CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 70-year-old
male with a history of coronary artery disease status post
coronary artery bypass graft in [**2186**] and known aortic
stenosis murmur for several years.  He recently developed
daily angina relieved by multiple nitroglycerin sprays.  The
patient has had multiple Interventional Cardiology procedures
in the interim with stents and angioplasty since his coronary
artery bypass graft.  He has a congenital bicuspid aortic
valve.  Echocardiogram in [**2196-7-22**] demonstrated an
ejection fraction of 35%, mild left ventricular hypokinesis,
inferior hypokinesis, moderate aortic stenosis, 2+ aortic
insufficiency.  Cardiac catheterization in [**2196-10-22**]
demonstrated an ejection fraction of approximately 50%, with
patent stents.  The left anterior descending artery was
occluded to 100%.  Circumflex was occluded to 100%.  The
patient now presents for re-do coronary artery bypass graft
and concomitant aortic valve replacement.

MEDICAL HISTORY: 1.  Hypertension.
2.  Skin cancer.
3.  Coronary artery disease.
4.  Osteoarthritis.
5.  Gastroesophageal reflux disease.
6.  Left carotid stenosis to 70-80%.
7.  Right vertebral artery occlusion.
8.  History of transient ischemic attacks.
9.  Peripheral vascular disease.
10. Hypercholesterolemia.
11. History of pancreatitis.
12. History of hepatitis.

MEDICATION ON ADMISSION: 

ALLERGIES: 1.  Zestril causes a cough.
2.  Dipyridamole causes an acute anaphylactic reaction.
3.  Aggrenox (contains dipyridamole).
4.  Question muscle relaxant causing laryngeal spasm and
trouble swallowing postoperatively in [**2191**].

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient admits to having one alcoholic
beverage a day.  Nonsmoker.  No recreational drug use.
Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Aortic valve disorders,Congestive heart failure, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Unspecified essential hypertension,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction
Crnry athrscl natve vssl,Accidental op laceration,Aortic valve disorder,CHF NOS,Abn react-anastom/graft,Esophageal reflux,Hypertension NOS,Ocl mlt bi art wo infrct
Admission Date:  [**2197-1-31**]       Discharge Date: [**2197-2-3**]

Date of Birth:   [**2125-12-8**]       Sex:  M

Service:

ADMISSION DIAGNOSES:
1.  Coronary artery disease.
2.  Hypertension.
3.  Skin cancer.
4.  Osteoarthritis.
5.  Gastroesophageal reflux disease.
6.  Complete occlusion of right vertebral artery.
7.  Left carotid stenosis to 70-80%.
8.  History of transient ischemic attacks.
9.  Peripheral vascular disease.
10. Hypercholesterolemia.
11. History of pancreatitis.
12. History of hepatitis.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease.
2.  Hypertension.
3.  Skin cancer.
4.  Osteoarthritis.
5.  Gastroesophageal reflux disease.
6.  Complete occlusion of right vertebral artery.
7.  Left carotid stenosis to 70-80%.
8.  History of transient ischemic attacks.
9.  Peripheral vascular disease.
10. Hypercholesterolemia.
11. History of pancreatitis.
12. History of hepatitis.
13. Status post re-do coronary artery bypass graft times two.

HISTORY OF PRESENT ILLNESS:  The patient is a 70-year-old
male with a history of coronary artery disease status post
coronary artery bypass graft in [**2186**] and known aortic
stenosis murmur for several years.  He recently developed
daily angina relieved by multiple nitroglycerin sprays.  The
patient has had multiple Interventional Cardiology procedures
in the interim with stents and angioplasty since his coronary
artery bypass graft.  He has a congenital bicuspid aortic
valve.  Echocardiogram in [**2196-7-22**] demonstrated an
ejection fraction of 35%, mild left ventricular hypokinesis,
inferior hypokinesis, moderate aortic stenosis, 2+ aortic
insufficiency.  Cardiac catheterization in [**2196-10-22**]
demonstrated an ejection fraction of approximately 50%, with
patent stents.  The left anterior descending artery was
occluded to 100%.  Circumflex was occluded to 100%.  The
patient now presents for re-do coronary artery bypass graft
and concomitant aortic valve replacement.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Skin cancer.
3.  Coronary artery disease.
4.  Osteoarthritis.
5.  Gastroesophageal reflux disease.
6.  Left carotid stenosis to 70-80%.
7.  Right vertebral artery occlusion.
8.  History of transient ischemic attacks.
9.  Peripheral vascular disease.
10. Hypercholesterolemia.
11. History of pancreatitis.
12. History of hepatitis.

PAST SURGICAL HISTORY:
1.  Cholecystectomy.
2.  Multiple skin cancer excisions.
3.  Bilateral bunionectomy.
4.  Bilateral cataract.
5.  Coronary artery bypass graft times two in [**2186**] with left
internal mammary artery to the left anterior descending
artery, saphenous vein graft to the OM1.
6.  Bilateral knee arthroscopies.
7.  Umbilical herniorrhaphy.
8.  Right inguinal herniorrhaphy.
9.  Tonsillectomy.

ALLERGIES:
1.  Zestril causes a cough.
2.  Dipyridamole causes an acute anaphylactic reaction.
3.  Aggrenox (contains dipyridamole).
4.  Question muscle relaxant causing laryngeal spasm and
trouble swallowing postoperatively in [**2191**].

PREOPERATIVE MEDICATIONS:
1.  Imdur 30 mg b.i.d.
2.  Cozaar 25 mg b.i.d.
3.  Aspirin 325 mg q. day.
4.  Lopressor 100 mg b.i.d.
5.  Diltiazem 240 mg q. day.
6.  Nitroglycerin sublingual spray p.r.n.
7.  Zocor 20 mg q. day.
8.  Rabeprazole 20 mg q. day.
9.  Vitamin E 400 units q. day.
10. Calcium with zinc supplementation.
11. Vitamin C 400 units q. day.
12. Multivitamin.
13. Salsalate 750 mg b.i.d.

SOCIAL HISTORY:  The patient admits to having one alcoholic
beverage a day.  Nonsmoker.  No recreational drug use.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  5'7", 175
pounds.  Heart rate of 63 and in sinus, blood pressure
127/44, 98% on room air.  Chest has a well-healed sternotomy
scar.  The sternum is stable.  Clear to auscultation
bilaterally.  Cardiovascular:  Regular rate and rhythm with a
holosystolic ejection murmur grade [**2-25**] radiating to both
sides of the neck.  Abdomen soft, non-tender, non-distended.
There is occasional tenderness in the left lower quadrant.
Hypoactive bowel sounds.  A well-healed umbilical hernia
scar.  Extremities are warm, well perfused.  No cyanosis
detected.  There is 1+ pedal edema on the left.  Well-healed
left saphenous vein excision scar from groin to ankle.  Pulse
examination is as follows and are equal bilaterally:  Carotid
1+, radial 2+, femoral 2+, dorsipedal 2+, posterior tibial
1+.

HOSPITAL COURSE:  On [**2197-1-23**], the patient was
admitted to [**Hospital1 69**] for aortic
valve replacement as well as re-do coronary artery bypass
graft times two.  For details of the operative procedure,
please see dictated operative note.  Of note, when the re-do
sternotomy was performed, the left internal mammary artery
was injured and repaired with 7-0 Prolene.  The valve was
replaced with a #23 mm [**Last Name (un) 3843**]-[**Doctor Last Name **] valve.  The bypass
grafts were performed with saphenous vein graft to the
posterior descending artery and saphenous vein graft to the
_______________________.  Postoperatively, the patient was
transferred to the ESRU for close monitoring.  He was
initially placed on a dobutamine drip and also Levophed for
hypotension.  The patient was immediately transfused fresh
frozen plasma and platelets for some mild postoperative
bleeding and elevated INR and PTT.  On postoperative day one,
the patient was transfused one unit of packed red blood cells
and his vasopressor drips were weaned off.  Lasix diuresis
was begun.  The patient was also started on Plavix due to the
injury to the left internal mammary artery as well as poor
target vessels.  Subsequent to this, the patient had an
essentially unremarkable postoperative course.  He progressed
well with physical therapy.  His chest tubes were
discontinued when outputs were less than 150 cc q. 8h., the
wires were removed on postoperative day three.  The patient
was transferred to the floor on postoperative day two and did
well on the floor.  He was cleared for physical therapy for
discharge to home.  Ultimately, the patient was discharged on
postoperative day three tolerating a regular diet, ambulating
well and having no more anginal pain.

CONDITION AT DISCHARGE:  Stable.  Cleared by Physical Therapy
for discharge home.

DIET:  Cardiac diet.

DISCHARGE MEDICATIONS:
1.  Lopressor 50 mg b.i.d.
2.  Lasix 20 mg b.i.d. times seven days.
3.  KCl 20 mEq b.i.d. times seven days.
4.  Colace 100 mg b.i.d.
5.  Plavix 75 mg q. day times three months.
6.  Percocet 5/325 one to two q. 4h. p.r.n.
7.  Zocor 20 mg q. day.

DISCHARGE INSTRUCTIONS:  The patient is being discharged to
home with the VNA for cardiopulmonary and wound checks.  He
should follow up with Dr. [**Last Name (STitle) **] in four weeks' time.  He
should follow up with his cardiologist in one to two weeks
for adjustment of medication as well as monitoring of
diuresis.  No heavy lifting or strenuous activity.  VNA
should remove his staples in two weeks' time.




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 5745**]
MEDQUIST36

D:  [**2197-2-3**]  15:27
T:  [**2197-2-3**]  15:31
JOB#:  [**Job Number 94171**]
{'Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Aortic valve disorders,Congestive heart failure, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Unspecified essential hypertension,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction'}


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 a 70-year-old
male with a history of coronary artery disease status post
coronary artery bypass graft in [**2186**] and known aortic
stenosis murmur for several years.  He recently developed
daily angina relieved by multiple nitroglycerin sprays.  The
patient has had multiple Interventional Cardiology procedures
in the interim with stents and angioplasty since his coronary
artery bypass graft.  He has a congenital bicuspid aortic
valve.  Echocardiogram in [**2196-7-22**] demonstrated an
ejection fraction of 35%, mild left ventricular hypokinesis,
inferior hypokinesis, moderate aortic stenosis, 2+ aortic
insufficiency.  Cardiac catheterization in [**2196-10-22**]
demonstrated an ejection fraction of approximately 50%, with
patent stents.  The left anterior descending artery was
occluded to 100%.  Circumflex was occluded to 100%.  The
patient now presents for re-do coronary artery bypass graft
and concomitant aortic valve replacement.

MEDICAL HISTORY: 1.  Hypertension.
2.  Skin cancer.
3.  Coronary artery disease.
4.  Osteoarthritis.
5.  Gastroesophageal reflux disease.
6.  Left carotid stenosis to 70-80%.
7.  Right vertebral artery occlusion.
8.  History of transient ischemic attacks.
9.  Peripheral vascular disease.
10. Hypercholesterolemia.
11. History of pancreatitis.
12. History of hepatitis.

MEDICATION ON ADMISSION: 

ALLERGIES: 1.  Zestril causes a cough.
2.  Dipyridamole causes an acute anaphylactic reaction.
3.  Aggrenox (contains dipyridamole).
4.  Question muscle relaxant causing laryngeal spasm and
trouble swallowing postoperatively in [**2191**].

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient admits to having one alcoholic
beverage a day.  Nonsmoker.  No recreational drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Aortic valve disorders,Congestive heart failure, unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Esophageal reflux,Unspecified essential hypertension,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction'}
