CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 79-year-old white
male with a history of coronary artery disease, COPD,
hypertension, and cerebrovascular accident, status post
stroke a few years ago by report.  Is being worked up for
carotid endarterectomy and positive ETT, and then referred to
cardiac catheterization prior to CEA.  On cardiac
catheterization, it was found that patient had 80% LM, 80%
LAD, 90-95% circumflex, and 90-95% RCA with stenosed right
ileac.  Stress exam showed moderate severe anterior anginal
ischemia with an EF of 46%.

MEDICAL HISTORY: 1. Hypertension.
2. Cerebrovascular accident with right weakness.
3. Hypercholesterolemia.
4. Peptic ulcer disease status post gastrectomy 30 years ago.
5. Carotid disease.
6. Melanoma on the right cheek.
7. Fractured right hip status post repair.
8. Migraine headaches.

MEDICATION ON ADMISSION: 1. Metoprolol 50 b.i.d.
2. Hydrochlorothiazide 25 q.d.
3. Lipitor 10 q.d.
4. Aspirin 325 q.d.

ALLERGIES: Cephalexin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco, no alcohol, and patient lives
with his wife.
Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Delirium due to conditions classified elsewhere
Crnry athrscl natve vssl,Chr airway obstruct NEC,Atrial fibrillation,Hypertension NOS,Ocl crtd art wo infrct,Late effect CV dis NEC,Muscskel sympt limb NEC,Delirium d/t other cond
Name:  [**Known lastname **], [**Known firstname 63**]                     Unit No:  [**Numeric Identifier 5835**]

Admission Date:  [**2121-7-28**]     Discharge Date:  [**2121-8-6**]

Date of Birth:   [**2042-5-3**]     Sex:  M

Service:

ADDENDUM:  The patient remained in the hospital until
[**2121-8-6**] secondary to rehabilitation placement.
The patient was placed without event on [**2121-8-6**]
and was discharged to rehabilitation.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 358**], M.D.  [**MD Number(1) 359**]

Dictated By:[**Dictator Info 5836**]

MEDQUIST36

D:  [**2121-8-6**]  12:56
T:  [**2121-8-6**]  13:04
JOB#:  [**Job Number 5837**]


Admission Date:  [**2121-7-28**]       Discharge Date:  [**2121-8-5**]


Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  Patient is a 79-year-old white
male with a history of coronary artery disease, COPD,
hypertension, and cerebrovascular accident, status post
stroke a few years ago by report.  Is being worked up for
carotid endarterectomy and positive ETT, and then referred to
cardiac catheterization prior to CEA.  On cardiac
catheterization, it was found that patient had 80% LM, 80%
LAD, 90-95% circumflex, and 90-95% RCA with stenosed right
ileac.  Stress exam showed moderate severe anterior anginal
ischemia with an EF of 46%.

The patient had no previous angina or shortness of breath or
dyspnea on exertion.  Denies diabetes mellitus, bleeding
dyscrasias, but does have positive fatigue in the legs.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Cerebrovascular accident with right weakness.
3. Hypercholesterolemia.
4. Peptic ulcer disease status post gastrectomy 30 years ago.
5. Carotid disease.
6. Melanoma on the right cheek.
7. Fractured right hip status post repair.
8. Migraine headaches.

SOCIAL HISTORY:  No tobacco, no alcohol, and patient lives
with his wife.

MEDICATIONS ON ADMISSION:
1. Metoprolol 50 b.i.d.
2. Hydrochlorothiazide 25 q.d.
3. Lipitor 10 q.d.
4. Aspirin 325 q.d.

ALLERGIES:  Cephalexin.

PHYSICAL EXAM ON ADMISSION:  Vital signs of 96.7, 64, 158/70,
and respiratory rate of 20.  Generally, the patient was in no
acute distress.  HEENT exam was pupils are equal, round, and
reactive to light and accommodation.  Extraocular movements
are intact, and eyes were anicteric and not injected.  Neck
is supple without lymphadenopathy without JVD.  There was 2+
carotids, soft left sided bruit.  Oropharynx was clear with
mucous membranes moist without erythema.  Respiratory exam
was clear to auscultation bilaterally.  Cardiac examination
was regular, rate, and rhythm without murmurs, rubs, or
gallops.  Abdomen exam:  Transverse scar, well healed, soft,
nontender, nondistended without hepatosplenomegaly,
normoactive bowel sounds.  Extremities are warm and well
perfused without clubbing, cyanosis, or edema.  Pulse
examination:  There is 2+ carotid pulses bilaterally with
bruit on the left side.  Femoral pulses 2+.  Radial pulses
2+.  DP and PT pulses are 2+.  Neurologic examination:  The
patient was alert and oriented times three, followed
commands.  Cranial nerves II through XII were grossly intact.
Strength was equal bilaterally.  Sensation was intact.
Symmetry was intact bilaterally.

Patient had an EKG on admission which showed a heart rate of
60 and left bundle branch block.

LABORATORIES ON ADMISSION:  From outside hospital showed a
white count of 8.6, hematocrit of 47.3, and platelet count of
274 with sodium 141, potassium 4.8, chloride 102, bicarb 34,
BUN 20, creatinine 0.9, glucose 103.  Coags:  PT 10.5, PTT
28, INR of 1.1, AST of 30, ALT of 24, alkaline phosphatase of
199, T bilirubin 1, albumin of 3.9, and negative urinalysis.

Patient was seen by Dr. [**Last Name (STitle) **] and was deemed ready for
coronary artery bypass graft on [**2121-7-29**].  On date of
admission date, the patient was started on Heparin drip at
800 units an hour and had an INR of 1.2 on [**2121-7-29**].
Repeat vascular laboratories, carotid duplex showed left ICA
stenosis of 80-99% with no stenosis of the right ICA.

Patient was taken to the operating room on [**2121-7-29**]
for coronary artery bypass graft x4, LIMA to LAD, saphenous
vein graft to diag, saphenous vein graft to OM-1, saphenous
vein graft to OM-2.  Surgeon was Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], first
assistant Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 33349**].

Postoperative day one, the patient was extubated on a
Neo-Synephrine drip of 0.7 and propofol was weaned off.
Insulin drip of 2.5.  Neurologically, the patient was intact,
and Vascular staff was consulted for evaluation of left sided
carotid stenosis.  The patient was seen by Dr. [**Last Name (STitle) **] on
[**2121-7-30**], and patient was transferred to the floor
on [**2121-7-31**] on Lopressor 12.5 b.i.d. after
Neo-Synephrine had been weaned off the day before and Lasix
20 b.i.d.

Physical Therapy began seeing patient on [**7-30**], and
continued to see patient throughout hospital stay and to
discharge.  Vascular staff once again saw patient for
preoperative workup on [**7-31**], however, the patient
had bouts of atrial fibrillation, and was treated with 20 mg
of Lopressor IV push and converted back to sinus, however,
the patient remained confused overnight and throughout the
day, and carotid endarterectomy was postponed secondary to
the patient's confusion and inability to sign consent.
However, the patient's confusion resolved, and head CT was
obtained at the time of the confusion, which showed global
atrophy and no acute hemorrhage with multiple bilateral
cerebral infarcts small that were chronic and no acute
changes, and there is also no change from prior baseline per
primary care physician.

Patient remained in sinus rhythm from CABG postoperative days
four and five, and was taken to the OR for left sided carotid
endarterectomy on [**2121-8-4**], postoperative day six
from CABG.

Left CEA with patch was performed by Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 7820**]
with 1300 of crystalloid given, 200 urine output with
estimated blood loss of 50 cc.  Patient did well
postoperatively, and was neurologically intact.  Tongue
midline.  Smile symmetric with bilateral carotid pulses, and
strength equal and nonfocal examination postoperative day 0.
Patient, however, was transfused 2 units of packed red blood
cells for a hematocrit drop from 25.3 to 23.

Patient continued to do well on postoperative day one, and
had some bouts of hypertension 160s, was controlled with
Lopressor.  Was discharged to rehabilitation facility on
medications:
1. Aspirin 325 p.o. q.d.
2. Lopressor 50 p.o. b.i.d.
3. Lipitor 10 p.o. q.d.
4. Tylenol #3 1-2 tablets p.o. q2-4h prn pain.
5. Zantac 150 mg p.o. b.i.d.
6. Ascorbic acid 500 mg b.i.d.
7. Colace 100 mg p.o. b.i.d.

DISCHARGE INSTRUCTIONS:  Was instructed to followup with
primary care physician [**Last Name (NamePattern4) **] [**11-21**] weeks.  Cardiologist in [**12-23**]
weeks, Dr. [**Last Name (STitle) **] in [**5-29**] days, and Dr. [**Last Name (STitle) **] in [**1-21**] weeks.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  Rehabilitation facility.

DISCHARGE DIAGNOSES:
1. Hypertension.
2. Hypercholesterolemia.
3. Peptic ulcer disease.
4. Coronary artery disease status post coronary artery bypass
graft.
5. Carotid disease status post left sided carotid
endarterectomy.



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


                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.

Dictated By:[**Last Name (NamePattern4) 10197**]
MEDQUIST36

D:  [**2121-8-5**]  08:21
T:  [**2121-8-5**]  08:22
JOB#:  [**Job Number 33350**]

cc:[**Last Name (NamePattern1) 33351**]
{'Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Delirium due to conditions classified elsewhere'}


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 79-year-old white
male with a history of coronary artery disease, COPD,
hypertension, and cerebrovascular accident, status post
stroke a few years ago by report.  Is being worked up for
carotid endarterectomy and positive ETT, and then referred to
cardiac catheterization prior to CEA.  On cardiac
catheterization, it was found that patient had 80% LM, 80%
LAD, 90-95% circumflex, and 90-95% RCA with stenosed right
ileac.  Stress exam showed moderate severe anterior anginal
ischemia with an EF of 46%.

MEDICAL HISTORY: 1. Hypertension.
2. Cerebrovascular accident with right weakness.
3. Hypercholesterolemia.
4. Peptic ulcer disease status post gastrectomy 30 years ago.
5. Carotid disease.
6. Melanoma on the right cheek.
7. Fractured right hip status post repair.
8. Migraine headaches.

MEDICATION ON ADMISSION: 1. Metoprolol 50 b.i.d.
2. Hydrochlorothiazide 25 q.d.
3. Lipitor 10 q.d.
4. Aspirin 325 q.d.

ALLERGIES: Cephalexin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No tobacco, no alcohol, and patient lives
with his wife. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Delirium due to conditions classified elsewhere'}
