CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 74-year-old
white female with a past medical history of coronary artery
disease and coronary artery bypass graft who came to the
Coronary Care Unit because of a ventricular arrhythmia.

MEDICAL HISTORY: 1.  Biliary sphincterotomy on [**10-1**] for biliary
stenosis.
2.  Coronary artery disease.
(a)  Status post a coronary artery bypass graft in [**2133**] (with
left internal mammary artery to left anterior descending
artery, saphenous vein graft to obtuse marginal, and
saphenous vein graft to posterior left ventricular, and
saphenous vein graft to posterior descending artery).
(b)  A stress test in [**2139-6-16**] which showed moderate
plaque in the lateral wall and an ejection fraction of 45%.
3.  Hypertension.
4.  Gastroesophageal reflux disease.
5.  Left nephrectomy for removal of suprarenal mass.
6.  Status post cholecystectomy.

MEDICATION ON ADMISSION: (Medications included)
1.  Nystatin.
2.  Fluconazole.
3.  Amiodarone drip 0.5 mg per hour.
4.  Mucomyst 600 mg by mouth twice per day.
5.  Aspirin 325 mg by mouth once per day.

ALLERGIES: 1.  SULFA (causes chest pain and hallucinations).
2.  BETA BLOCKERS (causes chest pain and hallucinations).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has no history of tobacco use.
No history of intravenous drug use.  The patient has no
alcohol use.  The patient lives with her daughter.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Subendo infarct, initial,Crnry athrscl natve vssl,Parox ventric tachycard,Surg compl-heart,CHF NOS,Chr airway obstruct NEC,Abn react-cardiac cath
Admission Date:  [**2139-10-5**]     Discharge Date:  [**2139-10-8**]

Date of Birth:   [**2065-2-2**]     Sex:  F

Service:  Coronary Care Unit/C-MED

HISTORY OF PRESENT ILLNESS:  The patient is a 74-year-old
white female with a past medical history of coronary artery
disease and coronary artery bypass graft who came to the
Coronary Care Unit because of a ventricular arrhythmia.

The patient was seen at [**Hospital 1474**] Hospital due to chest pain
three days prior.  Five days ago, the patient had an
endoscopic retrograde cholangiopancreatography for elevated
liver function tests leading to a sphincterotomy.  She then
returned with the same right-sided pain which she described
as sharp and intermittent (every two to three minutes).  She
was admitted for rule out myocardial infarction and an
elevated troponin I with flat creatine kinase values.  She
was given aspirin, Lovenox, and Plavix.  She had an episode
of ventricular arrhythmia at 30 to 70 beats which was
asymptomatic.  She was then transferred to [**Hospital1 346**] for cardiac catheterization.

At [**Hospital1 69**], the patient had a
cardiac catheterization.  This catheterization revealed three
patent grafts with one presumed occluded saphenous vein graft
to first obtuse marginal.  No intervention was undertaken.

However, while on the floor following the cardiac
catheterization, the patient had multiple runs of ventricular
beats lasting for over 30 beats.  She denied any chest pain,
shortness of breath, palpitations, or lightheadedness with
these episodes which occurred and resolved spontaneously.
Her chest pain was sharp and not associated with inspiration
or position.  It was similar to her pain with her endoscopic
retrograde cholangiopancreatography.

PAST MEDICAL HISTORY:
1.  Biliary sphincterotomy on [**10-1**] for biliary
stenosis.
2.  Coronary artery disease.
(a)  Status post a coronary artery bypass graft in [**2133**] (with
left internal mammary artery to left anterior descending
artery, saphenous vein graft to obtuse marginal, and
saphenous vein graft to posterior left ventricular, and
saphenous vein graft to posterior descending artery).
(b)  A stress test in [**2139-6-16**] which showed moderate
plaque in the lateral wall and an ejection fraction of 45%.
3.  Hypertension.
4.  Gastroesophageal reflux disease.
5.  Left nephrectomy for removal of suprarenal mass.
6.  Status post cholecystectomy.

ALLERGIES:
1.  SULFA (causes chest pain and hallucinations).
2.  BETA BLOCKERS (causes chest pain and hallucinations).

MEDICATIONS ON ADMISSION:  (Medications included)
1.  Nystatin.
2.  Fluconazole.
3.  Amiodarone drip 0.5 mg per hour.
4.  Mucomyst 600 mg by mouth twice per day.
5.  Aspirin 325 mg by mouth once per day.

MEDICATIONS ON TRANSFER:  (Medications on transfer from the
Coronary Care Unit)
 1.  Amiodarone 400 mg by mouth twice per day.
 2.  Clonidine 0.1 mg by mouth twice per day.
 3.  Norvasc 5 mg by mouth once per day.
 4.  Nitroglycerin paste one inch q.6h.
 5.  Neurontin 300 mg by mouth once per day.
 6.  Lasix 20 mg by mouth once per day.
 7.  Aspirin 325 mg by mouth once per day.
 8.  Plavix 75 mg by mouth once per day.
 9.  Lovenox 1 g/kg q.12h.
10.  Colchicine by mouth every day.
11.  Probenecid by mouth every day.
12.  Mucomyst.
13.  Advair 500/50 by mouth twice per day.
14.  Combivent.
15.  Vioxx 12.5 mg by mouth once per day.
16.  B12 1 mg by mouth every day.
17.  Folate 400 mg by mouth once per day.
18.  Neurontin 300 mg by mouth once per day.

SOCIAL HISTORY:  The patient has no history of tobacco use.
No history of intravenous drug use.  The patient has no
alcohol use.  The patient lives with her daughter.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
revealed the patient's temperature was 98.9 degrees
Fahrenheit, her heart rate was 71, her blood pressure was
134/55, her respiratory rate was 23, and her oxygen
saturation was 97% on room air.  Neck examination revealed
the neck was supple.  Jugular venous distention at about 6
cm.  Pulmonary examination revealed no wheezes or crackles.
Limited anteriorly.  Cardiovascular examination revealed
normal first heart sounds and second heart sounds.  No
murmurs, rubs, or gallops.  The abdomen was obese and benign.
Extremity examination revealed minimal puffy edema.

PERTINENT LABORATORY VALUES ON PRESENTATION:  The patient's
troponin I at the outside hospital was 16.4.  Her creatine
kinase was 163.

PERTINENT RADIOLOGY/IMAGING:  On [**10-4**], the patient's
electrocardiogram revealed a ventricular arrhythmia which
appeared to be an idioventricular rhythm.

A chest x-ray at the outside hospital showed increased
pulmonary vascular congestion.

CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM:

1.  CARDIOVASCULAR ISSUES:  (a)  Ischemia:  The patient with
non-ST-elevation myocardial infarction likely the week prior
to admission at the outside hospital based on her troponin
and creatine kinase values.

The patient had a cardiac catheterization with no
intervention or lesion.  Her aspirin and Lipitor were
continued.  The patient was unable to tolerate beta blockers
so they were held.  She also stopped receiving her Lovenox
from prior.  Her blood pressure remained stable, and she was
continued on her Norvasc, and captopril, and clonidine.  The
patient was started on Zocor, as she had not previously been
on a statin.

(b)  Pump:  The patient's ejection fraction was reportedly
46%, but she had no evidence of failure.

(c)  Rhythm:  The patient had an intravenous amiodarone load
and then was transitioned to by mouth amiodarone.  The
patient was not tolerating the by mouth beta blocker due to
hallucinations.  Therefore, the patient was continued on the
amiodarone.

The patient's blood pressure remained stable with
intermittent rhythms during her stay in the Coronary Care
Unit and was transferred out to the C-MED floor in a sinus
rhythm.  Before transfer to the floor, the patient remained
in a sinus rhythm times 24 hours.  She was continued on
telemetry.  Her amiodarone was discontinued.

The Electrophysiology Service was consulted for a question of
intervention, but they felt that the patient did not have
further issues as her rhythm had resolved and was likely just
a consequence of her recent ischemic event.

The patient was started on a low-dose of atenolol despite her
contraindications to beta blockers with hallucinations.  She
did not tolerate this.  She was to follow up with her
cardiologist and will have to take a different cardiac
medication, but in the setting of her known coronary artery
disease and recent arrhythmias this was the best medication
for her to be on.

2.  LIVER FUNCTION TEST ISSUES:  The patient's liver function
tests were slightly elevated but were trending down during
her entire admission.  These were likely in the setting of
her recent biliary stenosis and sphincterotomy.

3.  GOUT ISSUES:  The patient was continued on her colchicine
and allopurinol while in the hospital.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was good.  She was without chest pain and in a stable sinus
rhythm.

DISCHARGE STATUS:  Discharge status was to home.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 15994**] within one to two weeks (her cardiologist) to discuss
cardiac rehabilitation and also for blood work after starting
Zocor.
2.  The patient was instructed to follow up with her primary
care physician (Dr. [**Last Name (STitle) 9404**] within two weeks.

MEDICATIONS ON DISCHARGE:
 1.  Aspirin 325-mg tablets one tablet by mouth once per day.
 2.  Clonidine 0.1-mg tablets one tablet by mouth once per
day.
 3.  Protonix 40-mg tablets one tablet by mouth once per day.
 4.  Lasix 20-mg tablets one tablet by mouth once per day.
 5.  Probenecid 500-mg tablets one tablet by mouth once per
day
 6.  Gabapentin 300-mg tablets one tablet by mouth once per
day.
 7.  Cyanocobalamin one by mouth every day.
 8.  Plavix 75-mg tablets one tablet by mouth once per day.
 9.  Miconazole powder one three times per day.
10.  Colchicine 0.6-mg tablets one tablet by mouth every day.
11.  Atenolol 25-mg tablets one tablet by mouth once per day.
12.  Zocor 20-mg tablets one by mouth once per day.





                          [**First Name8 (NamePattern2) 870**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 5219**]

Dictated By:[**Last Name (NamePattern1) 8141**]

MEDQUIST36

D:  [**2139-11-10**]  15:17
T:  [**2139-11-12**]  10:37
JOB#:  [**Job Number 50741**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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 74-year-old
white female with a past medical history of coronary artery
disease and coronary artery bypass graft who came to the
Coronary Care Unit because of a ventricular arrhythmia.

MEDICAL HISTORY: 1.  Biliary sphincterotomy on [**10-1**] for biliary
stenosis.
2.  Coronary artery disease.
(a)  Status post a coronary artery bypass graft in [**2133**] (with
left internal mammary artery to left anterior descending
artery, saphenous vein graft to obtuse marginal, and
saphenous vein graft to posterior left ventricular, and
saphenous vein graft to posterior descending artery).
(b)  A stress test in [**2139-6-16**] which showed moderate
plaque in the lateral wall and an ejection fraction of 45%.
3.  Hypertension.
4.  Gastroesophageal reflux disease.
5.  Left nephrectomy for removal of suprarenal mass.
6.  Status post cholecystectomy.

MEDICATION ON ADMISSION: (Medications included)
1.  Nystatin.
2.  Fluconazole.
3.  Amiodarone drip 0.5 mg per hour.
4.  Mucomyst 600 mg by mouth twice per day.
5.  Aspirin 325 mg by mouth once per day.

ALLERGIES: 1.  SULFA (causes chest pain and hallucinations).
2.  BETA BLOCKERS (causes chest pain and hallucinations).

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has no history of tobacco use.
No history of intravenous drug use.  The patient has no
alcohol use.  The patient lives with her daughter. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Paroxysmal ventricular tachycardia,Cardiac complications, not elsewhere classified,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
