CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 68 year old
male who presented to the [**Hospital6 2018**] for same day arrival coronary artery bypass graft with
Dr. [**Last Name (STitle) **], Cardiothoracic Surgery.

MEDICAL HISTORY: Significant for as above, diabetes
Type 1, atrial fibrillation in the past with removal of a
curtain rod on which he had impaled himself in his youth and
he denied hypertension.  He denied asthma.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died of cancer.  He states there
was no family history of bleeding disorders and there was no
family history of stroke.

SOCIAL HISTORY: He denied ethanol abuse.  His personal
history was also not significant for stroke and not
significant for bleeding disorder.  He works as an engineer.
He lived with his wife.  [**Name (NI) **] is an ex-smoker and he only takes
occasional social drinks.
Coronary atherosclerosis of native coronary artery,Other complications due to other cardiac device, implant, and graft,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Comp-oth cardiac device,Intermed coronary synd,Atrial fibrillation,DMI wo cmp nt st uncntrl,Hypertension NOS,Status-post ptca
Admission Date:  [**2166-6-3**]       Discharge Date:  [**2166-6-9**]

Date of Birth:   [**2097-10-27**]       Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 68 year old
male who presented to the [**Hospital6 2018**] for same day arrival coronary artery bypass graft with
Dr. [**Last Name (STitle) **], Cardiothoracic Surgery.

Briefly he is a 68 years old, status post stenting of his
right coronary artery and left coronary artery in [**2164**].  He
had substernal chest pain over the last four to five weeks at
rest and prior to this he had exertional angina for six to
eight months.  His cardiac catheterization data showed a mid
left anterior descending, 60% stenosis, left circumflex 40%,
right coronary artery was 100% proximally occluded with an
ejection fraction of 77%.  He had a marginal branch of the
left circumflex.

PAST MEDICAL HISTORY:  Significant for as above, diabetes
Type 1, atrial fibrillation in the past with removal of a
curtain rod on which he had impaled himself in his youth and
he denied hypertension.  He denied asthma.

MEDICATIONS AT HOME:  Isosorbide Dinitrate now 30 mg once a
day, Mavik 1 mg every morning, Lipitor 10 mg once a day,
Aspirin 325 mg once a day, Sotalol 40 mg p.o. b.i.d., Novolin
45 units in the morning and 40 units in the evening.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  His father died of cancer.  He states there
was no family history of bleeding disorders and there was no
family history of stroke.

SOCIAL HISTORY:  He denied ethanol abuse.  His personal
history was also not significant for stroke and not
significant for bleeding disorder.  He works as an engineer.
He lived with his wife.  [**Name (NI) **] is an ex-smoker and he only takes
occasional social drinks.

PHYSICAL EXAMINATION:  His physical examination showed a
heartrate of 55 with a blood pressure of 113/60 and 120/58,
right and left respectively, weight of 189 lbs and a height
of 6 feet.  His physical examination was only remarkable for
some light copper wiring of his retina.  There was no
lymphadenopathy.  His lungs were clear to auscultation.  He
had a regular rate and rhythm to his heart without systolic
ejection murmur.  His abdomen had no scars and was soft and
benign.  He had palpable dorsalis pedis and posterior tibial
distally, slight loss of hair over the toes indicative of
possible early peripheral vascular disease but no obvious
chronic signs of ischemia.  He had no varicosities.
Neurologically he was alert and oriented without any focal
deficits on presentation.  He had palpable radial artery
pulses as well.  He had no carotid artery bruits bilaterally.

HOSPITAL COURSE:  The patient underwent a relatively
uneventful coronary artery bypass graft on same day arrival
on [**2166-6-9**] times two with left internal mammary artery
to left anterior descending, saphenous vein graft, obtuse
marginal, saphenous vein graft to posterior descending
artery.  Anesthesia was general.  His indication was unstable
angina.  The surgeon was Dr. [**Last Name (STitle) **].  Postoperatively he had
a right radial arterial line, a right internal jugular triple
lumen, he had two ventricular and two atrial wires, he had
two mediastinal tubes and one left pleural tube.
Cardiopulmonary bypass time was 46 minutes and crossclamp
time of the aorta was 37 minutes.  He was transferred back to
the Cardiothoracic Intensive Care Unit immediately post
surgery on Propofol at 20 mcg/kg/min and Neo-Synephrine at
0.5 mcg/kg/min.  Over night he was doing well and on the
evening of his surgery he was extubated successfully.  He
required some intermittent pacing at this time.  His chest
tubes were not putting out much.  In fact, his chest tubes
were discontinued as were as lines.  The original plan was to
transfer him to the floor, however, later on that afternoon
prior to his transfer he went into atrial fibrillation with a
heartrate into the 140s to at times 150 without evidence of
hemodynamic compromise.  He was then brought back to sinus
rhythm using a combination of beta blockers and Digoxin and
Sotalol on top of Lopressor.  The decision was made not to
coumadinize him.  He was in uncontrolled atrial fibrillation
for less than 48 hours.  However, he did require
Neo-Synephrine to be restarted for his atrial fibrillation
transiently.  The chest tube which had prior been scheduled
to be pulled out was not pulled out because of an air leak
and was discontinued on [**6-6**].  A chest x-ray following
that showed that he had a small pneumothorax.  He was
transferred to the floor successfully without incident and on
[**6-7**], follow up film showed that he did not have any
substantial pneumothorax, therefore he was stable.  The
patient's wires, Foley catheter, and central lines were all
discontinued during the course of his admission without any
problem.  [**Name (NI) **] was discharged home on [**2166-6-9**].

He, upon discharge, had physical examination which showed
that he was afebrile with stable vital signs, pulse 79, blood
pressure 134/66, saturations 94% on room air.  He had a
regular rate and rhythm.  He had no sternal drainage.  He had
no erythema.  He had no discharge whatsoever and his wound
was clean, dry and intact.  His abdomen was soft, nontender
and his extremities did not have any significant edema.

DISCHARGE MEDICATIONS:
1.  Amiodarone 400 mg p.o. t.i.d. times three days, 400 mg
b.i.d. times seven days and then 200 mg q.d. for his episode
of atrial fibrillation which has at this time been in sinus
rhythm for more than 48 hours.
2.  Lipitor 10 mg p.o. q.d.
3.  Aspirin 325 mg p.o. q.d.
4.  Colace 100 mg p.o. b.i.d.
5.  Potassium chloride 20 mEq p.o. q.d. for four days
6.  Lasix 20 mg p.o. q.d. times four days
7.  Lopressor 25 mg p.o. b.i.d.
8.  Tylenol 500 mg 1 gm q. [**3-1**] h. prn pain
9.  Motrin 600 mg q. 6 h. prn pain
10. Resume all home medications
11. Prescription given for narcotic pain killers

DISPOSITION:  Home.

FOLLOW UP:  He is to follow up with Dr. [**Last Name (STitle) **] in four weeks
and his primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 34715**] in three to four
weeks.

DISCHARGE INSTRUCTIONS:  He was discharged home without any
difficulty and to resume his home medication on discharge
with regards to his diabetes control and cardiac medications
as stated above.  The staples will come out 15 days
postoperatively.



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

Dictated By:[**Name8 (MD) 16758**]
MEDQUIST36

D:  [**2166-6-12**]  08:14
T:  [**2166-6-12**]  08:54
JOB#:  [**Job Number 34716**]
{'Coronary atherosclerosis of native coronary artery,Other complications due to other cardiac device, implant, and graft,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status'}


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 68 year old
male who presented to the [**Hospital6 2018**] for same day arrival coronary artery bypass graft with
Dr. [**Last Name (STitle) **], Cardiothoracic Surgery.

MEDICAL HISTORY: Significant for as above, diabetes
Type 1, atrial fibrillation in the past with removal of a
curtain rod on which he had impaled himself in his youth and
he denied hypertension.  He denied asthma.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: His father died of cancer.  He states there
was no family history of bleeding disorders and there was no
family history of stroke.

SOCIAL HISTORY: He denied ethanol abuse.  His personal
history was also not significant for stroke and not
significant for bleeding disorder.  He works as an engineer.
He lived with his wife.  [**Name (NI) **] is an ex-smoker and he only takes
occasional social drinks. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other complications due to other cardiac device, implant, and graft,Intermediate coronary syndrome,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status'}
