CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 24524**] is a 64-year-old
male who had a history of progressive exertional dyspnea
after quitting smoking approximately six months ago.  Workup
for this exertional dyspnea included an exercise treadmill
test that was ultimately positive for ischemic changes as
well as an echocardiogram and subsequently an elective
cardiac catheterization.  Cardiac catheterization completed
on [**2140-12-5**] showed left main coronary artery disease with
modest calcification and distal 50% taper.  The left anterior
descending also had moderate calcification with a proximal
70% lesion after D1 and R1.  The D2 moderate vessel was 90%
proximal tubular lesions, D1 and R1 had ectatic proximal
vessel and a large distal vessel.  The left circumflex artery
was nondominant vessel with a proximal 90% lesion with
moderate calcification as well.  The right coronary artery
was the dominant vessel, with a total proximal occlusion and
bridging with left-right collaterals.  The posterior
descending artery was known to be a good target.  Additional
findings on the catheterization were abdominal aorta with a
large infrarenal aneurysm beginning 13 mm below the renals,
bilaterally single without disease.  The largest extent of
the aneurysm was 4.8 cm with a length of over 11.7 cm.
Proximal runoffs reveals moderate ostial left iliac lesion.
The common femoral artery and the superficial femoral artery
are bilaterally normal.

MEDICAL HISTORY: History of inferior myocardial
infarction by electrocardiogram, mild chronic obstructive
pulmonary disease, hypertension, hypercholesterolemia, 6 cm
infrarenal abdominal aortic aneurysm as noted previously that
was picked up incidentally on examination by his cardiologist
several months ago, benign prostatic hypertrophy, gout,
greater than 75 pack year smoking history but he recently
quit in the last six months.  He is hypothyroid.

MEDICATION ON ADMISSION: Aspirin 325 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, atenolol 50 mg by
mouth once daily, allopurinol 100 mg by mouth once daily,
Flomax .4 mg by mouth once daily, Tapazole 20 mg by mouth
once daily, and Mavik 1 mg by mouth once daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Old myocardial infarction,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Gout, unspecified,Personal history of tobacco use
Crnry athrscl natve vssl,Abdom aortic aneurysm,Old myocardial infarct,Chr airway obstruct NEC,Hypothyroidism NOS,Hypertension NOS,Gout NOS,History of tobacco use
Admission Date:  [**2140-12-8**]       Discharge Date:  [**2140-12-12**]

Date of Birth:   [**2076-5-24**]       Sex:  M

Service:  CT SURGERY

HISTORY OF PRESENT ILLNESS:   Mr. [**Known lastname 24524**] is a 64-year-old
male who had a history of progressive exertional dyspnea
after quitting smoking approximately six months ago.  Workup
for this exertional dyspnea included an exercise treadmill
test that was ultimately positive for ischemic changes as
well as an echocardiogram and subsequently an elective
cardiac catheterization.  Cardiac catheterization completed
on [**2140-12-5**] showed left main coronary artery disease with
modest calcification and distal 50% taper.  The left anterior
descending also had moderate calcification with a proximal
70% lesion after D1 and R1.  The D2 moderate vessel was 90%
proximal tubular lesions, D1 and R1 had ectatic proximal
vessel and a large distal vessel.  The left circumflex artery
was nondominant vessel with a proximal 90% lesion with
moderate calcification as well.  The right coronary artery
was the dominant vessel, with a total proximal occlusion and
bridging with left-right collaterals.  The posterior
descending artery was known to be a good target.  Additional
findings on the catheterization were abdominal aorta with a
large infrarenal aneurysm beginning 13 mm below the renals,
bilaterally single without disease.  The largest extent of
the aneurysm was 4.8 cm with a length of over 11.7 cm.
Proximal runoffs reveals moderate ostial left iliac lesion.
The common femoral artery and the superficial femoral artery
are bilaterally normal.

Given the patient's significant three vessel coronary artery
disease and symptoms of occasional angina and dyspnea on
exertion, it was determined that he would be an appropriate
candidate for coronary artery bypass grafting.  The
Cardiothoracic Surgery service was consulted after the
catheterization procedure, and the following history was
obtained.

PAST MEDICAL HISTORY:   History of inferior myocardial
infarction by electrocardiogram, mild chronic obstructive
pulmonary disease, hypertension, hypercholesterolemia, 6 cm
infrarenal abdominal aortic aneurysm as noted previously that
was picked up incidentally on examination by his cardiologist
several months ago, benign prostatic hypertrophy, gout,
greater than 75 pack year smoking history but he recently
quit in the last six months.  He is hypothyroid.

ALLERGIES:   No known drug allergies.

MEDICATIONS ON ADMISSION:   Aspirin 325 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, atenolol 50 mg by
mouth once daily, allopurinol 100 mg by mouth once daily,
Flomax .4 mg by mouth once daily, Tapazole 20 mg by mouth
once daily, and Mavik 1 mg by mouth once daily.

LABORATORY DATA:   Preoperative hematocrit was 36.  BUN and
creatinine were 17 and 1.1.  Catheterization data as stated.
Chest x-ray showed no acute cardiopulmonary process.  His
electrocardiogram was significant for sinus bradycardia at
54, with Q waves in II, III and AVF.  He had no abnormal ST/T
wave changes.  He had early J-point elevation.  He did have
early R wave progression as well.

PHYSICAL EXAMINATION:   Heart rate 54, blood pressure 134/70,
no acute distress, no chest pain, no carotid bruits
auscultated.  The heart was regular, with a prominent S2, no
murmur.  The lungs were clear to auscultation except
decreased breath sounds throughout.  His abdominal
examination was soft, nontender, nondistended.  There was a
pulsatile mass palpated between the xiphoid and umbilicus,
approximately 5 cm by examination.  There was no
hepatosplenomegaly, there was no renal bruit.  Flank
examination was negative.  His lower extremities had palpable
dorsalis pedis and posterior tibial pulses distally
bilaterally.

HOSPITAL COURSE:   Given this presentation, it was elected to
bring him to the operating room on [**2140-12-8**].  He was first
discharged after his elective catheterization on [**2140-12-5**] and
ultimately readmitted on [**2140-12-8**], where he underwent an
elective coronary artery bypass graft x 4 with Dr. [**Last Name (STitle) **],
including a left internal mammary artery to the left anterior
descending, a right saphenous vein graft to the diagonal, as
well as a saphenous vein graft to the obtuse marginal and
saphenous vein graft to the right posterior descending
artery.  The patient tolerated the procedure well.
Intraoperative findings of transesophageal echocardiogram
were an ejection fraction of 45 to 50%, calcified aorta, good
distal targets.  His pericardium was left open.  He had a
right radial A-line.  He had a right internal jugular cordis
in place, CVP, right atrial catheter.  He had two ventricular
wires and two atrial wires, and two mediastinal tubes and one
pleural tube.  His mean arterial pressure was 77, with a
right atrial pressure of 9.  He was found to be in normal
sinus rhythm at a rate of 74.  He was on a propofol drip of
20 mcg/kg/minute for sedation.

He was transferred to the Cardiac Surgical Recovery Unit,
where in the first 24 hours after surgery, all of his drips
were weaned off and he was rapidly extubated.  He remained in
sinus rhythm at 88, with blood pressures in the 120s to 130s.
His hematocrit was 25 postoperatively, with a BUN and
creatinine of 18 and 1.  Neurologically, he remained intact.
He was started on his lasix, Lopressor, aspirin.  Chest tubes
were removed, as well as diet advanced.

He was subsequently transferred to the floor by postoperative
day number one.  He was up and ambulating on postoperative
day number one, feeling well.  He worked with Physical
Therapy aggressively, and continued pulmonary toilet with
incentive spirometry, coughing and deep breathing.  His
electrolytes were repleted as needed.

By postoperative day number two, he continued to feel well.
He had a low-grade temperature of 100.9, but otherwise the
remainder of his vitals were normal, with a heart rate of 94
and sinus, blood pressure of 114/60.  His Lopressor was
titrated accordingly.  He had  BUN and creatinine of 23 and
1.0, and a hematocrit of 24.

By postoperative day number four, the patient was ambulating.
His wires, chest tubes and Foley had been removed at this
point.  He was in sinus tachycardia to sinus rhythm, between
90 and 103.  His blood pressure was ranging 106 to 110 over
50s to 60s. Oxygen saturation was 95% on room air.  He had a
stable sternum, with no evidence of drainage.  His abdominal
examination was unchanged from admission.  His extremities
were warm and well perfused, with palpable pulses at dorsalis
pedis and posterior tibial bilaterally.

Subsequently the patient was deemed stable and appropriate
for discharge.

DISCHARGE MEDICATIONS:   Lopressor 75 mg by mouth twice a
day, Lipitor 10 mg by mouth once daily, lasix 20 mg by mouth
once daily for seven days, K-Dur 20 mEq by mouth once daily
for seven days, Protonix 40 mg by mouth once daily, aspirin
325 mg by mouth once daily, allopurinol 100 mg by mouth once
daily, Tapazole 20 mg by mouth once daily, Flomax .4 mg by
mouth once daily, percocet 5/325 one to two tablets by mouth
every four to six hours as needed, and Colace 100 mg by mouth
twice a day.

DISCHARGE STATUS:  To home with VNA.

CONDITION ON DISCHARGE:   Stable, afebrile, in normal sinus
rhythm, no evidence of sternal drainage.

DISPOSITION:   To home with VNA with instructions not to
undergo any heavy lifting greater than ten pounds for 30
days, no driving for 30 days.  Wound may get wet with shower.
He will have follow up with Dr. [**Last Name (STitle) **] in four weeks, follow
up with his cardiologist or primary care physician in three
weeks from the time of discharge.  VNA will assist the
patient.  If they happen to dismiss him after day seven
through ten, he can return to the Wound Care Clinic, where he
will receive a wound checkup.

DISCHARGE DIAGNOSIS:
1.  Significant three vessel coronary artery disease status
post coronary artery bypass graft x 4, with left internal
mammary artery to left anterior descending, saphenous vein
graft to diagonal, obtuse marginal and also right posterior
descending artery.
2.  Hypertension
3.  Hyperlipidemia
4.  6 cm abdominal aortic aneurysm
5.  Benign prostatic hypertrophy
6.  Mild chronic obstructive pulmonary disease
7.  50 pack year smoker
8.  History of inferior myocardial infarction and coronary
artery disease
9.  Hypothyroidism
10. Questionable history of osteoarthritis




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2140-12-11**]  22:42
T:  [**2140-12-12**]  00:35
JOB#:  [**Job Number 24525**]


Admission Date:                   Discharge Date:

Date of Birth:                    Sex:

Service:








                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2140-12-11**]  22:32
T:  [**2140-12-12**]  00:34
JOB#:  [**Job Number 24526**]
{'Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Old myocardial infarction,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Gout, unspecified,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: Mr. [**Known lastname 24524**] is a 64-year-old
male who had a history of progressive exertional dyspnea
after quitting smoking approximately six months ago.  Workup
for this exertional dyspnea included an exercise treadmill
test that was ultimately positive for ischemic changes as
well as an echocardiogram and subsequently an elective
cardiac catheterization.  Cardiac catheterization completed
on [**2140-12-5**] showed left main coronary artery disease with
modest calcification and distal 50% taper.  The left anterior
descending also had moderate calcification with a proximal
70% lesion after D1 and R1.  The D2 moderate vessel was 90%
proximal tubular lesions, D1 and R1 had ectatic proximal
vessel and a large distal vessel.  The left circumflex artery
was nondominant vessel with a proximal 90% lesion with
moderate calcification as well.  The right coronary artery
was the dominant vessel, with a total proximal occlusion and
bridging with left-right collaterals.  The posterior
descending artery was known to be a good target.  Additional
findings on the catheterization were abdominal aorta with a
large infrarenal aneurysm beginning 13 mm below the renals,
bilaterally single without disease.  The largest extent of
the aneurysm was 4.8 cm with a length of over 11.7 cm.
Proximal runoffs reveals moderate ostial left iliac lesion.
The common femoral artery and the superficial femoral artery
are bilaterally normal.

MEDICAL HISTORY: History of inferior myocardial
infarction by electrocardiogram, mild chronic obstructive
pulmonary disease, hypertension, hypercholesterolemia, 6 cm
infrarenal abdominal aortic aneurysm as noted previously that
was picked up incidentally on examination by his cardiologist
several months ago, benign prostatic hypertrophy, gout,
greater than 75 pack year smoking history but he recently
quit in the last six months.  He is hypothyroid.

MEDICATION ON ADMISSION: Aspirin 325 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, atenolol 50 mg by
mouth once daily, allopurinol 100 mg by mouth once daily,
Flomax .4 mg by mouth once daily, Tapazole 20 mg by mouth
once daily, and Mavik 1 mg by mouth once daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Old myocardial infarction,Chronic airway obstruction, not elsewhere classified,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Gout, unspecified,Personal history of tobacco use'}
