CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname 54864**] is a
62-year-old gentleman transferred to [**Hospital1 190**] from [**Hospital3 **].

MEDICAL HISTORY: (Significant for)
1.  Eczema (for which he uses steroid cream).
2.  Question of hypertension.
3.  He is also status post appendectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives half the year in [**State 108**] and half
the year on [**Location (un) **].  The patient lives with his wife.  [**Name (NI) **]
works for a bank.  He denies tobacco use.  Occasional ethanol
use.  No other drug or marijuana use.
Coronary atherosclerosis of native coronary artery,Contact dermatitis and other eczema, unspecified cause,Orthostatic hypotension,Unspecified essential hypertension
Crnry athrscl natve vssl,Dermatitis NOS,Orthostatic hypotension,Hypertension NOS
Admission Date:  [**2188-3-26**]       Discharge Date:  [**2188-4-2**]

Date of Birth:   [**2125-7-11**]       Sex:  M

Service:  Cardiothoracic

HISTORY OF PRESENT ILLNESS:  Mr. [**Known firstname **] [**Known lastname 54864**] is a
62-year-old gentleman transferred to [**Hospital1 190**] from [**Hospital3 **].

He is a patient of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 54865**].  He was seen in Dr.[**Name (NI) 54866**] office complaining of a 1-month history to 2-month
history of right lateral neck, chest, and shoulder pain with
exertion or emotional stress.  He had an exercise tolerance
test done on [**3-26**] that showed inferolateral ischemia.
The patient was begun on intravenous heparin, Plavix, Toprol,
Lipitor, and aspirin at [**Hospital3 **] following his
exercise tolerance test and transferred to [**Hospital1 346**] for cardiac catheterization.

PAST MEDICAL HISTORY:  (Significant for)
1.  Eczema (for which he uses steroid cream).
2.  Question of hypertension.
3.  He is also status post appendectomy.

ALLERGIES:  He has no known drug allergies.

MEDICATIONS AT HOME:  None.

MEDICATIONS ON TRANSFER:  (From [**Hospital3 **])
1.  Heparin.
2.  Toprol.
3.  Lipitor.
4.  Aspirin.
5.  Plavix.
6.  Integrilin.

SOCIAL HISTORY:  He lives half the year in [**State 108**] and half
the year on [**Location (un) **].  The patient lives with his wife.  [**Name (NI) **]
works for a bank.  He denies tobacco use.  Occasional ethanol
use.  No other drug or marijuana use.

PERTINENT RADIOLOGY/IMAGING:  As stated previously, the
patient was brought to [**Hospital1 69**]
for a cardiac catheterization.  His catheterization on the
day of transfer showed an 80% middle left anterior descending
artery stenosis, and 99% middle circumflex stenosis, and 80%
middle right coronary artery stenosis, and an left
ventricular end-diastolic pressure of 16, with an ejection
fraction of 52%.

Following catheterization, the patient had a carotid
ultrasound which showed a right internal carotid artery
stenosis of the less than 40% and no stenosis on the left
internal carotid artery.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Laboratory data
preoperatively revealed his hematocrit was 39.5.  His
potassium was 4.1.  His blood urea nitrogen was 14.  His
creatinine was 0.8.  Alanine-aminotransferase was 59, his
aspartate aminotransferase was 39, alkaline phosphatase was
58, amylase was 44, his total bilirubin was 0.5.

PHYSICAL EXAMINATION ON PRESENTATION:  The patient's physical
examination at the time of consultation revealed his heart
rate was 61, his blood pressure was 160/63, his respiratory
rate was 15, and his oxygen saturation was 95% on room air.
On neurologic examination, alert, awake, and oriented times
three.  He moved all extremities.  Head, eyes, ears, nose,
and throat examination revealed the pupils were equal, round,
and reactive to light.  The mucous membranes were moist.  The
neck was supple.  Cardiovascular examination revealed a
regular rate and rhythm.  No murmurs, rubs, or gallops.
Respiratory examination revealed breath sounds were clear to
auscultation.  No wheezes or rhonchi.  The abdomen was soft,
nontender, and nondistended.  There were positive bowel
sounds.  The extremities were warm and well perfused with no
varicosities or ulcerations.  Pulse examination on the right,
had a sheath in place.  On the left were 2+ popliteal, and
dorsalis pedis pulses and posterior tibialis were 2+
bilaterally, and carotids were 2+ with bruits bilaterally.
Skin showed multiple small erythematous areas on the arms,
legs, and trunk with scaling; consistent with eczema.

BRIEF SUMMARY OF HOSPITAL COURSE:   The patient was followed
by the Medicine Service for the next two days.  On [**3-28**],
he was brought to the operating room where he underwent
coronary artery bypass grafting.  Please see the Operative
Report for full details.

In summary, the patient had coronary artery bypass grafting
times four with a left internal mammary artery to the left
anterior descending artery, a right internal mammary artery
to the distal right coronary artery, a saphenous vein graft
to obtuse marginal, and a saphenous vein graft to the
diagonal.  The patient 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.
His anesthesia was reversed.  He successfully weaned from the
ventilator and extubated.  He remained hemodynamically stable
throughout the remainder of his operative day requiring only
a Neo-Synephrine infusion to maintain and adequate blood
pressure.

On postoperative day one, the patient remained
hemodynamically stable.  He was begun on diuretics as well as
beta blockade.  He was weaned off his Neo-Synephrine drip.
His mediastinal chest tubes and his central venous access
were removed.

On postoperative day two, the patient continued to do well.
The remainder of his chest tubes were removed.  His beta
blockade was increased, and he was transferred to the floor
for continuing postoperative care and cardiac rehabilitation.

Over the next several days, the patient had an uneventful
hospital course.  His activity level was increased with the
assistance of the nursing staff and the physical therapist.

On postoperative day four, it was decided that the following
day the patient would be stable and ready to be discharged to
home.

At the time of this dictation, the patient's physical
examination was as follows.  Vital signs revealed his
temperature was 99, his heart rate was 89 (sinus rhythm), his
blood pressure was 118/53, his respiratory rate was 18, and
his oxygen saturation was 94% on room air.  Weight
preoperatively was 100.5 kilograms and on discharge was 101.5
kilograms.  Physical examination revealed he was alert and
oriented times three.  He moved all extremities.  He followed
commands.  Respiratory examination revealed clear to
auscultation bilaterally.  Cardiovascular examination
revealed a regular rate and rhythm.  Normal first heart
sounds and second heart sounds with no murmurs.  The sternum
was stable.  Incision with Steri-Strips open to air, clean
and dry.  The abdomen was soft, nontender, and nondistended.
There were normal active bowel sounds.  Extremities were warm
and well perfused with no edema.  Left leg saphenous vein
graft site with Steri-Strips open to air, clean and dry.

Laboratory data revealed his white blood cell count was 10.7,
his hematocrit was 29.3, and his platelets were 317.  Sodium
was 139, potassium was 3.7, chloride was 100, bicarbonate was
29, blood urea nitrogen was 14, creatinine was 0.6, and his
blood glucose was 114.

MEDICATIONS ON DISCHARGE:
1.  Metoprolol 50 mg twice per day.
2.  Atorvastatin 20 mg once per day.
3.  Enteric-coated aspirin 325 mg once per day.
4.  Lasix 20 mg once per day (times 10 days).
5.  Potassium chloride 20 mEq once per day (times 10 days).
6.  Percocet 5/325 one to two tablets by mouth q.4h. as
needed.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was good.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease; status post coronary artery
bypass grafting with a left internal mammary artery to the
left anterior descending artery, right internal mammary
artery to the distal right coronary artery, saphenous vein
graft to the diagonal, and saphenous vein graft to the obtuse
marginal.
2.  Hypertension.
3.  Status post appendectomy.

DISCHARGE DISPOSITION:   The patient was to be discharged to
home.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to have followup in the [**Hospital 409**] Clinic in
two weeks.
2.  The patient was to follow up with Dr. [**Last Name (STitle) 54865**] in three to
four weeks.
3.  The patient was to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] in
six weeks.





                            [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

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

D:  [**2188-4-1**]  14:37
T:  [**2188-4-1**]  14:35
JOB#:  [**Job Number 54867**]
{'Coronary atherosclerosis of native coronary artery,Contact dermatitis and other eczema, unspecified cause,Orthostatic hypotension,Unspecified essential hypertension'}


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 firstname **] [**Known lastname 54864**] is a
62-year-old gentleman transferred to [**Hospital1 190**] from [**Hospital3 **].

MEDICAL HISTORY: (Significant for)
1.  Eczema (for which he uses steroid cream).
2.  Question of hypertension.
3.  He is also status post appendectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He lives half the year in [**State 108**] and half
the year on [**Location (un) **].  The patient lives with his wife.  [**Name (NI) **]
works for a bank.  He denies tobacco use.  Occasional ethanol
use.  No other drug or marijuana use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Contact dermatitis and other eczema, unspecified cause,Orthostatic hypotension,Unspecified essential hypertension'}
