CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 11060**] is a 64 -year-old
male with a history of coronary artery disease and two
previous myocardial infarctions, as well as
hypercholesterolemia, hypothyroidism, and diabetes mellitus,
who presented to the hospital with a complaint of hot
flashes that radiated throughout the chest into the arm.
This was his anginal equivalent.  He took two sublingual
nitroglycerin and had relief of the sensation.  He had a
second episode of this angina, also relieved with sublingual
nitroglycerin.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus for which he uses an
insulin pump.  This was initiated by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10088**] who
follows him.  He is located at the [**Hospital **] Clinic.
2.  Coronary artery disease.  He is status post myocardial
infarction times two with a cardiac catheterization from
[**2127-2-13**] which demonstrated a sequential stenosis
throughout the left anterior descending artery.  The left
circumflex had a 70% stenosis to a point located after the
obtuse marginal artery branch.  The first obtuse marginal
artery was 80% stenosed.  The right coronary artery had a 60%
stenosis and the ejection fraction was approximately 60%.
3.  Hypercholesterolemia.
4.  Memory problems.  These are gradual in onset.
5.  Hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He has no tobacco history and no alcohol
history.  He lives with his wife who is an independent woman
with no known medical problems.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified acquired hypothyroidism,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,DMI wo cmp nt st uncntrl,Hypothyroidism NOS,Pure hypercholesterolem
Admission Date:  [**2127-4-4**]       Discharge Date:  [**2127-4-11**]

Date of Birth:   [**2062-7-9**]       Sex:  M

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

ADMITTING PHYSICIAN:  [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D.

CONSULTATIONS:  Cardiothoracic Surgery and Physical Therapy.

PROCEDURES:
Coronary artery bypass graft times five on [**2127-4-8**].

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 11060**] is a 64 -year-old
male with a history of coronary artery disease and two
previous myocardial infarctions, as well as
hypercholesterolemia, hypothyroidism, and diabetes mellitus,
who presented to the hospital with a complaint of hot
flashes that radiated throughout the chest into the arm.
This was his anginal equivalent.  He took two sublingual
nitroglycerin and had relief of the sensation.  He had a
second episode of this angina, also relieved with sublingual
nitroglycerin.

Upon a third episode, he was taken to the Emergency Room
where his blood pressure was noted to be 148/61, his pulse
was 60, his O2 saturation was 98% on room air and he was
started on heparin.  Mr. [**Known lastname 11060**] was known to have three
vessel coronary artery disease.  This was documented by
cardiac catheterization performed on [**2127-2-20**].

PAST MEDICAL HISTORY:
1.  Insulin dependent diabetes mellitus for which he uses an
insulin pump.  This was initiated by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10088**] who
follows him.  He is located at the [**Hospital **] Clinic.
2.  Coronary artery disease.  He is status post myocardial
infarction times two with a cardiac catheterization from
[**2127-2-13**] which demonstrated a sequential stenosis
throughout the left anterior descending artery.  The left
circumflex had a 70% stenosis to a point located after the
obtuse marginal artery branch.  The first obtuse marginal
artery was 80% stenosed.  The right coronary artery had a 60%
stenosis and the ejection fraction was approximately 60%.
3.  Hypercholesterolemia.
4.  Memory problems.  These are gradual in onset.
5.  Hypothyroidism.

ADMITTING MEDICATIONS:  Include an insulin pump, Lipitor 20
mg po q day, Prinivil 5.0 mg po q day, aspirin 325 mg po q
day, Levoxyl 88 mcg po q day, Imdur 30 mg po q day, Lopressor
25 mg po bid, and vitamin B6.

ALLERGIES:  He has no known drug allergies.

SOCIAL HISTORY:  He has no tobacco history and no alcohol
history.  He lives with his wife who is an independent woman
with no known medical problems.

PHYSICAL EXAMINATION:  His admission vital signs were a
temperature of 96.8 F, a blood pressure of 130/70, pulse of
56, respirations 18, 96% O2 saturation on room air.  His
head, eyes, ears, nose, and throat examination was anicteric,
oropharynx clear, his mucous membranes were not dry.  His
neck examination revealed a jugular venous pulse of
approximately 10 cm.  His lungs were clear to auscultation
bilaterally.  His cardiac examination revealed a regular rate
and rhythm with no appreciable murmurs, rubs, or gallops.
His abdomen was soft, nontender, nondistended, he had
normoactive bowel sounds.  His extremities revealed no
clubbing, cyanosis, or edema.

His neurologic examination was alert and oriented times
three, he was able to register three of three, but he was
able to recall none of three independently.  With prompting
he recalled two of three.  His recognition, speech, and
naming were intact.  Calculations were normal and copying was
normal.  He was attentive and spelled the word "world"
backwards; however, he did not know the presidents up to
[**Hospital1 1806**].

ADMISSION LABORATORY DATA:  A white count of 8.9, a
hematocrit of 41.2, platelets of 297,000.  His sodium was
133, his potassium was 4.4, chloride was 96, bicarbonate 28,
his BUN was 16, creatinine was 1.4, his glucose was 249.  His
troponin was less than 0.3.  CPK was 79.

His electrocardiogram demonstrated a normal sinus rhythm at
58 beats per minute with no ST-T wave changes.  There were no
Q-waves, he had normal intervals.  There was no change from
his examination performed on [**2127-2-19**].

HOSPITAL COURSE:  He was admitted for evaluation of potential
myocardial infarction.  He was not thought to be in failure
at that time.  He was seen by the Cardiology attending who
felt that it would be appropriate at this time to have the
Cardiothoracic Surgery team assess the patient for a
potential coronary artery bypass graft.  Plans were made to
take the patient to the Operating Room on [**2127-4-8**].  At this
time he underwent a coronary artery bypass graft times five
vessels with a left internal mammary artery to left anterior
descending, a vein to the obtuse marginal, a vein to the
diagonal, a vein to the posterior left ventricular, and a
vein to the posterior descending artery.  The posterior left
ventricular to posterior descending artery was a sequential
graft.

This was performed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].  The patient
tolerated this procedure well and was taken to the
Cardiothoracic Intensive Care Unit with a blood pressure of
135/62, a central venous pressure of 4.0.  He was on an
insulin drip, a propofol drip, and a Neo-Synephrine drip.
The patient was extubated by postoperative day one and plans
were made to remove his chest tubes and transfer him to the
floor.  There was a large amount of output coming from his
chest tubes, approximately 500 cc over the ensuing 24 hours.
The chest tube was maintained in place until postoperative
day two.

The patient was evaluated by Physical Therapy Department for
gait training, stair training, and patient education.  The
patient was doing well.  His chest tubes were removed on
postoperative day two.  His Foley was removed, he was
ambulating.  Plans were made to let the patient go home as
soon as an activity level of five could be achieved.

On postoperative day three, the patient achieved an activity
level of five.  His insulin pump had been maintained until
the time of discharge.  The [**Last Name (un) **] Diabetes Center fellow
evaluated the patient and made plans for the patient to
receive NPH for his ride home.  His pacer wires were
removed.

DISPOSITION:  Discharged to home.

DISCHARGE CONDITION:  Good to excellent.

DISCHARGE MEDICATIONS:  Lopressor 100 mg po bid, Prinivil 5.0
mg po q day, Lipitor 20 mg po q day, Levoxyl 88 mcg po q day,
aspirin 81 mg po q day, and an insulin pump, as well as
Percocet 5/325 one to two tablets po q three to four hours
prn pain, and Colace 100 mg po bid.

FOLLOW UP:  Follow up is with the patient's primary care
physician who is Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 10088**], in approximately one
to two weeks, and to follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in
approximately four weeks for postoperative evaluation.  He is
also to follow up with the nursing staff on Far Six for a
wound check in approximately one week.



                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 13391**]
MEDQUIST36

D:  [**2127-4-11**]  12:04
T:  [**2127-4-11**]  12:11
JOB#:  [**Job Number **]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified acquired hypothyroidism,Pure hypercholesterolemia'}


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 11060**] is a 64 -year-old
male with a history of coronary artery disease and two
previous myocardial infarctions, as well as
hypercholesterolemia, hypothyroidism, and diabetes mellitus,
who presented to the hospital with a complaint of hot
flashes that radiated throughout the chest into the arm.
This was his anginal equivalent.  He took two sublingual
nitroglycerin and had relief of the sensation.  He had a
second episode of this angina, also relieved with sublingual
nitroglycerin.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus for which he uses an
insulin pump.  This was initiated by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10088**] who
follows him.  He is located at the [**Hospital **] Clinic.
2.  Coronary artery disease.  He is status post myocardial
infarction times two with a cardiac catheterization from
[**2127-2-13**] which demonstrated a sequential stenosis
throughout the left anterior descending artery.  The left
circumflex had a 70% stenosis to a point located after the
obtuse marginal artery branch.  The first obtuse marginal
artery was 80% stenosed.  The right coronary artery had a 60%
stenosis and the ejection fraction was approximately 60%.
3.  Hypercholesterolemia.
4.  Memory problems.  These are gradual in onset.
5.  Hypothyroidism.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He has no tobacco history and no alcohol
history.  He lives with his wife who is an independent woman
with no known medical problems. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified acquired hypothyroidism,Pure hypercholesterolemia'}
