CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 64-year-old male
with history of coronary artery disease status post recent
non-ST elevation myocardial infarction at the end of [**Month (only) 404**]
as well as stenting of the left anterior descending artery
with two stents, who presents with left sided chest
pain/pressure beginning approximately 10 pm on the night
before admission.  Onset of the chest pain was at rest, and
the pain was somewhat improved with Protonix and one
sublingual nitroglycerin, but the sensation persisted, and
the patient eventually called EMS.  He was given aspirin and
sublingual nitroglycerin by EMS with resolution of his
symptoms.

MEDICAL HISTORY: 1. Recent non-ST elevation myocardial infarction with a
troponin of 29 and a CK peak of 90.  Catheterization [**1-16**]
showed three-vessel disease and two stents were placed in the
left anterior descending artery.  He had chest pain after
this procedure, and was taken back to the catheterization
laboratory, but the catheterization was cut short by a GI
bleed.  Catheterization on [**1-16**] showed 70% proximal and 95%
mid left anterior descending artery stenosis, 70% left
circumflex lesion, 80% OM-2 lesion, and 80% right coronary
artery lesion.  Echocardiogram [**1-18**] showed left atrial
enlargement, right atrial enlargement, left ventricular
hypertrophy, ejection fraction greater than 55%, and 1+
aortic regurgitation.
2. Hyperlipidemia.
3. End-stage renal disease with dialysis on Monday,
Wednesday, Friday.
4. Pancreatitis.
5. Congestive obstructive pulmonary disease.
6. Hypertension.
7. Diverticulosis.
8. Cerebrovascular accident in [**2159**] with residual left sided
weakness.
9. Prior history of upper gastrointestinal bleed at [**Hospital6 11241**].
10. Fistula repair [**2165-1-15**].

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Patient comes from [**Country 2045**], and he lives with
his daughter and his wife.  [**Name (NI) **] denies any smoking.
Other complications due to other cardiac device, implant, and graft,Intermediate coronary syndrome,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia
Comp-oth cardiac device,Intermed coronary synd,Hyp kid NOS w cr kid V,Aortic valve disorder,Chr airway obstruct NEC,Atrial fibrillation,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS
Admission Date:  [**2165-2-14**]     Discharge Date:  [**2165-2-17**]

Date of Birth:   [**2100-11-15**]     Sex:  M

Service:  [**Hospital Unit Name 196**]

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 64-year-old male
with history of coronary artery disease status post recent
non-ST elevation myocardial infarction at the end of [**Month (only) 404**]
as well as stenting of the left anterior descending artery
with two stents, who presents with left sided chest
pain/pressure beginning approximately 10 pm on the night
before admission.  Onset of the chest pain was at rest, and
the pain was somewhat improved with Protonix and one
sublingual nitroglycerin, but the sensation persisted, and
the patient eventually called EMS.  He was given aspirin and
sublingual nitroglycerin by EMS with resolution of his
symptoms.

Patient says that the pain/pressure is the same sensation he
had at the time of his non-ST elevation myocardial
infarction.  Patient denied radiation of the pain, shortness
of breath, back, or abdominal pain, cough, nausea, or
vomiting, palpitations.  Patient was pain free at the time of
evaluation in the Emergency Department.  Heparin was started
in the Emergency Department.

PAST MEDICAL HISTORY:
1. Recent non-ST elevation myocardial infarction with a
troponin of 29 and a CK peak of 90.  Catheterization [**1-16**]
showed three-vessel disease and two stents were placed in the
left anterior descending artery.  He had chest pain after
this procedure, and was taken back to the catheterization
laboratory, but the catheterization was cut short by a GI
bleed.  Catheterization on [**1-16**] showed 70% proximal and 95%
mid left anterior descending artery stenosis, 70% left
circumflex lesion, 80% OM-2 lesion, and 80% right coronary
artery lesion.  Echocardiogram [**1-18**] showed left atrial
enlargement, right atrial enlargement, left ventricular
hypertrophy, ejection fraction greater than 55%, and 1+
aortic regurgitation.
2. Hyperlipidemia.
3. End-stage renal disease with dialysis on Monday,
Wednesday, Friday.
4. Pancreatitis.
5. Congestive obstructive pulmonary disease.
6. Hypertension.
7. Diverticulosis.
8. Cerebrovascular accident in [**2159**] with residual left sided
weakness.
9. Prior history of upper gastrointestinal bleed at [**Hospital6 11241**].
10. Fistula repair [**2165-1-15**].

MEDICATIONS:
1. Plavix 75 mg po q day.
2. Enalapril 20 mg po q day.
3. Labetalol 200 mg po q day.
4. Isordil 20 mg tid.
5. Clonidine patch q Monday.
6. Renagel.
7. Nephrocaps.
8. Protonix 40 mg [**Hospital1 **].
9. Sublingual nitroglycerin.

ALLERGIES:  None.

SOCIAL HISTORY:  Patient comes from [**Country 2045**], and he lives with
his daughter and his wife.  [**Name (NI) **] denies any smoking.

PHYSICAL EXAMINATION:  The patient is a well-developed, thin,
elderly appearing man.  Temperature is 99.0, blood pressure
88/63, heart rate of 81, respiratory rate of 16, and sating
98% on 3 liters.  Oropharynx was clear.  Mucous membranes
were moist.  There was no jugular venous distention.  Lungs
were clear bilaterally except for a few crackles at the
bases.  Heart rate was irregularly, irregular.  There were no
murmurs, rubs, or gallops.  Abdomen was soft, nontender, and
nondistended.  Extremities had no peripheral edema.  Rectal
was guaiac negative with no masses.

At the time of admission, electrocardiogram showed Q waves in
lead III, atrial fibrillation at a rate of approximately 70,
possibly alternating with flutter with variable block.

Chest x-ray showed no infiltrates and no effusions.

CK was 46 and troponin was 1.8.

HOSPITAL COURSE:
1. Cardiac:  The patient's history was suggestive of unstable
angina, and the patient was continued on a Heparin drip and
underwent cardiac catheterization, which showed significant
three vessel disease with 80% instent restenosis in the
proximal left anterior descending artery stent and 50% in the
distal stent.  At this point, the patient was pain free and
the case was discussed with Cardiothoracic Surgery.

At the time of this dictation, Cardiothoracic Surgery was
planning a coronary artery bypass graft after evaluation of
the carotid arteries by ultrasound.  Patient's blood pressure
was treated with labetalol, clonidine, enalapril, and
Norvasc.  Patient had a second episode of chest pain on
[**2165-2-16**] that had a component of radiation to his back.  He
therefore underwent CT scan of his chest and abdomen to rule
out any dissection of his aorta.  These examinations were all
negative for dissection.

Patient presented in atrial fibrillation, with a relatively
slow ventricular response.  The patient spontaneously
converted to a normal sinus rhythm while in the hospital
without any further intervention.

2. Renal:  Renal service was consulted to assist in the
management of this patient with end-stage renal disease.
Patient received dialysis after his cardiac catheterization
and then returned to his normal schedule of hemodialysis.
His Renagel was increased to 1600 mg tid.

3. GI:  Patient's stool was guaiacked on admission and after
his Heparin had been running for a day.  Both of these stools
guaiacks were negative, and he was continually followed for
evidence of bleeding.  The GI service was consulted, and felt
that the patient should be catheterized from a cardiac
standpoint despite any possible concerns over
gastrointestinal bleeding.  They suggested treating
gastrointestinal bleeding as it grows and not delaying
treatment of the patient's coronary artery disease because of
considerations of gastrointestinal bleeding.

4. Hematologic:  The patient was noted to have a baseline
anemia at the time of admission, and this was thought to be
due to a combination prior gastrointestinal bleeding as well
as end-stage renal disease.  At the time of this dictation,
iron studies were pending, and there was no evidence of
gastrointestinal bleeding.  Discharge was still in the
planning stage at the point of this dictation.




                          [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 2139**]

Dictated By:[**Last Name (NamePattern1) 4706**]

MEDQUIST36

D:  [**2165-2-17**]  21:03
T:  [**2165-2-18**]  09:09
JOB#:  [**Job Number 32514**]


Admission Date:  [**2165-2-14**]       Discharge Date:  [**2165-2-26**]

Date of Birth:   [**2100-11-15**]       Sex:  M

Service:  Cardiothoracic Surgery

History is taken through an interpreter.

HISTORY OF PRESENT ILLNESS:  Briefly, a 64-year-old male with
coronary artery disease status post recent non-ST elevation
myocardial infarction with stenting of the left anterior
descending artery x2 presents with a left chest pain and
pressure beginning at 10 pm the night prior to admission
while at rest.  Patient improved with Protonix, sublingual
nitroglycerin x1, but pressure persisted.  The patient called
ambulance, was given aspirin, and sublingual nitroglycerin x2
with resolution of symptoms.  Patient stated the pain was
same as prior episode of left chest pain, no radiation, no
shortness of breath, no back or abdominal pain, no cough, no
nausea or vomiting.  No palpitations.  Currently was pain
free on admission.  Heparin was started in the Emergency
Department.

Patient was afebrile and vital signs were stable.  Lungs were
clear to auscultation with a few crackles at the base.  Heart
rate was irregularly, irregular.  Abdomen was soft,
nontender, nondistended.

PAST MEDICAL HISTORY:
1. Recent non-ST elevation myocardial infarction in [**2165-1-16**].  The patient had a catheterization which found
three vessel disease, had stents placed in the left anterior
descending artery x2, and had a subsequent gastrointestinal
bleed.  An echocardiogram on [**1-18**] showed left
ventricular hypertrophy, an ejection fraction of greater than
55%, 1+ AR.
2. Hyperlipidemia.
3. End-stage renal disease on dialysis Monday, Wednesday,
Friday.
4. Pancreatitis.
5. Congestive obstructive pulmonary disease.
6. Hypertension.
7. Diverticulosis.
8. Gout.
9. History of cerebrovascular accident in [**2159**].
10. Hematemesis in [**2157**].  Esophagogastroduodenoscopy done at
[**Hospital1 **].
11. Fistula repairs done on [**1-15**].

MEDICATIONS:
1. Plavix 75.
2. Enalapril 20.
3. Labetalol 200.
4. Isordil 20 tid.
5. Clonidine patch #3 every Monday.
6. Renagel.
7. Nephrocaps.
8. Protonix 40 [**Hospital1 **].
9. Sublingual nitroglycerin prn.

ALLERGIES:  The patient had no known drug allergies.

SOCIAL HISTORY:  No history of smoking or alcohol.

LABORATORIES ON ADMISSION:  White count of 9.0, hematocrit of
30, platelets of 198.  Electrolytes were 138, 3.6, 97, 24,
62, 9.0, and 147.  PT is 13.4, INR 1.2, PTT 32.  Patient had
a CK of 46, troponin of 1.8.

ELECTROCARDIOGRAM:  Showed Q wave in lead III, 70s versus
flutter with variable block.

CHEST X-RAY:  Showed no infiltrates and no effusions.

The patient was admitted and underwent a second
catheterization which showed 80% instent restenosis in the
proximal stent in the left anterior descending artery and a
50% restenosis in the distal stent, 80% complex bifurcation
stenosis involving enlarged branching OM and a tortuous
vessel with severe diffuse disease with 80% in the right
coronary artery.

Preoperative cardiac evaluation had  mention of an atrial
fibrillation/flutter this admission, but the arrhythmia was
not deemed sufficient significance to provide additional
surgical risk.  The patient was explained his increased risk
due to his other medical conditions.  He understood and
agreed to proceed.  The patient underwent a coronary artery
bypass graft x3 with a LIMA to the left anterior descending
artery, saphenous vein graft to the DRCA and saphenous vein
graft to the OM.  The patient tolerated the procedure without
complication, extubated on postoperative day one, had an
episode of atrial fibrillation, which resolved.

On postoperative day two, the patient continued to well, and
continued to attend his hemodialysis sessions without
problems.  The patient had some issues with hypertension
being controlled on a nitrodrip.  Progress was made onto oral
medications and patient was transferred to the floor on
postoperative day #4.  The patient continued to do very well,
and was evaluated by Physical Therapy.  It was believed that
Mr. [**Known lastname **] would benefit from a stay in the rehabilitation
facility before returning to live with his daughters.  The
patient was tolerating po intake, had good pain control, and
was with good blood pressure control on oral medications.
Patient was felt to be ready for discharge to a
rehabilitation facility to followup with Dr. [**Last Name (STitle) 70**] in six
weeks and with his primary care provider [**Last Name (NamePattern4) **] [**12-20**] weeks.

DISCHARGE MEDICATIONS:
1. Amiodarone 200 mg [**Hospital1 **].
2. Clonidine 0.1 mg [**Hospital1 **].
3. Enalapril malleate 20 mg [**Hospital1 **].
4. Ibuprofen 400 mg q6h prn.
5. Tylenol 650 mg q4h prn.
6. Percocet 1-2 tablets q4h prn.
7. Aspirin 325 q day.
8. Zantac 150 mg q day.
9. Colace 100 mg [**Hospital1 **].
10. Lopressor 100 mg [**Hospital1 **].

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  To rehabilitation facility.

DISCHARGE DIAGNOSIS:  Status post coronary artery bypass
graft times three.




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

Dictated By:[**Name8 (MD) 5915**]
MEDQUIST36

D:  [**2165-2-26**]  08:45
T:  [**2165-2-26**]  08:59
JOB#:  [**Job Number 32515**]

cc:[**First Name8 (NamePattern2) 32516**]

Name:  [**Known lastname 5644**], [**Known firstname 5645**]                  Unit No:  [**Numeric Identifier 5646**]

Admission Date:  [**2165-2-14**]     Discharge Date:  [**2165-2-28**]

Date of Birth:   [**2100-11-15**]     Sex:  M

Service:  Cardiothoracic Surgery

ADDENDUM:  This is a 64-year-old male who was admitted to the
Cardiothoracic Surgery Service on [**2165-2-14**] and
discharged on [**2165-2-28**] to a rehabilitation facility.

The addendum constitutes the patient undergoing
Interventional Radiology tunnel catheterization stripping.
The catheter is working pretty well on dialysis, but noticed
right upper extremity swelling.  A right arm arteriovenous
fistula venoplasty was also performed.  There was a thrill at
the anastomotic site a long vein to the axillary region.  No
hematoma at the puncture site was noted, and the patient
underwent dialysis on the morning of discharge.  The
patient's right upper extremity swelling was noticeably
improved.

DISCHARGE DISPOSITION:  The patient was to be discharged to a
rehabilitation facility.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  To rehabilitation.

DISCHARGE DIAGNOSIS:  Status post coronary artery bypass
graft times three.

MEDICATIONS ON DISCHARGE:
 1.  Amiodarone 200 mg p.o. b.i.d. (through [**2165-3-5**])
and then changing to 200 mg p.o. q.d. (until follow up with
Cardiology).
 2.  Clonidine 0.1 mg p.o. b.i.d.
 3.  Enalapril maleate 20 mg p.o. b.i.d.
 4.  Ibuprofen 400 mg p.o. q.4-6h. as needed.
 5.  Tylenol 650 mg p.o. q.4h. as needed.
 6.  Nephrocaps one tablet p.o. q.d.
 7.  Percocet one to two tablets p.o. q.4-6h. as needed.
 8.  Enteric-coated aspirin 325 mg p.o. q.d.
 9.  Zantac 150 mg p.o. q.d.
10.  Colace 100 mg p.o. b.i.d.
11.  Lopressor 100 mg p.o. b.i.d.
12.  Norvasc 5 mg p.o. q.d.
13.  Renagel 2400 mg p.o. t.i.d. (with meals).

DISCHARGE INSTRUCTIONS/FOLLOWUP:  The patient will be
following up as stated previously with Dr. [**Last Name (STitle) 71**] in six
weeks and with Dr. [**Last Name (STitle) **] of Cardiology in two to three weeks.




                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 2728**]

Dictated By:[**Name8 (MD) 2182**]

MEDQUIST36

D:  [**2165-2-28**]  13:48
T:  [**2165-2-28**]  17:43
JOB#:  [**Job Number 5647**]
{'Other complications due to other cardiac device, implant, and graft,Intermediate coronary syndrome,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}


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: Mr. [**Known lastname **] is a 64-year-old male
with history of coronary artery disease status post recent
non-ST elevation myocardial infarction at the end of [**Month (only) 404**]
as well as stenting of the left anterior descending artery
with two stents, who presents with left sided chest
pain/pressure beginning approximately 10 pm on the night
before admission.  Onset of the chest pain was at rest, and
the pain was somewhat improved with Protonix and one
sublingual nitroglycerin, but the sensation persisted, and
the patient eventually called EMS.  He was given aspirin and
sublingual nitroglycerin by EMS with resolution of his
symptoms.

MEDICAL HISTORY: 1. Recent non-ST elevation myocardial infarction with a
troponin of 29 and a CK peak of 90.  Catheterization [**1-16**]
showed three-vessel disease and two stents were placed in the
left anterior descending artery.  He had chest pain after
this procedure, and was taken back to the catheterization
laboratory, but the catheterization was cut short by a GI
bleed.  Catheterization on [**1-16**] showed 70% proximal and 95%
mid left anterior descending artery stenosis, 70% left
circumflex lesion, 80% OM-2 lesion, and 80% right coronary
artery lesion.  Echocardiogram [**1-18**] showed left atrial
enlargement, right atrial enlargement, left ventricular
hypertrophy, ejection fraction greater than 55%, and 1+
aortic regurgitation.
2. Hyperlipidemia.
3. End-stage renal disease with dialysis on Monday,
Wednesday, Friday.
4. Pancreatitis.
5. Congestive obstructive pulmonary disease.
6. Hypertension.
7. Diverticulosis.
8. Cerebrovascular accident in [**2159**] with residual left sided
weakness.
9. Prior history of upper gastrointestinal bleed at [**Hospital6 11241**].
10. Fistula repair [**2165-1-15**].

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Patient comes from [**Country 2045**], and he lives with
his daughter and his wife.  [**Name (NI) **] denies any smoking. 

### Response:
{'Other complications due to other cardiac device, implant, and graft,Intermediate coronary syndrome,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Aortic valve disorders,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia'}
