CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient was in his usual
state of health and developed retrosternal chest pain with
shortness of breath and diaphoresis at rest.  The patient
took three sublingual nitroglycerin without resolution of his
ten out of ten chest pain.  The patient presented to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] Hospital in [**Location (un) 5028**] and was noted to be in atrial
fibrillation with a ventricular rate in the 160s.  His
systolic blood pressure was approximately 120.  His
ventricular rate was controlled with intravenous diltiazem.
He also received heparin, Integrilin and intravenous
nitroglycerin.  The patient also received a dose of morphine
and, despite the therapies, continued to have chest pain.  He
was transferred by [**Location (un) 7622**] to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **]
[**Last Name (Titles) **] and received 200 mcg of fentanyl during the flight.
Upon arrival, the patient was chest pain free.

MEDICAL HISTORY: 1.  Coronary artery disease, coronary
artery bypass grafting times three in [**2113**] with left internal
mammary artery to left anterior descending artery, saphenous
vein [**Year (4 digits) **] to ramus intermedius and saphenous vein [**Year (4 digits) **] to
right posterolateral.  2.  Diabetes mellitus type 2,
diagnosed two years ago, on oral hypoglycemic agents.  3.
History of pacemaker placement for "three seconds of
asystole" in [**2120**], pacer taken out for repeated
Staphylococcus aureus infections.

MEDICATION ON ADMISSION: Enteric coated aspirin 325 mg
p.o.q.d., metoprolol 12.5 mg p.o.q.d., Lipitor 10 mg
p.o.q.d., Zestril 5 mg p.o.q.d., Flovent 220 mcg two puffs
b.i.d., Coumadin 7.5 mg p.o.q.d. except for 10 mg p.o.q.
Friday, Glucotrol, and Lasix.

ALLERGIES: Isuprel inhaler.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father died of prostate cancer
and his mother died after three strokes.

SOCIAL HISTORY: The patient has a remote history of smoking
and quit in [**2112**].  He drinks alcohol occasionally and lives
at home with his wife.  [**Name (NI) **] is currently retired, and
previously worked as a longshoreman.  He has three children.
Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unspecified disorder of kidney and ureter,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Family history of ischemic heart disease
AMI NOS, initial,Crnry athrscl natve vssl,Atrial fibrillation,Renal & ureteral dis NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Fam hx-ischem heart dis
Admission Date:  [**2128-8-14**]     Discharge Date:  [**2128-8-20**]

Date of Birth:   [**2059-12-4**]     Sex:  M

Service:

CHIEF COMPLAINT/IDENTIFICATION:  The patient is a 68 year old
man with a history of atrial fibrillation, myocardial
infarction times four, and coronary artery bypass grafting
times three in [**2113**], who presents from an outside hospital
with persistent chest pain following an episode of rapid
ventricular response with his atrial fibrillation.

PAST MEDICAL HISTORY:  1.  Coronary artery disease, coronary
artery bypass grafting times three in [**2113**] with left internal
mammary artery to left anterior descending artery, saphenous
vein [**Year (4 digits) **] to ramus intermedius and saphenous vein [**Year (4 digits) **] to
right posterolateral.  2.  Diabetes mellitus type 2,
diagnosed two years ago, on oral hypoglycemic agents.  3.
History of pacemaker placement for "three seconds of
asystole" in [**2120**], pacer taken out for repeated
Staphylococcus aureus infections.

MEDICATIONS ON ADMISSION:  Enteric coated aspirin 325 mg
p.o.q.d., metoprolol 12.5 mg p.o.q.d., Lipitor 10 mg
p.o.q.d., Zestril 5 mg p.o.q.d., Flovent 220 mcg two puffs
b.i.d., Coumadin 7.5 mg p.o.q.d. except for 10 mg p.o.q.
Friday, Glucotrol, and Lasix.

ALLERGIES:  Isuprel inhaler.

HISTORY OF PRESENT ILLNESS:  The patient was in his usual
state of health and developed retrosternal chest pain with
shortness of breath and diaphoresis at rest.  The patient
took three sublingual nitroglycerin without resolution of his
ten out of ten chest pain.  The patient presented to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] Hospital in [**Location (un) 5028**] and was noted to be in atrial
fibrillation with a ventricular rate in the 160s.  His
systolic blood pressure was approximately 120.  His
ventricular rate was controlled with intravenous diltiazem.
He also received heparin, Integrilin and intravenous
nitroglycerin.  The patient also received a dose of morphine
and, despite the therapies, continued to have chest pain.  He
was transferred by [**Location (un) 7622**] to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **]
[**Last Name (Titles) **] and received 200 mcg of fentanyl during the flight.
Upon arrival, the patient was chest pain free.

The patient claims that he has had increasing dyspnea on
exertion over the past few weeks with climbing a flight of
stairs.  During that period of time, he also had some
occasional retrosternal chest pain, which had been relieved
with nitroglycerin.

SOCIAL HISTORY:  The patient has a remote history of smoking
and quit in [**2112**].  He drinks alcohol occasionally and lives
at home with his wife.  [**Name (NI) **] is currently retired, and
previously worked as a longshoreman.  He has three children.

FAMILY HISTORY:  The patient's father died of prostate cancer
and his mother died after three strokes.

PHYSICAL EXAMINATION:  On physical examination on arrival,
the patient had a temperature of 96.1, heart rate 80,
irregularly irregular, blood pressure 107/52, respiratory
rate 20 and oxygen saturation 99% on two liters nasal
cannula, with a weight of 90 kilograms  General:  Well
appearing man in no acute distress.  Head, eyes, ears, nose
and throat:  Oropharynx moist, no lymphadenopathy, anicteric
sclerae.  Cardiovascular:  No jugular venous distention,
normal S1 and S2, no S3 or S4, no murmurs or peripheral
edema, palpable pulses in extremities.  Respiratory:
Unremarkable apart from scattered crackles and wheezes.
Neurologic examination:  Alert and oriented times three, no
focal deficits.

LABORATORY DATA:  Platelet count was 247,000, hematocrit
37.6, and white blood cell count 15.7 with 92 neutrophils, 6
lymphocytes and no bands.  Partial thromboplastin time 85.3
on heparin, and INR was elevated at 3.2 with Coumadin.
Chem-7 was unremarkable apart from a potassium of 5.9 due to
a hemolyzed sample and a BUN of 25 and creatinine 1.2.
Cardiac enzymes showed a CK of 122, MB fraction 10 and
troponin 2.2.  Calcium was 9.4 and magnesium 1.9.

Electrocardiograms at the outside hospital demonstrated the
patient to be in atrial fibrillation with a rate of 150 and a
left bundle branch block with ST depressions in leads V2 to
V6; the ST depressions subsequently improved once the
patient's rate was brought down to a rate of 100.
Electrocardiogram on arrival at [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **]
[**Last Name (Titles) **] showed the patient to be in atrial fibrillation at a
rate of 90 with a left bundle branch block and no ischemic
changes.  Chest x-ray was normal, without any evidence of
congestive heart failure or pneumonia.

HOSPITAL COURSE:  The patient was not catheterized
immediately due to his elevated INR.  He was continued on the
heparin and nitroglycerin and Integrilin until his INR
decreased.

The patient was taken to the cardiac catheterization
laboratory on [**2128-8-16**].  On catheterization, the
patient was found to have a patent left internal mammary
artery to left anterior descending artery [**Last Name (LF) **], [**First Name3 (LF) **] occluded
saphenous vein [**First Name3 (LF) **] to the ramus intermedius and a patent
saphenous vein [**First Name3 (LF) **] to the right posterolateral.  The
patient was noted to have a normal circumflex artery and a
30% left main lesion.  At the time of cardiac
catheterization, the patient was felt to be of higher risk
for percutaneous coronary intervention, thus he did not
receive any intervention.

The patient continued on his heparin and his Integrilin and
nitroglycerin were weaned off.  The patient remained without
chest pain during his entire hospital stay.  It was noted on
the night of admission that the patient had a 15 beat run of
nonsustained ventricular tachycardia.  The patient was
generally asymptomatic after that episode, apart from some
mild palpitations and slight lightheadedness.  Because of
this event, the electrophysiology department was consulted.
Upon discussion with the patient, the patient declined an
AICD.  It was also felt, due to the patient's refusal to have
a pacemaker because of his previous bad experience with
pacemakers, that the patient should not be started on
amiodarone because of the potential to require a pacemaker
afterwards.

The patient had his metoprolol and lisinopril titrated
upwards during his hospital stay.  On [**2128-8-19**], the
patient underwent a stress Cestimibi study, which
demonstrated an area of mild reversibility in his lateral
wall.  He also had a fixed defect inferiorly.  His left
ventricular ejection fraction was noted to be at 44%.  During
the three minutes that he was able to tolerate the modified
[**Doctor First Name **] protocol, the patient experienced some lightheadedness
and a drop in his blood pressure from 130 systolic to 100
systolic.

Following the stress Cestimibi study, the patient's options
were discussed and the patient elected to proceed with
medical management at this time.  The patient was discharged
to home on [**2128-8-20**] in stable condition.

FOLLOW-UP:  The patient was instructed to follow up with his
primary care physician on [**2128-8-23**] for his INR
check.  He is to be on Lovenox 60 mg subcutaneously twice a
day while warfarin was being loaded and until further
notified by his primary care physician.

DISCHARGE MEDICATIONS:
Enteric coated aspirin 325 mg p.o.q.d.
Metoprolol 75 mg p.o.b.i.d.
Lisinopril 10 mg p.o.q.d.
Lipitor 10 mg p.o.q.d.
Zestril 5 mg p.o.q.d.
Flovent 220 mcg two puffs b.i.d.
Albuterol p.r.n.
Lovenox 60 mg s.c.b.i.d. until notified by primary care
physician to stop.
Lasix 20 mg p.o.q.h.s.
Glucotrol as directed.



                          [**Name6 (MD) 9272**] [**Name8 (MD) 9273**], M.D.  [**MD Number(1) 9274**]

Dictated By:[**Name8 (MD) 26201**]

MEDQUIST36

D:  [**2128-8-20**]  14:01
T:  [**2128-8-24**]  17:56
JOB#:  [**Job Number 36262**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unspecified disorder of kidney and ureter,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Family history of ischemic heart disease'}


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 was in his usual
state of health and developed retrosternal chest pain with
shortness of breath and diaphoresis at rest.  The patient
took three sublingual nitroglycerin without resolution of his
ten out of ten chest pain.  The patient presented to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] Hospital in [**Location (un) 5028**] and was noted to be in atrial
fibrillation with a ventricular rate in the 160s.  His
systolic blood pressure was approximately 120.  His
ventricular rate was controlled with intravenous diltiazem.
He also received heparin, Integrilin and intravenous
nitroglycerin.  The patient also received a dose of morphine
and, despite the therapies, continued to have chest pain.  He
was transferred by [**Location (un) 7622**] to [**First Name4 (NamePattern1) 3867**] [**Last Name (NamePattern1) **] [**First Name (Titles) **]
[**Last Name (Titles) **] and received 200 mcg of fentanyl during the flight.
Upon arrival, the patient was chest pain free.

MEDICAL HISTORY: 1.  Coronary artery disease, coronary
artery bypass grafting times three in [**2113**] with left internal
mammary artery to left anterior descending artery, saphenous
vein [**Year (4 digits) **] to ramus intermedius and saphenous vein [**Year (4 digits) **] to
right posterolateral.  2.  Diabetes mellitus type 2,
diagnosed two years ago, on oral hypoglycemic agents.  3.
History of pacemaker placement for "three seconds of
asystole" in [**2120**], pacer taken out for repeated
Staphylococcus aureus infections.

MEDICATION ON ADMISSION: Enteric coated aspirin 325 mg
p.o.q.d., metoprolol 12.5 mg p.o.q.d., Lipitor 10 mg
p.o.q.d., Zestril 5 mg p.o.q.d., Flovent 220 mcg two puffs
b.i.d., Coumadin 7.5 mg p.o.q.d. except for 10 mg p.o.q.
Friday, Glucotrol, and Lasix.

ALLERGIES: Isuprel inhaler.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father died of prostate cancer
and his mother died after three strokes.

SOCIAL HISTORY: The patient has a remote history of smoking
and quit in [**2112**].  He drinks alcohol occasionally and lives
at home with his wife.  [**Name (NI) **] is currently retired, and
previously worked as a longshoreman.  He has three children. 

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Unspecified disorder of kidney and ureter,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Family history of ischemic heart disease'}
