CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 78 year old male with
a history of coronary artery disease, status post myocardial
infarction thirty years ago who presented with increasing
angina over the past year associated with nocturnal
orthopnea. The patient suffers from anginal symptoms two to
three times per week.  Dobutamine stress test done [**2142-2-1**],
showed progressive anginal symptoms at low workload without
significant electrocardiographic changes.  However,
echocardiogram showed evidence of prior myocardial infarction
with inducible ischemia at achieved workload and persistent
apical hypokinesis.

MEDICAL HISTORY: 1.  Coronary artery disease, status post myocardial
    infarction thirty years ago.
2.  Insulin dependent diabetes mellitus with retinopathy.
3.  Gout.
4.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 1.  Atenolol 25 mg q.d.
2.  Dyazide 25/37.5 q.d.
3.  Atorvastatin 10 mg q.d.
4.  Aspirin 325 mg p.o. q.d.
5.  Insulin 70/30 60 units q.a.m.
6.  Nitroglycerin p.r.n.
7.  Colchicine p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient discontinued cigar smoking.
Prior alcohol use, he quit thirty years ago.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified transient mental disorder in conditions classified elsewhere,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Surg compl-heart,Atrial fibrillation,Transient mental dis NOS,DMI ophth nt st uncntrld,Diabetic retinopathy NOS,Nephritis NOS in oth dis
Name:  [**Known lastname 441**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 17657**]

Admission Date:  [**2142-7-16**]     Discharge Date:

Date of Birth:   [**2064-4-8**]     Sex:  M

Service:

ADDENDUM:  Discharge medications also include Lasix 20 mg po
q day times one week, potassium chloride 20 mEq po q day
times one week, and Lipitor 10 mg po q day.



                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Dictator Info **]

MEDQUIST36

D:  [**2142-7-24**]  18:03
T:  [**2142-7-24**]  21:58
JOB#:  [**Job Number 17658**]


Admission Date:  [**2142-7-16**]     Discharge Date:  [**2142-7-25**]


Service:  CARDIOTHORACIC

HISTORY OF PRESENT ILLNESS:  This is a 78 year old male with
a history of coronary artery disease, status post myocardial
infarction thirty years ago who presented with increasing
angina over the past year associated with nocturnal
orthopnea. The patient suffers from anginal symptoms two to
three times per week.  Dobutamine stress test done [**2142-2-1**],
showed progressive anginal symptoms at low workload without
significant electrocardiographic changes.  However,
echocardiogram showed evidence of prior myocardial infarction
with inducible ischemia at achieved workload and persistent
apical hypokinesis.

The patient underwent cardiac catheterization [**2142-5-8**], which
showed three vessel disease, mild mitral regurgitation, left
main 30%, left anterior descending 90%, right coronary artery
80%, left circumflex totally occluded with ejection fraction
of 50%.  Since he was an otherwise healthy older gentleman,
it was determined that he would benefit from coronary artery
bypass grafting.

PAST MEDICAL HISTORY:
1.  Coronary artery disease, status post myocardial
    infarction thirty years ago.
2.  Insulin dependent diabetes mellitus with retinopathy.
3.  Gout.
4.  Hypercholesterolemia.

MEDICATIONS ON ADMISSION:
1.  Atenolol 25 mg q.d.
2.  Dyazide 25/37.5 q.d.
3.  Atorvastatin 10 mg q.d.
4.  Aspirin 325 mg p.o. q.d.
5.  Insulin 70/30 60 units q.a.m.
6.  Nitroglycerin p.r.n.
7.  Colchicine p.r.n.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient discontinued cigar smoking.
Prior alcohol use, he quit thirty years ago.

PHYSICAL EXAMINATION:  Vital signs revealed heart rate 68,
respiratory rate 20, blood pressure 150/78.  In general, he
is an engaging older gentleman in no apparent distress.  Skin
no rashes, scars or lesions.  Head, eyes, ears, nose and
throat - The pupils are equal, round, and reactive to light
and accommodation.  Extraocular movements are intact.
Anicteric sclera.  The neck is supple.  The chest is clear to
auscultation bilaterally, no costovertebral angle tenderness.
Heart regular rate and rhythm, S1 and S2, no murmurs.  The
abdomen is soft, nontender, nondistended, normal bowel
sounds, no hepatosplenomegaly.  Extremities are warm and well
perfused, no cyanosis, clubbing or edema.  No varicosities
noted.  Neurologic - Cranial nerves II through XII are intact
and sensation is intact.  Strength is [**5-19**] in both
extremities.  The patient is alert and oriented times three.
Pulses 2+ femoral bilaterally, 1+ dorsalis pedis and radial
bilaterally.  No carotid bruits.

LABORATORY DATA:  White blood count 6.3, hemoglobin 12.7,
hematocrit 37.9, platelet count 249,000.  Prothrombin time
13.0, partial thromboplastin time 29.5, INR 1.1.  Chem7
revealed sodium 140, potassium 5.4, chloride 107, CO2 20,
blood urea nitrogen 41, creatinine 1.8, glucose 194.  AST 14,
LDH 183.

Chest x-ray revealed no acute cardiopulmonary process, no
pleural effusions, elevated left hemidiaphragm with
associated gastric distention, tortuous aorta, normal heart
size.

Cardiac catheterization results as noted above.
Echocardiogram results as noted above also.

HOSPITAL COURSE:  The patient was admitted the morning of
[**2142-7-16**], and underwent coronary artery bypass grafting,
saphenous vein graft to OM1, saphenous vein graft to left
anterior descending, saphenous vein graft to posterior
descending artery under general anesthesia.  He was
transferred to the Intensive Care Unit and extubated on the
evening of [**2142-7-16**].

He was transferred to [**Hospital Ward Name 121**] 6 on postoperative day number one
for continued cardiopulmonary recovery, however, on
postoperative day number two, the patient went into sinus
tachycardia with heart rate to the 160s.  He was given p.o.
Lopressor with good response.  On postoperative day number
three, he went into rapid atrial fibrillation with rate in
the 130s while ambulating.  Blood pressure was 140 systolic.
The patient spontaneously converted but continued to have
bursts of atrial fibrillation and was therefore started on
Amiodarone p.o.  The patient was also started on his
preoperative insulin 70/30 at 60 units q.a.m.

Later in the day, the patient was found sitting up in a chair
unresponsive, not following commands.  He was placed in the
bed.  He was hemodynamically stable at that time.  Heart rate
was in the 100s, blood pressure 140/70, oxygen saturation 96%
on two liters.  His blood sugar was found to be 80.  The
patient was given an amp of D50 in addition to an additional
25 mg Lopressor.  Blood sugar increased to 134.  The patient
started to awaken, became more responsive, was following
commands and moving all extremities, however, was still
somewhat confused.

The patient was then transferred to the Cardiothoracic
Intensive Care Unit for close neurologic monitoring.
Neurologic consultation was obtained.  On further
investigation, it was found that the patient had a history of
over one year of having a sella turcica mass which was
completely compressing his internal carotid artery on the
left per magnetic resonance scan., The patient's neurologic
status continued to improve to baseline at which he was alert
and oriented times four with sensation grossly intact,
cranial nerves grossly intact except for mild right ptosis
and motor strength intact bilaterally.

The patient had a transthoracic echocardiogram done which
showed normal left ventricular function, ejection fraction of
55%.  No effusions, no vegetations.  Bilateral carotid duplex
showed 100% left internal carotid artery occlusion, no
pathology on the right internal carotid artery with normal
antegrade flow, right to left, of his vertebral arteries.

The patient remained stable hemodynamically with his rate
controlled on Lopressor and in sinus rhythm on Amiodarone.
Neurologically, he remained oriented, however, had difficulty
ambulating and it was felt that an acute rehabilitation
facility would best serve his needs for cardiopulmonary
recovery.

On discharge, with suspected patient mental status change, it
was felt to possibly be multifactorial taking into effect his
history of an intracranial mass which is chronic with no
acute changes found on CT, possibly metabolic with tighter
glucose control sought, his postoperative atrial fibrillation
controlled on Lopressor and Amiodarone.

Th[**Last Name (STitle) 1050**] is to be discharged to rehabilitation facility to
follow-up with neurology consultation service, telephone
number [**Telephone/Fax (1) **], in one to two weeks, Dr.[**Name (NI) 108036**] pager
number [**Serial Number 108037**].  The patient also scheduled for outpatient
electroencephalogram on [**2142-7-28**], to evaluate for possible
seizure activity.  The patient is also to follow-up with Dr.
[**Last Name (Prefixes) **] in seven to ten days.

DISCHARGE MEDICATIONS:
1.  Lopressor 100 mg p.o. b.i.d.
2.  Amiodarone 400 mg p.o. t.i.d. times two days, then
Amiodarone 400 mg p.o. b.i.d. times seven days and then
Amiodarone 400 mg p.o. q.d. times seven days.
3.  Colace 100 mg p.o. b.i.d.
4.  Aspirin 81 mg p.o. q.d.
5.  Insulin 70/30 at 40 units subcutaneous q.a.m.
6.  Insulin sliding scale.
7.  Ranitidine 150 mg p.o. q.d.
8.  Colchicine 0.5 mg p.o. q.d. p.r.n. gout.
9.  Tylenol 650 mg p.o. q6hours p.r.n. pain.




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

Dictated By:[**Last Name (NamePattern1) 2682**]

MEDQUIST36

D:  [**2142-7-24**]  17:59
T:  [**2142-7-24**]  19:09
JOB#:  [**Job Number 40218**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified transient mental disorder in conditions classified elsewhere,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}


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 78 year old male with
a history of coronary artery disease, status post myocardial
infarction thirty years ago who presented with increasing
angina over the past year associated with nocturnal
orthopnea. The patient suffers from anginal symptoms two to
three times per week.  Dobutamine stress test done [**2142-2-1**],
showed progressive anginal symptoms at low workload without
significant electrocardiographic changes.  However,
echocardiogram showed evidence of prior myocardial infarction
with inducible ischemia at achieved workload and persistent
apical hypokinesis.

MEDICAL HISTORY: 1.  Coronary artery disease, status post myocardial
    infarction thirty years ago.
2.  Insulin dependent diabetes mellitus with retinopathy.
3.  Gout.
4.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 1.  Atenolol 25 mg q.d.
2.  Dyazide 25/37.5 q.d.
3.  Atorvastatin 10 mg q.d.
4.  Aspirin 325 mg p.o. q.d.
5.  Insulin 70/30 60 units q.a.m.
6.  Nitroglycerin p.r.n.
7.  Colchicine p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient discontinued cigar smoking.
Prior alcohol use, he quit thirty years ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified transient mental disorder in conditions classified elsewhere,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}
