CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 78 year old woman with
a history of coronary artery disease, type 2 diabetes and
COPD who presents to the coronary care unit after diagnostic
cardiac cath complicated by growing hematoma and hypotension.
She has a known history of coronary artery disease with long
standing angina at rest and dyspnea on exertion.  She had a
cath done in [**2190-7-27**] at [**Hospital 1474**] Hospital for anginal
symptoms which revealed 90% ostial lesion to a large ramus
off of the left circumflex as well as mid-RCA lesion of 99%
which was successfully treated with PTCA.  She had done well
subsequently, but for the past several months has begun to
have increasing frequency of chest discomfort that lasts
approximately 10 minutes in duration.  One month ago this
happened at rest once.  She now has this chest pain about one
time a week that resolves spontaneously.  Additionally she
has noted mild dyspnea on exertion as well as the fact that
she sleeps on two to three pillows, although this is not
clear if it is related to her dyspnea.  She underwent a
Persantine with Myoview on [**2193-9-30**], which revealed a
small reversible anteroapical defect and normal LV function
with EF of 76%.  She had no chest pain or EKG changes during
this test.  She was then referred for cath.

MEDICAL HISTORY: Coronary artery disease status post
cardiac cath at [**Hospital 1474**] Hospital on [**2190-8-20**] revealing mild
diffusely diseased LAD with a 30% to 40% diffusely diseased
ramus intermedius branch.  The first branch off the ramus had
90% ostial stenosis.  She had 30% to 40% stenosis of OM2.
She had 99% mid-RCA lesion that was PTCA'd open.  COPD.
Hypertension.  Hypercholesterolemia.  Type 2 diabetes
mellitus with hemoglobin A1C of 7.9 in [**2193-8-26**].
Arthritis.  Right sciatica.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She quit smoking 20 years ago.  She lives
with her daughter.
Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Hematoma complic proc,Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Chr airway obstruct NEC,Atrial fibrillation,DMII wo cmp nt st uncntr
Admission Date:  [**2193-12-17**]     Discharge Date:  [**2193-12-19**]


Service:  CCU

HISTORY OF PRESENT ILLNESS:  This is a 78 year old woman with
a history of coronary artery disease, type 2 diabetes and
COPD who presents to the coronary care unit after diagnostic
cardiac cath complicated by growing hematoma and hypotension.
She has a known history of coronary artery disease with long
standing angina at rest and dyspnea on exertion.  She had a
cath done in [**2190-7-27**] at [**Hospital 1474**] Hospital for anginal
symptoms which revealed 90% ostial lesion to a large ramus
off of the left circumflex as well as mid-RCA lesion of 99%
which was successfully treated with PTCA.  She had done well
subsequently, but for the past several months has begun to
have increasing frequency of chest discomfort that lasts
approximately 10 minutes in duration.  One month ago this
happened at rest once.  She now has this chest pain about one
time a week that resolves spontaneously.  Additionally she
has noted mild dyspnea on exertion as well as the fact that
she sleeps on two to three pillows, although this is not
clear if it is related to her dyspnea.  She underwent a
Persantine with Myoview on [**2193-9-30**], which revealed a
small reversible anteroapical defect and normal LV function
with EF of 76%.  She had no chest pain or EKG changes during
this test.  She was then referred for cath.

A diagnostic left heart cath was performed which revealed no
change in her disease since [**2190-7-27**], so no
intervention was performed.  Angio-Seal was inserted, but
failed to deploy to close.  Hemostasis was achieved by manual
pressure.  She was then taken to the holding area where,
after 10 minutes, she was noted to have an expanding right
groin hematoma.  Manual pressure was applied for 20 minutes
and a clamp was placed for 40 minutes.  During this episode
she received 1 mg of atropine for a heart rate in the 40s as
well as dopamine transiently.  She quickly responded with an
increase in her systolic blood pressure to 170s and heart
rate to 160s while on dopamine.  EKG at that time revealed
new onset atrial fibrillation at 108 beats per minute.  This
reverted spontaneously to normal sinus rhythm.  She also
received one unit of packed red blood cells and vascular
surgery was contact[**Name (NI) **].  [**Name2 (NI) 6**] ultrasound was done which showed
no evidence of pseudoaneurysm and patent vessels.

On arrival to the CCU she continued to have oozing from the
groin.  Manual pressure was applied yet again for 30 minutes.
She was hemodynamically stable and awake and oriented during
this period.  Hemostasis was then achieved which lasted for
two hours.  She rebled again and 25 minutes of pressure was
held at which point a fem-stat device was employed.

She noted the use of three to four aspirin a day for the past
few days for headaches, but had not received Plavix or
heparin or Coumadin that day or recently.  She had normal
coagulations and normal platelet count before and after her
procedure.

PAST MEDICAL HISTORY:  Coronary artery disease status post
cardiac cath at [**Hospital 1474**] Hospital on [**2190-8-20**] revealing mild
diffusely diseased LAD with a 30% to 40% diffusely diseased
ramus intermedius branch.  The first branch off the ramus had
90% ostial stenosis.  She had 30% to 40% stenosis of OM2.
She had 99% mid-RCA lesion that was PTCA'd open.  COPD.
Hypertension.  Hypercholesterolemia.  Type 2 diabetes
mellitus with hemoglobin A1C of 7.9 in [**2193-8-26**].
Arthritis.  Right sciatica.

MEDICATIONS:  Aspirin three to four q.day, Imdur 30 mg q.day,
Lipitor 20 mg q.day, Zestril 40 mg q.day, atenolol 50 mg
q.day, Lasix 80 mg q.day, Valium 10 mg t.i.d., 70/30 insulin
40 units q.a.m. and 20 units q.p.m., albuterol p.r.n., cod
liver oil, garlic tablets, multivitamin.

ALLERGIES:  Penicillin causes a rash.

SOCIAL HISTORY:  She quit smoking 20 years ago.  She lives
with her daughter.

PHYSICAL EXAMINATION:  This was a pleasant woman in no acute
distress who appeared younger than her stated age.  She was
afebrile, blood pressure 102/44, pulse 88, respiratory rate
18, oxygen saturation 99% on 4 liters nasal cannula.  She was
5'1" tall and weighed 190 pounds.  HEENT exam was
unremarkable.  She had no jugular venous distension.  Lungs
were clear to auscultation anteriorly.  Heart was regular
with no murmurs or gallops.  Abdomen was soft and obese.
Right groin had a firm ecchymotic hematoma.  There was no
bruit.  Extremities were without edema and with 2+ distal
pulses.

LABORATORY DATA:  On presentation white count was 11.9,
hematocrit 38.5, platelet count 366.  Hematocrit dropped to
37.1 immediately after the procedure.  It was followed and
settled out at around 35 after having received one unit of
blood.  Chem-7 was within normal limits except for glucose of
223.  Creatinine rose from 0.9 to 1.1.  INR was 0.9, PTT 29.3
before the procedure.  Total cholesterol in [**2193-8-26**] was
195, HDL 45, LDL 97, triglycerides 286.  As mentioned above,
groin ultrasound was negative for pseudoaneurysm and showed
patent vessels.

Cardiac catheterization revealed normal LV function with an
EF of 65%.  Left main was normal.  She had 50% ostial lesion
of D1.  She had a tortuous, but patent, LAD.  She had 50%
proximal stenosis of OM2.  She had 50% stenosis of proximal
upper pole of ramus intermedius and 60% proximal stenosis of
lower pole of ramus intermedius.  She had 40% mid-right
coronary artery stenosis as well.

HOSPITAL COURSE:  The patient received one bag of platelets
as it was believed that her continued oozing may have been
secondary to platelet dysfunction from excessive aspirin.  A
fem-stat device was in place which led to control of the
bleeding.  After one hour the pressure was relieved, although
the device was left in place.  She remained hemodynamically
stable for the rest of her hospital course.  She had no
further bleeding.  She did not develop a bruit.  The
ecchymosis slowly evolved.  The hematoma did not grow in
size.

After she was observed for 36 hours and after she was able to
ambulate well in the [**Doctor Last Name **] with physical therapy, she was
discharged home on her home medication regimen which was
unchanged.  To follow up with her primary cardiologist,
Dr. [**First Name8 (NamePattern2) 20069**] [**Last Name (NamePattern1) **] at [**Hospital 1474**] Hospital, in one to two weeks.

CONDITION ON DISCHARGE:  Improved.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease status post cardiac cath without
intervention complicated by right groin hematoma.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Diabetes.
5.  COPD.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 1552**]

MEDQUIST36

D:  [**2193-12-20**]  23:30
T:  [**2193-12-21**]  17:52
JOB#:  [**Job Number 38322**]
{'Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: This is a 78 year old woman with
a history of coronary artery disease, type 2 diabetes and
COPD who presents to the coronary care unit after diagnostic
cardiac cath complicated by growing hematoma and hypotension.
She has a known history of coronary artery disease with long
standing angina at rest and dyspnea on exertion.  She had a
cath done in [**2190-7-27**] at [**Hospital 1474**] Hospital for anginal
symptoms which revealed 90% ostial lesion to a large ramus
off of the left circumflex as well as mid-RCA lesion of 99%
which was successfully treated with PTCA.  She had done well
subsequently, but for the past several months has begun to
have increasing frequency of chest discomfort that lasts
approximately 10 minutes in duration.  One month ago this
happened at rest once.  She now has this chest pain about one
time a week that resolves spontaneously.  Additionally she
has noted mild dyspnea on exertion as well as the fact that
she sleeps on two to three pillows, although this is not
clear if it is related to her dyspnea.  She underwent a
Persantine with Myoview on [**2193-9-30**], which revealed a
small reversible anteroapical defect and normal LV function
with EF of 76%.  She had no chest pain or EKG changes during
this test.  She was then referred for cath.

MEDICAL HISTORY: Coronary artery disease status post
cardiac cath at [**Hospital 1474**] Hospital on [**2190-8-20**] revealing mild
diffusely diseased LAD with a 30% to 40% diffusely diseased
ramus intermedius branch.  The first branch off the ramus had
90% ostial stenosis.  She had 30% to 40% stenosis of OM2.
She had 99% mid-RCA lesion that was PTCA'd open.  COPD.
Hypertension.  Hypercholesterolemia.  Type 2 diabetes
mellitus with hemoglobin A1C of 7.9 in [**2193-8-26**].
Arthritis.  Right sciatica.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes a rash.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She quit smoking 20 years ago.  She lives
with her daughter. 

### Response:
{'Hematoma complicating a procedure,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
