CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient was originally seen
in the office by Dr. [**Last Name (Prefixes) **] on [**2171-11-14**].  Surgery was
delayed due to scheduling issues at that time, and the
patient was seen again on [**2171-12-4**].  This 59 year old
gentleman had no symptoms at rest but had a known history of
coronary artery disease since a prior catheterization in
[**2152**].  He had done well with medical therapy over the
previous eighteen years until the past few months which he
then stated he started to feel chest pressure but only at
peak exercise.  A stress echocardiogram showed anterior wall
hypokinesis.  This led to cardiac catheterization on
[**2171-10-18**], which revealed a right dominant system and 80
percent left anterior descending coronary artery lesion and
50 percent circumflex lesion and a 95 percent obtuse marginal
one lesion and 95 percent obtuse marginal two lesion, 50
percent lesion of the right coronary artery and a 70 percent
lesion of the posterior descending coronary artery.  The
patient had no mitral regurgitation, had an ejection fraction
of 71 percent.  Prior echocardiogram [**2171-10-8**], showed
ejection fraction of 60 percent, no mitral regurgitation, no
aortic insufficiency, but anterior hypokinesis and multiple
hypokinetic areas.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 1. Folic Acid 800 mcg daily.
2. Aspirin 162 mg daily.
3. Verapamil 240 mg sustained release p.o. daily.
4. Diovan 160 mg p.o. daily.
5. Lipitor 80 mg p.o. daily.
6. Zetia 10 mg p.o. daily.
7. Vitamin E 400 international units p.o. daily.
8. One drop right eye of an eye drop for his glaucoma.  The
   patient could not remember the name of the drug at the
   time of the examination.

ALLERGIES: He had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant family history as his father
died of a myocardial infarction at age 56 and his mother had
both myocardial infarction and stroke and died at age 85.

SOCIAL HISTORY: The patient smoked a rare pipe and stated he
had not smoked any in thirty-five years.  He admitted to two
to three glasses of wine per week.  He said he had no use of
recreational drugs.
Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Iatrogenic pneumothorax,Hypertension NOS,Pure hypercholesterolem
Admission Date: [**2171-12-16**]        Discharge Date: [**2171-12-22**]

Date of Birth:  [**2112-5-18**]        Sex:  M

Service:  CSU


HI[**Last Name (STitle) 2710**]OF PRESENT ILLNESS:  The patient was originally seen
in the office by Dr. [**Last Name (Prefixes) **] on [**2171-11-14**].  Surgery was
delayed due to scheduling issues at that time, and the
patient was seen again on [**2171-12-4**].  This 59 year old
gentleman had no symptoms at rest but had a known history of
coronary artery disease since a prior catheterization in
[**2152**].  He had done well with medical therapy over the
previous eighteen years until the past few months which he
then stated he started to feel chest pressure but only at
peak exercise.  A stress echocardiogram showed anterior wall
hypokinesis.  This led to cardiac catheterization on
[**2171-10-18**], which revealed a right dominant system and 80
percent left anterior descending coronary artery lesion and
50 percent circumflex lesion and a 95 percent obtuse marginal
one lesion and 95 percent obtuse marginal two lesion, 50
percent lesion of the right coronary artery and a 70 percent
lesion of the posterior descending coronary artery.  The
patient had no mitral regurgitation, had an ejection fraction
of 71 percent.  Prior echocardiogram [**2171-10-8**], showed
ejection fraction of 60 percent, no mitral regurgitation, no
aortic insufficiency, but anterior hypokinesis and multiple
hypokinetic areas.

PAST MEDICAL HISTORY:  Coronary artery disease.

Hypertension.

Hypercholesterolemia.

Remote chronic bronchitis.

Significant left lower extremity varicosities.

Glaucoma in the right eye which had been diagnosed between
his visits on [**2171-11-14**], and his second visit on [**2171-12-4**].

PAST SURGICAL HISTORY:  Right inguinal herniorrhaphy in [**2162**].

Vasectomy.

Wisdom teeth extraction.

MEDICATIONS ON ADMISSION:
1. Folic Acid 800 mcg daily.
2. Aspirin 162 mg daily.
3. Verapamil 240 mg sustained release p.o. daily.
4. Diovan 160 mg p.o. daily.
5. Lipitor 80 mg p.o. daily.
6. Zetia 10 mg p.o. daily.
7. Vitamin E 400 international units p.o. daily.
8. One drop right eye of an eye drop for his glaucoma.  The
   patient could not remember the name of the drug at the
   time of the examination.


ALLERGIES:  He had no known drug allergies.

FAMILY HISTORY:  Significant family history as his father
died of a myocardial infarction at age 56 and his mother had
both myocardial infarction and stroke and died at age 85.

SOCIAL HISTORY:  The patient smoked a rare pipe and stated he
had not smoked any in thirty-five years.  He admitted to two
to three glasses of wine per week.  He said he had no use of
recreational drugs.

PHYSICAL EXAMINATION:  On examination, his heart rate was 76
and regular, blood pressure 140/88 right and 150/84 on the
left, height six feet four inches with a weight of 220
pounds.  He was tall and very fit in no apparent distress.
His cranial nerves II through XII are grossly intact with a
nonfocal examination.  He was moving all extremities with 5/5
strength.  He had no bruits or jugular venous distention in
his neck.  His lungs were clear bilaterally.  His heart was
regular rate and rhythm, with S1 and S2 tones and no murmur
appreciated.  His abdomen was soft, nontender, nondistended
with hypoactive bowel sounds.  He had no hepatosplenomegaly
or costovertebral angle tenderness.  His extremities were
warm and well perfused with no cyanosis, clubbing or edema.
Significant left lower extremity varicosities were noted.
The right was normal.  Lower extremity varicosities were most
severe below his left knee.
He had two plus bilateral femoral, dorsalis pedis, posterior
tibial and radial pulses.  Pulse oximetry was performed with
oximetry placed on his right thumb.  The patient had a
significant flow plethysmography with a pulse oximetry on
both hands, both radial and ulnar.  The patient stated he was
right handed.  He had no carotid bruits.

LABORATORY DATA:  Preoperative laboratories included a white
blood cell count 9.8, hematocrit 39.9, platelet count
210,000.  Prothrombin time 12.1, partial thromboplastin time
30.7 with an INR 0.9.  Sodium 140, potassium 4.1, chloride
104, bicarbonate 27, blood urea nitrogen 23, creatinine 1.0,
blood sugar 75.  Urinalysis was negative.  Additional
laboratories included ALT 36, AST 27, alkaline phosphatase
69, total bilirubin 0.3, total protein 6.7, albumin 4.5,
globulin 2.2.  Hemoglobin A1C 5.4 percent.

Preoperative chest x-ray showed no active lung disease and no
evidence of congestive heart failure. Please refer to the
preoperative report dated [**2171-12-4**].  Preoperative
electrocardiogram showed sinus rhythm at 63 beats per minute
and normal electrocardiogram.

HO[**Last Name (STitle) **] COURSE:  The patient was referred to Dr. [**Last Name (Prefixes) **]
for coronary artery bypass grafting.  He was seen again on
the morning of [**2171-12-16**], the day of admission with no
changes in his medical condition or history since he had been
seen on [**2171-12-4**].  He was admitted on [**2171-12-16**], and
underwent coronary artery bypass grafting times three by Dr.
[**Last Name (Prefixes) **] with the left internal mammary artery to the left
anterior descending coronary artery, vein graft to the obtuse
marginal one and vein graft to the obtuse marginal two.  He
was transferred to the Cardiothoracic Intensive Care Unit in
stable condition on titrated Neo-Synephrine and Propofol
drips.  On postoperative day number one, he had been
extubated overnight and was stable with no events.  He
remained on a Neo-Synephrine drip at 0.25 mcg/kg/minute.
Postoperative laboratories were as follows:  White blood cell
count 10.6, hematocrit 30.1, platelet count 160,000.
Potassium 4.4, blood urea nitrogen 17, creatinine 0.8, with a
blood sugar of 104.  The patient was doing well.  He was
alert and oriented in no apparent distress.  His lungs were
clear bilaterally.  His abdomen was soft, nontender,
nondistended.  Later in the day he was weaned off his Neo-
Synephrine.  His chest tubes remained in place.  He started
beta blocker and Lasix diuresis and was transferred out to
the floor later in the day.  On postoperative day number two,
he had one episode of hypotension late in the day the day
prior.  He had a better blood pressure in the morning of
102/60.  His chest tube remained in place as he had an air
leak.  He was in sinus rhythm at 80 beats per minute.  His
laboratories were unremarkable.  His Lopressor was on hold
for his blood pressure as was his Lasix.  He started his
Aspirin and Lipitor and was switched over to p.r.n. Percocet
and started his Zantac.  He had decreased breath sounds both
bases, left greater than right.  His sternal incision was
clean, dry and intact as was his right lower extremity
incision.  His Foley remained in place.  The patient
continued to be orthostatic and his diuresis and beta
blockers were held as previously stated.  His Foley was
discontinued.  He was evaluated by physical therapy so he
could begin ambulating with the nurses and physical
therapists.  He was seen by case management also to help plan
for discharge.  On postoperative day number three, he
continued to have air leak from his left pleural chest tube,
but he had no further orthostasis.  His beta blockade was
restarted on a blood pressure of 106/66 and heart rate of 85.
His hematocrit remained stable at 27.3 with a creatinine of
0.8.  He was doing a level three and level four with physical
therapy.  Mediastinal chest tubes were removed.  Left pleural
tube remained in place.  The pacing wires were discontinued.
Chest x-ray was repeated on water seal and Lasix was
restarted as the patient had no further orthostasis.  The
patient was also seen by thoracic surgery.  Chest x-ray
showed partial collapse of his left lung.  His chest tube
remained in for his air leak.  He was saturating 96 percent
in room air.  His left pleural tube remained to low wall
suction.  He was tolerating his p.o. well.  His incisions
were clean, dry and intact.  On postoperative day number
four, his blood pressure dropped slightly to 90/60.  His
chest tube had no air leak on the morning of postoperative
day number four.  He was switched over to water seal.  His
central venous line was out.  His pacing wires had already
been removed.  He had some crackles at his left base.  He was
neurologically intact.  Incisions were clean, dry and intact
with only trace lower extremity edema. The patient continued
to work with physical therapy and made good progress with
ambulation.  A repeat chest x-ray was done later that day.
Repeat chest x-ray showed pneumothorax with the plan to try
and switch the patient back to water seal and then repeat
chest x-ray again.  The patient's discharge was held up based
on the results of his repeat chest x-ray.  The patient
continued to make great strides in terms of his ambulation.
On [**2171-12-22**], his heart was regular rate and rhythm, and his
lungs were clear bilaterally.  His abdomen was soft,
nontender, nondistended.  The patient was feeling well and
was doing level five of stairs.  He was saturating 95 percent
in room air with a heart rate of 79 and sinus rhythm and
blood pressure of 126/66.  His chest tube was removed after
the air leak disappeared with plans to discharge him if his
chest x-ray was OK.  He was deemed ready for discharge on
[**2171-12-22**].

DISCHARGE DIAGNOSES:  Status post coronary artery bypass
grafting times three.

Hypertension.

Hypercholesterolemia.

Remote chronic bronchitis.

Left lower extremity varicosities.

MEDICATIONS ON DISCHARGE:
1. Colace 100 mg p.o. twice a day.
2. Zantac 150 mg p.o. twice a day.
3. Tylenol 650 mg p.o. p.r.n. q4hours.
4. Percocet 5/325 one to two tablets p.o. p.r.n. q4hours for
   pain.
5. Lipitor 80 mg p.o. daily.
6. Enteric-Coated Aspirin 81 mg p.o. daily.
7. Metoprolol 12.5 mg p.o. twice a day.
8. Lasix 20 mg p.o. daily times seven days.


DI[**Last Name (STitle) 408**]E INSTRUCTIONS:  The patient was instructed to follow-
up with Dr. [**Last Name (Prefixes) **] in the office for his postoperative
surgical visit in approximately four weeks postdischarge and
to follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 1968**], postdischarge.  Again, the
patient was discharged to home with VNA services on
[**2171-12-22**].



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2172-1-15**] 11:35:06
T:  [**2172-1-15**] 19:49:12
Job#:  [**Job Number 58127**]
{'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Unspecified essential hypertension,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: The patient was originally seen
in the office by Dr. [**Last Name (Prefixes) **] on [**2171-11-14**].  Surgery was
delayed due to scheduling issues at that time, and the
patient was seen again on [**2171-12-4**].  This 59 year old
gentleman had no symptoms at rest but had a known history of
coronary artery disease since a prior catheterization in
[**2152**].  He had done well with medical therapy over the
previous eighteen years until the past few months which he
then stated he started to feel chest pressure but only at
peak exercise.  A stress echocardiogram showed anterior wall
hypokinesis.  This led to cardiac catheterization on
[**2171-10-18**], which revealed a right dominant system and 80
percent left anterior descending coronary artery lesion and
50 percent circumflex lesion and a 95 percent obtuse marginal
one lesion and 95 percent obtuse marginal two lesion, 50
percent lesion of the right coronary artery and a 70 percent
lesion of the posterior descending coronary artery.  The
patient had no mitral regurgitation, had an ejection fraction
of 71 percent.  Prior echocardiogram [**2171-10-8**], showed
ejection fraction of 60 percent, no mitral regurgitation, no
aortic insufficiency, but anterior hypokinesis and multiple
hypokinetic areas.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 1. Folic Acid 800 mcg daily.
2. Aspirin 162 mg daily.
3. Verapamil 240 mg sustained release p.o. daily.
4. Diovan 160 mg p.o. daily.
5. Lipitor 80 mg p.o. daily.
6. Zetia 10 mg p.o. daily.
7. Vitamin E 400 international units p.o. daily.
8. One drop right eye of an eye drop for his glaucoma.  The
   patient could not remember the name of the drug at the
   time of the examination.

ALLERGIES: He had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant family history as his father
died of a myocardial infarction at age 56 and his mother had
both myocardial infarction and stroke and died at age 85.

SOCIAL HISTORY: The patient smoked a rare pipe and stated he
had not smoked any in thirty-five years.  He admitted to two
to three glasses of wine per week.  He said he had no use of
recreational drugs. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Iatrogenic pneumothorax,Unspecified essential hypertension,Pure hypercholesterolemia'}
