CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 80-year-old
man who was brought to an outside hospital Emergency
Department after he had an unresponsive episode of [**2-1**]
minutes in duration.  The patient remained continent of both
bladder and bowel, no chest pain, significant for shortness
of breath.  EKG showed inferior changes and evidence of old
myocardial infarction.  The patient was started on
nitroglycerin, heparin drips and transferred for cardiac
catheterization.

MEDICAL HISTORY: 1. Essential tremor.  2. Hard of
hearing.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Cardiogenic shock,Cardiac complications, not elsewhere classified,Atrial fibrillation,Aortic valve disorders,Congestive heart failure, unspecified
AMI inferopost, initial,Crnry athrscl natve vssl,Cardiogenic shock,Surg compl-heart,Atrial fibrillation,Aortic valve disorder,CHF NOS
Admission Date:  [**2151-2-12**]       Discharge Date:  [**2151-2-25**]


Service:

ADMISSION DIAGNOSIS:
Unresponsive episode.

DISCHARGE DIAGNOSES:
1. Coronary artery disease
2. Status post coronary artery bypass grafting x 4.

HISTORY OF PRESENT ILLNESS:  The patient is an 80-year-old
man who was brought to an outside hospital Emergency
Department after he had an unresponsive episode of [**2-1**]
minutes in duration.  The patient remained continent of both
bladder and bowel, no chest pain, significant for shortness
of breath.  EKG showed inferior changes and evidence of old
myocardial infarction.  The patient was started on
nitroglycerin, heparin drips and transferred for cardiac
catheterization.

PAST MEDICAL HISTORY:  1. Essential tremor.  2. Hard of
hearing.

MEDICATIONS:  1. Inderal 80 mg q.d.  2. Primidone.

PHYSICAL EXAMINATION:  The patient was an elderly man in no
acute distress.  Vital signs were stable, afebrile.  HEENT:
Atraumatic, normocephalic, extraocular movements intact,
pupils were equal, round, and reactive to light, anicteric,
throat was clear.  Neck:  Supple, midline without masses or
lymphadenopathy.  Chest:  Clear to auscultation bilaterally.
Cardiovascular:  Regular rate and rhythm without murmur, rub
or gallop.  Abdomen:  Soft, nontender, nondistended without
masses or organomegaly, obese.  Extremities:  Warm,
nontender, nonedematous x 4.  Neurologic:  Grossly intact.

LABORATORY DATA:  On admission complete blood count was
4.6/12/35/144.  Chemistries were 136/3.5/102/20/24/0.8/108.
CK was 284, CK MB 42.5, troponin 0.24.

HOSPITAL COURSE:  The patient was admitted for cardiac
catheterization, given outside hospital findings on the EKG
consistent with a cardiac event.  Cardiac catheterization
revealed an ejection fraction of 35-40%, right dominant
coronary artery system with severe left main and three-vessel
disease.  There were also findings consistent with an acute
inferolateral myocardial infarction and the patient was
placed on an intra-aortic balloon pump.  Subsequent to the
cardiac catheterization, the patient was transferred to the
coronary care unit for close monitoring.  In the coronary
care unit he was maintained on his balloon pump.
Cardiovascular surgery was consulted and it was felt that the
patient would benefit from revascularization surgery.

On [**2151-2-15**], the patient was taken to the operating room for
coronary artery bypass grafting x 4 with intra-aortic balloon
pump placed preoperatively.  The anastomoses were as follows:
Left internal mammary artery to the diagonal artery,
saphenous vein graft to the left anterior descending coronary
artery, PL and OM.  Overall the patient tolerated the
procedure well without significant complication.

Postoperatively he was taken to the CSRU for closer
monitoring.  The intra-aortic balloon pump was weaned from a
1:1 rate to a 1:2 rate.  The patient was ultimately extubated
on postoperative day number one and the intra-aortic balloon
pump was discontinued at that time as well.  The patient did
require some Neo-Synephrine blood pressure support.  On
postoperative day two in the early morning, the patient went
into atrial fibrillation with a rapid response.  He received
an amiodarone bolus intravenously followed by an amiodarone
drip as well as Lopressor intravenous.  The patient converted
back to normal sinus rhythm after approximately three hours
of rate-controlled atrial fibrillation.

The remainder of his postoperative course was largely
unremarkable.  He did have a mild episode of confusion on
postoperative day four before he was transferred out of the
unit.  This resolved quickly without any intervention.

The patient was ultimately transferred to the floor on
postoperative day four and had no significant events after
that.  He was noted to have some serosanguinous drainage
coming from his sternal wound, but this was assessed by both
the fellow and the attending physician and felt to be
relatively stable.  Dr. [**Last Name (STitle) **] also made the decision that he
would not need any further operative management.  The
remainder of his postoperative course was concerned largely
with physical therapy and diuresis.  The patient was
ambulating well although he was noted to have saturations
dropping down into the mid-80s on room air while ambulating.
Ultimately, the patient was discharged on postoperative day
10 tolerating a regular diet and with adequate pain control,
and having only minimal drainage from his sternal wound.  He
was cleared for home by physical therapy.

Physical examination on discharge, in general the patient was
in no acute distress.  Vital signs were 98.1, heart rate 77,
blood pressure 128/63, respiratory rate 18, 100% on two
liters nasal cannula.  Chest:  Fine crackles at the bases.
There was some minimal serosanguinous drainage coming from
his sternal wound, although his sternum was stable.
Cardiovascular:  Regular rate and rhythm without murmurs,
gallops, or rubs.  The patient does have [**12-31**]+ edema improved
slightly over his floor stay.  Neurologic:  Grossly intact.

Laboratory studies on discharge were hematocrit 32.4,
chemistries 138/4.5/103/25/25/1.1/113.  Magnesium 2.5.

DISCHARGE CONDITION:  Stable.

DISPOSITION:  To home with services.

DIET:  Cardiac.

DISCHARGE MEDICATIONS:
1. Aspirin 325 mg q.d.
2. Amiodarone 400 mg q.d.
3. Lasix 40 mg b.i.d. x 7 days.
4. Potassium chloride 20 mEq b.i.d. x 7 days.
5. Lopressor 12.5 mg b.i.d.
6. Clindamycin 300 mg q.i.d. x 7 days.
7. Percocet 5/325, 1-2 tablets p.o. q. 4 hours p.r.n.
8. Colace 100 mg b.i.d.
9. Primidone 50 mg b.i.d.

DISCHARGE INSTRUCTIONS:
1. The patient is to continue incentive spirometry,
ambulation and physical therapy at home.
2. He is to have VNA for cardiopulmonary checks as well as
dry sterile dressing to the sternum b.i.d.  Frequency may
decrease to q.d. if drainage decreases appropriately.
3. The patient should follow up with cardiology in [**12-31**] weeks'
time and address the need for continuing diuresis as well as
adjustment of cardiac medications at that time.
4. The patient should follow up with Dr. [**Last Name (STitle) **] in four
weeks' time.





                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 5745**]
MEDQUIST36

D:  [**2151-2-25**]  13:17
T:  [**2151-2-25**]  13:31
JOB#:  [**Job Number 45811**]
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Cardiogenic shock,Cardiac complications, not elsewhere classified,Atrial fibrillation,Aortic valve disorders,Congestive heart failure, unspecified'}


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 80-year-old
man who was brought to an outside hospital Emergency
Department after he had an unresponsive episode of [**2-1**]
minutes in duration.  The patient remained continent of both
bladder and bowel, no chest pain, significant for shortness
of breath.  EKG showed inferior changes and evidence of old
myocardial infarction.  The patient was started on
nitroglycerin, heparin drips and transferred for cardiac
catheterization.

MEDICAL HISTORY: 1. Essential tremor.  2. Hard of
hearing.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of inferoposterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Cardiogenic shock,Cardiac complications, not elsewhere classified,Atrial fibrillation,Aortic valve disorders,Congestive heart failure, unspecified'}
