CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 71 year old
gentleman with a history of stable mild exertional angina
since the early [**2116**].  He has been medically managed through
the years and has been tolerating management well.  He
describes his symptoms as mild pressure across the chest
which resolved with rest.  He walks approximately four miles
each day as well.

MEDICAL HISTORY: 1.  Coronary artery disease times 30 years.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Noninsulin dependent diabetes mellitus.
5.  Moderate chronic obstructive pulmonary disease.
6.  Status post repair of triple aneurysm in [**2148-5-10**].
7.  Status post suprapubic prostatectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His family history is unremarkable except
for a small history of cerebrovascular accidents.

SOCIAL HISTORY: He currently lives at home with his wife.
[**Name (NI) **] had admitted to smoking heavily with a 90 pack year
smoking history, but quit 14 years prior.  He rarely drinks
any alcohol.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Emphysema (subcutaneous) (surgical) resulting from procedure,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Chr airway obstruct NEC,Atrial fibrillation,Pure hypercholesterolem,Hypertension NOS,Emphysema rsult frm proc,Abn react-anastom/graft
Admission Date:  [**2150-10-8**]       Discharge Date:  [**2150-10-25**]

Date of Birth:   [**2079-4-9**]       Sex:  M

Service:  CARDTHOR S

DIAGNOSIS:  Coronary artery disease for coronary artery
bypass graft.

HISTORY OF PRESENT ILLNESS:   Mr. [**Known lastname **] is a 71 year old
gentleman with a history of stable mild exertional angina
since the early [**2116**].  He has been medically managed through
the years and has been tolerating management well.  He
describes his symptoms as mild pressure across the chest
which resolved with rest.  He walks approximately four miles
each day as well.

On [**2150-8-26**], he had a stress test and developed
angina after four minutes, showing [**Street Address(2) 31707**]
depressions in leads V4 through V6.  Follow-up imaging
revealed a mild to moderate sized reversible anteroseptal and
antero-apical defect.  His ejection fraction was noted to be
48% at the time.

Subsequently he underwent cardiac catheterization at the [**Hospital1 1444**] on [**2150-10-6**], which
revealed left ventricular ejection fraction of 55% with a
mitral regurgitation.  He was also shown to have 80% stenosis
of the proximal right coronary artery, 100% stenosis of the
distal right coronary artery, 50% stenosis of the left main
artery, 100% stenosis of the mid left anterior descending,
80% stenosis of the proximal circumflex.

He was admitted on the same day for a coronary artery bypass
graft.

PAST MEDICAL HISTORY:
1.  Coronary artery disease times 30 years.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Noninsulin dependent diabetes mellitus.
5.  Moderate chronic obstructive pulmonary disease.
6.  Status post repair of triple aneurysm in [**2148-5-10**].
7.  Status post suprapubic prostatectomy.

MEDICATIONS:
1.  Aspirin 325 mg p.o. q. day.
2.  Diltiazem 180 mg p.o. q. day.
3.  Lipitor 10 mg p.o. q. h.s.
4.  Glucotrol XL 2.5 mg p.o. q. day.
5.  Lisinopril 5 mg p.o. q. day.

ALLERGIES:   No known drug allergies.

FAMILY HISTORY:   His family history is unremarkable except
for a small history of cerebrovascular accidents.

SOCIAL HISTORY:   He currently lives at home with his wife.
[**Name (NI) **] had admitted to smoking heavily with a 90 pack year
smoking history, but quit 14 years prior.  He rarely drinks
any alcohol.

PHYSICAL EXAMINATION:   On physical examination when he was
admitted, he was afebrile with stable vital signs.  He had
full extraocular movements and his pupils were equal and
reactive and he had no palpable cervical nodes.  His neck was
supple with no lymphadenopathy.  His carotids were two plus
bilaterally with no bruits.  His lungs were clear to
auscultation.  He had an irregular pulse and normal heart
sounds with no murmurs.  His abdominal examination was
benign.  His abdomen was nontender to palpation with normal
bowel sounds and no palpable masses.  He had good peripheral
pulses with warm extremities.  He had no peripheral edema.

HOSPITAL COURSE:   He was admitted to the hospital on [**2150-10-6**], for a coronary artery bypass graft.  On [**2150-10-8**], he was taken to the Operating Room for a coronary
artery bypass graft times four.  He had his left internal
mammary artery grafted to the left anterior descending;
saphenous vein graft to the diagonal and obtuse marginal, and
the saphenous vein graft to the patent ductus arteriosus.  He
was placed under general anesthesia and intubated for the
procedure.  He tolerated the procedure well and recovered
without complications.

Postoperatively he did well.  He remained neurologically
intact and his Neo-Synephrine was weaned.  On postoperative
day four, he experienced an episode of atrial fibrillation.
He was started on an amiodarone drip after a bolus and then
converted to 400 mg p.o. twice a day.  He converted back to
sinus rhythm.

He experienced some agitation while in the Intensive Care
Unit and became suddenly confused and belligerent.  He became
paranoid and refused certain treatments.  Psychiatry was
called for consultation and the diagnosis of postoperative
delirium was made.  He was started on Haldol 2 mg p.o. three
times a day p.r.n. and he continued to improve.

On postoperative day six, he was started on Lopressor 25 mg
p.o. twice a day.

On postoperative day seven, he was noted to have some
subcutaneous emphysema and air leak in the mediastinal tube
was noted.  The right chest tube was removed on postoperative
day eight but he persisted in having an air leak.
Ultimately, he had three chest tubes placed, one mediastinal
and two additional chest tubes.  He continued to have an air
leak.

Cardiology was consulted for his postoperative paroxysmal
atrial fibrillation in which he developed significant pauses
while on metoprolol, amiodarone and Haldol.  They felt that
his intrinsic sinus node function was okay.  They suggested
resuming his metoprolol 25 mg p.o. twice a day, holding the
amiodarone, and then anti-coagulating him if atrial
fibrillation persisted.  If this was required, they would
follow-up after the chest tubes were removed for replacement.

He continued to have some episodes of supraventricular
tachycardia which the Electrophysiology fellow thought was
atrial flutter.  During one of these episodes, a 12 lead EKG
was obtained which was suggestive of atrial flutter.  The
plan from Cardiology was then to ablate him once the chest
tubes were removed.

He remained in the unit on postoperative day 15 with a
persistent leak.  Both chest tubes and his mediastinal tubes
were clamped on postoperative day 15 and then one chest tube
was removed on hospital day 15.  His air leak has gradually
been decreasing as well as the subcutaneous emphysema.

On postoperative day 16, he was transferred to the floor.  He
was doing well with stable vital signs and in sinus rhythm.
His remaining chest tube on the right was removed and his
mediastinal tube was converted to a Heimlich valve with a
Foley bag attachment.  That evening, he had a short period of
atrial fibrillation in which he spontaneously converted back
to sinus rhythm.

He has currently been more than 24 hours without an
arrhythmia.  He is stable with normal vital signs.  He has
been ambulating with assistance and tolerating his p.o.
intake well.  He has had bowel movements.  His air leak has
continuously been improving.

He is finally stable for discharge home with follow-up
Physical Therapy.  He is to follow-up with Dr. [**Last Name (STitle) 1537**] in four
weeks.  He has been told to follow-up with his primary care
physician and his Cardiologist in one to two weeks.  He has
been advised not to lift weights greater than ten pounds for
three months.  He was advised not to drive for one month or
while on pain medications.

DISCHARGE MEDICATIONS:
1.  Metoprolol 12.5 mg p.o. twice a day.
2.  Lasix 20 mg p.o. twice a day times seven days.
3.  Potassium chloride 20 mEq p.o. twice a day times seven
days.
4.  Colace 100 mg p.o. twice a day.
5.  Enteric-coated aspirin 325 mg p.o. q. day.
6.  Percocet 5/325 mg one to two tablets p.o. q. four to six
hours for pain p.r.n.
7.  Glipizide 2.5 mg, one tablet p.o. q. day.
8.  Lipitor 10 mg tablet p.o. q. day.
9.  Haldol 1 mg p.o. three times a day p.r.n.



                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 50046**]
MEDQUIST36

D:  [**2150-10-24**]  18:09
T:  [**2150-10-24**]  18:26
JOB#:  [**Job Number 50047**]


Admission Date:  [**2150-10-8**]       Discharge Date:  [**2150-10-31**]

Date of Birth:   [**2079-4-9**]       Sex:  M

Service:  CARDIOTHORACIC

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 71 year old man
who was admitted to [**Hospital1 69**] with
stable mild exertional angina since the early [**2116**]'s.  He has
been medically managed throughout the years and has sone
well.  His symptoms include mild pressure across the chest
wall which resolves with rest.  He walks 4 miles every
morning.  He has had an exercise tolerance test done on
[**8-26**] and developed angina after 4 minutes with [**Street Address(2) 11741**] depressions in V4 through 6.  Imaging revealed a moderate
sized reversible distal anteroseptal and anteroapical defect,
his ejection fraction was estimated at 48%.  Following the
positive exercise tolerance he underwent cardiac
catheterization on [**10-6**] which revealed an ejection
fraction of 55%, mild mitral regurgitation, the left main was
50% stenosis, left anterior descending with 100% mid stenosis
and left circumflex with an 80% mid stenosis right coronary
artery with potential slit like lesion in the right coronary
artery supplied with collaterals from the left anterior
descending.  Following cardiac catheterization CT Surgery was
consulted and the patient was scheduled for coronary artery
bypass grafting.

PAST MEDICAL HISTORY:  Significant for coronary artery
disease times 30 years, hypertension, hypercholesterolemia,
noninsulin dependent diabetes mellitus, chronic obstructive
pulmonary disease, abdominal aortic aneurysm repaired in [**2148-6-9**], suprapubic prostatectomy in [**2146-8-10**].

MEDICATIONS:  Prior to admission include aspirin 325 mg q.d.,
Diltiazem 180 mg q.d., Lipitor 10 mg q.d., Glucotrol XL 2.5
mg q.d. and Lisinopril 5 mg p.o. q.d.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  Lives with his wife at home.  Cigarettes 90
pack years, quit 14 years ago.  Alcohol use is rare.

PHYSICAL EXAMINATION:  Elderly man in no acute distress.
HEENT:  Pupils equal and reactive to light, extraocular
movements intact.  Oropharynx is benign.  Dentures upper and
lower.  Neck is supple, no adenopathy or thyromegaly,
carotids are 2+ bilaterally without bruits.  Lungs are clear
bilaterally.  Cardiovascular regular rate and rhythm, S1, S2.
Abdomen is soft, nontender without masses, positive bowel
sounds, no hepatosplenomegaly, well healed diagonal scar.
Extremities without cyanosis, clubbing or edema, 2+ pulses
throughout.  Neurological examination is nonfocal.

On [**10-9**] the patient was brought to the Operating Room
where he had coronary artery bypass grafting, please see the
OR report for full details.  In summary the patient had
coronary artery bypass graft times four to the left anterior
descending, saphenous vein graft to the diagonal and to the
OM sequentially and saphenous vein graft to the posterior
descending artery.  His bypass time was 88 minutes with a
cross clamp time of 75 minutes.  He tolerated the operation
well and was transferred to the Operating Room to the
Cardiothoracic Intensive Care Unit.  At the time of transfer
the patient had a mean arterial pressure of 80.  He had a
heart rate of 80, was A-paced.  He had Neo-Synephrine at 1
mcg/kilo/min and Propofol at 15 mcg/kilo/min.

The patient did well in the immediate postoperative period.
His anesthesia was reversed.  He was weaned from the
ventilator and successfully extubated.  The patient's blood
pressure remained labile throughout the night, he remained on
a Neo-Synephrine drip and continued to be A-paced to maintain
an adequate blood pressure.

Postoperative day 1 the patient became confused and
belligerent, at times combative.  He was seen by the
Psychiatry Service.  Also on postoperative day one the
patient developed rapid atrial fibrillation which was treated
with Amiodarone following which the patient converted to
normal sinus rhythm and over the next several days the
patient continued to have episodes of rapid atrial
fibrillation.  His Amiodarone drip was continued
intermittently, converting the patient to a normal sinus
rhythm.  Hemodynamically the patient began to require
Neo-Synephrine infusion to maintain an adequate blood
pressure during periods of atrial fibrillation and therefore
he remained in the Intensive Care Unit.  Additionally the
patient did have periods of lucidity, however, a vast
majority of the time he remained confused and at times
combative.

By postoperative day 4, the patient was able to be weaned off
his Neo-Synephrine.  He continued to have periods of atrial
fibrillation.  His Amiodarone had been converted to oral
dosages.  He did, however, remained in the Intensive Care
Unit as he continued to be confused following consultation
from Psychiatry the patient was begun on standard dose
Haldol.  Additionally, the patient continued to have a
persistent air leak from his pleural chest tube with left
sided subcutaneous emphysema.

Postoperative day 8 it was decided the patient was stable and
ready to be transferred to the floor for continuing
postoperative care and cardiac rehabilitation.  Following
transfer to the floor the patient was re-admitted to the
Intensive Care Unit because he had an episode of bradycardia
with a heart rate in the 30's.  Electrophysiology was
consulted at that time and the patient's Amiodarone was
discontinued per Electrophysiology's recommendation.  Over
the next several days the patient began to have symptoms of
tachycardia as well as bradycardia.

By postoperative day 13 the patient had gone for several days
without any bradycardiac episodes although he did have
periods of atrial fibrillation and on postoperative day 15
the patient was again transferred to the floor for continuing
postoperative care.

The patient did well over the next several days.  However on
postoperative day 17 he did have an additional episode of
bradycardia that was felt to be isolated.  Finally on
postoperative day 19 the patient had a 6 second sinus pause.
Electrophysiology Service was again consulted and the
following day the patient went to Electrophysiology studies
and ultimately A. flutter ablation, please see EP report for
full details.  Following the ablation the patient was
transferred back for continuing care.  He did well in the
immediate period following his ablation and on postoperative
day 22 it was decided the patient was stable and ready to be
discharged to home.

At time of discharge, the patient's condition is as follows;
vital signs 98.4, heart rate 60 and sinus rhythm, blood
pressure 90/49, respiratory rate 18, O2 sat 93% on room air.
Weight preoperatively 84 kg at discharge, 76 kg.  Laboratory
data:  Sodium 139, potassium 3.9, chloride 114, CO2 29, BUN
19, creatinine 0.8, glucose 81, PT 16.9, PTT 35.2, INR 1.9.

PHYSICAL EXAMINATION:  Alert and oriented times three, moves
all extremities, follows commands.  Respiratory clear to
auscultation bilaterally.  Cardiac regular rate and rhythm
S1, S2.  Sternum is stable.  Incision with Steri-Strips open
to air, clean, dry.  Abdomen soft, nontender, nondistended.
Extremities are warm and well perfused with no edema.

DISCHARGE MEDICATIONS:  Aspirin 325 mg q.d., Glipizide XL 2.5
mg q.d., Lovastatin 10 mg q.d., Metoprolol 25 mg b.i.d.,
Warfarin titrate to a goal INR of 2.0 to 2.5 last 3 doses 3
mg and 2 mg on Wednesday, Thursday and Friday.

DISCHARGE CONDITION:  Good.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease status post coronary artery
bypass grafting times four with left internal mammary artery
to the left anterior descending, saphenous vein graft to
diagonal and OM sequentially and saphenous vein graft to the
posterior descending artery.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Noninsulin dependent diabetes mellitus.
5.  Atrial fibrillation.
6.  Chronic obstructive pulmonary disease.
7.  Status post abdominal aortic aneurysm repair.
8.  Status post suprapubic prostatectomy.

The patient's condition is good.  He is to be discharged to
home with visiting nurses.  He is to have follow-up in the
wound clinic in two weeks, follow-up with his primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], in [**2-10**] weeks, follow-up with Dr. [**Last Name (STitle) 1537**]
in 4 weeks and follow-up with Dr. [**Last Name (STitle) 50048**] also in 4 weeks.
The patient is to have an INR checked on Monday, [**11-2**] with
the results to be called to Dr.[**Name (NI) 50049**] office at
[**Telephone/Fax (1) 13266**].






                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 49159**]
MEDQUIST36

D:  [**2150-10-30**]  20:03
T:  [**2150-10-30**]  22:33
JOB#:  [**Job Number 50050**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Emphysema (subcutaneous) (surgical) resulting from procedure,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Mr. [**Known lastname **] is a 71 year old
gentleman with a history of stable mild exertional angina
since the early [**2116**].  He has been medically managed through
the years and has been tolerating management well.  He
describes his symptoms as mild pressure across the chest
which resolved with rest.  He walks approximately four miles
each day as well.

MEDICAL HISTORY: 1.  Coronary artery disease times 30 years.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Noninsulin dependent diabetes mellitus.
5.  Moderate chronic obstructive pulmonary disease.
6.  Status post repair of triple aneurysm in [**2148-5-10**].
7.  Status post suprapubic prostatectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His family history is unremarkable except
for a small history of cerebrovascular accidents.

SOCIAL HISTORY: He currently lives at home with his wife.
[**Name (NI) **] had admitted to smoking heavily with a 90 pack year
smoking history, but quit 14 years prior.  He rarely drinks
any alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension,Emphysema (subcutaneous) (surgical) resulting from procedure,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
