CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64-year-old
male with a past medical history significant for end-stage
renal disease (on hemodialysis) who was admitted on [**1-15**] to the Surgical Transplant Service for arteriovenous
fistula revision and thrombectomy.

MEDICAL HISTORY: 1.  End-stage renal disease (on hemodialysis on Monday,
Wednesday, and Friday).
2.  History of pancreatitis.
3.  Status post cerebrovascular accident in [**2149**] with
residual left hemiparesis.
4.  History of gout.
5.  Multiple Escherichia coli bacteremia infections.
6.  Diverticulosis.
7.  Chronic obstructive pulmonary disease.
8.  Hypertension.

MEDICATION ON ADMISSION: 1.  Enalapril 20 mg p.o. q.d.
2.  Labetalol 200 mg p.o. q.d.
3.  Isosorbide dinitrate 20 mg p.o. t.i.d.
4.  Clonidine TTS #3 patch every Thursday.
5.  Sevelamer 800 mg p.o. t.i.d.
6.  Nephrocaps one tablet p.o. q.d.
7.  Lipitor 40 mg p.o. q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history unknown.

SOCIAL HISTORY: The patient is an emigrant from [**Country 2045**].  The
patient is married and lives with his wife.  The patient
speaks Haitian Creole as well as some English.  The patient
denies a history of tobacco, alcohol, as well as illicit drug
use.
Other complications due to renal dialysis device, implant, and graft,Acute myocardial infarction of unspecified site, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hemorrhage of gastrointestinal tract, unspecified,Chronic airway obstruction, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Coronary atherosclerosis of native coronary artery,Gout, unspecified
Comp-ren dialys dev/grft,AMI NOS, initial,Hyp kid NOS w cr kid V,Gastrointest hemorr NOS,Chr airway obstruct NEC,Abn react-surg proc NEC,Late ef-hemplga side NOS,Crnry athrscl natve vssl,Gout NOS
Admission Date:  [**2165-1-15**]     Discharge Date:  [**2165-1-22**]

Date of Birth:   [**2100-11-15**]     Sex:  M

Service:  C-MED

HISTORY OF PRESENT ILLNESS:  The patient is a 64-year-old
male with a past medical history significant for end-stage
renal disease (on hemodialysis) who was admitted on [**1-15**] to the Surgical Transplant Service for arteriovenous
fistula revision and thrombectomy.

PAST MEDICAL HISTORY:
1.  End-stage renal disease (on hemodialysis on Monday,
Wednesday, and Friday).
2.  History of pancreatitis.
3.  Status post cerebrovascular accident in [**2149**] with
residual left hemiparesis.
4.  History of gout.
5.  Multiple Escherichia coli bacteremia infections.
6.  Diverticulosis.
7.  Chronic obstructive pulmonary disease.
8.  Hypertension.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Enalapril 20 mg p.o. q.d.
2.  Labetalol 200 mg p.o. q.d.
3.  Isosorbide dinitrate 20 mg p.o. t.i.d.
4.  Clonidine TTS #3 patch every Thursday.
5.  Sevelamer 800 mg p.o. t.i.d.
6.  Nephrocaps one tablet p.o. q.d.
7.  Lipitor 40 mg p.o. q.d.

SOCIAL HISTORY:  The patient is an emigrant from [**Country 2045**].  The
patient is married and lives with his wife.  The patient
speaks Haitian Creole as well as some English.  The patient
denies a history of tobacco, alcohol, as well as illicit drug
use.

FAMILY HISTORY:  Family history unknown.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
on transfer from the Surgery Service to Cardiology Service
revealed temperature was 98.6, blood pressure was 140/70,
heart rate was 91, respiratory rate was 16, and oxygen
saturation was 98% on room air.  In general, the patient was
a well-developed and well-nourished male complaining of chest
pain.  In moderate distress.  Head, eyes, ears, nose, and
throat examination revealed normocephalic and atraumatic.
Sclerae were anicteric.  Pupils were equal, round, and
reactive to light and accommodation.   The oropharynx was
clear.  Mucous membranes were moist.  The neck was supple.
No jugular venous distention or lymphadenopathy appreciated.
Cardiovascular examination revealed a regular rate and
rhythm.  Normal first heart sound and second heart sound.  A
systolic murmur at the right upper sternal border with no
third heart sound or fourth heart sound appreciated.
Pulmonary examination was clear to auscultation bilaterally
without wheezes, rhonchi, or rales.  Abdominal examination
revealed soft and nondistended.  Diffusely tender without
guarding or rebound.  Normal active bowel sounds.  Extremity
examination revealed no edema.  Dorsalis pedis and posterior
tibialis pulses were 2+.  Right arm arteriovenous fistula
dressing was clean, dry, and intact with a palpable thrill.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Admission
laboratories revealed complete blood count with a white blood
cell count of 5.2, hematocrit was 31.3, and platelets were
121.  INR was 1.1.  Chemistry-7 revealed sodium was 138,
potassium was 4.2, chloride was 99, bicarbonate was 19, blood
urea nitrogen was 76, creatinine was 3.3, and blood glucose
was 126.  Calcium was 9.4, magnesium was 2.1, and phosphate
was 9.5.  The patient had multiple sets of cardiac enzymes
with negative creatine kinase (peak of 90) and an evaluated
troponin I with a peak of 29.  She also had a cholesterol
panel during her hospitalization with a total cholesterol of
118, triglycerides were 87, high-density lipoprotein was 34,
and low-density lipoprotein was 67.  Hemoglobin A1c was 5.8.

RADIOLOGY/IMAGING:   The patient's electrocardiogram on
hospital day two demonstrated a normal sinus rhythm at 68
with atrioventricular conduction delay.  New T wave
inversions in leads I, aVL, V4 through V6.  Q waves in leads
in III and aVF.

HOSPITAL COURSE:   The patient underwent arteriovenous
fistula repair and thrombectomy on hospital day one without
complications.

However, on postoperative day one, the patient developed the
acute onset of substernal chest pain with diaphoresis,
nausea, and vomiting.  An electrocardiogram demonstrated new
T wave inversions in the anterolateral leads, and the patient
was sent for emergent cardiac catheterization.

Cardiac catheterization revealed 3-vessel disease with 70%
proximal and 95% mid left anterior descending artery
stenosis, 70% proximal left circumflex stenosis, 80% second
obtuse marginal stenosis, and 75% proximal and 80% mid right
coronary artery stenosis.  The patient underwent percutaneous
transluminal coronary angioplasty and stenting (times two) of
the left anterior descending artery with good results.

The patient had a stable post catheterization course until
[**1-17**]; when, during hemodialysis, the patient complained
of abdominal pain with nausea and vomiting.  Hemodialysis was
discontinued early, and the patient was returned to the floor
where the nausea and vomiting continued, and the patient
complained of recurrent chest pain.

A repeat electrocardiogram demonstrated anteroinferior ST
elevations, and the patient went for emergent re-look
catheterization.  Catheterization was without evidence of
acute thrombosis or change in anatomy, and no intervention
was required.

However, immediately status post catheterization, the patient
developed large hematemesis; initially coffee-grounds emesis
followed by bright red blood per rectum.  The patient was
hemodynamically stable and without chest pain at the time and
was transferred to the Cardiothoracic Intensive Care Unit for
further management.

The patient's blood pressure medications were held, and the
patient was transfused one unit of packed red blood cells for
a hematocrit of 25.6 (down from 31 twelve hours prior).  The
patient refused a nasogastric lavage and was started on
high-dose proton pump inhibitor without further episodes of
hematemesis.  The patient continued to remain hemodynamically
stable without further episodes of chest pain.

An echocardiogram was performed which demonstrated mild left
and right atrial dilatation, symmetric left ventricular
hypertrophy, normal right and left ventricular size and
function, with an ejection fraction of 55%, moderate aortic
root dilatation, and 1+ aortic regurgitation, and trivial
tricuspid regurgitation.

The patient was transferred to the Cardiac Medicine floor
where he remained for 48 hours.  The patient's hematocrit
remained stable with a discharge hematocrit of 33.4.  There
was no further need for a transfusion.  The patient remained
hemodynamically stable, and blood pressure medications were
restarted without complications.

The patient has a history of end-stage renal disease (on
hemodialysis three times per week).  The patient was
continued on hemodialysis throughout the hospitalization via
a temporary port while the arteriovenous fistula matured.
The arteriovenous fistula remained dressed and without signs
of infection.

CONDITION AT DISCHARGE:  Condition on discharge was good;
ambulating without difficulty, chest pain free, and without
further evidence of bleeding.

DISCHARGE DIAGNOSES:
 1.  Non-ST-elevation myocardial infarction.
 2.  Status post cardiac catheterization with percutaneous
transluminal coronary angioplasty and stenting of the left
anterior descending artery.
 3.  Upper gastrointestinal bleed (no intervention).
 4.  Status post arteriovenous fistula repair and
thrombectomy.
 5.  End-stage renal disease (on hemodialysis).
 6.  Cerebrovascular accident with residual left hemiparesis.
 7.  Chronic obstructive pulmonary disease.
 8.  Gout.
 9.  Diverticulosis.
10.  Multiple Escherichia coli bacteremia infections.

MEDICATIONS ON DISCHARGE:
1.  Plavix 75 mg p.o. q.d. (times three months).
2.  Enalapril 20 mg p.o. q.d.
3.  Labetalol 200 mg p.o. q.d.
4.  Protonix 40 mg p.o. b.i.d.
5.  Isosorbide dinitrate 20 mg p.o. t.i.d.
6.  Sevelamer hydrochloride 800 mg p.o. t.i.d.
7.  Nephrocaps one tablet p.o. q.d.
8.  Sublingual nitroglycerin 0.3 mg tablet as needed (for
chest pain).
9.  Clonidine patch TTS #3 every week.

DISCHARGE STATUS:  The patient was discharged to home with
[**Hospital6 407**] services for medication teaching
and compliance reinforcement.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to continue hemodialysis as
per usual on the day status post discharge.
2.  An appointment with Vascular/Transplant Surgery; follow
up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**1-31**] at 2 p.m. at [**Last Name (NamePattern1) 21589**].
3.  The patient was scheduled with primary care physician
(Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1728**]) for an initial appointment on [**2-11**]
at 3:30 p.m. in the [**Last Name (un) 469**] Building, sixth floor, [**Hospital6 6613**] Clinic.
4.  The patient was scheduled for an initial Gastroenterology
appointment with Dr. [**Last Name (STitle) **] on [**2-12**] at 1:20 in the [**Hospital 12053**] Clinic.
5.  The patient was scheduled for an initial Cardiology
appointment with Dr. [**Last Name (STitle) **] on [**2-13**] at 9 a.m. at [**Last Name (NamePattern1) 21589**].




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4582**], M.D.  [**MD Number(1) 4992**]

Dictated By:[**Name8 (MD) 4935**]

MEDQUIST36

D:  [**2165-1-25**]  12:48
T:  [**2165-1-29**]  07:53
JOB#:  [**Job Number 32513**]
{'Other complications due to renal dialysis device, implant, and graft,Acute myocardial infarction of unspecified site, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hemorrhage of gastrointestinal tract, unspecified,Chronic airway obstruction, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Coronary atherosclerosis of native coronary artery,Gout, unspecified'}


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 64-year-old
male with a past medical history significant for end-stage
renal disease (on hemodialysis) who was admitted on [**1-15**] to the Surgical Transplant Service for arteriovenous
fistula revision and thrombectomy.

MEDICAL HISTORY: 1.  End-stage renal disease (on hemodialysis on Monday,
Wednesday, and Friday).
2.  History of pancreatitis.
3.  Status post cerebrovascular accident in [**2149**] with
residual left hemiparesis.
4.  History of gout.
5.  Multiple Escherichia coli bacteremia infections.
6.  Diverticulosis.
7.  Chronic obstructive pulmonary disease.
8.  Hypertension.

MEDICATION ON ADMISSION: 1.  Enalapril 20 mg p.o. q.d.
2.  Labetalol 200 mg p.o. q.d.
3.  Isosorbide dinitrate 20 mg p.o. t.i.d.
4.  Clonidine TTS #3 patch every Thursday.
5.  Sevelamer 800 mg p.o. t.i.d.
6.  Nephrocaps one tablet p.o. q.d.
7.  Lipitor 40 mg p.o. q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history unknown.

SOCIAL HISTORY: The patient is an emigrant from [**Country 2045**].  The
patient is married and lives with his wife.  The patient
speaks Haitian Creole as well as some English.  The patient
denies a history of tobacco, alcohol, as well as illicit drug
use. 

### Response:
{'Other complications due to renal dialysis device, implant, and graft,Acute myocardial infarction of unspecified site, initial episode of care,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Hemorrhage of gastrointestinal tract, unspecified,Chronic airway obstruction, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Coronary atherosclerosis of native coronary artery,Gout, unspecified'}
