CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 82-year-old male who
was transferred in from [**Hospital3 35813**] Center in [**Location (un) **],
[**Doctor Last Name 792**]after experiencing chest pain while coming to
the hospital for preadmission testing for his carotid
endarterectomy surgery.

MEDICAL HISTORY: 1. Hypertension.
2. Diet controlled non-insulin-dependent diabetes mellitus.
3. Glaucoma.
4. Status post appendectomy.
5. Status post hernia repair.
6. Status post cataract surgery in [**2126**].
7. Right carotid disease.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He had a positive tobacco history, but he
quit 40 years ago.  No alcohol use at this time.
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Ventricular fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Asbestosis,Occlusion and stenosis of carotid artery without mention of cerebral infarction
Crnry athrscl natve vssl,Surg compl-heart,AMI anterolateral, init,Ventricular fibrillation,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Asbestosis,Ocl crtd art wo infrct
Admission Date: [**2128-7-12**]        Discharge Date: [**2128-7-24**]


Service:  CSU


HISTORY OF PRESENT ILLNESS:  This is an 82-year-old male who
was transferred in from [**Hospital3 35813**] Center in [**Location (un) **],
[**Doctor Last Name 792**]after experiencing chest pain while coming to
the hospital for preadmission testing for his carotid
endarterectomy surgery.

The patient had similar pain intermittently for the last few
weeks.  His pain was exacerbated by exertion and relieved
with rest.  He complained of midsternal and retrosternal
heaviness in [**Doctor Last Name **].  He was hemodynamically stable
with a systolic blood pressure of approximately 190.  His
chest pressure lasted 5 to 10 minutes.  Electrocardiogram
showed ST depressions in his anterior and lateral leads.

The patient state he had experienced similar pain prior to
going to that hospital that day.  It was also accompanied -
when he was doing yard work - with shortness of breath and
increased lower extremity edema over a period of
approximately three months.  He said the chest pain has been
increasing in frequency for three months also.

The patient was referred in after he was medically stabilized
and taken to the Catheterization Laboratory.  Catheterization
results were as follows.  Ejection fraction was 46 percent,
with a distal left main stenosis, an ostial circumflex lesion
of 95 percent, and a proximal right coronary artery lesion of
70 percent.  The patient was referred to the [**Hospital1 346**] for a coronary artery bypass
grafting.  Upon arrival to the hospital, the patient was pain
free.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Diet controlled non-insulin-dependent diabetes mellitus.
3. Glaucoma.
4. Status post appendectomy.
5. Status post hernia repair.
6. Status post cataract surgery in [**2126**].
7. Right carotid disease.


ALLERGIES:  He has no known drug allergies.

MEDICATIONS AT HOME:
1. Plavix 75 mg by mouth once per day.
2. Avandia 4 mg by mouth once per day.
3. Lasix 20 mg by mouth once per day.


SOCIAL HISTORY:  He had a positive tobacco history, but he
quit 40 years ago.  No alcohol use at this time.

PHYSICAL EXAMINATION ON ADMISSION:  His examination was
unremarkable.  He had no jaundice.  He appeared to be well
hydrated.  He had no bruits.  He had no murmur, rub or
gallop.  There were normal heart sounds.  The abdomen was
soft, nontender, and nondistended.  He was oriented
appropriately.

REVIEW OF SYSTEMS:  Negative for chronic obstructive
pulmonary disease, gastrointestinal bleed, transient ischemic
attack, syncope, or cerebrovascular accident.  At this time,
he was preoperative for carotid surgery.

LABORATORY DATA ON ADMISSION:  Preoperative laboratories
revealed sodium was 143, potassium was 3.2, chloride was 113,
bicarbonate was 21, blood urea nitrogen was 20, creatinine
was 0.8, and blood glucose was 131.  His creatine kinase was
31.  Calcium was 7.9.  His magnesium was 1.9.  White blood
cell count was 6.7, hematocrit was 32.8, and his platelet
count was 191,000.  Prothrombin time was 13.2, partial
thromboplastin time was 129, and INR was 1.1.  His urinalysis
was negative.

RADIOLOGY:  His chest x-ray on [**7-12**] showed a question of
a right lower lobe nodule with a known history of asbestos
exposure.

A computed tomography of the chest for the right lower lobe
nodule on [**7-12**] showed bilateral extensive calcified
pleural plaque consistent with a prior history of asbestos
exposure.  There was a large right lower lobe pleural nodule
and a second smaller node which was in the right lower lobe.
It also showed extensive coronary calcifications.  Please
refer to the final CT report dated [**7-12**].

SUMMARY OF HOSPITAL COURSE:  On [**7-13**], the patient
underwent coronary artery bypass grafting times three with a
left internal mammary artery to the left anterior descending,
a vein graft to the obtuse marginal, and a vein graft to the
right coronary artery by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].

The patient was transferred to the Cardiothoracic Intensive
Care Unit on an amiodarone drip at 1 mg per minute, an
insulin drip at 3 units per hour, a titrated propofol drip,
and a phenylephrine drip at 0.3 mg/kilogram per minute.

On postoperative day one, the patient was in a sinus rhythm
with a heart rate of 82 and a cardiac index of 2.9.  His
blood pressure was 130/50.  His laboratories were as follows.
Sodium was 138, potassium was 4.7, chloride was 107,
bicarbonate was 28, blood urea nitrogen was 10, creatinine
was 0.7, and blood glucose was 125.  His heart was regular in
rate and rhythm.  He had decreased breath sounds bilaterally.
His abdominal examination was benign.  His sternum was
stable.  His white blood cell count was 9.3.  His platelet
count was 156,000.  He was on an amiodarone drip at 0.5 mg
per minute.  The patient was extubated without incident later
in the afternoon on the day of his operation.

A Thoracic Surgery consultation had also been obtained on
[**7-13**] for evaluation of the incidental finding of a
pulmonary nodules on his computed tomography scan
preoperatively.

Early in the morning on [**7-14**], on postoperative day one,
the patient was alert and oriented, but he was a little more
lethargic in the evening prior.  His grasping strength was
strong and equal.  He was in a normal sinus rhythm without
ectopy on the amiodarone drip at 0.5 mg per minute.  He was
on and off nitroglycerin to keep his systolic blood pressure
in the 120 to 140 range.  He had a cardiac index of greater
than 2.8.  His right femoral arterial sheath was removed in
the early morning hours.

The patient was transferred to the floor late in the evening
on [**7-14**].  Pacing wires were in place.  He was a little
bit forgetful but was alert and oriented times three.  He was
encouraged to cough and deep breathe.  He was also seen by
Thoracic Surgery again.

On [**7-15**], the patient had his vital signs taken early in
the morning.  He was on incentive spirometry.  He tried to
climb out of bed.  He was disoriented.  He was reoriented.
His oxygen saturations and vital signs were the same as has
been previously taken.  He complained of some incisional pain
and was given some Percocet, and the bed alarm was put back
on for safety.  The patient was checked frequently.  He did
not attempt to get out of bed the rest of the night.

At 4:30 a.m., he had vital signs checked and had done
incentive spirometry at about 5:00 a.m.  The incisional pain
was better at that time.  At about 5:20 a.m., he was noted to
be pacing on telemetry which he had not done prior during the
night despite his AV wires.  His pacer box had been set at
60.  It was noted in telemetry that he went into ventricular
tachycardia and the VF on telemetry.  The patient turn blue
in the room.  Pads were on, and automatic external
defibrillator was indicated.  The patient was shocked for VF
with 200 joules delivered, and the patient went into atrial
fibrillation rhythm with random pacing at 75.  The code team
was alerted.

The patient was intubated and returned to the Cardiothoracic
Surgery Recovery Unit immediately at 6:00 a.m.  A new
internal jugular triple lumen was inserted on the Unit.  The
patient had been re-intubated by Anesthesia.  A chest x-ray
showed the line was at the brachiocephalic and superior vena
cava junction with no pneumothorax.  The patient remained in
the Cardiothoracic Intensive Care Unit.  He was seen by the
Electrophysiology Service who thought he had an acute
anterolateral ST elevation myocardial infarction and were
worried about the left internal mammary artery to left
anterior descending occlusion, noted his atrial fibrillation
with a rapid ventricular response, and he was immediately
taken to the Cardiac Catheterization Laboratory to rule out
any problems in his grafts.

In the Catheterization Laboratory, his grafts were all
patent.  He had no  more ectopy since the Catheterization
Laboratory.  He was continued on an amiodarone drip at 1 mg
per minute.  Physical Therapy was re-consulted.  They were
willing to evaluate him again when he got out to the floor.

On postoperative day three, he was extubated on the Unit.  He
was in a sinus rhythm at 60 with a good urine output.  He was
saturating 97 percent on 4 liters nasal cannula.  His
hematocrit was 24.4.  He had a temperature maximum of 99.3.
His potassium was 4, his blood urea nitrogen was 13, and his
creatinine was 0.9.  His heart was regular in rate and
rhythm.  His lungs were clear.  His abdominal examination was
benign.  His extremities had 1 plus edema.  The plan was to
continue him on the amiodarone drip.  On [**7-16**], the
patient was also transfused with 1 unit of packed red blood
cells for a hematocrit of 20 percent.  He had occasional
premature ventricular contractions and ectopy.  He was
reevaluated by Physical Therapy for his unsteady gait and a
little bit of lethargy.

He was seen by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], the stroke attending
neurologist on [**7-16**] for his facial droop and to rule out
a stroke, and her recommendations were noted.

The patient was unable to get a magnetic resonance imaging at
that time, as the patient had staples on his chest and pacing
wires in place.  Therefore, the patient was prepared for a
computed tomography scan.  The computed tomography scan of
his head was negative for cerebrovascular accident or bleed.
His neurologic examination was approximately at his baseline,
per Dr. [**Last Name (STitle) **], he was hemodynamically stable and in a normal
sinus rhythm.

On [**7-17**], on postoperative day four, his potassium was
4.1, his blood urea nitrogen was 13, and his creatinine was
0.3.  His hematocrit came up to 24.7.  He continued with
Lopressor.  His nitroglycerin was being weaned.  He received
magnesium repletion.  He was followed again by
Electrophysiology who recommended maximizing his beta
blockade.  They also recommended that his amiodarone be
discontinued and would consider an Electrophysiology study on
the week following discharge.

On postoperative day five, the patient was in a normal sinus
rhythm.  His white blood cell count was 7.3.  His hematocrit
was 31.9.  His platelet count was 200,000.  His examination
was unremarkable.  He continued to improve.  His blood
pressure was 110/61.  He was in a sinus rhythm at 72.  There
was no ectopy on his amiodarone.

On postoperative day six, he had no events overnight.  His
laboratories were stable.  His hematocrit was 33.  His
sternum was stable.  He had good breath sounds bilaterally,
and his heart was regular in rate and rhythm.  His blood
pressure was 120/41.  He did have some complications of
lightheadedness and nausea which started on [**7-19**] and a
decreased appetite.  He was given doses of Zofran with some
affect, and his nausea improved.

On [**7-18**], the patient was transferred to the floor.  He
was encouraged to use the incentive spirometry frequently and
to cough and deep breathe.  He had good bowel sounds but a
very poor appetite.  He had a productive cough.  He was in a
sinus rhythm.  He had no ectopy on the by mouth amiodarone.
An echocardiogram.  He was continued on oral amiodarone as
well as beta blockade with metoprolol at 12.5 mg twice per
day.

On postoperative day six, he had no ectopy.  His heart was
regular in rate and rhythm.  There were no murmurs.  He had
bilateral rhonchi in both upper zones of his lungs.  His
lungs were clear at the bases.  He had hypoactive bowel
sounds.  His sternum was stable.  All incisions were clean,
dry, and intact; including the saphenectomy sites on the
right leg.  His blood pressure was 180/78 in the morning
prior to his beta blocker dose.  He was saturating 95 percent
on 3 liters.  His blood sugar was 158; for which the patient
did receive some sliding scale insulin.  His hematocrit
stabilized in the middle 30s with a white blood cell count of
9.1.  His chest x-ray from [**7-20**] showed a mild-to-
moderate left pleural density on the left without any lung
compromise.  It also showed the bilateral plaque that were
consistent with asbestosis as on previous scan.  He had no
pneumothorax, infiltrates, or significant congestive heart
failure.  His echocardiogram from [**7-20**] showed moderate
left atrial enlargement and moderate right atrial enlargement
with an ejection fraction of greater than 55 percent.  No
aortic insufficiency, and 1 plus mitral regurgitation,
moderate mitral anular calcification, and trivial tricuspid
regurgitation.  He continued to have some nausea with no
appetite.  He was encouraged though.  He had not vomited in
24 hours.  He was also instructed to elevate his legs for his
peripheral pedal edema and was covered with sliding scale
insulin.  He was followed by the neurology consultation team.
He was seen again by Dr. [**Last Name (STitle) **].  He also continued to have
unsteadiness and was requiring two person support with
Physical Therapy and nursing to ambulate for his unsteady
gait.  Electrophysiology recommended discontinuing his
amiodarone, but Dr. [**Last Name (STitle) **] requested that it be continued for
one month and decreased to just 400 mg by mouth once per day.

On postoperative days eight and nine, the patient remained in
a sinus rhythm with no events overnight.  His examination was
unremarkable.  His amiodarone was decreased to 400 mg by
mouth once per day times one month.  A sputum culture was
sent for his productive cough, and he was encouraged to
continue coughing and deep breathing and using the incentive
spirometry as frequently as possible.  Case Management was
consulted and arranged for potential discharge back to [**Hospital3 57833**] Center.

On postoperative day nine, the patient noted improvement in
his nausea.  He did have a bowel movement.  His incisions
were clean, dry, and intact.  His cardiovascular examination
was otherwise benign.  He continued to have some ataxia but
was improving.  His Lasix was discontinued as he was below
his preoperative weight.  He did receive a single dose for an
increase of 1 kilogram from the prior day.  Discharge
planning was begun.  He remained afebrile and in stable
condition.

On postoperative day ten, he was saturating 94 percent on
room air with a good blood pressure of 130/60.  He was in a
sinus rhythm at 66.  His beta blocker remained in place at
12.5 mg twice per day.  He had decreased breath sounds at his
left base with occasional rhonchi at both bases.  He had
positive bowel sounds.  The incisions were clean, dry, and
intact.  His sternum was stable.  The Gram stain on the
culture showed gram-positive cocci consistent with
oropharyngeal flora.  Final sputum culture was still pending.
This will be checked prior to discharge.  The patient needs
tighter glucose control.  The patient was still encouraged to
have aggressive pulmonary toilet.  We anticipate a bed for
the patient on [**7-24**] in the morning to the facility [**Location (un) 57834**] [**State 792**]near his home.

DISCHARGE DIAGNOSES:
1. Status post coronary artery bypass grafting times three.
2. Hypertension.
3. Non-insulin-dependent diabetes.
4. Glaucoma.
5. Status post appendectomy.
6. Status post hernia repair.
7. Status post cataract surgery.


MEDICATIONS ON DISCHARGE:
1. Colace 100 mg by mouth twice per day.
2. Enteric coated aspirin 325 mg by mouth once per day.
3. Lipitor 10 mg by mouth once per day.
4. Bisacodyl 5-mg tablets enteric coated two tablets by mouth
   every day as needed.
5. Brimonidine tartrate 0.2 percent drops 1 drop both eyes
   twice per day.
6. Dorzolamide/Timolol 2/0.5 percent drops 1 drop both eyes
   twice per day.
7. Avandia 4 mg by mouth once per day.
8. Tylenol 325-mg tablets two tablets by mouth q.4h. as
   needed (for pain).
9. Metformin 500 mg by mouth twice per day.
10.      Protonix 40 mg by mouth once per day (enteric
   coated).
11.      Plavix 75 mg by mouth once per day.
12.      Latanoprost 0.005 percent drops 1 drop both eyes at
   hour of sleep.
13.      Captopril 6.25 mg by mouth three times per day.
14.      Trazodone hydrochloride 100 mg by mouth at hour of
   sleep as needed.
15.      Metoclopramide 10 mg by mouth four times per day (at
   meals and at bedtime).
16.      Amiodarone 400 mg by mouth once per day.
17.      Metoprolol 12.5 mg by mouth twice per day.
18.      Regular insulin per sliding scale at the
   rehabilitation facility.



DISCHARGE DISPOSITION:  Discharge is anticipated on Saturday
morning, [**7-24**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2128-7-23**] 11:38:10
T:  [**2128-7-23**] 12:48:48
Job#:  [**Job Number 57835**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Ventricular fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Asbestosis,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}


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 an 82-year-old male who
was transferred in from [**Hospital3 35813**] Center in [**Location (un) **],
[**Doctor Last Name 792**]after experiencing chest pain while coming to
the hospital for preadmission testing for his carotid
endarterectomy surgery.

MEDICAL HISTORY: 1. Hypertension.
2. Diet controlled non-insulin-dependent diabetes mellitus.
3. Glaucoma.
4. Status post appendectomy.
5. Status post hernia repair.
6. Status post cataract surgery in [**2126**].
7. Right carotid disease.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He had a positive tobacco history, but he
quit 40 years ago.  No alcohol use at this time. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute myocardial infarction of anterolateral wall, initial episode of care,Ventricular fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Asbestosis,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}
