CHIEF COMPLAINT: 

PRESENT ILLNESS: This 60-year-old female had a
known history of hypertension and angina with elevated
cholesterol and had increasing chest pain over the past 4
months. She describes her episodes as occurring with exertion
and it is approximately 8 out of a scale of 10, squeezing,
nonradiating, and resolved with rest. She had a positive
exercise tolerance test and ejection fraction of 65%. Had a
cardiac catheterization at [**Hospital1 **] prior to admission to
[**Hospital1 **] [**First Name (Titles) **] [**2179-6-3**]. Cardiac
catheterization revealed a 90% distal left main, 70% ostial
LAD, normal circumflex, normal right, and ejection fraction
of 60%. She was transferred into [**Hospital1 18**] for CABG and referred
to Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **].

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. Angina.
4. GERD.
5. Stress incontinence.
6. Depression.
7. Lupus.
8. Status post bilateral knee surgery.

MEDICATION ON ADMISSION: Aspirin 81 mg p.o. once a day,
atenolol 25 mg p.o. once a day, Protonix 40 mg p.o. once a
day, Ditropan 10 mg p.o. once a day, Lipitor 20 mg p.o. once
a day, [**Location (un) 63735**] Wort daily, and fish oil daily.

ALLERGIES: She is allergic to penicillin.

PHYSICAL EXAM: On exam, she was in no apparent distress, 5
feet tall, 86.2 kilograms with noted obesity. Pupils are
equal, round, and reactive to light and accommodation. EOMs
are intact. Her oropharynx was unremarkable. Her neck was
supple with full range of motion, no lymphadenopathy or
thyromegaly. Her carotids are 2+ bilaterally without bruits.
Her lungs were clear to A and P. Her heart was regular rate
and rhythm without any murmurs, rubs, or gallops and normal
S1, S2 tones. Her abdomen was obese, soft, nontender with
positive bowel sounds and no masses or hepatosplenomegaly.
Her extremities had no clubbing, cyanosis, or edema. She had
pulses 2+ bilaterally and bilateral groin sheaths were in
place. Her neuro exam was nonfocal.

FAMILY HISTORY: She had a positive family history for
coronary artery disease.

SOCIAL HISTORY: She lives alone and had no tobacco or
alcohol history.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Unspecified essential hypertension,Esophageal reflux,Depressive disorder, not elsewhere classified
Crnry athrscl natve vssl,Intermed coronary synd,Pure hypercholesterolem,Hypertension NOS,Esophageal reflux,Depressive disorder NEC
Admission Date: [**2179-6-3**]        Discharge Date: [**2179-6-11**]

Date of Birth:  [**2118-6-22**]        Sex:  F

Service:  CSU


HISTORY OF PRESENT ILLNESS:  This 60-year-old female had a
known history of hypertension and angina with elevated
cholesterol and had increasing chest pain over the past 4
months. She describes her episodes as occurring with exertion
and it is approximately 8 out of a scale of 10, squeezing,
nonradiating, and resolved with rest. She had a positive
exercise tolerance test and ejection fraction of 65%. Had a
cardiac catheterization at [**Hospital1 **] prior to admission to
[**Hospital1 **] [**First Name (Titles) **] [**2179-6-3**]. Cardiac
catheterization revealed a 90% distal left main, 70% ostial
LAD, normal circumflex, normal right, and ejection fraction
of 60%. She was transferred into [**Hospital1 18**] for CABG and referred
to Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **].

PAST MEDICAL HISTORY:
1. Hypertension.
2. Hypercholesterolemia.
3. Angina.
4. GERD.
5. Stress incontinence.
6. Depression.
7. Lupus.
8. Status post bilateral knee surgery.


ALLERGIES:  She is allergic to penicillin.

MEDICATIONS ON ADMISSION:  Aspirin 81 mg p.o. once a day,
atenolol 25 mg p.o. once a day, Protonix 40 mg p.o. once a
day, Ditropan 10 mg p.o. once a day, Lipitor 20 mg p.o. once
a day, [**Location (un) 63735**] Wort daily, and fish oil daily.

FAMILY HISTORY:  She had a positive family history for
coronary artery disease.

SOCIAL HISTORY:  She lives alone and had no tobacco or
alcohol history.

PHYSICAL EXAM:  On exam, she was in no apparent distress, 5
feet tall, 86.2 kilograms with noted obesity. Pupils are
equal, round, and reactive to light and accommodation. EOMs
are intact. Her oropharynx was unremarkable. Her neck was
supple with full range of motion, no lymphadenopathy or
thyromegaly. Her carotids are 2+ bilaterally without bruits.
Her lungs were clear to A and P. Her heart was regular rate
and rhythm without any murmurs, rubs, or gallops and normal
S1, S2 tones. Her abdomen was obese, soft, nontender with
positive bowel sounds and no masses or hepatosplenomegaly.
Her extremities had no clubbing, cyanosis, or edema. She had
pulses 2+ bilaterally and bilateral groin sheaths were in
place. Her neuro exam was nonfocal.

LABORATORIES:  Preop labs are as follows: White count 5.7,
hematocrit 39.8, platelet count 222,000. Sodium 140, K 5.5,
which corrected overnight, chloride 109, bicarbonate 27, BUN
14, creatinine 0.7, blood sugar of 118. PT 12.2, PTT 26.1
with an INR of 1.0. ALT 29, AST 45. CK 102. Alkaline
phosphatase 72, total bilirubin 0.4. Troponin 1.0. Magnesium
1.9, calcium 9.1, phosphorus 4.7. HBA1c 6.1%. Urinalysis was
positive for blood, but negative for bacteria.

Chest x-ray preoperatively showed minimal patchy atelectasis
with suboptimal views. Official report of chest x-ray dated
[**2179-6-3**].

Carotid ultrasound performed preoperatively showed less than
40% bilateral ICA stenoses and bilateral antegrade vertebral
flow. She also had an EKG done preoperatively, which showed
sinus bradycardia at 58, which was otherwise normal.

HOSPITAL COURSE:  Patient was admitted to the hospital after
transfer in from [**Hospital1 **] to our coronary care unit where
the rest of her preoperative workup was completed. On
hospital day 1, she was hemodynamically stable. Cardiology
was consulted. Patient was transferred onto the floor.
Creatinine was stable at 0.7, K 4.0. Hematocrit 39.8. She was
seen and evaluated by case management. Carotid studies were
completed the following day. See above results as dictated,
and the patient was transferred out to [**Hospital Ward Name 121**] 2 on the 15th for
continued monitoring over the weekend.

On hospital day 3, she was in sinus rhythm. Echocardiogram
was ordered. Her exam was unremarkable. Remained in sinus
rhythm at a rate of 65. Preliminary echocardiogram showed no
MR, normal LV function. Apical window was poor and unable to
assess a gradient across the aortic valve. Please refer to
the official report dated [**2179-6-5**].

On[**6-7**], patient underwent coronary artery bypass grafting
x2 by Dr. [**Last Name (Prefixes) **] with a LIMA to the LAD and a vein graft
to the ramus. Patient was transferred to the cardiothoracic
ICU in stable condition on a propofol drip and sinus rhythm.
On postoperative day 1, patient had been extubated the
evening before. She remained on an insulin drip at 2.2. units
per hour. Was hemodynamically stable with a pressure of
133/59, in sinus rhythm at 96. Creatinine was stable
postoperatively at 0.6 with a hematocrit of 30 and a white
count of 13.7. Chest tubes were removed. Swan was removed.
Beta-blockade began with Lopressor, and the patient was
transferred out to the floor.

On postoperative day 2, patient's exam was unremarkable other
than an ecchymotic area around her sternum, but incision was
clean, dry, and intact. Right lower extremity was clean, dry,
and intact. Central venous line was removed. Pacing wires
remained in place. Patient began IV Lasix diuresis and
continued completing her perioperative vancomycin. Creatinine
remained stable at 0.7 with a hematocrit of 27.3. Patient was
encouraged to begin ambulating, increasing her activity level
with nursing and physical therapists as well as encouraged to
work harder on her pulmonary toilet. Patient was seen and
evaluated by physical therapy, and transitioned to p.o.
Percocet for pain management.

On[**Last Name (STitle) 14810**]perative day 3, there were no events overnight.
Lopressor was increased to 25 mg p.o. b.i.d. Aspirin was
started for her anemia. Hematocrit had dropped from 27.3 to
25.4, and pacing wires were discontinued. On [**6-11**], patient
was discharged to home in stable condition with VNA services
with the following follow-up instructions: Patient was
instructed to followup with primary care physician in
approximately 2 weeks postdischarge, to followup with
patient's cardiologist 2 weeks postdischarge, and to see Dr.
[**Last Name (Prefixes) **] in the office in 4 weeks for postop surgical
visit.

DISCHARGE DIAGNOSES:
1. Status post coronary artery bypass grafting x2.
2. Hypertension.
3. Hypercholesterolemia.
4. Gastroesophageal reflux disease.
5. Stress incontinence.
6. Status post bilateral knee surgeries.
7. Depression.
8. Lupus.


DISCHARGE MEDICATIONS:
1. Colace 100 mg p.o. twice a day.
2. Protonix 40 mg p.o. once a day.
3. Enteric-coated aspirin 81 mg p.o. once a day.
4. Percocet 5/325 one to 2 tablets p.o. p.r.n. q.4h. as
   needed for pain.
5. Lipitor 20 mg p.o. once a day.
6. Metoprolol 25 mg p.o. twice a day.
7. Ferrous sulfate 325 mg tablet p.o. twice a day.
8. Vitamin C 500 mg p.o. twice a day.
9. Lasix 20 mg p.o. twice a day x7 days.
10.      Potassium chloride 20 mEq p.o. twice a day x7 days.


DISPOSITION:  Again, the patient was discharged to home with
VNA services in stable condition on [**2179-6-11**].



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2179-7-13**] 16:39:37
T:  [**2179-7-14**] 07:03:09
Job#:  [**Job Number 63736**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Unspecified essential hypertension,Esophageal reflux,Depressive disorder, not elsewhere classified'}


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 60-year-old female had a
known history of hypertension and angina with elevated
cholesterol and had increasing chest pain over the past 4
months. She describes her episodes as occurring with exertion
and it is approximately 8 out of a scale of 10, squeezing,
nonradiating, and resolved with rest. She had a positive
exercise tolerance test and ejection fraction of 65%. Had a
cardiac catheterization at [**Hospital1 **] prior to admission to
[**Hospital1 **] [**First Name (Titles) **] [**2179-6-3**]. Cardiac
catheterization revealed a 90% distal left main, 70% ostial
LAD, normal circumflex, normal right, and ejection fraction
of 60%. She was transferred into [**Hospital1 18**] for CABG and referred
to Dr. [**First Name (STitle) **] [**Last Name (Prefixes) **].

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. Angina.
4. GERD.
5. Stress incontinence.
6. Depression.
7. Lupus.
8. Status post bilateral knee surgery.

MEDICATION ON ADMISSION: Aspirin 81 mg p.o. once a day,
atenolol 25 mg p.o. once a day, Protonix 40 mg p.o. once a
day, Ditropan 10 mg p.o. once a day, Lipitor 20 mg p.o. once
a day, [**Location (un) 63735**] Wort daily, and fish oil daily.

ALLERGIES: She is allergic to penicillin.

PHYSICAL EXAM: On exam, she was in no apparent distress, 5
feet tall, 86.2 kilograms with noted obesity. Pupils are
equal, round, and reactive to light and accommodation. EOMs
are intact. Her oropharynx was unremarkable. Her neck was
supple with full range of motion, no lymphadenopathy or
thyromegaly. Her carotids are 2+ bilaterally without bruits.
Her lungs were clear to A and P. Her heart was regular rate
and rhythm without any murmurs, rubs, or gallops and normal
S1, S2 tones. Her abdomen was obese, soft, nontender with
positive bowel sounds and no masses or hepatosplenomegaly.
Her extremities had no clubbing, cyanosis, or edema. She had
pulses 2+ bilaterally and bilateral groin sheaths were in
place. Her neuro exam was nonfocal.

FAMILY HISTORY: She had a positive family history for
coronary artery disease.

SOCIAL HISTORY: She lives alone and had no tobacco or
alcohol history. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Pure hypercholesterolemia,Unspecified essential hypertension,Esophageal reflux,Depressive disorder, not elsewhere classified'}
