CHIEF COMPLAINT: The patient was admitted to the hospital
with a chief complaint of chest pressure.

PRESENT ILLNESS: Mrs. [**Known lastname 68941**] is a 68 year-old
woman with a past medical history significant for diabetes
mellitus, hypertension and end stage renal disease on
peritoneal dialysis presented to the Emergency Room with
chest pressure and shortness of breath times 24 hours.  The
night prior to admission the patient developed shortness of
breath and chest pain with a pressure like sensation that was
episodic in nature with no radiation to the neck or arm.  No
nausea, vomiting, lightheadedness.  On the arrival to the
Emergency Room the patient was pain free, but she was noted
to have systolic blood pressure from 240 to 250.  She was
treated with Hydralazine and intravenous nitroglycerin.
Additionally she was noted to have inferolateral ST
depressions and the troponin one came back at 2.8.  Therefore
she was given Lopresor and started on intravenous heparin and
nitroglycerin and the decision was made to admit her to the
Coronary Care Unit.

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus times
twenty years requiring insulin.  2.  Hypercholesterolemia.
3. Hypertension.  4.  Uterine fibroids leading to a total
abdominal hysterectomy.  5.  End stage renal disease
currently on peritoneal dialysis.  6.  Cerebrovascular
accident with slightly residual right arm weakness.  7.
Seizure disorder.  8.  Bladder diverticula.  9.  Multi
infarct dementia.  10.  Fall in [**2133-10-26**] leading to a
tibial fracture.

MEDICATION ON ADMISSION: Amlodipine 10 mg q.d., Clonidine
patch 0.2 mg q week, Diltiazem CD 360 mg q day, Losartan 50
mg q day, Senna tab one q.h.s., Nephrocaps one q.h.s., NPH
insulin 14 units q.a.m., Percocet one to two tabs q 4 hours
prn and Phos-Lo one tab t.i.d.

ALLERGIES: Penicillin, which causes pruritus.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is retired, formerly worked as
an employment counselor.  She lives at home and is able to
take care of herself.  She denies any alcohol or drug use.
She has ninety pack year history of smoking, stopped in [**2118**].
Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Infection and inflammatory reaction due to peritoneal dialysis catheter,Hematoma complicating a procedure,Unspecified pleural effusion,Cellulitis and abscess of upper arm and forearm,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery
Subendo infarct, initial,Hyp kid NOS w cr kid V,React-periton dialy cath,Hematoma complic proc,Pleural effusion NOS,Cellulitis of arm,DMII renl nt st uncntrld,Crnry athrscl natve vssl
Admission Date:  [**2136-1-5**]       Discharge Date:  [**2136-1-19**]

Date of Birth:   [**2066-5-29**]       Sex:  F

Service:  CARDIOTHORACIC

CHIEF COMPLAINT:  The patient was admitted to the hospital
with a chief complaint of chest pressure.

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known lastname 68941**] is a 68 year-old
woman with a past medical history significant for diabetes
mellitus, hypertension and end stage renal disease on
peritoneal dialysis presented to the Emergency Room with
chest pressure and shortness of breath times 24 hours.  The
night prior to admission the patient developed shortness of
breath and chest pain with a pressure like sensation that was
episodic in nature with no radiation to the neck or arm.  No
nausea, vomiting, lightheadedness.  On the arrival to the
Emergency Room the patient was pain free, but she was noted
to have systolic blood pressure from 240 to 250.  She was
treated with Hydralazine and intravenous nitroglycerin.
Additionally she was noted to have inferolateral ST
depressions and the troponin one came back at 2.8.  Therefore
she was given Lopresor and started on intravenous heparin and
nitroglycerin and the decision was made to admit her to the
Coronary Care Unit.

PAST MEDICAL HISTORY:  1.  Type 2 diabetes mellitus times
twenty years requiring insulin.  2.  Hypercholesterolemia.
3. Hypertension.  4.  Uterine fibroids leading to a total
abdominal hysterectomy.  5.  End stage renal disease
currently on peritoneal dialysis.  6.  Cerebrovascular
accident with slightly residual right arm weakness.  7.
Seizure disorder.  8.  Bladder diverticula.  9.  Multi
infarct dementia.  10.  Fall in [**2133-10-26**] leading to a
tibial fracture.

MEDICATIONS ON ADMISSION:  Amlodipine 10 mg q.d., Clonidine
patch 0.2 mg q week, Diltiazem CD 360 mg q day, Losartan 50
mg q day, Senna tab one q.h.s., Nephrocaps one q.h.s., NPH
insulin 14 units q.a.m., Percocet one to two tabs q 4 hours
prn and Phos-Lo one tab t.i.d.

ALLERGIES:  Penicillin, which causes pruritus.

SOCIAL HISTORY:  The patient is retired, formerly worked as
an employment counselor.  She lives at home and is able to
take care of herself.  She denies any alcohol or drug use.
She has ninety pack year history of smoking, stopped in [**2118**].

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs, temperature
98.6.  Heart rate 83.  Respiratory rate 29.  Blood pressure
174/64.  O2 sat 100% on 2 liters.  HEENT anicteric.  Neck is
supple.  No LAD.   No JVD.  Chest is clear to auscultation
bilaterally.  Cardiovascular normal S1 and S2 with 3/6
systolic ejection murmur heard at apex.  Abdomen is soft,
nontender with positive bowel sounds.  Extremities no
clubbing, cyanosis or edema.  Neurological examination is
nonfocal.

LABORATORIES ON ADMISSION:  White blood cell count 6.1,
hematocrit 29.5, platelets 202, PT 12.3, PTT 25, glucose 202,
BUN 49, sodium 142, potassium 3.3, chloride 99, CO2 27, BUN
49, creatinine 13.9, CK 222, troponin 2.8.  Electrocardiogram
normal sinus rhythm iwth ST depressions and T wave inversions
in V4 through 5 as well as 2, 3 and F.  The patient continued
to have intermittent chest pain.  She was therefore brought
to the Cardiac Catheterization laboratory.  Please see
catheterization report for full details.  In summary, the
catheterization showed 95% left main, 95% right coronary
artery, 90% left circumflex, 70% obtuse marginal one.

HOSPITAL COURSE:  An intra-aortic balloon pump was placed and
the patient was returned to the Coronary Care Unit.
Cardiothoracic Surgery was consulted at that time.  The
patient was accepted for cardiac surgery, however, initially
refused surgery.  It was found post cardiac catheterization
that the patient's peritoneal dialysis catheter was no longer
functioning.  A hemodialysis catheter was placed and the
patient was begun on hemodialysis.  Over the next several
days the patient was treated by the Medical Service and
followed by the Renal Service.  She was at that time thought
to have peritonitis a one of the cultures from her peritoneal
catheter had grown out staph of non aureus species.  She was
treated with Vancomycin and Levofloxacin.  She did on her
third day after admission agree to undergo coronary artery
bypass grafting.  CT Surgery was again consulted and she was
scheduled for coronary artery bypass grafting once the
peritonitis issue had been resolved.

On [**1-11**] the patient was brought to the Operating Room
at which time she underwent an off pump coronary artery
bypass graft times one.  Please see the operative report for
full details.  In summary, she had an off pump coronary
artery bypass graft times one with a left internal mammary
coronary artery to the left anterior descending coronary
artery.  She tolerated the surgery well and was transferred
from the Operating Room to the Cardiothoracic Intensive Care
Unit.  The patient was kept intubated and sedated throughout
the night of her operative day.  Her balloon pump was
maintained at one to one.  During that time she remained
hemodynamically stable.  On postoperative day one the patient
was weaned from the intra-aortic balloon pump and the balloon
pump was discontinued late in the afternoon on postoperative
day one.  Also on postoperative day one the patient's
sedation was discontinued.  She awoke from her sedation and
was weaned from the ventilator.  However, she remained
intubated throughout the remainder of postoperative day one.

Additionally, the patient's chest tube was discontinued on
postoperative day one.  On postoperative day two the patient
remained intubated in the morning.  She underwent dialysis
early in the morning and following her dialysis she was
extubated.  Following extubation the patient was noted to be
tachypneic.  A chest x-ray was done.  At that time the
patient was noted to have bilateral pleural effusions for
which bilateral chest tubes were placed.  The patient
remained in the Cardiothoracic Intensive Care Unit until
postoperative day five.  At that point she was felt to be
stable from a hemodynamic as well as a respiratory point and
she was transferred to the floor for continuing postoperative
care and cardiac rehabilitation.  Over the next several days
the patient continued to make slow progress with her cardiac
rehabilitation.

On postoperative day six the patient was returned to the
Operating Room with the Transplant Surgery Service.  At that
time she underwent removal of her peritoneal dialysis
catheter and insertion of a Perm-A-Cath in the right
subclavian vein.  This procedure was tolerated well and she
was returned to the floor for continuing postoperative care.
The patient continued to make slow progress over the next two
postoperative days and on postoperative day eight she was
deemed stable and ready for transfer to rehabilitation for
continuing care.

At the time of transfer the patient's physical examination is
as follows:  Vital signs temperature 98.6.  Heart rate 78
sinus rhythm.  Blood pressure 150/71.  Respiratory rate 18.
O2 sat 98%.  Weight preoperatively is 49 kilograms.  At
discharge is 46.6 kilograms.  Laboratory data at the time of
discharge:  White count had been 23,000 the day prior to
discharge.  Red blood cell count 28.2, platelets 101, sodium
139, potassium 4.1, chloride 101, CO2 26, BUN 32, creatinine
4.2, glucose 60.  Physical examination, neurological alert
and conversant.  Respiratory clear to auscultation
bilaterally.  Heart sounds regular rate and rhythm with a 3/6
systolic ejection murmur heard best at the left sternal
border.  Sternum is stable.  Incision with Steri-Strips open
to air clean and dry.  Abdomen is soft, nondistended.
Positive bowel sounds.  Midline tenderness at incision site.
Abdominal incision with dry sterile dressing.  No drainage.
Lower extremities are warm with no edema.  Right upper arm
has positive edema with a hematoma from the mid forearm to
the mid bicep that was noted prior to surgery.  This hematoma
appears to be slowly resolving and may be the source of her
elevated white blood cell count.

MEDICATIONS ON DISCHARGE:  Norvasc 10 mg q.d., Losartan 50 mg
q.d., Nephrocaps one q.h.s., Metoprolol 50 mg b.i.d., enteric
coated aspirin 325 mg q.d, Plavix 75 mg q.d., Colace 100 mg
b.i.d., Ranitidine 150 mg q.d., Catapres patch 0.2 mg q week,
Levaquin 500 mg q.o.d., Vancomycin 500 mg intravenous prn
when the trough level is less then 15 to be given during
hemodialysis.  Percocet 5/325 one to two tabs q 4 hours prn,
NPH insulin 7 units q.a.m., regular insulin sliding scale
q.a.c. and h.s.  The Levaquin and the Vancomycin are due to
be discontinued on [**1-23**].

DISCHARGE DIAGNOSES:
1.  Coronary artery disease status post off pump coronary
artery bypass grafting times one with a left internal mammary
coronary artery to the left anterior descending coronary
artery.
2.  Diabetes mellitus type 2.
3.  Hypertension.
4.  End stage renal disease status post Perm-A-Cath placement
currently on hemodialysis.
5.  Hypercholesterolemia.
6.  Status post cerebrovascular accident with right sided
weakness.
7.  Seizure disorder.
8.  Multi infarct dementia.
9.  Bladder diverticula.
10.  Status post total abdominal hysterectomy.

The patient is to be discharged to rehabilitation.  She is to
have follow up with her primary care physician in two weeks.
She is to have follow up with renal.  She is due for
hemodialysis on [**1-20**] and she is to have follow up with
Dr. [**Last Name (STitle) 1537**] in four weeks.






                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2136-1-19**]  10:32
T:  [**2136-1-19**]  10:57
JOB#:  [**Job Number **]


Name:  [**Known lastname 16501**], [**Known firstname **]                   Unit No:  [**Numeric Identifier 16502**]

Admission Date:  [**2136-1-5**]     Discharge Date:

Date of Birth:   [**2066-5-29**]     Sex:  F

Service:

DISCHARGE SUMMARY ADDENDUM:   Prior to discharge the patient
had a CT scan of the abdomen and chest per the request of
Infectious Disease.




                          [**First Name11 (Name Pattern1) 63**] [**Last Name (NamePattern4) 1508**], M.D.  [**MD Number(1) 1509**]

Dictated By:[**Name8 (MD) 1561**]

MEDQUIST36

D:  [**2136-1-23**]  12:41
T:  [**2136-1-25**]  11:52
JOB#:  [**Job Number 16503**]


Name:  [**Known lastname 16501**], [**Known firstname **]                   Unit No:  [**Numeric Identifier 16502**]

Admission Date:  [**2136-1-5**]     Discharge Date:  [**2136-1-24**]

Date of Birth:   [**2066-5-29**]     Sex:  F

Service:

ADDENDUM:  Prior to discharge she had elevated white count
and at the recommendation of infectious disease, a chest CT
and abdominal CT were obtained.  The abdominal CT showed no
focal fluid collection, no abscesses and no other signs of
infection.  The chest CT revealed a small loculated fluid
collection in the left pleural cavity.  Interventional
radiology was consulted and they felt that this was not
amenable to drainage.  The patient continued to remain
afebrile during this time.  Due to erythema induration of her
right arm, at the recommendation of infectious disease, a
right arm MRI was obtained.  The MRI revealed a fluid
collection which most probably was hematoma in a serpiginous
distribution.  Drainage from right arm hematoma aspiration
from late last week revealed growth of no organisms.  Upon
consultation with infectious disease, it was decided that
antibiotics could be discontinued since a definitive source
was not being treated.  It was deemed reasonable to discharge
the patient to rehabilitation facility and to observe her
status there.




                          [**First Name11 (Name Pattern1) 63**] [**Last Name (NamePattern4) 1508**], M.D.  [**MD Number(1) 1509**]

Dictated By:[**Name8 (MD) 1561**]

MEDQUIST36

D:  [**2136-1-24**]  15:49
T:  [**2136-1-27**]  09:59
JOB#:  [**Job Number 16504**]
{'Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Infection and inflammatory reaction due to peritoneal dialysis catheter,Hematoma complicating a procedure,Unspecified pleural effusion,Cellulitis and abscess of upper arm and forearm,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery'}


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: The patient was admitted to the hospital
with a chief complaint of chest pressure.

PRESENT ILLNESS: Mrs. [**Known lastname 68941**] is a 68 year-old
woman with a past medical history significant for diabetes
mellitus, hypertension and end stage renal disease on
peritoneal dialysis presented to the Emergency Room with
chest pressure and shortness of breath times 24 hours.  The
night prior to admission the patient developed shortness of
breath and chest pain with a pressure like sensation that was
episodic in nature with no radiation to the neck or arm.  No
nausea, vomiting, lightheadedness.  On the arrival to the
Emergency Room the patient was pain free, but she was noted
to have systolic blood pressure from 240 to 250.  She was
treated with Hydralazine and intravenous nitroglycerin.
Additionally she was noted to have inferolateral ST
depressions and the troponin one came back at 2.8.  Therefore
she was given Lopresor and started on intravenous heparin and
nitroglycerin and the decision was made to admit her to the
Coronary Care Unit.

MEDICAL HISTORY: 1.  Type 2 diabetes mellitus times
twenty years requiring insulin.  2.  Hypercholesterolemia.
3. Hypertension.  4.  Uterine fibroids leading to a total
abdominal hysterectomy.  5.  End stage renal disease
currently on peritoneal dialysis.  6.  Cerebrovascular
accident with slightly residual right arm weakness.  7.
Seizure disorder.  8.  Bladder diverticula.  9.  Multi
infarct dementia.  10.  Fall in [**2133-10-26**] leading to a
tibial fracture.

MEDICATION ON ADMISSION: Amlodipine 10 mg q.d., Clonidine
patch 0.2 mg q week, Diltiazem CD 360 mg q day, Losartan 50
mg q day, Senna tab one q.h.s., Nephrocaps one q.h.s., NPH
insulin 14 units q.a.m., Percocet one to two tabs q 4 hours
prn and Phos-Lo one tab t.i.d.

ALLERGIES: Penicillin, which causes pruritus.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is retired, formerly worked as
an employment counselor.  She lives at home and is able to
take care of herself.  She denies any alcohol or drug use.
She has ninety pack year history of smoking, stopped in [**2118**]. 

### Response:
{'Subendocardial infarction, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Infection and inflammatory reaction due to peritoneal dialysis catheter,Hematoma complicating a procedure,Unspecified pleural effusion,Cellulitis and abscess of upper arm and forearm,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery'}
