CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 76-year-old
male status post three-vessel coronary artery bypass grafting
in [**2146**] who presents with about a 36-hour history of
recurrent dyspnea and chest/shoulder pain.  In the outside
hospital emergency room, the patient was found to have ST
elevations in EKG leads 2, 3 and aVF with reciprocal changes
in the anterior leads.  The patient was transported to [**Hospital1 1444**].  Upon arrival the patient's
troponin was found to be 18.2.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other inferior wall, initial episode of care,Other emphysema,Congestive heart failure, unspecified,Coronary atherosclerosis of autologous vein bypass graft,Atrial fibrillation
AMI inferior wall, init,Emphysema NEC,CHF NOS,Crn ath atlg vn bps grft,Atrial fibrillation
Admission Date:  [**2163-7-1**]       Discharge Date:  [**2163-7-6**]

Date of Birth:   [**2087-3-9**]       Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  The patient is a 76-year-old
male status post three-vessel coronary artery bypass grafting
in [**2146**] who presents with about a 36-hour history of
recurrent dyspnea and chest/shoulder pain.  In the outside
hospital emergency room, the patient was found to have ST
elevations in EKG leads 2, 3 and aVF with reciprocal changes
in the anterior leads.  The patient was transported to [**Hospital1 1444**].  Upon arrival the patient's
troponin was found to be 18.2.

Cardiac catheterization revealed: Coronary arteries showed the
left main artery was found to be normal.  The left anterior
descending coronary artery was found to have a proximal
occlusion.  The LIMA graft to the LAD was found to be widely
patent.  The left circumflex coronary artery had a tubular 70%
occlusion and a moderate obtuse marginal branch stenosis.  The
right coronary artery was occluded proximally.  The SVT to
RCA was occluded with a taper suggestive of an acute occlusion.
There was a thrombus visible on catheterization.  The
intervention was a thrombectomy with clot removal in the right
coronary artery saphenous vein graft.  Angioplasty plus six
stents were placed in the graft. TIMI 3 flow was observed in the
graft.

PHYSICAL EXAMINATION:  The patient was found to have a blood
pressure of 91/49, heart rate 78, respiratory rate 16, she
was saturating at 98% on room air.  His pulmonary arterial
pressures were 35/18 with a mean of 24.  In general the
patient was lying comfortably in bed.  His HEENT examination
revealed pupils that were equal, round, and reactive to
light.  His head was normocephalic, atraumatic.  His neck
demonstrated no jugular venous distension.  His chest was
clear to auscultation bilaterally with no wheezing, rhonchi
or rales.  His cardiac examination exhibited faint heart
sounds, a normal S1 and S2 with no murmurs.  His abdomen was
obese, nontender.  His bowel sounds were hypoactive.  His
extremities were found to be warm with trace edema.  His
posterior tibial pulses were found to be 1+.  His dorsalis
pedis pulses were 1+ as well.  His neurological examination
was grossly intact.

LABORATORY DATA:  His laboratory studies on admission were
significant for a white count of 17.9.  His EKG was read as
normal sinus rhythm at 78 beats per minute.  The patient had
[**Street Address(2) 4793**] elevations in leads 2, 3 and aVF with T wave
inversions.  The patient's chest x-ray demonstrated some
pulmonary vascular congestion with some underlying
emphysematous changes.  The patient had a transthoracic
echocardiogram that revealed an ejection fraction of 20-30%,
akinetic inferior and posterior walls, severe hypokinesis in
the inferior septum.

HOSPITAL COURSE:  The patient was started on Lopressor,
aspirin, Plavix, fluvastatin and was also given Lasix p.r.n.
Initially the patient had large oxygen requirements typically
in the range of five liters.  After giving him Lasix doses
ranging from 40 to 80 mg p.r.n., he diuresed approximately
2-3 liters.  His oxygen requirements dropped to 100% on two
liters.  The patient was also given nebulizer treatments
p.r.n. to increase his breathing capacity.

The patient began a cardiac healthy diet and remained
afebrile for the course of his admission.

On hospital day six the patient had a brief episode of atrial
fibrillation lasting about 1-2 hours.  The patient
spontaneously converted out of this rhythm however Coumadin
was started for the risk of going into atrial fibrillation
again.  Physical therapy was brought on the case to help with
his breathing and his ambulatory status.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Stable.

DISCHARGE DIAGNOSIS:  Acute myocardial infarction with
elements of congestive heart failure.

DISCHARGE MEDICATIONS:
1. Aspirin EC 325 mg p.o. q.d.
2. Clopidogrel bisulfate 75 mg p.o. q.d. for nine months.
3. Amitriptyline HCl 50 mg p.o. h.s.
4. Gabapentin 300 mg p.o. b.i.d.
5. Pantoprazole 40 mg p.o. q. 24 hours.
6. Fluvastatin sodium 80 mg p.o. q.d.
7. Metoprolol 25 mg p.o. b.i.d.
8. Carbidopa/levodopa CR (25-100) one tablet p.o. b.i.d.
9. Albuterol nebulizer solution one neb i.h. q. 4 hours.
10. Ipratropium bromide one neb i.h. q. 8 hours.
11. Fluticasone propionate 100 mcg, two puffs i.h. b.i.d.
12. Warfarin 5 mg p.o. q.d.
13. Lisinopril 2.5 mg p.o. q.d.

FOLLOW-UP PLANS:
1. The patient is to be discharged to the [**Hospital1 **] Transitional
Care Unit.
[**Unit Number **]. He is to follow up with his primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 28436**], in three to seven days to have his INR checked and
electrolytes checked.





                            [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3812**]

Dictated By:[**Last Name (NamePattern1) 3809**]
MEDQUIST36

D:  [**2163-7-6**]  13:48
T:  [**2163-7-6**]  14:12
JOB#:  [**Job Number **]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Other emphysema,Congestive heart failure, unspecified,Coronary atherosclerosis of autologous vein bypass graft,Atrial fibrillation'}


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 76-year-old
male status post three-vessel coronary artery bypass grafting
in [**2146**] who presents with about a 36-hour history of
recurrent dyspnea and chest/shoulder pain.  In the outside
hospital emergency room, the patient was found to have ST
elevations in EKG leads 2, 3 and aVF with reciprocal changes
in the anterior leads.  The patient was transported to [**Hospital1 1444**].  Upon arrival the patient's
troponin was found to be 18.2.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Other emphysema,Congestive heart failure, unspecified,Coronary atherosclerosis of autologous vein bypass graft,Atrial fibrillation'}
