CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 82-year-old
male with a history of coronary artery disease, hypertension
and elevated cholesterol and diabetes.  He had a previous
myocardial infarction in [**2128**] with presentation of angina,
nausea and syncope.  The patient has done well since then
with no further anginal events until approximately three or
fourth months ago when he experienced occasional epigastric
discomfort.  These episodes of discomfort were accompanied by
mild shortness of breath with no nausea, vomiting or
diarrhea.  On [**2-7**], the patient said he had several episodes
of diarrhea and later in the day nausea and fatigue.  He
passed out at the dinner table with loss of consciousness
estimated to be several seconds.  The patient denied chest
pain or pressure, shortness of breath, palpitations,
lightheadedness and dizziness prior to passing out.  After
that event, the patient was taken to [**Hospital3 20445**] where he ruled in for non ST elevation myocardial
infarction with a positive troponin of 2.9 and MB fraction of
10.  Echocardiogram demonstrated ejection fraction of 60% and
1+ mitral regurgitation as well as basal inferior wall
akinesis.  The patient is now referred for cardiac
catheterization.

MEDICAL HISTORY: 1.  Coronary artery disease
2.  Prostate cancer treated with radiation in [**2125**]
3.  Type II diabetes mellitus
4.  Hypercholesterolemia
5.  Hypertension

MEDICATION ON ADMISSION: 

ALLERGIES: NIACIN CAUSES SEVERE FLUSHING.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Subendocardial infarction, subsequent episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortic aneurysm of unspecified site without mention of rupture,Unspecified essential hypertension,Pure hypercholesterolemia,Family history of ischemic heart disease
Crnry athrscl natve vssl,Surg compl-heart,Atrial fibrillation,Subendo infarct, subseq,DMII wo cmp nt st uncntr,Aortic aneurysm NOS,Hypertension NOS,Pure hypercholesterolem,Fam hx-ischem heart dis
Admission Date:  [**2135-2-10**]       Discharge Date:  [**2135-2-17**]


Service:

ADMISSION DIAGNOSIS:  Syncopal event

DISCHARGE DIAGNOSES:
1.  Coronary artery disease
2.  Coronary artery bypass graft x2

HISTORY OF PRESENT ILLNESS:  The patient is an 82-year-old
male with a history of coronary artery disease, hypertension
and elevated cholesterol and diabetes.  He had a previous
myocardial infarction in [**2128**] with presentation of angina,
nausea and syncope.  The patient has done well since then
with no further anginal events until approximately three or
fourth months ago when he experienced occasional epigastric
discomfort.  These episodes of discomfort were accompanied by
mild shortness of breath with no nausea, vomiting or
diarrhea.  On [**2-7**], the patient said he had several episodes
of diarrhea and later in the day nausea and fatigue.  He
passed out at the dinner table with loss of consciousness
estimated to be several seconds.  The patient denied chest
pain or pressure, shortness of breath, palpitations,
lightheadedness and dizziness prior to passing out.  After
that event, the patient was taken to [**Hospital3 20445**] where he ruled in for non ST elevation myocardial
infarction with a positive troponin of 2.9 and MB fraction of
10.  Echocardiogram demonstrated ejection fraction of 60% and
1+ mitral regurgitation as well as basal inferior wall
akinesis.  The patient is now referred for cardiac
catheterization.

PAST MEDICAL HISTORY:
1.  Coronary artery disease
2.  Prostate cancer treated with radiation in [**2125**]
3.  Type II diabetes mellitus
4.  Hypercholesterolemia
5.  Hypertension

PAST SURGICAL HISTORY:
1.  Abdominal aortic aneurysm repair in [**2108**]
2.  Left cataract surgery [**8-23**]

MEDICATIONS:
1.  Cardizem
2.  Allopurinol 100 mg qd
3.  Micronase 5 mg [**Hospital1 **]
4.  Glucophage 1000 mg [**Hospital1 **]
5.  Aspirin 325 mg qd

ALLERGIES:  NIACIN CAUSES SEVERE FLUSHING.

PHYSICAL EXAMINATION:
GENERAL:  The patient is an elderly man in no acute distress.
Appears younger than stated age.
VITAL SIGNS:  Stable, afebrile.  Height is 5 foot 6 inches,
weight 158 pounds.
HEAD, EARS, EYES, NOSE AND THROAT:  Normocephalic,
atraumatic.  Extraocular muscles are intact.  Pupils equal,
round and reactive to light.  Anicteric.  Throat is clear.
NECK:  Supple, midline with no masses or lymphadenopathy.
CHEST:  Clear to auscultation bilaterally.
CARDIOVASCULAR:  Regular rate and rhythm with no murmur, rub
or gallop.
ABDOMEN:  Soft, nontender, nondistended with no masses or
organomegaly.
EXTREMITIES:  Warm, non cyanotic with trace pedal edema.
There are some venostasis changes in bilateral lower
extremities.
NEUROLOGIC:  Grossly intact.

ADMISSION LABS:  Hematocrit 37.2, platelets 167.
Chemistries:  Sodium 142, potassium 4.5, BUN 17, creatinine
1.1.  INR is 1.0.

HOSPITAL COURSE:  The patient was admitted for cardiac
catheterization which was performed on [**2135-2-10**] and revealed
diffuse three vessel coronary artery disease and a normal
ejection fraction of approximately 59%.  Cardiac surgery
consultation was obtained which recommended urgent
revascularization procedure.  On [**2135-2-11**], the patient was
taken to the Operating Room and had a coronary artery bypass
graft x2 with left internal mammary artery to the LAD,
saphenous vein graft to the OM.  The patient tolerated the
procedure well and without complication.  Postoperatively,
the patient was extubated on postoperative day #0.

On the evening of postoperative day #1, the patient went into
atrial fibrillation with rapid response.  The patient was
given an amiodarone bolus and an amiodarone drip was started.
The patient converted to normal sinus rhythm on the morning
of postoperative day #2.  The patient was subsequently
transferred to the floor on postoperative day #3.  The
remainder of his stay was largely unremarkable.  He was noted
to have some drainage from his right saphenous vein graft
harvest site.  JP had been placed interoperatively and once
this had been removed, there was copious serosanguinous
drainage from the old JP site.  This was treated
conservatively with an ACE wrap and dry sterile dressings
prn.

On the evening of postoperative day #5, a single 2-0 silk
stitch was placed in the JP site to close it.  This decreased
the amount of drainage.  Of note, the patient was also
transfused on postoperative day #4 for a hematocrit of 27.6.
Physical therapy had worked with the patient and recommended
rehabilitation placement for him.  Ultimately, the patient
was discharged on postoperative day #6 tolerating a regular
diet and had adequate pain control on po pain medications and
having no anginal symptoms or anginal equivalents.

DISCHARGE PHYSICAL EXAMINATION:
GENERAL:  No acute distress.
VITAL SIGNS:  97.2??????, heart rate 61, blood pressure 127/71,
respirations 20, 97% on 3 liters.
CHEST:  Clear to auscultation bilaterally.  There is no
sternal click or drainage from the sternal incision.
CARDIOVASCULAR:  Regular rate and rhythm.
EXTREMITIES:  Notable for 1+ peripheral edema.  As mentioned
in the hospital course, there is a small JP site which has
been stitched closed in the right leg.  There continues to be
serosanguinous drainage from this old JP site.  There is no
significant erythema or any exudate.

DISCHARGE CONDITION:  Good

DISPOSITION:  Rehabilitation facility

DIET:  Cardiac and diabetic

DISCHARGE MEDICATIONS:
1.  Lopressor 25 mg [**Hospital1 **]
2.  Aspirin 325 mg qd
3.  Lasix 40 mg [**Hospital1 **] x7 days
4.  Potassium chloride 20 milliequivalents [**Hospital1 **] x7 days
5.  Allopurinol 100 mg qd
6.  Metformin 500 mg [**Hospital1 **]
7.  Glyburide 2.5 mg [**Hospital1 **]
8.  Percocet 5/325 1 to 2 q4h prn
9.  Colace 100 mg [**Hospital1 **]

DISCHARGE INSTRUCTIONS:  The patient is discharged to
rehabilitation facility.  He should continue with incentive
spirometry and ambulation prn.  Physical therapy to work with
him for gait training, endurance and mobility.  The patient
should have a dry sterile dressing to the right leg JP site
prn.  Elevate legs on two pillows while sleeping and elevate
legs in chair when in chair.  The patient should have the
stitch removed from his right leg in 10 to 14 days.  Follow
up with cardiology in one to two weeks time, address need for
continuing diuresis as well as adjustment of cardiac
medications at that time.  The patient should follow up with
Dr. [**Last Name (STitle) 70**] in six weeks.




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

Dictated By:[**Last Name (NamePattern1) 14041**]
MEDQUIST36

D:  [**2135-2-17**]  08:26
T:  [**2135-2-17**]  08:27
JOB#:  [**Job Number 30004**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Subendocardial infarction, subsequent episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortic aneurysm of unspecified site without mention of rupture,Unspecified essential hypertension,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 is an 82-year-old
male with a history of coronary artery disease, hypertension
and elevated cholesterol and diabetes.  He had a previous
myocardial infarction in [**2128**] with presentation of angina,
nausea and syncope.  The patient has done well since then
with no further anginal events until approximately three or
fourth months ago when he experienced occasional epigastric
discomfort.  These episodes of discomfort were accompanied by
mild shortness of breath with no nausea, vomiting or
diarrhea.  On [**2-7**], the patient said he had several episodes
of diarrhea and later in the day nausea and fatigue.  He
passed out at the dinner table with loss of consciousness
estimated to be several seconds.  The patient denied chest
pain or pressure, shortness of breath, palpitations,
lightheadedness and dizziness prior to passing out.  After
that event, the patient was taken to [**Hospital3 20445**] where he ruled in for non ST elevation myocardial
infarction with a positive troponin of 2.9 and MB fraction of
10.  Echocardiogram demonstrated ejection fraction of 60% and
1+ mitral regurgitation as well as basal inferior wall
akinesis.  The patient is now referred for cardiac
catheterization.

MEDICAL HISTORY: 1.  Coronary artery disease
2.  Prostate cancer treated with radiation in [**2125**]
3.  Type II diabetes mellitus
4.  Hypercholesterolemia
5.  Hypertension

MEDICATION ON ADMISSION: 

ALLERGIES: NIACIN CAUSES SEVERE FLUSHING.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Subendocardial infarction, subsequent episode of care,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Aortic aneurysm of unspecified site without mention of rupture,Unspecified essential hypertension,Pure hypercholesterolemia,Family history of ischemic heart disease'}
