CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 81 year-old
female with coronary artery disease, hypertension,
hypercholesterolemia, status post coronary artery bypass
graft in [**2185**] who presented to the Emergency Department with
substernal chest pain radiating to her jaw for one day.  The
patient took five nitroglycerin tablets with modest relief.
In the Emergency Department the patient had an episode of
chest pain when she was moving in to bed.  Electrocardiogram
was obtained, which showed decreased AT segments in anterior
leads V1 through V4.  Electrocardiogram changes resolved in
less then five minutes and so did the chest pain.  The
patient was admitted to the Medicine Service for further
evaluation and workup.

MEDICAL HISTORY: 1.  Coronary artery disease status
post coronary artery bypass graft in [**2185**].  Catheterization
in [**2193**], which showed deferred saphenous vein graft
occlusion. Catheterization in [**2194**] showed an increase filling
pressure, inferior hypokinesis, 30% osteal LMA and 80% obtuse
marginal occlusion.  Good collaterals.  2.  Villous adenoma.
3.  Osteoporosis.

MEDICATION ON ADMISSION: 1.  Atenolol 100 mg b.i.d.  2.
Amlodipine 25 mg q.d.  3.  Isosorbide mononitrate 60 mg q.d.
4.  Gemfibrozil 600 mg b.i.d.  5.  Captopril 50 mg b.i.d.  6.
Cholysteramine 4 mg b.i.d.  7.  Hydrochlorothiazide 25 mg
q.d.  8.  Diltiazem extended release 180 mg q.d.  9.
Alendronate 17 mg q Monday.

ALLERGIES: Mycin and Lovastatin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of autologous vein bypass graft,Atrial fibrillation,Acidosis,Pure hypercholesterolemia,Unspecified essential hypertension
Crn ath atlg vn bps grft,Atrial fibrillation,Acidosis,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2200-7-19**]       Discharge Date:  [**2200-7-29**]


Service:  CARDIAC SURGERY

PAST MEDICAL HISTORY:  1.  Coronary artery disease status
post coronary artery bypass graft in [**2185**].  Catheterization
in [**2193**], which showed deferred saphenous vein graft
occlusion. Catheterization in [**2194**] showed an increase filling
pressure, inferior hypokinesis, 30% osteal LMA and 80% obtuse
marginal occlusion.  Good collaterals.  2.  Villous adenoma.
3.  Osteoporosis.

PAST SURGICAL HISTORY:  1.  Status post coronary artery
bypass graft in1998.  2.  Status post ileocecectomy.  3.
Status post hysterectomy.

ALLERGIES:  Mycin and Lovastatin.

MEDICATIONS ON ADMISSION:  1.  Atenolol 100 mg b.i.d.  2.
Amlodipine 25 mg q.d.  3.  Isosorbide mononitrate 60 mg q.d.
4.  Gemfibrozil 600 mg b.i.d.  5.  Captopril 50 mg b.i.d.  6.
Cholysteramine 4 mg b.i.d.  7.  Hydrochlorothiazide 25 mg
q.d.  8.  Diltiazem extended release 180 mg q.d.  9.
Alendronate 17 mg q Monday.

HISTORY OF PRESENT ILLNESS:  The patient is an 81 year-old
female with coronary artery disease, hypertension,
hypercholesterolemia, status post coronary artery bypass
graft in [**2185**] who presented to the Emergency Department with
substernal chest pain radiating to her jaw for one day.  The
patient took five nitroglycerin tablets with modest relief.
In the Emergency Department the patient had an episode of
chest pain when she was moving in to bed.  Electrocardiogram
was obtained, which showed decreased AT segments in anterior
leads V1 through V4.  Electrocardiogram changes resolved in
less then five minutes and so did the chest pain.  The
patient was admitted to the Medicine Service for further
evaluation and workup.

PHYSICAL EXAMINATION:  The patient is pleasant, cooperative
and in no acute distress.  Neck JV flat.  No carotid bruits.
Cardiovascular normal S1 and S2.  Lungs clear to auscultation
bilaterally.  Abdomen soft, nontender, nondistended.  Bowel
sounds positive.  Extremities no edema.  Warm and well
perfuse.

LABORATORY:  White blood cell count 7.5, hematocrit 32.5,
platelets 360.  INR 1.2, PTT 25.9, sodium 134, potassium 4.6,
chloride 106, bicarb 17, BUN 31, creatinine 1.1, blood sugar
124, calcium 9.6, phosphate 3.8, magnesium 2.3.  CK 76,
troponin .3.

HOSPITAL COURSE:  The patient was admitted to the Medicine
Service.  Cardiac catheterization was done on [**7-21**],
which showed left ejection fraction of 50%, right main
occluded, left anterior descending coronary artery occluded,
left circumflex occluded, right circumflex occluded,
saphenous vein graft to left anterior descending coronary
artery 95% stenosis.  At that point the patient was urgently
referred to CT surgery for further evaluation.
Preoperatively the patient remained symptom free.  Vital
signs were stable.  The patient was taken to the Operating
Room on [**7-21**], were re-do coronary artery bypass graft
times one was performed with left anterior descending
coronary artery to saphenous vein graft.  Operation went
without complications.  Pacing wires as well as mediastinal
pleural tubes were placed intraoperatively.  The patient was
transferred to CSIU in stable condition.  Postoperative day
number one the patient was acidotic in blood gas, which was
treated with two ampules of bicarb.  The patient responded
appropriately with pH increasing from 7.28 to 7.35.
_____________ was placed.  The patient was intubated and
awake following commands.

The patient had a few episodes of frequent premature atrial
contractions.  The patient remained stable during these
episodes returning to normal sinus rhythm spontaneously.
Postoperatively, the patient is extubated without
complications.  Her Lopressor dose was increased.  The
patient was started on Amiodarone.  Postoperative day number
three the patient's vital signs were stable, occasional
bursts of premature atrial contractions.  The patient was
transferred to a floor.  On the floor the patient had an
episode of atrial fibrillation with a heart rate of 130 on
the monitor.  The patient was complaining of jaw pain
radiating into the left arm.  The electrocardiogram was
obtained, which showed ST depression in V2, V3.  The episode
lasted seven to ten minutes and the patient spontaneously
converted to normal sinus rhythm in which her
electrocardiogram changes reversed.

The patient was transferred back to CSIU.  She had a couple
of episodes of A tach, A flutter 2 to 1 and atrial
fibrillation with rates up to 140.  The patient was given
intravenous Lopressor and loaded with intravenous Amiodarone.
The Physiology Service was consulted, which recommended
increasing the dose of oral Lopresor.  The question of a
permanent pacemaker was raised, but it was decided to wait at
that time.  Postoperative day number four the patient was
transfused one unit of blood for low hematocrit to which she
properly responded to an increased hematocrit to 32.3.  The
patient was continued on Amiodarone.  Her dose of Lopressor
was increased.  The patient continues going in and out of
atrial fibrillation.  Postoperative day number five the
patient continues to go in and out of atrial fibrillation.
Her Lopressor dose was increased to 150 b.i.d.  Postoperative
day number six the patient's heart rate is 60 and A-paced.
Occasional episodes of atrial fibrillation with heart rates
to 140s.  The last episode of atrial fibrillation was in the
morning of [**7-27**].  The patient was transferred to a
regular floor.

Postoperative day number seven the patient is event free,
afebrile, vital signs stable.  The patient is ambulating with
physical therapy.  The issue of permanent pacemaker was
discussed again.  The electric physiology service decided
since the patient seemed to be pretty well controlled on oral
medication and had not required pacing for over 24 hours.
She does not need a permanent pacemaker at this time.  Her
Lopressor dose will be slowly turned down to a goal of 50 mg
b.i.d.  She will continue on oral Amiodarone at this time.
It was also noted that the patient had a couple of bullae
irregular shape approximately 2 by 3 cm along her right
saphenous incision site.  A few of them were hemorrhagic.
The patient denied a history of any skin condition or bullae
in the past.  She denies any skin manifestations, allergies
to medications in the past.  Bullae nontender.  No
surrounding erythema.  The patient will be observed at this
time.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient will be discharged with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
of Heart monitor once today's print out, which should be sent
to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 284**] for read out.  The patient should
undergo physical therapy with a goal of transition to
outpatient rehab.  Right saphenous dressing changes dry
b.i.d.  The patient should follow up with Dr. [**Last Name (STitle) 70**] in
six weeks for postoperative check.  The patient should follow
up with Dr. [**Last Name (STitle) **] in three to four weeks for her heart rate
issues.  The patient should follow up with her primary care
physician in two to three weeks for blood pressure check and
adjustment.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease status post coronary artery
bypass graft, status post re-do coronary artery bypass graft.
2.  Villous adenoma.
3.  Status post ileocecectomy.
4.  Status post hysterectomy.
5.  Osteoporosis.
6.  Status post atrial fibrillation and atrial tachycardia.

MEDICATIONS ON DISCHARGE:  Docusate 100 mg po b.i.d., Zantac
150 mg po b.i.d., enteric coated aspirin 325 mg po q.d.,
Tylenol 650 mg q 4 to 6 hours prn, Benadryl 25 mg po q.h.s.
prn, Cholestyramine 4 mg po b.i.d., Lasix 40 mg po b.i.d.
times ten days, potassium chloride 20 mg po b.i.d. times ten
days, Gemfibrozil 600 mg po b.i.d., Amiodarone 400 mg po q.d.
times three weeks and then 200 mg po q.d., Lopressor 100 mg
po b.i.d., Alendronate 17 mg q Monday.






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

Dictated By:[**Last Name (STitle) 7487**]
MEDQUIST36

D:  [**2200-7-28**]  21:59
T:  [**2200-7-29**]  06:33
JOB#:  [**Job Number **]
{'Coronary atherosclerosis of autologous vein bypass graft,Atrial fibrillation,Acidosis,Pure hypercholesterolemia,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: The patient is an 81 year-old
female with coronary artery disease, hypertension,
hypercholesterolemia, status post coronary artery bypass
graft in [**2185**] who presented to the Emergency Department with
substernal chest pain radiating to her jaw for one day.  The
patient took five nitroglycerin tablets with modest relief.
In the Emergency Department the patient had an episode of
chest pain when she was moving in to bed.  Electrocardiogram
was obtained, which showed decreased AT segments in anterior
leads V1 through V4.  Electrocardiogram changes resolved in
less then five minutes and so did the chest pain.  The
patient was admitted to the Medicine Service for further
evaluation and workup.

MEDICAL HISTORY: 1.  Coronary artery disease status
post coronary artery bypass graft in [**2185**].  Catheterization
in [**2193**], which showed deferred saphenous vein graft
occlusion. Catheterization in [**2194**] showed an increase filling
pressure, inferior hypokinesis, 30% osteal LMA and 80% obtuse
marginal occlusion.  Good collaterals.  2.  Villous adenoma.
3.  Osteoporosis.

MEDICATION ON ADMISSION: 1.  Atenolol 100 mg b.i.d.  2.
Amlodipine 25 mg q.d.  3.  Isosorbide mononitrate 60 mg q.d.
4.  Gemfibrozil 600 mg b.i.d.  5.  Captopril 50 mg b.i.d.  6.
Cholysteramine 4 mg b.i.d.  7.  Hydrochlorothiazide 25 mg
q.d.  8.  Diltiazem extended release 180 mg q.d.  9.
Alendronate 17 mg q Monday.

ALLERGIES: Mycin and Lovastatin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of autologous vein bypass graft,Atrial fibrillation,Acidosis,Pure hypercholesterolemia,Unspecified essential hypertension'}
