PENICILLIN.

SOCIAL HISTORY:  The patient is a 45-pack-year smoker.  She
quit two month ago.

PHYSICAL EXAMINATION ON PRESENTATION:  Admission physical
examination revealed heart rate was 66 (sinus rhythm), blood
pressure was 153/91, respiratory rate was 18, and oxygen
saturation was 98% on 2 liters.  The patient was in no
apparent distress.  Alert and oriented times three.  Head,
eyes, ears, nose, and throat examination revealed pupils were
equal, round, and reactive to light.  Extraocular movements
were intact.  Mucous membranes were moist.  The oropharynx
was clear.  The chest was clear to auscultation bilaterally.
Heart examination revealed a regular rate and rhythm.  No
murmurs, rubs, or gallops.  No significant jugular venous
distention.  The abdomen was soft, nontender, and
nondistended.  Cranial nerves II through XII were grossly
intact.  Moved all four extremities equally.  Extremities
revealed 2+ distal pulses with trace pretibial edema.

PERTINENT LABORATORY VALUES ON PRESENTATION:   Laboratory
data revealed white blood cell count was 7.8, hematocrit was
40, and platelet count was 404.  Sodium was 143, potassium
was 4.2, chloride was 106, bicarbonate was 25, blood urea
nitrogen was 20, creatinine was 0.6, and blood glucose was
107.

HOSPITAL COURSE BY ISSUE/SYSTEM:  The patient was admitted to
[**Hospital1 69**] for evaluation of acute
coronary syndrome.

The patient was taken to the Cardiac Catheterization
Laboratory on [**6-3**].  Cardiac catheterization showed normal
left ventricular systolic function and mild left ventricular
diastolic dysfunction with a left ventricular end-diastolic
pressure of 17.  The patient had an 80% left anterior
descending artery lesion and 80% first obtuse marginal
lesion.  A totally occluded mid left circumflex lesion with
distal left circumflex filling via left-to-left and
right-to-left collaterals.  A totally occluded right coronary
artery.

The patient was referred to Cardiothoracic Surgery for
evaluation.  The patient was noted to have a brief history of
a transient ischemic attack about two years ago with
right-sided weakness; lasting about three hours.  The patient
underwent an noninvasive vascular ultrasound of her carotids
which showed no significant stenosis in the right or left
carotid arteries.

The patient was taken to the operating room on [**2183-6-5**]
with Dr. [**Last Name (STitle) 70**] for a coronary artery bypass graft times
three with left internal mammary artery to left anterior
descending artery, saphenous vein graft to diagonal, and
saphenous vein graft to obtuse marginal.  Please see the
Operative Note for further details.

The patient was transferred to the Intensive Care Unit in
stable condition.  Upon arrival to the Intensive Care Unit,
the patient had moderate hypoxia which improved overnight,
and the patient was weaned and extubated from mechanical
ventilation on postoperative day one.  The patient remained
hemodynamically stable on low-dose Neo-Synephrine.  Chest
tubes had minimal drainage.  The patient was started on beta
blockers on postoperative day one, which she tolerated well.
The patient had problems with pain control initially and was
changed from Percocet to Dilaudid with good affect.

On the evening on postoperative day one, the patient had an
episode of rapid atrial fibrillation with rates up to 150.
The patient was given intravenous Lopressor and oral
amiodarone which the patient tolerated well.

The patient was transferred from the Intensive Care Unit to
the regular floor on postoperative day two.  The patient
converted into a sinus rhythm on the morning on postoperative
day two.  The patient remained hemodynamically stable and
tolerating amiodarone and Lopressor.  The patient began
ambulating with Physical Therapy.

On postoperative day three, the patient again had a brief
episode of atrial fibrillation which responded to additional
Lopressor and amiodarone and remained in a sinus rhythm
since.

On postoperative day four, the patient was cleared by
Physical Therapy for discharge to home by walking 500 feet
and climbing one flight of stairs and remaining
hemodynamically stable.  The patient had a low-grade fever on
postoperative day four.  A urinalysis was sent which was
negative.  The patient was encouraged to cough and deep
breathe and was subsequently afebrile.

DISCHARGE DISPOSITION:  The patient was cleared for discharge
to home on postoperative day five.

PHYSICAL EXAMINATION ON DISCHARGE:  Temperature maximum was
99.1, heart rate was 74 (in sinus rhythm); the patient was in
a sinus rhythm for over 24 hours.  Blood pressure was 110/64,
respiratory rate was 18, and oxygen saturation was 92% on
room air.  Weight on [**6-9**] was 79 kilograms.  The patient
was 74 kilograms preoperatively.

LABORATORY VALUES ON DISCHARGE:  White blood cell count was
9.4, hematocrit was 26.1, and platelet count was 444.  Sodium
was 137, potassium was 4.2, chloride was 98, bicarbonate was
32, blood urea nitrogen was 12, creatinine was 0.5, and blood
glucose was 131.  Neurologically, the patient was awake,
alert and oriented times three; nonfocal.  Heart was regular
in rate and rhythm.  No murmurs or rubs.  Respiratory
examination revealed breath sounds were coarse bilaterally.
No wheezes, rhonchi, or rales.  Gastrointestinal revealed
positive bowel sounds.  Soft, nontender, and nondistended.
Tolerating a regular diet.  The sternal incision was clean
and dry.  Steri-Strips were intact.  The sternum was stable.
Right lower extremity vein harvest site was clean and dry.
Steri-Strips were intact, and there was no erythema or
drainage.

MEDICATIONS ON DISCHARGE:
1.  Lopressor 25 mg p.o. twice per day.
2.  Lasix 20 mg p.o. twice per day (times seven days).
3.  Potassium chloride 20 mEq p.o. twice per day (times seven
days).
4.  Colace 100 mg p.o. twice per day.
5.  Zantac 150 mg p.o. twice per day.
6.  Enteric-coated aspirin 325 mg p.o. twice per day.
7.  Dilaudid 2 mg to 4 mg p.o. q.4h. as needed.
8.  Amiodarone 200 mg p.o. twice per day.

DISCHARGE STATUS:  The patient was to be discharged to home.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to follow up with her primary care
physician (Dr. [**Last Name (STitle) 3357**] in one to two weeks.
2.  The patient was to return to [**Hospital Ward Name 121**] Two for a wound check
in two weeks.
3.  The patient was to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] in
five weeks.





                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Last Name (NamePattern1) 52045**]

MEDQUIST36

D:  [**2183-6-9**]  17:59
T:  [**2183-6-10**]  00:25
JOB#:  [**Job Number 52046**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Personal history of tobacco use,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}


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 is a 61-year-old female
with a history of exertional chest pain for six months.

MEDICAL HISTORY: 1.  Hypertension.
2.  Asthma.
3.  Status post total abdominal hysterectomy and bilateral
salpingo-oophorectomy.
4.  Status post cholecystectomy.
5.  Status post appendectomy.
6.  Status post bladder surgery.

MEDICATION ON ADMISSION: Medications at home included
Norvasc.

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a 45-pack-year smoker.  She
quit two month ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Personal history of tobacco use,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}
