CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 80-year-old physician
with three vessel disease, left ventricular dysfunction,
mitral regurgitation, admitted for unstable angina.  Similar
episode several months ago.  Thrombus in left anterior
descending, without evidence of plaque rupture.  Exercising
regularly without angina.  Last night, walked in cold wind,
gave the patient angina.  During the night, recurrent
episodes at rest, relieved by nitroglycerin.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of unspecified site, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Pure hypercholesterolemia,Other left bundle branch block
AMI NOS, initial,Surg compl-heart,Atrial fibrillation,Mitral valve disorder,Crnry athrscl natve vssl,Abn react-surg proc NEC,Hypertension NOS,Pure hypercholesterolem,Left bb block NEC
Admission Date:  [**2168-10-24**]       Discharge Date:  [**2168-11-3**]


Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  This is an 80-year-old physician
with three vessel disease, left ventricular dysfunction,
mitral regurgitation, admitted for unstable angina.  Similar
episode several months ago.  Thrombus in left anterior
descending, without evidence of plaque rupture.  Exercising
regularly without angina.  Last night, walked in cold wind,
gave the patient angina.  During the night, recurrent
episodes at rest, relieved by nitroglycerin.

PHYSICAL EXAMINATION:  Heart rate 60, blood pressure 140/80.
Neck:  Jugular venous pressure normal.  Lungs:  Clear to
auscultation.  Cardiovascular:  II/VI systolic murmur.
Extremities:  No edema.

LABORATORY DATA:  Troponin less than 0.3, CK 180, MB
negative.  Electrocardiogram showed stable, no acute changes.

HOSPITAL COURSE:  The patient was admitted on [**2168-10-24**] to the
[**Hospital Unit Name 196**] service, where the patient was continued on his aspirin,
beta blocker, ACE inhibitor, Lipitor and Plavix.  He was
brought to the cardiac catheterization laboratory on [**2168-10-25**],
where they found the LMCA with moderate calcification and
distal taper to the left anterior descending/RI/LCX of 70%,
the left anterior descending with an ostial 60% calcified
lesion, the origin of the D1 with a 50% lesion, left
circumflex with a non-dominant vessel ostial 80% with
mid-segment tubular 70% stenosis, and right coronary artery
with dominant vessel proximally.

Due to the extent of the patient's disease, it was decided
that he should proceed with coronary artery bypass graft.  On
[**2168-10-28**], the patient was brought to the operating room, at
which time a four vessel coronary artery bypass graft was
performed.  The left internal mammary artery was brought to
the left anterior descending, saphenous vein graft to the
diagonal, saphenous vein graft to the obtuse marginal,
saphenous vein graft to the posterior descending artery.  The
patient tolerated the procedure well, and was brought to the
Cardiothoracic Intensive Care Unit.

Postoperatively, the patient continued to do well, and was
extubated without incident.  The patient maintained his
pulmonary artery pressure at 31/12, CVP of 9, coronary index
was maintained at 2.8, and on a milrinone drip at 0.2.

On postoperative day three, the patient was found to be
maintaining his blood pressure and heart rate without the use
of drips, and he was subsequently transferred to the Surgical
floor.  On postoperative day three in the late afternoon, the
patient converted to atrial fibrillation, at which time he
was started on amiodarone of 400 three times a day as well as
given 15 mg of intravenous Lopressor and 2 grams of
magnesium.  The patient remained in atrial fibrillation for
the next 48 hours, at which time it was decided to DC
cardiovert the patient.

On postoperative day six, the patient was brought to the EP
unit and was cardioverted using 200 joules.  The patient
converted to normal sinus rhythm and tolerated the procedure
well.  Amiodarone was subsequently continued.

On postoperative day seven, the patient converted back to
atrial fibrillation and it was believed at that time that the
patient should remain rate controlled, so the amiodarone was
decreased to 200 mg once daily and the patient was started on
his previous dose of atenolol 25 mg once daily.  The patient
was heparinized throughout his entire course of atrial
fibrillation and remained heparinized until his INR reached
greater than 2.0.

DISCHARGE STATUS:  Good

DISCHARGE DIAGNOSIS:  Status post coronary artery bypass
graft x 4 complicated by atrial fibrillation

DISCHARGE MEDICATIONS:
1.  Atenolol 25 mg by mouth once daily
2.  Amiodarone 200 mg by mouth once daily
3.  Warfarin 5 mg by mouth once daily
4.  Calcium carbonate 500 mg by mouth twice a day
5.  Aspirin 325 mg by mouth once daily
6.  Colace 100 mg by mouth twice a day
7.  Lasix 20 mg by mouth every 12 hours for one week
8.  K-Dur 20 mg by mouth every 12 hours for one week




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

Dictated By:[**Last Name (NamePattern1) 17480**]
MEDQUIST36

D:  [**2168-11-2**]  21:06
T:  [**2168-11-3**]  00:00
JOB#:  [**Job Number 95629**]


Name:  [**Last Name (LF) **], [**Known firstname 5204**]/DR.                    [**Last Name (STitle) 4221**] [**Name (STitle) **]:  [**Numeric Identifier 17615**]

Admission Date:  [**2168-10-24**]     Discharge Date:  [**2168-11-3**]

Date of Birth:   [**2088-5-5**]     Sex:  M

Service:  CARDIOTHORACIC SURGERY

ADDENDUM:  Dr. [**Last Name (STitle) **] was in atrial fibrillation
intermittently following coronary artery bypass surgery;
however, he was discharged in sinus rhythm.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 358**], M.D.  [**MD Number(1) 359**]

Dictated By:[**Last Name (NamePattern1) 17616**]

MEDQUIST36

D:  [**2168-12-8**]  05:16
T:  [**2168-12-13**]  09:45
JOB#:  [**Job Number 17617**]
{'Acute myocardial infarction of unspecified site, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Pure hypercholesterolemia,Other left bundle branch block'}


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 is an 80-year-old physician
with three vessel disease, left ventricular dysfunction,
mitral regurgitation, admitted for unstable angina.  Similar
episode several months ago.  Thrombus in left anterior
descending, without evidence of plaque rupture.  Exercising
regularly without angina.  Last night, walked in cold wind,
gave the patient angina.  During the night, recurrent
episodes at rest, relieved by nitroglycerin.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of unspecified site, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Pure hypercholesterolemia,Other left bundle branch block'}
