CHIEF COMPLAINT: The patient is an 85-year-old woman patient
of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] referred for an outpatient cardiac
catheterization due to progressive dyspnea on exertion on
positive ETT.

PRESENT ILLNESS: [**Known firstname 33864**] [**Known lastname 33865**] is an
85-year-old woman with no known cardiac history.  She
complains of several weeks of shortness of breath with a
minimal amount of exertion.  She states that she was recently
out with her daughter doing some shopping and her daughter
noticed that the patient was quite short of breath.  She
denied any history of chest discomfort, palpitations, or
dizziness.  Echocardiogram from [**Month (only) 359**] of this year revealed
mild to moderate MI, mild TIA, moderate pulmonary artery
hypertension, concentric LVH with an EF60%, sclerotic aortic
valve without stenosis, Persantine exercise tolerance also
done in [**Month (only) **], positive for nausea and 5.5-mm
inferolateral ST depression.  Myoview images revealed a
moderately large territory of distal anterior apical and
septal ischemia.  There is no history of prior infarct.  The
EF on myoview is 70%.  The patient's height is
5  feet 7 inches. Weight 172 pounds.

MEDICAL HISTORY: History is significant for prior
atrial fibrillation, COPD, low back pain, CVA three to four
years ago with some vision loss in the right eye.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is widowed.  She lives in an
[**Hospital3 **] at [**Location (un) 33866**].  She has several
supportive children.
Coronary atherosclerosis of native coronary artery,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Mitral valve disorders,Candidiasis of vulva and vagina,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Hemorrhage complic proc,Surg compl-heart,Atrial fibrillation,Mitral valve disorder,Candidal vulvovaginitis,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2180-12-4**]       Discharge Date:  [**2180-12-13**]


Service:  CARDIOTHOR

CHIEF COMPLAINT:  The patient is an 85-year-old woman patient
of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] referred for an outpatient cardiac
catheterization due to progressive dyspnea on exertion on
positive ETT.

HISTORY OF THE PRESENT ILLNESS:  [**Known firstname 33864**] [**Known lastname 33865**] is an
85-year-old woman with no known cardiac history.  She
complains of several weeks of shortness of breath with a
minimal amount of exertion.  She states that she was recently
out with her daughter doing some shopping and her daughter
noticed that the patient was quite short of breath.  She
denied any history of chest discomfort, palpitations, or
dizziness.  Echocardiogram from [**Month (only) 359**] of this year revealed
mild to moderate MI, mild TIA, moderate pulmonary artery
hypertension, concentric LVH with an EF60%, sclerotic aortic
valve without stenosis, Persantine exercise tolerance also
done in [**Month (only) **], positive for nausea and 5.5-mm
inferolateral ST depression.  Myoview images revealed a
moderately large territory of distal anterior apical and
septal ischemia.  There is no history of prior infarct.  The
EF on myoview is 70%.  The patient's height is
5  feet 7 inches. Weight 172 pounds.

PAST MEDICAL HISTORY:  History is significant for prior
atrial fibrillation, COPD, low back pain, CVA three to four
years ago with some vision loss in the right eye.

PAST SURGICAL HISTORY:  History is significant for
appendectomy, right hip replacement six to seven years ago.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS:  Medications, prior to admission revealed the
following:
1.  Aspirin 325 mg q.d.
2.  Atenolol 25 mg q.d.
3.  Betapace 40 mg b.i.d.
4.  Digoxin 0.125 mg q.d.
5.  Lipitor 10 mg q.d.

LABORATORY DATA:  Data, prior to admission, revealed the
white count of 10.2, hematocrit 37.0, platelet count 183,000,
INR .93, glucose 108, sodium 140, potassium 4.7, chloride
104, CO2 27, BUN 23, creatinine 1.0.

SOCIAL HISTORY:  The patient is widowed.  She lives in an
[**Hospital3 **] at [**Location (un) 33866**].  She has several
supportive children.

The patient underwent cardiac catheterization on [**11-28**].  Please see the catheterization report for full
details.  In summary, the catheterization showed 100% LAD
after the first diagonal filling left to left collaterals,
OM2 50%, RCA hazy, 90% ostial lesion, mid 50% lesion with EF
of 50% and calcified mitral annulus.  The patient tolerated
the procedure well.  The patient was to be discharged home
after cardiac catheterization to return in one week for
coronary artery bypass graft with Dr. [**Last Name (STitle) 1537**].  The patient was
re-admitted to [**Hospital1 69**] on
[**12-4**], at which time she was admitted to the operating
room, where she underwent off pump coronary artery bypass
grafting time three.  Please see the operating report for
full details.  She tolerated the procedure well.

In summary, she underwent coronary artery bypass grafting
times three with a LIMA to the LAD, vein graft to OM2 and
vein graft to right PDA.  The patient tolerated the procedure
well.  She was transferred from the operating to the
Cardiothoracic Intensive Care Unit.  At the time of transfer,
the patient had an arterial and a Swan-Ganz catheter, two
ventricular pacing wires, two mediastinal chest tubes, right
pleural chest tube and left pleural chest tube.  Mean
arterial pressure was 110.  CVP was 10 and she had propofol
at 3 mcg/kg per minute.  The patient's immediate
postoperative course was complicated by brisk bleeding via
her chest tubes.  Later in the evening, the patient was
returned to the operating room for re-exploration.  Following
the exploration, the patient was returned to the
Cardiothoracic Intensive Care Unit.  At that time she was
hemodynamically stable.  She did well in the Immediate Post
re-exploration period.  Anesthetics were reversed.  She was
weaned from the ventilator.  On the following morning she was
successfully extubated.  The patient remained in stable
condition throughout postoperative day #1.  Hemodynamically,
she was apaced at a rate of 85 with a blood pressure of
120/51 and a cardiac index of 2.3.  She was breathing
comfortably with oxygen saturations in the high 90s on four
liters of nasal prongs.  Abdomen was soft and nontender.
Underlying rhythm was a junctional rhythm at a rate of 20.
With her junctional rhythm the patient dropped her blood
pressure.  For this reason she was maintained on a dopamine
drip and continued to be apaced.

On postoperative day #2, the patient's epicardial pacing
wires failed.  Because of the failure to capture the
epicardiac pacing wires, it was necessary to replace the
patient's Swan-Ganz catheter with a pacing Swan-Ganz
catheter.  She tolerated that procedure well.  She continued
to be apaced with the pacing Swan.  The underlying rhythm at
that time was a junctional escape in the 40s with a blood
pressure of 60/40 with periods of asystole.  At that time
electrophysiology was consulted and asked to assess the
patient with no sinus rhythm or intermittent sinus rhythm
following coronary artery bypass grafting.

Over the next several days the patient remained
hemodynamically stable.  She remained in the Intensive Care
Unit, where she was apaced and followed by both
cardiothoracic surgery and electrophysiology to see if the
patient's sinus rhythm would return to normal function.

On postoperative day #7, it was decided that the likelihood
of recovery of the sinus rhythm was low, and at that time she
was taken to the electrophysiology laboratory where she
underwent EP testing and placement of a permanent pacemaker.

Following the pacemaker placement, the patient was
transferred to Far 6 for continuing postoperative care and
recovery from cardiothoracic surgery.

On postoperative day #8, it was decided that the patient was
stable and ready for transfer to rehabilitation for
continuing postoperative care and physical therapy following
coronary artery bypass graft and permanent pacemaker
placement.  At the time of transfer, the patient's condition
is stable.

PHYSICAL EXAMINATION:  Physical examination is as follows:
Temperature 98, heart rate 79, blood pressure 135/5,
respiratory rate 20, oxygen saturation 95% on room air.
Weight, preoperatively is 80.2 kg; on discharge 85.3 kg.

LABORATORY DATA:  Laboratory data revealed the following:
Hematocrit 29, white blood cell count 11, sodium 136,
potassium 4.5, BUN 19, creatinine 1.1, glucose 108.

PHYSICAL EXAMINATION:  The patient was alert, oriented times
three; moves all extremities, follows commands.  Respiratory:
Clear to auscultation bilaterally with diminished breath
sounds bilaterally at the bases.  Heart sounds:  Regular rate
and rhythm, S1 and S2.  Sternum is stable.  Incision with
staples, open to air, clean and dry.  Abdomen:  Soft,
nontender, nondistended, normoactive bowel sounds.
Extremities are warm and well perfused with no clubbing,
cyanosis or edema.  Right lower extremity incision with Steri
Strips open to air, clean and dry.  Left shoulder incision
revealed dry sterile dressing clean and dry.

DISCHARGE MEDICATIONS:
1.  Plavix 75 mg q.d.
2.  Captopril 12.5 mg t.i.d.
3.  Aspirin 325 mg q.d.
4.  Ranitidine 150 mg q.d.
5.  Colace 100 mg b.i.d.
6.  Amiodarone 400 mg q.d.
7.  Lopressor 25 mg b.i.d.
8.  Vancomycin 1 gram q.12h. times two more doses.

FOLLOW-UP CARE:  The patient is to have followup with
electrophysiology in the pacemaker clinic in ten days.  She
is also to have followup in the wound clinic in ten days and
to have followup with Dr. [**Last Name (STitle) 1537**] in one month.




                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern4) **]
MEDQUIST36

D:  [**2180-12-12**]  13:25
T:  [**2180-12-12**]  13:24
JOB#:  [**Job Number 33867**]
{'Coronary atherosclerosis of native coronary artery,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Mitral valve disorders,Candidiasis of vulva and vagina,Unspecified essential hypertension,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: The patient is an 85-year-old woman patient
of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] referred for an outpatient cardiac
catheterization due to progressive dyspnea on exertion on
positive ETT.

PRESENT ILLNESS: [**Known firstname 33864**] [**Known lastname 33865**] is an
85-year-old woman with no known cardiac history.  She
complains of several weeks of shortness of breath with a
minimal amount of exertion.  She states that she was recently
out with her daughter doing some shopping and her daughter
noticed that the patient was quite short of breath.  She
denied any history of chest discomfort, palpitations, or
dizziness.  Echocardiogram from [**Month (only) 359**] of this year revealed
mild to moderate MI, mild TIA, moderate pulmonary artery
hypertension, concentric LVH with an EF60%, sclerotic aortic
valve without stenosis, Persantine exercise tolerance also
done in [**Month (only) **], positive for nausea and 5.5-mm
inferolateral ST depression.  Myoview images revealed a
moderately large territory of distal anterior apical and
septal ischemia.  There is no history of prior infarct.  The
EF on myoview is 70%.  The patient's height is
5  feet 7 inches. Weight 172 pounds.

MEDICAL HISTORY: History is significant for prior
atrial fibrillation, COPD, low back pain, CVA three to four
years ago with some vision loss in the right eye.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is widowed.  She lives in an
[**Hospital3 **] at [**Location (un) 33866**].  She has several
supportive children. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Hemorrhage complicating a procedure,Cardiac complications, not elsewhere classified,Atrial fibrillation,Mitral valve disorders,Candidiasis of vulva and vagina,Unspecified essential hypertension,Pure hypercholesterolemia'}
