CHIEF COMPLAINT: The patient is a 69-year-old male referred
by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for an outpatient cardiac catheterization
secondary to a positive stress test.

PRESENT ILLNESS: This is a 60 year old male who
is status post fall and was being worked up for rotator cuff
repair when he had an abnormal electrocardiogram.  He has a
history of chronic obstructive pulmonary disease, diet
controlled diabetes mellitus, high cholesterol and
pericarditis.  He had an exercise treadmill test on [**2173-3-10**],
which was negative for chest pain but revealed moderate to
severe anterior apical ischemia with an ejection fraction of
54%.  He underwent cardiac catheterization on [**2173-3-11**], which
showed left main short nonobstructive, nonobstructive left
anterior descending, heavily obstructed proximal 60%, distal
100% occluded, filled by bridging collaterals, left
circumflex midsection 50% stenosed, right coronary artery
proximal 50% stenosed, left ventricular ejection fraction of
55% with no mitral regurgitation.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease.
2.  Diet controlled diabetes mellitus.
3.  High cholesterol.
4.  Pericarditis.
5.  Back surgery.
6.  Carpal tunnel surgery.
7.  Transurethral resection of prostate.
8.  Hypertension.

MEDICATION ON ADMISSION: 1.  Ecotrin.
2.  Lopressor.
3.  Lisinopril.
4.  Atorvastatin.
5.  Zantac.

ALLERGIES: Codeine which causes nausea and vomiting.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for coronary artery disease.  He
has two brothers who both have had coronary artery bypass
grafts.

SOCIAL HISTORY: The patient is an ex-smoker and quit 33
years ago.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical or other procedure not carried out because of contraindication,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Intermed coronary synd,Atrial fibrillation,Chr airway obstruct NEC,Abn react-cardiac cath,No proc/contraindication,Abn react-anastom/graft,DMII wo cmp nt st uncntr
Admission Date:  [**2173-3-11**]       Discharge Date:  [**2173-3-22**]

Date of Birth:   [**2103-5-5**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This is a 60 year old male who
is status post fall and was being worked up for rotator cuff
repair when he had an abnormal electrocardiogram.  He has a
history of chronic obstructive pulmonary disease, diet
controlled diabetes mellitus, high cholesterol and
pericarditis.  He had an exercise treadmill test on [**2173-3-10**],
which was negative for chest pain but revealed moderate to
severe anterior apical ischemia with an ejection fraction of
54%.  He underwent cardiac catheterization on [**2173-3-11**], which
showed left main short nonobstructive, nonobstructive left
anterior descending, heavily obstructed proximal 60%, distal
100% occluded, filled by bridging collaterals, left
circumflex midsection 50% stenosed, right coronary artery
proximal 50% stenosed, left ventricular ejection fraction of
55% with no mitral regurgitation.

PAST MEDICAL HISTORY:
1.  Chronic obstructive pulmonary disease.
2.  Diet controlled diabetes mellitus.
3.  High cholesterol.
4.  Pericarditis.
5.  Back surgery.
6.  Carpal tunnel surgery.
7.  Transurethral resection of prostate.
8.  Hypertension.

MEDICATIONS ON ADMISSION:
1.  Ecotrin.
2.  Lopressor.
3.  Lisinopril.
4.  Atorvastatin.
5.  Zantac.

ALLERGIES:  Codeine which causes nausea and vomiting.

SOCIAL HISTORY:  The patient is an ex-smoker and quit 33
years ago.

FAMILY HISTORY:  Positive for coronary artery disease.  He
has two brothers who both have had coronary artery bypass
grafts.

PHYSICAL EXAMINATION:  In general, the patient is alert and
oriented in no acute distress.  His neurologic examination is
grossly intact.  No carotid bruits noted.  Pulmonary - The
lungs are clear to auscultation bilaterally.  Cardiac -
Regular rate and rhythm, no murmurs noted.  The abdomen is
soft, nontender, nondistended.  Extremities - Cool feet,
positive dorsalis pedis and popliteal pulses bilaterally.  No
edema and no varicosities.

HOSPITAL COURSE:  The patient was admitted on [**2173-3-11**], and
taken to the operating room on [**2173-3-12**], where coronary
artery bypass graft times three was performed.
Postoperatively, the patient required Propofol and
Neo-Synephrine drip.  He left the operating room as well with
chest tubes and pacing wires in place.  He received four
doses of perioperative Vancomycin as antimicrobial
prophylaxis.  The patient initially did quite well and was
started on his postoperative medications of Lopressor and
Lasix.  His diet was advanced successfully.  His drips were
eventually weaned.  His chest tubes and pacing wires were
removed at the appropriate time.  The patient was initially
going to leave the Intensive Care Unit on postoperative day
number one but once he arrived to the floor, the patient had
an episode of rapid atrial fibrillation.  He received 8 mg of
Lopressor which caused his blood pressure to drop
precipitously.  He was then transferred back to the Intensive
Care Unit where he required a Neo-Synephrine drip again and
close observation.  The patient subsequently did well and he
was started on Amiodarone and continued on his Lopressor.
While in the Intensive Care Unit, the patient required a unit
of packed red blood cells for acute anemia.  When the patient
was adequately stable, he was transferred to the regular
cardiothoracic floor where he continued to do well.  He was
seen by physical therapy who were happy with his progress and
eventually cleared him to go home without continuing physical
therapy.  The patient was also seen by the Electrophysiology
team regarding his rapid atrial fibrillation.  They made
recommendations for anticoagulation and continued Lopressor
and Amiodarone treatment.  Over the next couple days, the
patient continued to have short bursts of rapid atrial
fibrillation that would spontaneously break within
approximately two minutes.  Finally on [**2173-3-20**], the patient
had another episode of rapid atrial fibrillation although
this episode did not break quickly.  He required 10 mg of
Lopressor and 150 mg of intravenous Amiodarone bolus to break
the episode.  Electrophysiology again was notified and they
recommended Lopressor 100 mg twice a day, Amiodarone 400 mg
twice a day times five days, Amiodarone 400 mg once daily
thereafter with follow-up in a couple weeks.  They also
recommended [**Doctor Last Name **] of Hearts for discharge.  They did indicate
that the patient would be safe for discharge.

It is now [**2173-3-20**], and the patient is ready for discharge.
He will likely go home in the morning on [**2173-3-21**], once INR
monitoring and [**Doctor Last Name **] of Hearts are organized.  The patient
will be discharged in good condition.

FOLLOW-UP:  He is to follow-up with Dr. [**Last Name (STitle) 70**] in four
weeks.  He is to follow-up with Dr. [**Last Name (STitle) **] in two weeks and
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17887**] in one to two weeks.

MEDICATIONS ON DISCHARGE:
1.  Lopressor 100 mg twice a day.
2.  Amiodarone 400 mg twice a day times five days and then
once daily.
3.  Coumadin dose daily per recommendations of Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 17887**] after daily INR checks.
4.  Percocet one to two tablets p.o. q4-6hours p.r.n. pain.
5.  Atorvastatin 20 mg p.o. once daily.
6.  Ranitidine 150 mg p.o. twice a day.
7.  Enteric Coated Aspirin 325 mg p.o. once daily.
8.  Colace 100 mg p.o. twice a day p.r.n.

The patient may shower but should not take baths.  The
patient should not drive while on pain medication.  The
patient should avoid strenuous activity.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Last Name (NamePattern4) 12487**]
MEDQUIST36

D:  [**2173-3-21**]  11:16
T:  [**2173-3-21**]  12:06
JOB#:  [**Job Number 49682**]


Admission Date:  [**2173-3-11**]       Discharge Date:  [**2173-3-25**]

Date of Birth:   [**2103-5-5**]       Sex:  M

Service:

CHIEF COMPLAINT:  The patient is a 69-year-old male referred
by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for an outpatient cardiac catheterization
secondary to a positive stress test.

HISTORY OF THE PRESENT ILLNESS:  Mr. [**Known lastname 27060**] was referred for
a stress test after having abnormal preoperative EKGs prior
to this workup for rotator cuff surgery.  The patient did not
have chest pain or shortness of breath at that time.  The
stress test was done on [**2173-3-10**].  During that time, the
patient did have chest pain and the test was stopped due to
fatigue.  Nuclear imaging revealed moderate to severe
anteroapical ischemia with an ejection fraction of 54%.

The patient had a catheterization on [**2173-3-11**] at the
[**Hospital6 256**].  The final assessment
was occlusive LAD disease with left circumflex and right
coronary artery disease.  At that time, Cardiothoracic
Surgery was consulted.

PAST MEDICAL HISTORY:
1.  COPD.
2.  Diet-controlled diabetes mellitus.
3.  Hypercholesterolemia.
4.  Pericarditis.
5.  Carpal tunnel surgery in [**2163**].
6.  Back surgery in [**2140**].
7.  TURP in [**2164**].
8.  Hypertension.

PREOPERATIVE MEDICATIONS:
1.  Aspirin.
2.  Lopressor 25 mg p.o. b.i.d.
3.  Lisinopril 40 mg p.o. q.d.
4.  Atorvostatin 20 mg p.o. q.d.
5.  Zantac 150 mg p.o. q.d.

PHYSICAL EXAMINATION ON ADMISSION:  Lungs:  Clear to
auscultation bilaterally.  Cardiac:  Regular rate and rhythm.
No murmurs detected.  Abdomen:  Soft, nontender,
nondistended.  Positive bowel sounds.  Extremities:  Cool
feet.  Positive DP and PT bilaterally.  No edema.  No
varicosities.

HOSPITAL COURSE:  The patient was admitted with the
preoperative diagnosis of coronary artery disease.  The
patient was brought to the Operating Room on [**2173-3-12**] and had
a CABG times three.  The patient had a LIMA to the LAD, and a
saphenous vein graft to the OM and then to the PDA.  Surgery
was performed by Dr. [**Last Name (STitle) 70**] and Dr. [**Last Name (STitle) 7625**].  The patient
was transported to the CSRU in stable condition.

On postoperative day number one, the patient complained of
increased pain which was treated with morphine, Toradol, and
Dilaudid.  The patient had his Swan discontinued and was out
of bed and walking.

On postoperative day number two and three, the patient
continued to do well, although had several bouts of rapid
atrial fibrillation which responded to Amiodarone boluses and
Lopressor.  At that time, beta blockers and Lasix were
initiated.

On postoperative day number four, the patient's hematocrit
was 24.6 and was transfused 1 unit of packed red blood cells.
On postoperative day number five, the patient was transferred
to the cardiac floor.

On the floor, this patient continued to do well.  The
patient's physical therapy level quickly returned to a level
V.  The patient had numerous bouts of rapid atrial
fibrillation into the 150 and 180 range.  Electrophysiology
was consulted and recommended gentle diuresis and treatment
with Amiodarone in combination with beta blockers.

Throughout the patient's hospitalization stay, his atrial
fibrillation continued to be rapid in the 150-180 range
intermittently.  Electrophysiology concluded that the patient
was not a candidate for nodal ablation or pacemaker.  At this
time, it was decided that we would maximize medical therapy.
The Amiodarone and Lopressor doses were increased
appropriately.

On [**2173-3-25**], the patient was well enough to be discharged to
home in stable condition.

DISCHARGE PHYSICAL EXAMINATION:  Vital signs:  Temperature
maximum 98, temperature current 98, heart rate 60 and sinus
with intermittent atrial fibrillation, BP 156/76, respiratory
rate 20, 02 saturation 96% on room air.  The patient was at
his preoperative weight.

Predischarge x-ray showed small bilateral effusions.

DISCHARGE DIAGNOSIS:
1.  Status post coronary artery bypass grafting times three
with left internal mammary artery to the left anterior
descending artery, saphenous vein graft to the obtuse
marginal and posterior descending artery.
2.  Chronic obstructive pulmonary disease.
3.  Diet-controlled diabetes mellitus.
4.  Hypercholesterolemia.
5.  Pericarditis.
6.  Status post transurethral resection of the prostate in
[**2164**].
7.  Status post carpal tunnel surgery.
8.  Status post vascular surgery in [**2140**].

DISCHARGE MEDICATIONS:
1.  Lopressor 75 mg p.o. b.i.d.
2.  Diltiazem 120 mg p.o. q.d.
3.  Amiodarone 400 mg p.o. q.d.
4.  Ativan 0.5 mg t.i.d.
5.  Coumadin 2 mg p.o. q.o.d., 1 mg p.o. q.o.d.
6.  Percocet 5/325 one to two tablets p.o. q. four to six
hours.
7.  Atorvostatin 20 mg p.o. q.d.
8.  Zantac 150 mg p.o. b.i.d.
9.  Aspirin 325 mg p.o. q.d.
10. Colace 100 mg p.o. b.i.d.

DISPOSITION:  The patient will be discharged home in good
stable condition with VNA.

FOLLOW-UP:  The patient will follow-up with Dr. [**Last Name (STitle) 70**] in
six weeks.  The patient will also follow-up with his primary
care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 49683**], in one week.  The
patient's Coumadin will be drawn by the visiting nurse and
called into the primary care office once a day.  Prior to
discharge, Dr. [**Last Name (STitle) 49683**] was contact[**Name (NI) **] by the Cardiothoracic
Service and agreed to monitor the patient's Coumadin during
the postoperative period.  The patient will call Dr.[**Name (NI) 45666**] office with any questions or concerns.




                            [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Last Name (NamePattern4) 959**]
MEDQUIST36

D:  [**2173-3-29**]  08:42
T:  [**2173-3-29**]  20:56
JOB#:  [**Job Number 49684**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical or other procedure not carried out because of contraindication,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: The patient is a 69-year-old male referred
by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] for an outpatient cardiac catheterization
secondary to a positive stress test.

PRESENT ILLNESS: This is a 60 year old male who
is status post fall and was being worked up for rotator cuff
repair when he had an abnormal electrocardiogram.  He has a
history of chronic obstructive pulmonary disease, diet
controlled diabetes mellitus, high cholesterol and
pericarditis.  He had an exercise treadmill test on [**2173-3-10**],
which was negative for chest pain but revealed moderate to
severe anterior apical ischemia with an ejection fraction of
54%.  He underwent cardiac catheterization on [**2173-3-11**], which
showed left main short nonobstructive, nonobstructive left
anterior descending, heavily obstructed proximal 60%, distal
100% occluded, filled by bridging collaterals, left
circumflex midsection 50% stenosed, right coronary artery
proximal 50% stenosed, left ventricular ejection fraction of
55% with no mitral regurgitation.

MEDICAL HISTORY: 1.  Chronic obstructive pulmonary disease.
2.  Diet controlled diabetes mellitus.
3.  High cholesterol.
4.  Pericarditis.
5.  Back surgery.
6.  Carpal tunnel surgery.
7.  Transurethral resection of prostate.
8.  Hypertension.

MEDICATION ON ADMISSION: 1.  Ecotrin.
2.  Lopressor.
3.  Lisinopril.
4.  Atorvastatin.
5.  Zantac.

ALLERGIES: Codeine which causes nausea and vomiting.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for coronary artery disease.  He
has two brothers who both have had coronary artery bypass
grafts.

SOCIAL HISTORY: The patient is an ex-smoker and quit 33
years ago. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Surgical or other procedure not carried out because of contraindication,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
