CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 59 year old male with
a history of coronary artery disease status post multiple
stents, hypertension, hyperlipidemia, and diabetes mellitus
type 2, who presents with an episode of choking sensation,
discomfort with radiation from the stomach to the chest,
worse with exertion.  It started the evening prior to
admission.  It was relieved with two sublingual
Nitroglycerin and the chest discomfort recurred with nausea
and diaphoresis with a mild headache.  He took two aspirin
and went to sleep.  Later that morning, the patient noted a
left sided chest discomfort which had returned and presented
to the Emergency Department.  He was given sublingual
Nitroglycerin which relieved the pain.

MEDICAL HISTORY: 1.  Coronary artery disease status post right coronary artery
stents in [**2164**], [**2169**].  Status post left circumflex in [**2165**]
and [**2168**].  Cardiac catheterization in [**12/2169**] showed left
anterior descending, proximal and medial 80 to 90% stenosed,
D1 90% stenosed and left circumflex stents patent; obtuse
marginal 90%, right coronary artery mid 95%.  PTC and
stented.  The ERCA stent patent.  Ejection fraction 44%.
2.  Posterior basilar hypokinesis.  Anterior lateral inferior
hypokinesis.
3.  Hypertension.
4.  Hyperlipidemia.
5.  Diabetes mellitus.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient had quit smoking 35 years ago
and used only occasional alcohol.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other nonspecific abnormal results of function study of cardiovascular system,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Crnry athrscl natve vssl,Intermed coronary synd,Comp-oth cardiac device,Parox ventric tachycard,Hypertension NOS,Hyperlipidemia NEC/NOS,Abn cardiovasc study NEC,DMII wo cmp nt st uncntr
Admission Date:  [**2170-3-26**]       Discharge Date:  [**2170-4-1**]

Date of Birth:   [**2111-3-25**]       Sex:  M

Service:  CARDIOTHOR

HISTORY OF PRESENT ILLNESS:   This is a 59 year old male with
a history of coronary artery disease status post multiple
stents, hypertension, hyperlipidemia, and diabetes mellitus
type 2, who presents with an episode of choking sensation,
discomfort with radiation from the stomach to the chest,
worse with exertion.  It started the evening prior to
admission.  It was relieved with two sublingual
Nitroglycerin and the chest discomfort recurred with nausea
and diaphoresis with a mild headache.  He took two aspirin
and went to sleep.  Later that morning, the patient noted a
left sided chest discomfort which had returned and presented
to the Emergency Department.  He was given sublingual
Nitroglycerin which relieved the pain.

The patient was started on a heparin drip.  He had already
taken his beta blocker and aspirin at home.  The patient
noted episodes exactly the same of this prior anginal episode
denied.

PAST MEDICAL HISTORY:
1.  Coronary artery disease status post right coronary artery
stents in [**2164**], [**2169**].  Status post left circumflex in [**2165**]
and [**2168**].  Cardiac catheterization in [**12/2169**] showed left
anterior descending, proximal and medial 80 to 90% stenosed,
D1 90% stenosed and left circumflex stents patent; obtuse
marginal 90%, right coronary artery mid 95%.  PTC and
stented.  The ERCA stent patent.  Ejection fraction 44%.
2.  Posterior basilar hypokinesis.  Anterior lateral inferior
hypokinesis.
3.  Hypertension.
4.  Hyperlipidemia.
5.  Diabetes mellitus.

ALLERGIES:   The patient has no known drug allergies.

MEDICATIONS AT HOME:
1.  Toprol XL 150.
2.  Plavix 75.
3.  Cozaar 25.
4.  Glucotrol 10 twice a day.
5.  Prilosec 20.
6.  Lipitor 10.
7.  Aspirin.
8.  Flogard 1.

SOCIAL HISTORY:   The patient had quit smoking 35 years ago
and used only occasional alcohol.

LABORATORY:  On admission the patient's white blood cell
count was 8.3, hematocrit 40.7, platelets 164.  Electrolytes
were within normal limits.  CK 49, troponin less than 0.3.

Chest x-ray showed no congestive heart failure, no
infiltrates.

Stress test on [**2170-2-27**], Stress MIBI showed moderate
partially reversible defects involving inferior and lateral
walls, improved when compared to [**2169-12-4**] which was
stress test prior to the second right coronary artery stent.

PHYSICAL EXAMINATION:   On examination, the patient was
afebrile, vital signs were stable.  Regular rate and rhythm.
Clear to auscultation.

HOSPITAL COURSE:  The patient underwent a catheterization on
[**2170-3-26**] which showed LMCA mild ostial plaquing, left
anterior descending proximal eccentric 80 to 90%, mid-serial
80% and apical 90%.  High diagonal ramus diffuse disease to
80 to 90%.  D2 small with diffuse disease 80 to 90%.  L6
single large bifurcating along with diminutive arteriovenous
groove circumflex.  Obtuse marginal one upper pole diffuse
disease to 60%, obtuse marginal one lower pole diffuse
disease to 80 to 90% in multiple places.  Right coronary
artery diffuse mild disease with mild in-stent restenosis.
Patent ductus arteriosus diffusely diseased to 50%.

The patient underwent coronary artery bypass graft times four
with a left internal mammary artery to left anterior
descending, saphenous vein graft to right coronary artery,
saphenous vein graft to the obtuse marginal and saphenous
vein graft to the diagonal on [**2170-3-28**].  The patient
tolerated the procedure without complications.

He was extubated on postoperative day one and transferred to
the Floor where he continued to do well with only minimal
sternal drainage overnight on postoperative day number three,
but the incision which was monitored continued, but was very
minimal.  The patient was felt to be ready for discharge on
postoperative day number four.  He was on a regular diet,
ambulating well, had good p.o. and pain control.

DISCHARGE STATUS:  The patient was to be sent home with
Visiting Nurses Association for dressing changes and wound
checks.

DISCHARGE INSTRUCTIONS:
1.  The patient to follow-up with Dr. [**Last Name (STitle) **] in four weeks.
2.  To follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1683**],
in one to two weeks.
3.  The patient to see Cardiologist in two to three weeks.

DISCHARGE MEDICATIONS:
1.  Lopressor 75 mg twice a day.
2.  Ibuprofen 400 mg q. six hours p.r.n.
3.  Glipizide 10 mg twice a day.
4.  Atorvastatin 10 mg q. day.
5.  Plavix 75 mg q. day.
6.  Percocet one to two tablets p.o. q. four to six hours
p.r.n.
7.  Tylenol 650 mg q. four hours p.r.n.
8.  Aspirin 325 mg q. day.
9.  Zantac 150 mg twice a day and to follow-up with cardiac
surgeon.
10. Lasix 20 mg twice a day times seven days.
11. Potassium chloride 20 mEq twice a day times seven days.
12. Colace 100 mg twice a day.
13. Milk of Magnesia 30 ml q. h.s. p.r.n.
14. Insulin sliding scale as needed.

CONDITION ON DISCHARGE:   Good.

DISCHARGE STATUS:   Home.

DISCHARGE DIAGNOSES:  Status post coronary artery bypass
graft times four.



                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Name8 (MD) 5915**]
MEDQUIST36

D:  [**2170-4-1**]  12:58
T:  [**2170-4-1**]  16:50
JOB#:  [**Job Number 25052**]

cc:[**Location (un) 25053**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other nonspecific abnormal results of function study of cardiovascular system,Diabetes mellitus without mention of complication, 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: 

PRESENT ILLNESS: This is a 59 year old male with
a history of coronary artery disease status post multiple
stents, hypertension, hyperlipidemia, and diabetes mellitus
type 2, who presents with an episode of choking sensation,
discomfort with radiation from the stomach to the chest,
worse with exertion.  It started the evening prior to
admission.  It was relieved with two sublingual
Nitroglycerin and the chest discomfort recurred with nausea
and diaphoresis with a mild headache.  He took two aspirin
and went to sleep.  Later that morning, the patient noted a
left sided chest discomfort which had returned and presented
to the Emergency Department.  He was given sublingual
Nitroglycerin which relieved the pain.

MEDICAL HISTORY: 1.  Coronary artery disease status post right coronary artery
stents in [**2164**], [**2169**].  Status post left circumflex in [**2165**]
and [**2168**].  Cardiac catheterization in [**12/2169**] showed left
anterior descending, proximal and medial 80 to 90% stenosed,
D1 90% stenosed and left circumflex stents patent; obtuse
marginal 90%, right coronary artery mid 95%.  PTC and
stented.  The ERCA stent patent.  Ejection fraction 44%.
2.  Posterior basilar hypokinesis.  Anterior lateral inferior
hypokinesis.
3.  Hypertension.
4.  Hyperlipidemia.
5.  Diabetes mellitus.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient had quit smoking 35 years ago
and used only occasional alcohol. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Paroxysmal ventricular tachycardia,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other nonspecific abnormal results of function study of cardiovascular system,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
