CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 75-year-old gentleman,
who has a history of known coronary artery disease had been
managed medically over the last several years with a PTCA in
[**2106**].  Recently has been experiencing increased exertional
angina.  Had a positive stress test in [**2121-9-20**],
which showed a large reversible inferolateral wall defect
with a fixed component of inferior apex, an ejection fraction
of 38%.  An echocardiogram [**10/2121**] showed mild left
ventricular hypertrophy, moderate inferior wall hypokinesis,
and ejection fraction of 50%.  Patient was referred to [**Hospital1 1444**] for cardiac catheterization.

MEDICAL HISTORY: 1. Coronary artery disease.
2. Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac arrest,Acute and subacute necrosis of liver,Acute pancreatitis,Congestive heart failure, unspecified,Mitral valve disorders,Iatrogenic cerebrovascular infarction or hemorrhage
Crnry athrscl natve vssl,Intermed coronary synd,Cardiac arrest,Acute necrosis of liver,Acute pancreatitis,CHF NOS,Mitral valve disorder,Iatrogen CV infarc/hmrhg
Admission Date:  [**2121-11-6**]       Discharge Date:  [**2121-11-24**]

Date of Birth:   [**2047-2-27**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This is a 75-year-old gentleman,
who has a history of known coronary artery disease had been
managed medically over the last several years with a PTCA in
[**2106**].  Recently has been experiencing increased exertional
angina.  Had a positive stress test in [**2121-9-20**],
which showed a large reversible inferolateral wall defect
with a fixed component of inferior apex, an ejection fraction
of 38%.  An echocardiogram [**10/2121**] showed mild left
ventricular hypertrophy, moderate inferior wall hypokinesis,
and ejection fraction of 50%.  Patient was referred to [**Hospital1 1444**] for cardiac catheterization.

PAST MEDICAL HISTORY:
1. Coronary artery disease.
2. Hyperlipidemia.

ALLERGIES:  No known drug allergies.

PREOPERATIVE MEDICATIONS:
1. Zocor 40 mg p.o. q.d.
2. Procardia 30 mg p.o. q.d.
3. Isosorbide dinitrate 30 mg p.o. t.i.d.
4. Inderal 30 mg p.o. t.i.d.
5. Aspirin 325 mg p.o. q.d.

Patient was admitted to the Cardiac Catheterization
Laboratory on [**2121-11-7**].  Cardiac catheterization showed
left ventricular end diastolic pressure of 26, ejection
fraction of 25%, 95% distal left main involving the ostia,
the LAD, and circumflex, 30% mid LAD, 95% very proximal left
circumflex, and 95% mid left circumflex after OM-1, dominant
diffusely diseased RCA with 90% mid lesion and 90% distal
lesion.  Patient was referred for cardiac surgery.

Patient was originally scheduled for surgery on [**11-11**]
or [**11-12**], however, on the evening of [**11-9**],
patient had episode of ventricular fibrillation, which
required d-c cardioversion with 200 joules.  Patient was
cardioverted into a sinus rhythm.  Patient recovered a good
blood pressure.  Patient was then transported to the Cardiac
Catheterization Laboratory, where an intra-aortic balloon
pump was placed, and Cardiac Surgery was consulted.  It was
decided at that time to take the patient urgently for a CABG
with Dr. [**Last Name (STitle) 1537**].

Patient underwent a CABG x4:  LIMA to LAD, SVG to OM-1, SVG
to OM-2, and SVG to PDA.  Patient tolerated the procedure
well.  Was transported to the Intensive Care Unit in stable
condition on Levophed and milrinone as well as intra-aortic
balloon pump.  Patient awoke postoperatively, followed
commands, moved all extremities, and was nonfocal
neurologically.

Patient was weaned and extubated from mechanical ventilation
on postoperative day #1.  The milrinone and Levophed were
weaned down to off.  The intra-aortic balloon pump was
discontinued on postoperative day #1.  Liver function tests
were drawn as it was felt that the patient had some jaundice.
The liver function tests were all significantly elevated with
an ALT of 1433, AST [**2075**], LDH 2408, alkaline phosphatase of
69, and a total bilirubin of 0.6.

It was recommended by the Hepatology service that a right
upper quadrant ultrasound be obtained to check flow to the
patient's liver.  However, it was felt that the etiology was
most likely ischemic hepatitis due to the poor forward flow
during the arrest and subsequent CABG.

The right upper quadrant ultrasound showed no obstruction, no
evidence of cholecystitis, and good blood flow to the liver.
The patient's liver function tests continued to rise.  It was
also recommended by the Hepatology service that a hepatitis
panel be sent which is pending at this date.

It was noted by the nurses on postoperative day #2, that this
patient's right upper extremity was felt to be weak.  It was
recommended carotid ultrasounds be obtained and patient have
a CT scan of his head.  Carotid ultrasound showed that the
patient had less than 40% narrowing of his carotids
bilaterally.

Around this time, the patient also had episodes of rapid
atrial fibrillation which causes decrease in his blood
pressure requiring cardioversion.  Patient had been started
on amiodarone due to the patient's elevated liver function
tests.  Electrophysiology service was consulted for
alternative to amiodarone.  It was recommended by
Electrophysiology service to discontinue the amiodarone due
to the patient's elevated liver enzymes.  Start the patient
on digoxin for rate control should the patient go into atrial
fibrillation, and it was also recommended to switch the
patient from Lopressor to atenolol.

On postoperative day #3, patient began working with Physical
Therapy.  Was able to ambulate only about 100 feet, still in
the Intensive Care Unit.  Still requiring Neo-Synephrine to
maintain adequate blood pressure.

On the early morning of postoperative day three, patient
developed periods of agitation and confusion.  It was felt
that this was due to Percocet.  Percocet was discontinued.
Patient was given low dose Haldol, and subsequently cleared.
Patient was switched to Dilaudid for pain control.  Patient's
mediastinal chest tubes were removed.

Left sided watershed stroke:  Neurology thought this was
likely due to hypoperfusion.  Patient's right upper extremity
weakness continued to improve.  Electrophysiology service was
again reconsulted for patient's atrial fibrillation as well
as patient's preoperative ventricular fibrillation, and the
need for electrophysiology study.  Echocardiogram per the EP
service, showed ejection fraction of 25-30% and it was
planned to take the patient for an EP study and question of
AICD implantation.

The day the patient was scheduled to go for his study, it was
noted the patient had elevated white blood cell count of
21,000.  The case was cancelled and the patient was brought
back to [**Hospital Ward Name 121**] 2.  Patient was pancultured and it was found
that patient had a mild pancreatitis.  The EP service felt
that the ventricular fibrillation was likely due to his
ischemic state preoperatively.  They felt that the study
could be deferred for 1-2 weeks while patient recovered from
his surgery.

A General Surgery consult was obtained for the patient's
pancreatitis.  Patient's lipase was 502 with an amylase of
183 and mild left upper quadrant pain.  Patient was made NPO.
CT scan of the abdomen was obtained, which showed no evidence
of significant pancreatitis.  The patient continued to be
NPO.

On [**11-20**], patient's amylase and lipase were trending
downward.  Patient had no abdominal pain.  Was started on
clear liquids and advanced to a regular diet without any
abdominal pain.  Patient's amylase and lipase continued to
trend downward.  It was decided by the Electrophysiology
service that patient was safe to be discharged to home and
will return for his study.

By postoperative day #15, patient had completed a level five
with Physical Therapy, and the patient was cleared for
discharge to home.

CONDITION ON DISCHARGE:  T max 99.1, pulse 80 sinus rhythm,
blood pressure 104/52, respiratory rate 16, on room air
oxygen saturation 97%.  Neurologically, the patient is awake,
alert, and oriented times three.  Right upper extremity has
significantly improved strength with barely perceptible
weakness.  Right lower extremity and left lower extremity
have equal strength bilaterally.  Heart:  Regular rate and
rhythm without rub or murmur.  Breath sounds are clear
bilaterally.  Abdomen is soft, nontender, nondistended,
positive bowel sounds, tolerating regular diet.  Sternal
incision:  The staples are intact, clean, and dry.  There is
no erythema or drainage.  Right lower extremity vein harvest
site is clean and dry.  Steri-Strips were intact.  There is
minimal erythema over the medial portion of the incision.
Extremities have 1+ edema.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Preoperative ventricular fibrillation.
3. Postoperative atrial fibrillation.
4. Postoperative pancreatitis.
5. Postoperative ischemic hepatitis.

DISCHARGE MEDICATIONS:
1. Zocor 40 mg p.o. q.d.
2. Enteric coated aspirin 325 mg p.o. q.d.
3. Colace 100 mg p.o. b.i.d.
4. Dilaudid 2 mg p.o. q.4-6h. prn.
5. Atenolol 100 mg p.o. q.d.
6. Digoxin 0.125 mg p.o. q.d.

DISCHARGE INSTRUCTIONS:  The patient is discharged to home in
stable condition with home Occupational and Physical Therapy.
Patient is to followup with Dr. [**Last Name (STitle) 54429**] in his office in
[**11-21**] weeks.  Patient has an appointment for an
electrophysiology study on [**12-5**] at 7 a.m.  Patient
will be contact[**Name (NI) **] by the Electrophysiology Department for
further instructions, and patient should see 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 (NamePattern1) 1541**]
MEDQUIST36

D:  [**2121-11-24**]  12:50
T:  [**2121-11-24**]  12:49
JOB#:  [**Job Number 54430**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac arrest,Acute and subacute necrosis of liver,Acute pancreatitis,Congestive heart failure, unspecified,Mitral valve disorders,Iatrogenic cerebrovascular infarction or hemorrhage'}


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 75-year-old gentleman,
who has a history of known coronary artery disease had been
managed medically over the last several years with a PTCA in
[**2106**].  Recently has been experiencing increased exertional
angina.  Had a positive stress test in [**2121-9-20**],
which showed a large reversible inferolateral wall defect
with a fixed component of inferior apex, an ejection fraction
of 38%.  An echocardiogram [**10/2121**] showed mild left
ventricular hypertrophy, moderate inferior wall hypokinesis,
and ejection fraction of 50%.  Patient was referred to [**Hospital1 1444**] for cardiac catheterization.

MEDICAL HISTORY: 1. Coronary artery disease.
2. Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac arrest,Acute and subacute necrosis of liver,Acute pancreatitis,Congestive heart failure, unspecified,Mitral valve disorders,Iatrogenic cerebrovascular infarction or hemorrhage'}
