CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78-year-old
female with untreated hypertension who presented to Dr.[**Name (NI) 53797**] office last week with angina and underwent Myoview
stress test with the finding of anterior apical reversible
defect.  At that time, she refused cardiac catheterization,
and was started on aspirin, Plavix and beta blockers.  Her
troponin at that time was 0.02.

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. Status post right knee replacement.
4. Status post appendectomy.
5. Osteoporosis.

MEDICATION ON ADMISSION: 1. Fosamax weekly.
2. Aspirin 81 mg po qd.
3. Multivitamin.
4. Lopressor 12.5 mg po bid which was started at [**Location (un) **].

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: Shows a pleasant female in no apparent
distress.  Heart rate 75, blood pressure 149/53, respirations
18, O2 sat 100% on room air.
HEENT:  Shows EOMI, PERRL.  Oropharynx is clear.
NECK:  Supple with no bruits.  She has bounding pulses and
positive JVP to 10 cm.
CHEST:  Clear to auscultation bilaterally.
HEART:  Regular rate and rhythm with a systolic ejection
murmur which is loudest at the second intercostal space.
ABDOMEN:  Soft, nontender, nondistended with positive bowel
sounds.
EXTREMITIES:  Show no pitting edema, but her legs are
swollen.

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone.  She does not smoke.  She
does not drink.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Pure hypercholesterolem,Osteoporosis NOS,Anemia NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2200-12-19**]       Discharge Date:  [**2200-12-29**]


Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is a 78-year-old
female with untreated hypertension who presented to Dr.[**Name (NI) 53797**] office last week with angina and underwent Myoview
stress test with the finding of anterior apical reversible
defect.  At that time, she refused cardiac catheterization,
and was started on aspirin, Plavix and beta blockers.  Her
troponin at that time was 0.02.

On the day admission, at Dr.[**Name (NI) 53798**] office, she again had
chest pain and was given sublingual Nitroglycerin with
relief.  She was then sent to [**Location (un) **] ER and was transferred
to [**Hospital1 18**] for cardiac catheterization.

Her cardiac catheterization showed normal LV systolic
function, mild LV diastolic dysfunction, heavily calcified
LAD with 80% ostial stenosis, and diffuse 70% proximal
disease.  At the first diagonal, there was a 50% stenosis and
a 60% tubular stenosis.  Her left circumflex showed 70%
ostial OM1 stenosis and OM2 had a 70% stenosis.  The right
coronary artery was small, diffusely diseased artery.  She
was then evaluated for probable coronary artery bypass
grafting.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Hypercholesterolemia.
3. Status post right knee replacement.
4. Status post appendectomy.
5. Osteoporosis.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  She lives alone.  She does not smoke.  She
does not drink.

MEDICATIONS ON ADMISSION:
1. Fosamax weekly.
2. Aspirin 81 mg po qd.
3. Multivitamin.
4. Lopressor 12.5 mg po bid which was started at [**Location (un) **].

REVIEW OF SYSTEMS:  Noncontributory.

PHYSICAL EXAM:  Shows a pleasant female in no apparent
distress.  Heart rate 75, blood pressure 149/53, respirations
18, O2 sat 100% on room air.
HEENT:  Shows EOMI, PERRL.  Oropharynx is clear.
NECK:  Supple with no bruits.  She has bounding pulses and
positive JVP to 10 cm.
CHEST:  Clear to auscultation bilaterally.
HEART:  Regular rate and rhythm with a systolic ejection
murmur which is loudest at the second intercostal space.
ABDOMEN:  Soft, nontender, nondistended with positive bowel
sounds.
EXTREMITIES:  Show no pitting edema, but her legs are
swollen.

LABS ON ADMISSION:  White count 7.7, hematocrit 40.7%,
platelet count 243,000, sodium 139, potassium 4.4, chloride
103, CO2 29, BUN 19, creatinine 0.9, blood glucose 107.

HOSPITAL COURSE:  The patient was transferred to the floor
following cardiac catheterization and started on
Nitroglycerin drip because she had chest pain after
catheterization.  This drip was discontinued secondary to
hypotension, and the patient was eventually started on an
Integrilin drip.  She did have further chest pain later that
evening and was restarted on a Nitroglycerin drip which she
tolerated well.  She had two more episodes of chest pain the
night prior to surgery, for which the Nitroglycerin was
titrated up, and she became chest pain free.

On [**2200-12-22**], she was brought to the operating room
and underwent coronary artery bypass grafting x 4 with the
left internal mammary artery to the diagonal, a saphenous
vein graft to the distal LAD, saphenous vein graft to the OM,
and saphenous vein graft to the PL branch.  The surgery was
performed by Dr. [**Last Name (STitle) **] with Dr. [**Last Name (STitle) 14968**] as assistant.  The
surgery was performed under general endotracheal anesthesia
with a cardiopulmonary bypass time of 71 minutes, and a
crossclamp time of 59 minutes.  The patient tolerated the
procedure well and was transferred to the Cardiac Surgery
Recovery Unit.  She was A-paced and on a propofol drip.  She
was eventually weaned off the propofol and weaned from
ventilatory support, and self-extubated without sequelae.

By postoperative day #1, she was hemodynamically stable and
doing well.  She was on an Insulin drip at 1 U/h.  She was
begun on IV lasix at 20 mg qd, and began to be diuresed.  Her
chest tubes were discontinued without incident, and she
remained in the Intensive Care Unit for alleged elevated
blood sugars and pulmonary toilet.

On postoperative day #2, she was agitated requiring Haldol
and restraints.  She was kept in the unit for one more day
hoping to be cleared neurologically.  By postoperative day
#3, her mental status had improved, although she did require
a sitter for the next two days.  Her mental status did slowly
improve, and she was begun on aggressive physical therapy
regimen.  She had her pacing wires discontinued on
postoperative day #4 without incident, and she did receive [**Initials (NamePattern4) **]
[**Last Name (NamePattern4) **] consult on this day, as she had been receiving Insulin
per postoperative sliding scale protocol.  It was felt that
her blood sugars having been elevated postoperatively that
she would need a follow-up with her primary care physician to
see if she would need further regimen as an outpatient, or if
diet control would control her blood sugars just as well.

Throughout the remainder of her hospital course, she did
receive diuretic to help lower her weight back to her
preoperative weight, and she was encouraged to ambulate while
awaiting rehab.  By postoperative day #7, it was felt she was
ready to be discharged to a rehabilitation facility.

DISCHARGE EXAM:  Shows her vital signs to be stable with a
heart rate of 62, blood pressure 142/57, respirations 18, O2
sat 95% on room air.  Her lungs are clear to auscultation
bilaterally.  Her heart regular rate and rhythm.  Her abdomen
is soft, nontender, nondistended with positive bowel sounds.
Her lower extremities are thick, but with nonpitting edema.
Her incisions are clean, dry and intact, and her sternum is
stable.  Her neuro status shows her to be alert and oriented
x 3 and grossly intact.

LABS ON DISCHARGE:  White count 11.8, hematocrit 30%,
platelet count 341,000, sodium 141, potassium 4.2, chloride
104, CO2 28, BUN 14, creatinine 0.9, blood glucose 96.  Her
chest x-ray does show very small bilateral effusions with
some mild atelectasis.

DISCHARGE STATUS:  Good.

DISCHARGE DIAGNOSIS:  Coronary artery bypass grafting x 4.

DISCHARGE MEDICATIONS:
1. Lopressor 50 mg po bid.
2. Aspirin 325 mg po qd.
3. Tylenol 325 mg 2 tablets po q 4 h prn.
4. Potassium chloride 20 mEq po bid for 7 days.
5. Lasix 20 mg po bid for 7 days.
6. Protonix 40 mg po qd.
7. Captopril 0.625 mg po tid.
8. Regular Insulin sliding scale.
9. Dulcolax suppository 1 PR qd prn constipation.

FOLLOW-UP:  She should follow-up with her primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 53799**], 1-2 weeks following discharge from
rehab, with Dr. [**Last Name (STitle) 28119**], her cardiologist, 2-3 weeks following
discharge from rehab, and Dr. [**Last Name (STitle) **] in 4 weeks.

DISCHARGE INSTRUCTIONS:  She should continue her ambulation
and incentive spirometry, and keep her wounds clean, dry and
intact.




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

Dictated By:[**Last Name (NamePattern1) 22592**]
MEDQUIST36

D:  [**2200-12-29**]  10:20
T:  [**2200-12-29**]  10:44
JOB#:  [**Job Number 53800**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: The patient is a 78-year-old
female with untreated hypertension who presented to Dr.[**Name (NI) 53797**] office last week with angina and underwent Myoview
stress test with the finding of anterior apical reversible
defect.  At that time, she refused cardiac catheterization,
and was started on aspirin, Plavix and beta blockers.  Her
troponin at that time was 0.02.

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. Status post right knee replacement.
4. Status post appendectomy.
5. Osteoporosis.

MEDICATION ON ADMISSION: 1. Fosamax weekly.
2. Aspirin 81 mg po qd.
3. Multivitamin.
4. Lopressor 12.5 mg po bid which was started at [**Location (un) **].

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: Shows a pleasant female in no apparent
distress.  Heart rate 75, blood pressure 149/53, respirations
18, O2 sat 100% on room air.
HEENT:  Shows EOMI, PERRL.  Oropharynx is clear.
NECK:  Supple with no bruits.  She has bounding pulses and
positive JVP to 10 cm.
CHEST:  Clear to auscultation bilaterally.
HEART:  Regular rate and rhythm with a systolic ejection
murmur which is loudest at the second intercostal space.
ABDOMEN:  Soft, nontender, nondistended with positive bowel
sounds.
EXTREMITIES:  Show no pitting edema, but her legs are
swollen.

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone.  She does not smoke.  She
does not drink. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
