CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 49 year old gentleman
who has a history over the last year of decreased exercise
tolerance.  He underwent a stress test on [**2153-2-19**],
which was significant for mild to moderate shortness of
breath, no chest pain, 3 mm inferior and mid precordial ST
elevation with lateral depression.  Images revealing severe
apical and moderate inferior wall defects with reversibility
of the anterior portion of the apical defect and six defects
in the inferior and inferoapical region.

MEDICAL HISTORY: Bipolar disorder,
hypercholesterolemia, noninsulin dependent diabetes mellitus,
positive tobacco, three to four cigarettes per day.

MEDICATION ON ADMISSION: 

ALLERGIES: Iodine and shellfish.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Acidosis,Paroxysmal ventricular tachycardia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Bipolar I disorder, most recent episode (or current) unspecified,Unspecified sleep apnea,Tobacco use disorder
Crnry athrscl natve vssl,Acidosis,Parox ventric tachycard,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Bipolor I current NOS,Sleep apnea NOS,Tobacco use disorder
Admission Date:  [**2153-3-22**]       Discharge Date:  [**2153-3-28**]

Date of Birth:   [**2104-5-15**]       Sex:  M

Service:  Cardiac Surgery

HISTORY OF PRESENT ILLNESS:  This is a 49 year old gentleman
who has a history over the last year of decreased exercise
tolerance.  He underwent a stress test on [**2153-2-19**],
which was significant for mild to moderate shortness of
breath, no chest pain, 3 mm inferior and mid precordial ST
elevation with lateral depression.  Images revealing severe
apical and moderate inferior wall defects with reversibility
of the anterior portion of the apical defect and six defects
in the inferior and inferoapical region.

PAST MEDICAL HISTORY:  Bipolar disorder,
hypercholesterolemia, noninsulin dependent diabetes mellitus,
positive tobacco, three to four cigarettes per day.

PAST SURGICAL HISTORY:  None.

ALLERGIES:  Iodine and shellfish.

PREOPERATIVE MEDICATIONS:
1.  Depakote ER 500 mg p.o. q.h.s.
2.  Depakote 250 mg p.o. h.s.
3.  Nardil 60 mg p.o. h.s.
4.  Metoprolol 25 mg p.o. b.i.d.
5.  Glipizide ER 10 mg p.o. q. day
6.  Xanax 0.5 mg q. day prn.
7.  Aspirin 325 mg p.o. q. day

PAST SURGICAL HISTORY:  The patient underwent a cardiac
catheterization on [**3-5**] which showed an left
ventricular end diastolic pressure of 23, ejection fraction
of 35%, 1+ mitral regurgitation, 90% proximal right coronary
artery, 90% distal left anterior descending, 80% first
diagonal, 80% mid circumflex and 90% obtuse marginal 1.

HOSPITAL COURSE:  The patient was admitted on [**2153-3-23**]
and was taken to the Operating Room with Dr. [**Last Name (STitle) 70**] for a
coronary artery bypass graft times two, saphenous vein graft
to left anterior descending and saphenous vein graft to
diagonal.  Please see operative note for further details.
The patient was transferred to the Intensive Care Unit in
stable condition on a Neo-Synephrine and Propofol infusion.
The patient was weaned and extubated from mechanical
ventilation on his first postoperative day.  After
extubation, the patient was found by a nurse to be
unresponsive, eventually arousable after repeat aggressive
tactile stimuli.  Blood gas at that time showed a severe
respiratory acidosis.  The patient received aggressive
pulmonary toilet and incentive spirometry with improvement in
his blood gas.  The patient was placed on BiPAP over night
with resolution of the respiratory acidosis.  Through all of
this, the patient remained hemodynamically stable with good
cardiac indices.  A pulmonary consult was obtained to
evaluate the patient for the hypercapnia.  It was felt that
the patient had obstructive sleep apnea and recommended
nocturnal BiPAP and nasal steroids and recommended following
up in six to eight weeks for a formal sleep study.  At that
time it was recommended that the patient be discharged with a
BiPAP mask when medically stable.

On postoperative day #2, the Neo-Synephrine had been weaned
off.  The patient had been restarted on his preoperative
psyche medications.  The patient was started on diuretic
therapy.  The patient's hematocrit was found to be 22,
received 2 units of packed red blood cells.  The patient
began working with physical therapy.  The patient's chest
tubes were removed on postoperative day #3 without incident.
The patient was transferred from the Intensive Care Unit to
the regular part of the hospital on postoperative day #4.
The patient continued to work with physical therapy.  By
postoperative day #5 he was able to ambulate 450 feet.  The
patient's pacing wires were removed on postoperative day #5
without incident.  On the evening of postoperative day #5,
the patient again was found to have a decreased hematocrit.
Chest x-ray obtained at that time showed small bilateral
pleural effusions.  The patient received 2 units of packed
red blood cells with appropriate rise in hematocrit to 26.
Early in the morning on postoperative day #6 the patient had
a five beat run of nonsustained ventricular tachycardia.  Dr.
[**Last Name (STitle) 3321**] was notified and it was recommended the patient
receive an echocardiogram to evaluate for the possibility of
wall motion abnormalities.  Echocardiogram on postoperative
day #6 showed normal left ventricular wall thickness, cavity
size and systolic function with an ejection fraction of
greater than 55%, normal right ventricular chamber size and
free wall motion, paradoxical septal motion, consistent with
cardiac surgery, trivial mitral regurgitation, mild tricuspid
regurgitation, mild pulmonary hypertension.  The results of
the study were again discussed with Dr. [**Last Name (STitle) 3321**] and it was
felt the patient could be discharged home to follow up with
Dr. [**Last Name (STitle) 3321**] in the office in one to two weeks.

Pulmonary was also consulted for recommendations regarding
home CPAP.  It was recommended that the patient receive
nocturnal CPAP with 9 cm of water with humidification and 2
liters of nasal oxygen let in and recommended an over night
polysomnogram for CPAP titration for six weeks.  At this time
it was decided the patient was cleared for discharge to home.

CONDITION ON DISCHARGE:  Temperature maximum 98.3, pulse 60
in sinus rhythm, blood pressure 100/60, respiratory rate 16,
room air oxygen saturation 96%.  Neurologically the patient
is awake, alert and oriented times three, quite anxious,
nonvocal.  Cardiovascular, regular rate and rhythm without
rub or murmur.  Respiratory, breath sounds are clear
bilaterally.  Gastrointestinal, positive bowel sounds,
nontender, nondistended.  Sternal incision is clean and dry.
Steri-Strips are intact.  Sternum is stable.  There is no air
seen and there is no drainage.  Right lower extremity has
minimal erythema.  The Steri-Strips are intact.  There is
minimal edema.

LABORATORY DATA:  White blood cell count 6.6, hematocrit
26.3, platelet count 298.  Sodium 142, potassium 4.1,
chloride 102, bicarbonate 30, BUN 16, creatinine 0.8, glucose
190, magnesium 2.2.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease.
2.  Status post coronary artery bypass graft.
3.  Obstructive sleep apnea.
4.  Postoperative nonsustained ventricular tachycardia.

DISCHARGE MEDICATIONS:
1.  Lasix 20 mg p.o. b.i.d. times seven days.
2.  Potassium chloride 20 mEq p.o. b.i.d. times seven days.
3.  Iron sulfate 325 mg p.o. q.i.d. times one month.
4.  Plavix 75 mg p.o. q. day.
5.  Nardil 60 mg p.o. q.h.s.
6.  Divalproex 250 mg p.o. q.h.s.
7.  Divalproex sustained release 500 mg p.o. q. day
8.  Beconase nasal spray one spray each nostril b.i.d.
9.  Colace 100 mg p.o. b.i.d.
10. Zantac 150 mg p.o. b.i.d.
11. Enteric coated Aspirin 325 mg p.o. q. day
12. Percocet 5/325 one to two p.o. q. 4-6 hours prn
13. Lopressor 12.5 mg p.o. b.i.d.
14. Glipizide 10 mg p.o. q. day.

CONDITION ON DISCHARGE:  Mr. [**Known lastname 52951**] is to be discharged to
home in good condition.

FOLLOW UP:  He is to follow up with Dr. [**Last Name (STitle) 70**] in five to
six weeks.  He is to follow up with Dr. [**Last Name (STitle) **] in one to two
weeks, he is to follow up with Dr. [**Last Name (STitle) 3321**] in one to two
weeks, and he is to call in four to six weeks to schedule a
sleep study.



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

Dictated By:[**Last Name (NamePattern1) 1541**]
MEDQUIST36

D:  [**2153-3-28**]  16:41
T:  [**2153-3-28**]  18:54
JOB#:  [**Job Number 52952**]
{'Coronary atherosclerosis of native coronary artery,Acidosis,Paroxysmal ventricular tachycardia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Bipolar I disorder, most recent episode (or current) unspecified,Unspecified sleep apnea,Tobacco use disorder'}


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 a 49 year old gentleman
who has a history over the last year of decreased exercise
tolerance.  He underwent a stress test on [**2153-2-19**],
which was significant for mild to moderate shortness of
breath, no chest pain, 3 mm inferior and mid precordial ST
elevation with lateral depression.  Images revealing severe
apical and moderate inferior wall defects with reversibility
of the anterior portion of the apical defect and six defects
in the inferior and inferoapical region.

MEDICAL HISTORY: Bipolar disorder,
hypercholesterolemia, noninsulin dependent diabetes mellitus,
positive tobacco, three to four cigarettes per day.

MEDICATION ON ADMISSION: 

ALLERGIES: Iodine and shellfish.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Acidosis,Paroxysmal ventricular tachycardia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Bipolar I disorder, most recent episode (or current) unspecified,Unspecified sleep apnea,Tobacco use disorder'}
