CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient comes in with chest
pain.  He awoke at 4 a.m. in the morning and went to the
bathroom.  He returned, and then on returning he had [**6-1**]
chest pressure with radiation to his left arm which he
considers his anginal equivalent.  He took two sublingual
nitroglycerin tablets, and the pain resolved.  Thirty minutes
later while in bed he had [**9-1**] chest pressure relieved with
one sublingual nitroglycerin.  The pain returned in 30
minutes again.  This time it was [**10-2**] to [**11-1**] with
diaphoresis.  No nausea, vomiting, or shortness of breath.
He called Emergency Medical Service.  They brought him to the
Emergency Department at [**Hospital1 69**].
He received three sublingual nitroglycerin in the ambulance
and some morphine, and there was no resolution of the pain.

MEDICAL HISTORY: (His past medical history is
significant for)
1.  Coronary artery disease with a non-Q-wave myocardial
infarction with 3-vessel coronary artery bypass graft back in
[**2135**].  In [**2144**] had two stents in his right coronary artery.
Back in [**2147-5-23**] he had two stents in his saphenous vein
grafts.
2.  He also has had prostate cancer, status post radiation
therapy which had led him to have consistently
guaiac-positive stools.
3.  He also has elevated cholesterol.
4.  Gout.
5.  He has had a right hip replacement.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died at the age of 65 from
coronary artery disease.  His brother had a myocardial
infarction in his 60s and died.  There is also hypertension
in the family.

SOCIAL HISTORY: He does not smoke.  He does not use ethanol;
he does not really drink ethanol.  No intravenous drug use.
His wife lives in the [**Name (NI) **] Home after having a
cerebrovascular accident back in [**2147-2-23**], which has
been very stressful for the patient over the past few weeks.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other vascular device, implant, and graft,Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate
Crnry athrscl natve vssl,Intermed coronary synd,Comp-oth vasc dev/graft,Surg compl-heart,Subendo infarct, initial,Hypertension NOS,Hx-prostatic malignancy
Admission Date:  [**2147-9-19**]       Discharge Date:  [**2147-9-27**]

Date of Birth:   [**2072-5-20**]       Sex:  M

Service:  C-MED Blue

HISTORY OF PRESENT ILLNESS:  The patient comes in with chest
pain.  He awoke at 4 a.m. in the morning and went to the
bathroom.  He returned, and then on returning he had [**6-1**]
chest pressure with radiation to his left arm which he
considers his anginal equivalent.  He took two sublingual
nitroglycerin tablets, and the pain resolved.  Thirty minutes
later while in bed he had [**9-1**] chest pressure relieved with
one sublingual nitroglycerin.  The pain returned in 30
minutes again.  This time it was [**10-2**] to [**11-1**] with
diaphoresis.  No nausea, vomiting, or shortness of breath.
He called Emergency Medical Service.  They brought him to the
Emergency Department at [**Hospital1 69**].
He received three sublingual nitroglycerin in the ambulance
and some morphine, and there was no resolution of the pain.

In the Emergency Department he was given a nitroglycerin drip
and heparin drip and had resolution of his pain.  He has been
pain free since.  The patient normally can walk several
blocks and greater than a flight of stairs.  He has no
paroxysmal nocturnal dyspnea.  No orthopnea.

REVIEW OF SYSTEMS:  On review of systems he denied headache,
dizziness, shortness of breath, cough, dysuria, nausea,
vomiting, diarrhea.  He has a little bit of constipation.

PAST MEDICAL HISTORY:  (His past medical history is
significant for)
1.  Coronary artery disease with a non-Q-wave myocardial
infarction with 3-vessel coronary artery bypass graft back in
[**2135**].  In [**2144**] had two stents in his right coronary artery.
Back in [**2147-5-23**] he had two stents in his saphenous vein
grafts.
2.  He also has had prostate cancer, status post radiation
therapy which had led him to have consistently
guaiac-positive stools.
3.  He also has elevated cholesterol.
4.  Gout.
5.  He has had a right hip replacement.

ALLERGIES:  He has no known drug allergies.

SOCIAL HISTORY:  He does not smoke.  He does not use ethanol;
he does not really drink ethanol.  No intravenous drug use.
His wife lives in the [**Name (NI) **] Home after having a
cerebrovascular accident back in [**2147-2-23**], which has
been very stressful for the patient over the past few weeks.

FAMILY HISTORY:  His father died at the age of 65 from
coronary artery disease.  His brother had a myocardial
infarction in his 60s and died.  There is also hypertension
in the family.

PHYSICAL EXAMINATION ON ADMISSION:  The physical examination
on admission showed a temperature of 97.8, pulse of 50, blood
pressure 122/46, 99% on 2 liters, respiratory rate 13, weight
was 155 pounds to 160 pounds.  His head revealed pupils were
equal, round, and reactive to light.  Anicteric.  Extraocular
movements were intact.  The oropharynx was clear and moist.
His neck revealed there was no jugular venous distention.
His neck was soft and supple, and there were no bruits.  His
lungs were clear to auscultation bilaterally.  His heart had
a regular rate and rhythm.  At times he was in sinus
bradycardia, S1/S2.  On examination, the patient (Mr. [**Known lastname 1726**])
did have a 2/6 systolic murmur in his right upper sternal
border.  Abdominal examination was nondistended.  Bowel
sounds were positive.  Soft and nontender.  Groin revealed
there were no bruits.  Extremities revealed no cyanosis,
clubbing or edema.  Dorsalis pedis pulses bilaterally.  His
genitourinary examination showed guaiac-positive stool.
Cranial nerves II through XII were grossly intact.  He was
nonfocal.  His sensory was intact.  Motor was [**5-27**] in the
upper and lower extremities.

LABORATORY VALUES ON ADMISSION:  Laboratory values on
admission showed a first set of creatine kinases were
actually negative at 45, troponin of less than 0.3.  His
SMA-7 was unremarkable except for a glucose of 174.

RADIOLOGY/IMAGING:   Electrocardiogram showed sinus
bradycardia with first-degree AV block, ST depressions in V4
to V6 which were new.

HOSPITAL COURSE:   The patient was admitted.  He was ruled
out for a myocardial infarction by enzymes, and he was
subjected to a Persantine thallium test which showed a
moderate reversible inferior wall defect with an ejection
fraction of 65%.

The patient was then taken to catheterization on [**9-21**]
which showed 2-vessel disease with left main coronary that
was normal.  The left anterior descending artery was 99%,
occluded left internal mammary artery to left anterior
descending artery was patent.  The left circumflex was 80%
proximally occluded, 80% mid before the first obtuse
marginal.  The right coronary artery with 50% mid.  Two
stents were patent.  The saphenous vein graft to first obtuse
marginal was found to be 90% in-stent thrombosis.  The
saphenous vein graft to first diagonal showed a 50% in-stent
occlusion, 50% in the saphenous vein graft.  Intervention of
the obtuse marginal thrombus was removed and TIMI-III flow
was achieved.  Left ventricular ejection fraction was 57%.
Left ventricular end-diastolic pressure was 12, which was
considered normal.

The patient was returned to his hospital bed.  On the night
of [**9-21**], he began to experience chest pressure which was
increasing in pain, and so the patient was taken for a
re-look angiography.  Again, his second catheterization
totally occluded saphenous vein graft to second obtuse
marginal and third obtuse marginal at the site of prior
intervention earlier that day.  In addition, the percutaneous
transluminal coronary angioplasty was complicated by what
appeared to be perforation in the actual native vessel of the
heart which appeared to be the second obtuse marginal; so,
the patient was corrected with tamponade using balloon.  The
patient was admitted to the Coronary Care Unit overnight.
Echocardiogram at this time showed no evidence of pericardial
effusion, and echocardiogram on the next morning in the
Coronary Care Unit showed no additional effusions.

The patient was transferred back to the floor on the morning
of [**Last Name (LF) 2974**], [**9-22**].  The patient continued to do experience
chest pain which he has had since his second intervention.
Enzymes drawn that day showed evidence for a myocardial
infarction with a creatine kinase of 1211, 97 MB fraction 8%,
and the next subsequent creatine kinases were 1065, 1213. The
patient also demonstrated ST elevations in his
electrocardiogram.  His electrocardiogram actually showed
over time evolving anterolateral non-Q-wave myocardial
infarction.  The patient's creatine kinases continued to
trend down from the time of his admission starting on
[**9-22**] after his myocardial infarction.

On [**9-23**] it was noted that his hematocrit had dropped
from the lower 30s to 24%, and the patient also complained of
new onset left shoulder pain; so, the patient underwent a CT
angiography which showed no dissection.  The aorta and a CT
of his abdomen and pelvis showed no retroperitoneal bleeds,
no femoral bleeds.  He was guaiac was actually negative
indicating no evidence for severe gastrointestinal bleeding.
Moreover, his hemolysis laboratory workup did not show
evidence of intravascular hemolysis.  The patient was
transfused with a total of 4 units of blood.  His hematocrit
decreased isolated but then began to recover and improve to
the point where on discharge he was below normal but above
30%.  It was never determined what the source of the decrease
in hematocrit was.



The patient underwent Physical Therapy after his myocardial
infarction and continued to improve.  It was determined later
that his shoulder pain which was ruled out for aortic
dissection turned out was probably related to a fall which he
had not reported against the side wall.  There was no loss of
consciousness at the time, and his pain improved with
treatment with Tylenol and nonsteroidal antiinflammatory
drugs.

CONDITION AT DISCHARGE/STATUS:  Given that the patient's
course improved after the myocardial infarction with
continuing trending down enzymes, electrocardiogram
resolving, and the patient's overall clinical picture
improved, he was discharged on [**9-27**] in improved status
to the [**Hospital3 2558**] Rehabilitation facility.

MEDICATIONS ON DISCHARGE:
1.  Enteric-coated aspirin 325 mg p.o. q.d.
2.  Plavix 75 mg p.o. q.d. times 23 more days.
3.  Lopressor 50 mg p.o. b.i.d.
4.  Mavik 4 mg p.o. q.d.
5.  Imdur 30 mg p.o. q.d.
6.  Serax 10 mg p.o. q.h.s. p.r.n.
7.  Colace 100 mg p.o. b.i.d.
8.  Tylenol 650 mg p.o. q.4-6h. p.r.n.

DISCHARGE DIAGNOSES:
1.  Non-Q-wave myocardial infarction in the anterolateral
region.
2.  Coronary artery disease.
3.  Hypertension.
4.  Prostate cancer, status post prostatectomy.

CODE STATUS:  His code status is still full.



                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8471**], M.D.  [**MD Number(1) 18174**]

Dictated By:[**Last Name (NamePattern1) 3033**]
MEDQUIST36

D:  [**2147-9-26**]  15:41
T:  [**2147-9-26**]  15:58
JOB#:  [**Job Number 94615**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other vascular device, implant, and graft,Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}


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 comes in with chest
pain.  He awoke at 4 a.m. in the morning and went to the
bathroom.  He returned, and then on returning he had [**6-1**]
chest pressure with radiation to his left arm which he
considers his anginal equivalent.  He took two sublingual
nitroglycerin tablets, and the pain resolved.  Thirty minutes
later while in bed he had [**9-1**] chest pressure relieved with
one sublingual nitroglycerin.  The pain returned in 30
minutes again.  This time it was [**10-2**] to [**11-1**] with
diaphoresis.  No nausea, vomiting, or shortness of breath.
He called Emergency Medical Service.  They brought him to the
Emergency Department at [**Hospital1 69**].
He received three sublingual nitroglycerin in the ambulance
and some morphine, and there was no resolution of the pain.

MEDICAL HISTORY: (His past medical history is
significant for)
1.  Coronary artery disease with a non-Q-wave myocardial
infarction with 3-vessel coronary artery bypass graft back in
[**2135**].  In [**2144**] had two stents in his right coronary artery.
Back in [**2147-5-23**] he had two stents in his saphenous vein
grafts.
2.  He also has had prostate cancer, status post radiation
therapy which had led him to have consistently
guaiac-positive stools.
3.  He also has elevated cholesterol.
4.  Gout.
5.  He has had a right hip replacement.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died at the age of 65 from
coronary artery disease.  His brother had a myocardial
infarction in his 60s and died.  There is also hypertension
in the family.

SOCIAL HISTORY: He does not smoke.  He does not use ethanol;
he does not really drink ethanol.  No intravenous drug use.
His wife lives in the [**Name (NI) **] Home after having a
cerebrovascular accident back in [**2147-2-23**], which has
been very stressful for the patient over the past few weeks. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other vascular device, implant, and graft,Cardiac complications, not elsewhere classified,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}
