CHIEF COMPLAINT: 

PRESENT ILLNESS: This 59-year-old patient was
referred by Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] for outpatient cardiac
catheterization due to ongoing angina and a positive stress
test which he had in [**2121-6-24**].  He was positive for
myocardial ischemia, and he had baseline anterior ST-T wave
changes on his electrocardiogram.  His echocardiogram on [**7-10**] showed preserved left ventricular systolic function, with
an ejection fraction of 60%, with normal right and left heart
valves.  He said he had left-sided chest pressure that comes
and goes on and off for 15 years.  It resolved spontaneously.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hypercholesterolemia (with high triglycerides).
3.  Paroxysmal atrial fibrillation.
4.  Pancreatitis in [**2119**] (with a hospital stay complicated by
delirium tremens and methicillin-resistant Staphylococcus
aureus ventilator-associated pneumonia.
5.  Polio.
6.  Gout.
7.  Ethanol abuse.
8.  Spinal stenosis.

MEDICATION ON ADMISSION: (Medications prior to
catheterization were as follows)
1.  Coumadin (varies his dosing).
2.  Toprol-XL 100 mg by mouth once per day.
3.  Digoxin 0.125 mg by mouth every day.
4.  Allopurinol 300 mg by mouth once per day.
5.  Colchicine 0.6 mg by mouth once per day.
6.  Altace 2.5 mg by mouth once per day.
7.  Tricor 160 mg by mouth once per day.
8.  GNC liver formula, dietary supplement, as well as a
pancreatic supplement (which is unlisted).

ALLERGIES: 1.  He listed an intolerance to LIPITOR.
2.  IODINE (gives him nausea and vomiting).
3.  QUESTION ATIVAN (which was given him delirium tremens
symptoms).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smoked one pack per day for five
years, but he quit 30 years ago.  He admits to three double
alcoholic drinks per day.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Other and unspecified alcohol dependence, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Impaired glucose tolerance test (oral),Unspecified essential hypertension,Pure hyperglyceridemia,Gout, unspecified
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Atrial fibrillation,Alcoh dep NEC/NOS-unspec,DMII wo cmp nt st uncntr,Impaired oral glucse tol,Hypertension NOS,Pure hyperglyceridemia,Gout NOS
Admission Date:  [**2121-10-16**]     Discharge Date:  [**2121-10-22**]

Date of Birth:   [**2064-9-16**]     Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  This 59-year-old patient was
referred by Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] for outpatient cardiac
catheterization due to ongoing angina and a positive stress
test which he had in [**2121-6-24**].  He was positive for
myocardial ischemia, and he had baseline anterior ST-T wave
changes on his electrocardiogram.  His echocardiogram on [**7-10**] showed preserved left ventricular systolic function, with
an ejection fraction of 60%, with normal right and left heart
valves.  He said he had left-sided chest pressure that comes
and goes on and off for 15 years.  It resolved spontaneously.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Hypercholesterolemia (with high triglycerides).
3.  Paroxysmal atrial fibrillation.
4.  Pancreatitis in [**2119**] (with a hospital stay complicated by
delirium tremens and methicillin-resistant Staphylococcus
aureus ventilator-associated pneumonia.
5.  Polio.
6.  Gout.
7.  Ethanol abuse.
8.  Spinal stenosis.

PAST SURGICAL HISTORY:   He had no past surgical history.

ALLERGIES:
1.  He listed an intolerance to LIPITOR.
2.  IODINE (gives him nausea and vomiting).
3.  QUESTION ATIVAN (which was given him delirium tremens
symptoms).

The patient was instructed when to stop his Coumadin and to
take premedications for his iodine allergy prior to his
cardiac catheterization which he did.  The patient's last
dose of Coumadin was on [**10-13**].

MEDICATIONS ON ADMISSION:  (Medications prior to
catheterization were as follows)
1.  Coumadin (varies his dosing).
2.  Toprol-XL 100 mg by mouth once per day.
3.  Digoxin 0.125 mg by mouth every day.
4.  Allopurinol 300 mg by mouth once per day.
5.  Colchicine 0.6 mg by mouth once per day.
6.  Altace 2.5 mg by mouth once per day.
7.  Tricor 160 mg by mouth once per day.
8.  GNC liver formula, dietary supplement, as well as a
pancreatic supplement (which is unlisted).

PERTINENT LABORATORY VALUES ON PRESENTATION:   Laboratories
from [**9-24**] were as follows; his white blood cell count
was 8.5, his hematocrit was 39.7, and his platelet count was
298,000.  Sodium was 141, potassium was 3.9, chloride was
100, bicarbonate was 26, blood urea nitrogen was 24, and his
creatinine was 0.2.  INR was 2.6.

PHYSICAL EXAMINATION ON PRESENTATION:  On examination, his
neck was supple with no jugular venous distention or bruits.
His heart was irregularly irregular from his atrial
fibrillation.  His lungs were clear bilaterally.  His
abdominal examination was benign.  An obese abdomen was
noted.  His extremities were without any cyanosis, clubbing,
or edema.  He was alert and oriented and moved all
extremities.  He was neurologically grossly intact.  He had
2+ peripheral pulses throughout.

SOCIAL HISTORY:  The patient smoked one pack per day for five
years, but he quit 30 years ago.  He admits to three double
alcoholic drinks per day.

CONCISE SUMMARY OF HOSPITAL COURSE:  The patient was brought
in on [**10-16**] to the CMI Service.  He was made nothing by
mouth after midnight and was given intravenous fluids with
plans to take him to the Catheterization Laboratory as well
as he was able to go.

On [**10-16**], Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] referred the patient to
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**].  He was seen by the Cardiothoracic Surgery
Services.  His cardiac catheterization on [**10-16**] showed a
normal left main, an 80% proximal left anterior descending
artery lesion, an 80% first diagonal lesion, an 80% first
diagonal lesion, a mid circumflex 80% lesion, and a 60%
proximal right coronary artery lesion with 70% distal.  His
ejection fraction was approximately 44%.

Preoperatively, his laboratories were as follows; his white
blood cell count was 6.8, his hematocrit 42.4, and his
platelet count was 230,000.  Sodium was 139, potassium was
4.3, chloride was 107, bicarbonate was 17, blood urea
nitrogen was 15, creatinine was 0.9, with blood glucose was
239.  His INR was 2.1 on [**10-16**].  His partial
thromboplastin time was greater than 150.  His
alanine-aminotransferase was 16, his aspartate
aminotransferase was 19, his lactate dehydrogenase was 163,
his alkaline phosphatase was 68, his total bilirubin was 0.7,
and his albumin was 3.6.

The patient was to receive 10 mg of vitamin K and 4 units of
fresh frozen plasma and then repeat his INR with plans to do
his off-pump coronary artery bypass surgery on the morning of
[**10-17**] if his INR dropped.

It was also recommended by the Cardiothoracic Surgery Service
that Cardiology allow the patient to have beer that evening.
He was also placed on checks to make sure that he did not go
into delirium tremens, and he was transfused the fresh frozen
plasma 4 units preoperatively.  He remained on the Cardiology
Service in preparation for his coronary artery bypass graft.

On [**10-17**], he underwent off-pump coronary artery bypass
grafting times one with a left internal mammary artery to the
left anterior descending artery and a maze procedure for his
atrial fibrillation.  Preoperatively, his INR did drop to 1.3
which made his surgery possible.

The progress note from postoperative day one is missing from
the chart.

On postoperative day two, the patient had a temperature
maximum of 100.4.  He was in a sinus rhythm in the 70s with a
blood pressure of 110/61.  He was saturating 95% on room air;
having already been extubated.  He was alert and oriented
times three.  His heart was regular in rate and rhythm.  His
lungs were clear bilaterally.  His abdominal examination was
benign.  He had minimal edema in his extremities.  He was
neurologically intact.  He was continued on Imdur and
amiodarone.  He responded well to his Lasix and was started
on a low standing dose.  His hematocrit was stable at 26.5,
with a postoperative white count of 8.4, a blood urea
nitrogen of 14, and a creatinine of 1.  He was seen by
Rehabilitation Services and transferred out to the floor.
Dr. [**Last Name (STitle) 1537**] stated the patient could have vodka if he wanted to.
On [**10-18**], the patient walked around the entire circuit
of the Cardiothoracic Surgery Recovery Unit before he was
transferred out to the floor.

On postoperative day three, he had no events.

On [**10-20**], he remained in a sinus rhythm with a good
blood pressure.  He was hemodynamically stable.  His
examination was unchanged.  He was saturating well on room
air.  He was in a sinus rhythm.  The plan was for him to go
to the Catheterization Laboratory that day (on [**10-20**])
for completion of his revascularization with stenting.  He
had good urine output and received Mucomyst prior to
catheterization with a stable creatinine.  On [**10-20**], he
went back to the Catheterization Laboratory.  The
catheterization showed a widely patent left internal mammary
artery to the left anterior descending artery and a normal
anastomosis.  He received stenting to the circumflex and then
stenting to the right coronary artery.

On postoperative day four, he had no chest pain.  He was
hemodynamically stable.  He was saturating well.  His
hematocrit was stable at 28.3 with a white count of 11.7.  He
was alert and oriented.  His lungs were clear.  His heart was
regular in rate and rhythm.  His Lopressor was increased to
50 mg twice per day for a heart rate of 89.  His creatinine
rose slightly from 0.9 to 1.1.  He continued to be monitored.
[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] consultation was requested to rule out diabetes
mellitus with a hemoglobin A1c sent off.  Discussions were
held about whether or not the patient would require Coumadin
dosing any postoperative atrial fibrillation.

[**Last Name (un) **] saw him on [**10-21**].  They recommended that this was
probably post surgical hyperglycemia related to stress
hormones, but they did note his elevated glucose before
coronary artery bypass graft and that he probably had a
diagnosis of diabetes mellitus with his triglycerides also in
the 3000 range.  They recommended that he probably was
diabetic or at least had impaired glucose tolerance and
recommended he come in for follow-up testing with [**Last Name (un) **] in
about two to three weeks after discharge.

He also continued to work with Physical Therapy out on the
floor to increase his ambulation stamina.

DISCHARGE DISPOSITION:  On [**10-22**], the patient was
discharged to home.

CONDITION AT DISCHARGE:  The patient was discharge in stable
condition on [**2121-10-22**].

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with Dr. [**Last Name (STitle) 52329**]
on [**10-23**] for an INR check and then every two weeks as
directed for his Coumadin dosing.
2.  The patient was to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] in the
office in one month for his postoperative visit.
3.  The patient was to followup with the [**Hospital **] Clinic as
directed.
4.  The patient was to follow up with Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] of
Cardiology in approximately two weeks.

MEDICATIONS ON DISCHARGE:
 1.  Coumadin 5 mg dosed on the evening of [**10-22**]; and
then per Dr. [**Last Name (STitle) 52329**].
 2.  Colace 100 mg by mouth twice per day.
 3.  Zantac 150 mg by mouth twice per day.
 4.  Aspirin 81 mg by mouth once per day.
 5.  Plavix 75 mg by mouth once per day.
 6.  Imdur 30 mg by mouth once per day.
 7.  Amiodarone 400 mg by mouth once per day.
 8.  Allopurinol 150 mg by mouth once per day.
 9.  Lopressor 50 mg by mouth twice per day.
10.  Tylenol No. 3 with codeine one to two tablets by mouth
q.4h. as needed (for pain).
11.  Thiamine 100 mg by mouth once per day.
12.  Folate 1 mg by mouth once per day.
13.  Multivitamin one tablet by mouth every day.

DISCHARGE DIAGNOSES:
 1.  Status post off-pump coronary artery bypass grafting
times one (with a left internal mammary artery to the left
anterior descending artery).
 2.  Status post percutaneous transluminal coronary
angioplasty and stenting and planned hybrid procedure to the
left circumflex and right coronary artery.
 3.  Non-insulin-dependent diabetes mellitus (this was a new
diagnosis).
 4.  Hypertension.
 5.  Hypercholesterolemia.
 6.  Hypertriglyceridemia.
 7.  Paroxysmal atrial fibrillation.
 8.  Pancreatitis in [**2119**] (with methicillin-resistant
Staphylococcus aureus ventilator-associated pneumonia and
delirium tremens).
 9.  Polio.
10.  Gout.
11.  Ethanol abuse.
12.  Spinal stenosis.






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

Dictated By:[**Last Name (NamePattern1) 76**]

MEDQUIST36

D:  [**2121-12-9**]  11:44
T:  [**2121-12-12**]  12:21
JOB#:  [**Job Number 52330**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Other and unspecified alcohol dependence, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Impaired glucose tolerance test (oral),Unspecified essential hypertension,Pure hyperglyceridemia,Gout, 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: This 59-year-old patient was
referred by Dr. [**First Name8 (NamePattern2) 122**] [**Last Name (NamePattern1) **] for outpatient cardiac
catheterization due to ongoing angina and a positive stress
test which he had in [**2121-6-24**].  He was positive for
myocardial ischemia, and he had baseline anterior ST-T wave
changes on his electrocardiogram.  His echocardiogram on [**7-10**] showed preserved left ventricular systolic function, with
an ejection fraction of 60%, with normal right and left heart
valves.  He said he had left-sided chest pressure that comes
and goes on and off for 15 years.  It resolved spontaneously.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hypercholesterolemia (with high triglycerides).
3.  Paroxysmal atrial fibrillation.
4.  Pancreatitis in [**2119**] (with a hospital stay complicated by
delirium tremens and methicillin-resistant Staphylococcus
aureus ventilator-associated pneumonia.
5.  Polio.
6.  Gout.
7.  Ethanol abuse.
8.  Spinal stenosis.

MEDICATION ON ADMISSION: (Medications prior to
catheterization were as follows)
1.  Coumadin (varies his dosing).
2.  Toprol-XL 100 mg by mouth once per day.
3.  Digoxin 0.125 mg by mouth every day.
4.  Allopurinol 300 mg by mouth once per day.
5.  Colchicine 0.6 mg by mouth once per day.
6.  Altace 2.5 mg by mouth once per day.
7.  Tricor 160 mg by mouth once per day.
8.  GNC liver formula, dietary supplement, as well as a
pancreatic supplement (which is unlisted).

ALLERGIES: 1.  He listed an intolerance to LIPITOR.
2.  IODINE (gives him nausea and vomiting).
3.  QUESTION ATIVAN (which was given him delirium tremens
symptoms).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smoked one pack per day for five
years, but he quit 30 years ago.  He admits to three double
alcoholic drinks per day. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Atrial fibrillation,Other and unspecified alcohol dependence, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Impaired glucose tolerance test (oral),Unspecified essential hypertension,Pure hyperglyceridemia,Gout, unspecified'}
