CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64 year old
female with a history of coronary artery disease, who is
status post PCI and stent of her left circumflex on [**9-30**]. History of congestive heart failure and
hypercholesterolemia and hypertension and noninsulin
dependent diabetes mellitus and chronic renal insufficiency,
with a baseline creatinine of 1.8.  She is status post non ST
segment elevation myocardial infarction on [**10-5**] and
after PCI, she had decrease in platelets, which were thought
to be secondary to Integrilin.

MEDICAL HISTORY: History of coronary artery disease;
status post PCI and stents of her left circumflex on [**2111-10-10**].  History of congestive heart failure.  History of
noninsulin dependent diabetes mellitus.
Hypercholesterolemia.  Hypertension.  Chronic renal
insufficiency with a baseline creatinine of 1.8.  She is
legally blind with a history of retinopathy, a history of
osteoarthritis. Status post total abdominal hysterectomy.
History of thrombocytopenia.  Status post appendectomy.
Status post left ankle fracture with pins.

MEDICATION ON ADMISSION: Protonic 40 mg p.o. q. day.
Zocor 10 mg p.o. q. day.
Plavix 75 mg p.o. q. day.
Aspirin 80 mg p.o. q. day.
Zoloft 25 mg p.o. q. day.
Lasix 20 mg p.o. q. day.
Lopid 100 mg p.o. q. day.
Insulin 70/30, 40 units q. a.m. and 20 units q. p.m.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives with her husband.  She quit
smoking cigarettes 40 years ago but prior to that, has a 20
pack year history.  She does not drink alcohol.
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Subendocardial infarction, subsequent episode of care,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,CHF NOS,Thrombocytopenia NOS,Atrial fibrillation,Pure hypercholesterolem,Hypertension NOS,Status-post ptca,Subendo infarct, subseq,DMII ophth nt st uncntrl
Admission Date:  [**2111-11-11**]       Discharge Date:  [**2111-11-21**]

Date of Birth:   [**2046-10-28**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 64 year old
female with a history of coronary artery disease, who is
status post PCI and stent of her left circumflex on [**9-30**]. History of congestive heart failure and
hypercholesterolemia and hypertension and noninsulin
dependent diabetes mellitus and chronic renal insufficiency,
with a baseline creatinine of 1.8.  She is status post non ST
segment elevation myocardial infarction on [**10-5**] and
after PCI, she had decrease in platelets, which were thought
to be secondary to Integrilin.

She was admitted on [**10-23**] with shortness of breath
and chest pain and ruled out for a myocardial infarction.
She had a positive MIBI scan and underwent cardiac
catheterization on [**2111-10-27**] which revealed the left main to be
patent; the left anterior descending artery with diffuse
disease and a 70% proximal stenosis.  The left circumflex was
with patent stents and small filling defect in the right
coronary artery with 60% distal stenosis, 80% at the
posterior descending artery and an echo revealed an ejection
fraction of 40%. She was then referred to Dr. [**Last Name (STitle) 70**] for
possible coronary artery bypass grafting.

PAST MEDICAL HISTORY:  History of coronary artery disease;
status post PCI and stents of her left circumflex on [**2111-10-10**].  History of congestive heart failure.  History of
noninsulin dependent diabetes mellitus.
Hypercholesterolemia.  Hypertension.  Chronic renal
insufficiency with a baseline creatinine of 1.8.  She is
legally blind with a history of retinopathy, a history of
osteoarthritis. Status post total abdominal hysterectomy.
History of thrombocytopenia.  Status post appendectomy.
Status post left ankle fracture with pins.

SOCIAL HISTORY:  She lives with her husband.  She quit
smoking cigarettes 40 years ago but prior to that, has a 20
pack year history.  She does not drink alcohol.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
Protonic 40 mg p.o. q. day.
Zocor 10 mg p.o. q. day.
Plavix 75 mg p.o. q. day.
Aspirin 80 mg p.o. q. day.
Zoloft 25 mg p.o. q. day.
Lasix 20 mg p.o. q. day.
Lopid 100 mg p.o. q. day.
Insulin 70/30, 40 units q. a.m. and 20 units q. p.m.

REVIEW OF SYSTEMS:  Noncontributory.

PHYSICAL EXAMINATION:  She is well-developed, well-nourished
female in no apparent distress.  Vital signs revealed a
temperature of 98.; blood pressure 123/77; heart rate of 60;
respirations of 15; oxygen saturation of 97% on two liters.
HEAD, EYES, EARS, NOSE AND THROAT:  Pupils are equal, round,
and reactive to light and accommodation.  Extraocular
movements intact.  Oropharynx is benign with bilateral
dentures, right upper and lower.  Her neck is supple with
full range of motion, no lymphadenopathy or thyromegaly.
Carotid pulses are 2+ bilaterally without bruit.  Her lungs
are clear to auscultation bilaterally.  Heart is regular rate
and rhythm without murmurs, rubs or gallops.  She has a
normal S1 and S2.  Her abdomen is obese with positive bowel
sounds.  Soft, nontender, nondistended, with no masses and no
hepatosplenomegaly.  Extremities are without cyanosis,
clubbing or edema.  Pulses are 2+ and equal bilaterally
throughout her extremities.  Neurologic:  Nonfocal.

HOSPITAL COURSE:  On the day of admission, Ms. [**Known lastname 93621**] was
taken to the operating room and underwent coronary artery
bypass grafting times three with the left internal mammary
artery to the diagonal; saphenous vein graft to the left
anterior descending artery and saphenous vein graft to the
obtuse marginal.  The surgery was performed by Dr. [**Last Name (STitle) 70**]
with Dr. [**Last Name (STitle) 7625**] and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], PA-C as
assistant.  The surgery was performed under general
endotracheal anesthesia with cardiopulmonary bypass time of
90 minutes and a cross clamp time of 29 minutes.  The patient
tolerated the procedure well and was transferred to the
Intensive Care Unit with two ventricular, one atrial and one
ground wire, one mediastinal and one left pleural chest tube.
 She was transferred on Propofol drip and in normal sinus
rhythm.

Upon awakening from anesthesia, she was weaned to C-Pap but
remained intubated for the next day because of respiratory
metabolic acidosis.  She did receive multiple amps of
bicarbonate and this did normalize and she was able to be
extubated on postoperative day number two. Throughout that
time, she did require insulin drip and was followed by the
renal service.  Also, on postoperative day number two, she
did have her chest tube discontinued without incident.  She
did eventually require Dopamine drip at 3 mcg and
Neo-Synephrine to increase her blood pressure to help in
perfusing her kidneys.  She was weaned off of those by
postoperative day number two.  By postoperative day number
three, she was starting to be more aggressively diuresed and
was started on 60 three times a day of Lasix.  Also, on
postoperative day number three, she also went into rapid
atrial fibrillation for brief periods of time but converted
to a junctional rhythm on her own.  At this time, she was
noted to have continued junctional rhythm and because her
ventricular wires were working but her atrial wires did not.
She did have the pads placed in case she did brady down.  She
was restarted on her Dopamine drip to help with her heart
rate and help maintain her but did not have any other
recommendations.

She was then taken to the catheterization laboratory on
[**11-16**] and had a bipolar pacemaker placed.  Also during
this time, she had been on heparin drip and her platelet
count was noted to drop.  An HIB antibody test was sent off
and she was noted to be HIB positive.

On [**11-17**], on postoperative day number six, she was
transferred to the surgical floor for more aggressive
physical therapy and cardiac rehabilitation.  On
postoperative day number seven, her pacing wires were
discontinued without incident and her Lasix was changed from
intravenous to p.o. as she was diuresing well.  Also of note,
creatinine had risen back to its baseline of 1.8.  On
postoperative day number eight, she was ambulating some with
physical therapy and it was felt that she would benefit from
a short rehabilitation stay.  On postoperative day number
nine, she was screened for rehabilitation and accepted to a
short term rehabilitation facility.  She will be discharged
to this rehabilitation facility on postoperative day number
ten, [**2111-11-21**].

Her discharge examination shows her to be alert and oriented
times three and in no apparent distress.  She is afebrile.
Heart rate of 82; blood pressure of 166/67; respirations 18;
oxygen saturation of 95% on room air.  Heart:  Regular rate
and rhythm. Lungs are clear to auscultation bilaterally.  Her
abdomen is soft, nontender, nondistended.  Her extremities
show 1+ pedal edema.  Wounds are clean, dry and intact and
her sternum is stable.

LABORATORY DATA:  White count of 5.1; hematocrit of 31.1% and
platelet count of 140,000.  Sodium of 141; potassium of 4.8;
chloride of 104; C02 31; BUN 46; creatinine 1.6 and blood
glucose of 168.

Discharge chest x-ray shows no infiltrates and two bilateral
small effusions.  She will be discharged to rehabilitation in
good condition and her discharge medications include the
following:
1.) Protonic 40 mg p.o. q. day.
2.) Colace 100 mg p.o. twice a day.
3.) Potassium chloride 20 meq twice a day.
4.) Lasix 40 mg p.o. q. day.
5.) Enteric coated aspirin 325 mg p.o. q. day.
6.) Percocet one to two tablets p.o. every four hours prn for
    pain.
7.) Plavix 75 mg p.o. q. day.
8.) Zoloft 50 mg p.o. q. day.
9.) Zocor 10 mg p.o. q. day.
10.) Insulin 70/30, 30 units subcutaneous q. a.m. and 10
     units subcutaneous q. p.m. and regular insulin sliding
     scale, which will be attached to her discharge paper
     work.

She should follow-up with Dr. [**First Name (STitle) 18488**], her primary care
physician in one to two weeks; with her cardiologist in two
to three weeks; with her physicians at the [**Hospital 3208**] Clinic and
with Dr. [**Last Name (STitle) 70**] in six weeks.



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

Dictated By:[**Last Name (NamePattern1) 93622**]
MEDQUIST36

D:  [**2111-11-20**]  06:38
T:  [**2111-11-20**]  19:00
JOB#:  [**Job Number 93623**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Subendocardial infarction, subsequent episode of care,Diabetes with ophthalmic manifestations, 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: 

PRESENT ILLNESS: The patient is a 64 year old
female with a history of coronary artery disease, who is
status post PCI and stent of her left circumflex on [**9-30**]. History of congestive heart failure and
hypercholesterolemia and hypertension and noninsulin
dependent diabetes mellitus and chronic renal insufficiency,
with a baseline creatinine of 1.8.  She is status post non ST
segment elevation myocardial infarction on [**10-5**] and
after PCI, she had decrease in platelets, which were thought
to be secondary to Integrilin.

MEDICAL HISTORY: History of coronary artery disease;
status post PCI and stents of her left circumflex on [**2111-10-10**].  History of congestive heart failure.  History of
noninsulin dependent diabetes mellitus.
Hypercholesterolemia.  Hypertension.  Chronic renal
insufficiency with a baseline creatinine of 1.8.  She is
legally blind with a history of retinopathy, a history of
osteoarthritis. Status post total abdominal hysterectomy.
History of thrombocytopenia.  Status post appendectomy.
Status post left ankle fracture with pins.

MEDICATION ON ADMISSION: Protonic 40 mg p.o. q. day.
Zocor 10 mg p.o. q. day.
Plavix 75 mg p.o. q. day.
Aspirin 80 mg p.o. q. day.
Zoloft 25 mg p.o. q. day.
Lasix 20 mg p.o. q. day.
Lopid 100 mg p.o. q. day.
Insulin 70/30, 40 units q. a.m. and 20 units q. p.m.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives with her husband.  She quit
smoking cigarettes 40 years ago but prior to that, has a 20
pack year history.  She does not drink alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status,Subendocardial infarction, subsequent episode of care,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled'}
