CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 46813**] had been in his
usual state of health until early [**Month (only) 359**] when he started to
experience dyspnea and chest tightness on exertion.  On
[**9-30**], he was admitted to [**Hospital6 8283**]
wit4h congestive heart failure.  His troponin was 0.22.  He
was subsequently referred to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for further
Cardiology work-up.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Aortic valve disorders,Intermediate coronary syndrome,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Coronary atherosclerosis of native coronary artery,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Other drugs and medicinal substances causing adverse effects in therapeutic use
Aortic valve disorder,Intermed coronary synd,CHF NOS,Surg compl-heart,Atrial fibrillation,Ac kidny fail, tubr necr,Crnry athrscl natve vssl,Ocl mlt bi art wo infrct,Adv eff medicinal NEC
Admission Date:  [**2117-12-7**]       Discharge Date:  [**2117-12-18**]

Date of Birth:                    Sex:  M

Service:

ADDENDUM:
HOSPITAL COURSE:  On postoperative day number two, in
addition to the Cardiology consult (Cardiology cardioverted
the patient), a Renal consult was obtained to inquire about
the patient's rising creatinine.  At that time, it was
thought that the patient was in acute tubular necrosis, most
likely secondary to contrast and probably a brief
hypoperfusion intraoperatively.  There was no evidence of
atheroemboli in the extremities on their examination at that
time.

On postoperative day four, the patient's creatinine was noted
to come down from 2.0 to 1.8, and the patient's acute tubular
necrosis was thought to be resolving.  The patient's
milrinone was weaned, and Lopressor 25 mg by mouth was
started subsequent to intravenous boluses for transient
tachycardia.  The patient remained on a heparin drip, which
was titrated for PTT to 50 for anticoagulation for the brief
period of the atrial fibrillation and subsequent
cardioversion.  The patient's postoperative course was also
complicated by a persistent hypertension with blood pressures
to approximately systolic blood pressure equal to 180, with
mean arterial pressures of 60 to 80s.  At that time,
nitroprusside was started and eventually weaned, and
Hydralazine was continued around the clock in order to keep
the blood pressure at approximately 130s.

At this time, Physical Therapy was consulted and evaluated
the patient, and it is important to note that the patient was
on cardiopulmonary bypass and was cross-clamped for a brief
period.

By postoperative day number six, the patient was weaned off
nitroprusside completely, and the blood pressure stabilized
in the range of 100 to 150 systolic blood pressure.  At that
time as well, the patient's creatinine decreased to 1.6, and
the Renal team was satisfied that the patient's acute tubular
necrosis was resolving and signed off.  At that time, the
patient was stable, and was transferred to the Surgical
floor.

The patient maintained a low blood pressure and oxygen
saturation of 92% on 1 liter, and was diuresing
appropriately, given his small dose of twice a day lasix.

On postoperative day number nine, the patient's wires were
discontinued, and the patient was discharged home.

DISCHARGE CONDITION:  Good.

DISCHARGE DISPOSITION:  Home.

FOLLOW-UP PLAN:  Follow up with primary care physician in one
week.  Follow up with Dr. [**Last Name (STitle) 1537**] in four weeks.

DISCHARGE MEDICATIONS:  Norvasc 5 mg by mouth twice a day,
amiodarone 400 mg by mouth twice a day for three days, then
400 mg by mouth once daily, Hydralazine 50 mg by mouth three
times a day, Plavix 75 mg by mouth once daily, aspirin 325 mg
by mouth once daily, Zantac 150 mg by mouth once daily, lasix
20 mg by mouth twice a day, K-Dur 20 mEq by mouth twice a
day, Colace 100 mg by mouth twice a day, Lopressor 75 mg by
mouth twice a day, percocet 5/325 one to two tablets every
three hours as needed for pain.




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

Dictated By:[**Last Name (NamePattern4) 46815**]
MEDQUIST36

D:  [**2117-12-19**]  17:26
T:  [**2117-12-20**]  00:41
JOB#:  [**Job Number 46816**]


Admission Date:  [**2117-12-7**]       Discharge Date:  [**2117-12-18**]

Date of Birth:   [**2041-3-24**]       Sex:  M

Service:  CARDIOTHOR

HISTORY OF PRESENT ILLNESS:   Mr. [**Known lastname 46813**] had been in his
usual state of health until early [**Month (only) 359**] when he started to
experience dyspnea and chest tightness on exertion.  On
[**9-30**], he was admitted to [**Hospital6 8283**]
wit4h congestive heart failure.  His troponin was 0.22.  He
was subsequently referred to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for further
Cardiology work-up.

On [**2117-10-21**], the patient had an echocardiogram which
revealed critical aortic stenosis with [**First Name8 (NamePattern2) **] [**Location (un) 109**] of 0.9
centimeters squared, a maximum gradient of 38 millimeters of
Mercury and a peak gradient of 24 millimeters of Mercury.

There was no aortic regurgitation.  There was mild mitral
regurgitation.  There was inferior wall hypokinesis and mild
septal hypokinesis.  The ejection fraction was 27%.  This was
compared with an echocardiogram done in [**3-/2115**], which
revealed mild aortic stenosis and an ejection fraction of
70%.

The patient underwent a stress on [**2117-11-29**].  He exercised
for five minutes and 19 seconds and had large area of
anterior non-transmural and inferior septal complete
transmural ischemia.  The ejection fraction was 27% with
inferior akinesis and global hypokinesis.

The patient reports that he has not had any recent exertional
symptoms, but was having symptoms in [**Month (only) 359**] after he had
left the hospital.  He denies claudication, orthopnea,
paroxysmal nocturnal dyspnea, lightheadedness. The patient
was subsequently referred to [**Hospital1 188**] for a cardiac catheterization.

LABORATORY:  Pertinent labs on admission were white blood
cell count 5.3, hematocrit 42.3, platelets 189, BUN 38,
creatinine 1.7, INR of 1.0.

HOSPITAL COURSE:   The patient was admitted on [**2117-12-7**],
for cardiac catheterization.  At that time, the cardiac
catheterization showed 70% ostial stenosis at the left main,
calcified left anterior descending without critical disease.
In addition, the left circumflex showed moderate ostial
stenosis at the obtuse marginal 1, and the right coronary
artery showed 95% proximal lesion.  The left ventricular
ejection fraction was 30% with one plus mitral regurgitation
and critical aortic insufficiency.

The patient was subsequently admitted to the [**Hospital Unit Name 196**] Service
where Dr. [**Last Name (STitle) **] was the attending.  Dr. [**Last Name (STitle) 1537**] of Cardiothoracic
surgery was consulted for this patient who had an indication
for coronary artery bypass graft with aortic valve
replacement.  The risks and benefits of cardiac surgery were
discussed with the patient as well as the additional risks
that the patient carried with known 100% right carotid and
70% left carotid stenosis.

The patient was consented for a coronary artery bypass graft
and aortic valve replacement with full understanding of the
risks.

The patient was taken to the Operating Room on [**2117-12-9**], at
which time a coronary artery bypass graft times three was
performed.  The left internal mammary artery was brought to
the left anterior descending, the saphenous vein graft was
brought to the patent ductus arteriosus, and a saphenous vein
graft was brought to the obtuse marginal.

In addition, aortic valve replacement was performed using a
#23 millimeter CE-pericardial valve under general
endotracheal anesthesia.  The pericardium was left open.  An
arterial line and Swan-Ganz catheter was placed
interoperatively.

Two ventricular and two atrial wires were placed.  Two
mediastinal and one left pleural chest tube were placed.

The patient tolerated the procedure well and postoperatively,
was brought to the CSRU in stable condition.

The patient was extubated and saturating at 95% on four
liters nasal cannula at postoperative day one.
Cardiovascular wise on postoperative day one the patient was
weaned off of Levophed and received Vancomycin
prophylactically in the preoperative period.

The patient's postoperative course was immediately
complicated by a brief run of atrial flutter and atrial
fibrillation at which time Amiodarone drip was started after
a bolus times four of 150 mg of intravenous amiodarone.

The patient was immediately DC synchronized with 200 joules
times one and cardioverted through sinus rhythm with PR of
220 milliseconds.




                DICTATION ENDS.

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

Dictated By:[**Last Name (NamePattern1) 14176**]
MEDQUIST36

D:  [**2117-12-19**]  16:46
T:  [**2117-12-19**]  22:02
JOB#:  [**Job Number 46814**]
{'Aortic valve disorders,Intermediate coronary syndrome,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Coronary atherosclerosis of native coronary artery,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Other drugs and medicinal substances causing adverse effects in therapeutic use'}


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: Mr. [**Known lastname 46813**] had been in his
usual state of health until early [**Month (only) 359**] when he started to
experience dyspnea and chest tightness on exertion.  On
[**9-30**], he was admitted to [**Hospital6 8283**]
wit4h congestive heart failure.  His troponin was 0.22.  He
was subsequently referred to [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for further
Cardiology work-up.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Aortic valve disorders,Intermediate coronary syndrome,Congestive heart failure, unspecified,Cardiac complications, not elsewhere classified,Atrial fibrillation,Acute kidney failure with lesion of tubular necrosis,Coronary atherosclerosis of native coronary artery,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Other drugs and medicinal substances causing adverse effects in therapeutic use'}
