CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 73-year-old male
with a recent onset of angina with exertion.  He had a
positive ETT at [**Hospital **] Hospital on [**2165-3-13**].  He was
subsequently transferred to [**Hospital1 188**] for cardiac catheterization.

MEDICAL HISTORY: 1. Insulin dependent-diabetes mellitus.
2. Hypercholesterolemia.
3. Question of hypertension.
4. Remote history of smoking.

MEDICATION ON ADMISSION: 

ALLERGIES: No known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,DMI wo cmp nt st uncntrl,Pure hypercholesterolem
Admission Date:  [**2165-3-14**]       Discharge Date:  [**2165-3-22**]

Date of Birth:   [**2092-3-8**]       Sex:  M

Service:

ADMISSION DIAGNOSIS:  Unstable angina.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Status post coronary artery bypass graft x4.

HISTORY OF PRESENT ILLNESS:  Patient is a 73-year-old male
with a recent onset of angina with exertion.  He had a
positive ETT at [**Hospital **] Hospital on [**2165-3-13**].  He was
subsequently transferred to [**Hospital1 188**] for cardiac catheterization.

PAST MEDICAL HISTORY:
1. Insulin dependent-diabetes mellitus.
2. Hypercholesterolemia.
3. Question of hypertension.
4. Remote history of smoking.

MEDICATIONS:
1. Pravachol 40 mg q day.
2. Aspirin 325 mg q day.
3. Humulin lente insulin 21 units q am, 23 units q pm.
4. Humalog sliding scale [**Hospital1 **].

ALLERGIES:  No known allergies.

PHYSICAL EXAMINATION:  General:  The patient is an elderly
man in no acute distress.  He is well-nourished and appears
younger than his stated age.  HEENT is atraumatic,
normocephalic.  Extraocular movements are intact.  Pupils are
equal, round, and reactive to light.  Anicteric.  Throat is
clear.  Neck is supple and midline without masses or
lymphadenopathy.  Chest was clear to auscultation
bilaterally.  Cardiovascular is regular, rate, and rhythm
without murmurs, rubs, or gallops.  Abdomen is soft,
nontender, nondistended.  Extremities are warm and well
perfused without cyanosis or edema x4.  Neurologic is intact.

LABORATORIES ON ADMISSION:  Complete blood count:
5.8/41.4/223.  PT 10.7, PTT 28.9, INR is 0.77.  Chemistries:
138/5.0/103/31/17/1.2/270.

ELECTROCARDIOGRAM:  Significant for normal sinus rhythm with
borderline first degree A-V block and left bundle branch
block.

HOSPITAL COURSE:  The patient was admitted subsequent to a
positive ETT from his cardiologist at [**Hospital **] Hospital.  He
had a cardiac catheterization performed on [**2165-3-14**] which
revealed ejection fraction of approximately 60%.  There was a
right dominant coronary artery system with significant three
vessel coronary artery disease.

Cardiac Surgery Service was consulted for urgent RV
vascularization procedure, and the patient was admitted for
anticoagulation with Heparin.  Patient had an unremarkable
preoperative course, but did have a few isolated incidents of
asymptomatic ventricular tachycardia.  He was begun on beta
blockade appropriately, and maintained on a Heparin drip.

On [**2165-3-18**], the patient underwent coronary artery bypass
grafting x4 without significant complication.  The patient
was transferred to the Intensive Care Unit on a propofol
drip.  He was given perioperative levo/Vanco.  The patient
was extubated on postoperative day 0 and seemed to be doing
very well.

Postoperative day #1, the patient was transferred to the
floor.  The patient had no significant postoperative events
and continued to work with Physical Therapy on ambulation and
conditioning.

Postoperative day #3, the patient was cleared by Physical
Therapy for discharge to home.  On postoperative day #4, the
patient was discharged to home tolerating a regular diet, and
adequate pain control on po pain medications, and without any
anginal symptoms.

Patient's sugars were found to be running high on the floor,
and control of the patient's insulin injections was usually
agreed upon to be given back to the patient.  He has
experienced that his diabetes management felt more
comfortable this way.

PHYSICAL EXAM ON DISCHARGE:  In no acute distress.  Chest was
clear to auscultation bilaterally.  Regular, rate, and
rhythm.  No sternal click.  No draining from sternal
incision.  Trace pedal edema.  Neurologically intact.

LABORATORIES ON DISCHARGE:  Complete blood count:
7.9/10.0/29.9/125.  Chemistry:  139/4.0/103/28/15/1.0/295.
Magnesium 1.6.

DISCHARGE MEDICATIONS:
1. Lopressor 25 mg [**Hospital1 **].
2. Colace 100 mg [**Hospital1 **].
3. Aspirin 325 mg q day.
4. Percocet 5/325 [**2-14**] q4h prn.
5. Pravachol 40 mg q day.
6. Lasix 20 mg q day x7 days.
7. Potassium chloride 20 mEq q day x7 days.
8. Lente insulin per patient's regimen.
9. Humalog sliding scale per patient's regimen.

DISCHARGE CONDITION:  Good.

DISPOSITION:  Home.

DIET:  Cardiac/diabetic.

DI[**Last Name (STitle) 408**]E INSTRUCTIONS:  The patient is to followup with his
cardiologist at [**Hospital **] Hospital within 1-2 weeks.  Patient
should also followup with Dr. [**Last Name (Prefixes) **] in four weeks'
time.  He is encouraged to continue ambulating and using
incentive spirometry.




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern1) 5745**]
MEDQUIST36

D:  [**2165-3-21**]  21:57
T:  [**2165-3-22**]  05:24
JOB#:  [**Job Number 26810**]


Admission Date:  [**2165-3-14**]       Discharge Date:  [**2165-3-23**]

Date of Birth:   [**2092-3-8**]       Sex:  M

Service:

ADDENDUM:  Previous discharge summary dictation was on
[**2165-3-21**].

On the evening of postoperative day number three at
approximately 11:00 p.m., the patient went into rapid atrial
fibrillation with aberrant conduction.  An attempt was made
to convert to normal sinus rhythm by giving 10 mg of IV
Lopressor as well as 150 mg of Amiodarone.  The patient's
aberrant conduction responses decreased in frequency, but the
patient did not convert.  An addition 10 mg of Lopressor was
given.  The patient's systolic blood pressures remained above
90 with the heart rate fluctuating between 110 and 130.

At that time, Cardiology and EPS was consulted.  They
confirmed the diagnosis of rapid atrial fibrillation with
aberrant conduction and recommended rate control into the 90s
as blood pressure would allow.  The patient received an
additional 20 mg of p.o. Lopressor as well as 10 mg of IV
Lopressor until the systolic blood pressures ran into the
90s.  The patient's heart rate at that time was between
100-110.  No further attempts to rate control were made as
concern was for blood pressure.

At approximately 5:30 a.m. on postoperative day number four,
the patient converted back into normal sinus rhythm.  He was
kept for observation and increased beta blockade and had no
further arrhythmias.

Discussion was had between the attending, Dr. [**First Name (STitle) **] [**Last Name (Prefixes) 411**] as well as Cardiology and EPS Services.  The patient
was subsequently discharged on postoperative day number five,
tolerating a regular diet and adequate pain control on p.o.
pain medications and not having any further arrhythmias
subsequent to the episode of atrial fibrillation.  He was
also fitted for [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts Holter Monitor.

CONDITION ON DISCHARGE:  Good.

DISPOSITION:  To home.

DIET:  Cardiac and diabetic.

DISCHARGE MEDICATIONS:
1.  Colace 100 mg b.i.d.
2.  Aspirin 325 mg q.d.
3.  Percocet 5/325 one to two q. four hours p.r.n.
4.  Pravachol 20 mg q.d.
5.  Lasix 20 mg q.d. times five days.
6.  Potassium chloride 20 mEq q.d. times five days.
7.  Lente insulin per the patient's regimen.
8.  Humalog sliding scale per the patient's regimen.
9.  Lopressor 37.5 mg t.i.d.
10. Amiodarone 400 mg b.i.d.

DISCHARGE INSTRUCTIONS:  The patient is to follow-up either
with Dr. [**Last Name (STitle) **], Cardiology, or Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **]
within one week.  He should also continue following up with
his cardiologist at [**Hospital **] Hospital.  He is encouraged to
continue ambulating and using incentive spirometry.  He was
also discharged with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] of Hearts monitor, information to
be transmitted to the EPS Laboratory here for Dr. [**Last Name (STitle) **].




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern1) 5745**]
MEDQUIST36

D:  [**2165-3-23**]  09:15
T:  [**2165-3-24**]  08:06
JOB#:  [**Job Number **]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Pure hypercholesterolemia'}


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: Patient is a 73-year-old male
with a recent onset of angina with exertion.  He had a
positive ETT at [**Hospital **] Hospital on [**2165-3-13**].  He was
subsequently transferred to [**Hospital1 188**] for cardiac catheterization.

MEDICAL HISTORY: 1. Insulin dependent-diabetes mellitus.
2. Hypercholesterolemia.
3. Question of hypertension.
4. Remote history of smoking.

MEDICATION ON ADMISSION: 

ALLERGIES: No known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Pure hypercholesterolemia'}
