CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 79-year-old
white male who is very active, who developed on the day prior
to admission, chest pain.  After the second episode of chest
pain, the patient presented to an outside hospital for an
evaluation.  The patient was admitted to the outside hospital
and a cardiac catheterization was performed.  The cardiac
catheterization by report revealed a three vessel disease
including 100% occlusion of RCA, 80-90% occlusion of LAD, and
90% occlusion of the circumflex artery.  The patient's
ejection fraction was approximately 50%.  While in the
hospital the patient experienced a non Q wave myocardial
infarction.  As a result, the patient was transferred to [**Hospital1 1444**] for further evaluation and
possible surgical intervention.

MEDICAL HISTORY: Hypertension, hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Other left bundle branch block,Unspecified essential hypertension,Pure hypercholesterolemia
Subendo infarct, initial,Surg compl-heart,Cardiac arrest,Crnry athrscl natve vssl,Left bb block NEC,Hypertension NOS,Pure hypercholesterolem
Name:  [**Known lastname 8276**], [**Known firstname **]                    Unit No:  [**Numeric Identifier 8277**]

Admission Date:  [**2191-9-1**]     Discharge Date: [**2191-9-14**]

Date of Birth:   [**2111-12-23**]     Sex:  M

Service:

ADDENDUM:

Status post coronary artery bypass graft times three on
[**9-2**].  This is an addendum to the discharge summary.
Addendum includes the discharge medications.

DISCHARGE MEDICATIONS:   As of [**2191-9-14**]
1)  Amiodarone 400 mg p.o. q.d.
2)  Digoxin 0.125 p.o. q.d.
3)  Coumadin to check for dose adjustment daily for a goal
INR of 2.0, 5 mg given on [**9-30**] and [**9-14**] with an INR
today of 1.5.  Level to be checked tomorrow.
4)  Lipitor 10 mg p.o. q.d.
5)  Lasix 20 mg p.o. q. 12 times two weeks with KCL 20 mEq
p.o. q. 12 hours times two weeks.
6)  Ibuprofen 400 mg p.o. q. six p.r.n. for pain.
7)  Diphenhydramine 25 mg p.o.q.h.s. p.r.n. sleep.




                          [**First Name11 (Name Pattern1) 63**] [**Last Name (NamePattern4) 1508**], M.D.  [**MD Number(1) 1509**]

Dictated By:[**Last Name (NamePattern1) 8278**]

MEDQUIST36

D:  [**2191-9-14**]  11:25
T:  [**2191-9-14**]  13:01
JOB#:  [**Job Number 8279**]


Admission Date:  [**2191-9-1**]       Discharge Date:  [**2191-9-14**]


Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 79-year-old
white male who is very active, who developed on the day prior
to admission, chest pain.  After the second episode of chest
pain, the patient presented to an outside hospital for an
evaluation.  The patient was admitted to the outside hospital
and a cardiac catheterization was performed.  The cardiac
catheterization by report revealed a three vessel disease
including 100% occlusion of RCA, 80-90% occlusion of LAD, and
90% occlusion of the circumflex artery.  The patient's
ejection fraction was approximately 50%.  While in the
hospital the patient experienced a non Q wave myocardial
infarction.  As a result, the patient was transferred to [**Hospital1 1444**] for further evaluation and
possible surgical intervention.

PAST MEDICAL HISTORY:  Hypertension, hypercholesterolemia.

PAST SURGICAL HISTORY:  No significant history.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  On admission, Metoprolol 25 mg q day, Lipitor
10 mg q day, Lovenox 80 mg [**Hospital1 **], Nitro paste, Ambien 5 mg po q
h.s.

PHYSICAL EXAMINATION:  The patient was alert and oriented, in
no apparent distress.  Vital signs, temperature 96.8, blood
pressure 128/64, heart rate 72, respiratory rate 18, 95% on
room air.  HEENT exam was within normal limits.  There was no
jugulovenous distension, no bruits, clear to auscultation
bilaterally, regular rate with 2/6 systolic ejection murmur.
Abdomen soft, nontender, nondistended with bowel sounds
present, no hepatosplenomegaly.  Extremities without edema,
with veins intact.

LABORATORY DATA:  On admission the patient's hematocrit was
40.3, white blood cell count 5.2, platelet count 194,000, PT
13.4, INR 1.3.  Urinalysis was negative.  Glucose 123,
creatinine 0.8, urea 16, potassium 4.3.  Chest x-ray
performed on [**8-15**] showed no evidence of congestive heart
failure.  There was some linear atelectasis in the left lower
zone.

HOSPITAL COURSE:  The patient was diagnosed with
atherosclerotic occlusive coronary artery disease and left
bundle branch block.  The patient was taken to the operating
room on [**2191-9-2**].  The patient underwent emergent three vessel
coronary artery bypass grafting with saphenous veins to the
left anterior descending coronary artery, posterolateral
branch of the circumflex and first diagonal, with three
segments of reversed vein using coalescent clips on the
distals.  There was a complication during the procedure.
Specifically, when the Swan catheter was introduced into the
right ventricle, the patient went into complete heart block
with no ventricular escape.  The patient then developed
ventricular fibrillation presumably due to hypotension and
poor coronary perfusion in the setting of left main.
Cardiopulmonary resuscitation was initiated and the patient
was defibrillated with resumption of heart block.  Please see
the full operative report for detail.  After the procedure,
the patient was transferred to the Intensive Care Unit in
guarded condition.  The patient remained intubated on
admission.  The patient was originally tachycardic.  His
hematocrit was noted to be dropping from mid 40's to upper
30's.  The patient was continued on Amiodarone.  He continued
to make adequate urine output.  The patient was also
continued on Lopressor.  An EP fellow was consulted regarding
assisting with transvenous pacemaker placements.  On
postoperative day #2 while still in the Intensive Care Unit,
the patient spiked a fever of 103.4.  His blood and urine
cultures showed no growth.  The patient was continued on Levo
and Epi.  On postoperative day #2 the patient experienced
atrial fibrillation with rates in the 140's, treated with
Amiodarone.  The patient then converted to sinus rhythm.  The
patient was continued on AV pacing via epicardial A lead and
transvenous lead.  The chest tubes were discontinued on
postoperative day #3.  The patient was noted to be in atrial
flutter.  The patient was slowly being weaned off the
ventilator.  The patient was extubated on [**2191-9-8**].  The
patient began tolerating sips of liquids.  No breakthrough
atrial fibrillation was noted.  The patient was also
continued on Digitoxin and started on IV Heparin.  His
Levophed was weaned off.  Amiodarone was continued and
adjusted appropriately.  The patient continued to do well
while extubated in the Intensive Care Unit.  His antibiotic
was discontinued.  The patient was working with physical
therapy on ambulation.  On postoperative day #10 the
patient's blood pressure was in 115-140 range with heart rate
in the 70's and 80's, sinus rhythm.  The patient continued to
be hemodynamically stable.  On [**2191-9-13**] the patient was
transferred to the regular floor.  The patient's pacing wires
were discontinued.  The patient was anticoagulated with
Coumadin and IV Heparin to achieve a therapeutic INR.  [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
of Hearts monitor was placed on the patient.  The patient was
discharged on [**2191-9-14**] in stable condition.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE DISPOSITION:  [**Hospital1 700**] in
[**State 350**], (Rehabilitation Center).

DISCHARGE DIAGNOSIS:
1. Status post three vessel coronary artery bypass graft
complicated by complete heart block which was successfully
reversed.
2.  Hypertension.
3.  Hypercholesterolemia.

DISCHARGE MEDICATIONS:  Coumadin 5 mg po q day, Amiodarone
400 mg po q day, Digoxin 0.25 mg po q day, Aspirin 325 mg po
q day, Lasix 20 mg po bid times 10 days, Potassium Chloride
20 mEq po bid times 10 days, Colace 100 mg po bid, Percocet
1-2 tabs po q 4-6 hours prn pain, Protonix 40 mg po q day.

DISCHARGE INSTRUCTIONS:  The patient is to follow-up with his
surgeon, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1537**] in approximately four weeks.  The
patient is to follow-up with his primary care physician
within the next week.  The patient is to obtain PT and PTT
laboratories within the next three days with the results sent
to his primary care physician and his surgeon.  The patient
is to see a cardiologist before seeing his surgeon.




                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 1741**]
MEDQUIST36

D:  [**2191-9-13**]  20:11
T:  [**2191-9-13**]  20:21
JOB#:  [**Job Number 45125**]
{'Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Other left bundle branch block,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 is a 79-year-old
white male who is very active, who developed on the day prior
to admission, chest pain.  After the second episode of chest
pain, the patient presented to an outside hospital for an
evaluation.  The patient was admitted to the outside hospital
and a cardiac catheterization was performed.  The cardiac
catheterization by report revealed a three vessel disease
including 100% occlusion of RCA, 80-90% occlusion of LAD, and
90% occlusion of the circumflex artery.  The patient's
ejection fraction was approximately 50%.  While in the
hospital the patient experienced a non Q wave myocardial
infarction.  As a result, the patient was transferred to [**Hospital1 1444**] for further evaluation and
possible surgical intervention.

MEDICAL HISTORY: Hypertension, hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Cardiac arrest,Coronary atherosclerosis of native coronary artery,Other left bundle branch block,Unspecified essential hypertension,Pure hypercholesterolemia'}
