CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 74-year-old gentleman
who was seen in the [**Hospital3 3583**] Emergency Room with a
1-month complaint of progressive shortness of breath,
exertional left and right arm pain radiating to the chest,
associated with shortness of breath, reporting pain resolving
with rest.  At the outside hospital, the patient ruled in for
a non-Q-wave myocardial infarction with peak troponin levels
of 2.6.  Electrocardiogram showed inferior T wave
abnormalities.

MEDICAL HISTORY: 1.  Gastroesophageal reflux disease.
2.  Arthritis.
3.  Status post right knee arthroscopic surgery.
4.  History of esophageal cancer; status post
esophageal/partial gastrectomy in [**2156**].
5.  History of sternal fracture.
6.  History of esophageal stricture; status post multiple
esophageal dilatations.
7.  Remote alcohol abuse; quit in [**2156**].
8.  Remote tobacco use; quit in [**2158**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other specified complications of procedures not elsewhere classified,Esophageal reflux,Personal history of tobacco use
Subendo infarct, initial,Crnry athrscl natve vssl,Surg compl-heart,Atrial fibrillation,Oth spcf cmplc procd NEC,Esophageal reflux,History of tobacco use
Admission Date:  [**2175-5-3**]     Discharge Date:  [**2175-5-11**]

Date of Birth:   [**2100-11-6**]     Sex:  M

Service:  Cardiac Surgery

HISTORY OF PRESENT ILLNESS:  This is a 74-year-old gentleman
who was seen in the [**Hospital3 3583**] Emergency Room with a
1-month complaint of progressive shortness of breath,
exertional left and right arm pain radiating to the chest,
associated with shortness of breath, reporting pain resolving
with rest.  At the outside hospital, the patient ruled in for
a non-Q-wave myocardial infarction with peak troponin levels
of 2.6.  Electrocardiogram showed inferior T wave
abnormalities.

The patient was transferred to [**Hospital1 188**] for cardiac catheterization.

PAST MEDICAL HISTORY:
1.  Gastroesophageal reflux disease.
2.  Arthritis.
3.  Status post right knee arthroscopic surgery.
4.  History of esophageal cancer; status post
esophageal/partial gastrectomy in [**2156**].
5.  History of sternal fracture.
6.  History of esophageal stricture; status post multiple
esophageal dilatations.
7.  Remote alcohol abuse; quit in [**2156**].
8.  Remote tobacco use; quit in [**2158**].

ALLERGIES:  No known drug allergies.

MEDICATIONS ON DISCHARGE:  (Preoperative medications
included)
1.  Aspirin 81 mg p.o. once per day.
2.  Protonix 40 mg p.o. once per day.
3.  Lopressor 25 mg p.o. four times per day.
4.  Lipitor 10 mg p.o. once per day.

MEDICATIONS ON TRANSFER:  The patient was transferred from
the outside hospital on heparin and nitroglycerin drips.

HOSPITAL COURSE:  The patient was taken to the Cardiac
Catheterization Laboratory on [**2175-5-3**].  Cardiac
catheterization showed normal left ventricular systolic
function, with a 50% left main lesion, 80% ostial/proximal
left anterior descending artery lesion, 50% ostial circumflex
lesion, and 80% complex right coronary artery lesion.

Cardiothoracic Surgery was consulted, and it was decided that
the patient was a candidate for cardiac surgery.

The patient was to the operating room on [**2175-5-4**] for a
coronary artery bypass graft times three with Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 70**].  The patient had a left internal mammary artery to
left anterior descending artery, saphenous vein graft to
obtuse marginal, and saphenous vein graft to right posterior
descending artery.  Please see the Operative Note for further
details.

The patient was transferred to the Intensive Care Unit
postoperatively in stable condition.  The patient was weaned
and extubated from mechanical ventilation on the first
postoperative evening.

On postoperative day one, the patient complained of bilateral
arm numbness and weakness which was not the same as his
preoperative angina.  The patient had an electrocardiogram
which was unchanged.  This sensation was thought to be due to
positioning during surgery, and the sensation gradually
improved over the next couple of days.  The patient remained
hemodynamically stable on no cardiac medications.  On
postoperative day one, the patient was started on Lopressor.

The chest tube were removed on postoperative day two.  The
pacing wires were removed without incident on postoperative
day two.  The patient began ambulating in the Intensive Care
Unit.  The patient remained in the Intensive Care Unit for a
couple of extra days due to lack of floor bed availability.

The patient was transferred from the Intensive Care Unit to
the floor on postoperative day four.  On the evening of
postoperative day four, the patient had a temperature of
101.8.  The patient was pan-cultured.  As of the day of
discharge, his urine culture was negative.  His sputum
culture grew oropharyngeal flora.  His blood cultures were
pending, and his chest x-ray was without infiltrate.

The patient was encouraged to use his incentive spirometer,
and the fever defervesced.  The patient did not have any
further elevated temperatures.

On postoperative day five, the patient had a 5-beat run of
tachycardia which was presumed to be a ventricular
tachycardia.  The patient had an electrocardiogram done at
this time which was negative for any ischemic changes.  The
patient had an echocardiogram done which showed grossly
normal left ventricular function.  The patient had no further
ventricular tachycardia.

The patient remained hemodynamically stable and was cleared
for discharge to home on postoperative day seven.

CONDITION AT DISCHARGE:  Temperature maximum of 97, heart
rate was 70 (sinus rhythm without ectopy), blood pressure was
115/59, respiratory rate was 18, and oxygen saturation was
97% on room air.  The patient's weight on [**5-11**] was 77.1
kilograms.  Preoperatively, the patient weighed 75.6
kilograms.

PERTINENT LABORATORY VALUES:  White blood cell count was 6.1,
hematocrit was 28.6, and platelet count was 295.  Sodium was
137, potassium was 5, chloride was 101, bicarbonate was 27,
blood urea nitrogen was 20, creatinine was 1.1, and blood
glucose was 88.  Prothrombin time was 13.2 and partial
thromboplastin time was 36.6.

A chest x-ray from [**5-8**] only showed small bilateral
pleural effusions.

PHYSICAL EXAMINATION:  The patient was neurologically awake,
alert and oriented times three.  The examination was
nonfocal.  Strength in the upper and lower extremities was
equal bilaterally.  Heart was regular in rate and rhythm
without rubs or murmurs.  The lungs were decreased at the
posterior bases without wheezes or rhonchi.  Abdominal
examination revealed the abdomen was soft, nontender, and
nondistended. Positive bowel sounds.  The patient had a bowel
movement.  The patient was tolerating a regular diet.
External incision and Steri-Strips were intact.  The sternum
was stable.  The incisions was clean and dry without
erythema.  The left leg vein harvest site revealed
Steri-Strips were intact without erythema or drainage.  The
extremities had 1 to 2+ pitting edema.

MEDICATIONS ON DISCHARGE:
 1.  Lopressor 50 mg p.o. twice per day.
 2.  Lasix 20 mg p.o. twice per day (times seven days).
 3.  Potassium chloride 20 mEq p.o. twice per day (times
seven days).
 4.  Percocet 5/325 one to two tablets p.o. q.4h. as needed.
 5.  Colace 100 mg p.o. twice per day.
 6.  Protonix 40 mg p.o. once per day.
 7.  Niferex 150 mg p.o. once per day.
 8.  Vitamin C 500 mg p.o. twice per day.
 9.  Enteric-coated aspirin 325 mg p.o. once per day.
10.  Lipitor 10 mg p.o. once per day.

DISCHARGE STATUS:  The patient was to be discharged to home.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to follow up with Dr. [**Last Name (STitle) 5310**] on [**5-22**] at 4:45 p.m.
2.  The patient was to call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] office and
follow up with Dr. [**Last Name (STitle) 70**] in four to six weeks.





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

Dictated By:[**Last Name (NamePattern1) 28087**]

MEDQUIST36

D:  [**2175-5-11**]  11:24
T:  [**2175-5-11**]  11:37
JOB#:  [**Job Number 47841**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other specified complications of procedures not elsewhere classified,Esophageal reflux,Personal history of tobacco use'}


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 74-year-old gentleman
who was seen in the [**Hospital3 3583**] Emergency Room with a
1-month complaint of progressive shortness of breath,
exertional left and right arm pain radiating to the chest,
associated with shortness of breath, reporting pain resolving
with rest.  At the outside hospital, the patient ruled in for
a non-Q-wave myocardial infarction with peak troponin levels
of 2.6.  Electrocardiogram showed inferior T wave
abnormalities.

MEDICAL HISTORY: 1.  Gastroesophageal reflux disease.
2.  Arthritis.
3.  Status post right knee arthroscopic surgery.
4.  History of esophageal cancer; status post
esophageal/partial gastrectomy in [**2156**].
5.  History of sternal fracture.
6.  History of esophageal stricture; status post multiple
esophageal dilatations.
7.  Remote alcohol abuse; quit in [**2156**].
8.  Remote tobacco use; quit in [**2158**].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other specified complications of procedures not elsewhere classified,Esophageal reflux,Personal history of tobacco use'}
