CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 56-year-old male
with a history of hypertension and diabetes mellitus type 2,
hypercholesterolemia, who presented to his primary care
physician with complaints of chronic nonproductive cough
times the past seven months, coinciding with initiation of
ACE inhibitor therapy.  He also complained of dizziness,
fatigue, and occasional diaphoresis, not related to exertion.
He reports that he can walk up two flights of stairs and ride
a bike without any shortness of breath, dyspnea on exertion,
chest pain, chest pressure.  Additionally, he denies edema,
paroxysmal nocturnal dyspnea, orthopnea, syncope, presyncope.

MEDICAL HISTORY: 1. Diabetes mellitus x5 years.
2. Hypertension.
3. Hypercholesterolemia.
4. Gout.
5. Glaucoma.
6. History of struck by lightening in [**2092**].

MEDICATION ON ADMISSION: 

ALLERGIES: Patient reports allergies to Morphine resulting
in rash, and amoxicillin resulting in diarrhea.

PHYSICAL EXAM: 

FAMILY HISTORY: Patient reports that his mother died at age
58 from complications of congestive heart failure and
diabetes.  Father deceased from stroke.

SOCIAL HISTORY: Patient is married.  He is semiretired from
sales.  He denies any alcohol use.  Denies illicit drug use.
Reports one pack per day smoking history for many years
having quit in [**2111**].
Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Chronic diastolic heart failure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Crnry athrscl natve vssl,Hematoma complic proc,Chr diastolic hrt fail,Abn react-surg proc NEC,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2128-7-15**]     Discharge Date:  [**2128-7-17**]

Date of Birth:   [**2071-10-19**]     Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  Patient is a 56-year-old male
with a history of hypertension and diabetes mellitus type 2,
hypercholesterolemia, who presented to his primary care
physician with complaints of chronic nonproductive cough
times the past seven months, coinciding with initiation of
ACE inhibitor therapy.  He also complained of dizziness,
fatigue, and occasional diaphoresis, not related to exertion.
He reports that he can walk up two flights of stairs and ride
a bike without any shortness of breath, dyspnea on exertion,
chest pain, chest pressure.  Additionally, he denies edema,
paroxysmal nocturnal dyspnea, orthopnea, syncope, presyncope.

He was recently on antibiotics for cough with some relief.
He had a recent admission in [**2128-4-8**] for a laminectomy.
Patient's primary care physician ordered an exercise
tolerance test/Myoview to rule out cardiac cause of his
cough.  He exercised 18 minutes per standard [**Doctor First Name **] protocol.
He had a blunted heart rate response and got 0.5 mg of
atropine at 16.5 minutes.  He had no complaints of chest
pain.  He achieved 74% maximal heart rate.  Myoview imaging
revealed anterior ischemia.  Therefore, the patient was sent
for cardiac catheterization on [**2128-7-15**].

Catheterization revealed severe diffuse LAD disease with
proximal tandem 70% stenosis, subtotally occluded mid vessel,
very small apical LAD.  Left ventricular ejection fraction
was preserved at 65%.  He underwent successful PTCA, stenting
of the LAD with two overlapping Cypher stents.  Additionally,
the left main coronary artery was noted to be nonobstructed.
Left circumflex was nonobstructed.  OM-1 was large vessel
with an eccentric mid 40% stenosis.  RCA showed a 50% mid
stenosis.

Initially, the patient tolerated coronary catheterization
well.  He was transferred to the holding area.  He then
developed episode of hypotension to BP of 70s after femoral
sheath removal.  He received IV fluid therapy, Integrilin was
discontinued, and dopamine drip was started.  He was taken to
CT scan to rule out retroperitoneal hematoma.  CT scan
revealed a psoas hematoma.

PAST MEDICAL HISTORY:
1. Diabetes mellitus x5 years.
2. Hypertension.
3. Hypercholesterolemia.
4. Gout.
5. Glaucoma.
6. History of struck by lightening in [**2092**].

PAST SURGICAL HISTORY:
1. Status post laminectomy 05/[**2127**].
2. Status post hernia repair.
3. Status post multiple knee and shoulder surgeries.

ALLERGIES:  Patient reports allergies to Morphine resulting
in rash, and amoxicillin resulting in diarrhea.

MEDICATIONS PRIOR TO ADMISSION:
1. Aspirin 325 mg po q day.
2. Atenolol 50 mg po q day.
3. Triamterene/hydrochlorothiazide 75/50 mg po q day.
4. Glucophage 1,000 mg po bid.
5. Lisinopril 40 mg po q day.
6. Pravachol 60 mg po q day.
7. Betoptic one drop each eye [**Hospital1 **].

FAMILY HISTORY:  Patient reports that his mother died at age
58 from complications of congestive heart failure and
diabetes.  Father deceased from stroke.

SOCIAL HISTORY:  Patient is married.  He is semiretired from
sales.  He denies any alcohol use.  Denies illicit drug use.
Reports one pack per day smoking history for many years
having quit in [**2111**].

PHYSICAL EXAM ON ADMISSION:  Vital signs:  Temperature 99.0,
blood pressure 113/43, pulse 70, respiratory rate 20, and
oxygen saturation 98% on 4 liters O2 nasal cannula.  General
appearance:  Well-developed, well-nourished male lying flat,
denying pain, plethoric face, in no acute distress.  HEENT:
Normocephalic, atraumatic.  Sclerae are anicteric.  Mucous
membranes moist.  No jugular venous distention or increased
jugular venous pressure noted.  Carotids with normal upstroke
and amplitude.  Lungs:  Clear to auscultation bilaterally.
Cardiovascular:  Regular, rate, and rhythm.  S1 heart sound
obscured by 3/6 systolic murmur heard best at right upper
sternal border.  Murmur did not radiate to carotids.  No
carotid, abdominal, femoral bruits.  Abdomen:  Obese, soft,
nontender, and nondistended, positive bowel sounds, no
hepatosplenomegaly.  Extremities:  Cool, pale, no edema
noted.  Groin:  Ecchymotic lesion 1 x 3" noted in right
groin.  No masses.  No oozing from catheterization site.
Slightly nontender, no bruit auscultated.

PERTINENT LABORATORIES, X-RAYS, AND OTHER STUDIES:
Laboratories on admission showed complete blood count with
white blood cells 15.0, hematocrit of 36.8, platelet count of
239.  Serum chemistries showed sodium of 139, potassium 4.5,
chloride 103, bicarbonate 26, BUN 23, creatinine 1.6, glucose
97.  Additional electrolytes showed phosphorus 2.2, magnesium
1.5, CK 47.

Exercise tolerance test/Myoview ([**2128-7-14**]):  Showed blunted
heart rate response, so patient was given 0.5 mg of atropine
to increase heart rate.  Myoview images revealed anterior
wall ischemia.

ELECTROCARDIOGRAM:  Shows sinus rhythm, first degree A-V
prolongation.  [**Street Address(2) 4793**] elevations in leads V2 through V5, no
left ventricular hypertrophy noted.  Left atrial abnormality.
Incomplete right bundle branch block.

CATHETERIZATION ([**2128-7-15**]):  Showed ejection fraction
approximately 65% with normal left ventricular function.  No
mitral regurgitation.  Left main coronary artery without
significant disease.  Left LAD with proximal tandem 70%
stenosis, subtotally occluded mid vessel, the left circumflex
with nonobstruction.  OM-1 with eccentric mid 40% lesion.
RCA with 50% mid lesion.  LAD lesion was stented x2 with
Cypher stents.

CT SCAN OF THE ABDOMEN/PELVIS WITHOUT CONTRAST ([**2128-7-15**]):
Showed moderate to large right pelvic hematoma, originating
in the region of the right psoas muscle.

BRIEF SUMMARY OF HOSPITAL COURSE:
1. Coronary artery disease:  Patient with three vessel
disease on cardiac catheterization and status post PCI with
two Cypher stents placed in his left anterior descending
artery.  Plan was to continue aspirin, Plavix, statin, and
beta blocker/ACE inhibitor, if the patient's blood pressure
tolerated.  Namely, the patient should be on aspirin and
Plavix for nine months post-stent.  As he had complications,
hematoma development, Integrilin was discontinued.

He was managed and monitored for symptoms of chest pain or
dyspnea, and this was of concern for possible stent
thrombosis.  He remained chest pain free throughout the
remainder of his hospital course, and cardiac enzymes were
ruled out for myocardial infarction.

Ventriculogram performed during coronary catheterization
showed an ejection fraction of 65%.  Therefore, the patient's
cardiac decompensation was likely secondary to diastolic
dysfunction secondary to a longstanding history of
hypertension.  Initially, plan was made to continue ACE
inhibitor and beta blocker therapy if the patient's blood
pressure tolerated.  However, he arrived to the floor in need
of pressor support on a dopamine drip.  He was weaned off the
dopamine slowly as the blood pressure tolerated, and atenolol
50 mg po q day, and Valsartan 240 mg po q day were added to
his medication regimen.  Please note, that the patient had
been on an ACE inhibitor prior to admission, however, it was
felt that the side-effects from the ACE inhibitor therapy
could be contributing to his complaint of cough, and
therefore an angiotensin receptor blocker was substituted in
place of the ACE inhibitor.

2. Right psoas muscle hematoma:  Vascular Surgery was
consulted.  They recommended serial hematocrit values,
hemodynamic monitoring, and serial peripheral pulse checks.
The patient was transfused 2 units of packed red blood cells
for a drop in his hematocrit from 37 to 27.  He tolerated
this well.  Additionally, Heparin and Integrilin were
discontinued as this is felt to be contributed to bleeding
complications.  At time of discharge, the patient's
hematocrit value had been stable for greater than 24 hours.
Value at discharge was 36.3.

3. Diabetes mellitus:  Patient's outpatient metformin dose
was held after receiving an intravenous contrast load during
cardiac catheterization, out of concern for possible acute
tubular necrosis, exacerbation of renal insufficiency, and
possible development of lactic acidosis.  He was monitored
with serial fingerstick blood glucose testing and covered on
regular insulin-sliding scale.  He was started on a diabetic
diet.

Postcatheterization, he was given Mucomyst 600 mg po bid due
to his history of renal insufficiency.

4. Renal insufficiency:  On admission, the patient's
creatinine was elevated.  It was not clear if this was his
baseline or the results of intervention.  It was felt that it
was multifactorial given his history of hypertension and
diabetes.  Postcatheterization, he was hydrated aggressively
with IV fluid therapy.  Initially, his ACE inhibitor was held
for renal production.  After two days of fluid therapy, the
patient's creatinine value returned to stable level of 0.9,
and this was the level at the time of discharge.

5. GI:  As the patient's chronic cough could be secondary to
gastroesophageal reflux disease, he was started on Protonix
40 mg po q day.

6. Activity level:  Prior to discharge, the patient was
cleared by Physical Therapy staff, is not needed Physical
Therapy services after discharge.  At time of discharge, he
was ambulating independently.

CONDITION ON DISCHARGE:  Good.  Right groin hematoma stable
with hematocrit stable at 36.3 at time of discharge.  Cleared
by Physical Therapy for discharge to home.

DISCHARGE STATUS:  The patient was discharged to home.

DISCHARGE DIAGNOSES:
1. Coronary artery disease status post catheterization,
status post stent placement.
2. Right groin hematoma.
3. Heart failure, diastolic dysfunction.
4. Diabetes mellitus type 2.
5. Hypertension.
6. Hypercholesterolemia.
7. Gout.
8. Glaucoma.

DISCHARGE MEDICATIONS:
1. Pravastatin 20 mg three tablets po q day.
2. Betaxolol 0.25% solution one drop each eye [**Hospital1 **].
3. Aspirin 325 mg one po q day.
4. Metformin 500 mg two po bid.
5. Clopidogrel 75 mg po q day for nine months.
6. Atenolol 50 mg one po q day.
7. Valsartan 80 mg one po q day.
8. Outpatient occupational therapy, patient with history of
coronary artery disease, status post cardiac catheterization
and stent placement.  He is given a prescription to institute
a program of outpatient cardiac rehabilitation therapy.

FOLLOW-UP PLANS:  Patient was told that he must make
follow-up appointments with his primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) **] and with his cardiologist, Dr. [**Last Name (STitle) **].  He can call
[**Telephone/Fax (1) 3183**] to make an appointment with each of those
providers.  He was instructed to make an appointment within
the next 1-2 weeks.

Additionally, he was told to notify his primary care
physician or visit an Emergency Room immediately if he
experienced any chest pain, shortness of breath, dizziness,
or lightheadedness, palpitations, back pain, pain in his
catheterization site, or fainting.  He is instructed that we
had changed some of his medications.  He was told to
discontinue his triamterene/hydrochlorothiazide and his
lisinopril.  He was instructed that he was started on the new
medications of valsartan 80 mg po q day and Plavix 75 mg po q
day.  Finally, he was told not to operate any heavy
machinery, including a motor vehicle for the next one week.



                          [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 2139**]

Dictated By:[**Last Name (NamePattern1) 257**]

MEDQUIST36

D:  [**2128-7-17**]  17:56
T:  [**2128-7-21**]  09:42
JOB#:  [**Job Number 44223**]

cc:[**Last Name (NamePattern4) 44224**]
{'Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Chronic diastolic heart failure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: Patient is a 56-year-old male
with a history of hypertension and diabetes mellitus type 2,
hypercholesterolemia, who presented to his primary care
physician with complaints of chronic nonproductive cough
times the past seven months, coinciding with initiation of
ACE inhibitor therapy.  He also complained of dizziness,
fatigue, and occasional diaphoresis, not related to exertion.
He reports that he can walk up two flights of stairs and ride
a bike without any shortness of breath, dyspnea on exertion,
chest pain, chest pressure.  Additionally, he denies edema,
paroxysmal nocturnal dyspnea, orthopnea, syncope, presyncope.

MEDICAL HISTORY: 1. Diabetes mellitus x5 years.
2. Hypertension.
3. Hypercholesterolemia.
4. Gout.
5. Glaucoma.
6. History of struck by lightening in [**2092**].

MEDICATION ON ADMISSION: 

ALLERGIES: Patient reports allergies to Morphine resulting
in rash, and amoxicillin resulting in diarrhea.

PHYSICAL EXAM: 

FAMILY HISTORY: Patient reports that his mother died at age
58 from complications of congestive heart failure and
diabetes.  Father deceased from stroke.

SOCIAL HISTORY: Patient is married.  He is semiretired from
sales.  He denies any alcohol use.  Denies illicit drug use.
Reports one pack per day smoking history for many years
having quit in [**2111**]. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Hematoma complicating a procedure,Chronic diastolic heart failure,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
