CHIEF COMPLAINT: Stable angina.

PRESENT ILLNESS: Mr. [**Known lastname 29201**] is a pleasant
68-year-old male with known three vessel coronary artery
disease since a cardiac catheterization in [**2132**].  He reports
that he has discomfort in his chest on exertion approximately
one to two times per week, which is relieved by rest.  This
has been stable for quite some time.  He was found to have a
positive result on a stress test done in [**9-17**].

MEDICAL HISTORY: 1. Coronary artery disease.  2.
Hypertension.  3. Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient denies past history of tobacco use.
He states that he consumes alcohol in a social manner.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Surg compl-heart,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2138-12-24**]     Discharge Date:  [**2138-12-31**]

Date of Birth:   [**2070-3-19**]     Sex:  M

Service:  CT Surgery

CHIEF COMPLAINT:  Stable angina.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 29201**] is a pleasant
68-year-old male with known three vessel coronary artery
disease since a cardiac catheterization in [**2132**].  He reports
that he has discomfort in his chest on exertion approximately
one to two times per week, which is relieved by rest.  This
has been stable for quite some time.  He was found to have a
positive result on a stress test done in [**9-17**].

PAST MEDICAL HISTORY:  1. Coronary artery disease.  2.
Hypertension.  3. Hypercholesterolemia.

PAST SURGICAL HISTORY:  1. Status post appendectomy.

MEDICATIONS:  1. Norvasc, 5 mg once per day.  2. Toprol, 50
mg once per day.  3. Lipitor, 60 mg once per day.  4.
Aspirin, 81 mg once per day.  5. Altace, 10 mg once per day.
6. Folate, 1 mg once per day.  7. Multivitamin, one tablet
once per day.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  Patient denies past history of tobacco use.
He states that he consumes alcohol in a social manner.

FAMILY HISTORY:  Noncontributory.

INITIAL PHYSICAL EXAMINATION:  On initial physical
examination, height is 5 feet 6?????? inches, weight is 200
pounds.  Mr. [**Known lastname 29201**] is a pleasant 68-year-old male who
appears older than his stated age.  His heart rate is in
sinus rhythm at 57 beats per minute, with a blood pressure of
111/63, and a room air oxygen saturation of 100%.
Neurologically, he is grossly intact.  His cardiac
examination shows a regular rate and rhythm with no murmurs.
His lungs are clear to auscultation bilaterally.  His abdomen
is obese, soft, nontender, and nondistended.  He has no
hepatosplenomegaly, and no other palpable masses.  His
extremities are warm, dry, and well perfused, with no
varicosities.  On pulse exam, he has 2+ palpable radial
femoral and popliteal artery pulses bilaterally, and 1+
palpable dorsalis pedis and posterior tibial artery pulses
bilaterally.  His neck is supple with 2+ palpable carotid
pulses and no bruits.
LABORATORY/DIAGNOSTICS:  Prior to admission, CBC was
significant for a white blood cell count of 5.9, hematocrit
of 35.4, and a platelet count of 245.  Chem-7 showed a sodium
of 136, potassium of 4.0, chloride of 103, bicarbonate of 25,
BUN of 22, and a creatinine of 1.2, with a blood glucose of
128.  His PT and PTT were 13 and 28.5, respectively, and
total cholesterol was 209.

EKG showed sinus rhythm.

Chest x-ray showed only degenerative changes of the thoracic
spine with no other noted abnormalities.

Mr. [**Known lastname 29201**] [**Last Name (Titles) 1834**] cardiac catheterization, preoperatively,
on [**2138-11-24**].  At this time, he was found to have severe three
vessel disease with 100% occlusion of the mid LAD, 100%
occlusion of the mid circumflex, and 100% occlusion at the
mid right coronary artery.  His left ventricular ejection
fraction, at this time, was calculated to be approximately
61%.

HOSPITAL COURSE:  On [**2138-12-24**], Mr. [**Known lastname 29201**] was admitted to the
Operating Room where he [**Known lastname 1834**] a coronary artery bypass
graft times four.  Please see the dictated operative note for
full details of this procedure.  In summary, he had a left
internal mammary artery to left anterior descending artery
graft, as well as saphenous vein graft to the obtuse marginal
I and obtuse marginal II, as well as the posterior descending
artery.  He tolerated the procedure well and was transferred,
postoperatively, to the Cardiac Surgery Recovery Unit.  He
arrived to the CSRU on a Neo-Synephrine drip at 0.5 mcg, and
a propofol drip at 20 mcg.  He was being A-paced at 88 beats
per minute.  He, subsequently, went into atrial fibrillation
and his blood pressure dropped to the 60's systolic.  This
did not respond to two liters of lactated Ringer's and fluid
boluses or raising his Neo-Synephrine drip to 2.5 mcg and
weaning off his propofol.  At this time, he was given Hespan
500, to which his blood pressure responded well.  It went up
to the 160's, and he was subsequently placed on low dose
nitroglycerin.  On postoperative day number zero, Mr. [**Known lastname 29201**]
continued to have a high chest tube output, being in atrial
fibrillation, had a drop in cardiac index.  For this, he was
treated with four units of FFB, four units of packed red
blood cells, and a six pack of platelets.  He was also
cardioverted, at this time, due to a low cardiac index while
in atrial fibrillation, to which he converted to sinus rhythm
and improved his cardiac index to back above 2.

On postoperative day number one, he remained intubated and
A-paced.  He was on a Neo-Synephrine drip at 1.25 mcg and
amiodarone drip at 0.5, a propofol drip at 30, and an insulin
drip at 3.  During the day on postoperative day number one,
he was slowly weaned from the vent, but decision was made to
keep him intubated overnight on postoperative day number one.
He was also slowly weaned from his Neo-Synephrine and
propofol, which were only restarted when, again, the decision
was made to keep him intubated overnight.  He continued to
improved and, on postoperative day number two, remained in a
normal sinus rhythm.  He was, again, slowly weaned from the
vent and slowly weaned from his Neo-Synephrine and propofol
drips.  He was, subsequently, extubated, which he tolerated
well, on postoperative day number two, and his Neo-Synephrine
and propofol drips were weaned off.  He continued to be on an
amiodarone drip at 0.5 mcg, and maintained sinus rhythm with
occasional APC's.  Chest tube output also decreased
significantly during postoperative day number two and, after
chest x-ray, his chest tubes were removed.  He continued to
do well and remained in sinus rhythm.  He was being diuresed
aggressively and continued to require or have a high oxygen
requirement to maintain his oxygen saturations.  He was
deemed stable on postoperative day number four to be
transferred to the regular floor.

After being transferred to the floor, he slowly improved his
room air blood oxygen saturation, rising from 86% on
postoperative day number five to 96% on postoperative day
number seven.  He continued to diurese well, showing
significant improvement in his peripheral edema.  He did
extremely well with physical therapy, and was taking a
regular diet and doing well.  On postoperative day number
seven, it was felt that the patient was stable and ready for
discharge, but that he would benefit from a stay in an
extended care rehabilitation facility.

PHYSICAL EXAMINATION AT THE TIME OF DISCHARGE:  Mr. [**Known lastname 29201**]
was found to have a temperature of 99.5?????? Fahrenheit with a
heart rate of 70 in sinus rhythm and a blood pressure of
122/68.  His room air oxygen saturation was 97%.  He was
continuing to diurese well, at this time.  His heart showed a
regular rate and rhythm with no murmurs.  His breath sounds
were clear to auscultation bilaterally.  His sternal incision
was healing nicely with no erythema or drainage.  His abdomen
was soft, nontender, and nondistended, with normoactive bowel
sounds.  His extremities were warm and well perfused, showing
approximately 1+ peripheral edema in the lower extremities.

DISCHARGE MEDICATIONS:  1. Enteric coated aspirin, 325 mg by
mouth once per day.  2. Lasix, 40 mg by mouth twice per day.
3. Folic acid, 1 mg by mouth once per day.  4. Atorvastatin,
60 mg by mouth once per day.  5. Amiodarone, 400 mg by mouth
twice per day.  6. Lopressor, 12.5 mg by mouth twice per day.
7. Percocet, one to two tablets by mouth every 4-6 hours as
needed for pain.  8. Zantac, 150 mg by mouth twice per day.
9. Colace, 100 mg by mouth twice per day.  10. Potassium
chloride, 20 mEq by mouth twice per day.
CONDITION ON DISCHARGE:  Stable.

DISPOSITION:  To an extended care rehabilitation facility.

DISCHARGE DIAGNOSES:  1. Coronary artery bypass graft times
four.  2. Hypertension.  3. Hypercholesterolemia.

DIET:  Cardiac heart healthy diet.

ACTIVITY:  As tolerated, though he will benefit from
continued work with physical therapy.






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

Dictated By:[**Name8 (MD) 29202**]

MEDQUIST36

D:  [**2138-12-31**]  08:53
T:  [**2138-12-31**]  08:47
JOB#:  [**Job Number 29203**]


Admission Date:  [**2138-12-24**]       Discharge Date:  [**2138-12-31**]

Date of Birth:   [**2070-3-19**]       Sex:  M

Service:  Cardiothoracic Surgery

CHIEF COMPLAINT:  Stable exertional chest discomfort relieved
with rest.






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

Dictated By:[**Name8 (MD) 11089**]
MEDQUIST36

D:  [**2138-12-31**]  08:14
T:  [**2138-12-31**]  08:18
JOB#:  [**Job Number 24665**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,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: Stable angina.

PRESENT ILLNESS: Mr. [**Known lastname 29201**] is a pleasant
68-year-old male with known three vessel coronary artery
disease since a cardiac catheterization in [**2132**].  He reports
that he has discomfort in his chest on exertion approximately
one to two times per week, which is relieved by rest.  This
has been stable for quite some time.  He was found to have a
positive result on a stress test done in [**9-17**].

MEDICAL HISTORY: 1. Coronary artery disease.  2.
Hypertension.  3. Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Patient denies past history of tobacco use.
He states that he consumes alcohol in a social manner. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia'}
