CHIEF COMPLAINT: Coronary artery disease.

PRESENT ILLNESS: The patient is a 75 year old
woman with a history of atrial fibrillation, congestive heart
failure and transient ischemic attacks who had a cardiac
catheterization on [**2163-12-20**], after developing
dyspnea.  The cardiac catheterization was significant for
diffuse disease in the small obtuse marginal 2 and 90%
stenosis of the mid and distal right coronary artery and
moderate aortic stenosis.  On [**2163-12-21**] she underwent
a rotational atherectomy and stenting of the right coronary
artery.  On [**2164-1-26**], she had an echocardiogram
which showed left ventricular hypertrophy, inferior basal
hypokinesis and ejection fraction of 55%, mild mitral
stenosis and mitral valve orifice of 2 by 2 cm, moderate
aortic stenosis with a peak gradient of 45 and an aortic
valve of .9 cm by 2 cm and [**Hospital1 **]-atrial enlargement.  On [**2164-9-28**], she underwent an exercise tolerance test which was
positive.  Over the past year she has been treated for
progressive shortness of breath with no exertion.  For
example, when walking 10 feet from bed to bathroom causes
dyspnea.  She does not even feel she would be capable of
climbing stairs due to the severity of her dyspnea.  She does
not have any chest pain.

MEDICAL HISTORY: Significant for hypertension,
hypercholesterolemia, diabetes mellitus, congestive heart
failure and transient ischemic attacks (ten years ago),
arthritis, neuropathy, paroxysmal atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone in [**Hospital3 **].
Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Unspecified pleural effusion,Unspecified essential hypertension,Pure hypercholesterolemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status
Aortic valve disorder,Crnry athrscl natve vssl,CHF NOS,Pleural effusion NOS,Hypertension NOS,Pure hypercholesterolem,Atrial fibrillation,DMII wo cmp nt st uncntr,Status-post ptca
Admission Date:  [**2165-2-21**]       Discharge Date:  [**2165-3-8**]

Date of Birth:   [**2089-10-9**]       Sex:  F

Service:  Cardiac Surgery

CHIEF COMPLAINT:  Coronary artery disease.

HISTORY OF PRESENT ILLNESS:  The patient is a 75 year old
woman with a history of atrial fibrillation, congestive heart
failure and transient ischemic attacks who had a cardiac
catheterization on [**2163-12-20**], after developing
dyspnea.  The cardiac catheterization was significant for
diffuse disease in the small obtuse marginal 2 and 90%
stenosis of the mid and distal right coronary artery and
moderate aortic stenosis.  On [**2163-12-21**] she underwent
a rotational atherectomy and stenting of the right coronary
artery.  On [**2164-1-26**], she had an echocardiogram
which showed left ventricular hypertrophy, inferior basal
hypokinesis and ejection fraction of 55%, mild mitral
stenosis and mitral valve orifice of 2 by 2 cm, moderate
aortic stenosis with a peak gradient of 45 and an aortic
valve of .9 cm by 2 cm and [**Hospital1 **]-atrial enlargement.  On [**2164-9-28**], she underwent an exercise tolerance test which was
positive.  Over the past year she has been treated for
progressive shortness of breath with no exertion.  For
example, when walking 10 feet from bed to bathroom causes
dyspnea.  She does not even feel she would be capable of
climbing stairs due to the severity of her dyspnea.  She does
not have any chest pain.

Cardiac risk factors include hypertension,
hypercholesterolemia and diabetes.  On [**2165-2-6**] she
underwent a cardiac catheterization and was found to have two
vessel disease.  The left main coronary artery had a 10%
distal lesion.  The left anterior descending had a 70-80%
lesion in the mid portion.  The proximal left circumflex was
diffusely diseased and had an 80% lesion.  The obtuse
marginal 1 branch was occluded and the obtuse marginal 2 and
obtuse marginal 2 branches were small vessels.  The right
coronary artery stents were patent.  It was also found that
she had a left ventricular ejection fraction of 46%.  The
mean gradient across the aortic valve was 37 mm of mercury.
The aortic valve area was 1 cm squared.  Following this
cardiac catheterization the patient was evaluated by the
Cardiothoracic Service and now she presents to [**Hospital6 1760**] for definitive therapy.

PAST MEDICAL HISTORY:  Significant for hypertension,
hypercholesterolemia, diabetes mellitus, congestive heart
failure and transient ischemic attacks (ten years ago),
arthritis, neuropathy, paroxysmal atrial fibrillation.

PAST SURGICAL HISTORY:  None.

ADMISSION MEDICATIONS:  Ecotrin 325 mg p.o. q.d.; Lasix 80 mg
p.o. q. AM, 40 mg p.o. q. PM; Iron 325 mg p.o. q.d.; Prilosec
20 mg p.o. q.d.; Nitropatch 0.4 mg per hour 8 AM to 8 PM;
Lopressor 25 mg p.o. b.i.d.; Digoxin .125 mg p.o. q. day; NPH
Insulin 40 units q AM and 20 units q PM; regular insulin 7
units q. AM and 5 units q. PM; Arthrotec 75 mg p.o. b.i.d.;
Amiodarone 200 mg p.o. q.d.

SOCIAL HISTORY:  She lives alone in [**Hospital3 **].

PHYSICAL EXAMINATION:  The patient is an obese female in no
acute distress.  Temperature is 98.5, pulse 55, blood
pressure 125/51, she is sating 93% on room air.  Glucose is
306.  Chest is clear.  Heart is regular rate and rhythm.
Abdomen is soft and nontender.  There is no peripheral edema.

LABORATORY DATA:  Laboratory data on admission includes white
count 7, hematocrit 50.1, platelets 215, sodium 138,
potassium 4.4, chloride 99, bicarbonate 28, BUN 40,
creatinine 1.5 and glucose of 263.  Electrocardiogram shows
sinus rhythm at a rate of 59 with first degree
atrioventricular block.  There is left axis deviation and
left ventricular hypertrophy.  The chest x-ray showed
cardiomegaly with small bilateral pleural effusions, no
pulmonary vascular congestions to suggest heart failure.

HOSPITAL COURSE:  The patient went to the Operating Room on
the day of admission and underwent an aortic valve
replacement with a 21 mm pericardial valve and a coronary
artery bypass graft with an left internal mammary artery to
the left anterior descending anastomosis.  She tolerated the
procedure well.  She transferred to the Surgery Intensive
Care Unit with mean arterial pressure of 65, CP of 12, being
A-V paced and on Neosynephrine at 0.5 mcg/kg/min.
Postoperatively in the unit she was weaned off of the
Neosynephrine.  Her blood pressure remained stable.  She was
given 1 unit of blood for a hematocrit of 26.  She was given
colloid Hespan for low urine output which showed no
improvement.  She was then placed on renal dose Dopamine.
The Dopamine began to improve her hemodynamics and urine
output.  She was then started on Lasix to continue with
diuresis.  She remained hemodynamically stable and afebrile
and on postoperative day #2 she was transferred to the floor
for the remainder of her recovery.  On postoperative day #3
the patient had an episode of shortness of breath and was
found to be in atrial fibrillation on the monitor.  Her chest
tube was discontinued.  Her Foley catheter was discontinued
and wires were discontinued.  She was continued on Lasix for
diuresis.  She was continued on her Amiodarone 200 mg p.o.
q.d.  She was continued on Lopressor.  On postoperative day
#5 she had another episode of atrial flutter with a rate of
70 and blood pressure of 153/82.  She was continued on
Lopressor.  On the same postoperative days, the patient
developed wheezing with oxygen saturations in the 90s on 4
liters of nasal cannula.  She was unable to wean off of
oxygen.  Pulmonary consultation was obtained and working with
them the patient received chest x-ray which showed large left
pleural effusion.  The patient was switched from her
Lopressor and placed on Imdur 30 mg p.o. q.d., Diltiazem 40
mg p.o. t.i.d. and her Lopressor was stopped.  The patient
was also begun to receive aggressive diuresis with
intravenous Lasix t.i.d. and was given Albuterol metered dose
inhaler or nebulizers q. 4 hours prn.  On postoperative day
#6 the patient continued to have decreased saturations,
increasing need for oxygen supplement.  It was decided that
the patient should undergo a thoracentesis.  The procedure
resulted in 1200 cc of blood-tinged fluid.  Samples were sent
for culture and staining.  As soon as the fluid was removed
from her left pleural cavity the patient's breathing
subjectively immediately improved.  The patient's oxygen
saturations increased to 99% on 2 liters.  The patient was
able to participate in physical therapy, ambulate and denied
any shortness of breath.  The patient was continued to be
aggressively diuresed.  For the episodes of atrial
fibrillation the patient was also anticoagulated with heparin
and started on Coumadin.  Her current latest INR was 1.5 and
she is being dosed for a goal of 2 to 3 for the atrial
fibrillation.  The valve that she received is biosynthetic
and does not require anticoagulation.  The patient continues
to work in physical therapy at activity level #2.  The
patient is now stable and ready for rehabilitation.

DISCHARGE DIAGNOSIS:
1.  Status post coronary artery disease, status post coronary
artery bypass graft times one
2.  Aortic valve stenosis, status post aortic valve
replacement with 21 ml pericardial valve
3.  Atrial fibrillation
4.  Diabetes mellitus
5.  Hypertension
6.  Hypercholesterolemia
7.  Transient ischemic attacks

MEDICATIONS ON DISCHARGE:
1.  Colace 100 mg p.o. b.i.d.
2.  Aspirin 325 mg p.o. q.d.
3.  Protonix 40 mg p.o. q.d.
4.  Amiodarone 200 mg p.o. q.d.
5.  Albuterol metered dose inhaler 2 puffs q. 4 hours
6.  Imdur 30 mg p.o. q.d.
7.  Diltiazem 30 mg p.o. q. 6 hours
8.  Lasix 40 mg p.o. t.i.d.
9.  Coumadin 4 mg p.o. q.d.
10. Tylenol 650 mg one to two p.o. q. 4 hours prn
11. Percocet 1 to 2 p.o. q. 4 hours prn
12. Insulin sliding scale

CONDITION ON DISCHARGE:  Stable.

FOLLOW UP:  Follow up with Dr. [**Last Name (STitle) 1537**] in four weeks.  The
patient will follow up with the primary care physician, [**Last Name (NamePattern4) **].
[**Last Name (STitle) 12982**] in two to three weeks.

DISPOSITION:  The patient is ready for discharge to
rehabilitation.




                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern1) 3835**]
MEDQUIST36

D:  [**2165-3-7**]  15:22
T:  [**2165-3-7**]  16:24
JOB#:  [**Job Number 34399**]
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Unspecified pleural effusion,Unspecified essential hypertension,Pure hypercholesterolemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: Coronary artery disease.

PRESENT ILLNESS: The patient is a 75 year old
woman with a history of atrial fibrillation, congestive heart
failure and transient ischemic attacks who had a cardiac
catheterization on [**2163-12-20**], after developing
dyspnea.  The cardiac catheterization was significant for
diffuse disease in the small obtuse marginal 2 and 90%
stenosis of the mid and distal right coronary artery and
moderate aortic stenosis.  On [**2163-12-21**] she underwent
a rotational atherectomy and stenting of the right coronary
artery.  On [**2164-1-26**], she had an echocardiogram
which showed left ventricular hypertrophy, inferior basal
hypokinesis and ejection fraction of 55%, mild mitral
stenosis and mitral valve orifice of 2 by 2 cm, moderate
aortic stenosis with a peak gradient of 45 and an aortic
valve of .9 cm by 2 cm and [**Hospital1 **]-atrial enlargement.  On [**2164-9-28**], she underwent an exercise tolerance test which was
positive.  Over the past year she has been treated for
progressive shortness of breath with no exertion.  For
example, when walking 10 feet from bed to bathroom causes
dyspnea.  She does not even feel she would be capable of
climbing stairs due to the severity of her dyspnea.  She does
not have any chest pain.

MEDICAL HISTORY: Significant for hypertension,
hypercholesterolemia, diabetes mellitus, congestive heart
failure and transient ischemic attacks (ten years ago),
arthritis, neuropathy, paroxysmal atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone in [**Hospital3 **]. 

### Response:
{'Aortic valve disorders,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Unspecified pleural effusion,Unspecified essential hypertension,Pure hypercholesterolemia,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Percutaneous transluminal coronary angioplasty status'}
