CHIEF COMPLAINT: 

PRESENT ILLNESS: 

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 1. Atenolol 25 q.d.
2. Norvasc 10 q.d.
3. Zocor 20 q.d.
4. Plavix 75 q.d.

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: Neurologically:
Alert and oriented times three.  Moves all extremities,
follows commands.  Nonfocal exam.  Respiratory:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rate and
rhythm, S1, S2.  Sternum is stable.  Incision with Steri-
Strips open to air clean and dry.  Abdomen is soft,
nontender, nondistended with normoactive bowel sounds.
Colostomy with pink stoma.  Extremities are warm and well
perfused with 1 plus edema.  Right saphenous vein graft site
with Steri-Strips open to air, clean and dry.

FAMILY HISTORY: No significant family history.

SOCIAL HISTORY: Lives in [**Hospital1 3494**] with his wife.  [**Name (NI) **] is
very independent and active.  Denies alcohol use.  Denies
tobacco use.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of large intestine
Crnry athrscl natve vssl,Intermed coronary synd,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Hx of colonic malignancy
Admission Date: [**2164-7-19**]        Discharge Date: [**2164-7-25**]

Date of Birth:  [**2089-8-11**]        Sex:  M

Service:  CSU


HISTORY:  The patient is a direct admission to the operating
room for coronary artery bypass grafting.  He underwent
cardiac catheterization at [**Hospital1 **] [**First Name (Titles) **] [**2164-6-12**].  His chief complaint was shortness of breath and cold
sweats along with not feeling well and mild dyspnea, which
were new symptoms.  He had a positive exercise tolerance test
and was referred for cardiac catheterization.  His
catheterization showed an EF of 50 percent with left main 30
percent, LAD 100 percent mid and 50 percent proximal lesions,
circumflex 100 percent, ostia 30 percent proximal lesion with
a 70 percent PDA proximal lesion.

PAST MEDICAL HISTORY:  Hypertension.

Hyperlipidemia.

Colostomy after colon resection due to colon cancer.

ALLERGIES:  The patient states no known drug allergies.

MEDICATIONS ON ADMISSION:
1. Atenolol 25 q.d.
2. Norvasc 10 q.d.
3. Zocor 20 q.d.
4. Plavix 75 q.d.


SOCIAL HISTORY:  Lives in [**Hospital1 3494**] with his wife.  [**Name (NI) **] is
very independent and active.  Denies alcohol use.  Denies
tobacco use.

FAMILY HISTORY:  No significant family history.

PHYSICAL EXAMINATION:  Height 5'7".  Weight 197 pounds.
Vital signs:  Afebrile.  Heart rate 63, sinus rhythm, blood
pressure 143/69, respiratory rate 16, and O2 saturation 94
percent on room air.  General:  Lying flat in bed in no acute
distress.  Neurologic:  Alert and oriented times three,
nonfocal examination.  Cranial nerves are grossly intact.
Neck is supple.  No lymphadenopathy and no bruits.
Respiratory:  Clear to auscultation bilaterally.
Cardiovascular:  Regular rate and rhythm, S1, S2, with no
murmurs, rubs, or gallops.  Abdomen is soft, nontender,
nondistended with normoactive bowel sounds.  Colostomy with a
pink stoma.  Extremities are warm and well perfused with no
edema or varicosities.  Pulses:  Radial 2 plus bilaterally.
Dorsalis pedis 2 plus bilaterally.  Posterior tibial 2 plus
bilaterally.  Femoral 1 plus bilaterally.

LABORATORY DATA:  White count 6.4, hematocrit 43.3, platelets
170.  PT 15.5, PTT 34.3, INR 1.5.  Sodium 136, potassium 4.1,
chloride 104, CO2 23, BUN 14, creatinine 0.9, and glucose
210.  ALT 19, AST 14.8, alkaline phosphatase 70, amylase 74,
total bilirubin 0.6, albumin 3.7.  Urinalysis was negative.

EKG:  Sinus bradycardia with left anterior fascicular block.
Nonspecific ST changes.

CHEST X-RAY:  Small rounded opacity noted in the left lung
base likely representing a nipple shadow.

HOSPITAL COURSE:  As stated previously, the patient was a
direct admission to the operating room, where he underwent
coronary artery bypass grafting x4.  Please see the OR report
for full details.  In summary, the patient had a CABG x4 with
a free LIMA to the LAD, saphenous vein graft to diag,
saphenous vein graft to OM, and saphenous vein graft to the
PDA.  His bypass time was 101 minutes with a cross-clamp time
of 63 minutes.  He tolerated the operation well.  Was
transferred from the operating room to the Cardiothoracic
Intensive Care Unit.

Patient did well in the immediate postoperative period.  His
anesthesia was reversed.  His sedation was discontinued and
he was successfully weaned from the ventilator and extubated.
He remained hemodynamically stable throughout the day of his
surgery requiring a Neo-Synephrine infusion to maintain an
adequate blood pressure.

On postoperative day one, patient continued to do well.  He
remained hemodynamically stable.  His Neo-Synephrine drip was
weaned to off.  His chest tubes were removed.  Diuresis was
begun and he stayed in the Cardiothoracic Intensive Care Unit
because he was on Neo-Synephrine drip during part of the day.

On postoperative day two, the patient continued to remain
hemodynamically stable.  His diuretics were increased.
Central lines were discontinued, and he was transferred to
the floor for continuing postoperative care and cardiac
rehabilitation.  Once on the floor, the patient had an
uneventful hospital course.  His activity level was gradually
advanced with the assistance of the nursing staff and
physical therapy.  He was noted to have several short bursts
of SVT for which his beta blockade was increased.  On
postoperative day six, it was decided that the patient was
stable and ready to be discharged to home.

At the time of this dictation, patient's physical exam is as
follows:  Vital signs:  Temperature 98.8, heart rate 77,
sinus rhythm, blood pressure 113/75, respiratory rate 20, and
O2 saturation 94 percent on room air.  Weight preoperatively
95 kg.  At discharge, 92.2 kg.  Laboratory data:  Hematocrit
25.9, sodium 136, potassium 4.5, chloride 99, CO2 28, BUN 22,
creatinine 1.1, glucose 127.  Physical exam:  Neurologically:
Alert and oriented times three.  Moves all extremities,
follows commands.  Nonfocal exam.  Respiratory:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rate and
rhythm, S1, S2.  Sternum is stable.  Incision with Steri-
Strips open to air clean and dry.  Abdomen is soft,
nontender, nondistended with normoactive bowel sounds.
Colostomy with pink stoma.  Extremities are warm and well
perfused with 1 plus edema.  Right saphenous vein graft site
with Steri-Strips open to air, clean and dry.

CONDITION ON DISCHARGE:  Good.

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

DISCHARGE DIAGNOSES:  Coronary artery disease status post
coronary artery bypass grafting x4 with a free left internal
mammary artery to the left anterior descending artery,
saphenous vein graft to diagonal, saphenous vein graft to
obtuse margin, saphenous vein graft to posterior descending
artery.

Hypertension.

Hypercholesterolemia.

Colon cancer status post colectomy with colostomy.

Diabetes mellitus type 2.

FOLLOW-UP INSTRUCTIONS:  The patient is to have followup in
the [**Hospital 409**] Clinic in two weeks.  Follow up with Dr. [**Last Name (STitle) 105058**] in
[**12-20**] weeks.  Follow up with Dr. [**Last Name (STitle) **] in four weeks.

DISCHARGE MEDICATIONS:
1. OxyContin 5/325 1-2 tablets q.4h. prn.
2. Lasix 20 mg q.d. for two weeks.
3. Aspirin 325 q.d.
4. Metoprolol 50 mg b.i.d.
5. Potassium chloride 20 mEq q.d. for two weeks.
6. Simvastatin 20 mg q.d.
7. Niferex 150 mg q.d. x1 month.


DISCHARGE INSTRUCTIONS:  Additionally, the patient is to
check his fingerstick blood sugars t.i.d. with results being
reported to his primary care provider.



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

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2164-7-25**] 18:25:59
T:  [**2164-7-26**] 04:22:44
Job#:  [**Job Number **]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of large intestine'}


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: 

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 1. Atenolol 25 q.d.
2. Norvasc 10 q.d.
3. Zocor 20 q.d.
4. Plavix 75 q.d.

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: Neurologically:
Alert and oriented times three.  Moves all extremities,
follows commands.  Nonfocal exam.  Respiratory:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rate and
rhythm, S1, S2.  Sternum is stable.  Incision with Steri-
Strips open to air clean and dry.  Abdomen is soft,
nontender, nondistended with normoactive bowel sounds.
Colostomy with pink stoma.  Extremities are warm and well
perfused with 1 plus edema.  Right saphenous vein graft site
with Steri-Strips open to air, clean and dry.

FAMILY HISTORY: No significant family history.

SOCIAL HISTORY: Lives in [**Hospital1 3494**] with his wife.  [**Name (NI) **] is
very independent and active.  Denies alcohol use.  Denies
tobacco use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of large intestine'}
