CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 74 year old, white
female patient, who underwent coronary artery bypass graft
times four in [**2176**], now presenting with increasing dyspnea on
exertion.  She had a follow-up cardiac catheterization in
[**Month (only) 547**] of this year for increasing symptoms as well as known
aortic stenosis.  This revealed patent left internal mammary
artery to the left anterior descending graft, as well as
patent saphenous vein to the right coronary with saphenous
vein graft to the obtuse marginal one, jump graft to the
obtuse marginal two occluded.  This also revealed aortic
stenosis with an aortic valve area of 0.8 cm square and a
peak gradient of 50 mm.  A left ventricular ejection fraction
was 62 percent at that time and she also had 1 plus mitral
regurgitation.  She was referred for a redo coronary artery
bypass graft as well as aortic valve replacement.

MEDICAL HISTORY: Significant for prior cardiac surgery,
as previously stated.  Prior angioplasty in [**2175**].
Hypertension.  Hypercholesterolemia.  Non insulin dependent
diabetes mellitus.  Osteoarthritis of her back.  Depression.
Gastroesophageal reflux disease.  Anemia.  Hypothyroidism.
Aortic stenosis.  Mitral regurgitation. Status post total
abdominal hysterectomy.  Status post bladder suspension.
Status post Cesarean section.  Status post left shoulder
surgery.  Status post back surgery.

MEDICATION ON ADMISSION: 1. Aspirin 325 mg p.o. q. Day.
2. Atenolol 100 mg p.o. q. Day.
3. Cardizem CD 240 mg p.o. q. Day.
4. Imdur 120 mg p.o. q. Day.
5. Zoloft 150 mg p.o. twice a day.
6. Prilosec 20 mg p.o. q. Day.
7. Avandia 4 mg p.o. q. Day.
8. Lipitor 20 mg p.o. q. Day.
9. Slow Niacin 250 mg p.o. q. Day.
10.      Isosorbide 60 mg p.o. twice a day.
11.      Bextra 20 mg p.o. q. Day.
12.      Synthroid 175 mcg p.o. q. Day.
13.      Iron supplement.

ALLERGIES: The patient states an allergy to Kefzol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a former heavy smoker, quit
17 years ago and denies alcohol use.
Aortic valve disorders,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Acute respiratory failure,Coronary atherosclerosis of autologous vein bypass graft,Delirium due to conditions classified elsewhere
Aortic valve disorder,Disrup-external op wound,Urin tract infection NOS,Acute respiratry failure,Crn ath atlg vn bps grft,Delirium d/t other cond
Admission Date: [**2193-6-24**]        Discharge Date: [**2193-7-15**]

Date of Birth:  [**2119-3-10**]        Sex:  F

Service:  CSU


HISTORY OF PRESENT ILLNESS:  This is a 74 year old, white
female patient, who underwent coronary artery bypass graft
times four in [**2176**], now presenting with increasing dyspnea on
exertion.  She had a follow-up cardiac catheterization in
[**Month (only) 547**] of this year for increasing symptoms as well as known
aortic stenosis.  This revealed patent left internal mammary
artery to the left anterior descending graft, as well as
patent saphenous vein to the right coronary with saphenous
vein graft to the obtuse marginal one, jump graft to the
obtuse marginal two occluded.  This also revealed aortic
stenosis with an aortic valve area of 0.8 cm square and a
peak gradient of 50 mm.  A left ventricular ejection fraction
was 62 percent at that time and she also had 1 plus mitral
regurgitation.  She was referred for a redo coronary artery
bypass graft as well as aortic valve replacement.

PAST MEDICAL HISTORY:  Significant for prior cardiac surgery,
as previously stated.  Prior angioplasty in [**2175**].
Hypertension.  Hypercholesterolemia.  Non insulin dependent
diabetes mellitus.  Osteoarthritis of her back.  Depression.
Gastroesophageal reflux disease.  Anemia.  Hypothyroidism.
Aortic stenosis.  Mitral regurgitation. Status post total
abdominal hysterectomy.  Status post bladder suspension.
Status post Cesarean section.  Status post left shoulder
surgery.  Status post back surgery.

MEDICATIONS ON ADMISSION:
1. Aspirin 325 mg p.o. q. Day.
2. Atenolol 100 mg p.o. q. Day.
3. Cardizem CD 240 mg p.o. q. Day.
4. Imdur 120 mg p.o. q. Day.
5. Zoloft 150 mg p.o. twice a day.
6. Prilosec 20 mg p.o. q. Day.
7. Avandia 4 mg p.o. q. Day.
8. Lipitor 20 mg p.o. q. Day.
9. Slow Niacin 250 mg p.o. q. Day.
10.      Isosorbide 60 mg p.o. twice a day.
11.      Bextra 20 mg p.o. q. Day.
12.      Synthroid 175 mcg p.o. q. Day.
13.      Iron supplement.


ALLERGIES:  The patient states an allergy to Kefzol.

SOCIAL HISTORY:  The patient is a former heavy smoker, quit
17 years ago and denies alcohol use.

HOSPITAL COURSE:  The patient was admitted to the hospital on
the day prior to planned surgery for intravenous diuresis
with Lasix.  However, on preoperative evaluation, she was
found to be thrombocytopenic with a platelet count in the
90's. For that reason, her surgery was initially cancelled
and hematology consult was obtained.  After a few days on the
medical floor and follow-up with the hematology service, it
was felt that she had ITP and that it was safe to proceed
with surgery.  The patient was subsequently taken to the
operating room on [**2193-6-28**] where she underwent coronary
artery bypass graft redo, times one to the right coronary
artery as well as an aortic valve replacement with a 23 mm
[**Last Name (un) 3843**]-[**Doctor Last Name **] pericardial valve.  Postoperatively, she
was on Milrinone, epinephrine, Neo-Synephrine, insulin,
intravenous drips and Propofol and was transported from the
operating room to the cardiac surgery recovery unit in good
condition.

On postoperative day number one, the patient extubated
herself. It would not have been the plan to extubate her, as
she did not have a cuff leak and there were concerns about
airway edema.  She was, at that time, treated with
intravenous steroids and she remained extubated. She also
discontinued her central line about the same time.  She
continued to remain restless and quite agitated over the next
few days and ultimately required reintubation early in the
morning of [**7-1**], due to increasing respiratory distress,
tachypnea and hypoxia.  She also had a new left femoral
central line placed at that time for intravenous access.

Pulmonary medicine consultation was obtained at that time.
She was started on intravenous Presidex to help with her
agitation issues. She was treated aggressively with steroids,
maintained on ventilatory support over the next few days.
She was ultimately extubated successfully on [**7-3**],
postoperative day number five, and has remained extubated
with stable respiratory status.  It did, however, take a
number of days for her mental status to clear.  During her
mental status work-up, she was found to have urinary tract
infection.  This was found to be resistant pseudomonas for
which she was placed on intravenous Zosyn.  She has
subsequently had a repeat urine culture from [**7-10**] which
was negative and she received a full seven day course of
intravenous Zosyn.  Over the next few days, her mental status
continued to clear but, because she was not completely lucid
on [**7-5**], a neurology consult was obtained.  CT scan of
her head was obtained and there was no acute infarction shown
and no intracranial hemorrhage.  It was the recommendation of
the neurology service to continue with the patient,
aggressively treat the urinary tract infection and avoid all
sedating medications.  The patient was ultimately transferred
for the cardiac surgery Recovery Room to the postoperative
telemetry floor on [**7-8**].  Because of continued
agitation, a psychiatry consult was obtained.  The patient's
agitation had been treated with intravenous Haldol and it was
the recommendation of the psychiatry consult service to
continue with intravenous Haldol with maintenance, as well as
with prn dosing.  It was also advised that patient have a one-
to-one sitter, as long as she was agitated for patient safety
reasons.

Over the next few days, the patient was noted to have some
sternal drainage at the distal portion of her sternal wound.
There was no surrounding erythema and the wound ultimately
dehisced a small area, about 4 cm in length and maybe 1 cm
deep. It remained clean, without erythema or purulent
drainage, with just some serosanguinous drainage
intermittently.  Wet to dry dressings had been applied to
that wound.  The patient had a PICC line placed on [**7-10**]
to facilitate continued need for Zosyn.  Over the next few
days, her mental status improved significantly and the sitter
was discontinued by [**7-12**].  She remained hemodynamically
stable throughout, in normal sterile fashion, with room air
oxygen saturation in the mid to high 90's.  Her Haldol was
ultimately weaned over the next few days and discontinued
today, on [**7-15**].  The patient's condition today is as
follows:  Neurologically, she is alert and oriented with no
complaints. Her temperature is 97.8. Heart rate 67 and normal
sinus rhythm.  Respiratory rate 18. Blood pressure 131/52.
Room air oxygenation is 98 percent.  She is alert and
oriented with no apparent deficits today.  Pulmonary
examination: Lungs are clear to auscultation bilaterally.
Coronary examination:  Regular rate and rhythm.  Abdomen is
soft and obese, nontender.  Extremities:  Warm and well
perfused with no evidence of peripheral edema.  As previously
stated, the lower pole of the posterior wound remains open,
approximately 4 cm in length, with no erythema and no
purulent drainage.  She also has a very small, left groin
wound that is open, approximately a cm to 2 cm in length and
she also has some yeast in the groin area.

DISCHARGE MEDICATIONS:
1. Lopressor 75 mg p.o. twice a day.
2. Colace 100 mg p.o. twice a day.
3. Enteric coated aspirin, 325 mg p.o. q. Day.
4. Captopril 12.5 mg p.o. three times a day.
5. Zoloft 200 mg p.o. q. Day.
6. Vioxx 25 mg p.o. q. Day.
7. Protonix 40 mg p.o. q. Day.
8. Avandia 4 mg p.o. q. Day.
9. Lipitor 20 mg p.o. q. Day.
10.      Synthroid 150 mg p.o. q. Day.
11.      Zosyn 2.25 grams intravenous q. Six hours throughout
   completion of dosing on [**7-16**], which will be her
   seventh day.
12.      Haldol is discontinued today.
13.      Heparin 5000 units subcutaneous twice a day until
   the patient is fully ambulatory.
14.      Lasix will be discontinued prior to discharge.


DISCHARGE DIAGNOSES:  Aortic stenosis, status post aortic
valve replacement.

Coronary artery disease status post coronary artery bypass
graft.

Postoperative delirium.

Postoperative urinary tract infection.

DISCHARGE INSTRUCTIONS:  The patient is to be discharged
today. She is to follow-up with her primary care physician,
[**Last Name (NamePattern4) **]. [**Last Name (STitle) 9960**], at [**Hospital6 3872**] in one to two weeks.
She is to follow-up with her cardiologist, Dr. [**First Name8 (NamePattern2) 449**]
[**Last Name (NamePattern1) **], [**Hospital6 3872**], in one to two weeks. She
is to follow-up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in two to three
weeks for postoperative check.

DISCHARGE CONDITION:  Good.




                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern1) 5664**]
MEDQUIST36
D:  [**2193-7-15**] 12:11:26
T:  [**2193-7-15**] 13:08:52
Job#:  [**Job Number **]


Name:  [**Known lastname 18340**], [**Known firstname 565**]         Unit No:  [**Numeric Identifier 18341**]

Admission Date: [**2193-6-24**]        Discharge Date: [**2193-7-18**]

Date of Birth:  [**2119-3-10**]        Sex:  F

Service:  CSU


The patient had remained in the hospital due to inability to
obtain a rehabilitation bed for her. She now, however, has a
bed and will be transferred to rehabilitation today to
progress her cardiac rehabilitation and increase her
mobility. In the interim while she has remained in the
hospital, she has completed her course of Zosyn for the
previously described resistant urinary tract infection and
therefore, her PICC line has been removed. There are no other
changes in her discharge medications or in her condition. She
has remained hemodynamically stable throughout with no change
in her physical examination.



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 3125**]

Dictated By:[**Last Name (NamePattern1) 10301**]
MEDQUIST36
D:  [**2193-7-18**] 13:26:59
T:  [**2193-7-18**] 13:52:45
Job#:  [**Job Number 18342**]
{'Aortic valve disorders,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Acute respiratory failure,Coronary atherosclerosis of autologous vein bypass graft,Delirium due to conditions classified elsewhere'}


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 a 74 year old, white
female patient, who underwent coronary artery bypass graft
times four in [**2176**], now presenting with increasing dyspnea on
exertion.  She had a follow-up cardiac catheterization in
[**Month (only) 547**] of this year for increasing symptoms as well as known
aortic stenosis.  This revealed patent left internal mammary
artery to the left anterior descending graft, as well as
patent saphenous vein to the right coronary with saphenous
vein graft to the obtuse marginal one, jump graft to the
obtuse marginal two occluded.  This also revealed aortic
stenosis with an aortic valve area of 0.8 cm square and a
peak gradient of 50 mm.  A left ventricular ejection fraction
was 62 percent at that time and she also had 1 plus mitral
regurgitation.  She was referred for a redo coronary artery
bypass graft as well as aortic valve replacement.

MEDICAL HISTORY: Significant for prior cardiac surgery,
as previously stated.  Prior angioplasty in [**2175**].
Hypertension.  Hypercholesterolemia.  Non insulin dependent
diabetes mellitus.  Osteoarthritis of her back.  Depression.
Gastroesophageal reflux disease.  Anemia.  Hypothyroidism.
Aortic stenosis.  Mitral regurgitation. Status post total
abdominal hysterectomy.  Status post bladder suspension.
Status post Cesarean section.  Status post left shoulder
surgery.  Status post back surgery.

MEDICATION ON ADMISSION: 1. Aspirin 325 mg p.o. q. Day.
2. Atenolol 100 mg p.o. q. Day.
3. Cardizem CD 240 mg p.o. q. Day.
4. Imdur 120 mg p.o. q. Day.
5. Zoloft 150 mg p.o. twice a day.
6. Prilosec 20 mg p.o. q. Day.
7. Avandia 4 mg p.o. q. Day.
8. Lipitor 20 mg p.o. q. Day.
9. Slow Niacin 250 mg p.o. q. Day.
10.      Isosorbide 60 mg p.o. twice a day.
11.      Bextra 20 mg p.o. q. Day.
12.      Synthroid 175 mcg p.o. q. Day.
13.      Iron supplement.

ALLERGIES: The patient states an allergy to Kefzol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a former heavy smoker, quit
17 years ago and denies alcohol use. 

### Response:
{'Aortic valve disorders,Disruption of external operation (surgical) wound,Urinary tract infection, site not specified,Acute respiratory failure,Coronary atherosclerosis of autologous vein bypass graft,Delirium due to conditions classified elsewhere'}
