CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 50 year old
male with a past medical history of psoriasis who presented
to an outside hospital complaining of chest pain of one day
duration.  He was watching a baseball game the night prior to
admission and initially felt a left arm numbness with several
twinges of chest discomfort.  There was no nausea and
vomiting that was associated.  When the patient presented to
the outside hospital the patient was ruled out for an acute
myocardial infarction by enzyme and received medical
treatment and was chest pain free.  He underwent an exercise
tolerance test which showed a 1 mm ST segment depression in
Lead 2, 3 and AVF, and ST segment depression in V1 through V6
with T wave inversion during the recovery period.  Given this
positive exercise tolerance test, the patient was transferred
to the [**Hospital6 256**] for cardiac
catheterization.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Ventricular fibrillation,Atrioventricular block, complete,Acute myocardial infarction of inferoposterior wall, initial episode of care,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,Other psoriasis
Crnry athrscl natve vssl,Surg compl-heart,Ventricular fibrillation,Atriovent block complete,AMI inferopost, initial,Abn react-anastom/graft,Accid in resident instit,Other psoriasis
Admission Date:  [**2135-11-4**]       Discharge Date:  [**2135-11-12**]

Date of Birth:   [**2085-5-12**]       Sex:  M

Service:  Cardiac Surgery Service

HISTORY OF PRESENT ILLNESS:  The patient is a 50 year old
male with a past medical history of psoriasis who presented
to an outside hospital complaining of chest pain of one day
duration.  He was watching a baseball game the night prior to
admission and initially felt a left arm numbness with several
twinges of chest discomfort.  There was no nausea and
vomiting that was associated.  When the patient presented to
the outside hospital the patient was ruled out for an acute
myocardial infarction by enzyme and received medical
treatment and was chest pain free.  He underwent an exercise
tolerance test which showed a 1 mm ST segment depression in
Lead 2, 3 and AVF, and ST segment depression in V1 through V6
with T wave inversion during the recovery period.  Given this
positive exercise tolerance test, the patient was transferred
to the [**Hospital6 256**] for cardiac
catheterization.

The [**Hospital 228**] medical history is significant only for
psoriasis.  The patient denies any allergies to medications
and does not take any medications at home.

The patient's social history is not significant and he denies
any tobacco.  The patient occasionally drinks alcohol.

The family history is not significant for any coronary artery
disease.

PHYSICAL EXAMINATION:  On physical examination on admission,
the patient was afebrile at 98.0, heartrate 66, blood
pressure 134/61, respiratory rate 20, sating 94% on room air.
The patient was lying comfortably in bed, alert and oriented
times three, not in apparent distress.  Head, eyes, ears,
nose and throat examination showed the pupils equally round
and reactive to light and accommodation with extraocular
movements intact.  The neck was supple, no jugulovenous
distension.  The chest examination was clear to auscultation
bilaterally.  The cardiac examination was regular rate and
rhythm with S1 and S2, no murmurs were appreciated.  The
abdominal examination was with good bowel sounds, soft,
nontender, nondistended.  Extremities were warm without any
evidence of edema, cyanosis or clubbing.  Neurologically the
patient's cranial nerves II through XII were grossly intact
and the patient did not have any gross motor or sensory
deficits.

LABORATORY DATA:  Laboratory data on admission revealed white
count 8.1, hematocrit 40.4, platelet of 314.  PT/PTT were
12.6 and 24.2 respectively with an INR of 1.1.  Chemistry,
sodium 134, potassium 3.7, chloride 103, carbon dioxide 22,
BUN 10, creatinine 0.7 and glucose 111.  ..................
was 30.  Alkaline phosphatase was 51, total bilirubin 0.8,
amylase 45.  Chest x-ray at the outside hospital showed no
infiltrates or consolidations in the lung fields and there
were no pulmonary effusions noted.  The patient underwent a
cardiac catheterization on [**2135-11-4**] and was found to
have a hazy 70% proximal stenosis of the left anterior
descending and a 90% stenosis of the proximal left circumflex
involving the origin of the obtuse marginal 1 and an 80%
distal stenosis of the left circumflex involving the origin
of obtuse marginal 3.  There was no significant disease
reported in the nondominant right coronary artery.  The left
ventriculogram showed no mitral regurgitation and calculated
ejection fraction was 45%.  There was mild diffuse
hypokinesis that was noted.

HOSPITAL COURSE:  Given the extent of the disease process of
the left circumflex artery (the proximal segment with obtuse
marginal 1 and the distal segment with obtuse marginal 3),
the patient essentially had a three vessel disease and
cardiac surgery consult was called.




                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 10201**]
MEDQUIST36

D:  [**2135-11-24**]  21:04
T:  [**2135-11-24**]  22:51
JOB#:  [**Job Number 50650**]


Name:  [**Known lastname 9396**], [**Known firstname 9397**]                     Unit No:  [**Numeric Identifier 9398**]

Admission Date:  [**2135-11-4**]     Discharge Date:  [**2135-11-12**]

Date of Birth:   [**2085-5-12**]     Sex:  M

Service:  Cardiac Surgery Service

By postoperative day #2 the patient did not have further
arrhythmias or ventricular ectopies with volume resuscitation
with crystalloid and colloid.  The patient was taken off the
nitroglycerin drip and started on p.o. Imdur and the patient
was taken off of the Levophed drip with good maintenance of
blood pressure.  The patient was continued on Amiodarone drip
through postoperative day #3 and the patient was carefully
monitored for arrhythmias and ectopies.  With the volume
resuscitation the patient did not have any further
arrhythmias from postoperative day #2 on.  On postoperative
day #4 the patient was transferred out of Cardiac Surgery
Recovery Unit to the regular floor.  On the floor the patient
was monitored with Telemetry and was found to have occasional
brief runs of ventricular ectopy, the electrophysiology
service was again consulted.  After evaluation, the patient
was found to be in stable condition and was discharged on
postoperative day #5 given the fact that the patient was able
to undergo all steps of physical therapy requirements.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE DISPOSITION:  Home.

DISCHARGE DIAGNOSIS:  Coronary artery disease, three vessel
disease status post coronary artery bypass graft, left
internal mammary artery to left anterior descending,
saphenous vein graft to posterior descending artery and
radial to obtuse marginal 1 with intraoperative ventricular
fibrillation and postoperative ventricular arrhythmias.

DISCHARGE MEDICATIONS:  Lasix 20 mg p.o. q. 12
[**Doctor First Name **]-Ciel 20 mEq p.o. q. 12
Colace 100 mg p.o. b.i.d.
Aspirin 325 mg p.o. q.d.
Tylenol 650 mg p.o. q. 4 hours prn
Milk of magnesia 30 cc p.o. q.h.s. prn
Dulcolax 10 mg p.r. q.d. prn
Imdur SR 30 mg p.o. q.d.
..................  2 to 4 mg p.o. q. 4-6 hours prn
Iron Poly saccharate 150 mg p.o. q.d.
Multivitamin one tablet p.o. q.d.
Vitamin C 500 mg p.o. b.i.d.
Ibuprofen 400 mg p.o. q. 6 hours
Lopressor 25 mg p.o. b.i.d.
Captopril 6.25 mg p.o. t.i.d.

FOLLOW UP:  The patient is to follow up with his primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] and his cardiologist, Dr. [**Last Name (STitle) **]
within two weeks from discharge.  The patient is to have his
follow up for his ventricular arrhythmias with Dr. [**Last Name (STitle) **].
The patient is to follow up with Dr. [**Last Name (STitle) **] in four weeks from
discharge.


                          [**First Name11 (Name Pattern1) 63**] [**Last Name (NamePattern4) 1508**], M.D.  [**MD Number(1) 1509**]

Dictated By:[**Last Name (NamePattern1) 6014**]

MEDQUIST36

D:  [**2135-11-24**]  21:26
T:  [**2135-11-24**]  23:11
JOB#:  [**Job Number 9400**]


Name:  [**Known lastname 9396**], [**Known firstname 9397**]                     Unit No:  [**Numeric Identifier 9398**]

Admission Date:  [**2135-11-4**]     Discharge Date:  [**2135-11-12**]

Date of Birth:   [**2085-5-12**]     Sex:  M

Service:  Cardiac Surgery Service

The patient underwent a coronary artery bypass graft times
three on [**2135-11-7**] with left internal mammary artery
to the left anterior descending, saphenous vein graft to left
dominant posterior descending artery and a radial artery to
obtuse marginal 1.  Please see the operative report for
further details.  Most significantly the patient experienced
multiple episodes of ventricular fibrillation,
intraoperatively post bypass.  The patient was given multiple
shocks with restoration of sinus rhythm and the patient was
able to tolerate the rest of the surgery, though with a
labile blood pressure.  The patient was in a guarded state
and upon completion of the surgery was transferred
immediately to the Cardiac Surgery Recovery Unit sedated,
intubated and ventilated.  On postoperative day #0 the
patient was found to have significant ectopy over night with
runs of ventricular tachycardia and one episode of complete
heartblock.  The patient was given intravenous fluid boluses
and the patient was loaded on intravenous Amiodarone and
continued on a maintenance dose.  The patient also received
one unit of packed red blood cells.  Given the episodes of
ventricular fibrillation during surgery and significant
ventricular tachycardia in the postoperative period,
electrophysiology consult was called.  Electrophysiology
consult recommended that the patient be taken off of
Amiodarone given the assessment that this was an
ischemia-related arrhythmia.  The patient was carefully
monitored and was given volume resuscitation based on the
electrophysiology consult and the patient's blood pressure
was supported with Levophed drip.  The patient was also
maintained on a nitroglycerin drip for his radial artery
graft.




                          [**First Name11 (Name Pattern1) 63**] [**Last Name (NamePattern4) 1508**], M.D.  [**MD Number(1) 1509**]

Dictated By:[**Last Name (NamePattern1) 6014**]

MEDQUIST36

D:  [**2135-11-24**]  21:14
T:  [**2135-11-24**]  23:04
JOB#:  [**Job Number 9399**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Ventricular fibrillation,Atrioventricular block, complete,Acute myocardial infarction of inferoposterior wall, initial episode of care,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,Other psoriasis'}


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: The patient is a 50 year old
male with a past medical history of psoriasis who presented
to an outside hospital complaining of chest pain of one day
duration.  He was watching a baseball game the night prior to
admission and initially felt a left arm numbness with several
twinges of chest discomfort.  There was no nausea and
vomiting that was associated.  When the patient presented to
the outside hospital the patient was ruled out for an acute
myocardial infarction by enzyme and received medical
treatment and was chest pain free.  He underwent an exercise
tolerance test which showed a 1 mm ST segment depression in
Lead 2, 3 and AVF, and ST segment depression in V1 through V6
with T wave inversion during the recovery period.  Given this
positive exercise tolerance test, the patient was transferred
to the [**Hospital6 256**] for cardiac
catheterization.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Ventricular fibrillation,Atrioventricular block, complete,Acute myocardial infarction of inferoposterior wall, initial episode of care,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,Other psoriasis'}
