CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 73-year-old male
admitted from an outside hospital to Cardiology with a
positive Thallium test with cardiac catheterization revealing
99% blockage of the left anterior descending artery with 50%
right coronary artery blockage, and was transferred to [**Hospital1 1444**] for coronary artery bypass
graft.

MEDICAL HISTORY: 1. Hypertension.
2. Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Carpal tunnel syndrome,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Disrup-external op wound,Urin tract infection NOS,Carpal tunnel syndrome,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2132-3-19**]       Discharge Date:  [**2132-4-18**]

Date of Birth:   [**2058-8-17**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This is a 73-year-old male
admitted from an outside hospital to Cardiology with a
positive Thallium test with cardiac catheterization revealing
99% blockage of the left anterior descending artery with 50%
right coronary artery blockage, and was transferred to [**Hospital1 1444**] for coronary artery bypass
graft.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Hyperlipidemia.

PAST SURGICAL HISTORY:  Distant appendectomy.

ALLERGIES:  The patient had no known drug allergies.

MEDICATIONS AT HOME:
1. Hyzaar.
2. Norvasc.
3. Lipitor.

PHYSICAL EXAMINATION:  On admission, patient was regular,
rate, and rhythm.  Clear to auscultation bilaterally.
Afebrile.  Vital signs were stable.

LABORATORIES:  White count of 12, hematocrit 38.8, platelets
of 277.  Electrolytes were within normal limits except for a
creatinine of 1.8.  LFTs and coags were normal.

HOSPITAL COURSE:  The patient underwent a coronary artery
bypass graft x4 on [**2132-3-20**] without any problems.  On
postoperative day one, the patient was noted to have
bilateral hand swelling.  Neurology was consulted, and this
is thought to be intraoperative median nerve compression as
it was improving as time progressed.

On postoperative day #3, the patient was noted to have
sternal drainage, respiratory distress, and acute
hypotension.  The patient was intubated.  Increased sternal
drainage was noted and abdominal distention was noted.  Chest
x-ray shows a widen mediastinum, but no obvious blood.  A
transesophageal echocardiogram showed no tamponade and the
decision was made to take the patient to the operating room
for an exploratory laparotomy and exploratory thoracotomy, at
which point no intraabdominal blood was noted and no
retroperitoneal blood was noted, but there was distention of
the colon noted per the General Surgery team.

Transplant Surgery was consulted intraoperatively, and they
noted enlarged fatty liver with significant venous
congestion.  The patient was felt to be stable for a
candidate for sternal rewiring.  Plastic Surgery was
consulted, and an omental flap transposition with bilateral
bifemoral muscle flaps was done for sternal closure.  VAC
dressing was applied.  Patient subsequently underwent a split
thickness skin graft to the omental flap, and the VAC
dressing reapplied on [**2132-3-30**].

Three days later on [**4-2**], the patient was noted to
have a right sided wound suture line disruption for which the
patient underwent a sternal wound exploration and reclosure
of the VAC on [**4-7**] after the patient had undergone
enough diuresis for such a procedure.  The patient was placed
on strict bed rest for the Plastic Surgery team in order to
attempt to resect the wound closure.  The patient
subsequently had an uncomplicated resolution of his hospital
stay as he was able to tolerate regular diet and had good
pain control with oral pain medications, and was eventually
allowed to ambulate with strict sternal precautions, and felt
to be ready to be discharged to a rehabilitation facility on
[**2132-4-18**].

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  Rehabilitation facility.

DIAGNOSES:
1. Status post coronary artery bypass graft x4.
2. Omental flap transposition with bilateral pectoral flap
for sternal closure.
3. Split thickness skin graft to omental flap.
4. Sternal wound exploration and reclosure.

FO[**Last Name (STitle) **]P INSTRUCTIONS:  The patient is to be following up
with Dr. [**Last Name (Prefixes) **] in four weeks or upon discharge from the
rehabilitation facility, also with Plastic Surgery in [**2-14**]
weeks, with primary care provider, [**Name10 (NameIs) **] with cardiologist as
well.

DISCHARGE MEDICATIONS:
1. Bacitracin ointment application to the sternal wound.
2. Zinc sulfate 220 mg po q day.
3. Multivitamins q day.
4. Lopressor 25 mg po bid.
5. Iron sulfate 325 mg q day.
6. Haldol 1 mg po q hs.
7. Vancomycin 1 gram IV q day for five more days.
8. Plavix 75 mg po q day.
9. Aspirin 81 mg po q day.
10. Tylenol 325-650 mg po q4-6h prn.
11. Amiodarone 200 mg po bid.
12. Albuterol 1-2 puffs q4h.
13. Ascorbic acid 500 mg po bid.




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

Dictated By:[**Name8 (MD) 5915**]
MEDQUIST36

D:  [**2132-4-17**]  23:33
T:  [**2132-4-18**]  06:00
JOB#:  [**Job Number 29490**]


Name:  [**Known lastname 5156**], [**Known firstname **]                     Unit No:  [**Numeric Identifier 5157**]

Admission Date:  [**2132-3-19**]     Discharge Date:  [**2132-4-21**]

Date of Birth:   [**2058-8-17**]     Sex:  M

Service:

This is an addendum to the discharge summary dictated on
[**2132-4-18**].  The addendum covers [**2132-4-18**], to day of
discharge, [**2132-4-21**].

On the 7th the patient was seen again by the plastic surgery
team.  Vital signs were stable.  Patient was doing well, was
afebrile.  The wound was healing slowly, but nicely.  They
recommended leaving the JPs in so any potential fluid would
not impede wound healing.  They recommended that if patient
were to go to rehab, he could follow up in clinic for
reevaluation of possible JP drain site.  Patient continued to
have wound and dressing care with bacitracin applied to the
staple lines on the abdomen which were intact.  The JP drain
sites were benign.  Patient continued on vancomycin via the
right PICC line.

On postoperative days 30 and 27 the patient continued on
vancomycin, was in sinus rhythm at 80 with blood pressure of
105/70, sating 96% in room air.  Lungs were clear.  Heart was
regular rate and rhythm.  Incisions were otherwise
unremarkable.  Patient continued with wound care and
ambulation with plans to discharge to rehab as soon as a bed
was available.  Unfortunately, patient began to do "too well"
for rehab and was expected to go home on the following
Monday.  Patient was taking good p.o., making good urine and
was afebrile, was stable and continued to ambulate on the
floor.

On postoperative days 31 and 28 the patient again continued
with vancomycin therapy via PICC line.  He continued to be
stable with good pain control and remained afebrile.  The
plan was to discontinue one of the JPs that had no output
over three days and to leave the other two in place for the
moment to help collect any fluid that might accumulate at the
right side of the wound where the superior pole of the
incision had some separation.  They recommended discharging
patient on low dose Keflex as the sutures were likely to stay
in for approximately three weeks.  Patient was seen again by
case management over the weekend.  They offered a rehab bed
at [**Hospital6 5158**] TCU.  On the day of discharge, on the
10th, patient was stable.  Vital signs were good.  Heart was
regular rate and rhythm.  Lungs were clear.  There were no
changes in the incisions.  They appeared to be clean and
intact otherwise.

DISCHARGE DIAGNOSES:
1.  Status post coronary artery bypass grafting times four.
2.  Status post omental flap transposition with bilateral
pectoral flaps for sternal closure.
3.  Split thickness skin graft to the omental flap.
4.  Sternal wound exploration and reclosure.
5.  Hyperlipidemia.
6.  Hypertension.

DISCHARGE MEDICATIONS:
1.  Bacitracin ointment application to the sternal wound.
2.  Zinc sulfate 220 mg p.o. q.day.
3.  Multivitamin one q.day.
4.  Lopressor 25 mg p.o. b.i.d.
5.  Iron sulfate 325 mg p.o. q.d.
6.  Haldol 1 mg p.o. q.h.s.
7.  Vancomycin 1 gm IV q.day for five more days after
discharge.
8.  Plavix 75 mg p.o. q.d.
9.  Aspirin 81 mg p.o. q.d.
10. Tylenol 325 to 650 mg p.o. p.r.n. q.four to six hours.
11. Albuterol ipratropium one to two puffs q.four hours
nebulizer.
12. Amiodarone 200 mg p.o. b.i.d.
13. Ascorbic acid 500 mg p.o. b.i.d.
14. Keflex 500 mg p.o. q.d. until plastic surgery followup
visit.

DI[**Last Name (STitle) 1390**]E INSTRUCTIONS:  The patient was instructed to visit
Dr. [**Last Name (Prefixes) **] in approximately four weeks or upon discharge
from the rehab facility.  He was instructed to see his
primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], in one to two weeks
and to follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 5111**] from plastic surgery in
approximately one to two weeks.

Please refer to the discharge summary from [**4-18**] for
additional information.  Patient was discharged to rehab on
[**2132-4-21**].






                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Last Name (NamePattern1) 981**]

MEDQUIST36

D:  [**2132-6-3**]  15:02
T:  [**2132-6-3**]  15:10
JOB#:  [**Job Number 5159**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Carpal tunnel syndrome,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: 

PRESENT ILLNESS: This is a 73-year-old male
admitted from an outside hospital to Cardiology with a
positive Thallium test with cardiac catheterization revealing
99% blockage of the left anterior descending artery with 50%
right coronary artery blockage, and was transferred to [**Hospital1 1444**] for coronary artery bypass
graft.

MEDICAL HISTORY: 1. Hypertension.
2. Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Carpal tunnel syndrome,Unspecified essential hypertension,Pure hypercholesterolemia'}
