CHIEF COMPLAINT: Ms. [**Known lastname 53015**] is an 82-year-old patient of Dr.
[**First Name4 (NamePattern1) 3075**] [**Last Name (NamePattern1) **] and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3321**] referred for outpatient
cardiac cath after a positive exercise tolerance test with
exertional symptoms.

PRESENT ILLNESS: An 82-year-old woman, with new
onset exertional chest pain since [**Holiday 1451**], notices
angina after climbing one flight of stairs or rushing around.
Chest pain is easily resolved with rest.  Uses no
Nitroglycerin.  During dobutamine stress echo, the patient
experienced chest heaviness, and the EKG was uninterpretable
due to left bundle branch block.  Echo imaging at rest showed
normal LV systolic function, no AI, and mild MR.  [**Name13 (STitle) **]
dobutamine showed inferoseptal and inferoposterior
hypokinesis.  The patient had carotid ultrasounds done on
[**12-14**] which showed significant plaque formation in the
common carotid arteries, carotid bulb, and the origin of the
internal carotid arteries bilaterally.  Right ICA showed a
60-69% stenosis.  The origin of the left ICA showed a 40-50%
stenosis.

MEDICAL HISTORY: 1. Hypertension.
2. Hyperlipidemia.
3. Left bundle branch block.
4. Glaucoma.
5. Hypercholesterolemia.
6. Hernia repairs.
7. Appendectomy.
8. Bilateral cataract surgery.
9. Hysterectomy.
10.Bursitis.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: Alert and oriented x 3.  Moves all
extremities.  Follows commands.  Respiratory decreased in the
left base, otherwise clear to auscultation.  Cardiac -
regular rate and rhythm, S1, S2, no murmurs.  Sternum stable.
Incision with Steri-Strips, open to air, clean and dry.
Abdomen soft, nontender, nondistended, normoactive bowel
sounds.  Extremities warm and well-perfused with 1-2+ pedal
edema.  Right saphenous vein graft site with Steri-Strips,
open to air, clean and dry.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Atrioventricular block, complete,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified glaucoma,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Surg compl-heart,Atrial fibrillation,Atriovent block complete,Hypertension NOS,Hyperlipidemia NEC/NOS,Glaucoma NOS,Abn react-anastom/graft
Admission Date:  [**2182-1-22**]       Discharge Date:  [**2182-2-4**]


Service:  CARDIOTHORACIC

CHIEF COMPLAINT:  Ms. [**Known lastname 53015**] is an 82-year-old patient of Dr.
[**First Name4 (NamePattern1) 3075**] [**Last Name (NamePattern1) **] and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3321**] referred for outpatient
cardiac cath after a positive exercise tolerance test with
exertional symptoms.

HISTORY OF PRESENT ILLNESS:  An 82-year-old woman, with new
onset exertional chest pain since [**Holiday 1451**], notices
angina after climbing one flight of stairs or rushing around.
Chest pain is easily resolved with rest.  Uses no
Nitroglycerin.  During dobutamine stress echo, the patient
experienced chest heaviness, and the EKG was uninterpretable
due to left bundle branch block.  Echo imaging at rest showed
normal LV systolic function, no AI, and mild MR.  [**Name13 (STitle) **]
dobutamine showed inferoseptal and inferoposterior
hypokinesis.  The patient had carotid ultrasounds done on
[**12-14**] which showed significant plaque formation in the
common carotid arteries, carotid bulb, and the origin of the
internal carotid arteries bilaterally.  Right ICA showed a
60-69% stenosis.  The origin of the left ICA showed a 40-50%
stenosis.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Hyperlipidemia.
3. Left bundle branch block.
4. Glaucoma.
5. Hypercholesterolemia.
6. Hernia repairs.
7. Appendectomy.
8. Bilateral cataract surgery.
9. Hysterectomy.
10.Bursitis.

ALLERGIES:  The patient states no known drug allergies.

MEDS:
1. Moexipril 22.5 qd.
2. Alphagan 0.15% 1 drop to the OS [**Hospital1 **].
3. Cosopt 0.1% 1 drop OU [**Hospital1 **].
4. Lipitor 10 mg q hs.
5. Tenex 1 mg q hs.
6. Trazodone 50 mg q hs.
7. Aspirin 81 mg q hs.
8. Citracal.
9. Multivitamin with calcium.
10.Motrin prn.
11.Nitroglycerin prn.

LAB DATA PRIOR TO ADMISSION:  White count 7.2, hematocrit
38.1, platelets 378, sodium 140, potassium 4.8, chloride 102,
CO2 30, BUN 15, creatinine 0.8, INR 1.1.

HOSPITAL COURSE:  The patient was admitted to the cardiac
catheterization laboratory where she underwent cardiac
catheterization.  Please see report for full details.  In
summary, the patient had a cath which showed 80-90% left
main, mild diffuse disease of the LAD, 90% circumflex, 60%
ostial RCA, and an EF of 55%.  Following cardiac
catheterization, cardiac surgery was consulted.  The patient
was seen and accepted for coronary artery bypass grafting.

On [**1-23**], the patient was brought to the operating
room.  Please see the OR report for full details.  In
summary, the patient had a CABG x 4 with a LIMA to the RI, a
saphenous vein graft to the LAD, and a saphenous vein graft
to OM2 and PLB sequentially.  The patient's bypass time was
82 minutes.  Her crossclamp time was 65 minutes.  She
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.
Her anesthesia was reversed.  She was weaned from the
ventilator and successfully extubated.  She remained
hemodynamically stable throughout the evening of her
operative date, requiring Levophed drip to support her blood
pressure.  On postoperative day #1, the patient remained
hemodynamically stable.  She was noted to be in a first
degree heart block and continued to need Levophed infusion to
maintain adequate blood pressure.  During the course of
postoperative day #1, the Levophed infusion was transitioned
to a Neo-Synephrine infusion to maintain her blood pressure.
Also, EP service was consulted because along with the first
degree heart block, the patient had periods of bradycardia.

On postoperative day #2, the patient was weaned from her
Neo-Synephrine drip and begun on diuretics.  Also, her chest
tubes were discontinued.  The patient continued to be
followed by the electrophysiology service, as she continued
to have periods of bradycardia.  By postoperative day #4, the
patient was in a predominantly sinus rhythm with a heart rate
in the 80s.  She did have multiple PACs with one short burst
of atrial fibrillation and was, therefore, trialed on a low
dose beta blocker.  Following the beta blocker, she again
became bradycardic and that was discontinued.  Therefore, the
patient remained in the Cardiothoracic Intensive Care Unit
until postoperative day #6.  At that time, she was
hemodynamically stable, had been adequately diuresed, had
begun on low dose oral beta blockade which was tolerated
well, and she was then transferred to the floor for continued
postoperative care and cardiac rehabilitation.

Once on the floor, the patient had an uneventful course with
the exception that she did have a period of postoperative
atrial fibrillation which responded to increased beta
blockade.  Following increased beta blockade, the patient
converted to a sinus rhythm and stayed in a sinus rhythm
throughout the rest of her hospitalization.  The patient was,
however, begun on heparin and insulin at that time.  With the
assistance of the nursing staff and physical therapy, the
patient's activity level was increased to level [**2-7**], meaning
that she could walk 200-300' on a flat surface.  She never
attained a level 5 and was, therefore, screened for
rehabilitation.  On postoperative day #12, it was felt that
the patient was stable and ready to be discharged to
rehabilitation.

VITAL SIGNS AT DISCHARGE:  Temperature 97.8, heart rate 73,
sinus rhythm, blood pressure 129/57, respiratory rate 20, O2
sat 96% on room air, weight preoperatively 55.3 kg, at
discharge 59.3 kg.

LAB DATA:  White count 8.3, hematocrit 29.5, platelets 400,
sodium 140, potassium 4.4, chloride 105, CO2 29, BUN 13,
creatinine 0.6, glucose 104, PT 14.3, PTT 72.4, INR 1.4.

PHYSICAL EXAM:  Alert and oriented x 3.  Moves all
extremities.  Follows commands.  Respiratory decreased in the
left base, otherwise clear to auscultation.  Cardiac -
regular rate and rhythm, S1, S2, no murmurs.  Sternum stable.
Incision with Steri-Strips, open to air, clean and dry.
Abdomen soft, nontender, nondistended, normoactive bowel
sounds.  Extremities warm and well-perfused with 1-2+ pedal
edema.  Right saphenous vein graft site with Steri-Strips,
open to air, clean and dry.

DISCHARGE MEDICATIONS:
1. Lasix 20 mg [**Hospital1 **] x 7 days, then qd x 7 days.
2. Potassium chloride 20 mEq [**Hospital1 **] x 7 days, then qd x 7 days.
3. Colace 100 mg [**Hospital1 **].
4. Zantac 150 mg qd.
5. Atorvastatin 10 mg qd.
6. Metoprolol 50 mg [**Hospital1 **].
7. Cosopt 0.1% 1 drop OU [**Hospital1 **].
8. Alphagan 0.15% 1 drop OS [**Hospital1 **].
9. Warfarin to maintain a target INR of 2.0, 4 mg on [**2-4**].
The past 3 nights, [**2106-2-1**] and 29, the patient had
received 3 mg on each of those night.
10.Percocet 5/325, 1-2 tabs q 4 h prn.

CONDITION AT DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1. Coronary artery disease status post coronary artery bypass
grafting with left internal mammary artery to the ramus
intermedius, with saphenous vein graft to left anterior
descending, and saphenous vein graft to second obtuse
marginal, and posterolateral branch sequentially.
2. Hypertension.
3. Hypercholesterolemia.
4. Postoperative atrial fibrillation.
5. Glaucoma.
6. Sciatica.
7. Status post hernia repairs.
8. Status post appendectomy.
9. Status post bilateral cataract surgery.
10.Status post hysterectomy.

FOLLOW-UP:  With Dr. [**Last Name (STitle) **], her primary care provider, [**Last Name (NamePattern4) **] [**2-7**]
weeks.  Follow-up with Dr. [**Last Name (STitle) 3321**] as directed by Dr.
[**Last Name (STitle) **].  Follow-up with Dr. [**Last Name (STitle) 70**] in 6 weeks.




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

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

D:  [**2182-2-4**]  11:48
T:  [**2182-2-4**]  11:51
JOB#:  [**Job Number 53016**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Atrioventricular block, complete,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified glaucoma,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: Ms. [**Known lastname 53015**] is an 82-year-old patient of Dr.
[**First Name4 (NamePattern1) 3075**] [**Last Name (NamePattern1) **] and [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3321**] referred for outpatient
cardiac cath after a positive exercise tolerance test with
exertional symptoms.

PRESENT ILLNESS: An 82-year-old woman, with new
onset exertional chest pain since [**Holiday 1451**], notices
angina after climbing one flight of stairs or rushing around.
Chest pain is easily resolved with rest.  Uses no
Nitroglycerin.  During dobutamine stress echo, the patient
experienced chest heaviness, and the EKG was uninterpretable
due to left bundle branch block.  Echo imaging at rest showed
normal LV systolic function, no AI, and mild MR.  [**Name13 (STitle) **]
dobutamine showed inferoseptal and inferoposterior
hypokinesis.  The patient had carotid ultrasounds done on
[**12-14**] which showed significant plaque formation in the
common carotid arteries, carotid bulb, and the origin of the
internal carotid arteries bilaterally.  Right ICA showed a
60-69% stenosis.  The origin of the left ICA showed a 40-50%
stenosis.

MEDICAL HISTORY: 1. Hypertension.
2. Hyperlipidemia.
3. Left bundle branch block.
4. Glaucoma.
5. Hypercholesterolemia.
6. Hernia repairs.
7. Appendectomy.
8. Bilateral cataract surgery.
9. Hysterectomy.
10.Bursitis.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: Alert and oriented x 3.  Moves all
extremities.  Follows commands.  Respiratory decreased in the
left base, otherwise clear to auscultation.  Cardiac -
regular rate and rhythm, S1, S2, no murmurs.  Sternum stable.
Incision with Steri-Strips, open to air, clean and dry.
Abdomen soft, nontender, nondistended, normoactive bowel
sounds.  Extremities warm and well-perfused with 1-2+ pedal
edema.  Right saphenous vein graft site with Steri-Strips,
open to air, clean and dry.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Cardiac complications, not elsewhere classified,Atrial fibrillation,Atrioventricular block, complete,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified glaucoma,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
