CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 76 year old female
patient, who was transferred to [**Hospital1 188**] after having undergone a cardiac catheterization at
[**Hospital6 2910**] for a planned right coronary
artery intervention.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Polymyalgia rheumatica.  Status post cerebrovascular accident
in [**2-26**].  She had an abnormal stress test which was followed
up with the aforementioned catheterization.  This revealed
two vessel coronary artery disease and she was transferred to
[**Hospital1 69**] for right coronary
artery intervention.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a former smoker.  She smoked
one pack a day for many years and quit in [**2144-2-23**].
Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Iatrogenic pneumothorax,Unspecified essential hypertension,Pure hypercholesterolemia,Polymyalgia rheumatica
Crnry athrscl natve vssl,Accidental op laceration,Atrial fibrillation,Iatrogenic pneumothorax,Hypertension NOS,Pure hypercholesterolem,Polymyalgia rheumatica
Admission Date: [**2144-7-16**]        Discharge Date: [**2144-7-25**]

Date of Birth:  [**2067-6-25**]        Sex:  F

Service:  CSU


HISTORY OF PRESENT ILLNESS:  This is a 76 year old female
patient, who was transferred to [**Hospital1 188**] after having undergone a cardiac catheterization at
[**Hospital6 2910**] for a planned right coronary
artery intervention.

PAST MEDICAL HISTORY:  Hypertension.  Hypercholesterolemia.
Polymyalgia rheumatica.  Status post cerebrovascular accident
in [**2-26**].  She had an abnormal stress test which was followed
up with the aforementioned catheterization.  This revealed
two vessel coronary artery disease and she was transferred to
[**Hospital1 69**] for right coronary
artery intervention.

MEDICATIONS:
1. Plavix 75 mg p.o. q. Day.
2. Prednisone 25 mg p.o. q. Day.
3. Hydrochlorothiazide 25 mg p.o. q. Day.
4. Norvasc 5 mg p.o. q. Day.
5. Calcium.
6. Aspirin 81 mg p.o. q. Day.
7. Potassium chloride 10 mEq p.o. q. Day.


SOCIAL HISTORY:  The patient is a former smoker.  She smoked
one pack a day for many years and quit in [**2144-2-23**].

PHYSICAL EXAMINATION:  On admission to the hospital, the
patient was alert and oriented, however, forgetful.  Lungs
were clear to auscultation.  Regular rate and rhythm cardiac
examination.  Her abdomen was soft, obese and nontender.  Her
extremities had trace edema bilaterally.

LABORATORY DATA:  Unremarkable.

HOSPITAL COURSE:  The patient was taken to the
catheterization laboratory here, for attempted angioplasty
and stent of the right coronary artery.  However, this
resulted in acute occlusion of the stent, necessitating
emergency coronary artery bypass graft.  The patient was
taken to the operating room on [**2144-7-16**], where she
underwent an emergent coronary artery bypass graft times two
with a left internal mammary artery to the left anterior
descending, saphenous vein graft to the distal right coronary
artery.  Postoperatively, she was on Dobutamine, Propofol and
insulin drips and was transported from the operating room to
the cardiac surgical recovery unit in good condition.  The
patient went with an intra-aortic balloon pump, which was
placed in the cardiac catheterization laboratory.

Initially, in the first 24 hours, the patient had some
problems with hypoxia and restlessness and she was maintained
on Propofol drip until her pulmonary status stabilized.  She
remained on Dobutamine, Nitroglycerin intravenous drips, as
well as Neo-Synephrine.  She was begun with diuresis on
postoperative day number two, received a unit of packed red
blood cells and had her intra-aortic balloon pump
discontinued on postoperative day number one.  The patient,
on postoperative day number two, continued with hypoxia and
chest x-ray was obtained.  This showed a small right
pneumothorax but the patient continued to worsen from an
oxygenation standpoint throughout the course of the day.  A
repeat chest x-ray showed an increasing size of the right
pneumothorax and right chest tube was inserted at that time.
Initially, a small air leak was obtained and  a repeat chest
x-ray showed near complete resolution of the pneumothorax.

By postoperative day number three, the patient's respiratory
status had significantly improved and she was weaned from
mechanical ventilation and subsequently extubated
successfully.  She began to become hypertensive; therefore,
Lopressor was increased and she was continuing to be
diuresed.  On postoperative day number four, the patient
remained on intravenous nitroglycerin for hypertension as
well as Metoprolol, Aspirin, Plavix and Lasix.  She was awake
and alert; however, she was confused and disoriented with
periods of intermittent agitation.

On postoperative day number five, she was weaned off
vasoactive intravenous drips.  She remained hemodynamically
stable on five liter nasal cannula with an oxygen saturation
of 96 percent.  Her Captopril was increased.  Her chest x-ray
revealed no signs of pneumothorax and her chest tube was
subsequently discontinued.  On postoperative day number four,
the patient had some atrial fibrillation but this was non
sustained.  She appeared to have had it for less than an hour
and has not had subsequent dysrhythmia.
When she did have the atrial fibrillation/flutter, her
potassium was noted to be 3.0 at that time.  Since her
potassium had been repleted, she had not had further atrial
dysrhythmia.  On postoperative day number six, neurology
consultation had been obtained due to the family's request,
because of the patient's continued episodes of agitation and
disorientation.  Head CT scan was obtained.  This showed no
acute infarction.  The patient subsequently had a urinalysis
sent which was negative and she has been incontinent of urine
intermittently.

On postoperative day number seven, the patient remained
having intermittent bouts of agitation, mostly overnight and
was treated with low dose Haldol.  She was hemodynamically
stable and beginning to progress from an ambulation
standpoint, although she was only able to walk a short
distance in her room with assistance.  On postoperative day
number eight, [**7-24**], the patient remained stable from a
hemodynamic standpoint and felt that she would be best served
by being discharged from the hospital to progress with
physical therapy at a rehabilitation facility.

LABORATORY DATA:  Most recent laboratory values are from
today, [**7-24**], which include a white blood cell count of
13,900 which is down from the previously recorded 15.8.  Her
hematocrit is 31.5.  Platelet count is 224,000.  Sodium of
136; potassium of 3.2; chloride 102; C02 23; BUN 15;
creatinine 0.8; glucose 137.  The patient also has a recent
Clostridium difficile which was sent due to some diarrhea and
this was negative.

Most recent chest x-rays from today, [**7-24**], shows no
evidence of pneumothorax and left lower lobe collapse with a
small left pleural effusion.

PHYSICAL EXAMINATION:  Temperature is 99.3; pulse 92 and
normal sinus rhythm; blood pressure 157/70; respiratory rate
24.  Oxygen saturation on room air is 94 to 96 percent.  The
patient has been incontinent of urine and her input and
output have not been clearly recorded as a result of this.
Her weight today is 86.3 kg, which is below her preoperative
weight of 89 kg.  The patient also, as previously stated, had
a urinalysis on [**7-23**], which was negative.  Neurologically,
the patient is awake and responsive; however, disoriented to
time and place, reorients easily.  Pulmonary examination:
She has few scattered, upper airway rhonchi; otherwise, her
lungs are clear to auscultation.  Coronary examination is
regular rate and rhythm.  Abdomen is obese, soft, nontender.
Extremities have 1 plus edema bilaterally.  Her sternal and
leg incisions are healing well with a few areas of ecchymosis
throughout.  She has no erythema or drainage from any of her
incisions.  She does, however, have what looks to be a yeast
rash in her groin area, for which she was started on Nystatin
powder today.

DISCHARGE MEDICATIONS:
1. Lasix 20 mg p.o. twice a day.  This should be re-evaluated
   in about five to seven days, to assess for continued need
   for diuresis after that point.
2. Aspirin 325 mg p.o. q. Day.
3. Tylenol 650 mg p.o. q. Four hours prn for pain.
4. Plavix 75 mg p.o. q. Day for three months or until
   discontinued by her cardiologist, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 2912**].
5. Captopril 25 mg p.o. three times a day.
6. Prednisone 20 mg p.o. q. Day.  This should also be re-
   evaluated by the patient's primary endocrinologist.  She
   is on the Prednisone for polymyalgia rheumatica and, upon
   discharge from rehabilitation, she should follow-up with
   her endocrinologist at that time.  His name is Dr. [**Last Name (STitle) 55838**].
7. Lopressor 75 mg p.o. twice a day.
8. Potassium chloride 40 mEq. p.o. twice a day.
9. Miconazole powder to perineal area three times a day prn.
10.      Protonix 40 mg p.o. q. Day.


DISCHARGE DIAGNOSES:  Coronary artery disease.

Status post coronary artery bypass graft.

Hypertension.

Hypercholesterolemia.

Polymyalgia rheumatica.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**]

Dictated By:[**Last Name (NamePattern1) 5664**]
MEDQUIST36
D:  [**2144-7-24**] 16:35:58
T:  [**2144-7-24**] 17:36:45
Job#:  [**Job Number 55839**]
{'Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Iatrogenic pneumothorax,Unspecified essential hypertension,Pure hypercholesterolemia,Polymyalgia rheumatica'}


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 76 year old female
patient, who was transferred to [**Hospital1 188**] after having undergone a cardiac catheterization at
[**Hospital6 2910**] for a planned right coronary
artery intervention.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Polymyalgia rheumatica.  Status post cerebrovascular accident
in [**2-26**].  She had an abnormal stress test which was followed
up with the aforementioned catheterization.  This revealed
two vessel coronary artery disease and she was transferred to
[**Hospital1 69**] for right coronary
artery intervention.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a former smoker.  She smoked
one pack a day for many years and quit in [**2144-2-23**]. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Atrial fibrillation,Iatrogenic pneumothorax,Unspecified essential hypertension,Pure hypercholesterolemia,Polymyalgia rheumatica'}
