CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 68-year-old
female with a past history of hypertension,
hypercholesterolemia, and atherosclerosis, who presented to
an outside hospital for exertional substernal chest pressure
approximately six hours prior to admission following climbing
a flight of stairs.  This was on [**2101-4-8**].  The patient
described the pain as pressure-like associated with dyspnea,
[**9-20**] radiating to the right arm.  The patient took a
sublingual nitroglycerin at home with partial relief but the
pain persisted and the patient called paramedics.  Chest pain
was completely relieved after two nitroglycerin sprays.  Of
note, the patient had similar symptoms two weeks prior to
admission and went to [**Hospital3 **] Hospital where she had a
stress test that was negative.  The patient denied orthopnea,
paroxysmal nocturnal dyspnea, cough, fever, chills, dysuria,
nausea, or vomiting.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hypercholesterolemia.
3.  Atherosclerosis.
4.  Right carotid artery occlusion.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to sulfa drugs and
Atenolol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for approximate 45 pack year
smoking history and approximately two alcoholic drinks per
day.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Unspecified pleural effusion,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Stricture of artery,Personal history of tobacco use
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Pleural effusion NOS,Cardiac dysrhythmias NEC,Hypertension NOS,Pure hypercholesterolem,Stricture of artery,History of tobacco use
Admission Date:  [**2101-4-8**]       Discharge Date:  [**2101-4-18**]

Date of Birth:   [**2032-5-19**]       Sex:  F

Service:  CARDIAC SURGERY

HISTORY OF THE PRESENT ILLNESS:  The patient is a 68-year-old
female with a past history of hypertension,
hypercholesterolemia, and atherosclerosis, who presented to
an outside hospital for exertional substernal chest pressure
approximately six hours prior to admission following climbing
a flight of stairs.  This was on [**2101-4-8**].  The patient
described the pain as pressure-like associated with dyspnea,
[**9-20**] radiating to the right arm.  The patient took a
sublingual nitroglycerin at home with partial relief but the
pain persisted and the patient called paramedics.  Chest pain
was completely relieved after two nitroglycerin sprays.  Of
note, the patient had similar symptoms two weeks prior to
admission and went to [**Hospital3 **] Hospital where she had a
stress test that was negative.  The patient denied orthopnea,
paroxysmal nocturnal dyspnea, cough, fever, chills, dysuria,
nausea, or vomiting.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Hypercholesterolemia.
3.  Atherosclerosis.
4.  Right carotid artery occlusion.

PAST SURGICAL HISTORY:
1.  Right femoral popliteal bypass surgery.
2.  Bilateral total knee replacement.

ADMISSION MEDICATIONS:
1.  Univasc.
2.  Lipitor.
3.  Hydrochlorothiazide.
4.  Lopressor.
5.  Aspirin.
6.  Levoxyl 150 mg p.o. q.d.

ALLERGIES:  The patient is allergic to sulfa drugs and
Atenolol.

SOCIAL HISTORY:  Significant for approximate 45 pack year
smoking history and approximately two alcoholic drinks per
day.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  The patient
was afebrile, vital signs stable, saturating 100% on 2 liters
nasal cannula.  Head:  Normocephalic, atraumatic.  Sclerae
were anicteric.  Neck:  Soft, supple, no JVD, no bruits
noted.  Heart:  Significant for distant heart sounds, S1, S2,
no murmurs noted.  Lungs:  Significant for mild right basilar
crackles.  Abdomen:  Soft, nontender, nondistended, positive
bowel sounds.  Extremities:  Unremarkable.  Neurologic:
Unremarkable.

LABORATORY/RADIOLOGIC DATA:  EKG revealed positive ST
depressions in the lateral leads which were new from prior
studies and troponin was 0.25 which was indeterminate for
positivity.

HOSPITAL COURSE:  The patient is a 68-year-old female with
positive EKG changes, unstable angina, and possibly positive
troponin with known peripheral vascular disease who was
transferred to [**Hospital1 18**] from an outside hospital for further
assessment and treatment of possible coronary artery disease.

The patient was taken emergently to the Catheterization
Laboratory on [**2101-4-8**] which revealed a severe left main and
critical three vessel coronary artery disease.  Cardiac
Surgery was consulted on a stat priority basis on [**2101-4-8**]
for possibility of emergent CABG.

The patient also had a balloon pump placed, #7 French with no
complications in the Cardiac Catheterization Laboratory.

Th[**Last Name (STitle) 1050**] was taken to the OR on [**2101-4-8**] by Dr. [**Last Name (Prefixes) 411**] for emergent CABG times three.  For more details,
please see the operative report.  The patient postoperatively
was transferred to the CRSU where the patient was extubated
on postoperative day number one.

In addition, on postoperative day number one, the balloon
pump was removed.  Postoperative day number two was
significant for a junctional rhythm which required V pacing.
Otherwise, hemodynamically stable.  EP Cardiology was
consulted at this time who recommended discontinuation of
beta blocker.

On postoperative day number four, the patient had bradycardia
down into the 40s with junctional beat requiring additional
pacing.  The blood pressure was stable.

Final EP Cardiology recommendations included eventual
reinitiation of beta blocker as well as echocardiogram in one
month.  Later on postoperative day number four, the patient
was transferred to the floor in stable condition.  On
postoperative day number five, the patient was started on
Captopril 6.25 mg t.i.d.

On postoperative day number six, the patient's wires were
discontinued.  Later on postoperative day number six, the
patient desaturated to 75-85% while walking.  These symptoms
improved over the next couple of days.  Chest x-ray on
postoperative day number seven revealed no change from
previous with a mild left pleural effusion and some mild left
basilar atelectasis.

On postoperative day number eight, the patient was restarted
on beta blocker per EP Cardiology which she tolerated well.
On postoperative day number ten, the patient was doing well
in sinus rhythm.  The blood pressure was within normal limits
with only 1 liter oxygen requirement.  Chest x-ray revealed
no change.  The patient was screened for rehabilitation.  Of
note, the patient had some erythema at the inferior pole of
her sternotomy incision which was swabbed with Betadine and
dressed.

DISCHARGE DISPOSITION:  To rehabilitation.

DISCHARGE CONDITION:  Good.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease.
2.  Peripheral vascular disease.
3.  Right carotid disease.
4.  Hyperlipidemia.
5.  Hyperthyroidism.
6.  Anxiety.

DISCHARGE MEDICATIONS:
1.  Colace 100 mg p.o. b.i.d. p.r.n. constipation.
2.  Aspirin 325 mg p.o. q.d.
3.  Percocet one to two tablets p.o. q. four to six hours
p.r.n. pain.
4.  Plavix 75 mg p.o. q.d.
5.  Levoxyl 150 micrograms p.o. q.d.
6.  Lipitor 20 mg p.o. q.d.
7.  Captopril 6.75 mg p.o. t.i.d.
8.  Metoprolol 25 mg p.o. b.i.d.
9.  Lasix 40 mg p.o. q. eight hours times three days.
10. Potassium chloride 20 mEq p.o. q. 12 hours times three
days.

FO[**Last Name (STitle) **]P:  The patient is to follow-up with the Wound Care
Clinic in one week.  The patient is to follow-up with primary
care physician in two to four weeks and cardiologist in two
to four weeks.  The patient is to follow-up with Dr. [**Last Name (Prefixes) 411**] in four weeks.

Tentative discharge date is either [**2101-4-18**] or [**2101-4-19**].  If
longer, a discharge summary addendum will be dictated.




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 7190**]
MEDQUIST36

D:  [**2101-4-18**]  10:09
T:  [**2101-4-18**]  10:28
JOB#:  [**Job Number 53072**]

 (cclist)
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Unspecified pleural effusion,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Stricture of artery,Personal history of tobacco use'}


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 68-year-old
female with a past history of hypertension,
hypercholesterolemia, and atherosclerosis, who presented to
an outside hospital for exertional substernal chest pressure
approximately six hours prior to admission following climbing
a flight of stairs.  This was on [**2101-4-8**].  The patient
described the pain as pressure-like associated with dyspnea,
[**9-20**] radiating to the right arm.  The patient took a
sublingual nitroglycerin at home with partial relief but the
pain persisted and the patient called paramedics.  Chest pain
was completely relieved after two nitroglycerin sprays.  Of
note, the patient had similar symptoms two weeks prior to
admission and went to [**Hospital3 **] Hospital where she had a
stress test that was negative.  The patient denied orthopnea,
paroxysmal nocturnal dyspnea, cough, fever, chills, dysuria,
nausea, or vomiting.

MEDICAL HISTORY: 1.  Hypertension.
2.  Hypercholesterolemia.
3.  Atherosclerosis.
4.  Right carotid artery occlusion.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to sulfa drugs and
Atenolol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for approximate 45 pack year
smoking history and approximately two alcoholic drinks per
day. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Unspecified pleural effusion,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Pure hypercholesterolemia,Stricture of artery,Personal history of tobacco use'}
