CHIEF COMPLAINT: Fever.

PRESENT ILLNESS: The patient is a 70 year old man
who is admitted to the Podiatry Service in [**2166-11-13**],
for a necrotic eschar times two on his lateral right
mid-foot.  He was seen and evaluated by Vascular Surgery at
that time and was felt to be a poor candidate for
re-vascularization.  The ulcers were managed conservatively
with antibiotics.  He presented to the Emergency Room on
[**1-23**] with fever.  He was initially admitted to the
Vascular Surgery service.

MEDICAL HISTORY: 1.  Coronary artery disease.
2.  Diabetes mellitus, type 2.
3.  Peripheral vascular disease.
4.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to penicillin which causes a rash
and codeine which causes confusion.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Atherosclerosis of native arteries of the extremities with ulceration,Ulcer of other part of foot,Cellulitis and abscess of foot, except toes,Cardiac complications, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Coronary artery anomaly,Other chronic pulmonary heart diseases,Pure hypercholesterolemia
Ath ext ntv art ulcrtion,Ulcer other part of foot,Cellulitis of foot,Surg compl-heart,Atrial fibrillation,Crnry athrscl natve vssl,Coronary artery anomaly,Chr pulmon heart dis NEC,Pure hypercholesterolem
Admission Date:  [**2167-1-23**]       Discharge Date:  [**2167-2-6**]

Date of Birth:   [**2096-8-27**]       Sex:  M

Service:  CARDIOTHOR

CHIEF COMPLAINT:  Fever.

HISTORY OF PRESENT ILLNESS:  The patient is a 70 year old man
who is admitted to the Podiatry Service in [**2166-11-13**],
for a necrotic eschar times two on his lateral right
mid-foot.  He was seen and evaluated by Vascular Surgery at
that time and was felt to be a poor candidate for
re-vascularization.  The ulcers were managed conservatively
with antibiotics.  He presented to the Emergency Room on
[**1-23**] with fever.  He was initially admitted to the
Vascular Surgery service.

PAST MEDICAL HISTORY:
1.  Coronary artery disease.
2.  Diabetes mellitus, type 2.
3.  Peripheral vascular disease.
4.  Hypercholesterolemia.

PAST SURGICAL HISTORY:
1.  Bilateral hallux amputations.

MEDICATIONS:  At time of admission include:
1.  Glucophage 1000 mg twice a day.
2.  Glyburide 10 mg q. a.m., 5 mg q. p.m.
3.  Atenolol 50 mg q. day.
4.  Lisinopril 2.5 mg q. day.
5.  Ambien 5 mg p.r.n.

ALLERGIES:  He is allergic to penicillin which causes a rash
and codeine which causes confusion.

PHYSICAL EXAMINATION:  At time of admission, vital signs with
temperature 103.0 F.; blood pressure 100/56; heart rate 128;
respiratory rate 16; O2 saturation 79% on room air.  General,
in no acute distress.  Chest:  Heart sounds regular rate and
rhythm, S1, S2.  Chest clear to auscultation bilaterally
anterior only.  Abdomen is soft, nontender, nondistended.
Extremities:  Femoral pulses bilaterally.  Popliteal pulses
bilaterally.  Dorsalis pedis and posterior tibial
Doppler-able pulses bilaterally, posterior tibial greater
than the dorsalis pedis.  Right lateral foot with open ulcer
distal to the tarsus with more proximal abscess which drained
purulent material.

LABORATORY:  At time of admission, white count 22.9,
hematocrit 34.8, sodium 132, potassium 4.3, chloride 95, CO2
22, BUN 23, creatinine 1.2, glucose 99.  Cultures from [**1-1**]
showed Staphylococcus aureus, coagulase positive, Oxicillin
resistant.

Chest x-ray showed no pleural effusions, no infiltrates, no
congestive heart failure and no pneumonia.

HOSPITAL COURSE:  The patient was admitted to the Vascular
Service.  His foot ulcer was incised and debrided.  He was
started on Vancomycin, Ciprofloxacin, and Flagyl with three
times a day wet-to-dry dressing changes.

On the day after admission, the patient reported feeling
nauseous.  Given his past admission and catheterization
revealing three-vessel disease, cardiac enzymes were sent and
it showed a positive troponin and therefore the Cardiology
Service was consulted.  The patient underwent an angiogram of
his lower extremity which showed infra-popliteal three-vessel
occlusions.  Cardiology was again consulted to review his
catheterization which was done in [**2166-10-13**].  Please
see catheterization report for full details.

In summary, the catheterization showed he had a co-dominant
system with obstructive three-vessel disease.  The left
anterior descending had a 70% stenosis; the left circumflex
had a 50 to 60% stenosis.  The right coronary artery had a
focal 70% stenosis.  There was also a nominus artery noted
which originated at the proximal right coronary artery and
travelled in a superior access.  The artery was anastomosed
to the pulmonary artery.  He had elevated right and left
sided filling pressures with a wedge of 18.  Calculated
cardiac output was 6.1.  There was no pressure gradient at
the aortic valve.

Following the Cardiology Service consultation, Vascular
Surgery consulted Cardiothoracic Surgery to see if the
patient could undergo coronary re-vascularization prior to
his lower extremity re-vascularization.

The patient was seen by Cardiothoracic Surgery and consented
to undergo a coronary artery bypass grafting.  On [**1-29**],
he was brought to the Operating Room at which time he had a
coronary artery bypass graft times three; please see the OR
report for full details.  In summary, he had a coronary
artery bypass graft times three with a left internal mammary
artery to the left anterior descending and SVG to the PDA and
an SVG to the obtuse marginal.  He tolerated the operation
well and was transferred from the Operating Room to the
Cardiothoracic Intensive Care Unit.

The patient did well in the immediate postoperative period.
The day of the surgery he was kept sedated and intubated.
Over the course of the night on the morning of postoperative
day one, his sedation was discontinued.  Over the course of
that morning he was weaned from his ventilator and ultimately
extubated.  In addition, his cardioactive intravenous
medications were weaned off.  His Swan-Ganz catheter was
removed and his chest tubes were also removed.

Late in the afternoon of postoperative day one, the patient
experienced atrial fibrillation with a ventricular response
of about 120.  He was started on Amiodarone and Lopressor at
that time, after which he converted to normal sinus rhythm.
Postoperative day two, the patient remained hemodynamically
stable.  At that time, a decision was made to transfer him to
the floor for continuing postoperative care and cardiac
rehabilitation.

Over the next several days, the patient did well.  He
remained hemodynamically stable.  His activity level was
slowly increased with the assistance of the nursing staff and
Physical Therapy.  He continued to be followed by the
Vascular Service as well as the [**Hospital **] Clinic for his
diabetes mellitus.  On postoperative day four, a PICC line
was placed in his left antecubital space and plans were made
to transfer the patient to rehabilitation center for
continuing postoperative care and cardiac rehabilitation.

On postoperative day nine, the patient was deemed stable and
ready for transfer to a rehabilitation center.  At that time,
his physical examination is as follows:  Vital signs,
temperature 98.0 F.; heart rate 79 and sinus rhythm; blood
pressure 120/65; respiratory rate 18; O2 saturation 98% on
two liters nasal prongs.  Weight preoperatively was 140
kilograms; at discharge it is 149 kilograms.

Laboratory data, white count 10.7, hematocrit 24, platelets
404.  Sodium 135, potassium 5.0, chloride 99, CO2 27, BUN 23,
creatinine 1.1, glucose 106.

PHYSICAL EXAMINATION:  Neurologic:  Alert and oriented, moves
all extremities, conversant.  Respiratory:  Clear to
auscultation bilaterally; somewhat diminished in the bases
bilaterally.  Heart sounds regular rate and rhythm, S1, S2,
no murmurs, rubs or gallops.  Sternum is stable; incision
with staples, open to air, clean and dry.  Abdomen is large
and nontender with positive bowel sounds.  Extremities:
Right lateral foot wound is beefy red with a moist base; no
odor and minimal serous drainage.  Left lower extremity
saphenous vein graft sites are healing well.  Incision with
Steri-Strips, open to air, clean and dry.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease status post coronary artery
    bypass graft times three with a left internal mammary
    artery to the left anterior descending; saphenous vein
    graft to the patent ductus arteriosus and a saphenous
    vein graft to obtuse marginal.
2.  Diabetes mellitus, type 2.
3.  Hypercholesterolemia.
4.  Peripheral vascular disease status post incision and
    drainage of the left foot; wound culture positive for
    Methicillin resistant Staphylococcus aureus.

PAST SURGICAL HISTORY:
Bilateral hallux amputations.

MEDICATIONS AT TIME OF DISCHARGE:
1.  Combivent MDI four puffs q. six hours.
2.  Heparin 5000 units subcutaneously three times a day.
3.  Amiodarone 400 mg twice a day times seven days and then
    q. day.
4.  Metoprolol 25 mg twice a day.
5.  Furosemide 20 mg twice a day.
6.  Potassium chloride 20 mEq twice a day.
7.  Colace 100 mg twice a day.
8.  Enteric coated aspirin 325 q. day.
9.  Nicoderm patch 21 mg q. 24 hours.
10. Ranitidine 150 mg twice a day.
11. Vancomycin 1 gram intravenous q. 12 hours times one
    month.
12. Glucophage 1000 mg twice a day.
13. Glyburide 10 mg q. a.m. and 5 mg q. p.m.
14. Regular insulin sliding scale.
15. Percocet 5/325 one to two tablets q. four hours p.r.n.

DISPOSITION:   The patient is to be discharged to
rehabilitation.

DISCHARGE INSTRUCTIONS:
1.  He is to have follow-up with Vascular Surgery in two
    weeks.
2.  Follow-up with his primary care provider in three to four
    weeks.
3.  Follow-up with Dr. [**Last Name (STitle) **] in four weeks.
4.  The staples are to be removed at rehabilitation on
    [**2-22**].


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

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2167-2-6**]  10:54
T:  [**2167-2-6**]  11:11
JOB#:  [**Job Number 29274**]
{'Atherosclerosis of native arteries of the extremities with ulceration,Ulcer of other part of foot,Cellulitis and abscess of foot, except toes,Cardiac complications, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Coronary artery anomaly,Other chronic pulmonary heart diseases,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: Fever.

PRESENT ILLNESS: The patient is a 70 year old man
who is admitted to the Podiatry Service in [**2166-11-13**],
for a necrotic eschar times two on his lateral right
mid-foot.  He was seen and evaluated by Vascular Surgery at
that time and was felt to be a poor candidate for
re-vascularization.  The ulcers were managed conservatively
with antibiotics.  He presented to the Emergency Room on
[**1-23**] with fever.  He was initially admitted to the
Vascular Surgery service.

MEDICAL HISTORY: 1.  Coronary artery disease.
2.  Diabetes mellitus, type 2.
3.  Peripheral vascular disease.
4.  Hypercholesterolemia.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to penicillin which causes a rash
and codeine which causes confusion.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Atherosclerosis of native arteries of the extremities with ulceration,Ulcer of other part of foot,Cellulitis and abscess of foot, except toes,Cardiac complications, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Coronary artery anomaly,Other chronic pulmonary heart diseases,Pure hypercholesterolemia'}
