CHIEF COMPLAINT: 

PRESENT ILLNESS: This 66-year-old white female
has a history of known coronary artery disease and is status
post a remote MI many years ago, with a history of chronic
stable angina since that time.  She was recently admitted at
the beginning of [**Month (only) 547**] with chest pain, and had slightly
elevated troponins.  At that point, a cardiac catheterization
was recommended, but the patient refused.  She went home from
[**Hospital3 417**] Hospital and returned the following day with
severe discomfort in the chest, and agreed to a cardiac cath.
She was then transferred to [**Hospital1 **]-[**Hospital1 **] for cardiac cath, as
Dr. [**Last Name (STitle) **] is her doctor.

MEDICAL HISTORY: 1. History of coronary artery disease, status post MI in the
past.
2. History of hyperlipidemia.
3. History of insulin dependent diabetes.
4. History of hypertension.
5. History of severe right MCA stenosis, status post old
small left cerebral infarct.
6. History of Congestive heart failure
7. History of TIAs.

MEDICATION ON ADMISSION: 1. Aspirin 325 mg po qd.
2. Plavix 75 mg po qd.
3. Lopressor 50 mg po qid.
4. Zocor 20 mg po qd.
5. Colace 100 mg po bid.
6. Zestril 5 mg po qd.
7. Potassium.
8. Sublingual Nitro.
9. Digoxin 0.125 mg po qd.
10.Lasix 120 mg po qd.
11.Humalog insulin sliding scale and Lente, dose unknown.

ALLERGIES: No known allergies.

PHYSICAL EXAM: She is a well-developed, well-nourished white
female in no apparent distress.
VITAL SIGNS:  Stable.  Afebrile.
HEENT EXAM:  Normocephalic, atraumatic.  Extraocular
movements intact.  Oropharynx benign.
NECK:  Supple.  Full range of motion.  No lymphadenopathy or
thyromegaly.  Carotids 1+ and equal bilaterally without
bruits.
LUNGS:  Clear to auscultation and percussion.
CARDIOVASCULAR EXAM:  Regular rate and rhythm.  Normal S1,
S2, with no rubs, murmurs or gallops.
ABDOMEN:  Soft, nontender with positive bowel sounds.  No
masses or hepatosplenomegaly.
EXTREMITIES:  Without clubbing, cyanosis or edema.  Pulses
were 1+ and equal bilaterally with the exception of the DPs
which were trace bilaterally.
NEURO EXAM:  Nonfocal.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Mitral valve disorders,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Family history of ischemic heart disease,Personal history of tobacco use
Subendo infarct, initial,Mitral valve disorder,CHF NOS,Crnry athrscl natve vssl,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Fam hx-ischem heart dis,History of tobacco use
Admission Date:  [**2156-5-27**]       Discharge Date:  [**2156-6-3**]

Date of Birth:   [**2090-3-24**]       Sex:  F

Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  This 66-year-old white female
has a history of known coronary artery disease and is status
post a remote MI many years ago, with a history of chronic
stable angina since that time.  She was recently admitted at
the beginning of [**Month (only) 547**] with chest pain, and had slightly
elevated troponins.  At that point, a cardiac catheterization
was recommended, but the patient refused.  She went home from
[**Hospital3 417**] Hospital and returned the following day with
severe discomfort in the chest, and agreed to a cardiac cath.
She was then transferred to [**Hospital1 **]-[**Hospital1 **] for cardiac cath, as
Dr. [**Last Name (STitle) **] is her doctor.

PAST MEDICAL HISTORY:
1. History of coronary artery disease, status post MI in the
past.
2. History of hyperlipidemia.
3. History of insulin dependent diabetes.
4. History of hypertension.
5. History of severe right MCA stenosis, status post old
small left cerebral infarct.
6. History of Congestive heart failure
7. History of TIAs.

MEDICATIONS ON ADMISSION:
1. Aspirin 325 mg po qd.
2. Plavix 75 mg po qd.
3. Lopressor 50 mg po qid.
4. Zocor 20 mg po qd.
5. Colace 100 mg po bid.
6. Zestril 5 mg po qd.
7. Potassium.
8. Sublingual Nitro.
9. Digoxin 0.125 mg po qd.
10.Lasix 120 mg po qd.
11.Humalog insulin sliding scale and Lente, dose unknown.

ALLERGIES:  No known allergies.

REVIEW OF SYSTEMS:  Significant for generalized fatigue.

PHYSICAL EXAM:  She is a well-developed, well-nourished white
female in no apparent distress.
VITAL SIGNS:  Stable.  Afebrile.
HEENT EXAM:  Normocephalic, atraumatic.  Extraocular
movements intact.  Oropharynx benign.
NECK:  Supple.  Full range of motion.  No lymphadenopathy or
thyromegaly.  Carotids 1+ and equal bilaterally without
bruits.
LUNGS:  Clear to auscultation and percussion.
CARDIOVASCULAR EXAM:  Regular rate and rhythm.  Normal S1,
S2, with no rubs, murmurs or gallops.
ABDOMEN:  Soft, nontender with positive bowel sounds.  No
masses or hepatosplenomegaly.
EXTREMITIES:  Without clubbing, cyanosis or edema.  Pulses
were 1+ and equal bilaterally with the exception of the DPs
which were trace bilaterally.
NEURO EXAM:  Nonfocal.

STUDIES:  She also had an echocardiogram on [**2156-5-18**] which
revealed mild left ventricular enlargement with moderate to
severe impairment of the left ventricular systolic function,
and an estimated LVEF of 25-30%.  There was akinesis of the
mid and apical portion of the septum.  There was mild
thickening of the mitral valve leaflets and annulus, with
moderate to severe MR, and mild tricuspid insufficiency.

HOSPITAL COURSE:  So, she was transferred to the [**Hospital1 **] where she underwent an emergency cath which
revealed that the left main had a small filling defect.  The
LAD had ostial proximal subtotal stenosis with decreased
flow, and they felt there was a clot in the left main
coronary artery.  The left circumflex had diffuse moderate
disease.  The RCA was proximally occluded with distal vessels
filled by LCA collaterals, and aortography showed diffuse
atheromatous disease of the aorta and significant disease in
the left iliac.

Dr. [**Last Name (STitle) 70**] was consulted and took the patient for an
emergency CABG x 2 with LIMA to the LAD and reversed
saphenous vein graft to the OM, and a mitral valve
annuloplasty with a #26 [**Doctor Last Name 405**] band.  The patient tolerated
the procedure well and was transferred to the CSRU on
milrinone and epinephrine.  She remained intubated overnight
and was extubated the following day.  She remained
hemodynamically stable, and her epi was weaned off on the
first day.  Postop day #2, her milrinone was weaned and then
DC'd on postop day #3.  On postop day #3, her chest tubes
were DC'd.

She continued to slowly progress, and on postop day #4 she
was transferred to the floor in stable condition.  She had
her wires DC'd on postop day #5 and was very slow with
ambulation, and slow to progress.  She was followed as well
by [**Last Name (un) **] and had her insulin changed to Lantus with still
Humalog sliding scale.  She also had a white count of
13-16,000, and had an echo on postop day #7 which showed no
vegetations.  All of her cultures were negative, and she was
discharged to rehab in stable condition.

LABS ON DISCHARGE:  White count 14,700, hematocrit 30.7,
platelets 376,000, sodium 138, potassium 4.3, chloride
98-232, BUN 18, creatinine 0.9, blood sugar 143.

DISCHARGE MEDICATIONS:
1. Lasix 20 mg po bid for 7 days.
2. KCL 10 mEq po qd for 7 days.
3. Colace 100 mg po bid.
4. Aspirin 325 qd.
5. Plavix 75 mg po qd.
6. Zocor 20 mg po qd.
7. Dilaudid 2 mg q 4-6 h prn pain.
8. Lopressor 50 mg po bid.
9. Glargine 24 U subcu q hs.
10.Humalog sliding scale.

FOLLOW-UP:  She will be followed by Dr. [**Last Name (STitle) 9006**] in [**1-30**] weeks,
Dr. [**First Name (STitle) 1557**] in [**4-1**] weeks, Dr. [**Last Name (STitle) 70**] in 6 weeks, and Dr.
[**Last Name (STitle) **] in 1 month.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Mitral valve regurgitation.
3. Insulin dependent diabetes.
4. Hypertension.
5. Hypercholesterolemia.




                            [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Last Name (NamePattern1) 11726**]
MEDQUIST36

D:  [**2156-6-3**]  12:30
T:  [**2156-6-3**]  12:30
JOB#:  [**Job Number 95512**]
{'Subendocardial infarction, initial episode of care,Mitral valve disorders,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,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 66-year-old white female
has a history of known coronary artery disease and is status
post a remote MI many years ago, with a history of chronic
stable angina since that time.  She was recently admitted at
the beginning of [**Month (only) 547**] with chest pain, and had slightly
elevated troponins.  At that point, a cardiac catheterization
was recommended, but the patient refused.  She went home from
[**Hospital3 417**] Hospital and returned the following day with
severe discomfort in the chest, and agreed to a cardiac cath.
She was then transferred to [**Hospital1 **]-[**Hospital1 **] for cardiac cath, as
Dr. [**Last Name (STitle) **] is her doctor.

MEDICAL HISTORY: 1. History of coronary artery disease, status post MI in the
past.
2. History of hyperlipidemia.
3. History of insulin dependent diabetes.
4. History of hypertension.
5. History of severe right MCA stenosis, status post old
small left cerebral infarct.
6. History of Congestive heart failure
7. History of TIAs.

MEDICATION ON ADMISSION: 1. Aspirin 325 mg po qd.
2. Plavix 75 mg po qd.
3. Lopressor 50 mg po qid.
4. Zocor 20 mg po qd.
5. Colace 100 mg po bid.
6. Zestril 5 mg po qd.
7. Potassium.
8. Sublingual Nitro.
9. Digoxin 0.125 mg po qd.
10.Lasix 120 mg po qd.
11.Humalog insulin sliding scale and Lente, dose unknown.

ALLERGIES: No known allergies.

PHYSICAL EXAM: She is a well-developed, well-nourished white
female in no apparent distress.
VITAL SIGNS:  Stable.  Afebrile.
HEENT EXAM:  Normocephalic, atraumatic.  Extraocular
movements intact.  Oropharynx benign.
NECK:  Supple.  Full range of motion.  No lymphadenopathy or
thyromegaly.  Carotids 1+ and equal bilaterally without
bruits.
LUNGS:  Clear to auscultation and percussion.
CARDIOVASCULAR EXAM:  Regular rate and rhythm.  Normal S1,
S2, with no rubs, murmurs or gallops.
ABDOMEN:  Soft, nontender with positive bowel sounds.  No
masses or hepatosplenomegaly.
EXTREMITIES:  Without clubbing, cyanosis or edema.  Pulses
were 1+ and equal bilaterally with the exception of the DPs
which were trace bilaterally.
NEURO EXAM:  Nonfocal.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Mitral valve disorders,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Family history of ischemic heart disease,Personal history of tobacco use'}
