CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 53-year-old
male who was admitted to an outside hospital on [**2152-6-21**] with
CHF and chest pain.  The patient ruled out by cardiac
enzymes, but had a BNP greater than 1400.  The patient was
started on Natrecor and sublingual nitroglycerin.  On
[**2152-6-23**], he became hypotensive with systolic blood pressures
in the 80s, also had chest pain.  CK, at that time, was 278
with troponin 9.3.  No catheterization secondary to it being
the weekend.  His hematocrit was 33 on [**2152-6-26**].  The patient
then had chest tightness.  He received sublingual
nitroglycerin and IV Lopressor.  The patient was then sent
here for management of CHF with consideration of CABG and
management of now acute renal failure.  Otherwise, the
patient has a history of IDDM since age 7, CAD, MI x2,
refused CABG in [**8-5**], and history of CHF.  Recent
echocardiogram revealed dilated LV with inferior akinesis,
which was new.  The patient also had moderate MR, severe
pulmonary hypertension, and an EF of 30 percent.  Otherwise,
the patient has had a CVA in the past.  He has a history of
chronic renal insufficiency, peripheral vascular disease,
bilateral fem-[**Doctor Last Name **], status post amputation of his second toe
in both feet, neuropathy, retinopathy, GERD, and the patient
was admitted with chest pain and CHF.  On [**2152-6-23**], the
patient had systolic blood pressures in the 80s.  He had
chest pain.  Sublingual nitroglycerin, morphine, and fentanyl
patch were given.  He was admitted to the CCU, got IV
nitroglycerin, heparin gtt, Natrecor, Lasix, and made pain
free, ruled in; however, on the day of admission to the
[**Hospital1 18**], had new ST depressions in V4 through V6, received
sublingual nitroglycerin, became chest pain free, and his CHF
regimen was then changed to Natrecor and Bumex.

MEDICAL HISTORY: His past medical history is
significant for type 1 diabetes, since the age of 7; MI x2,
CAD, refused CABG in [**8-5**], history of CHF with an EF of 30
percent, history of CVA, history of  peripheral vascular
disease, status post bilateral fem-[**Doctor Last Name **], status post
amputation of second toe in both feet, history of neuropathy,
retinopathy, and GERD.

MEDICATION ON ADMISSION: 

ALLERGIES: ATIVAN AND NSAID.

PHYSICAL EXAM: 

FAMILY HISTORY: His sister has a history of diabetes and has
had an MI in the past.

SOCIAL HISTORY: He is retired, wife is a CCU nurse, has
children, no tobacco, no ETOH.
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Ulcer of heel and midfoot,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Peripheral vascular disease, unspecified,Esophageal reflux
Subendo infarct, initial,CHF NOS,Ulcer of heel & midfoot,Acute kidney failure NOS,Crnry athrscl natve vssl,Chr pulmon heart dis NEC,Periph vascular dis NOS,Esophageal reflux
Admission Date: [**2152-6-26**]        Discharge Date: [**2152-6-30**]

Date of Birth:  [**2099-6-21**]        Sex:  M

Service:  CCU


HISTORY OF PRESENT ILLNESS:  The patient is a 53-year-old
male who was admitted to an outside hospital on [**2152-6-21**] with
CHF and chest pain.  The patient ruled out by cardiac
enzymes, but had a BNP greater than 1400.  The patient was
started on Natrecor and sublingual nitroglycerin.  On
[**2152-6-23**], he became hypotensive with systolic blood pressures
in the 80s, also had chest pain.  CK, at that time, was 278
with troponin 9.3.  No catheterization secondary to it being
the weekend.  His hematocrit was 33 on [**2152-6-26**].  The patient
then had chest tightness.  He received sublingual
nitroglycerin and IV Lopressor.  The patient was then sent
here for management of CHF with consideration of CABG and
management of now acute renal failure.  Otherwise, the
patient has a history of IDDM since age 7, CAD, MI x2,
refused CABG in [**8-5**], and history of CHF.  Recent
echocardiogram revealed dilated LV with inferior akinesis,
which was new.  The patient also had moderate MR, severe
pulmonary hypertension, and an EF of 30 percent.  Otherwise,
the patient has had a CVA in the past.  He has a history of
chronic renal insufficiency, peripheral vascular disease,
bilateral fem-[**Doctor Last Name **], status post amputation of his second toe
in both feet, neuropathy, retinopathy, GERD, and the patient
was admitted with chest pain and CHF.  On [**2152-6-23**], the
patient had systolic blood pressures in the 80s.  He had
chest pain.  Sublingual nitroglycerin, morphine, and fentanyl
patch were given.  He was admitted to the CCU, got IV
nitroglycerin, heparin gtt, Natrecor, Lasix, and made pain
free, ruled in; however, on the day of admission to the
[**Hospital1 18**], had new ST depressions in V4 through V6, received
sublingual nitroglycerin, became chest pain free, and his CHF
regimen was then changed to Natrecor and Bumex.

ALLERGIES:  ATIVAN AND NSAID.

PAST MEDICAL HISTORY:  His past medical history is
significant for type 1 diabetes, since the age of 7; MI x2,
CAD, refused CABG in [**8-5**], history of CHF with an EF of 30
percent, history of CVA, history of  peripheral vascular
disease, status post bilateral fem-[**Doctor Last Name **], status post
amputation of second toe in both feet, history of neuropathy,
retinopathy, and GERD.

MEDICATIONS:  The patient's medications on admission
included,
1. Natrecor 0.1 mg/kg/min.
2. Heparin 850 units/hour.
3. Nitrate 250 mg.
4. Bumex.
5. NPH, 24 units in the morning and 6 units in the evening.
6. PhosLo.
7. Aspirin 81 mg 1 p.o. q.d.
8. Zocor 80 mg 1 p.o. q.d.
9. Plavix 75 mg 1 p.o. q.d.
10.      Protonix 40 mg 1 p.o. b.i.d.
11.      Multivitamin.
12.      Toprol XL 150 mg 1 p.o. q.d.
13.      Also the patient at home is on Cozaar, Lasix,
   glyburide, and Zestril.


SOCIAL HISTORY:  He is retired, wife is a CCU nurse, has
children, no tobacco, no ETOH.

FAMILY HISTORY:  His sister has a history of diabetes and has
had an MI in the past.

PHYSICAL EXAMINATION:  Physical exam on admission includes
the following, heart rate 87, blood pressure 109/72,
temperature is 98.2 degrees, weight is 92.2 kg, saturating at
99 percent on 2 liters, respiratory rate is 12.  Generally,
the patient is a very pleasant male, in no acute distress.
HEENT:  Normocephalic, atraumatic.  Extraocular movements are
intact.  Oropharynx is clear with moist mucous membranes.
Neck is supple with no thyromegaly.  JVD is to the jaw.
Cardiac Exam revealed regular rate and rhythm with a
holosytolic murmur at the apex radiating to the axilla.  Lungs
are clear to auscultation with crackles one- half the
way up bilaterally.  No wheezes or rales.  Abdomen has good
bowel sounds, soft, nontender, and nondistended with no
hepatosplenomegaly.  Extremities are free of any clubbing,
cyanosis, or edema.  Second middle toe is missing
bilaterally.  His extremities are cool, positive dopplerable
DPs bilaterally.  Positive dopplerable right PT, but no left
PT.

The patient's EKG on admission, normal sinus rhythm; left
atrial enlargement; ST elevations in V1, V2; ST depressions
in V4, V5; T-wave inversion in V5, V6; Q wave in lead III.
Echocardiogram from [**2152-6-23**] revealed a dilated left
ventricle; inferior, inferolateral, distal, anterior, distal
anterior septal and apical akinesis, EF of 30 to 35 percent,
moderate MR, trace AI, mild TR, severe pulmonary
hypertension, left atrial enlargement compared to [**2151-11-28**],
inferior wall motion abnormalities, new left ventricular
function is worse and PA pressures are higher.  On [**2152-8-5**],
the patient had a cardiac catheterization, which revealed a
codominant system, LMCA was normal, LAD with 80 percent
proximal stenosis, 90 percent D1 left circumflex, OM1 with 80
percent lesion, RCA 70 percent mid lesion.  The patient's
telemetry was normal sinus rhythm.  His data on admission,
white count 6.9, hematocrit 33.8, platelet count 191.
Calcium 10.0, sodium 139, potassium 3.8, chloride 101,
bicarbonate 26, BUN 85; creatinine is 5.8, baseline was 3.8.

HOSPITAL COURSE:  Cardiac.  The patient had an echocardiogram
performed on [**2152-6-27**], which revealed the following:  An EF
of 20 percent, left atrium that is mildly dilated, mild
symmetric left ventricular hypertrophy, left ventricular
cavity size is normal, overall left ventricular systolic
function is severely depressed; and left wall motion was as
follows:  The patient had resting regional left ventricular
wall motion abnormalities as follows, mid anteroseptal
akinetic, mid inferoseptal akinetic, mid inferior akinetic,
mid inferolateral akinetic, anterior apex akinetic, septal
apex akinetic, inferior apex akinetic, lateral apex akinetic.
One plus TR was seen, one plus MR.  [**Name13 (STitle) **] underwent cardiac
catheterization on [**2152-6-27**], which revealed the following:
Right coronary diffusely diseased, proximal LAD diffusely
diseased, left main normal, distal LAD diffusely diseased, D1
diffusely diseased, mid circumflex discrete 70 percent
lesion, obtuse marginal discrete 80 percent lesion.
Selective coronary angiography demonstrated a right dominant
circulation with three-vessel coronary artery disease.  The
LMCA had no angiographically apparent flow-limiting stenosis.
LAD was diffusely diseased in the proximal portion with a
more focal 80 percent stenosis and diffuse disease into the
distal vessel, first diagonal branch was diffusely deceased,
the left circumflex had a 60 to 70 percent mid vessel
stenosis, OM1 had focal 80 percent stenosis in proximal
portion, RCA was dominant diffusely diseased vessel, distal
RCA was subtotally occluded with TIMI 0-1 flow.  Selective
angiography of the LIMA and RIMA demonstrated normal vessels
without angiographic evidence of flow-limiting
atherosclerotic disease, pull back of catheters from the left
subclavian artery demonstrated no evidence of a
hemodynamically significant stenosis in the major vessel.
Left ventriculography was deferred.  The resting hemodynamics
demonstrated moderate pulmonary hypertension with a mean PAP
pressure of 40.  Left and right sided filling pressures were
moderately elevated with mean RAP of 14, mean pulmonary-
capillary wedge pressure 29.  Cardiac index is preserved at
2.6 liters per minute per sq. m.  A 11.5 French and 19.15 cm
long Quinton dialysis catheter was placed in the right
femoral vein at the end of the case.  Successful PTCA and
stent of the mid and proximal RCA with a 2.0 x 13 mm pixel
and then by 2.5 x 16 and then by 2.5 x 24 and 2.5 x 12 Taxus
stents back to the ostium.  There was no residual stenosis,
no dissection with TIMI 3 flow noted.

Coronary artery disease status post NSTEMI, status post
cardiac catheterization.

The patient was maintained on aspirin, Plavix, Lipitor, and
Lopressor.  He was continued on heparin gtt initially.  For
afterload reduction, the patient was maintained on Isordil
and hydralazine.  ACE inhibitor was not entertained given his
acute on chronic renal insufficiency.  Carotid ultrasound was
obtained and revealed noncritical stenoses of his carotid
arteries bilaterally.

Congestive heart failure.  The patient was maintained on
Natrecor gtt.  Additionally, the patient had his femoral
Quinton pulled and a right IJ Quinton placed for
hemodialysis.  The patient was maintained on hemodialysis and
had very good diuretic effect.

Renal failure.  The patient was maintained on hemodialysis as
stated above.  He had evidence of hyponatremia during his
hospitalization, which was felt secondary to congestive heart
failure as well as acute renal failure.

Insulin-dependent diabetes mellitus.  The patient was
maintained on NPH regular insulin sliding scale and the NPH
was titrated up during his hospitalization.

Prophylaxis.  The patient was maintained on heparin, bowel
regimen, and PPI.

DISCHARGE DIAGNOSES:  Type I diabetes.

Hypertension.

End-stage renal disease.

Hypercholesterolemia.

Peripheral vascular disease.

Status post myocardial infarction with stents to the RCA.

FO[**Last Name (STitle) 996**]P:  Dr. [**Last Name (Prefixes) **], CT Surgery, at [**Telephone/Fax (1) 170**].
The patient is to call on [**2152-7-4**] to schedule an appointment
within one week.

The patient was to continue on outpatient dialysis at
[**Location (un) 14248**]Dialysis Center beginning on [**2152-7-4**].  The
patient is to set up an appointment with his primary care
physician within one week of discharge.

DISCHARGE MEDICATIONS:
1. Calcium acetate 667 mg 1 p.o. t.i.d. with meals
2. Multivitamin 1 p.o. q.d.
3. Plavix 75 mg 1 p.o. q.d.
4. Aspirin 325 mg 1 p.o. q.d.
5. NPH, to be used as directed.
6. Toprol XL 25 mg to be taken 5 tablets 1 p.o. q.d.
7. Protonix 40 mg 1 p.o. q.d.
8. Atorvastatin 40 mg 1 p.o. q.d.


DI[**Last Name (STitle) 408**]E STATUS:  He will be discharged to home.  Will
follow up with Dr. [**Last Name (Prefixes) **] and have hemodialysis.

DISCHARGE CONDITION:  Stable.  He is oxygenating well on room
air.  He is hemodynamically stable and had no further
episodes of chest pain, shortness of breath, or other cardiac
symptoms.



                        [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**MD Number(2) 13600**]

Dictated By:[**Last Name (NamePattern1) 18827**]
MEDQUIST36
D:  [**2152-8-31**] 12:58:35
T:  [**2152-9-1**] 09:27:03
Job#:  [**Job Number 39566**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Ulcer of heel and midfoot,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Peripheral vascular disease, unspecified,Esophageal reflux'}


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 53-year-old
male who was admitted to an outside hospital on [**2152-6-21**] with
CHF and chest pain.  The patient ruled out by cardiac
enzymes, but had a BNP greater than 1400.  The patient was
started on Natrecor and sublingual nitroglycerin.  On
[**2152-6-23**], he became hypotensive with systolic blood pressures
in the 80s, also had chest pain.  CK, at that time, was 278
with troponin 9.3.  No catheterization secondary to it being
the weekend.  His hematocrit was 33 on [**2152-6-26**].  The patient
then had chest tightness.  He received sublingual
nitroglycerin and IV Lopressor.  The patient was then sent
here for management of CHF with consideration of CABG and
management of now acute renal failure.  Otherwise, the
patient has a history of IDDM since age 7, CAD, MI x2,
refused CABG in [**8-5**], and history of CHF.  Recent
echocardiogram revealed dilated LV with inferior akinesis,
which was new.  The patient also had moderate MR, severe
pulmonary hypertension, and an EF of 30 percent.  Otherwise,
the patient has had a CVA in the past.  He has a history of
chronic renal insufficiency, peripheral vascular disease,
bilateral fem-[**Doctor Last Name **], status post amputation of his second toe
in both feet, neuropathy, retinopathy, GERD, and the patient
was admitted with chest pain and CHF.  On [**2152-6-23**], the
patient had systolic blood pressures in the 80s.  He had
chest pain.  Sublingual nitroglycerin, morphine, and fentanyl
patch were given.  He was admitted to the CCU, got IV
nitroglycerin, heparin gtt, Natrecor, Lasix, and made pain
free, ruled in; however, on the day of admission to the
[**Hospital1 18**], had new ST depressions in V4 through V6, received
sublingual nitroglycerin, became chest pain free, and his CHF
regimen was then changed to Natrecor and Bumex.

MEDICAL HISTORY: His past medical history is
significant for type 1 diabetes, since the age of 7; MI x2,
CAD, refused CABG in [**8-5**], history of CHF with an EF of 30
percent, history of CVA, history of  peripheral vascular
disease, status post bilateral fem-[**Doctor Last Name **], status post
amputation of second toe in both feet, history of neuropathy,
retinopathy, and GERD.

MEDICATION ON ADMISSION: 

ALLERGIES: ATIVAN AND NSAID.

PHYSICAL EXAM: 

FAMILY HISTORY: His sister has a history of diabetes and has
had an MI in the past.

SOCIAL HISTORY: He is retired, wife is a CCU nurse, has
children, no tobacco, no ETOH. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Ulcer of heel and midfoot,Acute kidney failure, unspecified,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Peripheral vascular disease, unspecified,Esophageal reflux'}
