CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: This 74 year old woman was
transferred from [**Hospital 1562**] Hospital after rule-in myocardial
infarction and cardiac catheterization which showed three
vessel disease.  The patient was admitted to [**Hospital 1562**]
Hospital after awaking during the night with chest pressure
and she went to the bathroom, she felt dizzy, fell down and
lost consciousness.  She did have a myocardial infarction 12
years ago.  Catheterization at that time showed no blockages.
Stress test this past summer was "okay."  A recent cardiac
catheterization showed a left main coronary artery stenosis
40%, left anterior descending 80%, and anomalous septal
branch 99% stenosis, left circumflex 45% stenosis and a right
circumflex greater than 90% stenosis.

MEDICAL HISTORY: Hypertension, hypercholesterolemia,
coronary artery disease, myocardial infarction ten years ago.
Peripheral vascular disease, carotid disease and disc
surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: She is allergic to Amoxicillin which gives her
hives.

PHYSICAL EXAM: 

FAMILY HISTORY: No family history of coronary artery
disease.

SOCIAL HISTORY: She lives with her husband.  She does have a
positive smoking history but she quit five years ago.
Ethanol, she takes one drink a day.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Methicillin susceptible pneumonia due to Staphylococcus aureus,Iron deficiency anemia secondary to blood loss (chronic),Pulmonary collapse,Atherosclerosis of aorta,Impacted cerumen,Personal history of tobacco use
Subendo infarct, initial,Crnry athrscl natve vssl,Meth sus pneum d/t Staph,Chr blood loss anemia,Pulmonary collapse,Aortic atherosclerosis,Impacted cerumen,History of tobacco use
Admission Date:  [**2128-11-30**]       Discharge Date:  [**2128-12-21**]

Date of Birth:   [**2054-6-29**]       Sex:  F

Service:  Cardiac Surgery

CHIEF COMPLAINT:  Chest pain.

HISTORY OF PRESENT ILLNESS:  This 74 year old woman was
transferred from [**Hospital 1562**] Hospital after rule-in myocardial
infarction and cardiac catheterization which showed three
vessel disease.  The patient was admitted to [**Hospital 1562**]
Hospital after awaking during the night with chest pressure
and she went to the bathroom, she felt dizzy, fell down and
lost consciousness.  She did have a myocardial infarction 12
years ago.  Catheterization at that time showed no blockages.
Stress test this past summer was "okay."  A recent cardiac
catheterization showed a left main coronary artery stenosis
40%, left anterior descending 80%, and anomalous septal
branch 99% stenosis, left circumflex 45% stenosis and a right
circumflex greater than 90% stenosis.

PAST MEDICAL HISTORY:  Hypertension, hypercholesterolemia,
coronary artery disease, myocardial infarction ten years ago.
Peripheral vascular disease, carotid disease and disc
surgery.

ALLERGIES:  She is allergic to Amoxicillin which gives her
hives.

MEDICATIONS:  Medications at home include Atacard 32 mg p.o.
q.d., Norvasc 5 mg p.o. q.d., Aspirin.  Medications on
transfer included heparin drip, Nitroglycerin drip, Aspirin
325, Protonix.

SOCIAL HISTORY:  She lives with her husband.  She does have a
positive smoking history but she quit five years ago.
Ethanol, she takes one drink a day.

FAMILY HISTORY:  No family history of coronary artery
disease.

LABORATORY DATA:  Her outside hospital laboratory data were
significant for an elevated creatinine kinase of 627 and an
elevated troponin of 6.25, creatinine kinase at the outside
laboratory showed a sinus rhythm at 43, ST elevations in 2, 3
and AVF and depression in lateral leads V2 to V6.
Echocardiogram showed good ejection fraction of 65%, mild
mitral regurgitation and moderate tricuspid regurgitation.

PHYSICAL EXAMINATION:  On physical examination she was
afebrile, sinus rate, 145, 114/56, 18 and 99% on 2 liters.
Thin woman in no acute distress.  She is alert and oriented
times three and follows commands.  No focal deficits on
neurological examination.  Head and neck examination, she is
pupils equal, round and reactive to light and accommodation.
Extraocular movements intact.  Anicteric.  Mucous membranes
are moist.  Neck is supple, no lymphadenopathy, positive
bruits bilaterally.  Chest examination, heart is regular rate
and rhythm, S1 and S2, no murmurs.  Lungs are clear to
auscultation bilaterally.  Abdomen is soft, nontender,
nondistended.  Her extremities, warm and well perfused, no
cyanosis, clubbing or edema with 2+ and equal pulses in the
carotids, femorals, radials and dorsalis pedis.

HOSPITAL COURSE:  This is a patient who has three vessel
disease who is admitted to the Cardiac Surgery Service for a
coronary artery bypass graft evaluation and treatment.  She
was admitted and over the next couple of days she was
observed with Telemetry and preopped for a coronary artery
bypass graft procedure.  On [**2128-12-2**], after being
appropriately consented, the patient was taken to the
Operating Room for a coronary artery bypass graft.  Please
refer to the previously dictated operative note by Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 70**] from [**2128-12-2**].  In brief, a left internal
mammary artery was connected to the left anterior descending
artery, however, further grafts could not be performed as the
aorta was extremely calcified and the right coronary artery
was bifurcated in an awkward angle.  Therefore she was sent
to the catheterization laboratory.  Basically the operation
was stopped after a single bypass graft and then the patient
was sent to the catheterization laboratory where she
underwent a right coronary artery stent placement.  The
patient tolerated both of these surgical interventions well
and was transferred to the Cardiac Surgery Recovery Unit in
good condition.  That evening the patient was extubated and
weaned off of all of her intravenous drips and did well in
the Cardiac Surgery Recovery Unit.  On postoperative day #2,
the patient did well enough that she was transferred to the
floor.  The rest of her admission can be described in the
organ-based fashion.

Central nervous system - The patient did not have any central
nervous system symptoms during her admission, however, her
pain was controlled well with Percocet and at the time of
discharge she was taking one Percocet every four hours for
break-through pain.

Cardiovascularly, the patient underwent a coronary artery
bypass graft on [**2128-12-2**].  She also underwent two
percutaneous transluminal coronary angioplasty stent
placements, on [**2128-12-2**] and [**2128-12-8**] with
good result.  She has done very well with respective to her
cardiovascular status since her surgeries.

Pulmonary, immediately after surgery the patient suffered
from increased secretion and a chronic sort of nonproductive
cough.  She was followed with serial and chest x-rays which
at first did not show anything but some nonspecific
postoperative atelectasis with some small effusions, however,
by postoperative day #7, on [**12-9**], these were read as
having a right middle lobe collapse.  Pulmonary consult was
obtained.  A [**12-13**] computerized axial tomography scan
showed a right lower lobe collapse and focal consolidation.
On [**12-14**], the patient was bronchoscoped revealing
tracheobronchial malacia and right middle lobe and right
lower lobe collapse secondary to increased secretions.  These
were sent off for culture and subsequently grew out
Methicillin-sensitive resistant Staphylococcus aureus.
Follow up chest x-ray on [**12-17**] and [**12-19**] both
showed decreased consolidations and collapse.

Renal, the patient was adequately diuresed and was 44.4 kg at
the time of discharge which was very close to her
preoperative weight.

Hematologically, the patient had several episodes of anemia
which responded well to red blood cell transfusion.

Fluids, electrolytes and nutrition, the patient's nutritional
status revealed she was tolerating a regular diet soon after
surgery but had decreased appetite and calorie counts were
followed.  Prior to her discharge it was noted that she was
taking 85% of her recommended caloric intake prior to
discharge.

Otorhinolaryngology, throughout her floor admission, the
patient complained of clogged ears and cerumen impaction
which she suffers from chronically.  An Otorhinolaryngology
consult was obtained which recommended otic drops and a
follow up appointment in the [**Hospital 29326**] Clinic with
Dr. [**First Name (STitle) **] before discharge on [**12-20**].

Infectious disease, the patient had one contaminated sputum
culture which reveal gram positive cocci, a bit of a red
[**Doctor Last Name **], but bronchoalveolar lavage from [**12-14**] did grow
out 4+ Staphylococcus aureus which were resistant to
Oxacillin.  She was immediately started on Vancomycin and
soon her white count came down and she began feeling better.
She had a more productive cough and began to breath much
better on Vancomycin.  On [**12-19**], the patient was
switched over to Linezolid for p.o. coverage and as discussed
with Infectious Disease she was recommended to go home with
two weeks of Linezolid coverage for her Methicillin-sensitive
resistant Staphylococcus aureus pneumonia.  So, Ms [**Name13 (STitle) 53957**]
was being discharged on [**2128-12-20**], postoperative day
#18.

DISCHARGE DIAGNOSIS:
1.  Hypertension
2.  Hypercholesterolemia
3.  Coronary artery disease
4.  Acute myocardial infarction
5.  Peripheral vascular disease
6.  Methicillin-sensitive resistant Staphylococcus aureus
pneumonia
7.  Tracheobronchial malacia
8.  Right lower lobe, right middle lobe collapse due to
accumulated secretions
9.  Chronic blood loss anemia requiring transfusion
10. Cerumen impaction

FOLLOW UP:  She has follow up appointments with Dr. [**First Name (STitle) **] in
[**Hospital 29326**] Clinic, Dr. [**Last Name (STitle) **] her primary care
physician, [**Name10 (NameIs) **] cardiologist, her [**Doctor Last Name 70**], her
cardiothoracic surgeon and Dr. [**First Name (STitle) **] her interventional
cardiologist.

DISCHARGE MEDICATIONS:
1.  Linezolid 600 p.o. q. 12
2.  Aspirin 81 mg p.o. q.d.
3.  Plavix 75 mg p.o. q.d.
4.  Percocet one tablet p.o. q. 4 hours prn for pain
5.  Norvasc 5 mg p.o. q.d. around the clock
6.  Colace 100 mg p.o. b.i.d. as needed for constipation
7.  Albuterol inhaler
8.  Neomycin/Polymyxin otic drips




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

Dictated By:[**Last Name (NamePattern1) 1179**]
MEDQUIST36

D:  [**2128-12-19**]  20:47
T:  [**2128-12-19**]  20:57
JOB#:  [**Job Number 53958**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Methicillin susceptible pneumonia due to Staphylococcus aureus,Iron deficiency anemia secondary to blood loss (chronic),Pulmonary collapse,Atherosclerosis of aorta,Impacted cerumen,Personal history of tobacco use'}


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: Chest pain.

PRESENT ILLNESS: This 74 year old woman was
transferred from [**Hospital 1562**] Hospital after rule-in myocardial
infarction and cardiac catheterization which showed three
vessel disease.  The patient was admitted to [**Hospital 1562**]
Hospital after awaking during the night with chest pressure
and she went to the bathroom, she felt dizzy, fell down and
lost consciousness.  She did have a myocardial infarction 12
years ago.  Catheterization at that time showed no blockages.
Stress test this past summer was "okay."  A recent cardiac
catheterization showed a left main coronary artery stenosis
40%, left anterior descending 80%, and anomalous septal
branch 99% stenosis, left circumflex 45% stenosis and a right
circumflex greater than 90% stenosis.

MEDICAL HISTORY: Hypertension, hypercholesterolemia,
coronary artery disease, myocardial infarction ten years ago.
Peripheral vascular disease, carotid disease and disc
surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: She is allergic to Amoxicillin which gives her
hives.

PHYSICAL EXAM: 

FAMILY HISTORY: No family history of coronary artery
disease.

SOCIAL HISTORY: She lives with her husband.  She does have a
positive smoking history but she quit five years ago.
Ethanol, she takes one drink a day. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Methicillin susceptible pneumonia due to Staphylococcus aureus,Iron deficiency anemia secondary to blood loss (chronic),Pulmonary collapse,Atherosclerosis of aorta,Impacted cerumen,Personal history of tobacco use'}
