CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 77 year old
man who is undergoing a preoperative evaluation for a
laryngeal tumor biopsy.  During a routine evaluation he had
electrocardiogram changes that lead him to a stress test
which was positive and then lead to cardiac catheterization
that showed two vessel disease with a 70 percent left
anterior descending coronary artery lesion, a 90 percent
diagonal lesion and 100 percent circumflex coronary artery
lesion and an ejection fraction of 50 percent.  The patient
had his laryngeal biopsy followed by six weeks of radiation
therapy and returned as a postoperative admit for coronary
artery bypass grafting.  The cardiac catheterization was done
in [**2131-8-12**].  He underwent an echocardiogram in [**2131-7-12**] that showed near 55 percent with mild mitral
regurgitation and mild inferior wall hypokinesis.

MEDICAL HISTORY: The patient's past medical history is
significant for hypertension, hyperlipidemia, cerebrovascular
accident in [**2131-5-12**], paroxysmal atrial fibrillation, second
degree heart block, coronary artery disease, laryngeal cancer
status post radiation therapy.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is significant for a father
who had an myocardial infarction in his 80s.

SOCIAL HISTORY: The patient has a remote tobacco history,
quit in [**2092**], prior to which she had 120 pack year history.
The patient lives with his daughter and has rare alcohol use.
Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Atrial fibrillation,Other second degree atrioventricular block,Anemia, unspecified,Personal history of malignant neoplasm of larynx,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Benign neoplasm of colon,Internal hemorrhoids without mention of complication
Crnry athrscl natve vssl,Mitral/aortic val insuff,Atrial fibrillation,Av block-2nd degree NEC,Anemia NOS,Hx-laryngeal malignancy,DMII wo cmp nt st uncntr,Hypertension NOS,Benign neoplasm lg bowel,Int hemorrhoid w/o compl
Admission Date: [**2132-2-27**]        Discharge Date: [**2132-3-8**]

Date of Birth:  [**2054-3-30**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 77 year old
man who is undergoing a preoperative evaluation for a
laryngeal tumor biopsy.  During a routine evaluation he had
electrocardiogram changes that lead him to a stress test
which was positive and then lead to cardiac catheterization
that showed two vessel disease with a 70 percent left
anterior descending coronary artery lesion, a 90 percent
diagonal lesion and 100 percent circumflex coronary artery
lesion and an ejection fraction of 50 percent.  The patient
had his laryngeal biopsy followed by six weeks of radiation
therapy and returned as a postoperative admit for coronary
artery bypass grafting.  The cardiac catheterization was done
in [**2131-8-12**].  He underwent an echocardiogram in [**2131-7-12**] that showed near 55 percent with mild mitral
regurgitation and mild inferior wall hypokinesis.

PAST MEDICAL HISTORY:  The patient's past medical history is
significant for hypertension, hyperlipidemia, cerebrovascular
accident in [**2131-5-12**], paroxysmal atrial fibrillation, second
degree heart block, coronary artery disease, laryngeal cancer
status post radiation therapy.

PAST SURGICAL HISTORY:  Past surgical history is significant
for appendectomy and laryngeal biopsy.

MEDICATIONS:  The patient's medications prior to admission
include aspirin 325 once daily, Lipitor 40 once daily,
Norvasc 5 once daily, isosorbide 30 once daily, atenolol 12.5
once daily.

ALLERGIES:  The patient states no known drug allergies.

FAMILY HISTORY:  Family history is significant for a father
who had an myocardial infarction in his 80s.

SOCIAL HISTORY:  The patient has a remote tobacco history,
quit in [**2092**], prior to which she had 120 pack year history.
The patient lives with his daughter and has rare alcohol use.

PHYSICAL EXAMINATION:  At preoperative testing, height 5 feet
8 inches, weight 132 pounds.  General, in no acute distress.
Skin is without lesions.  Head, eyes, ears, nose and throat,
pupils equal, round and reactive to light.  Extraocular
movements intact.  Anicteric.  Noninjected.  Neck is supple
with a soft mass on the front of his neck, no
lymphadenopathy, no bruits.  Chest is clear to auscultation.
Heart, S1 and S2 with an S4, no murmur, rubs or gallops.
Abdomen:  Soft, nontender, nondistended with normoactive
bowel sounds.  Extremities are warm and well perfused with no
edema or varicosities.  Neurologic is alert and oriented
times three, moves all extremities and follows commands.
Nonfocal examination.  Pulses are 1plus throughout.

HOSPITAL COURSE:  As stated previously the patient was a
direct admission to the Operating Room, please see the
operating room report for full details.  In summary, the
patient had a coronary artery bypass graft times four with a
left internal mammary artery to the diagonal, saphenous vein
graft to the left anterior descending coronary artery,
saphenous vein graft to obtuse marginal and saphenous vein
graft to posterior descending coronary artery.  Additionally,
the patient had a resection of an aortic valve lesion which
turned out to be consistent with Lambl's excrescence.  The
patient's bypass time was 102 minutes with a cross clamp time
of 86 minutes.  He tolerated the operation well and was
transferred from the Operating Room to the cardiothoracic
Intensive Care Unit.  At the time of transfer, the patient
was atrially paced at 78 beats/minute with a mean arterial
pressure of 69 and a central venous pressure of 2.  He
atherosclerotic heart disease Neo-Synephrine at 0.5
mcg/kg/min and Propofol at 20 mcg/kg/min.  The patient did
well in the immediate postoperative period.  His anesthesia
was reversed.  Sedation was discontinued.  He was weaned from
the ventilator and successfully extubated.  On postoperative
day Number 1, the patient continued to do well.  He was
hemodynamically stable requiring only nitroglycerin to
maintain an adequate blood pressure.  The patient was begun
on beta blockade as well as diuretics.  His nitroglycerin
infusion was weaned, and given his prior history of heparin
block, the electrophysiology service was consulted and the
patient remained in the Cardiothoracic Intensive Care Unit.
On postoperative day Number 2, the patient had atrial
fibrillation which he was successfully cardioverted out of.
Additionally, the patient was begun on heparin for his atrial
fibrillation.  On postoperative day Number 3, the patient's
Swan-Ganz catheter as well as chest tubes was removed.  He
was noted to have intermittent periods of atrial
fibrillation.  He was again cardioverted and started on
Amiodarone following cardioversion.  The decision was made at
that time to keep the patient in the Cardiothoracic Intensive
Care Unit as it was anticipated that the patient would need a
pacemaker prior to discharge given his slow ventricular
response after cardioversion.

On postoperative day Number 5, the patient was brought to the
Cardiac Catheterization Laboratory where he underwent
placement of a permanent pacemaker.  Please see PP report for
full details.  Following placement of the pacemaker the
patient was transferred to Far 2 for continuing postoperative
care and cardiac rehabilitation.  Once on the floor, the
patient was progressing slowly from his coronary artery
bypass grafting as well as pacemaker placement, when on
postoperative day Number 6 from coronary artery bypass graft
and day Number 1 from pacemaker placement, he was noted to
have bloody stool.  He was placed on intravenous Protonix and
a gastroenterology consult was called.  The patient remains
hemodynamically stable during this period and his hematocrit
also remains stable during this period.  Following full prep,
the patient underwent colonoscopy on postoperative day Number
8.  The colonoscopy showed two benign appearing polyps that
were nonbleeding as well as internal hemorrhoids and multiple
nonbleeding diverticula in the sigmoid colon.  The patient
did not undergo polypectomy at that time as he was somewhat
anticoagulated due to his atrial fibrillation.  He tolerated
the procedure well and was transferred back to Far 2.  Over
the next few days the patient was monitored with serial
hematocrits.  He remained hemodynamically stable and on
postoperative day Number 10, it was decided that the patient
was stable and ready to be transferred to rehabilitation for
continuing care.

At the time of this dictation the patient's physical
examination is as follows:  Temperature 99, heart rate 69
paced, blood pressure 131/57, respiratory rate 20, oxygen
saturation 100 percent on room air.  Weight preoperatively
62.1 kg, at discharge 61.5 kg.  Laboratory data revealed
white count 6.7, hematocrit 27.5, platelets 331, PT 16, INR
1.7 with one additional INR to be checked on the morning of
discharge.  Sodium 143, potassium 3.5, chloride 111, carbon
dioxide 26, BUN 12, creatinine 1.0, glucose 68.
Neurologically alert and oriented times three, moves all
extremities.  Follows commands.  Pulmonary, clear to
auscultation bilaterally.  Cardiac, regular rate and rhythm,
sternum is stable, incision with staples, without erythema or
drainage.  Abdomen is soft, nontender with normoactive bowel
sounds.  Extremities are warm with no edema.  Left leg
incision from endoscopic harvest site with Steri-Strips clean
and dry.  Left shoulder incision from pacemaker implantation
with Steri-Strips, clean and dry with dry sterile dressing.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DISPOSITION:  He is to be discharged to the
[**Hospital1 3494**] TCU.

DISCHARGE DIAGNOSIS:  Status post coronary artery bypass
grafting times four with left internal mammary artery to the
diagonal, saphenous vein graft to the left anterior
descending coronary artery, saphenous vein graft to obtuse
marginal and saphenous vein graft to posterior descending
coronary artery.

Second degree heart block status post permanent pacemaker,
Medtronics Sigma STR303.

Status post gastrointestinal bleed and colonoscopy.

Paroxysmal atrial fibrillation.

Laryngeal carcinoma status post radiation therapy.

Hypertension.

Hypercholesterolemia.

Transient ischemic attack.

FOLLOW UP:  The patient is to have follow up with Dr. [**Last Name (STitle) **]
in four weeks, follow up with Dr. [**Last Name (STitle) **] in the Device
Clinic in one week.  Follow up with Dr. [**Last Name (STitle) **] or Dr. [**First Name (STitle) 572**],
Gastroenterology Service on [**5-14**], at 9:30.


DISCHARGE MEDICATIONS:
1. Colace 100 mg b.i.d.
2. Aspirin 81 mg once daily.
3. Percocet 5/325 one to two tablets q. 4-6 hours prn.
4. Metoprolol 25 mg b.i.d.
5. Prilosec 40 mg b.i.d.
6. Amiodarone 400 mg once daily times two weeks and then 200
   mg once daily.
7. Atorvastatin 40 mg once daily.
8. Lisinopril 10 mg once daily.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 1714**], [**MD Number(1) 1715**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2132-3-7**] 19:21:23
T:  [**2132-3-7**] 20:17:22
Job#:  [**Job Number 57719**]
{'Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Atrial fibrillation,Other second degree atrioventricular block,Anemia, unspecified,Personal history of malignant neoplasm of larynx,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Benign neoplasm of colon,Internal hemorrhoids without mention of complication'}


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: Mr. [**Known lastname **] is a 77 year old
man who is undergoing a preoperative evaluation for a
laryngeal tumor biopsy.  During a routine evaluation he had
electrocardiogram changes that lead him to a stress test
which was positive and then lead to cardiac catheterization
that showed two vessel disease with a 70 percent left
anterior descending coronary artery lesion, a 90 percent
diagonal lesion and 100 percent circumflex coronary artery
lesion and an ejection fraction of 50 percent.  The patient
had his laryngeal biopsy followed by six weeks of radiation
therapy and returned as a postoperative admit for coronary
artery bypass grafting.  The cardiac catheterization was done
in [**2131-8-12**].  He underwent an echocardiogram in [**2131-7-12**] that showed near 55 percent with mild mitral
regurgitation and mild inferior wall hypokinesis.

MEDICAL HISTORY: The patient's past medical history is
significant for hypertension, hyperlipidemia, cerebrovascular
accident in [**2131-5-12**], paroxysmal atrial fibrillation, second
degree heart block, coronary artery disease, laryngeal cancer
status post radiation therapy.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is significant for a father
who had an myocardial infarction in his 80s.

SOCIAL HISTORY: The patient has a remote tobacco history,
quit in [**2092**], prior to which she had 120 pack year history.
The patient lives with his daughter and has rare alcohol use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Mitral valve insufficiency and aortic valve insufficiency,Atrial fibrillation,Other second degree atrioventricular block,Anemia, unspecified,Personal history of malignant neoplasm of larynx,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Benign neoplasm of colon,Internal hemorrhoids without mention of complication'}
