CHIEF COMPLAINT: 

PRESENT ILLNESS: This 68 year-old male with a
past medical history of GERD and osteoarthritis who presents
with approximately eight weeks of intermittent exertional
chest pain.   He had a total of approximately six episodes
that was always elicited by exerted and palliated by stopping
his activity.  Pain is described as being nonradiating,
substernal in nature associated with occasional shortness of
breath.  He denied any nausea, vomiting or palpitations.  He
went to his primary care physician with the above complaint
and ultimately underwent an echocardiogram that then led to
cardiac catheterization at an outside hospital.  Because of
the significant disease seen on catheterization he was
transferred to the [**Hospital1 69**] on
[**2174-12-24**]

MEDICAL HISTORY: Gastroesophageal reflux disease,
osteoarthritis and urge incontinence and benign prostatic
hypertrophy.  His total cholesterol is 200 and he has never
been treated for hypercholesterolemia.

MEDICATION ON ADMISSION: Prevacid, Naprosyn, Detrol,
aspirin.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Atrial fibrillation,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2174-12-24**]       Discharge Date:  [**2175-1-1**]

Date of Birth:   [**2107-1-2**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This 68 year-old male with a
past medical history of GERD and osteoarthritis who presents
with approximately eight weeks of intermittent exertional
chest pain.   He had a total of approximately six episodes
that was always elicited by exerted and palliated by stopping
his activity.  Pain is described as being nonradiating,
substernal in nature associated with occasional shortness of
breath.  He denied any nausea, vomiting or palpitations.  He
went to his primary care physician with the above complaint
and ultimately underwent an echocardiogram that then led to
cardiac catheterization at an outside hospital.  Because of
the significant disease seen on catheterization he was
transferred to the [**Hospital1 69**] on
[**2174-12-24**]

PAST MEDICAL HISTORY:  Gastroesophageal reflux disease,
osteoarthritis and urge incontinence and benign prostatic
hypertrophy.  His total cholesterol is 200 and he has never
been treated for hypercholesterolemia.

PAST SURGICAL HISTORY:  Arthroscopy times four of the right
knee.  He has no known drug allergies.

MEDICATIONS ON ADMISSION:  Prevacid, Naprosyn, Detrol,
aspirin.

He denied any tobacco or ethanol history.  He does have a
very strong family history for coronary artery disease.

PHYSICAL EXAMINATION:  Vital signs on examination: 98.1,
blood pressure was 134/76, heart rate was 67 in sinus, no
acute distress.  Mucous membranes were moist, trachea is
midline, no carotid bruit.  Heart was regular rate and rhythm
with normal S1 and S2, no murmur, rub or gallop.  Abdomen was
benign, positive bowel sounds auscultated.  Extremities had
no evidence of clubbing, cyanosis, edema or calf tenderness.
He had slight varicose veins on the right lower extremity,
palpable dorsalis pedis and posterior tibial pulses
bilaterally.  Neurologically he is grossly intact.

He was admitted to Dr. [**Last Name (STitle) **] for preoperative coronary
artery bypass graft.  It should be noted that the patient had
admission electrocardiogram which shows normal sinus rhythm
with nonspecific ST and T wave change.  Initially his
hematocrit was 43.  He had a BUN/creatinine of 20/1.0.
Cardiac catheterization at outside hospital showed
significant left main disease and therefore coronary artery
bypass graft was planned.

On [**2174-12-27**] the patient underwent coronary artery bypass
graft times three including a LIMA to the LAD, left saphenous
vein graft to the OM1 and a saphenous vein graft to the OM2.
The patient tolerated the procedure well and was brought to
the cardiac surgery recovery unit in stable condition.  He
was being supported with NeoSynephrine 5 mcg/kilo/minute and
also sedation at 20 mcg/kilo/minute.  He was atrial paced at
90 and had a mean arterial pressure of 80 and a right atrial
pressure of 9.  His pericardium was left open as well as
having a right radial arterial line, a Swan Ganz catheter in
the right internal jugular position as well two ventricular
and one atrial wires for external pacing, two mediastinal and
one left pleural were also placed intra-operatively.  On
postoperative day number one the patient was off his drips.
He was given perioperative Vancomycin dose as a prophylactic
measure.  He had a temperature of 100.1.  He was 80 in normal
sinus rhythm, no longer being paced.  He did have a low blood
pressure of 80/60.  His saturations were 96 on a shovel mask,
a CVP of only 2.  His hematocrit was 32 and he had a
BUN/creatinine of 18/.9.  Neurologically he was intact.  His
Lasix and Lopressor were held.  His chest tubes were removed.
Respiratory-wise he was given pulmonary toilet and his diet
was advanced to cardiac.  He was ultimately transferred to
the floor later day on postoperative day number one where he
continued to improve.  On the night of postoperative day #2,
however, he went into atrial fibrillation with rapid
ventricular response.  He was started on Lopressor and
amiodarone.  He was given two does of intravenous Lopressor
as well during the initial management.  Electrolytes were
repleted for a potassium of 3.9 and magnesium of 1.8.  After
being in atrial fibrillation for approximately ten hours he
broke into sinus rhythm and was rate controlled with beta
blockade and amiodarone.  The rest of the [**Hospital 228**] hospital
stay was unremarkable.  He remained in sinus rhythm.  He was
ambulating well with physical therapy, tolerating a full
cardiac diet.  Chest x-ray after chest tube removal just
shows bilateral plate like atelectasis with no evidence of
pneumothorax.  Cardiac silhouette was normal in size.  His
vital on discharge were noted for a temperature of 99.6,
heart rate of 77 and sinus rhythm, 119/55 blood pressure.
His saturations were 95 percent on room air.  His hematocrit
on discharge was 30 with a BUN/creatinine of 24 and .9.  His
sternum was stable with staples in place.  He had no
erythema, no exudate.  His lungs were clear with decreased
breath sounds at the bases.  His abdomen was benign.  His
lower extremities were warm and well perfused with palpable
dorsalis pedis and posterior tibial bilaterally.  The
saphenous vein graft harvest site was clean, dry and intact.
No evidence of drainage.

Patient's discharge medications are to include the following:
aspirin 325 mg p.o. q. day, Plavix 75 mg p.o. q day times
three months, amiodarone 400 mg p.o. t.i.d. times seven days
and then changed to 400 mg p.o. b.i.d. times seven days and
then finally 400 mg p.o. q day times 14 days and then stop
after one month's therapy, Percocet 325 1 to 2 tablets q 4
hours p.r.n., Colace 100 mg p.o. b.i.d. to be taken as long
as he is on Percocet, ibuprofen 600 mg p.o. t.i.d. with
meals, Detrol 2 mg p.o. b.i.d., Lipitor 10 mg p.o. q day,
Protonix 40 mg p.o. q. day.

Patient will go home with [**Hospital6 407**] services
today as well as be instructed not to undergo any heavy
lifting, nothing greater than 10 pound, no driving time 30
days.  He may shower.  Staples will be removed in the wound
care clinic in approximately seven to ten days from the time
of discharge.

Follow up instructions are to see Dr. [**Last Name (STitle) **] in four weeks,
to follow up with his primary care physician in two weeks and
he will receive [**Hospital6 407**] services for wound
care check as previously stated.

CONDITION ON DISCHARGE:  To home with Visiting Nurses
Association services.

DISCHARGE STATUS:  Stable, afebrile, in sinus rhythm, no
sternal wound drainage.

FINAL DIAGNOSIS:
Significant left main coronary artery disease, status post
coronary artery bypass graft times three.




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

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2175-1-1**]  10:31
T:  [**2175-1-1**]  10:48
JOB#:  [**Job Number 30870**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension'}


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 68 year-old male with a
past medical history of GERD and osteoarthritis who presents
with approximately eight weeks of intermittent exertional
chest pain.   He had a total of approximately six episodes
that was always elicited by exerted and palliated by stopping
his activity.  Pain is described as being nonradiating,
substernal in nature associated with occasional shortness of
breath.  He denied any nausea, vomiting or palpitations.  He
went to his primary care physician with the above complaint
and ultimately underwent an echocardiogram that then led to
cardiac catheterization at an outside hospital.  Because of
the significant disease seen on catheterization he was
transferred to the [**Hospital1 69**] on
[**2174-12-24**]

MEDICAL HISTORY: Gastroesophageal reflux disease,
osteoarthritis and urge incontinence and benign prostatic
hypertrophy.  His total cholesterol is 200 and he has never
been treated for hypercholesterolemia.

MEDICATION ON ADMISSION: Prevacid, Naprosyn, Detrol,
aspirin.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Pure hypercholesterolemia,Unspecified essential hypertension'}
