CHIEF COMPLAINT: Mr. [**Known lastname **] is an 84-year-old man referred
by Dr. [**Last Name (STitle) 120**] for outpatient cardiac catheterization because
of a positive ETT.

PRESENT ILLNESS: Mr. [**Known lastname **] is preoped for a
right iliac artery aneurysms repair.  At the time of
preoperative workup, the patient stated he was having left
sided chest pain and shortness of breath for the past 3-6
months.  These episodes occur at rest as well as with
activity.  The discomfort and shortness of breath resolve
within 5-10 minutes and occur 2-3x/week.  Persantine MIBI was
done on [**5-25**].  The patient had dyspnea during the
infusion, no electrocardiogram changes, imaging was limiting
due to patient's motion, and revealed the possible reversible
moderate inferior wall defect and a possible reversible
defect involving the anterior aspect.

MEDICAL HISTORY: 1. Hypertension.
2. Diabetes.
3. Peripheral neuropathy.
4. Supraventricular tachycardia.
5. Hernia repair.
6. Cataract surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Polyneuropathy in diabetes,Aneurysm of iliac artery,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled
Neuropathy in diabetes,Iliac artery aneurysm,Hypertension NOS,Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Atrial fibrillation,CHF NOS,DMII neuro nt st uncntrl
Admission Date:  [**2112-6-1**]       Discharge Date:  [**2112-6-8**]


Service:  Cardiothoracic

CHIEF COMPLAINT:  Mr. [**Known lastname **] is an 84-year-old man referred
by Dr. [**Last Name (STitle) 120**] for outpatient cardiac catheterization because
of a positive ETT.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is preoped for a
right iliac artery aneurysms repair.  At the time of
preoperative workup, the patient stated he was having left
sided chest pain and shortness of breath for the past 3-6
months.  These episodes occur at rest as well as with
activity.  The discomfort and shortness of breath resolve
within 5-10 minutes and occur 2-3x/week.  Persantine MIBI was
done on [**5-25**].  The patient had dyspnea during the
infusion, no electrocardiogram changes, imaging was limiting
due to patient's motion, and revealed the possible reversible
moderate inferior wall defect and a possible reversible
defect involving the anterior aspect.

An echocardiogram done on the [**6-6**], showed moderately
decreased ejection fraction of 57% with posterior akinesis
consistent with electrocardiogram evidence of an old
posterior myocardial infarction.  There was mild aortic
regurgitation and mild mitral regurgitation.  The patient was
referred to [**Hospital1 69**] for cardiac
catheterization.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Diabetes.
3. Peripheral neuropathy.
4. Supraventricular tachycardia.
5. Hernia repair.
6. Cataract surgery.

ALLERGIES:  He has no known drug allergies.

MEDICATIONS PRIOR TO ADMISSION:
1. Corgard 20 mg q day.
2. Verapamil 40 mg tid.
3. Glyburide 5 mg q day.

Patient's electrocardiogram prior to catheterization showed
inferior ST elevations and anterolateral ST depressions,
sinus bradycardia with an old IMI.

LABORATORIES:  White count 7.2, hematocrit 39.9, platelets
200.  Sodium 145, potassium 3.9, chloride 102, CO2 33, BUN
20, creatinine 0.9, glucose 153, INR 1.1.  CK 75, and normal
LFTs.

Chest x-ray showed no congestive heart failure or effusions.

PHYSICAL EXAMINATION:  Five foot 7 inches, 73 kg, heart rate
64, blood pressure 140/59, respiratory rate 20.  Neurologic:
cranial nerves II through XII are grossly intact, nonfocal
examination.  Excellent strength in all four extremities.
Respiratory is clear to auscultation bilaterally.  Heart
sounds regular, rate, and rhythm, S1, S2.  Abdomen is soft,
nontender, nondistended, positive bowel sounds, no
hepatosplenomegaly.  Extremities are warm and well perfused
with no clubbing, cyanosis, or edema.  No varicosities.  Neck
with no jugular venous distention and no bruits.

Patient was brought to the cardiac catheterization
laboratory.  Please see the catheterization report for full
details.  In summary, the catheterization showed left main
with mild disease, left anterior descending artery with a
total occluding at the left main origin.  Circumflex with a
95% occlusion, right coronary artery with 90% occlusion and
global hypokinesis.

Following cardiac catheterization, the patient was referred
to CT Surgery for evaluation for coronary artery bypass
graft.  He was seen by CT Surgery, and accepted for coronary
artery bypass grafting.  On [**6-3**], the patient was brought
to the operating room.  Please see operating room report for
full details.  In summary, the patient had coronary artery
bypass graft x3 with a LIMA to the left anterior descending
artery, saphenous vein graft to the OM, and saphenous vein
graft to the PDA.  He tolerated the procedure well, and was
transferred from the operating room to the Cardiothoracic
Intensive Care Unit.

At the time of transfer, the patient had Neo-Synephrine at
0.2 mcg/kg/min, propofol at 30 mcg/kg/min, and aprotinin at
25 cc/hour.  He was A-paced at 80 beats per minute with a
mean arterial pressure of 70 and a CVP of 13.

The patient did well in the immediate postoperative period.
He was weaned from all cardioactive IV medications.  His
anesthesia was reversed and sedation was discontinued.  He
was weaned from the ventilator and successfully extubated.

Postoperative day one, the patient remained hemodynamically
stable.  He was kept in the Intensive Care Unit because of an
episode of rapid atrial fibrillation, a period of hypotension
associated with rapid atrial fibrillation.  At that point, he
was started on amiodarone and converted back to a sinus
rhythm.

Postoperative day two, patient remained hemodynamically
stable.  His chest tubes were removed.  Central line was
discontinued, and he was transferred from the floor for
continuing postoperative care and cardiac rehabilitation.
Over the next several days with the assistance of the nursing
staff and Physical Therapy staff.  Patient's activity level
was increased until on postoperative day #5, it was decided
that the patient was stable and ready to be transferred to a
rehabilitation center for continuing postoperative care and
rehabilitation.

At the time of transfer, the patient's physical examination
is as follows:  Vital signs:  Temperature of 97.3, heart rate
60 sinus rhythm, blood pressure 117/80, respiratory rate 18,
and O2 saturation is 94% on room air.  Weight preoperatively
71.5 kg.  At discharge, 72.4 kg.  Laboratory data:  White
count 9.6, hematocrit 30.9, platelets 137, sodium 135,
potassium 3.6, chloride 99, CO2 27, BUN 16, creatinine 0.9,
glucose 124.

Physical examination:  Alert and oriented times three, moves
all extremities, follows commands.  Respiratory:  Breath
sounds are clear to auscultation bilaterally, although
slightly diminished in the left base.  Cardiac:  Regular,
rate, and rhythm, S1, S2 with a slight systolic ejection
murmur.  Sternum is stable, incision with Steri-Strips, open
to air clean and dry.  Abdomen is soft, nontender, and
nondistended, normoactive bowel sounds.  Extremities are warm
and well perfused with no edema.  Left saphenous vein graft
sites with Steri-Strips open to air, clean, and dry.  Large
ecchymotic area of the left upper thigh.

DISCHARGE MEDICATIONS:
1. Lasix 20 mg q day x7 days.
2. Potassium chloride 20 mEq q day x7 days.
3. Colace 100 mg [**Hospital1 **].
4. Amiodarone 400 mg q day x1 week, then 200 mg q day x1
month.
5. Nadolol 20 mg q day.
6. Ranitidine 150 mg [**Hospital1 **].
7. Enteric coated aspirin 325 q day.
8. Glyburide 5 mg q day.
9. Regular insulin-sliding scale.
10. Percocet 5/325 1-2 tablets q4h prn.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1. Coronary artery disease status post coronary artery bypass
grafting x3 with a left internal mammary artery to the left
anterior descending artery, saphenous vein graft to the
posterior descending artery, and saphenous vein graft to the
obtuse marginal.
2. Diabetes mellitus.
3. Hypertension.
4. Supraventricular tachycardia.
5. Neuropathy.
6. Congestive heart failure.
7. Hernia repair.
8. Cataract surgery.
9. Right iliac aneurysm to be addressed by Vascular Surgery
following recovery from coronary artery bypass grafting.

DISCHARGE INSTRUCTIONS:  The patient is discharged to
rehabilitation.  He is to have followup with his primary care
provider three weeks following his discharge from
rehabilitation, and follow up with Dr. [**Last Name (STitle) 70**] in six weeks
from discharge from [**Hospital1 69**].




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

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

D:  [**2112-6-8**]  11:56
T:  [**2112-6-8**]  12:24
JOB#:  [**Job Number **]
{'Polyneuropathy in diabetes,Aneurysm of iliac artery,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}


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: Mr. [**Known lastname **] is an 84-year-old man referred
by Dr. [**Last Name (STitle) 120**] for outpatient cardiac catheterization because
of a positive ETT.

PRESENT ILLNESS: Mr. [**Known lastname **] is preoped for a
right iliac artery aneurysms repair.  At the time of
preoperative workup, the patient stated he was having left
sided chest pain and shortness of breath for the past 3-6
months.  These episodes occur at rest as well as with
activity.  The discomfort and shortness of breath resolve
within 5-10 minutes and occur 2-3x/week.  Persantine MIBI was
done on [**5-25**].  The patient had dyspnea during the
infusion, no electrocardiogram changes, imaging was limiting
due to patient's motion, and revealed the possible reversible
moderate inferior wall defect and a possible reversible
defect involving the anterior aspect.

MEDICAL HISTORY: 1. Hypertension.
2. Diabetes.
3. Peripheral neuropathy.
4. Supraventricular tachycardia.
5. Hernia repair.
6. Cataract surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: He has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Polyneuropathy in diabetes,Aneurysm of iliac artery,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Congestive heart failure, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}
