CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 59-year-old gentleman
who had a known history of coronary artery disease, status
post myocardial infarction with a left anterior descending
stent in [**2160**] following ventricular fibrillation arrest.  He
reported having done very well until the past couple of
months with now increasing left neck tightness with exertion
that resolved with rest.  The patient denied chest pain,
shortness of breath, fatigue, nausea, vomiting, or edema.

MEDICAL HISTORY: 1. Myocardial infarction.
2. Coronary artery disease with a left anterior descending
   stent in [**2160**].
3. Ventricular fibrillation arrest.
4. Hypertension.
5. Hypercholesterolemia.
6. Varicose veins.

MEDICATION ON ADMISSION: Aspirin 325 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, lisinopril 10 mg by
mouth once daily, atenolol 25 mg by mouth once daily, and
Viagra as needed.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: He had a positive family history with both
his father and brother dying of myocardial infarctions at
young ages and mother with mitral stenosis.

SOCIAL HISTORY: The patient lives in [**Location 2498**] with his son.
[**Name (NI) **] works full time as a banker.  He quit smoking in [**2160**] with
greater than a 10-pack-year history.  He has had no alcohol
in three years.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Rash and other nonspecific skin eruption,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Family history of ischemic heart disease,Personal history of tobacco use
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Old myocardial infarct,Status-post ptca,Nonspecif skin erupt NEC,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Anemia NOS,Fam hx-ischem heart dis,History of tobacco use
Admission Date: [**2168-10-27**]        Discharge Date: [**2168-11-3**]

Date of Birth:  [**2109-3-23**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  This is a 59-year-old gentleman
who had a known history of coronary artery disease, status
post myocardial infarction with a left anterior descending
stent in [**2160**] following ventricular fibrillation arrest.  He
reported having done very well until the past couple of
months with now increasing left neck tightness with exertion
that resolved with rest.  The patient denied chest pain,
shortness of breath, fatigue, nausea, vomiting, or edema.

A stress test performed on [**10-25**] showed a large severe
anteroapical, septal, and inferior ischemia areas and apical
hypokinesis with an ejection fraction of 60 percent.

The patient was brought into the hospital on [**2168-10-27**]
and brought immediately to the Cardiac Catheterization
Laboratory.  Catheterization revealed a 95 percent right
coronary artery lesion, a tight 99 percent proximal left
anterior descending lesion, and an 80 percent first obtuse
marginal lesion.  The patient was referred to Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 70**] for urgent coronary artery bypass grafting.

PAST MEDICAL HISTORY:
1. Myocardial infarction.
2. Coronary artery disease with a left anterior descending
   stent in [**2160**].
3. Ventricular fibrillation arrest.
4. Hypertension.
5. Hypercholesterolemia.
6. Varicose veins.


PAST SURGICAL HISTORY:  Includes tonsillectomy, right wrist
ganglion wound, and appendectomy.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON ADMISSION:  Aspirin 325 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, lisinopril 10 mg by
mouth once daily, atenolol 25 mg by mouth once daily, and
Viagra as needed.

SOCIAL HISTORY:  The patient lives in [**Location 2498**] with his son.
[**Name (NI) **] works full time as a banker.  He quit smoking in [**2160**] with
greater than a 10-pack-year history.  He has had no alcohol
in three years.

FAMILY HISTORY:  He had a positive family history with both
his father and brother dying of myocardial infarctions at
young ages and mother with mitral stenosis.

PHYSICAL EXAMINATION ON ADMISSION:  He was 5 feet 11 inches,
weight was 200 pounds, in sinus rhythm at 50, with a blood
pressure of 88 systolic (diastolic not recorded), his
respiratory rate was 13, and saturating 97 percent on room
air.  He was lying flat in bed in no apparent distress.
Alert and oriented times three.  Appropriate and grossly
neurologically intact.  He had fine rales in his right base.
The left lung was clear.  Heart was regular in rate and
rhythm with S1 and S2 tones.  No murmurs, rubs, or gallops.
The abdomen was soft, nontender, and nondistended.  There
were positive bowel sounds.  The extremities were warm and
well perfused with no edema.  He had positive varicosities in
his right lower extremity.  The pulses on the right were 2
plus dorsalis pedis, 2 plus posterior tibial.  On the left,
pulses were 1 plus radial, 2 plus dorsalis pedis, and 2 plus
posterior tibial.

PREOPERATIVE LABORATORY DATA ON ADMISSION:  White blood cell
count was 7, hematocrit was 38.4, and platelet count was
166,000.  Sodium was 139, potassium was 3.9, chloride was
103, bicarbonate was 25, blood urea nitrogen was 18,
creatinine was 0.8, with a blood sugar of 143.  Prothrombin
time was 12.8, partial thromboplastin time was 25, and INR
was 1.  Alanine-aminotransferase was 18, aspartate
aminotransferase was 16, alkaline phosphatase was 53, amylase
was 64, total bilirubin was 0.7, and albumin was 4.2.
Hemoglobin A1C  was 6.1 percent preoperatively.

RADIOLOGY:  Preoperative electrocardiogram showed a sinus
rhythm at 64 with a probable old inferior myocardial
infarction.  Please refer to the electrocardiogram report
dated [**2168-10-27**].

SUMMARY OF HOSPITAL COURSE:  On [**10-27**], in the late
afternoon the patient was taken to the Operating Room and had
a coronary artery bypass graft times three by Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]
[**Last Name (NamePattern4) 70**] with a left internal mammary artery to the left
anterior descending, a right internal mammary artery to the
right coronary artery, and a vein graft to the obtuse
marginal.  He was transferred to the Cardiothoracic Intensive
Care Unit in stable condition.

On postoperative day one, the patient had been extubated
overnight.  He was in a sinus rhythm at 92 with a blood
pressure of 100/66.  He was saturating 98 percent on 4 liters
nasal cannula.  He was on an insulin drip at 3 units an hour
and a Neo-Synephrine drip at 1.5 mcg/kg/minute.  The patient
was in no distress.  His heart was regular in rate and
rhythm.  Chest tubes remained in place.  He had decreased
breath sounds at both bases.  His abdomen was soft.  He had 1
plus peripheral edema.

Postoperative laboratories as follows.  White blood cell
count was 11.7, his hematocrit was 28.9, and platelet count
was 169,000.  Sodium was 141, potassium was 4.3, chloride was
108, bicarbonate was 25, blood urea nitrogen was 11,
creatinine was 0.6, and blood glucose was 74 (on his insulin
drip).

His Neo-Synephrine was weaned over the course of the day.  He
did receive a 500-cc saline bolus to help boost his blood
pressure slightly and help wean the Neo-Synephrine.  Oxygen
was weaned.  Chest tubes remained in place with a plan to
transfer the patient to the floor when he was completely
weaned off his Neo-Synephrine.  He remained in the Intensive
Care Unit.

On postoperative day two, the patient an episode of rapid
atrial fibrillation into the 140s with a drop in his blood
pressure to 82/30.  He received an amiodarone 150-mg bolus.
He otherwise remained hemodynamically stable after that with
a normalizing blood pressure of 107/62 and a heart rate back
in a sinus rhythm at 84.  Overnight, he was started on an
amiodarone drip at 0.5 mg/minute.  His Neo-Synephrine was
weaned from 1.25 to 0.8 mcg/kg/minute.  He remained in a
sinus rhythm.  His chest tubes were discontinued.  He
received 2 units of packed red blood cells which brought his
hematocrit up to 28.  He was saturating 96 percent on 4
liters nasal cannula.  He still had decreased breath sounds
at his bases.  The incisions were clean, dry, and intact.
His pacing wires were discontinued.  He was allowed out of
bed with Physical Therapy but remained in the Intensive Care
Unit as he remained on a Neo-Synephrine drip.  He was alert
and oriented and was following commands appropriately.

Later that day, the patient was transferred out to the floor
on [**10-31**] to begin his ambulation and working with
Physical Therapy; which he began right away.  He was
receiving oral Percocet for sternal discomfort and incisional
pain.

On postoperative day five, he had a scant amount of sternal
drainage of the distal portion of his incision and some
difficulty voiding the prior day.  Flomax was started to help
assist him in this process.  He had no incisional erythema,
though.  His Foley catheter was discontinued.  A voiding
check was performed again.  A central venous line was
discontinued.  Beta blockade continued with Lopressor 12.5 mg
by mouth twice daily.  Lasix diuresis continued orally.  The
patient was continued on amiodarone and Plavix.  The patient
continued to work with Physical Therapy.  Attempts were also
made to wean down his oxygen via nasal cannula.  He was
ambulating with a level III on [**10-31**].  Discharge
planning was begun with the patient planning to stay with his
sister postoperatively.  The patient continued to walk and
work with the nurses that evening.

On postoperative day six, he also had a slight sternal
dressing that was unremarkable.  His white count was 4.9,
hematocrit was 26.5, and creatinine was stable at 0.8.  He
was receiving Percocet as needed for incisional discomfort.
He did have the sternal drainage - a small amount - from the
lower pole of his sternal incision but none the following
morning, and he was encouraged to continue to ambulate, and
discharge planning continued.  He was also seen by Case
Management who worked out that he would have Visiting Nurses
Association services while he was staying with his sister.
[**Name (NI) **] was also seen by the Clinical Nutrition team.

The patient was evaluated for a rash on his back and upper
buttocks.  The patient said this was not uncommon.  He had
experienced this before.  It possibly might have been related
to one of his medications.  Examination showed small diffuse
papules nonvesicular erythematous area on the superior
portion of his buttocks and mid back.  It appeared to be a
probable dermatitis which was stable.  The patient was seen
by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 43107**] and was also treated with Benadryl.
His examination was also otherwise unremarkable.

On postoperative day six, the date of discharge, he was alert
and oriented.  His lungs were clear bilaterally.  His heart
was regular in rate and rhythm.  He had good bowel sounds.
His incisions were clean, dry, and intact with no erythema
and no sternal drainage.  His amiodarone was decreased to 400
mg twice daily, and the patient was discharged to home with
Visiting Nurses Association services to stay with his sister.

DISCHARGE FOLLOWUP:  Discharge instructions for followup were
given to the patient.  He was instructed to follow up with
Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 17025**] - his primary care physician [**Name Initial (PRE) **] [**Name10 (NameIs) **]
approximately one to two weeks post discharge.  He was
instructed to follow up with Dr. [**First Name (STitle) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] - his
cardiologist - in approximately two to three weeks post
discharge and to see Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 70**] in the office in
approximately six weeks post discharge for his postoperative
surgical visit.

DISCHARGE DIAGNOSES:
1. Status post coronary artery bypass grafting times three.
2. Status post myocardial infarction with left anterior
   descending stent.
3. Status post ventricular fibrillation arrest.
4. Hypertension.
5. Hypercholesterolemia.
6. Varicose veins - right lower extremity.


MEDICATIONS ON DISCHARGE:
1. Atenolol 25 mg by mouth once daily.
2. Potassium chloride 20 mEq by mouth twice daily (times six
   days).
3. Colace 100 mg by mouth twice daily.
4. Enteric coated aspirin 325 mg by mouth once daily.
5. Plavix 75 mg by mouth once daily.
6. Amiodarone 400 mg by mouth twice daily for seven days,
   then amiodarone 400 mg by mouth once daily for one week,
   then amiodarone 200 mg by mouth once daily.
7. Lipitor 10 mg by mouth once daily.
8. Multivitamin one capsule by mouth once daily.
9. Polysaccharide-Iron Complex 150 mg by mouth once daily.
10.      Vitamin C 500 mg by mouth twice daily.
11.      Tamsulosin hydrochloride sustained-release 0.4 mg by
   mouth once daily at bedtime.
12.      Ibuprofen 600 mg by mouth q.8h. as needed (take with
   food).
13.      Percocet 5/325 one to two tablets by mouth q.4-6h.
   as needed (for pain).
14.      Lasix 20 mg by mouth twice daily (times seven days).


CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  The patient was discharge home on [**2168-11-3**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2168-12-13**] 10:45:24
T:  [**2168-12-13**] 11:39:44
Job#:  [**Job Number 57474**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Rash and other nonspecific skin eruption,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Family history of ischemic heart disease,Personal history of tobacco use'}


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 59-year-old gentleman
who had a known history of coronary artery disease, status
post myocardial infarction with a left anterior descending
stent in [**2160**] following ventricular fibrillation arrest.  He
reported having done very well until the past couple of
months with now increasing left neck tightness with exertion
that resolved with rest.  The patient denied chest pain,
shortness of breath, fatigue, nausea, vomiting, or edema.

MEDICAL HISTORY: 1. Myocardial infarction.
2. Coronary artery disease with a left anterior descending
   stent in [**2160**].
3. Ventricular fibrillation arrest.
4. Hypertension.
5. Hypercholesterolemia.
6. Varicose veins.

MEDICATION ON ADMISSION: Aspirin 325 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, lisinopril 10 mg by
mouth once daily, atenolol 25 mg by mouth once daily, and
Viagra as needed.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: He had a positive family history with both
his father and brother dying of myocardial infarctions at
young ages and mother with mitral stenosis.

SOCIAL HISTORY: The patient lives in [**Location 2498**] with his son.
[**Name (NI) **] works full time as a banker.  He quit smoking in [**2160**] with
greater than a 10-pack-year history.  He has had no alcohol
in three years. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Rash and other nonspecific skin eruption,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Family history of ischemic heart disease,Personal history of tobacco use'}
