CHIEF COMPLAINT: Chest pain on admission.

PRESENT ILLNESS: The patient is an 82 year old
with extensive cardiac history including a prior myocardial
infarction and recent abnormal stress test who presented to
the hospital with chest pain. She denied any nausea,
vomiting, fever or chills. There were no other associated
symptoms. She had relief with sublingual nitroglycerine. The
pain had lasted two hours. This was similar to her episode of
angina in [**2189**] at which time she required a stent in her left
anterior descending coronary artery for ischemia. She was
admitted to the medical service and her work up revealed
significant two vessel coronary artery disease and the
cardiac surgery team was consulted.

MEDICAL HISTORY: 1. Anterior myocardial infarction in [**2182**], status post left
   anterior descending coronary artery stent.
2. Re-stenosis with recurrent angina in [**2190-2-26**] with
   percutaneous transluminal coronary angioplasty and left
   anterior descending coronary artery stent.
3. History of atrial fibrillation.
4. Status post pacer placement for atrial fibrillation.
5. Hypertension.
6. Duodenal ulcer.

MEDICATION ON ADMISSION: Include Lopressor 50 mg p.o.
b.i.d., Digoxin 0.25 mg daily, Lasix 20 mg daily, Plavix 75
mg daily, isosorbide 30 mg p.o. b.i.d., Avapro 300 mg daily,
Zantac 150 mg b.i.d., Coumadin 5 mg daily, Zetia 10 mg daily,
Ativan 0.5 mg p.r.n. h.s., Welchol 3 tablets t.i.d.

ALLERGIES: She has allergy to amoxicillin, sulfa, Norvasc
and statins.

PHYSICAL EXAM: 

FAMILY HISTORY: Is noncontributory.

SOCIAL HISTORY: She lives at home with her sister, denies
any ETOH or alcohol use.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Atrial fibrillation,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of breast
Subendo infarct, initial,Crnry athrscl natve vssl,Iatrogenic pneumothorax,Atrial fibrillation,Anemia NOS,Hypertension NOS,Pure hypercholesterolem,Old myocardial infarct,Status-post ptca,Hx of breast malignancy
Admission Date: [**2193-3-21**]        Discharge Date: [**2193-4-4**]


Service:  CSU


CHIEF COMPLAINT:  Chest pain on admission.

HISTORY OF PRESENT ILLNESS:  The patient is an 82 year old
with extensive cardiac history including a prior myocardial
infarction and recent abnormal stress test who presented to
the hospital with chest pain. She denied any nausea,
vomiting, fever or chills. There were no other associated
symptoms. She had relief with sublingual nitroglycerine. The
pain had lasted two hours. This was similar to her episode of
angina in [**2189**] at which time she required a stent in her left
anterior descending coronary artery for ischemia. She was
admitted to the medical service and her work up revealed
significant two vessel coronary artery disease and the
cardiac surgery team was consulted.

PAST MEDICAL HISTORY:
1. Anterior myocardial infarction in [**2182**], status post left
   anterior descending coronary artery stent.
2. Re-stenosis with recurrent angina in [**2190-2-26**] with
   percutaneous transluminal coronary angioplasty and left
   anterior descending coronary artery stent.
3. History of atrial fibrillation.
4. Status post pacer placement for atrial fibrillation.
5. Hypertension.
6. Duodenal ulcer.


PAST SURGICAL HISTORY:  Status post right mastectomy in [**2188**].
Status post hysterectomy. Status post appendectomy. Status
post cataract surgery. Status post bilateral vein stripping.

MEDICATIONS ON ADMISSION:  Include Lopressor 50 mg p.o.
b.i.d., Digoxin 0.25 mg daily, Lasix 20 mg daily, Plavix 75
mg daily, isosorbide 30 mg p.o. b.i.d., Avapro 300 mg daily,
Zantac 150 mg b.i.d., Coumadin 5 mg daily, Zetia 10 mg daily,
Ativan 0.5 mg p.r.n. h.s., Welchol 3 tablets t.i.d.

SOCIAL HISTORY:  She lives at home with her sister, denies
any ETOH or alcohol use.

FAMILY HISTORY:  Is noncontributory.

ALLERGIES:  She has allergy to amoxicillin, sulfa, Norvasc
and statins.

PHYSICAL EXAMINATION:  On admission her vital signs included
a temperature of 97.8, pulse of 66, blood pressure of 149/60,
98 percent on room air. She is comfortable in no acute
distress. Neck was supple with no jugular venous distension.
Lungs were clear to auscultation bilaterally. Heart was
regular with no murmurs, rubs or gallops. Abdomen was soft
and nontender with good bowel sounds. Her extremities had no
edema and palpable pulses bilaterally.

LABORATORY RESULTS:  White count was 7.5, hematocrit 36.7,
platelets 268, INR was 2.9. Sodium 137, potassium 4.0,
chloride 104, bicarb 25, BUN 16, creatinine 0.8 and glucose
of 112, troponin was 0.16. Electrocardiogram showed atrial
pacing at 60 beats per minute, no change from a previous
electrocardiogram. Chest x-ray demonstrated no
cardiopulmonary process.

She did undergo cardiac catheterization on [**2193-3-22**]. This
showed hypokinetic anterolateral wall and akinetic apical
wall, normal valves, a 60 percent stenosis at the mid RCA,
30% left main stenosis, 60 % proximal circumflex, 90% OM1 and
100% proximal left anterior descending coronary artery. Left
ventricular ejection fraction was 55%. She underwent a
carotid series on [**2193-3-22**] which demonstrated left sided 60 to
69% stenosis and a right sided stenosis which was less than
40%.

HOSPITAL COURSE:  The patient was admitted to the cardiac
medicine service initially prior to the catheterization where
she was medically managed with aspirin, beta blockers,
Plavix. She remained asymptomatic during this time and she
underwent a preoperative preparation and went for surgery. On
hospital day #5 she went to the operating room where she
underwent a coronary artery bypass graft x1 off pump left
internal mammary artery to left anterior descending coronary
artery. She tolerated the procedure well, was transferred
intubated to the Cardiac Intensive Care Unit. Over the first
postoperative night her drips were weaned. She was extubated
on postoperative day #1 and had stable hemodynamics. She was
transferred to the floor on postoperative day #1. She
developed atrial fibrillation with rapid ventricular response
in the 140s. Though she remained hemodynamically stable she
was controlled with beta blockade. Her electrolytes were
optimized and she was transfused for postoperative anemia.
During the remainder of her recovery she did have
intermittent episodes of atrial fibrillation though never
hemodynamically significant.

She was evaluated and passed to level 5 physical therapy
evaluation. Her chest x-rays demonstrated a persistent small
left apical pneumonitis which was followed with serial chest
x-rays. Her chest tubes were removed sequentially and this
never led to any respiratory compromise. She was restarted on
her medications and she is now stable and ready for discharge
to home.

DISCHARGE DIAGNOSES:
1. Acute coronary artery disease.
2. Atrial fibrillation.
3. Hypertension.
4. Duodenal ulcer.
5. Persistent left pneumothorax.


INTERVENTIONS:  Off pump coronary artery bypass graft, left
internal mammary artery to left anterior descending coronary
artery.

MEDICATIONS ON DISCHARGE:  Colace 100 mg p.o. b.i.d., Zantac
150 mg p.o., b.i.d., aspirin 81 mg daily, Percocet 5/325 one
to two tablets p.o. q 4 hours p.r.n., Plavix 75 mg p.o.
daily, ezetimibe10 mg daily, colesevelam 625 p.o. t.i.d.,
Digoxin 0.25 daily, Lasix 40 mg p.o. daily x7 days, Lopressor
50 mg p.o. b.i.d., diltiazem 240 sustained release p.o.
daily, Coumadin 5 mg p.o. daily.

LABORATORY DATA ON DISCHARGE:  Last INR is 2.1.


DISPOSITION:  Patient is stable for discharge to home. She
will be followed by [**Hospital6 407**] who will check
her wound, check her medications, check vital signs.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**]

Dictated By:[**Last Name (NamePattern1) 8958**]
MEDQUIST36
D:  [**2193-4-3**] 15:21:55
T:  [**2193-4-3**] 16:50:32
Job#:  [**Job Number 41675**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Atrial fibrillation,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of breast'}


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: Chest pain on admission.

PRESENT ILLNESS: The patient is an 82 year old
with extensive cardiac history including a prior myocardial
infarction and recent abnormal stress test who presented to
the hospital with chest pain. She denied any nausea,
vomiting, fever or chills. There were no other associated
symptoms. She had relief with sublingual nitroglycerine. The
pain had lasted two hours. This was similar to her episode of
angina in [**2189**] at which time she required a stent in her left
anterior descending coronary artery for ischemia. She was
admitted to the medical service and her work up revealed
significant two vessel coronary artery disease and the
cardiac surgery team was consulted.

MEDICAL HISTORY: 1. Anterior myocardial infarction in [**2182**], status post left
   anterior descending coronary artery stent.
2. Re-stenosis with recurrent angina in [**2190-2-26**] with
   percutaneous transluminal coronary angioplasty and left
   anterior descending coronary artery stent.
3. History of atrial fibrillation.
4. Status post pacer placement for atrial fibrillation.
5. Hypertension.
6. Duodenal ulcer.

MEDICATION ON ADMISSION: Include Lopressor 50 mg p.o.
b.i.d., Digoxin 0.25 mg daily, Lasix 20 mg daily, Plavix 75
mg daily, isosorbide 30 mg p.o. b.i.d., Avapro 300 mg daily,
Zantac 150 mg b.i.d., Coumadin 5 mg daily, Zetia 10 mg daily,
Ativan 0.5 mg p.r.n. h.s., Welchol 3 tablets t.i.d.

ALLERGIES: She has allergy to amoxicillin, sulfa, Norvasc
and statins.

PHYSICAL EXAM: 

FAMILY HISTORY: Is noncontributory.

SOCIAL HISTORY: She lives at home with her sister, denies
any ETOH or alcohol use. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Atrial fibrillation,Anemia, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Personal history of malignant neoplasm of breast'}
