CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 57-year-old
male with a history of hypertension, coronary artery disease,
and abdominal aortic aneurysm.  He developed flutter, 4 to 5
out of 10 chest pain at 11:45 a.m. while working on a
computer at home.  The pain radiates to left arm.  The
patient took 2 nitroglycerin tablets and then another 2
without relief.  The patient then went to outside hospital.
At outside hospital, EKG showed 2 to [**Street Address(2) 2051**] changes in the
inferior leads.  The patient received Plavix, heparin, and
nitroglycerin along with morphine and oxygen, and he was
transferred to [**Hospital1 69**] for
primary percutaneous coronary intervention.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Paroxysmal supraventricular tachycardia,Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ
AMI inferior wall, init,CHF NOS,Parox atrial tachycardia,Crnry athrscl natve vssl,Abdom aortic aneurysm,Hypertension NOS,Status autm crd dfbrltr
Admission Date: [**2162-9-14**]        Discharge Date: [**2162-9-22**]

Date of Birth:  [**2105-3-4**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  The patient is a 57-year-old
male with a history of hypertension, coronary artery disease,
and abdominal aortic aneurysm.  He developed flutter, 4 to 5
out of 10 chest pain at 11:45 a.m. while working on a
computer at home.  The pain radiates to left arm.  The
patient took 2 nitroglycerin tablets and then another 2
without relief.  The patient then went to outside hospital.
At outside hospital, EKG showed 2 to [**Street Address(2) 2051**] changes in the
inferior leads.  The patient received Plavix, heparin, and
nitroglycerin along with morphine and oxygen, and he was
transferred to [**Hospital1 69**] for
primary percutaneous coronary intervention.

PAST MEDICAL HISTORY:  Coronary artery disease.

Hypertension.

Hypercholesterolemia.

Unstable angina.

Status post 5 stents to right coronary artery in [**2153**].

He had abdominal aortic aneurysm.

Benign prostatic hypertrophy.

MEDICATIONS:
1. Atenolol 100 mg p.o. q.d.
2. Lipitor 10 mg p.o. q.d.
3. Aspirin 81 mg p.o. q.d.
4. Multivitamin p.o. q.d.


ALLERGIES:  He is allergic to PENICILLIN.

LABORATORY AND DIAGNOSTIC DATA:  The patient's labs on
[**2162-9-14**] were as follows, white blood cell count of 11.9,
hemoglobin 14.4, hematocrit 41.1, platelets 206, sodium 140,
potassium 3.9, chloride 107, bicarbonate 26, BUN 17,
creatinine 0.5, glucose 116, AST was 65, ALT 33, total
bilirubin 0.2, alkaline phosphatase 79, LDH 226, CPK 863, CK-
MB 85, and troponin T 2.38.  His PT was 13.3, PTT 33.7, and
INR 1.1.  His UA was negative.  Chest x-ray on [**2162-9-15**]
showed heart normal in size with tortuous aorta.  No vascular
congestion, consolidations, or effusions, probable segmental
atelectasis in one or both lungs.  The patient's EKG on
[**2162-9-14**] was as follows, heart rate of 60 and in normal sinus
rhythm, prior inferior myocardial infarction compared to the
previous tracing.  Repeat prior inferior myocardial
infarction, ST-segment elevation on leads II, III, aVF, and
V4 to V6, T waves in the upper leads, which may represent
pseudonormalization.  Echocardiogram on [**2162-9-14**], mild
regional left ventricular systolic dysfunction with
hypokinesis of the basal inferior septum, distal septum, and
main inferior lateral walls.  The aortic valve leaflets are
mildly thickened but not stenotic.  There is no aortic
regurgitation.  The mitral valve appears structurally normal.
There is no mitral valve prolapse.  Ascending aorta measures
3.7 cm.  Left ventricular ejection fraction is 40 percent.
Cardiac catheterization on [**2162-9-14**] revealed left main
disease and 3-vessel coronary artery disease along with acute
inferior myocardial infarction.  The left main coronary
artery had a 60 to 70 percent distal lesion.  Left circumflex
was a large vessel with an eccentric 90 percent stenosis
before a large OM1 and OM2.  Right coronary artery had a 100
percent thrombotic occlusion.  There are 5 prior patent
stents with diffuse 50% instant restenosis.  Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **].
[**Last Name (NamePattern1) **] consulted this patient on [**2162-9-14**] after the
echocardiogram and catheterization.  The patient preferred to
come back for surgery after a week or 2, and he was
discharged from the hospital.  On [**2162-9-15**], the patient was
still in the hospital, and he changed his mind and decided to
have the surgery done.  The patient was preop'd for surgery
on [**2162-9-16**].  On [**2162-9-16**], the patient was brought in to the
operating room, he received coronary artery bypass graft
times 3.

PHYSICAL EXAMINATION:  On admission, heart rate of 62, normal
sinus rhythm, respiratory rate of 16, BP of 137/82, and
weight of 82 kg.  His conjunctivae were nonicteric.
Extraocular movements were intact.  Pupils were equal, round,
and reactive to light.  Jugular veins were nondistended.
Neck was supple.  No thyromegaly.  No lymphadenopathy.  His
lungs were clear to auscultation bilaterally.  His heart had
regular rate and rhythm with S1 and S2.  No murmurs.  His
abdomen was positive for bowel sounds, soft, nontender, and
nondistended.  Cranial nerves II through XII were intact.  No
focal deficits.  Carotids were 2 plus with no bruits
bilaterally.  Extremities were nonedematous with DP pulses of
1 plus and PT pulses of 2 plus.

HOSPITAL COURSE:  On [**2162-9-16**], the patient went to operating
room for procedure of coronary artery bypass graft times 3,
left internal mammary artery to LAD, saphenous vein graft to
OM, and saphenous vein graft to PDA.  Cardiopulmonary bypass
time was 88 minutes and cross-clamp time was 46 minutes.  The
patient was transferred to cardiac ICU in stable condition
with a heart rate of 87 per minute, atrial paced.  He was on
nitroglycerin 1 mcg per kg per minute, propofol being
titrated, aprotinin 25 cc per hour.

Postoperative day 1, the patient was hemodynamically stable
with a heart rate of 91, normal sinus, blood pressure of
110/63.  He was on metoprolol at 12.5 mg and on antibiotic
vancomycin.  His physical exam was unremarkable.  He was also
on Lasix and his Swan was discontinued.  The patient was
weaned from mechanical ventilation on [**2162-9-17**] and overnight,
he was breathing on his own.  On [**2162-9-18**], he was 96 percent
on 4 L nasal cannula.  He was hemodynamically stable.  Heart
rate 93, normal sinus, blood pressure 114/55.  He had
decreased breath sounds on physical exam.

Again, on postoperative day 2, which was [**2162-9-18**], there were
no events.  The patient was still on Lasix 20 mg and
metoprolol 12.5 mg.  On postoperative day 3, the patient was
off Neo-Synephrine.  His chest tubes were discontinued.  His
epicardial pacing wires were discontinued.  He had a
temperature of 101 degrees.  His heart rate was 98.  His
pulse oximetry was 96 percent on 2 L nasal cannula.  His BP
was 122/62.  His Foley was discontinued.  Also on
postoperative day 2, the patient had a hematocrit of 33.3
with platelets of 238, hemoglobin of 11.3, and white count of
21.7.  By postoperative day 3, white count was 12.1,
hematocrit 30.6, and platelets 225.  His glucose was 119,
potassium 3.2, and BUN and creatinine were 11 and 0.7.  The
patient was discharged to Far 2 from the cardiac surgery ICU.

On postoperative day 4, the patient was transferred to Far 2.
He was hemodynamically stable.  Pulse rate of 96, BP of
112/60, hematocrit of 28.7, and platelets of 270.  He had
coarse breath sounds bilaterally.  Plan was to check the
chest x-ray and increase Lopressor to 37.5 mg p.o. b.i.d.
Also on [**2162-9-20**], rehabilitation services were requested.  PT
evaluated the patient on postoperative day 5, which was
[**2162-9-21**].  The patient had small amount of sternal drainage
from yesterday, minimal overnight; otherwise, the patient was
anxious to go home with T-max of 100, BP of 118/74, and pulse
rate of 84, sinus rhythm.  Sternal incision was now clear,
dry, and intact.  His extremities were edematous, 1 plus.
Chest x-ray showed no pneumothorax or effusions.

On postoperative day 6, the patient was discharged to home.
His physical exam on the day of discharge was as follows:  He
was alert and oriented times 3.  No focal deficits.
Ambulating without difficulty.  His lungs were clear
bilaterally without wheezes or rales.  His heart rate was
regular rate and rhythm.  Positive S1 and S2.  No murmurs.
He had positive bowel sounds, nondistended, and nontender.
His abdomen was soft.  His sternal incision was clean, dry,
and intact with staples.  His extremities were clean, dry,
and intact.  At saphenectomy site, he had 1 plus edema.  He
had no calf tenderness.  No Homans signs.

CONDITION ON DISCHARGE:  The patient was discharged in stable
condition on the following medications.

DISCHARGE MEDICATIONS:
1. Colace 100 mg p.o. b.i.d.
2. Aspirin 325 mg p.o. q.d.
3. Plavix 75 mg 1 p.o. q.d.
4. Lasix 20 mg 1 p.o. q.d. for 7 days.
5. Potassium chloride 10 mEq 2 p.o. q.d.
6. Atorvastatin 10 mg 1 p.o. q.d.
7. Dilaudid 2 mg 1 or 2 tablets p.o. q. 4-6h. p.r.n.
8. Atenolol 100 mg 1 p.o. q.d.


DISPOSITION:  He was discharged to home with services.

FINAL DIAGNOSES:  Coronary artery disease, status post
coronary artery bypass graft times 3.

Status post angioplasty to right coronary artery.

Hypertension.

Hypercholesterolemia.

Abdominal aortic aneurysm.

DISCHARGE INSTRUCTIONS:  He was recommended to follow up with
PCP [**Last Name (NamePattern4) **]. [**First Name (STitle) 7325**] in 1 to 2 weeks, to follow up with
cardiologist Dr. [**Last Name (STitle) 11882**] in 2 to 3 weeks, and to follow up with
cardiothoracic surgeon Dr. [**Last Name (STitle) **] in 3 to 4 weeks.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**]

Dictated By:[**Last Name (NamePattern1) 11830**]
MEDQUIST36
D:  [**2162-9-23**] 16:57:11
T:  [**2162-9-24**] 11:42:45
Job#:  [**Job Number 11883**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Paroxysmal supraventricular tachycardia,Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ'}


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 a 57-year-old
male with a history of hypertension, coronary artery disease,
and abdominal aortic aneurysm.  He developed flutter, 4 to 5
out of 10 chest pain at 11:45 a.m. while working on a
computer at home.  The pain radiates to left arm.  The
patient took 2 nitroglycerin tablets and then another 2
without relief.  The patient then went to outside hospital.
At outside hospital, EKG showed 2 to [**Street Address(2) 2051**] changes in the
inferior leads.  The patient received Plavix, heparin, and
nitroglycerin along with morphine and oxygen, and he was
transferred to [**Hospital1 69**] for
primary percutaneous coronary intervention.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to PENICILLIN.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Congestive heart failure, unspecified,Paroxysmal supraventricular tachycardia,Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ'}
