CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 70-year-old male with
known coronary artery disease status post coronary artery
bypass grafting 11 years ago who presented with one hour of
substernal chest pain, 10 out of 10 in severity.  He went to
[**Hospital3 1443**] Hospital where electrocardiogram showed
acute inferior myocardial infarction.  He received
................., intravenous Heparin, intravenous
Nitroglycerin, and Plavix.  While he was chest pain free
after these interventions, he was still noted to have ST
elevations on electrocardiogram.  He was therefore
transferred to [**Hospital6 256**] for
cardiac catheterization.

MEDICAL HISTORY: Coronary artery disease, coronary
artery bypass grafting in [**2119**] at [**Hospital1 2025**], mild hypertension,
hypercholesterolemia.

MEDICATION ON ADMISSION: Atenolol 50 mg p.o. q.a.m. and 25
mg p.o. q.p.m., Colestipol 5 g p.o. q.d., Zocor 20 mg p.o.
q.d., Aspirin 81 mg p.o. q.d.

ALLERGIES: PROTAMINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco.  No alcohol.
Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery
Hypertension NOS,Pure hypercholesterolem,Anemia NOS,AMI inferior wall, init,Crnry athrscl natve vssl
Admission Date:  [**2131-5-25**]       Discharge Date:  [**2131-5-30**]

Date of Birth:   [**2060-10-6**]       Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  This is a 70-year-old male with
known coronary artery disease status post coronary artery
bypass grafting 11 years ago who presented with one hour of
substernal chest pain, 10 out of 10 in severity.  He went to
[**Hospital3 1443**] Hospital where electrocardiogram showed
acute inferior myocardial infarction.  He received
................., intravenous Heparin, intravenous
Nitroglycerin, and Plavix.  While he was chest pain free
after these interventions, he was still noted to have ST
elevations on electrocardiogram.  He was therefore
transferred to [**Hospital6 256**] for
cardiac catheterization.

Left heart catheterization showed three-vessel disease with
80% left main, 80% proximal left anterior descending, patent
ramus but subtotal circumflex occlusion, and totally occluded
right coronary artery.  There was a saphenous vein graft to
the right coronary artery with diffuse 80% thrombosis and 80%
occlusion after the posterior descending artery anastomosis.
The LIMA was patent to the left anterior descending.
Proximal vein graft thrombus was cleared with an export
catheter, and then a stent was deployed.

Attention was next turned to the distal vein graft lesion
upon which an additional stent was placed.  There was no
residual stenosis seen, and TIMI3 flow was achieved.

Right heart catheterization showed a cardiac output of 3.3
with an index of 1.63, mean wedge pressure of 12, pulmonary
artery pressure of 20/9, right atrial pressure of 11.

Following the procedure, the patient became bradycardiac and
hypotensive requiring Atropine and Dopamine drip and was thus
transferred to the Coronary Intensive Care Unit for further
management.

PAST MEDICAL HISTORY:  Coronary artery disease, coronary
artery bypass grafting in [**2119**] at [**Hospital1 2025**], mild hypertension,
hypercholesterolemia.

MEDICATIONS ON ADMISSION:  Atenolol 50 mg p.o. q.a.m. and 25
mg p.o. q.p.m., Colestipol 5 g p.o. q.d., Zocor 20 mg p.o.
q.d., Aspirin 81 mg p.o. q.d.

ALLERGIES:  PROTAMINE.

SOCIAL HISTORY:  No tobacco.  No alcohol.

PHYSICAL EXAMINATION:  Vital signs:  On admission temperature
was 96.6??????, pulse 86, respirations 22, blood pressure 104/63,
oxygen saturation 98%.  He was on a Dopamine and Integrilin
drip.  General:  He was a pale, elderly male lying in bed
complaining of nausea and chest pain, but he was in no acute
distress.  He was alert and oriented times three.  HEENT:
Pupils equal, round and reactive to light.  Extraocular
movements intact.  Normocephalic, atraumatic.  Moist mucous
membranes.  Neck:  JVP was not seen.  Supple.  No
lymphadenopathy.  Pulmonary:  Clear to auscultation
bilaterally listening only anteriorly.  Cardiovascular:
There was a distant S1 and S2.  No S3 or S4.  Regular, rate
and rhythm.  No murmurs, rubs or gallops.  Abdomen:  Soft,
nontender, nondistended.  Positive bowel sounds.  Groin:
There was a right venous sheath and a left arterial sheath.
There was no hematoma.  No oozing.  No bruits heard.
Extremities:  Distal lower extremity pulses were not
palpable, but dorsalis pedis and posterior tibial pulses were
heard on Doppler.  The feet were warm and seem well perfused.
There was no clubbing, cyanosis, or edema.  Neurological:
Cranial nerves II-XII intact.  Strength and motor was not
tested.

LABORATORY DATA:  Sodium 141, potassium 3.8, chloride 104,
bicarb 26, BUN 17, creatinine 1.0, glucose 136, CK 108, MB 9,
troponin T 0.21 at the outside; CBC showed a white count of
8.9, hematocrit 47.2, platelet count 198, differential of the
white count was 50% polys, 40% lymphocytes, 5% monocytes, 4%
eosinophils; total protein 7.1, albumin 3.9, bilirubin 0.5,
alkaline phosphatase 68, ALT 20, AST 50; INR less than 1.0,
PTT 26, PT 9.9.

Electrocardiogram at the [**Hospital3 1443**] Hospital showed ST
elevations in leads II, III, and AVF.  There was ST
depression in leads I and AVL.  There were Q-waves in leads
III and AVF.  There were T-wave inversions in leads II, III,
and AVF, I, AVL, and V5-V6.  There was frequent ectopy.

After cardiac catheterization at our hospital, the
electrocardiogram showed sinus tachycardia at 127 beats per
minute.  There was a [**Street Address(2) 4793**] elevation in lead II and AVF.
There was [**Street Address(2) 2051**] elevations in lead III.  There was 1-[**Street Address(2) 7093**] depression in leads I and AVL, with T-wave inversion in
all limb leads, V5 and V6.

IMPRESSION:  This is a 70-year-old male with coronary artery
disease and coronary artery bypass grafting 11 years ago who
presented with an ST elevation myocardial infarction, who
received .................. Heparin, Plavix, Aspirin, and
Lopressor at the outside hospital resulting in persistent ST
elevations despite becoming chest pain free.

He was transferred here for cardiac catheterization and
received two stents to thromboses in the saphenous vein
grafts to the right coronary system.

HOSPITAL COURSE:  1.  Cardiac:  The patient was continued on
Aspirin, Plavix, and statin.  Integrilin was continued for 18
hours after catheterization.  Initially given the patient's
hypotension, he was continued on Dopamine for approximately
36 hours to keep his mean arterial pressure above 60.  He was
given aggressive fluid repletion, as well as 1 U packed red
blood cells for a hematocrit of 28.  The Dopamine was
eventually weaned off, and we initiated low-dose
beta-blockade, as well as ACE inhibitor.

The patient noted some orthopnea and paroxysmal nocturnal
dyspnea.  Although his lungs were clear, we presumed that he
had become hypervolemic from aggressive fluid repletion
during his episode of hypotension.  We therefore initiated
low-dose Lasix with improvement in his symptoms.

Finally we performed an echocardiogram on hospital day #3.
This showed normal left atrium, normal left ventricular wall
thickness and cavity size, an ejection fraction of 40%, with
inferior and inferoseptal akinesis, with normal right
ventricular chamber size and wall motion.  There was no
mitral regurgitation or aortic regurgitation seen.

We discharged the patient on low-dose beta-blocker and ACE
inhibitor.  These should be increased as tolerated as an
outpatient.  Cardiology follow-up was arranged with Dr.
[**First Name (STitle) 3236**] at [**Hospital3 1443**] Hospital.

Hematology:  The patient was transfused 1 U of blood cells
for a hematocrit of 28.  Following this, his hematocrit
remained stable at approximately 32.

Gastrointestinal:  The patient had considerable nausea with
his hypotension which was treated with Zofran which provided
symptomatic relief.  He was also provided with Protonix for
GI prophylaxis.

DISCHARGE MEDICATIONS:  Aspirin 1 p.o. q.d., Zocor 20 mg p.o.
q.d., Colestid 5 g p.o. q.d., Plavix 75 mg p.o. q.d.,
Atenolol 25 mg p.o. q.d., Lisinopril 2.5 mg p.o. q.d., Lasix
20 mg p.o. q.d., this should be taken for 7 days, then
stopped.  Potassium, BUN, and creatinine should be checked
prior to redosing Lasix.

FOLLOW-UP:  The patient will follow-up with his primary care
physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] and with his new cardiologist Dr. [**First Name (STitle) 3236**].

DISCHARGE STATUS:  To home.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSIS:
1.  Myocardial infarction.
2.  Anemia.
3.  Hypotension.
4.  Status post two stents to existing saphenous vein graft.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 2734**]
MEDQUIST36

D:  [**2131-5-30**]  14:37
T:  [**2131-5-30**]  14:41
JOB#:  [**Job Number **]
{'Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Acute myocardial infarction of other inferior wall, initial episode of care,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: 

PRESENT ILLNESS: This is a 70-year-old male with
known coronary artery disease status post coronary artery
bypass grafting 11 years ago who presented with one hour of
substernal chest pain, 10 out of 10 in severity.  He went to
[**Hospital3 1443**] Hospital where electrocardiogram showed
acute inferior myocardial infarction.  He received
................., intravenous Heparin, intravenous
Nitroglycerin, and Plavix.  While he was chest pain free
after these interventions, he was still noted to have ST
elevations on electrocardiogram.  He was therefore
transferred to [**Hospital6 256**] for
cardiac catheterization.

MEDICAL HISTORY: Coronary artery disease, coronary
artery bypass grafting in [**2119**] at [**Hospital1 2025**], mild hypertension,
hypercholesterolemia.

MEDICATION ON ADMISSION: Atenolol 50 mg p.o. q.a.m. and 25
mg p.o. q.p.m., Colestipol 5 g p.o. q.d., Zocor 20 mg p.o.
q.d., Aspirin 81 mg p.o. q.d.

ALLERGIES: PROTAMINE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco.  No alcohol. 

### Response:
{'Unspecified essential hypertension,Pure hypercholesterolemia,Anemia, unspecified,Acute myocardial infarction of other inferior wall, initial episode of care,Coronary atherosclerosis of native coronary artery'}
