CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 63 year old male who
complained of substernal chest pain and epigastric pain for
approximately three minutes for two days.  He had exertional
chest pain for one to two years, but had increasing frequency
of the chest pain for the last couple of months.  He noticed
it while lifting weights when the pain started and it usually
resolved with rest, however, because of its increasing
nature, he decided to come in for evaluation.  He denied any
nausea, diaphoresis, radiation or chest pain, shortness of
breath, paroxysmal nocturnal dyspnea, orthopnea, or pedal
edema.  He did have a history of gastroesophageal reflux
disease which he was noted to have an increasing epigastric
pain when he was sitting up; however, there was no
correlation between the two symptoms.

MEDICAL HISTORY: 1.  High cholesterol.
2.  Depression.
3.  Chronic obstructive pulmonary disease.
4.  Emphysema.
5.  Borderline hypertension.

MEDICATION ON ADMISSION: 1.  Albuterol nebulizers.
2.  Serevent.
3.  Aspirin.
4.  Flovent.
5.  Lipitor.
6.  [**Doctor First Name **].
7.  Sublingual Nitroglycerin.
8.  Claritin.
9.  Wellbutrin.
10. Beclomethasone.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He has a positive history for smoking as
well as a positive history for alcohol abuse.
Coronary atherosclerosis of native coronary artery,Pneumonia due to other gram-negative bacteria,Intermediate coronary syndrome,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal delirium,Bacteremia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Pneumo oth grm-neg bact,Intermed coronary synd,Alcoh dep NEC/NOS-unspec,Delirium tremens,Bacteremia,Atrial fibrillation,DMII wo cmp nt st uncntr
Admission Date:  [**2174-7-25**]       Discharge Date:  [**2174-8-23**]

Date of Birth:   [**2111-3-22**]       Sex:  M

Service:  .

HISTORY OF PRESENT ILLNESS:  This is a 63 year old male who
complained of substernal chest pain and epigastric pain for
approximately three minutes for two days.  He had exertional
chest pain for one to two years, but had increasing frequency
of the chest pain for the last couple of months.  He noticed
it while lifting weights when the pain started and it usually
resolved with rest, however, because of its increasing
nature, he decided to come in for evaluation.  He denied any
nausea, diaphoresis, radiation or chest pain, shortness of
breath, paroxysmal nocturnal dyspnea, orthopnea, or pedal
edema.  He did have a history of gastroesophageal reflux
disease which he was noted to have an increasing epigastric
pain when he was sitting up; however, there was no
correlation between the two symptoms.

The patient presented to the Emergency Department but did not
have chest pain or EKG changes at that time.

PAST MEDICAL HISTORY:
1.  High cholesterol.
2.  Depression.
3.  Chronic obstructive pulmonary disease.
4.  Emphysema.
5.  Borderline hypertension.

SOCIAL HISTORY:   He has a positive history for smoking as
well as a positive history for alcohol abuse.

MEDICATIONS ON ADMISSION:
1.  Albuterol nebulizers.
2.  Serevent.
3.  Aspirin.
4.  Flovent.
5.  Lipitor.
6.  [**Doctor First Name **].
7.  Sublingual Nitroglycerin.
8.  Claritin.
9.  Wellbutrin.
10. Beclomethasone.

PHYSICAL EXAMINATION:   On vital signs he was afebrile; his
vital signs were otherwise stable.  He was 95% on room air.
He is in no apparent distress.  Pupils are equal, round and
reactive to light.  His neck with no jugular venous
distention; it was supple.  His heart was regular rate and
rhythm with no murmurs, rubs or gallops.  His pulmonary
examination was clear to auscultation bilaterally.  Abdomen
was soft, nontender, nondistended, and bowel sounds are
present.  Extremities are two plus dorsalis pedis with no
cyanosis, clubbing or edema.

LABORATORY:  On admission, his sodium was 141, potassium 4.3,
chloride 107, bicarbonate of 21, BUN of 19, creatinine 1.0,
blood sugar 170.  His white count was 5.7, hematocrit of
43.3, platelet count of 232 and his cardiac enzymes were
normal with a CK of 82, MB of zero, troponin of less than
0.3.

The patient was admitted to the hospital for a cardiac
evaluation.  A cardiac stress test was done at that time and
it was positive.

HOSPITAL COURSE:   The patient was then taken to cardiac
catheterization where it was found that his cardiac
catheterization was positive for multi-vessel disease.  At
that time, Cardiothoracic Surgery was consulted.  During
cardiac catheterization, the patient required IABP for
pressor support and cardiac surgery was consulted.  The
patient was transferred to the Coronary Care Unit at that
time.

On [**2174-7-29**], the patient was taken to the Operating Room
for a coronary artery bypass graft times four, left internal
mammary artery  to left anterior descending; saphenous vein
graft to patent ductus arteriosus; saphenous vein graft to
diagonal and saphenous vein graft to obtuse marginal 1 and
obtuse marginal 2.  The patient was transferred to the CSRU
postoperatively.

The patient was doing well in the postoperative period.  He
was slowly weaned from his ventilator, however, he had high
chest tube outputs and his IABP was slowly weaned prior to
any attempts at extubation.  His IABP was slowly weaned and
on 1:3 it was able to be removed.  The patient had a run of
rapid atrial fibrillation also postoperatively, which was
rate controlled at that time.

On postoperative day number three, the patient had a right
pleural effusion which required chest tube placement for
drainage and he was begun on diuresis.  He was also started
on Levofloxacin for positive sputum with Gram positive rods,
four plus, after a temperature spiked.

Due to his prolonged ventilatory support, tube feeds were
started.  The patient was slowly weaned, however, the patient
required significant Ativan and it was believed to be that
the patient was suffering withdrawal symptoms underneath the
sedation.  Attempts to wean the patient were unsuccessful at
that time, however, the patient was able to stay supported on
C-PAP ventilation.  The patient was extubated on
postoperative day number 11, however, the patient was unable
to protect his airway and needed to be reintubated
postoperatively on postoperative day number 12 due to low
saturations.

Cultures during that time continued to grow.  He had profuse
sputum which grew out Serratia which was multi-drug
resistant.  The patient was started on cefepime.  The patient
continued to have high secretions which required a great deal
of suctioning and also Pulmonary was consulted for a
bronchoscopy.

Infectious Disease was also contact[**Name (NI) **] for assistance with
antibiotic selection for the multi-drug resistant Serratia.

On postoperative day number 20, the patient was successfully
weaned from his ventilator and was extubated.  The patient
was then started on Cefepime for his Serratia which continued
to improve.  It was planned for a PICC line for long-term
intravenous antibiotics, however this could not be placed at
the bedside so Interventional Radiation placed PICC was
planned.

The patient was transferred to the Floor on postoperative day
number 27.  While on the Floor, he continued to receive
aggressive pulmonary toilet, chest Physical Therapy and
ambulation.  The patient was on one-to-one sitters, however,
that was stopped on [**2174-8-21**], postoperative number 23.  The
patient continued to improve.

On [**2174-8-22**], the patient will be taken for Interventional
Radiology who placed a PICC line for intravenous Cefepime and
the patient is at that point in time, stable for discharge to
rehabilitation.

CONDITION ON DISCHARGE:   The patient is discharged to
rehabilitation in stable condition.

DISCHARGE MEDICATIONS:
1.  Albuterol one to two puffs inhaler q. four hours p.r.n.
2.  Insulin sliding scale.
3.  NPH 10 units q. a.m. and q. p.m.
4.  Lipitor 40 mg p.o. q. day.
5.  Bupropion 75 mg p.o. q. day.
6.  Haldol 2 mg p.o. twice a day.
7.  Albuterol two puffs q. six hours.
8.  Solu-Medrol 2 puffs twice a day.
9   Flovent two puffs twice a day.
10. Protonix 40 mg p.o. q. day.
11. Ipratropium two puffs twice a day.
12. Cefepime 2 grams intravenous q. 12 hours.
13. Enteric-coated aspirin 325 p.o. q. day.
14. Percocet one to two tablets p.o. q. four hours p.r.n.
15. Colace 100 mg p.o. twice a day.
16. Lopressor 75 mg p.o. twice a day.

DISPOSITION:    The patient is discharged to rehabilitation
in stable condition.

DISCHARGE DIAGNOSES:
1.  High cholesterol.
2.  Coronary artery disease status post coronary artery
bypass graft times four.
3.  Depression.
4.  Alcohol withdrawal, delirium tremens.
5.  Pneumonia status post Cefepime treatment.

DI[**Last Name (STitle) 408**]E INSTRUCTIONS:
1.  He is instructed to follow-up with Dr. [**Last Name (Prefixes) **] in
four weeks.
2.  He is instructed to follow-up with his primary care
physician in one to two weeks.
3.  To follow-up with his Cardiologist in two to four weeks.


Please see addendum for exact discharge date as well as any
change in the medications.



                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**First Name (STitle) **]
MEDQUIST36

D:  [**2174-8-21**]  20:03
T:  [**2174-8-21**]  23:01
JOB#:  [**Job Number 103503**]


Name:  [**Known lastname **], [**Known firstname 33**]                    Unit No:  [**Numeric Identifier 16774**]

Admission Date:  [**2174-7-25**]     Discharge Date:  [**2174-8-30**]

Date of Birth:   [**2111-3-22**]     Sex:  M

Service:

ADDENDUM:

This is an addendum to the hospital course.

Patient completed a 14 day course of Cefepime.  The patient
worked intensely with Physical Therapy.  He was cleared to go
home on supplemental oxygen.  In addition, the patient was
seen by the diabetes consultant.  The patient was to follow
up with [**Hospital 16775**] Clinic as well.

DISCHARGE MEDICATIONS:
1.  Salmeterol two puffs inhaler b.i.d. p.r.n.
2.  Haldol 2 mg p.o. b.i.d.
3.  Percocet one to two tablets p.o. q. four to six hours
p.r.n. pain.
4.  Flovent 110 mcg two puffs inhaler b.i.d. p.r.n.
5.  Pantoprazole 40 mg p.o. q. day.
6.  Colace 100 mg p.o. b.i.d.
7.  Aspirin EC 325 mg p.o. q. day.
8.  Albuterol nebulizers, one nebulizer inhaler q four hours
p.r.n.
9.  Bupropion 75 mg p.o. q. day.
10. Lipitor 40 mg p.o. q. day
11. Lopressor 50 mg p.o. b.i.d.
12. Glargine 20 units at bedtime.
13. Subcutaneous insulin (regular) according to sliding
scale.

DISCHARGE INSTRUCTIONS:
1.  The patient is to see his surgeon, Dr. [**Last Name (STitle) 676**] in
approximately four weeks.
2.  The patient is to see his primary care physician, [**Last Name (NamePattern4) **].
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in approximately one week.
3.  The patient is to see a cardiologist in approximately
three to four weeks.
4.  The patient is to see a diabetes specialist within the
next one to two weeks to follow up his newly diagnosed
diabetes.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3224**], M.D.  [**MD Number(1) 3225**]

Dictated By:[**Last Name (NamePattern1) 1388**]

MEDQUIST36

D:  [**2174-8-30**]  08:51
T:  [**2174-8-30**]  09:41
JOB#:  [**Job Number 16776**]


Name:  [**Known lastname **], [**Known firstname 33**]                    Unit No:  [**Numeric Identifier 16774**]

Admission Date:  [**2174-7-25**]     Discharge Date:  [**2174-8-30**]

Date of Birth:   [**2111-3-22**]     Sex:  M

Service:

ADDENDUM:

This is an addendum to the hospital course.

Patient completed a 14 day course of Cefepime.  The patient
worked intensely with Physical Therapy.  He was cleared to go
home on supplemental oxygen.  In addition, the patient was
seen by the diabetes consultant.  The patient was to follow
up with [**Hospital 16775**] Clinic as well.

DISCHARGE MEDICATIONS:
1.  Salmeterol two puffs inhaler b.i.d. p.r.n.
2.  Haldol 2 mg p.o. b.i.d.
3.  Percocet one to two tablets p.o. q. four to six hours
p.r.n. pain.
4.  Flovent 110 mcg two puffs inhaler b.i.d. p.r.n.
5.  Pantoprazole 40 mg p.o. q. day.
6.  Colace 100 mg p.o. b.i.d.
7.  Aspirin EC 325 mg p.o. q. day.
8.  Albuterol nebulizers, one nebulizer inhaler q four hours
p.r.n.
9.  Bupropion 75 mg p.o. q. day.
10. Lipitor 40 mg p.o. q. day
11. Lopressor 50 mg p.o. b.i.d.
12. Glargine 20 units at bedtime.
13. Subcutaneous insulin (regular) according to sliding
scale.

DISCHARGE INSTRUCTIONS:
1.  The patient is to see his surgeon, Dr. [**Last Name (STitle) 676**] in
approximately four weeks.
2.  The patient is to see his primary care physician, [**Last Name (NamePattern4) **].
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in approximately one week.
3.  The patient is to see a cardiologist in approximately
three to four weeks.
4.  The patient is to see a diabetes specialist within the
next one to two weeks to follow up his newly diagnosed
diabetes.


                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3224**], M.D.  [**MD Number(1) 3225**]

Dictated By:[**Last Name (NamePattern1) 1388**]

MEDQUIST36

D:  [**2174-8-30**]  08:51
T:  [**2174-8-30**]  09:41
JOB#:  [**Job Number 16776**]
{'Coronary atherosclerosis of native coronary artery,Pneumonia due to other gram-negative bacteria,Intermediate coronary syndrome,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal delirium,Bacteremia,Atrial fibrillation,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: This is a 63 year old male who
complained of substernal chest pain and epigastric pain for
approximately three minutes for two days.  He had exertional
chest pain for one to two years, but had increasing frequency
of the chest pain for the last couple of months.  He noticed
it while lifting weights when the pain started and it usually
resolved with rest, however, because of its increasing
nature, he decided to come in for evaluation.  He denied any
nausea, diaphoresis, radiation or chest pain, shortness of
breath, paroxysmal nocturnal dyspnea, orthopnea, or pedal
edema.  He did have a history of gastroesophageal reflux
disease which he was noted to have an increasing epigastric
pain when he was sitting up; however, there was no
correlation between the two symptoms.

MEDICAL HISTORY: 1.  High cholesterol.
2.  Depression.
3.  Chronic obstructive pulmonary disease.
4.  Emphysema.
5.  Borderline hypertension.

MEDICATION ON ADMISSION: 1.  Albuterol nebulizers.
2.  Serevent.
3.  Aspirin.
4.  Flovent.
5.  Lipitor.
6.  [**Doctor First Name **].
7.  Sublingual Nitroglycerin.
8.  Claritin.
9.  Wellbutrin.
10. Beclomethasone.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He has a positive history for smoking as
well as a positive history for alcohol abuse. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Pneumonia due to other gram-negative bacteria,Intermediate coronary syndrome,Other and unspecified alcohol dependence, unspecified,Alcohol withdrawal delirium,Bacteremia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
