CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64 year old
white female who has a history of known coronary artery
disease, hypertension, diabetes mellitus and
hypercholesterolemia who presented with seven days of chest
pain which was relieved with Nitroglycerin.  In [**2150-2-19**] she seemed to be a nonoperative candidate due to poor
targets.  Since then she has had stable angina until the
symptoms began prior to this admission.

MEDICAL HISTORY: Her past medical history is
significant for coronary artery disease where a
catheterization in [**2150-2-19**], showed left main 50%, left
anterior descending of 95%, circumflex 95%, right coronary
artery of 70%.  Echocardiogram done at that time showed an
ejection fraction of 55% with distal septal akinesis with a
history of diastolic dysfunction, hypertension, diabetes,
hypercholesterolemia, gastroesophageal reflux disease, status
post transient ischemic attacks, status post total abdominal
hysterectomy, status post periumbilical hernia repair and
status post bilateral knee surgeries.  She is status post
bilateral breast lumpectomies which were benign and status
post a right shoulder lipoma removed.

MEDICATION ON ADMISSION: Lipitor 40 mg p.o. q.d., Norvasc
10 mg p.o. q.d., Neurontin 100 mg p.o. t.i.d., Glucophage
1000 mg p.o. b.i.d., Toprol 150 mg p.o. b.i.d., Prilosec 20
mg p.o. q.d., Prinivil 5 mg p.o. q.d., Lasix 40 mg p.o. q.d.,
Multivitamin and Nitroglycerin patch, sublingual
Nitroglycerin.

ALLERGIES: She has allergies to Morphine which gives her
hives, Darvocet which gives her a rash, Tegretol which causes
nausea, and codeine which causes nausea.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is unemployed and lives with her
husband.  [**Name (NI) 1139**], she smoked three packs per day for 30
years and quit 20 years ago.  Alcohol, she does not drink.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Cardiac complications, not elsewhere classified,Congestive heart failure, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Atrial fibrillation,Nonspecific abnormal findings in stool contents
Subendo infarct, initial,Crnry athrscl natve vssl,Hematoma complic proc,Surg compl-heart,CHF NOS,DMII neuro nt st uncntrl,Anemia NOS,Atrial fibrillation,Abn find-stool contents
Admission Date:  [**2153-1-13**]       Discharge Date:  [**2153-2-13**]

Date of Birth:   [**2088-7-17**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 64 year old
white female who has a history of known coronary artery
disease, hypertension, diabetes mellitus and
hypercholesterolemia who presented with seven days of chest
pain which was relieved with Nitroglycerin.  In [**2150-2-19**] she seemed to be a nonoperative candidate due to poor
targets.  Since then she has had stable angina until the
symptoms began prior to this admission.

PAST MEDICAL HISTORY:  Her past medical history is
significant for coronary artery disease where a
catheterization in [**2150-2-19**], showed left main 50%, left
anterior descending of 95%, circumflex 95%, right coronary
artery of 70%.  Echocardiogram done at that time showed an
ejection fraction of 55% with distal septal akinesis with a
history of diastolic dysfunction, hypertension, diabetes,
hypercholesterolemia, gastroesophageal reflux disease, status
post transient ischemic attacks, status post total abdominal
hysterectomy, status post periumbilical hernia repair and
status post bilateral knee surgeries.  She is status post
bilateral breast lumpectomies which were benign and status
post a right shoulder lipoma removed.

SOCIAL HISTORY:  She is unemployed and lives with her
husband.  [**Name (NI) 1139**], she smoked three packs per day for 30
years and quit 20 years ago.  Alcohol, she does not drink.

ALLERGIES:  She has allergies to Morphine which gives her
hives, Darvocet which gives her a rash, Tegretol which causes
nausea, and codeine which causes nausea.

MEDICATIONS ON ADMISSION:  Lipitor 40 mg p.o. q.d., Norvasc
10 mg p.o. q.d., Neurontin 100 mg p.o. t.i.d., Glucophage
1000 mg p.o. b.i.d., Toprol 150 mg p.o. b.i.d., Prilosec 20
mg p.o. q.d., Prinivil 5 mg p.o. q.d., Lasix 40 mg p.o. q.d.,
Multivitamin and Nitroglycerin patch, sublingual
Nitroglycerin.

REVIEW OF SYSTEMS:  Positive for intermittent blurry vision,
positive for dysphagia which resolved on its own and
nitroglycerin.  Positive shortness of breath with chest pain.
She has no palpitations.  She does have gastroesophageal
reflux disease, no melena and no hematochezia.  She has
positive urinary incontinence and positive for multiple
urinary tract infections this year, no weakness or numbness.
No new transient ischemic attack.  Her last carotid
ultrasound was probably a year and a half prior to admission.
No history of cerebrovascular accident.

PHYSICAL EXAMINATION:  On physical examination she is a
pleasant, obese female in no apparent distress.  Vital signs
show a heart rate of 69, blood pressure 75/72, respirations
15, oxygen saturations 100% on 4 liters of nasal cannula.
Her head, eyes, ears, nose and throat shows pupils equal,
round, and reactive to light and accommodation, extraocular
movements intact.  Oropharynx clear.  She has dentures on
upper jaw.  Her neck is supple with no bruits.  Carotid
artery pulses are 1+ bilaterally.  Her heart is regular rate
and rhythm with no murmur, rub or gallop.  Her lungs have
bilateral respiratory wheezes.  Her abdomen, hypoactive bowel
sounds, soft, nontender, nondistended with no
hepatosplenomegaly.  Extremities show no cyanosis, clubbing
or edema.  Her dorsalis pedis pulses are 2+ on the left and
1+ on the right and her posterior tibial pulses are 1+
bilaterally.  Neurological examination shows her to be alert
and oriented times three and grossly intact.

LABORATORY DATA:  Cardiac catheterization showed an ejection
fraction of 60% with 70% ostial lesion in the left main with
moderate calcification in the distal 90% lesion.  The left
anterior descending artery is totally occluded in the mid
vessel with distal right to left collaterals as the distal
target.  Her first diagonal has proximal disease and a small
left circumflex artery has a mid vessel occlusion with distal
flow to the right to left collateral and a good distal
target.  The right coronary artery has 90% ostial lesion, 90%
mid vessel lesion and distal posterior descending artery and
posterior left vessel are good targets.

HOSPITAL COURSE:  The patient while awaiting surgery
underwent multiple workups.  She had a consult from the Heart
Failure Service to evaluate her possible transplant due to
her diastolic dysfunction with the anticipation of having Ls
at backup during surgery.  She also needed to have carotid
ultrasound.  While awaiting surgery she also received a
consult from the [**Hospital **] Clinic in anticipation of better
controlling her blood sugars.  While awaiting surgery on
[**1-18**], she was noted to have guaiac positive stools and
received a gastrointestinal consult.  It was felt that she
would need an upper endoscopy and while awaiting this
examination she also upon removal of her right groin she
developed a sheath hematoma.  Computerized tomography scan
showed a collection measuring 20 by 9 by 5 cm.  She did
receive 1 unit of packed red blood cells for a drop in her
hematocrit but otherwise was hemodynamically stable.  There
was no further workup other than a femoral ultrasound and
Venodynes were recommended and documentation was made for
recommendation.  This hematoma eventually resolved and there
was no residual prior to surgery from this complication on
catheterization.  With her history of transient ischemic
attacks she had a neurology consult for which she had a head
computerized tomography scan and computerized tomographic
angiography to investigate for any intracranial
arthrosclerosis.  There was none to be found on report of the
computerized tomography scan of her head and because of this
it was felt that she was at no increased risk for
neurological event during surgery.

On [**2153-1-22**], she underwent her upper endoscopy where
normal esophagus, normal stomach and normal duodenum were
found.  It was felt that she would need a colonoscopy at some
point in the future, although she did not receive this prior
to going to surgery as it was felt that she had no further
guaiac positive stools and with her coronary artery disease
she would be at risk to have this procedure until her
coronary artery bypass grafting was complete.  By [**1-26**],
her workup for possible transplant candidate was complete and
it was felt at that time due to her body mass index she was
not a transplant candidate.  It was felt though she was good
risk for coronary artery bypass graft with Ls at backup and
plan at that point was to continue and proceed with surgery
within the next week.  The remainder of her preoperative
course was uneventful and on [**2153-1-30**] she went to the
Operating Room and underwent coronary artery bypass grafting
times two with saphenous vein graft to the right coronary
artery and saphenous vein graft to the first diagonal.  The
surgery was performed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] with Dr.
[**Last Name (STitle) 8420**] as assistant and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], PA-C as assistant.
The surgery was performed under general endotracheal
anesthesia with the cardiopulmonary bypass time of 129
minutes and crossclamp time of 83 minutes.  The patient
tolerated the procedure well and was transferred to the
Intensive Care Unit with two atrial and two ventricular
pacing wires, two mediastinal chest tubes and A-paced and on
Milrinone, Levophed, Insulin, Amiodarone and Propofol drips.

By postoperative day #1, she was stable and continued on her
drips except for the Propofol for which she had been reversed
and weaned.  By postoperative day #2 she was extubated and
also had an episode of rapid atrial fibrillation for which
she received Amiodarone bolus and was started on low dose
beta blocker.  She was also transfused 1 unit of packed red
blood cells for a low hematocrit.  On postoperative day #3
her chest tubes were discontinued without incident and her
Swan was discontinued and switched over to triple lumen.  At
that point she had been weaned from her Milrinone and other
pressors and was doing well on just the Amiodarone drip for
her atrial fibrillation and blood pressure control and
heart rate control with Lopressor.  Throughout this time she
continued to make improvements in the unit and had her heart
rate under control despite going in and out of atrial
fibrillation.  She did receive extra boluses of Amiodarone
and eventually on postoperative day #5 she was started on
heparin for anticoagulation secondary to her atrial
fibrillation.

By postoperative day #7, she was transferred to the Surgical
Floor and although she had been working with physical therapy
in the Intensive Care Unit began more aggressive work while
on the floor.  At that point, her hospital course was mostly
focused on maintaining good blood glucose control, working
with physical therapy and awaiting her INR to increase to a
goal of 2 to 2.5 for her anticoagulation for atrial
fibrillation.  During this time, she was cleared by physical
therapy having passed Level 5 and two days prior to discharge
she did develop some epigastric pain and had liver function
tests which were all within normal limits.  Chest x-ray and
KUB were also negative.  The epigastric pain resolved with
good bowel regimen and the patient has not had any more.  By
postoperative day #13, her INR was 2.4 and it was felt that
she was ready for discharge to home.

She will receive [**Hospital6 407**] services and home
physical therapy and will follow up as described below.

DISCHARGE STATUS:  Good.

DISCHARGE DIAGNOSIS:  Status post coronary artery bypass
grafting times two with saphenous vein graft to the right
coronary artery and saphenous vein graft to the obtuse
marginal.  She is status post postoperative atrial
fibrillation, hypertension, hypercholesterolemia and diabetes
mellitus.

DISCHARGE MEDICATIONS:
1.  Prilosec 20 mg p.o. q.d.
2.  Plavix 75 mg p.o. q.d., this was due to her poor targets
during bypass surgery.
3.  Benadryl 25 mg p.o. q.h.s. prn sleep.
4.  Isordil 30 mg p.o. q. day.
5.  Percocet 1 to 2 tablets p.o. q. 4 hours prn pain.
6.  Amiodarone 400 mg p.o. b.i.d. for seven days, then 400 mg
p.o. q.d. for seven days, then 200 mg p.o. q.d., and this
should be re-evaluated by her cardiologist in regards to her
atrial fibrillation as a need for further treatments.
7.  Lopressor 75 mg p.o. q.d.
8.  Lisinopril 20 mg p.o. q.d.
9.  Lasix 20 mg p.o. b.i.d. for 14 days
10. Glipizide XL 20 mg p.o. q.d.
11. Aspirin enteric coated, 81 mg p.o. q.d.
12. Dulcolax 10 mg p.o. q.d. prn
13. Potassium chloride 20 mEq p.o. q.d.
14. Lantis insulin 15 units subcutaneous q.h.s.
15. Coumadin 5 mg p.o. q.d. or as directed by physician to
maintain [**Name Initial (PRE) **] goal INR of 2 to 2.5.

FOLLOW UP:  Her follow up should include an appointment with
Dr. [**Last Name (STitle) 34633**] within one to two weeks.  She should see her
cardiologist, Dr. [**Last Name (STitle) **] in two to three weeks.  Follow up
with Dr. [**Last Name (STitle) **] in four weeks and she should also follow
up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**3-6**] at 9 AM.  Her follow up
should include PT/INR drawn with instructions to patient for
Coumadin dosing as needed to maintain goal INR of 2 to 2.5.



                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern1) 31272**]
MEDQUIST36

D:  [**2153-2-13**]  12:05
T:  [**2153-2-13**]  12:22
JOB#:  [**Job Number 34634**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Cardiac complications, not elsewhere classified,Congestive heart failure, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Atrial fibrillation,Nonspecific abnormal findings in stool contents'}


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 64 year old
white female who has a history of known coronary artery
disease, hypertension, diabetes mellitus and
hypercholesterolemia who presented with seven days of chest
pain which was relieved with Nitroglycerin.  In [**2150-2-19**] she seemed to be a nonoperative candidate due to poor
targets.  Since then she has had stable angina until the
symptoms began prior to this admission.

MEDICAL HISTORY: Her past medical history is
significant for coronary artery disease where a
catheterization in [**2150-2-19**], showed left main 50%, left
anterior descending of 95%, circumflex 95%, right coronary
artery of 70%.  Echocardiogram done at that time showed an
ejection fraction of 55% with distal septal akinesis with a
history of diastolic dysfunction, hypertension, diabetes,
hypercholesterolemia, gastroesophageal reflux disease, status
post transient ischemic attacks, status post total abdominal
hysterectomy, status post periumbilical hernia repair and
status post bilateral knee surgeries.  She is status post
bilateral breast lumpectomies which were benign and status
post a right shoulder lipoma removed.

MEDICATION ON ADMISSION: Lipitor 40 mg p.o. q.d., Norvasc
10 mg p.o. q.d., Neurontin 100 mg p.o. t.i.d., Glucophage
1000 mg p.o. b.i.d., Toprol 150 mg p.o. b.i.d., Prilosec 20
mg p.o. q.d., Prinivil 5 mg p.o. q.d., Lasix 40 mg p.o. q.d.,
Multivitamin and Nitroglycerin patch, sublingual
Nitroglycerin.

ALLERGIES: She has allergies to Morphine which gives her
hives, Darvocet which gives her a rash, Tegretol which causes
nausea, and codeine which causes nausea.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She is unemployed and lives with her
husband.  [**Name (NI) 1139**], she smoked three packs per day for 30
years and quit 20 years ago.  Alcohol, she does not drink. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Cardiac complications, not elsewhere classified,Congestive heart failure, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified,Atrial fibrillation,Nonspecific abnormal findings in stool contents'}
