CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 42720**] is a 70 year old
male with a long history of coronary artery disease.  He
underwent his first coronary artery bypass grafting in [**2159**]
at [**Hospital6 1129**].  He then experienced
recurrent anginal symptoms and had a repeat coronary artery
bypass grafting in [**2172**] at an outside hospital.  Of note is
that his second coronary artery bypass graft was complicated
by hemodynamic instability requiring intra-aortic balloon
pump.  The patient consequently did well until [**2180-5-24**] when
he began developing exertional anginal symptoms especially
radiating to his left arm.  Over the past few months he has
experienced daily angina with ambulation such as walking to
the mailbox.  On [**2180-11-5**], the patient was awakened
by what he described as chest burning, which then proceeded
to worsen, relieved only slightly with sublingual
Nitroglycerin.  The patient presented to an outside hospital
and his pain was relieved with sublingual Nitroglycerin and
also Aspirin was administered.  His creatinine kinase enzymes
were flat.  He had a recent cardiac catheterization ([**2180-10-24**]) which showed multivessel coronary artery disease with
extensive graft disease and with patent saphenous venous
graft to the diagonal/left anterior descending but with
stenosis at the side-to-side anastomosis at the diagonal.
The patient has been painfree since [**11-5**] and has been
on intravenous Integrilin and Lovenox.  On review of systems
the patient complained of the left arm and jaw discomfort
with minimal activity on a daily basis.  The patient also has
developed paroxysmal nocturnal dyspnea over the past few
months, left extremity edema and positional orthostatic
dizziness at times.  The patient denies orthopnea or
claudication.

MEDICAL HISTORY: 1.  Coronary artery disease, status
post coronary artery bypass graft in [**2159**] and a redo coronary
artery bypass graft in [**2172**]; 2.  Hypertension; 3.  Diabetes
mellitus; 4.  Status post bilateral knee replacement in [**2178**]
and [**2179**]; 5.  Status post cholecystectomy in [**2174**]; 6.
History of basal cell carcinoma.

MEDICATION ON ADMISSION: 1.  Toprol XL 75 mg p.o. q. day;
2.  Multivitamins; 3.  Nitropaste as needed; 4.  Accupril 20
mg p.o. q. day; 5.  Avandia 8 mg p.o. q. day; 6.  Norvasc 5
mg p.o. q. day; 7.  Lipitor 10 mg p.o. q. day; 8.  Digoxin
0.125 mg p.o. q. day; 9.  Lovenox 80 mg subcutaneously
b.i.d.; 10. Folate one tablet once a day; 11. Glyburide 2.5
mg p.o. q. day; 12. Integrilin intravenously.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married, lives with his wife,
social alcohol use and no tobacco use.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Atrial fibrillation,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem
Admission Date:  [**2180-11-7**]       Discharge Date:  [**2180-11-14**]

Date of Birth:   [**2109-12-30**]       Sex:  M

Service:  Cardiac Surgery

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 42720**] is a 70 year old
male with a long history of coronary artery disease.  He
underwent his first coronary artery bypass grafting in [**2159**]
at [**Hospital6 1129**].  He then experienced
recurrent anginal symptoms and had a repeat coronary artery
bypass grafting in [**2172**] at an outside hospital.  Of note is
that his second coronary artery bypass graft was complicated
by hemodynamic instability requiring intra-aortic balloon
pump.  The patient consequently did well until [**2180-5-24**] when
he began developing exertional anginal symptoms especially
radiating to his left arm.  Over the past few months he has
experienced daily angina with ambulation such as walking to
the mailbox.  On [**2180-11-5**], the patient was awakened
by what he described as chest burning, which then proceeded
to worsen, relieved only slightly with sublingual
Nitroglycerin.  The patient presented to an outside hospital
and his pain was relieved with sublingual Nitroglycerin and
also Aspirin was administered.  His creatinine kinase enzymes
were flat.  He had a recent cardiac catheterization ([**2180-10-24**]) which showed multivessel coronary artery disease with
extensive graft disease and with patent saphenous venous
graft to the diagonal/left anterior descending but with
stenosis at the side-to-side anastomosis at the diagonal.
The patient has been painfree since [**11-5**] and has been
on intravenous Integrilin and Lovenox.  On review of systems
the patient complained of the left arm and jaw discomfort
with minimal activity on a daily basis.  The patient also has
developed paroxysmal nocturnal dyspnea over the past few
months, left extremity edema and positional orthostatic
dizziness at times.  The patient denies orthopnea or
claudication.

PAST MEDICAL HISTORY:  1.  Coronary artery disease, status
post coronary artery bypass graft in [**2159**] and a redo coronary
artery bypass graft in [**2172**]; 2.  Hypertension; 3.  Diabetes
mellitus; 4.  Status post bilateral knee replacement in [**2178**]
and [**2179**]; 5.  Status post cholecystectomy in [**2174**]; 6.
History of basal cell carcinoma.

SOCIAL HISTORY:  The patient is married, lives with his wife,
social alcohol use and no tobacco use.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  1.  Toprol XL 75 mg p.o. q. day;
2.  Multivitamins; 3.  Nitropaste as needed; 4.  Accupril 20
mg p.o. q. day; 5.  Avandia 8 mg p.o. q. day; 6.  Norvasc 5
mg p.o. q. day; 7.  Lipitor 10 mg p.o. q. day; 8.  Digoxin
0.125 mg p.o. q. day; 9.  Lovenox 80 mg subcutaneously
b.i.d.; 10. Folate one tablet once a day; 11. Glyburide 2.5
mg p.o. q. day; 12. Integrilin intravenously.

PHYSICAL EXAMINATION:  Afebrile, weight 192.  Heartrate 73.
Blood pressure 141/72, 95% on room air.  General examination,
in no apparent distress.  Neurologic examination, oriented
times three, neurologically grossly intact.  Lung
examination, clear to auscultation bilaterally.  Cardiac
examination, regular rate and rhythm, no murmurs, rubs or
gallops.  Head, eyes, ears, nose and throat examination, no
carotid bruits, no jugulovenous distension.  Temporal pulses
present, otherwise unremarkable.  Extremities, warm, well
perfused, 2+ pulses present bilaterally in the upper and
lower extremities.  Trace lower extremity edema.

LABORATORY DATA:  Electrocardiogram performed on [**2180-11-5**] showed sinus rhythm with heartrate of 81 with incomplete
left bundle branch block.  White blood cell count was 6.6,
hematocrit 40.5, platelets 251, INR 1.0, sodium 135, BUN 33,
creatinine 1.5, glucose 163, potassium 3.8.

HOSPITAL COURSE:  The patient was seen by Cardiac Surgery.
Given the worsening of his symptoms as well as the findings
on recent cardiac catheterization it was thought that a redo
coronary artery bypass graft would be appropriate.  First and
intra-aortic balloon pump was placed prior to surgery.  The
procedure was without complications.  The patient was started
on intravenous heparin.  On [**2180-11-7**], the patient
underwent third time redo coronary artery bypass grafting
with radial artery to left anterior descending coronary
artery and lesser saphenous vein to the obtuse marginal
coronary artery.  The procedure was without complications.
Please see the full operative report for further details.
The patient was transferred to the Intensive Care Unit.  He
remained intubated.  He was hemodynamically stable.  The
patient remained in sinus rhythm.  His blood pressures were
stable.  His incision remained clean, dry and intact.
However, on postoperative day #1 while in the Intensive Care
Unit, the patient went into rapid atrial fibrillation.  He
was loaded with Amiodarone dose and was placed on a standing
dose as well.  The patient soon converted to sinus rhythm
only with occasional premature ventricular contractions.  On
postoperative day #1 the patient was noted to have hematuria.
The Urology Service was consulted.  A two-way Foley catheter
was placed and the bladder was irrigated.  No clots were
seen.  The patient continued to make adequate urine.  On
postoperative day #2 the patient's hematocrit was noted to be
23.  He was transfused with packed cells.  Chest tubes were
removed on postoperative day #3.  His Swan-Ganz catheter was
removed on postoperative day #3 as well.  The patient was put
on Imdur.  Physical therapy was consulted which followed the
patient during his hospitalization and eventually cleared him
to go home.  The patient's urine eventually cleared.  The
patient had another burst of atrial fibrillation on
postoperative day #4.  His urine catheter was finally removed
on postoperative day #4.  The patient was maintained on a
standing dose of Amiodarone.  The patient was transferred to
the regular floor on postoperative day #4 in stable
condition.  He was also maintained on p.o. Lopressor.  His
heartrate remained in the 60s and 70s in sinus rhythm.  He
remained afebrile.  His incision was clean, dry and intact.
The patient was discharged to home on postoperative day #5
(on [**2180-11-14**]) in stable condition.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DISPOSITION:  Home.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease, status post redo coronary artery
bypass graft times two.
2.  Atrial fibrillation.
3.  Hypertension.
4.  Diabetes mellitus.

DISCHARGE MEDICATIONS:
1.  Avandia 8 mg p.o. b.i.d.
2.  Glyburide 5 mg p.o. q. day
3.  Lasix 20 mg p.o. b.i.d. times 14 days
4.  Potassium chloride 20 mg p.o. b.i.d. times 14 days
5.  Amiodarone 400 mg p.o. q. day times 30 days
6.  Lopressor 25 mg p.o. b.i.d.
7.  Percocet 1 to 2 tablets p.o. q. 6 hours prn pain
8.  Colace 100 mg p.o. b.i.d. prn constipation
9.  Aspirin 325 mg p.o. q. day
10. Imdur 60 mg p.o. q. day times 90 days
11. Accupril 20 mg p.o. q. day
12. Multivitamin

DISCHARGE INSTRUCTIONS:
1.  The patient is to follow up with her cardiac surgeon, Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] in approximately six weeks.
2.  The patient is to follow up with her cardiologist, Dr.
[**Last Name (STitle) 44710**] in approximately two to three weeks.
3.  The patient is to follow up with her primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 3142**] in approximately one to two weeks.




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

Dictated By:[**Last Name (NamePattern1) 1741**]
MEDQUIST36

D:  [**2180-11-15**]  15:48
T:  [**2180-11-15**]  16:00
JOB#:  [**Job Number 12310**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}


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: Mr. [**Known lastname 42720**] is a 70 year old
male with a long history of coronary artery disease.  He
underwent his first coronary artery bypass grafting in [**2159**]
at [**Hospital6 1129**].  He then experienced
recurrent anginal symptoms and had a repeat coronary artery
bypass grafting in [**2172**] at an outside hospital.  Of note is
that his second coronary artery bypass graft was complicated
by hemodynamic instability requiring intra-aortic balloon
pump.  The patient consequently did well until [**2180-5-24**] when
he began developing exertional anginal symptoms especially
radiating to his left arm.  Over the past few months he has
experienced daily angina with ambulation such as walking to
the mailbox.  On [**2180-11-5**], the patient was awakened
by what he described as chest burning, which then proceeded
to worsen, relieved only slightly with sublingual
Nitroglycerin.  The patient presented to an outside hospital
and his pain was relieved with sublingual Nitroglycerin and
also Aspirin was administered.  His creatinine kinase enzymes
were flat.  He had a recent cardiac catheterization ([**2180-10-24**]) which showed multivessel coronary artery disease with
extensive graft disease and with patent saphenous venous
graft to the diagonal/left anterior descending but with
stenosis at the side-to-side anastomosis at the diagonal.
The patient has been painfree since [**11-5**] and has been
on intravenous Integrilin and Lovenox.  On review of systems
the patient complained of the left arm and jaw discomfort
with minimal activity on a daily basis.  The patient also has
developed paroxysmal nocturnal dyspnea over the past few
months, left extremity edema and positional orthostatic
dizziness at times.  The patient denies orthopnea or
claudication.

MEDICAL HISTORY: 1.  Coronary artery disease, status
post coronary artery bypass graft in [**2159**] and a redo coronary
artery bypass graft in [**2172**]; 2.  Hypertension; 3.  Diabetes
mellitus; 4.  Status post bilateral knee replacement in [**2178**]
and [**2179**]; 5.  Status post cholecystectomy in [**2174**]; 6.
History of basal cell carcinoma.

MEDICATION ON ADMISSION: 1.  Toprol XL 75 mg p.o. q. day;
2.  Multivitamins; 3.  Nitropaste as needed; 4.  Accupril 20
mg p.o. q. day; 5.  Avandia 8 mg p.o. q. day; 6.  Norvasc 5
mg p.o. q. day; 7.  Lipitor 10 mg p.o. q. day; 8.  Digoxin
0.125 mg p.o. q. day; 9.  Lovenox 80 mg subcutaneously
b.i.d.; 10. Folate one tablet once a day; 11. Glyburide 2.5
mg p.o. q. day; 12. Integrilin intravenously.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married, lives with his wife,
social alcohol use and no tobacco use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}
