CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 83-year-old gentleman
with a past medical history significant for hypertension,
hyperlipidemia, history of several transient ischemic attacks
over the past year, unilateral renal agenesis, status post
open reduction of the right leg at the age of 30, and status
post resection of several skin cancers.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Unspecified essential hypertension,Pure hypercholesterolemia,Nonspecific abnormal electrocardiogram [ECG] [EKG],Personal history of malignant melanoma of skin,Renal agenesis and dysgenesis
Crnry athrscl natve vssl,Hematoma complic proc,Hypertension NOS,Pure hypercholesterolem,Abnorm electrocardiogram,Hx-malig skin melanoma,Renal agenesis
Admission Date:  [**2122-12-4**]     Discharge Date:  [**2122-12-14**]


Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  This is an 83-year-old gentleman
with a past medical history significant for hypertension,
hyperlipidemia, history of several transient ischemic attacks
over the past year, unilateral renal agenesis, status post
open reduction of the right leg at the age of 30, and status
post resection of several skin cancers.

This 83-year-old male was in his usual state of health until
this past [**Month (only) **] when he began developing extreme dyspnea
associated with substernal chest burning on exertion which
resolved with rest.  Since that time he has had no further
chest discomfort; however, he has noticed increased shortness
of breath on exertion.

He underwent an exercise stress test, at which he had to
cease exercising after 2 minutes and 46 seconds due to
anginal symptoms.  The test was notable for anterior ST
depressions and a reversible apical defect, at which time he
was referred for cardiac catheterization.

A cardiac catheterization was performed on [**2122-12-4**]
which revealed 80% left main coronary artery disease, 90%
left anterior descending artery disease involving the first
diagonal, and 90% mid right coronary artery disease.  Left
ventricular systolic function was normal with an ejection
fraction of 70%.

The patient was subsequently referred to the Cardiac Surgery
Service for coronary artery bypass grafting.

HOSPITAL COURSE:  The patient underwent coronary artery
bypass grafting times four on [**2122-12-7**] with a left
internal mammary artery to the left anterior descending
artery, saphenous vein graft to the posterior descending
artery, saphenous vein graft to first obtuse marginal, and
saphenous vein graft to the diagonal.  Total cardiopulmonary
bypass time was 92 minutes.  Total cross-clamp time was 58
minutes.  The patient was transferred in stable condition to
the Cardiac Surgery Recovery Unit.

The patient's blood pressure was initially labile, requiring
Neo-Synephrine, nitroglycerin, and some fluids, with the
patient's nitroglycerin drip increasing to 4 mcg/kg per
minute, which was eventually switched to Nipride to maintain
a systolic blood pressure of 110 to 120.

Of note, the patient had a right femoral hematoma which had
not changed in size since surgery.

On postoperative day one, no significant events over the last
24 hours.  The patient was afebrile, and vital signs were
stable, with an adequate urine output.  Physical examination
was benign aside from the right groin hematoma which no
expansion and no bruit.

The patient's white blood cell count was 17.7, hematocrit was
24.7, and platelet count was 118.  Sodium was 134, potassium
was 5.5, blood urea nitrogen was 18, creatinine was 0.8, and
blood glucose was 121.

The patient was transferred to the floor on postoperative day
one with no complaints.  He was administered one unit of
packed red blood cells which was administered with Lasix.

On postoperative day two, the patient was afebrile, in a
normal sinus rhythm at 98.  Otherwise, vital signs were
stable.  On physical examination, the patient had crackles at
the left lower base of the lungs.  Marginal urine output.  He
had decreased urine output the night prior.  Lasix was
administered with little results.  The plan was to continue
to diurese the patient, increase the patient's Lasix, and to
discontinue the patient's Foley catheter as we continued to
monitor the patient's urine output.

On postoperative day three, the patient with no complaints.
The patient was afebrile.  Vital signs were stable.   In a
sinus rhythm at 84.  The patient was alert and oriented times
three.  The patient still with coarse breath sounds
bilaterally.  A chest tube was still in place.

On postoperative day four, the patient was alert and oriented
times three.  Vital signs were stable. In a normal sinus
rhythm in the 90s.  On physical examination, the patient
still with scattered rales with mild wheezing at the left
base.

On postoperative day five, the patient with complaints of
mild pain with coughing; for which Percocet provided relief.
Still with coarse breath sounds bilaterally with wheezing on
exertion.  The patient was treated with nebulizer treatments
as well as chest physical therapy.  A chest x-ray was
ordered.  The patient was urinating well.  Upon ambulation,
the patient desaturated to 89% with 2 liters of oxygen.  His
heart rate was in the 80s to 100s with premature atrial
contractions during ambulation.

On postoperative day six, the patient was afebrile.  In sinus
tachycardia at 100.  Otherwise, vital signs were stable.
Physical examination was benign.  The patient with no
complaints of pain and voiding well.

On postoperative day seven, the patient was without
complaints.  The patient was discharged home with visiting
nurse services.  Physical examination revealed the patient
with clear breath sounds bilaterally.  In a normal sinus
rhythm.  The patient still with oxygen saturations to the mid
80s on room air with ambulation; however, it was felt that no
home oxygen was necessary.  The patient was not short of
breath upon ambulation, and the patient's lungs sounded
clearer.  At rest, the patient was saturating at 93% on room
air.

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE STATUS:  Discharge status was to home.

MEDICATIONS ON DISCHARGE:
1.  Lasix 40 mg p.o. b.i.d. (for seven days).
2.  Ascorbic acid 500 mg p.o. b.i.d.
3.  Simvastatin 20 mg p.o. q.d.
4.  Plavix 75 mg p.o. q.d.
5.  Percocet one to two tablets p.o. q.4-6h. as needed (for
pain).
6.  Colace 100 mg p.o. b.i.d.
7.  Metoprolol 50 mg p.o. b.i.d.
8.  Polysaccharide-Iron Complex tablets 150 mg p.o. q.d.
9.  K-Dur 20 mEq p.o. b.i.d. (for seven days).

DISCHARGE INSTRUCTIONS/FOLLOWUP:   The patient was to follow
up with Dr. [**Last Name (STitle) 70**] in four weeks.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease.
2.  Status post coronary artery bypass grafting times four.





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

Dictated By:[**Doctor Last Name 2011**]

MEDQUIST36

D:  [**2123-3-25**]  12:11
T:  [**2123-3-26**]  08:55
JOB#:  [**Job Number 46776**]
{'Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Unspecified essential hypertension,Pure hypercholesterolemia,Nonspecific abnormal electrocardiogram [ECG] [EKG],Personal history of malignant melanoma of skin,Renal agenesis and dysgenesis'}


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 an 83-year-old gentleman
with a past medical history significant for hypertension,
hyperlipidemia, history of several transient ischemic attacks
over the past year, unilateral renal agenesis, status post
open reduction of the right leg at the age of 30, and status
post resection of several skin cancers.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Unspecified essential hypertension,Pure hypercholesterolemia,Nonspecific abnormal electrocardiogram [ECG] [EKG],Personal history of malignant melanoma of skin,Renal agenesis and dysgenesis'}
