CHIEF COMPLAINT: Asked to see this patient following cardiac
catheterization where he was found to have three-vessel
disease with an EF of 30 percent.

PRESENT ILLNESS: 72-year-old man with known CAD
status post a MI in [**2148**] underwent cardiac catheterization on
the day of admission and was found to have three-vessel
disease with calcified left main and EF of 30 percent by echo
done in [**2175-3-25**]. The patient had recently stopped digoxin.
He is status post DC cardioversion in [**2175-3-25**]. Woke with
palpitations and chest pain radiating to his jaw. Called [**7-26**]-
1 who on arrival found him to be in a wide complex
tachycardia with a heart rate 180s and hypotension.  They had
to defibrillate him at the scene with 100 joules. He then
went into A-fib with a rate of 115 and better hemodynamics.
At that time, he was transported to   [**Hospital1 18**] for cardiac
catheterization.

MEDICAL HISTORY: Includes CAD status post MI times two,
A-fib, CVA in '[**69**] with residual left-sided weakness,
hypertension, diabetes mellitus type 2 which is diet-
controlled, hypercholesterolemia.  Patient's catheterization
showed a calcified left main, LAD with 80 and 90 percent mid
lesion, left circumflex with a 60-70 percent lesion in the
origin, OM-2 with an 80 percent lesion, RCA with diffuse
disease, RPL with 80 percent lesion.

MEDICATION ON ADMISSION: 

ALLERGIES: Include ampicillin which causes anaphylaxis.

PHYSICAL EXAM: Neuro:  Alert and oriented times three. Moves
all extremities.  Follows commands. Slightly weak on the left
side.  Respiratory:  Clear to auscultation bilaterally.
Cardiovascular:  Regular rate and rhythm, S1-S2 with no
murmurs.  Sternum is stable.  Incision with Steri-Strips open
to air, clean and dry.  Abdomen is soft, non tender,
nondistended.  Positive bowel sounds.  Extremities are warm
and well-perfused with 1-2 plus edema.  Left leg saphenous
vein graft harvest site with Steri-Strips open to air,  clean
and dry. Both left arm and leg with large ecchymotic areas.

FAMILY HISTORY: 

SOCIAL HISTORY: Married, lives with wife, remote tobacco
history, quit in [**2148**] and occasional alcohol use.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled
Subendo infarct, initial,Crnry athrscl natve vssl,Atrial fibrillation,CHF NOS,Hyp kid NOS w cr kid V,DMII renl nt st uncntrld
Admission Date: [**2175-8-10**]        Discharge Date: [**2175-8-21**]

Date of Birth:  [**2103-4-18**]        Sex:  M

Service:  CSU


CHIEF COMPLAINT:  Asked to see this patient following cardiac
catheterization where he was found to have three-vessel
disease with an EF of 30 percent.

HISTORY OF PRESENT ILLNESS:  72-year-old man with known CAD
status post a MI in [**2148**] underwent cardiac catheterization on
the day of admission and was found to have three-vessel
disease with calcified left main and EF of 30 percent by echo
done in [**2175-3-25**]. The patient had recently stopped digoxin.
He is status post DC cardioversion in [**2175-3-25**]. Woke with
palpitations and chest pain radiating to his jaw. Called [**7-26**]-
1 who on arrival found him to be in a wide complex
tachycardia with a heart rate 180s and hypotension.  They had
to defibrillate him at the scene with 100 joules. He then
went into A-fib with a rate of 115 and better hemodynamics.
At that time, he was transported to   [**Hospital1 18**] for cardiac
catheterization.

PAST MEDICAL HISTORY:  Includes CAD status post MI times two,
A-fib, CVA in '[**69**] with residual left-sided weakness,
hypertension, diabetes mellitus type 2 which is diet-
controlled, hypercholesterolemia.  Patient's catheterization
showed a calcified left main, LAD with 80 and 90 percent mid
lesion, left circumflex with a 60-70 percent lesion in the
origin, OM-2 with an 80 percent lesion, RCA with diffuse
disease, RPL with 80 percent lesion.

SOCIAL HISTORY:  Married, lives with wife, remote tobacco
history, quit in [**2148**] and occasional alcohol use.

ALLERGIES:  Include ampicillin which causes anaphylaxis.

MEDICATIONS:
1. Aspirin 81 once daily.
2. Atenolol 100 once daily.
3. Lisinopril 40 once daily.
4. Lipitor 10 once daily.
5. Coumadin 5 on Monday through Friday and 7.5 on Saturday
   and Sunday.
6. Digoxin had been recently discontinued.
7. Lasix 20 once daily.
8. Amiodarone at 1 mg per hour.


LABORATORY DATA:  EKG showed a sinus rhythm with left bundle
branch block, rate of [**Street Address(2) 95877**] depressions in I, II and
III, as well as V3-6 and flip Ts in AVL. Chest x-ray shows no
congestive heart failure.  No significant abnormalities, a
tortuous aorta.  UA is pending.

White count 5.5, hematocrit 41.6, platelets 105, PT 17.8, PTT
32.6, INR 2.0, sodium 142, potassium 4.3, chloride 107, CO2
of 27, BUN 28, creatinine 1.5, glucose 105, CK 181 and 259,
troponin 0.6.

PHYSICAL EXAMINATION:  Neurologically alert and oriented
times three.  Moves all extremities with some left-sided
weakness.  Follows commands.  Respiratory:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rate and
rhythm. S1-S2 with no murmur.  Abdomen:  Soft, nontender,
nondistended with positive bowel sounds.  Extremities are
warm with no edema.  Pulses:  Carotid two plus with a soft
bruit on the right, two plus with no bruit on the left.
Radial two plus bilaterally.  Femoral two plus bilaterally.
Dorsalis pedis one plus bilaterally.

HOSPITAL COURSE:  The patient was seen by Dr. [**Last Name (STitle) **] and a
plan was made to obtain a carotid duplex, echocardiogram, to
stop the Coumadin and begin heparin drip and to wait until
the patient's INR normalized prior to the patient undergoing
surgery.  The patient was followed by the medical service
preoperatively and ultimately on [**8-16**], he was brought
to the operating room at which time he underwent coronary
artery bypass grafting times four.  Please see the OR report
for full details. In summary, the patient had a CABG times
four with the LIMA to the LAD, saphenous vein graft to OM,
saphenous vein graft to PDA with a Y to the RPLV. His bypass
time was 95 minutes with a cross-clamp time of 67 minutes.
He tolerated the operation well and was transferred from the
operating room to the Cardiothoracic Intensive Care Unit.

At the time of transfer, the patient was A-paced at a rate of
88.  He had a mean arterial pressure of 66 with a CVP of 14.
He had epinephrine at 0.02 mcg/kg/min, propofol at 30
mcg/kg/min and nitroglycerin and 0.5 mcg/kg/min.

The patient did well in the immediate postoperative period.
He remained hemodynamically stable.  He was reversed from his
anesthesia, weaned from the ventilator and successfully
extubated. During this period, he remained hemodynamically
stable.

Postoperative day one, the patient continued to be
hemodynamically stable although he did have a high oxygen
requirement. During the course of postoperative day one, the
patient was weaned from his epinephrine drip.  He was also
weaned from his Nipride drip during which the patient
remained hemodynamically stable. On postoperative day two,
the patient's Swan-Ganz catheter was removed.  His was on
beta blockade as well as hydralazine. His chest tubes were
removed and he was transferred to the floor for continuing
postoperative care and cardiac rehabilitation.

Once on the floor, the patient had an uneventful
postoperative course.  His activity level was advanced with
the assistance of the nursing staff as well as the Physical
Therapy Department.

On postoperative day three, his temporary pacing wires were
discontinued and he was begun back on his Coumadin.

On postoperative day five, it was decided that the patient
was stable and ready to be discharged to home. At the time of
this dictation, the patient's physical exam is as follows.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 98.4, heart
rate 68, sinus rhythm, blood pressure 138/72, respiratory
rate 18, O2 sat 97 percent on room air.

LABORATORY DATA:  White count 5.9, hematocrit 31, platelets
132, PT 12.7, PTT 18.4, INR 1.0, sodium 138, potassium 3.9,
chloride 102, CO2 of 27, BUN 27, creatinine 1.4, glucose 113.
Weight preoperatively 92 kg, at discharge 92.4 kg.

PHYSICAL EXAM:  Neuro:  Alert and oriented times three. Moves
all extremities.  Follows commands. Slightly weak on the left
side.  Respiratory:  Clear to auscultation bilaterally.
Cardiovascular:  Regular rate and rhythm, S1-S2 with no
murmurs.  Sternum is stable.  Incision with Steri-Strips open
to air, clean and dry.  Abdomen is soft, non tender,
nondistended.  Positive bowel sounds.  Extremities are warm
and well-perfused with 1-2 plus edema.  Left leg saphenous
vein graft harvest site with Steri-Strips open to air,  clean
and dry. Both left arm and leg with large ecchymotic areas.

CONDITION ON DISCHARGE:  Patient's condition at discharge is
good.

DISCHARGE DIAGNOSES:  CAD status post coronary artery bypass
grafting times four with LIMA to the LAD, saphenous vein
graft to OM and saphenous vein graft to the PDA with a jump
to the RPLV.

A-fib.

CVA.

Diabetes mellitus.

DISCHARGE MEDICATIONS:
1. Lisinopril 20 mg once daily.
2. Aspirin 81 mg once daily.
3. Lasix 20 mg once daily.
4. Potassium chloride 20 mEq once daily.
5. Colace 100 mg b.i.d.
6. Percocet 5/325, 1-2 tablets q. 4-6 hours p.r.n.
7. Amiodarone 400 mg b.i.d. times one week, then 400 mg once
   daily times one week, then 200 mg once daily.
8. Atorvastatin 40 mg once daily.
9. Lopressor 25 mg b.i.d.
10.      Additionally, the patient is to take Coumadin as
   directed by the [**Hospital 197**] Clinic with a goal INR of two to
   three.  His Coumadin dose for Monday the 27th, Tuesday the
   28th, and Wednesday the 29th will be 7.5 mg with an INR
   checked on Thursday the 30th, the results to be called to
   [**Hospital 95878**] [**Hospital 197**] Clinic.


DISPOSITION:  Patient is to be discharged home with visiting
nurses.

FOLLOW UP:  He is to have follow-up in the [**Hospital 409**] Clinic in 2
weeks, follow-up at the [**Hospital 197**] Clinic on Thursday the 30th,
follow-up with Dr. [**Last Name (STitle) **] in 4 weeks, follow-up with Dr.
[**Last Name (STitle) **] in [**2-28**] weeks and follow-up with Dr. [**First Name (STitle) **] on [**9-22**] as previously scheduled.



                        [**Name6 (MD) **] [**Name8 (MD) **], M.D. [**MD Number(2) 5897**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2175-8-21**] 20:32:08
T:  [**2175-8-22**] 15:55:57
Job#:  [**Job Number 95879**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, 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: Asked to see this patient following cardiac
catheterization where he was found to have three-vessel
disease with an EF of 30 percent.

PRESENT ILLNESS: 72-year-old man with known CAD
status post a MI in [**2148**] underwent cardiac catheterization on
the day of admission and was found to have three-vessel
disease with calcified left main and EF of 30 percent by echo
done in [**2175-3-25**]. The patient had recently stopped digoxin.
He is status post DC cardioversion in [**2175-3-25**]. Woke with
palpitations and chest pain radiating to his jaw. Called [**7-26**]-
1 who on arrival found him to be in a wide complex
tachycardia with a heart rate 180s and hypotension.  They had
to defibrillate him at the scene with 100 joules. He then
went into A-fib with a rate of 115 and better hemodynamics.
At that time, he was transported to   [**Hospital1 18**] for cardiac
catheterization.

MEDICAL HISTORY: Includes CAD status post MI times two,
A-fib, CVA in '[**69**] with residual left-sided weakness,
hypertension, diabetes mellitus type 2 which is diet-
controlled, hypercholesterolemia.  Patient's catheterization
showed a calcified left main, LAD with 80 and 90 percent mid
lesion, left circumflex with a 60-70 percent lesion in the
origin, OM-2 with an 80 percent lesion, RCA with diffuse
disease, RPL with 80 percent lesion.

MEDICATION ON ADMISSION: 

ALLERGIES: Include ampicillin which causes anaphylaxis.

PHYSICAL EXAM: Neuro:  Alert and oriented times three. Moves
all extremities.  Follows commands. Slightly weak on the left
side.  Respiratory:  Clear to auscultation bilaterally.
Cardiovascular:  Regular rate and rhythm, S1-S2 with no
murmurs.  Sternum is stable.  Incision with Steri-Strips open
to air, clean and dry.  Abdomen is soft, non tender,
nondistended.  Positive bowel sounds.  Extremities are warm
and well-perfused with 1-2 plus edema.  Left leg saphenous
vein graft harvest site with Steri-Strips open to air,  clean
and dry. Both left arm and leg with large ecchymotic areas.

FAMILY HISTORY: 

SOCIAL HISTORY: Married, lives with wife, remote tobacco
history, quit in [**2148**] and occasional alcohol use. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}
