CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 68 year old
white female with a history of asthma and coronary artery
disease with exertional angina, who was recently admitted to
St. [**Hospital **] Hospital with shortness of breath and chest pain.
She was found to be in congestive heart failure with lateral
ST depressions on EKG, positive troponin to 5.6.  The patient
was transferred to [**Hospital1 18**] for a cardiac catheterization.

MEDICAL HISTORY: 1.  Asthma with frequent steroid tapers; one endotracheal
intubation in the past.
2.  Chronic obstructive pulmonary disease.
3.  Gastroesophageal reflux disease.
4.  Transient ischemic attacks.
5.  Lacunar stroke in [**2178**].
6.  Coronary artery disease with exertional angina.
7.  Diabetes mellitus on insulin.
8.  Hypertension.
9.  Anaphylactic reaction to aspirin.
10. Anaphylaxis to ACE inhibitors.
11. Total hip replacement in [**2182**].

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with intermittent claudication
Subendo infarct, initial,Crnry athrscl natve vssl,CHF NOS,Obs chr bronc w(ac) exac,Atrial fibrillation,DMI wo cmp nt st uncntrl,Ath ext ntv at w claudct
Admission Date:  [**2187-3-21**]       Discharge Date:  [**2187-4-6**]

Date of Birth:   [**2118-10-20**]       Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 68 year old
white female with a history of asthma and coronary artery
disease with exertional angina, who was recently admitted to
St. [**Hospital **] Hospital with shortness of breath and chest pain.
She was found to be in congestive heart failure with lateral
ST depressions on EKG, positive troponin to 5.6.  The patient
was transferred to [**Hospital1 18**] for a cardiac catheterization.

PAST MEDICAL HISTORY:
1.  Asthma with frequent steroid tapers; one endotracheal
intubation in the past.
2.  Chronic obstructive pulmonary disease.
3.  Gastroesophageal reflux disease.
4.  Transient ischemic attacks.
5.  Lacunar stroke in [**2178**].
6.  Coronary artery disease with exertional angina.
7.  Diabetes mellitus on insulin.
8.  Hypertension.
9.  Anaphylactic reaction to aspirin.
10. Anaphylaxis to ACE inhibitors.
11. Total hip replacement in [**2182**].

MEDICATIONS:
1.  Dilantin 100 mg p.o. three times a day.
2.  Bumex 6 mg p.o. q. a.m., 2 mg p.o. q. p.m.
3.  Procardia XL 120 mg p.o. q. day.
4.  Reglan 10 mg p.o. q. day.
5.  Insulin 75/25, 16 mg p.o. q. a.m.; 60 mg p.o. q. p.m.
6.  Prevacid 30 mg p.o. twice a day.
7.  Hydralazine 25 mg p.o. three times a day.
8.  Plavix 75 mg p.o. q. day.
9.  Accolade 200 mg p.o. twice a day.
10. Nitro-Dur 0.6 mg patch.
11. Levaquin 500 mg p.o. q. day.
12. Neurontin.
13. Catapres 0.3 mg transdermal q. week.

LABORATORY:  Cardiac catheterization demonstrated
three-vessel disease, left MCA 80 to 90% calcified osteo,
left anterior descending 70% proximal and diffuse disease,
left circumflex 90% OM2 and right coronary totally occluded
proximally, left greater than right.

PHYSICAL EXAMINATION:  On physical examination, elderly
pleasant woman in moderate respiratory distress with audible
wheeze.  Neck:  Supple, obese, unable to use jugular venous
distention.  Lungs:  Wheezing bilaterally.  Cardiovascular:
S1 and S2 normal but heart sounds were muffled.  Abdomen
obese, nontender, nondistended. Extremities:  Doppler-able
pulses bilaterally.

HOSPITAL COURSE:  The patient was admitted to the [**Hospital Unit Name 196**]
Service and underwent carotid study on [**2187-3-22**], which
showed narrowing of 40 to 59% bilaterally of the internal
carotid arteries and right subclavian steal.  A Vascular
Surgery consultation was called regarding the subclavian
steal and no vascular intervention was recommended at that
time.

Initially, the patient was refusing surgery.  On [**2187-3-25**],
a Cardiac Surgery consultation was called as the patient
seemed to change her mind regarding the intervention.
Although the patient was high-risk for coronary artery bypass
graft it seemed to be the best option for the patient.  This
was explained to her.  A consent was signed on [**2187-3-25**].

The patient was taken to the Operating Room on [**2187-3-26**],
for a coronary artery bypass graft times three with left
internal mammary artery to the left anterior descending,
reverse saphenous vein graft to right coronary artery and to
obtuse marginal.  The morning of postoperative day number
one, the patient was re-intubated for poor oxygenation and
mental status changes.

A Pulmonary consultation was obtained and they suggested
aggressive diuresis with a wedge pressure of 10 to 15 as
goal.  The patient received two units of packed red blood
cells for a hematocrit of 23.5 on postoperative day number
one.  A ventilator wean was started on postoperative day
number three and the patient was extubated.  The patient
continued to require chest PT and suctioning for good
pulmonary toilet, but the patient did not require
re-intubation.

On postoperative day number five, the patient had an episode
of atrial fibrillation.  The patient was given Amiodarone
p.o. and spontaneously converted to sinus.  The patient
continued to improve and by postoperative day number nine was
off all drips.  The patient was transferred to the floor on
postoperative day nine.  On postoperative day number ten, the
patient's wires and Foley catheter were removed.  Physical
Therapy worked with the patient on postoperative day number
ten and recommended rehabilitation facility.

On postoperative day number eleven, the patient was
discharged to rehabilitation in stable condition.

DISCHARGE DIAGNOSES:
1.  Status post coronary artery bypass graft times three with
left internal mammary artery to the left anterior descending,
and reverse saphenous vein graft to right coronary artery and
obtuse marginal.

DISCHARGE MEDICATIONS:
1.  Prednisone 5 mg p.o. q. day.
2.  Accolade 20 mg p.o. twice a day.
3.  Dilantin 100 mg p.o. three times a day.
4.  Levaquin 500 mg p.o. q. day times two more days.
5.  Protonix 40 mg p.o. q. day.
6.  Combivent Metered-Dose Inhaler four puffs q. four hours
p.r.n.
7.  Nystatin Powder to groin p.r.n.
8.  Percocet one to two tablets p.o. q. four to six hours
p.r.n.
9.  Amiodarone 400 mg p.o. q. day.
10. Heparin 5000 units subcutaneously three times a day.
11. [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o. twice a day.
12. Colace 100 mg p.o. twice a day.
13. Plavix 75 mg p.o. q. day.
14. Imdur 90 mg p.o. q. day.
15. Digoxin 0.25 mg p.o. q. day.
16. Aldactone 75 mg p.o. twice a day.

DISCHARGE INSTRUCTIONS:
1.  The patient was to follow-up in four weeks with Dr.
[**Last Name (STitle) **].
2.  The patient was to follow-up in one week after
rehabilitation with her primary care physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) 3924**]
Reback.

CONDITION AT DISCHARGE:   The patient was discharged in
stable condition.


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

Dictated By:[**Last Name (NamePattern1) 6067**]
MEDQUIST36

D:  [**2187-4-6**]  09:25
T:  [**2187-4-6**]  09:33
JOB#:  [**Job Number 38920**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with intermittent claudication'}


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
white female with a history of asthma and coronary artery
disease with exertional angina, who was recently admitted to
St. [**Hospital **] Hospital with shortness of breath and chest pain.
She was found to be in congestive heart failure with lateral
ST depressions on EKG, positive troponin to 5.6.  The patient
was transferred to [**Hospital1 18**] for a cardiac catheterization.

MEDICAL HISTORY: 1.  Asthma with frequent steroid tapers; one endotracheal
intubation in the past.
2.  Chronic obstructive pulmonary disease.
3.  Gastroesophageal reflux disease.
4.  Transient ischemic attacks.
5.  Lacunar stroke in [**2178**].
6.  Coronary artery disease with exertional angina.
7.  Diabetes mellitus on insulin.
8.  Hypertension.
9.  Anaphylactic reaction to aspirin.
10. Anaphylaxis to ACE inhibitors.
11. Total hip replacement in [**2182**].

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Atrial fibrillation,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Atherosclerosis of native arteries of the extremities with intermittent claudication'}
