CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an
81-year-old female with a history of coronary artery disease,
status post angioplasty about three years prior and prior to
that around ten years prior.  The patient had cardiac
catheterization two weeks prior to admission as part of a
workup preop for leg surgery.  Catheterization showed
significant disease.  The patient was scheduled for CABG,
plus/minus MVR.

MEDICAL HISTORY: 1.  Peripheral vascular disease.
2.  CAD.
3.  Hypertension.
4.  Hypothyroidism.
5.  Gout.
6.  MR.
7.  Hemorrhoids.

MEDICATION ON ADMISSION: 1.  Prednisone 40.
2.  Neurontin 300 h.s.
3.  Levothroid 0.1.
4.  Imdur 120.
5.  Protonix 40.
6.  Atenolol 50.
7.  Aspirin.
8.  Iron sulfate.
9.  Albuterol.
10. Lipitor.
11. Remeron 30 h.s.
12. Bumex 2.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking.  No alcohol.
Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Intermediate coronary syndrome,Other postoperative infection,Cellulitis and abscess of leg, except foot,Atrial fibrillation,Other chronic pulmonary heart diseases,Gout, unspecified,Unspecified acquired hypothyroidism
Crnry athrscl natve vssl,Mitral valve disorder,Intermed coronary synd,Other postop infection,Cellulitis of leg,Atrial fibrillation,Chr pulmon heart dis NEC,Gout NOS,Hypothyroidism NOS
Admission Date:  [**2190-3-9**]       Discharge Date:  [**2190-3-26**]


Service:  CARDIOTHORACIC SURGERY

HISTORY OF THE PRESENT ILLNESS:  The patient is an
81-year-old female with a history of coronary artery disease,
status post angioplasty about three years prior and prior to
that around ten years prior.  The patient had cardiac
catheterization two weeks prior to admission as part of a
workup preop for leg surgery.  Catheterization showed
significant disease.  The patient was scheduled for CABG,
plus/minus MVR.

The patient started having an episode of substernal chest
pain one week prior to admission, nonradiationg pressure,
happening at rest, resolving within minutes.  The patient's
daughter called the PCP who recommended going to the
Emergency Department at the [**Hospital6 27369**].  The
patient's symptoms were improved with sublingual
nitroglycerin.

The patient had issues controlling blood pressure and was
placed on Atenolol, Imdur, and nitroglycerin drip.  The
patient was transferred to [**Hospital1 18**] for further management.
Cardiac catheterization in [**2190-1-30**] showed the RCA
with 80% proximal and distal, 50% mid, left main 60%, LAD and
LCA commendable and noted severe pulmonary hypertension.  An
echocardiogram showed LV of 75%, noted LVH, mild MR,
pulmonary hypertension.  Stress nuclear test showed small
apical reversible defect.

PAST MEDICAL HISTORY:
1.  Peripheral vascular disease.
2.  CAD.
3.  Hypertension.
4.  Hypothyroidism.
5.  Gout.
6.  MR.
7.  Hemorrhoids.

PAST SURGICAL HISTORY:
1.  Carotid endarterectomy.
2.  Status post angioplasty.
3.  Left knee surgery.
4.  Right RCR.

MEDICATIONS ON ADMISSION:
1.  Prednisone 40.
2.  Neurontin 300 h.s.
3.  Levothroid 0.1.
4.  Imdur 120.
5.  Protonix 40.
6.  Atenolol 50.
7.  Aspirin.
8.  Iron sulfate.
9.  Albuterol.
10. Lipitor.
11. Remeron 30 h.s.
12. Bumex 2.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  No smoking.  No alcohol.

LABORATORY DATA/STUDIES:  Outside hospital chest x-ray showed
cardiomegaly, no infiltrate, no effusion.

EKG showed normal sinus rhythm, right bundle branch block.

CT of the chest showed left upper lobe scarring, borderline
cardiomegaly, hiatal hernia, nonobstructing right upper pole
calculus, and atrophic left kidney.

White count 10.3, hematocrit 33.5.  INR 0.9, potassium 5.3,
BUN 50, creatinine 1.4, glucose 122.  CKs times three were 6,
15, and 9.  Troponin times three were 0.07, 0.05, and 0.05.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  The patient
was afebrile.  The vital signs were stable.  Heart:  Regular
rate and rhythm.  Lungs:  Clear to auscultation bilaterally.

HOSPITAL COURSE:  The patient underwent CABG times one, LIMA
to the LAD, without complications.  The patient had the
hospital course complicated by right lower extremity incision
cellulitis, treated with appropriate antibiotics, improving
throughout the stay.

The patient also has atrial fibrillation and appropriately
Coumadinized with 2 mg of Coumadin with INR of 2.6.  The
patient is to have Coumadin held on [**2190-3-26**] and PT/INR
checked on [**2190-3-27**] to readjust Coumadin dosing for a
goal of 1.8 to 2.5.

The patient was felt to be ready for discharge to a
rehabilitation facility per Physical Therapy assessment.  She
was tolerating a regular diet and had good oral pain control.
The patient was scheduled to follow-up with Dr. [**Last Name (STitle) **] in four
weeks and her primary care doctor in one to two weeks and her
cardiologist in two to three weeks.

DISCHARGE MEDICATIONS:
1.  Lasix 20 b.i.d. times seven days.
2.  .................... 200 mg times five days.
3.  Lopressor 50 b.i.d.
4.  Ranitidine 2 mg q.d.
5.  Ciprofloxacin 500 mg q.d. times 11 days.
6.  Vancomycin 1 gram q.d. times six days.
7.  Levothyroxine 100 micrograms q.d.
8.  Atorvostatin 10 mg q.d.
9.  Amiodarone 400 mg q.d. times one month.
10. Norvasc 10 mg q.d.
11. Albuterol inhaler one to two puffs p.r.n.
12. Lansoprazole 30 mg q.d.
13. Plavix 75 mg q.d.
14. Imdur 30 mg q.d.
15. Percocet one to two tablets q. four to six hours p.r.n.
16. Tylenol 650 mg q. four hours p.r.n.
17. Aspirin 325 mg q.d.
18. Colace 100 mg p.o. b.i.d.
19. Milk of magnesia 30 ml q.h.s. p.r.n.
20. Miconazole powder 2% topical applied t.i.d.
21. Chlorhexidine gluconate 15 milliliters p.o. t.i.d.
22. Clotrimazole one troche q.d.
23. Nystatin swish and swallow 5 ml q.i.d.

The patient is to have a blood test with PT/INR on [**2190-3-27**]
to adjust Coumadin dosing to a goal INR of 1.8 to 2.5.  The
patient will have Coumadin dose held on [**2190-3-26**].  The
patient is also to have electrolytes checked at
rehabilitation facility for assessment of potassium level
based on her elevated creatinine and increasing Lasix.

CONDITION AT DISCHARGE:  Good.

DISCHARGE STATUS:  To rehabilitation facility.

DISCHARGE DIAGNOSIS:
1.  Status post coronary artery bypass graft times one.
2.  Percutaneous transluminal coronary angioplasty times
three to the right coronary artery.






Dictated By:[**Name8 (MD) 5915**]
MEDQUIST36

D:  [**2190-3-26**]  03:06
T:  [**2190-3-26**]  17:18
JOB#:  [**Job Number 46084**]

cc:[**Last Name (STitle) 46085**]
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Intermediate coronary syndrome,Other postoperative infection,Cellulitis and abscess of leg, except foot,Atrial fibrillation,Other chronic pulmonary heart diseases,Gout, unspecified,Unspecified acquired hypothyroidism'}


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 an
81-year-old female with a history of coronary artery disease,
status post angioplasty about three years prior and prior to
that around ten years prior.  The patient had cardiac
catheterization two weeks prior to admission as part of a
workup preop for leg surgery.  Catheterization showed
significant disease.  The patient was scheduled for CABG,
plus/minus MVR.

MEDICAL HISTORY: 1.  Peripheral vascular disease.
2.  CAD.
3.  Hypertension.
4.  Hypothyroidism.
5.  Gout.
6.  MR.
7.  Hemorrhoids.

MEDICATION ON ADMISSION: 1.  Prednisone 40.
2.  Neurontin 300 h.s.
3.  Levothroid 0.1.
4.  Imdur 120.
5.  Protonix 40.
6.  Atenolol 50.
7.  Aspirin.
8.  Iron sulfate.
9.  Albuterol.
10. Lipitor.
11. Remeron 30 h.s.
12. Bumex 2.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking.  No alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Intermediate coronary syndrome,Other postoperative infection,Cellulitis and abscess of leg, except foot,Atrial fibrillation,Other chronic pulmonary heart diseases,Gout, unspecified,Unspecified acquired hypothyroidism'}
