CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 72-year-old man with
past medical history significant for hypertension, coronary
artery disease, status post non-Q-wave myocardial infarction
in [**2196-12-21**] as well as retinal detachment bilaterally
[**2194**], memory loss, and prostate cancer status post
brachytherapy.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1. Accupril 20 mg q day.
2. Atenolol 50 mg q day.
3. Imdur 30 mg q day.
4. Lescol 40 mg q day.
5. Aricept 5 mg q hs.

ALLERGIES: Versed which produces acute confusion.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Three to four ounces of scotch per night, no
cigarettes.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atherosclerosis of renal artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Malignant neoplasm of prostate,Anemia, unspecified,Pure hypercholesterolemia,Alzheimer's disease
Subendo infarct, initial,CHF NOS,Crnry athrscl natve vssl,Renal artery atheroscler,Hy kid NOS w cr kid I-IV,Malign neopl prostate,Anemia NOS,Pure hypercholesterolem,Alzheimer's disease
Admission Date:  [**2196-12-27**]     Discharge Date:  [**2197-1-6**]

Date of Birth:   [**2124-10-17**]     Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  This is a 72-year-old man with
past medical history significant for hypertension, coronary
artery disease, status post non-Q-wave myocardial infarction
in [**2196-12-21**] as well as retinal detachment bilaterally
[**2194**], memory loss, and prostate cancer status post
brachytherapy.

ALLERGIES:  Versed which produces acute confusion.

MEDICATIONS ON ADMISSION:
1. Accupril 20 mg q day.
2. Atenolol 50 mg q day.
3. Imdur 30 mg q day.
4. Lescol 40 mg q day.
5. Aricept 5 mg q hs.

The patient was transferred to an outside hospital on the
following medications:
1. Mucomyst 600 mg [**Hospital1 **].
2. Atenolol 50 mg q day.
3. Imdur 60 mg q day.
4. Lasix 20 mg q am.
5. Lescol 40 q day.
6. Aricept 5 mg q day.
7. Aspirin 325 mg q day.
8. Lovenox.
10. Norvasc 10 q day.

SOCIAL HISTORY:  Three to four ounces of scotch per night, no
cigarettes.

This is a 72-year-old man who presented to [**Hospital 1474**] Hospital
five days prior to admission to [**Hospital1 188**] with acute onset of shortness of breath and pulmonary
edema, found to be in a hypertensive crisis at 200/110,
however, no chest pain at the time with troponins peaking
[**12-21**] at 2.5 with flat CKs.  Patient had a non-Q-wave
myocardial infarction.  He was worked with Myoview apical
inferoseptal ischemia was found with an ejection fraction
around 50%.  His blood pressure at that time was also very
difficult to control due to the patient's hydronephrosis.

He was then transferred to [**Hospital1 188**] on [**2196-12-27**] for cardiac catheterization.
Cardiac catheterization was performed at that time, which
revealed 70% ostial left anterior descending artery stenosis
with proximal 85% stenosis, 80% stenosis of the third diag,
80% stenosis of the OM-3, 90% stenosis of the right coronary
artery.  Left ventriculography was not performed, however,
the left renal artery was found to be 90% stenosed
proximally, left renal artery was found to be 80% stenosed
proximally.  The plan was to have the patient return to the
catheterization laboratory the following afternoon for
bilateral renal artery stenting with surgical
revascularization to follow.

Patient underwent coronary artery bypass grafting x3 [**2196-12-30**].  Patient had left internal mammary artery to the
left anterior descending artery, saphenous vein graft to the
posterior descending artery, saphenous vein graft to the
obtuse marginal.  Total cardiopulmonary bypass time was 119
minutes with a cross-clamp time of 62 minutes.  The patient
was transferred in normal sinus rhythm to the Cardiac Surgery
Recovery Unit on propofol at 30 and nitroglycerin at 0.5.

Because there was questionable plaque in the aorta, Dr.
[**Last Name (STitle) 70**] requested a neurologic assessment on the patient,
therefore the patient was reversed and passed the neurologic
assessment, but because the patient's blood pressures were up
in the 180s and 190s, the patient was placed on propofol to
try to get the blood pressure back under control.  Patient
still had difficulty with his blood pressures staying high in
the 140s to 160s while on Nipride and nitroglycerin as well
as propofol, however, there was a period at which time the
blood pressure dipped down to 70s, at which time all of the
hypertensive medications were stopped with a little
Neo-Synephrine and fluid bolus given which resolved the
issue.  Nipride was then restarted which maintained the blood
pressure in the 120-130 range.

Postoperative day one, patient is afebrile.  Vital signs
stable.  Physical examination unremarkable with a white count
of 14, hematocrit of 32, platelet count of 216, BUN of 23,
creatinine 1.4 with baseline of 1.4.  Plan was to restart the
patient's beta blockers, to administer 20 mg of Lasix [**Hospital1 **], to
administer hydralazine to keep the blood pressure under
control, and to continue the chest tube since the patient
still had a high output, and to restart the patient the
dimension medications.

Postoperative day two, 24 hour events included the removal of
the Swan and the restarting of the patient's beta blockers
and Lasix.  Patient had a low grade temperature of 100, white
count of 13.4, hematocrit of 30.3, and in sinus rhythm at 80
with stable blood pressure 130/50.  Chest tubes still putting
out serosanguinous fluid.  Patient is stable, however,
becoming confused and disoriented at times, however, not
agitated.

Postoperative day four, no new cardiac issues overnight with
less confusion, mentating well, and decreased chest tube
drainage.  The patient is afebrile in sinus rhythm at 61,
blood pressure still elevated at 171/77, sating at 97% on 2
liters nasal cannula.  Physical examination unchanged.  Plan
was to watch chest tube output with the hope of discontinuing
the chest tubes today with the plan to start discharge
planning.

Postoperative day five, patient still with blood pressure
control issues, afebrile in sinus rhythm at 64, though with a
blood pressure of 174/88, sating at 95 on room air with a
white count of 9.2, hematocrit of 31.1, BUN of 26, creatinine
1.0, glucose of 83.  Plan is to titrate captopril as needed
in order to lower the blood pressure.  Patient still in and
out of confusion, however, alert and anxious about being
discharged home.

Postoperative day six, patient still with persistent
hypertension, however, doing very well otherwise despite
multiple medication adjustments, still afebrile in sinus
rhythm at 80 with a plan to continue to titrate captopril and
possibly switching over to Accupril which the patient was on
preoperatively.

Patient was discharged with visiting nurse services, [**2197-1-6**] in stable condition.

DISCHARGE MEDICATIONS:
1. Quinapril 20 mg po q day.
2. Norvasc 5 mg po q day.
3. Plavix 75 mg po q day.
4. Lasix 20 mg po bid x5 days.
5. Potassium chloride 20 mEq po bid.
6. Atenolol 50 mg po q day.
7. Atorvastatin 40 mg po q day.
8. Donepezil 5 mg po q hs.
9. Percocet 1-2 tablets po q4-6h prn pain.
10. Aspirin 325 mg po q day.
11. Colace 100 mg po bid.
12. Zantac 150 mg po bid.

FOLLOW-UP INSTRUCTIONS:  Patient is being discharged home
with [**Hospital1 1474**] Visiting Nurse services with the patient to
make a follow-up appointment with his cardiologist in [**1-10**]
weeks and his cardiac surgeon in [**3-12**] weeks.

DISCHARGE DIAGNOSIS:  Coronary artery disease status post
coronary artery bypass grafting x3.




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

Dictated By:[**Doctor Last Name 2011**]

MEDQUIST36

D:  [**2197-2-21**]  15:34
T:  [**2197-2-22**]  08:47
JOB#:  [**Job Number 45774**]
{"Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atherosclerosis of renal artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Malignant neoplasm of prostate,Anemia, unspecified,Pure hypercholesterolemia,Alzheimer's disease"}


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 72-year-old man with
past medical history significant for hypertension, coronary
artery disease, status post non-Q-wave myocardial infarction
in [**2196-12-21**] as well as retinal detachment bilaterally
[**2194**], memory loss, and prostate cancer status post
brachytherapy.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 1. Accupril 20 mg q day.
2. Atenolol 50 mg q day.
3. Imdur 30 mg q day.
4. Lescol 40 mg q day.
5. Aricept 5 mg q hs.

ALLERGIES: Versed which produces acute confusion.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Three to four ounces of scotch per night, no
cigarettes. 

### Response:
{"Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Atherosclerosis of renal artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Malignant neoplasm of prostate,Anemia, unspecified,Pure hypercholesterolemia,Alzheimer's disease"}
