CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78 year old man
with an abnormal stress test referred to [**Hospital1 18**] for cardiac
catheterization prior to having surgery on his cervical
spine.  Two weeks prior to admission the patient complained
of chest heaviness with pains radiating down his arms while
lying in bed.  He reports that for several days before that
he started an exercise program involving new arm exercises.
The pain lasted for five minutes and then resolved.  He does
report that over the last several years he has worked on a
treadmill on a daily basis for 30 minutes without any
symptoms.  He had a Persantine stress test done on [**1-17**] that was negative for chest pain or EKG changes,
however, nuclear imaging showed a small area of septal
ischemia with an EF of 60 percent and normal wall motion.

MEDICAL HISTORY: The patient's past medical history is
significant for chronic ataxia related to a cervical spine
disease, chronic nystagmus, hyperkalemia, arthritis, spinal
stenosis status post lumbar laminectomy, bilateral carpal
tunnel surgery, trigger finger surgery and hernia repair, as
well as BPH.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states an allergy to sulfa and to
Keflex.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is noncontributory.

SOCIAL HISTORY: Married.  Retired electronics engineer.
Coronary atherosclerosis of native coronary artery,Hyperpotassemia,Lack of coordination,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other forms of nystagmus,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Contact dermatitis and other eczema, unspecified cause,Spinal stenosis, lumbar region, without neurogenic claudication
Crnry athrscl natve vssl,Hyperpotassemia,Lack of coordination,Osteoarthros NOS-unspec,Nystagmus NEC,BPH w/o urinary obs/LUTS,Dermatitis NOS,Spin sten,lumbr wo claud
Admission Date: [**2132-1-28**]        Discharge Date: [**2132-2-3**]

Date of Birth:  [**2053-9-14**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  The patient is a 78 year old man
with an abnormal stress test referred to [**Hospital1 18**] for cardiac
catheterization prior to having surgery on his cervical
spine.  Two weeks prior to admission the patient complained
of chest heaviness with pains radiating down his arms while
lying in bed.  He reports that for several days before that
he started an exercise program involving new arm exercises.
The pain lasted for five minutes and then resolved.  He does
report that over the last several years he has worked on a
treadmill on a daily basis for 30 minutes without any
symptoms.  He had a Persantine stress test done on [**1-17**] that was negative for chest pain or EKG changes,
however, nuclear imaging showed a small area of septal
ischemia with an EF of 60 percent and normal wall motion.

PAST MEDICAL HISTORY:  The patient's past medical history is
significant for chronic ataxia related to a cervical spine
disease, chronic nystagmus, hyperkalemia, arthritis, spinal
stenosis status post lumbar laminectomy, bilateral carpal
tunnel surgery, trigger finger surgery and hernia repair, as
well as BPH.

ALLERGIES:  The patient states an allergy to sulfa and to
Keflex.

MEDICATIONS:  Meds on admission include Flomax, 0.4 daily;
Avodart, 0.5 mg daily; Hydrochlorothiazide, 25 daily;
aspirin, 325 daily.

FAMILY HISTORY:  Family history is noncontributory.

SOCIAL HISTORY:  Married.  Retired electronics engineer.

LABORATORY DATA:  White count 11.6, hematocrit 45.4,
platelets 375, INR 1.1.  Sodium 143, potassium 4.9, chloride
104, CO2 34, BUN 28, creatinine 1.4, glucose 112.

EKG was sinus rhythm at a rate of 70 with a left axis.

PHYSICAL EXAMINATION:  Height 5 feet 7 inches.  Weight 140
pounds.  Vital Signs:  Temperature 98.  Heart rate 78.  Blood
pressure 156/74.  Respiratory rate 16.  O2 sat 99 percent on
room air.  Neurologic:  Alert and oriented.  Moves all
extremities.  Follows commands.  Respiratory:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rate and
rhythm.  S1 and S2 with no murmurs.  Abdomen is soft and
nontender and non-distended with normoactive bowel sounds.
Extremities are warm and well perfused with no lower
extremity edema.

HOSPITAL COURSE:  The patient was admitted to cardiology
where he underwent cardiac catheterization.  Please see the
catheter report for full details.  In summary, it showed left
main 70 percent disease, LAD 80 percent disease, left
circumflex 90 percent disease and RCA with 70 percent disease
before the PDA.  A ventriculostomy was not performed.
Cardiac surgery was consulted.  On [**1-29**] the patient was
brought to the operating room, where he underwent coronary
artery bypass grafting.  Please see the OR report for full
details.  In summary, the patient had a CABG times four with
LIMA to the LAD, saphenous vein graft to diagonal, saphenous
vein graft to OM and saphenous vein graft to RCA.  His bypass
time was 103 minutes with a cross clamp time of 82 minutes.
He tolerated the operation well and was transferred from the
operating room to the Cardiothoracic Intensive Care Unit.
The patient did well in the immediate postoperative period.
His anesthesia was reversed, he was weaned from the
ventilator and successfully extubated.  He did well on the
day of surgery, remaining hemodynamically stable, requiring
only Neo-Synephrine infusion to maintain an adequate blood
pressure.

On postoperative day one the patient continued to be
hemodynamically stable.  His Neo-Synephrine infusion was
weaned as tolerated.  He was begun on gentle diuresis and he
remained in the ICU for continuing hemodynamic monitoring.

On postoperative day two the patient continued to do well.
His Neo-Synephrine infusion continued to be weaned.  His
hematocrit was noted to be 23.6 and he received 2 units of
packed red blood cells, following which the patient weaned
from his Neo-Synephrine infusion completely.  His chest tubes
were removed and he was transferred from the Intensive Care
Unit to the floor continuing postoperative care and cardiac
rehabilitation.

Over the next two days the [**Hospital 228**] hospital course was
uneventful.  His activity level was increased with the
assistance of the nursing staff and physical therapy staff.
He continued to be diuresed and his beta blockade was
adjusted as tolerated.

On postoperative day four it was decided that the following
day the patient will be stable and ready to be discharged to
rehabilitation.

At the time of this dictation the patient's physical exam is
as follows:  Temperature 99.  Heart rate 79.  Sinus rhythm.
Blood pressure 108/49.  Respiratory rate 18.  O2 saturation
93 percent on room air.  Weight preoperatively was 66 kilos,
at discharge 74 kilos.  Neurologically alert and oriented.
Moves all extremities.  Strength equal bilaterally.  Nonfocal
exam.  Pulmonary clear to auscultation with a few fine
crackles at the bases.  Cardiac:  Regular rate and rhythm.
S1 and S2 with no murmurs.  Sternum is stable.  Incision with
staples.  No erythema or drainage.  The abdomen is soft and
nontender and non-distended with normoactive bowel sounds.
The patient's extremities are warm and well perfused with
trace edema.  Right endoscopic vein harvest site with Steri-
Strips, clean and dry without erythema or drainage.

Lab data:  Hematocrit 26, sodium 142, potassium 4.2, chloride
104, CO2 36, BUN 20, creatinine 1.3, glucose 103.

The patient is to be discharged to rehabilitation.  His
condition at the time of discharge is good.  He is to follow
up with Dr. [**Last Name (STitle) 4469**] in two to three weeks following his
discharge from rehabilitation, and follow up with Dr. [**Last Name (STitle) **]
in four weeks from his discharge from [**Hospital1 18**].

DISCHARGE DIAGNOSES:
1. Coronary artery disease, status post coronary artery
   bypass grafting times four with a LIMA to the LAD,
   saphenous vein graft to diagonal, saphenous vein graft to
   OM, and saphenous vein graft to RCA.
2. Chronic ataxia.
3. Chronic nystagmus.
4. Hyperkalemia.
5. Arthritis.
6. Spinal stenosis, status post lumbar laminectomy.
7. Status post carpal tunnel surgery.
8. Trigger finger surgery.
9. Hernia repair.
10.      Benign prostatic hypertrophy.


DISCHARGE MEDICATIONS:
1. Lopressor, 20 mg daily times 2 weeks.
2. Potassium chloride, 20 mEq daily times 2 weeks.
3. Colace, 100 mg [**Hospital1 **] while taking any narcotic.
4. Aspirin, 81 mg daily.
5. Percocet 5/325, 1 to 2 tablets q4-6h as needed.
6. Plavix, 75 mg daily times three months.
7. Flomax, 0.4 mg at bedtime.
8. Avodart, 0.5 mg at bedtime.
9. Metoprolol, 25 mg [**Hospital1 **].




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

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2132-2-2**] 15:44:28
T:  [**2132-2-2**] 16:22:11
Job#:  [**Job Number 104067**]


Name:  [**Known lastname **],[**Known firstname 970**]                 Unit No:   [**Numeric Identifier 16864**]

Admission Date:  [**2132-1-28**]              Discharge Date:   [**2132-2-5**]

Date of Birth:  [**2053-9-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Sulfa (Sulfonamides) / Keflex

Attending:[**First Name3 (LF) 4551**]
Addendum:
Mr. [**Known lastname **] remained an in-patient from [**2-3**] (time of
discharge summary) through [**2-5**] due to lack of bed availability
at rehabilitation facilities.
This time was significant only for a contact dermatitis on his
buttocks, extending down to his upper thighs, treated with Sarna
lotion and non-bleached linens.
He is at this time, ready for discharge to rehab.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 3287**] TCU

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

Completed by:[**2132-2-5**]
{'Coronary atherosclerosis of native coronary artery,Hyperpotassemia,Lack of coordination,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other forms of nystagmus,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Contact dermatitis and other eczema, unspecified cause,Spinal stenosis, lumbar region, without neurogenic claudication'}


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 78 year old man
with an abnormal stress test referred to [**Hospital1 18**] for cardiac
catheterization prior to having surgery on his cervical
spine.  Two weeks prior to admission the patient complained
of chest heaviness with pains radiating down his arms while
lying in bed.  He reports that for several days before that
he started an exercise program involving new arm exercises.
The pain lasted for five minutes and then resolved.  He does
report that over the last several years he has worked on a
treadmill on a daily basis for 30 minutes without any
symptoms.  He had a Persantine stress test done on [**1-17**] that was negative for chest pain or EKG changes,
however, nuclear imaging showed a small area of septal
ischemia with an EF of 60 percent and normal wall motion.

MEDICAL HISTORY: The patient's past medical history is
significant for chronic ataxia related to a cervical spine
disease, chronic nystagmus, hyperkalemia, arthritis, spinal
stenosis status post lumbar laminectomy, bilateral carpal
tunnel surgery, trigger finger surgery and hernia repair, as
well as BPH.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states an allergy to sulfa and to
Keflex.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is noncontributory.

SOCIAL HISTORY: Married.  Retired electronics engineer. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Hyperpotassemia,Lack of coordination,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Other forms of nystagmus,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Contact dermatitis and other eczema, unspecified cause,Spinal stenosis, lumbar region, without neurogenic claudication'}
