CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 66-year-old man,
who had developed nocturnal dyspnea and congestive heart
failure starting about six months ago with increasing
frequency since [**Month (only) 404**].  In early [**Month (only) 958**], he developed chest
pain and was admitted to [**Hospital1 **] for rule out MI.  He was
cathed at that time.  Catheterization showed 80% occlusion of
the RCA, 80% occlusion of the LAD, 90% occlusion of the OM,
and subtotal diagonal-1 occlusion with preserved LV function.
At that time, he was referred to Dr. [**Last Name (Prefixes) **] for coronary
artery bypass grafting.

MEDICAL HISTORY: 1. Hypertension.
2. An ablation for SVT in [**2133**].
3. L4-5 compression fracture.
4. BPH.
5. Hypercholesterolemia.
6. Diabetes mellitus.
7. Chronic renal insufficiency.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient states an allergy to penicillin.

PHYSICAL EXAM: Height 5'7", weight 250 pounds.  General:  No
acute distress.  Skin:  Warm and dry, no lesions, rashes, or
abrasions.  HEENT:  Pupils are equal, round, and reactive to
light.  Extraocular movements are intact.  Mucous membranes
moist.  Neck is supple, no lymphadenopathy, no bruits, no
JVD.  Chest was clear to auscultation bilaterally.  Heart:
Regular rate and rhythm, no murmurs, rubs, or gallops.
Abdomen is soft, nontender, and nondistended with positive
bowel sounds.  Extremities are warm, well perfused with no
clubbing, cyanosis, or edema.  No varicosities.
Neurological:  Alert and oriented times three, nonfocal exam.
Pulses are 1+ throughout.

FAMILY HISTORY: Significant for coronary artery disease.
His father had a CABG in the past.

SOCIAL HISTORY: Denies tobacco and alcohol use.  Lives at
home with his wife.
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Atrial fibrillation,First degree atrioventricular block,Redundant prepuce and phimosis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,CHF NOS,Pure hypercholesterolem,BPH w/o urinary obs/LUTS,Hypertension NOS,Atrial fibrillation,Atriovent block-1st degr,Redun prepuce & phimosis,DMII wo cmp nt st uncntr
Admission Date:  [**2142-4-27**]       Discharge Date:  [**2142-5-7**]

Date of Birth:   [**2075-9-27**]       Sex:  M

Service:  Cardiothoracic Service

HI[**Last Name (STitle) 2710**]OF PRESENT ILLNESS:  Patient is a 66-year-old man,
who had developed nocturnal dyspnea and congestive heart
failure starting about six months ago with increasing
frequency since [**Month (only) 404**].  In early [**Month (only) 958**], he developed chest
pain and was admitted to [**Hospital1 **] for rule out MI.  He was
cathed at that time.  Catheterization showed 80% occlusion of
the RCA, 80% occlusion of the LAD, 90% occlusion of the OM,
and subtotal diagonal-1 occlusion with preserved LV function.
At that time, he was referred to Dr. [**Last Name (Prefixes) **] for coronary
artery bypass grafting.

PAST MEDICAL HISTORY:
1. Hypertension.
2. An ablation for SVT in [**2133**].
3. L4-5 compression fracture.
4. BPH.
5. Hypercholesterolemia.
6. Diabetes mellitus.
7. Chronic renal insufficiency.

MEDICATIONS PREOPERATIVELY:
1. Imdur 60 mg q.d.
2. Lisinopril 40 mg q.d.
3. Lasix 80 mg b.i.d.
4. Potassium chloride 20 mEq b.i.d.
5. Labetalol 300 mg b.i.d.
6. Allopurinol 300 mg 3x a week.
7. Glucovance 2.5/500 one tablet q.d.
8. Lantus insulin 30 units q.p.m.
9. Enteric-coated aspirin one q.d.
10. Multivitamin one q.d.
11. Saw [**Location (un) 6485**] one q.d.
12. Flaxseed oil 1000 units q.d.
13. Plavix 75 mg q.d.
14. Zinc chloride 80/5 one tablet q.d. recently discontinued.

ALLERGIES:  Patient states an allergy to penicillin.

FAMILY HISTORY:  Significant for coronary artery disease.
His father had a CABG in the past.

OCCUPATION:  He is a retired machinist.

SOCIAL HISTORY:  Denies tobacco and alcohol use.  Lives at
home with his wife.

PHYSICAL EXAM:  Height 5'7", weight 250 pounds.  General:  No
acute distress.  Skin:  Warm and dry, no lesions, rashes, or
abrasions.  HEENT:  Pupils are equal, round, and reactive to
light.  Extraocular movements are intact.  Mucous membranes
moist.  Neck is supple, no lymphadenopathy, no bruits, no
JVD.  Chest was clear to auscultation bilaterally.  Heart:
Regular rate and rhythm, no murmurs, rubs, or gallops.
Abdomen is soft, nontender, and nondistended with positive
bowel sounds.  Extremities are warm, well perfused with no
clubbing, cyanosis, or edema.  No varicosities.
Neurological:  Alert and oriented times three, nonfocal exam.
Pulses are 1+ throughout.

EKG:  Sinus rhythm with no acute changes.

Chest x-ray:  Preoperatively showed a normal sized heart, a
tortuous aorta, normal pulmonary vasculature, no effusions,
no pneumothorax.  Degenerative changes noted in the thoracic
spine.

LABORATORY DATA:  White count 7.7, hematocrit 49, platelets
233.  PT 14, PTT 36, INR 1.3.  Sodium 143, potassium 4.4,
chloride 98, CO2 31, BUN 17, creatinine 1.0.  Urinalysis is
negative.  Total bilirubin 0.7, albumin 4.4..

HOSPITAL COURSE:  Patient was scheduled to be a postoperative
admit and on [**4-27**], he was admitted to the osteoporosis,
where he underwent coronary artery bypass grafting x3.
Please see the OR report for full details.  In summary, the
patient had a CABG x3 with LIMA to the LAD, saphenous vein
graft to OM-1, and saphenous vein graft to the RCA with a
right carotid endarterectomy.  Patient's bypass time was 137
minutes with a cross-clamp time of 103 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's mean arterial pressure
was 77 with a CVP of 13.  He was A-V paced at 80 beats per
minute, and at that time, he had Neo-Synephrine at 0.5
mcg/kg/minute and propofol at 20 mcg/kg/minute.  Patient did
well in the immediate postoperative period.  His anesthesia
was reversed.  He was weaned from the ventilator and
successfully extubated.

On postoperative day one, the patient remained
hemodynamically stable.  He was weaned from vasoactive IV
medications.  He was started on oral pain medications as well
as metoprolol, however, he continued to complain of severe
incisional pain, and was therefore begun on PCA.  For that
reason, he was kept in the Intensive Care Unit.

On postoperative day two, the patient continued to be
hemodynamically stable.  However, it was noted that he did
have postoperative atrial fibrillation.  At that time, his
metoprolol was increased, and he was begun on amiodarone.
Patient continued to have periods of atrial fibrillation and
first degree A-V block following the initiation of
amiodarone.

By postoperative day three, the patient was hemodynamically
stable, and was felt to be ready to be transferred from the
Cardiothoracic Intensive Care Unit to the floor for
continuing postoperative care and cardiac rehabilitation.  At
that time, his central lines were removed.  His chest tubes
were removed, and his pacing wires remained in place.

Once on the floor with the assistance of Physical Therapy and
the nursing staff, the patient's activity level was
increased.  However, on postoperative day four, the patient
became increasingly confused and agitated requiring Ativan
and Haldol intravenously, and he again went into atrial
fibrillation at times with a ventricular rate of 120 and a
blood pressure of 120-140/60.  In order to more closely
monitor his cardiac status as well as his neurologic status,
the decision was made to transfer the patient back to
Intensive Care Unit at that time.  Infusion workup was
initiated at that time.  Patient's electrolytes, LFTs, and
blood cultures all returned within normal limits.  Patient
remained in the Intensive Care Unit for three additional days
during which time he was begun on IV amiodarone following
which he converted to a normal sinus rhythm.

His confusion cleared and on postoperative day seven, the
patient was transferred back to [**Hospital Ward Name 121**] 2 for continued
postoperative care and cardiac rehabilitation.  Again with
the assistance of the nursing staff and Physical Therapy, the
patient's activity level was increased.  It was noted that
the patient did have a small amount of serous drainage from
the distal pole of his sternal wound.  This was felt to be
due to thrashing incurred during the patient's agitated
episodes.  The wounds were painted with Betadine and covered
with dry sterile dressings.  There was no erythema noted at
that time.  Additionally, the patient did receive one dose of
vancomycin following which a bright red rash was noted.  The
vancomycin was discontinued and clindamycin was begun at that
time.

Over the next several days, the patient had an uneventful
hospital course.  He remained hemodynamically stable and
afebrile.  On postoperative day 10, it was decided that the
patient would be stable and ready for transfer to
rehabilitation for continuing postoperative recovery.

At time of transfer, the patient's physical exam was as
follows:  Vital signs:  Temperature 98.2, heart rate 76 sinus
rhythm, blood pressure 143/79, respiratory rate 20, and O2
saturation 96% on room air.  Weight preoperatively was 112
kg, at discharge 116 kg.  Laboratory data:  White count 10.6,
hematocrit 32.3, platelets 446.  Sodium 140, potassium 3.8,
chloride 101, CO2 29, BUN 26, creatinine 1.2, glucose 134.

Physical exam:  Alert and oriented times three, moves all
extremities.  Follows commands.  Respiratory:  Clear to
auscultation bilaterally.  Cardiac:  Regular rate and rhythm,
S1, S2 with no murmur.  Sternum is stable.  Incision with a
small open area at the base of the incision.  Minimal amount
of serous drainage.  Abdomen is soft, nontender, and
nondistended with normoactive bowel sounds.  Extremities are
warm and well perfused with 2-3+ edema.  Saphenous vein graft
sites with Steri-Strips, draining serous fluid bilaterally
left greater than right.

DISCHARGE MEDICATIONS:
1. Lasix 40 mg IV b.i.d.
2. Potassium chloride 20 mEq b.i.d.
3. Lisinopril 40 mg b.i.d.
4. Amiodarone 400 mg q.d. x2 weeks, then 200 mg q.d.
5. Enteric-coated aspirin 325 mg q.d.
6. Plavix 75 mg q.d. x3 months.
7. Pantoprazole 40 mg q.d.
8. Allopurinol 150 mg q.d.
9. Glucovance 2.5/500 one tablet q.d.
10. Clindamycin 600 mg q.8h. x1 week.
11. Flagyl 500 mg q.8h. x1 week.
12. Metoprolol 100 mg b.i.d.
13. Regular insulin-sliding scale and glargine 30 units
q.h.s.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  He is to be discharged to rehabilitation.

FO[**Last Name (STitle) **]P INSTRUCTIONS:  He is to followup with Dr. [**Last Name (Prefixes) 411**] in four weeks and follow up with Dr. [**Last Name (STitle) 12614**] at
[**Hospital1 **] in [**4-12**] weeks.



                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2142-5-7**]  09:53
T:  [**2142-5-7**]  10:05
JOB#:  [**Job Number 12615**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Atrial fibrillation,First degree atrioventricular block,Redundant prepuce and phimosis,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: 

PRESENT ILLNESS: Patient is a 66-year-old man,
who had developed nocturnal dyspnea and congestive heart
failure starting about six months ago with increasing
frequency since [**Month (only) 404**].  In early [**Month (only) 958**], he developed chest
pain and was admitted to [**Hospital1 **] for rule out MI.  He was
cathed at that time.  Catheterization showed 80% occlusion of
the RCA, 80% occlusion of the LAD, 90% occlusion of the OM,
and subtotal diagonal-1 occlusion with preserved LV function.
At that time, he was referred to Dr. [**Last Name (Prefixes) **] for coronary
artery bypass grafting.

MEDICAL HISTORY: 1. Hypertension.
2. An ablation for SVT in [**2133**].
3. L4-5 compression fracture.
4. BPH.
5. Hypercholesterolemia.
6. Diabetes mellitus.
7. Chronic renal insufficiency.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient states an allergy to penicillin.

PHYSICAL EXAM: Height 5'7", weight 250 pounds.  General:  No
acute distress.  Skin:  Warm and dry, no lesions, rashes, or
abrasions.  HEENT:  Pupils are equal, round, and reactive to
light.  Extraocular movements are intact.  Mucous membranes
moist.  Neck is supple, no lymphadenopathy, no bruits, no
JVD.  Chest was clear to auscultation bilaterally.  Heart:
Regular rate and rhythm, no murmurs, rubs, or gallops.
Abdomen is soft, nontender, and nondistended with positive
bowel sounds.  Extremities are warm, well perfused with no
clubbing, cyanosis, or edema.  No varicosities.
Neurological:  Alert and oriented times three, nonfocal exam.
Pulses are 1+ throughout.

FAMILY HISTORY: Significant for coronary artery disease.
His father had a CABG in the past.

SOCIAL HISTORY: Denies tobacco and alcohol use.  Lives at
home with his wife. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Pure hypercholesterolemia,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified essential hypertension,Atrial fibrillation,First degree atrioventricular block,Redundant prepuce and phimosis,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
