CHIEF COMPLAINT: Left elbow pain.

PRESENT ILLNESS: This is a 72-year-old male with
a long history of coronary artery disease (status post
coronary artery bypass graft in [**2138**], multiple
catheterizations and interventions), hypertension,
hyperlipidemia, past tobacco history, family history of
coronary artery disease, who reports a long history of angina
manifested as left elbow pain.  However, prior to this week,
angina occurred twice a week on average with episodes lasting
only a few minutes reaching about [**2-11**] in intensity.  Then,
two days prior to this admission the patient began noticing
increasing elbow pain that waxed and waned over the next few
days but never completely subsided.  The pain was limited to
the left elbow, reached as high as [**4-13**] to [**5-14**], and was not
accompanied by shortness of breath, chest pain, palpitations,
nausea, vomiting or diaphoresis.  He took sublingual
nitroglycerin without relief, only later realizing that his
nitroglycerin had long ago expired.  When pain persisted, he
presented to the doctor today and was subsequently referred
to the emergency department.

MEDICAL HISTORY: 1.  Coronary artery disease; status post 4-vessel coronary
artery bypass graft in [**2148**] (saphenous vein graft to D1, left
anterior descending artery, first obtuse marginal, posterior
descending artery); status post percutaneous transluminal
coronary angioplasty in [**2152-4-3**] after an acute myocardial
infarction with stenting of the saphenous vein graft to the
first obtuse marginal (95% occlusion); [**2152-11-3**]
catheterization with 40% lesion in the saphenous vein graft
to the right coronary artery and a 90% lesion in the
saphenous vein graft to first obtuse marginal which was
stented times two;  [**2154-11-4**] catheterization and
percutaneous transluminal coronary angioplasty with stenting
of saphenous vein graft to right coronary artery;  [**2155-11-4**] catheterization with percutaneous transluminal coronary
angioplasty and stenting of the left circumflex.
 2.  Hypertension.
 3.  Hyperlipidemia.
 4.  Abdominal aortic aneurysm (4 cm in diameter; has been
stable; followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]).
 5.  Prostate cancer.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
2.  Isordil 20 mg p.o. t.i.d.
3.  Norvasc 10 mg p.o. q.d.
4.  Lopressor 100 mg p.o. b.i.d.
5.  Accupril 40 mg p.o. q.d.
6.  Cardura 4 mg p.o. b.i.d.
7.  Lipitor 40 mg p.o. q.d.
8.  Sublingual nitroglycerin 0.3 mg p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His sister died of heart disease at age 65.
Father died of heart disease at age 78.  Family history also
positive for diabetes.

SOCIAL HISTORY: The patient is married and lives with his
son.  The patient has lived in a nursing home since [**2156-11-3**].  He worked in a furniture warehouse.  He denies
alcohol use.  He does have greater than a 90-pack-year
smoking history, but he quit in [**2138**].
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Accidental puncture or laceration during a procedure, not elsewhere classified,Conjunctivitis, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Aortocoronary bypass status
Subendo infarct, initial,Crn ath atlg vn bps grft,Accidental op laceration,Conjunctivitis NOS,Hypertension NOS,Pure hypercholesterolem,Aortocoronary bypass
Admission Date:  [**2158-3-1**]     Discharge Date:  [**2158-3-7**]

Date of Birth:   [**2082-10-9**]     Sex:  M

Service:  C-MED

CHIEF COMPLAINT:  Left elbow pain.

HISTORY OF PRESENT ILLNESS:  This is a 72-year-old male with
a long history of coronary artery disease (status post
coronary artery bypass graft in [**2138**], multiple
catheterizations and interventions), hypertension,
hyperlipidemia, past tobacco history, family history of
coronary artery disease, who reports a long history of angina
manifested as left elbow pain.  However, prior to this week,
angina occurred twice a week on average with episodes lasting
only a few minutes reaching about [**2-11**] in intensity.  Then,
two days prior to this admission the patient began noticing
increasing elbow pain that waxed and waned over the next few
days but never completely subsided.  The pain was limited to
the left elbow, reached as high as [**4-13**] to [**5-14**], and was not
accompanied by shortness of breath, chest pain, palpitations,
nausea, vomiting or diaphoresis.  He took sublingual
nitroglycerin without relief, only later realizing that his
nitroglycerin had long ago expired.  When pain persisted, he
presented to the doctor today and was subsequently referred
to the emergency department.

PAST MEDICAL HISTORY:
 1.  Coronary artery disease; status post 4-vessel coronary
artery bypass graft in [**2148**] (saphenous vein graft to D1, left
anterior descending artery, first obtuse marginal, posterior
descending artery); status post percutaneous transluminal
coronary angioplasty in [**2152-4-3**] after an acute myocardial
infarction with stenting of the saphenous vein graft to the
first obtuse marginal (95% occlusion); [**2152-11-3**]
catheterization with 40% lesion in the saphenous vein graft
to the right coronary artery and a 90% lesion in the
saphenous vein graft to first obtuse marginal which was
stented times two;  [**2154-11-4**] catheterization and
percutaneous transluminal coronary angioplasty with stenting
of saphenous vein graft to right coronary artery;  [**2155-11-4**] catheterization with percutaneous transluminal coronary
angioplasty and stenting of the left circumflex.
 2.  Hypertension.
 3.  Hyperlipidemia.
 4.  Abdominal aortic aneurysm (4 cm in diameter; has been
stable; followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]).
 5.  Prostate cancer.

 6.  Renal cell carcinoma, status post nephrectomy in [**2156-2-2**]
 7.  Chronic renal insufficiency.
 8.  Colitis.
 9.  Degenerative joint disease, especially of the right hip
and lower spine.
10.  Bilateral inguinal hernia repair.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Aspirin 325 mg p.o. q.d.
2.  Isordil 20 mg p.o. t.i.d.
3.  Norvasc 10 mg p.o. q.d.
4.  Lopressor 100 mg p.o. b.i.d.
5.  Accupril 40 mg p.o. q.d.
6.  Cardura 4 mg p.o. b.i.d.
7.  Lipitor 40 mg p.o. q.d.
8.  Sublingual nitroglycerin 0.3 mg p.r.n.

SOCIAL HISTORY:  The patient is married and lives with his
son.  The patient has lived in a nursing home since [**2156-11-3**].  He worked in a furniture warehouse.  He denies
alcohol use.  He does have greater than a 90-pack-year
smoking history, but he quit in [**2138**].

FAMILY HISTORY:  His sister died of heart disease at age 65.
Father died of heart disease at age 78.  Family history also
positive for diabetes.

PHYSICAL EXAMINATION:  Heart rate 92, blood pressure 136/80,
97% oxygen saturation nasal cannula.  In general, the patient
was pleasant, comfortable, in no apparent distress.  HEENT
revealed arcus senilis bilaterally anicteric.  Pupils were
equal, round and reactive to light.  Extraocular movements
were intact.  Moist mucous membranes.  No oral lesions.  Neck
was supple.  No lymphadenopathy.  No bruits.  No jugular
venous distention.  Lungs were clear to auscultation
bilaterally.  Heart had a regular rate and rhythm, normal S1
and S2.  No murmurs, rubs or gallops.  Abdomen had positive
bowel sounds, soft, obese, nontender.  Extremities with 1+
bilateral lower extremity pretibial edema, 2+ posterior
tibialis pulses bilaterally, 1+ dorsalis pedis pulses
bilaterally, 2+ femoral pulses bilaterally.  No bruits.
Rectal was OB negative per emergency department.

LABORATORY:  CBC with a white blood cell count of 6,
hematocrit 40.2, platelets 190.  Chem-7 revealed sodium
of 140, potassium 4.8, chloride 105, bicarbonate 23, BUN 27,
creatinine 1.7, glucose 95.  Coagulations revealed an
INR of 1, PTT 26.1.  Creatine kinase 125, MB 10, MB index 8,
troponin 2.5.  Peak creatine kinase 209.  Peak MB 26 with an
MB index of 12.  Troponin I of 12.4.

Electrocardiogram revealed normal sinus rhythm at 92 beats
per minute, right bundle-branch block, borderline
first-degree AV block, axis 93 degrees, 1-mm ST elevations in
V4 through V6 (new compared with electrocardiogram from
[**2156-6-24**]).

[**2158-3-2**], catheterization revealed a right-dominant
system and 3-vessel disease.  Left main was normal.  Left
anterior descending artery totally occluded proximally.
Right coronary artery totally occluded proximally.  Left
circumflex proximal 60% stenosis.  Regarding the patient's
grafts:  Saphenous vein graft to left anterior descending
artery with no stenosis, saphenous vein graft to posterior
descending artery with 90% proximal, 50% in-stent stenosis,
saphenous vein graft to left circumflex was patent with
native obtuse marginal with 80% lesion.

Ventriculography revealed an ejection fraction of 52%.

The patient underwent successful percutaneous transluminal
coronary angioplasty of saphenous vein graft to posterior
descending artery with direct stenting of the proximal
lesion.  In addition, percutaneous transluminal coronary
angioplasty was done on the in-stent restenosis of the
saphenous vein graft to posterior descending artery with less
than 20% residual stenosis and TIMI-III flow.

Chest x-ray showed no evidence of cardiopulmonary process.

[**3-3**] ultrasound on right groin revealed a 2-cm to 2.5-cm
round pseudoaneurysm at the common femoral artery.  A repeat
ultrasound on [**2158-3-6**], with Duplex color Doppler
revealed no evidence of pseudoaneurysm, hematoma, or AV
fistula.

Echocardiogram revealed left atrial moderate dilatation,
interatrial septum (consistent with right atrial pressure),
mild left ventricular hypertrophy, ejection fraction of
question 35%, hypokinetic anterolateral wall and akinetic
inferoposterior wall with mild 1 to 2+ mitral regurgitation.

HOSPITAL COURSE:  This is a 75-year-old male with a history
of hypertension, hyperlipidemia, coronary artery disease,
status post coronary artery bypass graft and multiple
interventions, and smoking who presented with five hours of
resting angina partially relieved by nitroglycerin.
Electrocardiogram with ST elevations in V4 through V6 and
enzymes that ruled in for an acute myocardial infarction.
The patient was admitted to Eleven Riseman and started on IV
nitroglycerin, continued on beta blocker, heparin, and
aspirin.  He was placed on Integrilin and taken to cardiac
catheterization on [**3-2**].

Catheterization revealed 3-vessel disease with totally
occluded right coronary artery and left anterior descending
artery, 90% proximal stenosis and 50% in-stent stenosis of
the saphenous vein graft to posterior descending artery
graft, native obtuse marginal 80% lesion, 60% proximal left
circumflex lesion.  His saphenous vein graft to left anterior
descending artery graft revealed no stenosis, and the
saphenous vein graft to left circumflex graft was patent.
The patient had percutaneous transluminal coronary
angioplasty and stents placed to his 90% proximal saphenous
vein graft to posterior descending artery graft leading to 0%
residual stenosis.  The patient also had percutaneous
transluminal coronary angioplasty to dilate the in-stent
stenosis of the saphenous vein graft to posterior descending
artery which lead to less than 20% residual stenosis and
TIMI-III flow.  Catheterization also revealed mild
ventricular systolic and diastolic dysfunction.

The patient's post catheterization course was complicated by
a right femoral pseudoaneurysm measuring 2 cm to 2.5 cm.
This occurred over the weekend, and the patient was scheduled
to have thrombin injection on Monday; however, a repeat
ultrasound on Monday (two days after appearance of the bruit)
revealed no evidence of pseudoaneurysm.  On the following day
the patient saw physical therapy and was discharged home.

Of note, the patient's cardiac medications were maximized
during his hospitalization.  His Lopressor originally 50 mg
b.i.d. was increased to as much as 100 mg and then gradually
decreased back down to 50 mg because of bradycardia to the
40s with sinus pauses of 2 seconds.  Because the patient was
still hypertensive with mild ventricular systolic
dysfunction, captopril was started and increased to 75 mg
p.o. t.i.d.   Further adjustments should be made as an
outpatient.

On the day of discharge, the patient complained of greenish
left eye discharge with crusting.  Eye was mildly injected.
He will be sent home with antibiotic drops to treat
conjunctivitis.

DISCHARGE DIAGNOSES:
1.  Acute myocardial infarction.
2.  3-vessel coronary artery disease.
3.  Successful percutaneous transluminal coronary angioplasty
and stent of proximal saphenous vein graft to posterior
descending artery lesion.  In addition, successful
percutaneous transluminal coronary angioplasty of in-stent
stenosis within the saphenous vein graft to posterior
descending artery.
4.  Right groin pseudoaneurysm, self resolved.

5.  Left eye conjunctivitis.
6.  Hypertension.

Rest of diagnoses as per past medical history.

MEDICATIONS ON DISCHARGE:
1.  Polytrim 1 drop three times a day times seven days to
left eye.
2.  Plavix 75 mg p.o. q.d.
3.  Aspirin 325 mg p.o. q.d.
4.  Lipitor 40 mg p.o. q.d.
5.  Captopril 75 mg p.o. t.i.d.
6.  Lopressor 50 mg p.o. b.i.d.
7.  Cardura 4 mg p.o. q.d.
8.  Sublingual nitroglycerin 0.3 mg p.r.n.

FOLLOWUP:
1.  The patient was to follow up with Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] at
[**Telephone/Fax (1) 105949**] (Cardiology) in two to four weeks.
2.  Follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) **](Vascular
Surgery); the patient was to call for followup.
3.  Follow up with Dr. [**First Name8 (NamePattern2) 46**] [**Last Name (NamePattern1) 2450**]; the patient was to call
for followup.

CONDITION AT DISCHARGE:  Stable.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 8227**]

Dictated By:[**Name8 (MD) 13956**]

MEDQUIST36

D:  [**2158-3-7**]  13:14
T:  [**2158-3-7**]  13:53
JOB#:  [**Job Number 48573**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Accidental puncture or laceration during a procedure, not elsewhere classified,Conjunctivitis, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Aortocoronary bypass status'}


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: Left elbow pain.

PRESENT ILLNESS: This is a 72-year-old male with
a long history of coronary artery disease (status post
coronary artery bypass graft in [**2138**], multiple
catheterizations and interventions), hypertension,
hyperlipidemia, past tobacco history, family history of
coronary artery disease, who reports a long history of angina
manifested as left elbow pain.  However, prior to this week,
angina occurred twice a week on average with episodes lasting
only a few minutes reaching about [**2-11**] in intensity.  Then,
two days prior to this admission the patient began noticing
increasing elbow pain that waxed and waned over the next few
days but never completely subsided.  The pain was limited to
the left elbow, reached as high as [**4-13**] to [**5-14**], and was not
accompanied by shortness of breath, chest pain, palpitations,
nausea, vomiting or diaphoresis.  He took sublingual
nitroglycerin without relief, only later realizing that his
nitroglycerin had long ago expired.  When pain persisted, he
presented to the doctor today and was subsequently referred
to the emergency department.

MEDICAL HISTORY: 1.  Coronary artery disease; status post 4-vessel coronary
artery bypass graft in [**2148**] (saphenous vein graft to D1, left
anterior descending artery, first obtuse marginal, posterior
descending artery); status post percutaneous transluminal
coronary angioplasty in [**2152-4-3**] after an acute myocardial
infarction with stenting of the saphenous vein graft to the
first obtuse marginal (95% occlusion); [**2152-11-3**]
catheterization with 40% lesion in the saphenous vein graft
to the right coronary artery and a 90% lesion in the
saphenous vein graft to first obtuse marginal which was
stented times two;  [**2154-11-4**] catheterization and
percutaneous transluminal coronary angioplasty with stenting
of saphenous vein graft to right coronary artery;  [**2155-11-4**] catheterization with percutaneous transluminal coronary
angioplasty and stenting of the left circumflex.
 2.  Hypertension.
 3.  Hyperlipidemia.
 4.  Abdominal aortic aneurysm (4 cm in diameter; has been
stable; followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]).
 5.  Prostate cancer.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
2.  Isordil 20 mg p.o. t.i.d.
3.  Norvasc 10 mg p.o. q.d.
4.  Lopressor 100 mg p.o. b.i.d.
5.  Accupril 40 mg p.o. q.d.
6.  Cardura 4 mg p.o. b.i.d.
7.  Lipitor 40 mg p.o. q.d.
8.  Sublingual nitroglycerin 0.3 mg p.r.n.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His sister died of heart disease at age 65.
Father died of heart disease at age 78.  Family history also
positive for diabetes.

SOCIAL HISTORY: The patient is married and lives with his
son.  The patient has lived in a nursing home since [**2156-11-3**].  He worked in a furniture warehouse.  He denies
alcohol use.  He does have greater than a 90-pack-year
smoking history, but he quit in [**2138**]. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of autologous vein bypass graft,Accidental puncture or laceration during a procedure, not elsewhere classified,Conjunctivitis, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Aortocoronary bypass status'}
