CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 69-year-old white
male who has a history of coronary artery disease,
hypertension, and noninsulin-dependent diabetes, who
presented to [**Hospital6 33**] on [**2188-1-4**] with jaw pain
on exertion.  He did not have shortness of breath,
diaphoresis, or nausea and vomiting.  He did rule in for an
MI with a peak CK of 498, troponin of 1.21, and MB of 52.3.
he underwent cardiac catheterization which revealed a 90-95%
left main stenosis, an occluded left circumflex and was
transferred for CABG.  He has a normal RCA and LV aneurysm.
He had an echocardiogram in [**12-6**] which showed an EF of
35-40%.

MEDICAL HISTORY: 1.  History of coronary artery disease, status post MI times
two 15 years ago and in [**2182**].
2.  History of noninsulin-dependent diabetes.
3.  History of LV aneurysm with thrombus.
4.  Status post right leg embolectomy in [**2183**].
5.  Status post left knee arthroplasty.
6.  History of AAA, 3.5 cm.
7.  History of chronic renal insufficiency with a baseline of
1.4.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for coronary artery disease.

SOCIAL HISTORY: He has a 40 pack year smoking history and
quit four years ago.  He does not drink alcohol.  He lives
alone and works as a security guard.
Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Abdominal aneurysm without mention of rupture
Subendo infarct, initial,Surg compl-heart,Atrial fibrillation,Crnry athrscl natve vssl,Secundum atrial sept def,Abdom aortic aneurysm
Admission Date:  [**2188-1-8**]       Discharge Date:  [**2188-1-17**]

Date of Birth:   [**2118-8-18**]       Sex:  M

Service:

HISTORY OF THE PRESENT ILLNESS:  This is a 69-year-old white
male who has a history of coronary artery disease,
hypertension, and noninsulin-dependent diabetes, who
presented to [**Hospital6 33**] on [**2188-1-4**] with jaw pain
on exertion.  He did not have shortness of breath,
diaphoresis, or nausea and vomiting.  He did rule in for an
MI with a peak CK of 498, troponin of 1.21, and MB of 52.3.
he underwent cardiac catheterization which revealed a 90-95%
left main stenosis, an occluded left circumflex and was
transferred for CABG.  He has a normal RCA and LV aneurysm.
He had an echocardiogram in [**12-6**] which showed an EF of
35-40%.

PAST MEDICAL HISTORY:
1.  History of coronary artery disease, status post MI times
two 15 years ago and in [**2182**].
2.  History of noninsulin-dependent diabetes.
3.  History of LV aneurysm with thrombus.
4.  Status post right leg embolectomy in [**2183**].
5.  Status post left knee arthroplasty.
6.  History of AAA, 3.5 cm.
7.  History of chronic renal insufficiency with a baseline of
1.4.

ADMISSION MEDICATIONS:
1.  Lopressor 25 mg p.o. b.i.d.
2.  Metformin 1,000 mg p.o. b.i.d.
3.  Lasix, question of the dose.
4.  Zantac, question of the dose.
5.  Coumadin 5 mg p.o. q.d., the last dose on [**2188-1-4**].
6.  Plavix 75 mg p.o. q.d. which was started at the outside
hospital.

ALLERGIES:  The patient has no known drug allergies.

FAMILY HISTORY:  Significant for coronary artery disease.

SOCIAL HISTORY:  He has a 40 pack year smoking history and
quit four years ago.  He does not drink alcohol.  He lives
alone and works as a security guard.

REVIEW OF SYSTEMS:  Significant for slight vision loss in the
right eye.

PHYSICAL EXAMINATION ON ADMISSION:  General: The patient is a
well-developed, well-nourished white male in no apparent
distress.  Vital signs:  Temperature 97.8, pulse 99,
respirations 14, blood pressure 125/72.  HEENT:
Normocephalic, atraumatic.  The extraocular movements were
intact.  The pupils were equal and reactive to light and
accommodation.  The oropharynx was benign.  Poor dentition,
upper dentures.  Neck:  Supple, full range of motion.  No
lymphadenopathy or thyromegaly.  Carotids 2+ and equal
bilaterally without bruits.  Lungs:  Clear to auscultation
and percussion.  Cardiovascular:  Regular rate and rhythm.
Normal S1 and S2 without rubs, murmurs, or gallops.  Abdomen:
Soft, nontender, with positive bowel sounds, no masses or
hepatosplenomegaly.  Extremities:  He had an intra-aortic
balloon pump in the left groin and was without clubbing,
cyanosis or edema.  Pulses were 2+ and equal bilaterally
except for 1+ bilaterally in the DP and PT.  Neurologic:
Nonfocal.

HOSPITAL COURSE:  He was admitted to the CRSU after he was
transferred from [**Hospital6 33**] and he had an
intra-aortic balloon pump placed.  He also had carotid
studies which revealed no significant hemodynamic lesion in
either right or left bifurcation.  He also had a cardiac
echocardiogram preoperatively which revealed that there were
LV wall abnormalities, basal inferolateral hypokinesis,
midinferolateral hypokinesis, anterior apex was akinetic.
The septal apex was akinetic, inferior apex was akinetic, and
the lateral apex was hypokinetic.  The right ventricular wall
motion was normal.  There was a mild apical aneurysm of the
left ventricle.  There were no masses or thrombi seen.  His
ejection fraction was 35%.

On [**2188-1-9**], he underwent a CABG times three with LIMA to the
LAD, reverse saphenous vein graft to the distal RCA and the
diagonal and he had a repair of an ASD.  His cross-clamp time
was 81 minutes, total bypass time 119 minutes.  He tolerated
the procedure well and was transferred to the CRSU on
milrinone and propofol.  He was extubated on his
postoperative night.

On postoperative day number one, he had his intra-aortic
balloon pump discontinued without incident.  On postoperative
day number three, he was weaned off his milrinone and Neo and
his chest tubes were discontinued.  He also went into atrial
fibrillation and was converted to sinus with Diltiazem but
this was also weaned off.

On postoperative day number four, he was transferred to the
floor in stable condition.  He did have another episode of
atrial fibrillation and was started on Amiodarone and
remained in sinus rhythm.  He continued to progress.  His
creatinine baseline was 1.4 and it increased to 1.9.  On
postoperative day number eight, he was discharged to home in
stable condition.

LABORATORY/RADIOLOGIC DATA:  On discharge, his laboratories
revealed a hematocrit of 34.5, white count 10,900, platelets
229,000.  Chemistries are pending and will be on the
addendum.

DISCHARGE MEDICATIONS:
1.  Colace 100 mg p.o. b.i.d.
2.  Ecotrin 325 mg p.o. q.d.
3.  Percocet one to two p.o. q. four to six hours p.r.n.
pain.
4.  Lopressor 25 mg p.o. t.i.d.
5.  Glucophage 1,000 mg p.o. b.i.d.
6.  Amiodarone 400 mg p.o. b.i.d. times one week and then
decrease to 400 mg p.o. q.d. for a week and then decrease to
200 mg p.o. q.d.
7.  Zantac 150 mg p.o. b.i.d.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease.
2.  Atrial septal defect.
3.  Postoperative atrial fibrillation.
4.  Noninsulin-dependent diabetes.

FOLLOW-UP:  The patient will be seen by Dr.
.................... in one to two weeks and by Dr. [**Last Name (STitle) 1537**] in
four weeks.




                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 6516**]
MEDQUIST36

D:  [**2188-1-16**]  05:00
T:  [**2188-1-16**]  17:16
JOB#:  [**Job Number 34295**]


Name:  [**Known lastname **], [**Known firstname 6028**]                     Unit No:  [**Numeric Identifier 6029**]

Admission Date:  [**2188-1-8**]     Discharge Date:  [**2188-1-18**]

Date of Birth:   [**2118-8-18**]     Sex:  M

Service:

ADDENDUM:  Please refer to dictation which follows the
hospital course through [**1-16**].  This dictation refers
only to [**1-17**] and [**1-18**].

The patient's course on [**1-17**] and [**Month (only) 1860**] was
uneventful with the exception that he was seen by the [**Hospital 616**]
Clinic for diabetes control.  Following the recommendations
of [**Last Name (un) 616**], the patient was started on twice per day insulin
regimen with 70/30 insulin.  His dose was initially 6 units
subcutaneously in the morning and at dinner time.  On
[**1-18**], that dose was increased to 8 units
subcutaneously in the morning and at dinner time with a
sliding-scale with regular insulin.

The patient was deemed ready for discharge to home with
visiting nurse followup on [**2188-1-18**].  At that time,
the patient's physical examination was as follows.  Vital
signs revealed his temperature was 98.2 degrees Fahrenheit,
his heart rate was 74 (sinus rhythm), his blood pressure was
132/80, his respiratory rate was 18, and his oxygen
saturation was 95% on room air.  Physical examination
revealed the patient was alert and oriented times three.  He
moved all extremities and followed commands.  The lungs were
clear to auscultation bilaterally.  Cardiovascular
examination revealed a regular rate and rhythm.  First heart
sounds and second heart sounds.  The sternum was stable.  The
incision with Steri-Strips open to air and was clean and dry.
The abdomen was soft, nontender, and nondistended.  There
were normal active bowel sounds.   The extremities were warm
and well perfused with no edema.  The right leg incision with
Steri-Strips open to air and was clean and dry.

His laboratory data revealed a white blood cell count of
10.9, his hematocrit was 34.5, and his platelets were 229.
The patient's sodium was 140, potassium was 5.3, chloride was
107, bicarbonate was 22, blood urea nitrogen was 20,
creatinine was 2, and blood glucose was 137.  His prothrombin
time was 12.9, his partial thromboplastin time was 23.4, and
his INR was 1.1.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease; status post coronary artery
bypass grafting times three with a left internal mammary
artery to the left anterior descending artery, saphenous vein
graft to the right coronary artery, saphenous vein graft to
the diagonal, and atrial septal defect repair.
2.  Type 2 diabetes mellitus.
3.  History of left ventricular aneurysm with thrombus.
4.  Status post right leg embolectomy.
5.  Status post left knee arthroplasty.
6.  History of abdominal aortic aneurysm of 3.5 cm.
7.  History of chronic renal insufficiency (with a baseline
creatinine of 1.4).

MEDICATIONS ON DISCHARGE:  (Discharge medications included)
1.  Metoprolol 25 mg by mouth three times per day.
2.  Aspirin 325 mg by mouth once per day.
3.  Insulin (70/30) 8 units subcutaneously in the morning and
at dinner time.
4.  Regular insulin sliding-scale; insulin sliding-scale
q.8h.; for glucose levels of 0 to 70 to drink juice and
crackers; for glucose levels of 71 to 200 use   no insulin;
for glucose levels of 201 to 250 use 2 units subcutaneously;
for glucose levels of 251 to 300 use 4 units subcutaneously;
and for glucose levels of 301 call medical doctor.  He was to
follow the sliding-scale four times per day.
5.  Pantoprazole 40 mg by mouth once per day.
6.  Warfarin 5 mg by mouth on [**1-17**], [**1-18**],
[**1-19**], and [**1-20**] and then have his INR check on
Monday, [**1-21**] and follow Coumadin dosing as directed by
Dr.[**Name (NI) 6030**] office.
7.  Percocet 5/325-mg tablets one to two tablets by mouth
q.4h. as needed.

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

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to have diabetic teaching by the social
hospital and the [**Hospital6 1346**].
2.  The patient was instructed to follow up in Dr.[**Name (NI) 6031**] office in two weeks.
3.  The patient was instructed to follow up in the [**Hospital 4011**]
Clinic in two weeks.
4.  The patient was instructed to follow up with Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] in four weeks.
5.  Additionally, the patient was to schedule followup with
the Podiatry Service of his and Dr.[**Name (NI) 6030**] choice.





                          [**First Name11 (Name Pattern1) 63**] [**Last Name (NamePattern4) 1508**], M.D.  [**MD Number(1) 1509**]

Dictated By:[**Name8 (MD) 3027**]

MEDQUIST36

D:  [**2188-1-18**]  15:13
T:  [**2188-1-19**]  00:47
JOB#:  [**Job Number 6032**]
{'Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Abdominal aneurysm without mention of rupture'}


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 69-year-old white
male who has a history of coronary artery disease,
hypertension, and noninsulin-dependent diabetes, who
presented to [**Hospital6 33**] on [**2188-1-4**] with jaw pain
on exertion.  He did not have shortness of breath,
diaphoresis, or nausea and vomiting.  He did rule in for an
MI with a peak CK of 498, troponin of 1.21, and MB of 52.3.
he underwent cardiac catheterization which revealed a 90-95%
left main stenosis, an occluded left circumflex and was
transferred for CABG.  He has a normal RCA and LV aneurysm.
He had an echocardiogram in [**12-6**] which showed an EF of
35-40%.

MEDICAL HISTORY: 1.  History of coronary artery disease, status post MI times
two 15 years ago and in [**2182**].
2.  History of noninsulin-dependent diabetes.
3.  History of LV aneurysm with thrombus.
4.  Status post right leg embolectomy in [**2183**].
5.  Status post left knee arthroplasty.
6.  History of AAA, 3.5 cm.
7.  History of chronic renal insufficiency with a baseline of
1.4.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for coronary artery disease.

SOCIAL HISTORY: He has a 40 pack year smoking history and
quit four years ago.  He does not drink alcohol.  He lives
alone and works as a security guard. 

### Response:
{'Subendocardial infarction, initial episode of care,Cardiac complications, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Ostium secundum type atrial septal defect,Abdominal aneurysm without mention of rupture'}
