CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: Mrs. [**Known lastname 1617**] is an 80 year old
female with a past medical history significant for diabetes
mellitus and hypertension.  She states that she was in her
usual state of health until [**Holiday **], [**2110**], at which time
she began experiencing substernal chest pressure, which
radiated to the neck and throat, as well as shortness of
breath multiple times per day.  These episodes were relieved
by rest.

MEDICAL HISTORY: 1.  Diabetes mellitus x 10 to 20 years.
2.  Hypertension.
3.  Aortic stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The family history is noncontributory.

SOCIAL HISTORY: The patient has a past history of tobacco
use, however, she quit 22 years ago.  She denies any
excessive alcohol consumption.  She lives with her daughter.
Acute myocardial infarction of other inferior wall, initial episode of care,Aortic valve disorders,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
AMI inferior wall, init,Aortic valve disorder,Urin tract infection NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2111-2-21**]       Discharge Date:  [**2111-3-2**]


Service:  CARDIOTHORACIC SURGERY

CHIEF COMPLAINT:  Chest pain.

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known lastname 1617**] is an 80 year old
female with a past medical history significant for diabetes
mellitus and hypertension.  She states that she was in her
usual state of health until [**Holiday **], [**2110**], at which time
she began experiencing substernal chest pressure, which
radiated to the neck and throat, as well as shortness of
breath multiple times per day.  These episodes were relieved
by rest.

She presented to the Emergency Department at the [**Hospital6 3873**] on [**2111-2-13**], complaining of 8 out of
10 chest pain and persistent shortness of breath.  The
Cardiology Service was called to evaluate her and she was
started on a Nitroglycerin drip.  An electrocardiogram done
at the time showed ST depressions in the anterolateral leads
and she was found to have a CKMB of 25.6 and a troponin of
3.28.  She was known to have critical aortic stenosis by
echocardiogram in [**2110-12-5**].

She was admitted to the outside hospital, started on
Lopressor, intravenous Heparin and intravenous Integrelin and
aggressive diuresis was started with intravenous Lasix.  Her
chest pain and dyspnea resolved and she was stabilized on the
aforementioned medical regimen.  She subsequently underwent
cardiac catheterization, on [**2111-2-18**], which revealed
critical aortic stenosis; 70, 80 and 90 percent stenosis of a
dominant right coronary artery and 60 to 70 percent stenosis
of the proximal circumflex and 50 percent stenosis of the
proximal mid left anterior descending artery.

The decision was made to transfer her to the [**Hospital6 1760**] for coronary artery bypass
grafting and aortic valve replacement.

She denies having any chest pain, shortness of breath,
dyspnea on exertion, dizziness or lightheadedness on arrival
to the [**Hospital6 256**].  She denies any
prior history of transient ischemic attacks or
cerebrovascular accidents as well as any history of
peripheral vascular disease.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus x 10 to 20 years.
2.  Hypertension.
3.  Aortic stenosis.

PAST SURGICAL HISTORY:
1.  Laparoscopic cholecystectomy in [**2110**].

MEDICATIONS ON ADMISSION FROM TRANSFER:
1.  Lopressor 25 mg by mouth twice per day.
2.  Captopril 6.25 mg by mouth three times per day.
3.  Lasix 40 mg intravenous twice per day.
4.  Regular Insulin sliding scale.
5.  NitroPaste one inch every 8 hours.
6.  Enteric coated Aspirin 325 mg by mouth once per day.
7.  Protonics 40 mg by mouth once per day.
8.  Ativan .5 mg by mouth every four hours as needed for
anxiety or agitation.
9.  Tylenol 650 mg every four hours as needed for fever or
pain.
10. Sublingual Nitroglycerin 0.3 mg as needed for chest pain.
11. Nystatin ointment to her groins.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient has a past history of tobacco
use, however, she quit 22 years ago.  She denies any
excessive alcohol consumption.  She lives with her daughter.

FAMILY HISTORY:  The family history is noncontributory.

PHYSICAL EXAMINATION ON ADMISSION:  Mrs. [**Known lastname 1617**] was found to
have a temperature of 98.4 degrees Fahrenheit with a heart
rate of 61 beats per minute in normal sinus rhythm and a
blood pressure of 150/60.  Her room air oxygen saturation was
95% and her weight was 78.2 kg.  In general, she was
pleasant, awake and alert, appearing younger than her stated
age and in no acute distress.  Her pupils were equally
reactive and reactive to light and accommodation.  Her
extraocular muscles were intact and her mucous membranes were
moist.  Her neck was supple with no jugular venous distention
and she had 2+ palpable carotid pulses with no bruits and no
lymphadenopathy.  On cardiac examination, she had a regular
rate and rhythm with normal S1 and S2 and a III/VI systolic
ejection murmur best heard at the right upper sternal border.
No S3, no S4 and no rubs.  Her lungs were clear to
auscultation bilaterally with good air entry and movement.
Her abdomen was obese, soft, nontender and nondistended.  She
had no hepatosplenomegaly or palpable masses.  Her
extremities were warm and dry with 0 to 1+ lower extremity
edema bilaterally.  Neurological examination, short, gross,
motor and sensory systems were intact.  On pulsed
examination, she was found to have 2+ radial and femoral
pulses bilaterally and 1+ palpable popliteal, dorsalis pedis
and posterior tibial pulses bilaterally.

LABORATORIES ON ADMISSION:  Her CBC showed a white blood cell
count of 13.8 with a hematocrit of 36.8.  On chem 7 she had a
sodium of 138; potassium, 3.9; chloride, 96; bicarbonate, 30;
BUN, 46; creatinine, 1.0; with a blood glucose of 207.  Her
magnesium on admission was 1.5.  Her PTT was 38.2 and her INR
was 1.2.

HOSPITAL COURSE:  Mrs. [**Known lastname 1617**] was admitted to the
Cardiothoracic Surgical Service and she was placed on
telemetry and her transfer medications were continued with a
decrease in her dosage of Lasix.  She was originally
scheduled to go to the Operating Room on [**2111-2-24**],
but was found to have signs of a urinary tract infection by
urinalysis which was later confirmed by urine culture.  She
was started on Levofloxacin.

She was taken to the Operating Room subsequently on [**2111-2-25**], where she underwent a coronary artery bypass graft
x 2 as well as an aortic valve replacement with a 21 mm
Mosaic valve.  Please refer to the dictated Operative Note
for full details of this procedure.  She tolerated the
procedure well and was transferred, intubated, to the Cardiac
Surgical Intensive Care Unit postoperatively.

Once in the Cardiac Surgical Intensive Care Unit, a slow wean
from the ventilator was begun.  She was transfused two units
of packed red blood cells for a hematocrit of 21.6.  Her
cardiac index remained within normal limits and her chest
tubes drained moderate to small amounts of serosanguinous
drainage.  Her blood pressures became somewhat labile and she
required alternating titration of Neo-Synephrine and
Nitroglycerin.  She was repleted with fresh frozen plasma,
Hespan and two liters of Crystalloid to which she responded
with greater stability in her blood pressure and less
frequent need for titration of pressors or antihypertensives.

Mrs.[**Known lastname 13688**] pacer was shut off later on postoperative day
#1 as she has an underlying normal sinus rhythm with a heart
rate in the 70s to 80s.  Her cardiac index remained
consistently above 2, so her Swan-Ganz catheter was
discontinued.  Later on that day she was weaned from the
ventilator and extubated without incident, requiring nasal
cannula oxygen to maintain her oxygen saturations.  Her lungs
were clear to auscultation at this time and incentive
spirometry was encouraged.

She did have a slight drop of urine output to which an
increased dose of Lasix was added to her medical regimen.  An
Insulin drip was also begun for labile blood glucose numbers.

She continued to do well on postoperative day #2 with
continued titration of Lopressor and Lasix as needed for her
blood pressure and volume status.  Her hematocrit on this day
was 29.7.  Later on postoperative day #2 she was deemed
stable and ready for transfer to the Floor.

Once on the Floor, she continued to improve physically.  She
did show some signs of disorientation and mental confusion on
her first night on the Floor, requiring a sitter, but since
that time has been clear mentally and has been functioning
independently.

She worked aggressively with Physical Therapy, building up
small amounts of strength and mobility, but it was felt that
she would require further assistance and physical therapy in
order to build strength and mobility to adequate levels where
she could return home and perform her activities of daily
living independently.

Her chest tubes were removed without incident on
postoperative day #3 due to significant drop off in
serosanguinous drainage from them.  She did have one episode
of 9 beats of supraventricular tachycardia which were self
limited and self resolving, after which time she returned to
[**Location 213**] sinus rhythm and remained in such a rhythm with a rate
in the high 60s to low 70s.

On postoperative day #5, she was deemed stable and ready for
discharge from the hospital.  It was at this time felt,
however, that she would require further monitoring and care
at an extended care rehabilitation facility as well as
further physical therapy aid in order to build her strength
and mobility so that she could perform her activities of
daily living independently.

MEDICATIONS ON DISCHARGE:
1.  Lopressor 50 mg p.o. b.i.d.
2.  Lasix 20 mg p.o. b.i.d. x ten days.
3.  Potassium Chloride 20 mEq p.o. b.i.d. x ten days.
4.  Colace 100 mg p.o. b.i.d.
5.  Enteric coated Aspirin 325 mg p.o. q day.
6.  Zantac 150 mg p.o. b.i.d.
7.  Percocet one to two tablets p.o. q 4 to 6 hours prn pain.
8.  Protonics 40 mg p.o. q day.
9.  Glyburide 10 mg p.o. b.i.d.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE DISPOSITION:  To an extended care rehabilitation
facility.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease, status post coronary artery
bypass graft x 2 on [**2111-2-25**].
2.  Critical aortic stenosis, status post aortic valve
replacement on [**2111-2-25**].
3.  Diabetes mellitus.
4.  Hypertension.

DIET:  Diet should be cardiac heart healthy as well as 1,800
calorie American Diabetic Association diet.

ACTIVITY:  Activity should be as tolerated, however, the
patient will continue to require physical therapy aid in
order to help build strength and mobility.



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

Dictated By:[**First Name3 (LF) 13689**]
MEDQUIST36

D:  [**2111-3-2**]  13:15
T:  [**2111-3-2**]  14:30
JOB#:  [**Job Number 13690**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Aortic valve disorders,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}


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: Chest pain.

PRESENT ILLNESS: Mrs. [**Known lastname 1617**] is an 80 year old
female with a past medical history significant for diabetes
mellitus and hypertension.  She states that she was in her
usual state of health until [**Holiday **], [**2110**], at which time
she began experiencing substernal chest pressure, which
radiated to the neck and throat, as well as shortness of
breath multiple times per day.  These episodes were relieved
by rest.

MEDICAL HISTORY: 1.  Diabetes mellitus x 10 to 20 years.
2.  Hypertension.
3.  Aortic stenosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: The family history is noncontributory.

SOCIAL HISTORY: The patient has a past history of tobacco
use, however, she quit 22 years ago.  She denies any
excessive alcohol consumption.  She lives with her daughter. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Aortic valve disorders,Urinary tract infection, site not specified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
