CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms. [**Known lastname 36913**] is a 74-year-old
blind female who was transferred from [**Hospital3 1443**]
Hospital status post cardiac catheterization.  Her history
goes that she was in excellent health until one month prior
to admission, when she noted a new onset of dyspnea on
exertion accompanied by chest heaviness.  The night of
[**2156-12-1**], she experienced rest dyspnea and spent most of the
night sleeping in a chair.  She saw her primary care doctor,
who admitted her to [**Hospital3 1443**] Hospital, where she
ruled out for a myocardial infarction.  Her initial
electrocardiogram revealed a chronic left bundle branch
block.  An adenosine Thallium was done [**2156-12-3**], which
revealed an ejection fraction of 71% and an anteroapical
ischemia.  An echocardiogram and carotid ultrasound for
carotid bruits were performed prior to transfer, and were
ultimately negative for significant hemodynamic disease.  The
patient denied any history of claudication, no paroxysmal
nocturnal dyspnea, no orthopnea, no lightheadedness, no pedal
edema.  Her coronary artery disease risk factors included
hypertension, a questionable history of diabetes mellitus, no
evidence of hypercholesterolemia, has never smoked in the
past, but does have a strong positive family history for
coronary disease.

MEDICAL HISTORY: Legally blind since birth,
osteoporosis, hypertension.

MEDICATION ON ADMISSION: Aspirin 325 mg by mouth once
daily, Lopressor 25 mg by mouth twice a day, Bumex 1 mg by
mouth once daily, Colace 100 mg by mouth twice a day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives with a friend and has a seeing
eye dog.
Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Osteoporosis, unspecified
CHF NOS,Crnry athrscl natve vssl,Atrial fibrillation,Surg compl-heart,Hypertension NOS,Osteoporosis NOS
Admission Date:  [**2156-12-3**]       Discharge Date:  [**2156-12-11**]

Date of Birth:   [**2082-6-21**]       Sex:  F

Service:  CT SURGERY

HISTORY OF PRESENT ILLNESS:   Ms. [**Known lastname 36913**] is a 74-year-old
blind female who was transferred from [**Hospital3 1443**]
Hospital status post cardiac catheterization.  Her history
goes that she was in excellent health until one month prior
to admission, when she noted a new onset of dyspnea on
exertion accompanied by chest heaviness.  The night of
[**2156-12-1**], she experienced rest dyspnea and spent most of the
night sleeping in a chair.  She saw her primary care doctor,
who admitted her to [**Hospital3 1443**] Hospital, where she
ruled out for a myocardial infarction.  Her initial
electrocardiogram revealed a chronic left bundle branch
block.  An adenosine Thallium was done [**2156-12-3**], which
revealed an ejection fraction of 71% and an anteroapical
ischemia.  An echocardiogram and carotid ultrasound for
carotid bruits were performed prior to transfer, and were
ultimately negative for significant hemodynamic disease.  The
patient denied any history of claudication, no paroxysmal
nocturnal dyspnea, no orthopnea, no lightheadedness, no pedal
edema.  Her coronary artery disease risk factors included
hypertension, a questionable history of diabetes mellitus, no
evidence of hypercholesterolemia, has never smoked in the
past, but does have a strong positive family history for
coronary disease.

PAST MEDICAL HISTORY:   Legally blind since birth,
osteoporosis, hypertension.

PAST SURGICAL HISTORY:   None.

ALLERGIES:   No known drug allergies.

MEDICATIONS ON ADMISSION:   Aspirin 325 mg by mouth once
daily, Lopressor 25 mg by mouth twice a day, Bumex 1 mg by
mouth once daily, Colace 100 mg by mouth twice a day.

REVIEW OF SYSTEMS:   There is no evidence of cerebrovascular
accident, transient ischemic attack or melena.

SOCIAL HISTORY:   She lives with a friend and has a seeing
eye dog.

PHYSICAL EXAMINATION:   Height 5'2", weight 123 pounds, pulse
96 and regular, blood pressure 156/68.  The neck showed no
evidence of jugular venous distention.  Carotids were 1+.
Bilateral bruit was auscultated.  The lungs were clear.  The
heart was S1, S2, systolic murmur at the left sternal border
was present.  The abdomen was nontender, nondistended, no
hepatosplenomegaly, positive bowel sounds.  The extremities
were warm and well perfused.  She had palpable pulses from
the femoral to the dorsalis pedis and posterior tibial
bilaterally.

LABORATORY DATA:   BUN and creatinine 15 and .7, CBC not
available.  Electrocardiogram on admission shows left bundle
branch block, sinus rhythm.  Chest x-ray initially showed
ground-glass appearance.  A Pulmonary consult revealed no
evidence of pulmonary disease.  Chest x-ray changes are due
to congestive heart failure, and the patient was started on
Bumex.

ASSESSMENT:   She is a 74-year-old woman with new onset
dyspnea on exertion and a positive adenosine Thallium, and
was therefore referred for cardiac catheterization.

HOSPITAL COURSE:   On [**2156-12-3**], Ms. [**Known lastname 36913**] [**Last Name (Titles) 1834**] a
cardiac catheterization showing a 90% distal left anterior
descending lesion involving part of the left circumflex and
left main.  Additionally, there was a 50% proximal right
coronary artery occlusion and a 50% mid-right coronary artery
occlusion.  Given the severe 90% distal left main disease
involving the proximal left anterior descending and proximal
left circumflex, as well as the previously-mentioned right
coronary artery lesions, 50% proximally and mid, a coronary
artery bypass graft consult with Dr. [**Last Name (STitle) **] was acquired.

The patient was admitted to the C-Med service initially.  She
remained hemodynamically stable status post catheterization.
She was preopped on [**2156-12-5**], when Dr. [**Last Name (STitle) **] reviewed the
patient's case.  Her laboratories at that time were noted for
a CBC of 10,000 white count, 36 hematocrit, 297,000 platelet
count.  PT and PTT were 11 and 23 respectively, and INR was
1.0.  Her BUN and creatinine were 23 and .6.  Chest x-ray
done preoperatively showed no acute cardiopulmonary process.

On [**2156-12-6**], the patient went to the operating room with Dr.
[**Last Name (STitle) **], where she [**Last Name (STitle) 1834**] a coronary artery bypass graft x
4, including grafts from left internal mammary artery to the
left anterior descending, a saphenous vein graft to the
oblique marginal I, saphenous vein graft to the oblique
marginal II, and a saphenous vein graft to the right
posterior descending artery.  The patient tolerated the
procedure well, and was transferred to the Cardiac Intensive
Care Unit, where she was extubated on the night of surgery.
She was transfused one unit postoperatively.  She was stable
and on an insulin drip at this time, and Nipride was
additionally weaned due to some postoperative hypertension.

Once the patient was started on oral antihypertensives,
Lopressor, and diuresis was begun with lasix, her pressures
normalized.  The Nipride drip was quickly weaned.  Her
postoperative hematocrit was 29 on postoperative day number
one, and BUN and creatinine were 23 and .6 respectively.  She
was ultimately transported to the floor on postoperative day
number one, where she did well, remained hemodynamically
stable.

Over the ensuing 48 hours, she worked aggressively with
Physical Therapy and reached a Level III ambulation status by
postoperative day number three.  Intermittently her heart
rate would get into the 130s to 150s by monitor, however,
there was no active capture of this rhythm by
electrocardiogram, as as soon as the patient was evaluated by
house officer at the bedside, the rhythm disturbance would
seem to spontaneously disappear.  Her Lopressor was
ultimately titrated to 50 mg by mouth twice a day on
postoperative day number three, however, she did end up going
into atrial fibrillation with a rapid ventricular response.
This was diagnosed by electrocardiogram and clinically by
evaluating the telemetry strips on the Cardiac floor monitor.

The patient ultimately had to be treated with 20 mg
intravenous Lopressor given over an hour.  Since this did not
work, a Diltiazem drip was started at 10 mg/hour.  After
approximately four to six hours of Diltiazem drip, the
patient broke into sinus.  Her pressures were dropping into
the 110 to 106 range.  As a consequence of this, the
Diltiazem drip was discontinued.  Once she was in a sinus
rhythm, her pressures remained in the systolic ranges of 110
to 120.  She remained stable mentating wise.

Her discharge laboratories were noted for a hematocrit of 30,
a BUN and creatinine of 20 and .6, and a magnesium of 3 and a
calcium of 1.06, and a phosphate of 2.8.  Her weight was down
to 57.3 kg.  Otherwise she was stable.

By postoperative day number four, the patient was still
ambulating at a Level III, working with Physical Therapy, and
receiving pulmonary toilet as well.  Her temperature was
99.5.  Her heart rate was 90 and sinus rhythm.  Blood
pressure was 106 to 125 systolic over 50s diastolic.  Her
room air saturation was 94%, 18 respiratory rate and
unlabored.  The sternum was stable, with staples intact, no
evidence of drainage, no evidence of erythema.  Her wires
were present, however, they were discontinued on
postoperative day number three.  Her lungs were clear to
auscultation except for bibasilar crackles.

Ultimately her Lopressor was increased to 100 mg by mouth
twice a day.  Amiodarone was begun on postoperative day
number three.  She was encouraged to ambulate as much as
possible.  Physical Therapy consultation was obtained.  Her
electrolytes were repleted.

By postoperative day number four, the patient was afebrile,
stable, in sinus rhythm, and deemed appropriate for discharge
to home, where she lives with a friend who is a close
assistant and will be able to help her in her recovery.

CONDITION ON DISCHARGE:   To home with Visiting Nurse
assistance.

DISCHARGE STATUS:  Afebrile, normal sinus rhythm.

DISCHARGE DIAGNOSIS:
1.  Significant distal left main disease and proximal and
mid-right coronary artery lesions status post coronary artery
bypass graft x 4

DISCHARGE MEDICATIONS:   Lopressor 100 mg by mouth twice a
day, lasix 20 mg by mouth once daily for seven days, K-Dur 20
mEq by mouth once daily for seven days, aspirin 325 mg by
mouth once daily, Zantac 150 mg by mouth twice a day,
amiodarone 400 mg by mouth three times a day for one week
then 400 mg by mouth twice a day for one week, then 400 mg by
mouth once daily for 14 days and then discontinue, percocet
5/325 one to two tablets by mouth every four to six hours as
needed, Colace 100 mg by mouth twice a day.

DISCHARGE INSTRUCTIONS:   The patient is not to do any heavy
lifting greater than ten pounds for one month.  She will have
follow up in the Wound Care Clinic in one week, when she will
have her staples removed.  She is to see her primary care
provider or cardiologist in three weeks from the time of
discharge, and will follow up with Dr. [**Last Name (STitle) **] in the [**Last Name (NamePattern1) 21589**] office in approximately 30 days from the time
of discharge.




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

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

D:  [**2156-12-10**]  23:31
T:  [**2156-12-11**]  00:00
JOB#:  [**Job Number 36914**]
{'Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Osteoporosis, 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: Ms. [**Known lastname 36913**] is a 74-year-old
blind female who was transferred from [**Hospital3 1443**]
Hospital status post cardiac catheterization.  Her history
goes that she was in excellent health until one month prior
to admission, when she noted a new onset of dyspnea on
exertion accompanied by chest heaviness.  The night of
[**2156-12-1**], she experienced rest dyspnea and spent most of the
night sleeping in a chair.  She saw her primary care doctor,
who admitted her to [**Hospital3 1443**] Hospital, where she
ruled out for a myocardial infarction.  Her initial
electrocardiogram revealed a chronic left bundle branch
block.  An adenosine Thallium was done [**2156-12-3**], which
revealed an ejection fraction of 71% and an anteroapical
ischemia.  An echocardiogram and carotid ultrasound for
carotid bruits were performed prior to transfer, and were
ultimately negative for significant hemodynamic disease.  The
patient denied any history of claudication, no paroxysmal
nocturnal dyspnea, no orthopnea, no lightheadedness, no pedal
edema.  Her coronary artery disease risk factors included
hypertension, a questionable history of diabetes mellitus, no
evidence of hypercholesterolemia, has never smoked in the
past, but does have a strong positive family history for
coronary disease.

MEDICAL HISTORY: Legally blind since birth,
osteoporosis, hypertension.

MEDICATION ON ADMISSION: Aspirin 325 mg by mouth once
daily, Lopressor 25 mg by mouth twice a day, Bumex 1 mg by
mouth once daily, Colace 100 mg by mouth twice a day.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives with a friend and has a seeing
eye dog. 

### Response:
{'Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Cardiac complications, not elsewhere classified,Unspecified essential hypertension,Osteoporosis, unspecified'}
