CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 73 year old
male with a history of coronary artery disease and aortic
stenosis who has had a jaw tightness with walking short
distances.  He has been followed by his cardiologist given
his history of coronary artery disease and was discovered to
have aortic stenosis.  This aortic stenosis is followed by
echocardiogram.  The patient's coronary history is
significant for percutaneous transluminal coronary
angioplasty with stent to obtuse marginal one.  This
percutaneous transluminal coronary angioplasty was
complicated by formation of a right femoral AV fistula and
pseudoaneurysm which eventually required surgical repair.
Cardiac catheterization in [**2196-12-7**], showed 80 percent
in-stent restenosis of the obtuse marginal one which was
treated with roto.  Cardiac catheterization in [**2198-1-6**],
showed 30 percent in-stent restenosis of obtuse marginal one.
Also at that time, the patient was discovered to have a
moderate to severe aortic stenosis with a mean gradient of 26
mmHg.  Ejection fraction was 61 percent at the time.  The
patient was followed by echocardiogram and echocardiogram in
[**2199-11-6**], showed progression of the aortic stenosis with
a mean gradient at 64 mmHg.  The aortic valve area was
calculated to be 0.9 with preserved left ventricular
function.  Cardiac catheterization done [**2200-6-18**], showed a
worsening of the aortic stenosis.  Although the mean gradient
was calculated to be 48 mmHg, the calculated valve area was
0.8 centimeter square.  At this time, the coronary
angiography showed the left main to be normal.  The left
anterior descending coronary artery showed mildly diffuse
disease with discrete 40 to 50 percent midstenosis.  The left
circumflex had mild diffuse disease at 40 percent in-stent
stenosis and right coronary artery had no angiographically
significant obstruction.  Left ventricular function was
preserved at 65 percent with no regional wall motion
abnormality.  Given these findings, the patient was seen by
cardiac surgery for surgical intervention.  Based on the
findings, the patient agreed to undergo aortic valve
replacement and coronary artery bypass graft at the same
time.

MEDICAL HISTORY: 1. Coronary artery disease, status post percutaneous
   transluminal coronary angioplasty with multiple in-stent
   restenoses complicated by right femoral pseudoaneurysm
   requiring surgical repair, worsening aortic stenosis.
2. History of hypertension.
3. History of diabetes mellitus.
4. History of hypercholesterolemia.

MEDICATION ON ADMISSION: 1. Aspirin 81 mg p.o. once daily.
2. Lipitor 10 mg p.o. once daily.
3. Lisinopril 40 mg p.o. once daily.
4. Atenolol 50 mg p.o. once daily.
5. Glipizide 10 mg p.o. once daily.

ALLERGIES: The patient denies any allergies to medications.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient denies any smoking and reports
occasional alcohol use.
Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Percutaneous transluminal coronary angioplasty status
Crnry athrscl natve vssl,Aortic valve disorder,DMII oth uncntrld,Hypertension NOS,Pure hypercholesterolem,Ocl crtd art wo infrct,Status-post ptca
Admission Date: [**2200-6-25**]        Discharge Date: [**2200-6-29**]

Date of Birth:  [**2126-9-17**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  The patient is a 73 year old
male with a history of coronary artery disease and aortic
stenosis who has had a jaw tightness with walking short
distances.  He has been followed by his cardiologist given
his history of coronary artery disease and was discovered to
have aortic stenosis.  This aortic stenosis is followed by
echocardiogram.  The patient's coronary history is
significant for percutaneous transluminal coronary
angioplasty with stent to obtuse marginal one.  This
percutaneous transluminal coronary angioplasty was
complicated by formation of a right femoral AV fistula and
pseudoaneurysm which eventually required surgical repair.
Cardiac catheterization in [**2196-12-7**], showed 80 percent
in-stent restenosis of the obtuse marginal one which was
treated with roto.  Cardiac catheterization in [**2198-1-6**],
showed 30 percent in-stent restenosis of obtuse marginal one.
Also at that time, the patient was discovered to have a
moderate to severe aortic stenosis with a mean gradient of 26
mmHg.  Ejection fraction was 61 percent at the time.  The
patient was followed by echocardiogram and echocardiogram in
[**2199-11-6**], showed progression of the aortic stenosis with
a mean gradient at 64 mmHg.  The aortic valve area was
calculated to be 0.9 with preserved left ventricular
function.  Cardiac catheterization done [**2200-6-18**], showed a
worsening of the aortic stenosis.  Although the mean gradient
was calculated to be 48 mmHg, the calculated valve area was
0.8 centimeter square.  At this time, the coronary
angiography showed the left main to be normal.  The left
anterior descending coronary artery showed mildly diffuse
disease with discrete 40 to 50 percent midstenosis.  The left
circumflex had mild diffuse disease at 40 percent in-stent
stenosis and right coronary artery had no angiographically
significant obstruction.  Left ventricular function was
preserved at 65 percent with no regional wall motion
abnormality.  Given these findings, the patient was seen by
cardiac surgery for surgical intervention.  Based on the
findings, the patient agreed to undergo aortic valve
replacement and coronary artery bypass graft at the same
time.

PAST MEDICAL HISTORY:
1. Coronary artery disease, status post percutaneous
   transluminal coronary angioplasty with multiple in-stent
   restenoses complicated by right femoral pseudoaneurysm
   requiring surgical repair, worsening aortic stenosis.
2. History of hypertension.
3. History of diabetes mellitus.
4. History of hypercholesterolemia.


ALLERGIES:  The patient denies any allergies to medications.

MEDICATIONS ON ADMISSION:
1. Aspirin 81 mg p.o. once daily.
2. Lipitor 10 mg p.o. once daily.
3. Lisinopril 40 mg p.o. once daily.
4. Atenolol 50 mg p.o. once daily.
5. Glipizide 10 mg p.o. once daily.


SOCIAL HISTORY:  The patient denies any smoking and reports
occasional alcohol use.

REVIEW OF SYMPTOMS:  Otherwise, review of systems is
unremarkable.

PHYSICAL EXAMINATION:  The patient was afebrile with stable
vital signs and not in apparent distress, awake, alert and
oriented times three.  The head examination was normocephalic
and atraumatic.  The pupils are equal, round and reactive to
light and accommodation.  Extraocular movements were intact.
The neck was supple with evidence of cervical
lymphadenopathy.  There was no thyromegaly.  There was
thought to be carotid bruit appreciated.  The lungs are clear
to auscultation bilaterally .  Cardiac examination showed
regular rate and rhythm, S1 and S2, grade III/VI systolic
ejection murmur appreciated.  The abdomen was with bowel
sounds, soft, nontender, nondistended, without
hepatosplenomegaly.  The extremities were without cyanosis,
clubbing or edema.  The pulses were two plus bilaterally at
dorsalis pedis.

LABORATORY DATA:  Preoperative workup included carotid
ultrasound which was consistent with a right sided 70 to 79
percent internal carotid artery stenosis with decreased
velocity in the right vertebral artery.  The left internal
carotid artery showed less than 40 percent stenosis.

HOSPITAL COURSE:  The patient presented to the operating room
on [**2200-6-25**], for aortic valve replacement with number 21 CE
tissue and coronary artery bypass graft times one, left
internal mammary artery to left anterior descending coronary
artery.  The patient underwent this surgery without any
immediate complication.  Please see the operative report for
further details.  The patient's postoperative course was
rather uncomplicated.  The patient was easily extubated on
postoperative day zero.  The patient was also to start on
p.o. Lopressor by postoperative day one and by postoperative
day number two, the patient was on the floor without any
evidence of arrhythmia.  The patient's chest tube and
epicardial pacing wires were discontinued on postoperative
day number two.  The patient's p.o. Lopressor was increased
until good heart rate control and blood pressure control was
achieved.  The patient's fingerstick levels were poorly
controlled on preoperative Glucotrol doses and [**Last Name (un) **]
consultation was called.  The patient was evaluated by [**Last Name (un) **]
team and was started on 20 units of Lantus at nighttime with
coverage with sliding scale.  The patient was also advised to
take his Glucotrol 5 mg twice a day.  On the day of
discharge, the patient was afebrile with stable vital signs.
The patient was awake, alert and oriented times three and not
in apparent distress with supple neck.  Cardiac examination
revealed regular rate and rhythm, S1 and S2, systolic
ejection grade II/VI.  The lungs were clear to auscultation
bilaterally .  The abdomen was soft, nontender, nondistended.
The sternum was clean, dry and intact and stable.  The
patient had bilateral lower extremity edema, mildly pitting
to midtibial levels, and decreasing.  A chest x-ray three
days prior to discharge showed clear lung fields with no
pleural effusion and no vascular congestion or pneumothorax.

DISCHARGE STATUS:  The patient was discharged home.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Severe aortic stenosis, status post aortic valve
   replacement with number 21 CE tissue and coronary artery
   bypass graft times one, left internal mammary artery to
   left anterior descending coronary artery.
3. Hypertension.
4. Hypercholesterolemia.
5. Diabetes mellitus type 2.


MEDICATIONS ON DISCHARGE:
1. Lopressor 100 mg p.o. twice a day.
2. Aspirin enteric coated 325 mg p.o. once daily.
3. Lipitor 10 mg p.o. once daily.
4. Vicodin 500 mg p.o. q6hours p.r.n. pain.
5. Colace 100 mg p.o. twice a day.
6. Ibuprofen 600 mg p.o. q6hours.
7. Milk of Magnesia.
8. Lasix 20 mg p.o. twice a day for seven days.
9. Potassium Chloride 30 mEq p.o. twice a day for seven days.
10.      Glipizide 5 mg p.o. twice a day.
11.      Lantus 20 units q.h.s.
12.      Humalog sliding scale as per directions.


FOLLOW UP:  The patient is to follow-up with Dr. [**Last Name (STitle) 3497**]
(cardiology) in approximately two weeks and is to follow-up
with Dr. [**Last Name (STitle) 70**] in approximately six weeks.  The patient
is to follow-up with [**Hospital **] Clinic as scheduled.





                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**]

Dictated By:[**Last Name (NamePattern1) 12164**]
MEDQUIST36
D:  [**2200-6-29**] 10:41:28
T:  [**2200-6-29**] 11:52:01
Job#:  [**Job Number 33041**]
{'Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Percutaneous transluminal coronary angioplasty status'}


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 a 73 year old
male with a history of coronary artery disease and aortic
stenosis who has had a jaw tightness with walking short
distances.  He has been followed by his cardiologist given
his history of coronary artery disease and was discovered to
have aortic stenosis.  This aortic stenosis is followed by
echocardiogram.  The patient's coronary history is
significant for percutaneous transluminal coronary
angioplasty with stent to obtuse marginal one.  This
percutaneous transluminal coronary angioplasty was
complicated by formation of a right femoral AV fistula and
pseudoaneurysm which eventually required surgical repair.
Cardiac catheterization in [**2196-12-7**], showed 80 percent
in-stent restenosis of the obtuse marginal one which was
treated with roto.  Cardiac catheterization in [**2198-1-6**],
showed 30 percent in-stent restenosis of obtuse marginal one.
Also at that time, the patient was discovered to have a
moderate to severe aortic stenosis with a mean gradient of 26
mmHg.  Ejection fraction was 61 percent at the time.  The
patient was followed by echocardiogram and echocardiogram in
[**2199-11-6**], showed progression of the aortic stenosis with
a mean gradient at 64 mmHg.  The aortic valve area was
calculated to be 0.9 with preserved left ventricular
function.  Cardiac catheterization done [**2200-6-18**], showed a
worsening of the aortic stenosis.  Although the mean gradient
was calculated to be 48 mmHg, the calculated valve area was
0.8 centimeter square.  At this time, the coronary
angiography showed the left main to be normal.  The left
anterior descending coronary artery showed mildly diffuse
disease with discrete 40 to 50 percent midstenosis.  The left
circumflex had mild diffuse disease at 40 percent in-stent
stenosis and right coronary artery had no angiographically
significant obstruction.  Left ventricular function was
preserved at 65 percent with no regional wall motion
abnormality.  Given these findings, the patient was seen by
cardiac surgery for surgical intervention.  Based on the
findings, the patient agreed to undergo aortic valve
replacement and coronary artery bypass graft at the same
time.

MEDICAL HISTORY: 1. Coronary artery disease, status post percutaneous
   transluminal coronary angioplasty with multiple in-stent
   restenoses complicated by right femoral pseudoaneurysm
   requiring surgical repair, worsening aortic stenosis.
2. History of hypertension.
3. History of diabetes mellitus.
4. History of hypercholesterolemia.

MEDICATION ON ADMISSION: 1. Aspirin 81 mg p.o. once daily.
2. Lipitor 10 mg p.o. once daily.
3. Lisinopril 40 mg p.o. once daily.
4. Atenolol 50 mg p.o. once daily.
5. Glipizide 10 mg p.o. once daily.

ALLERGIES: The patient denies any allergies to medications.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient denies any smoking and reports
occasional alcohol use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Aortic valve disorders,Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Percutaneous transluminal coronary angioplasty status'}
