CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 81 year-old female
who was admitted to the Cardiac Critical Care Unit as a
transfer from an outside hospital.  She was intubated,
sedated and was being supported with an intra-aortic balloon
pump at that time.  The HPI for this patient is ascertained
from transfer records only.  By record it states that the
patient was experiencing approximately two days of increasing
shortness of breath and cough.  Initially she was seen by her
primary care physician in the [**Name9 (PRE) 1474**] Emergency Room and he
evaluated and thought this was secondary to an asthma
exacerbation.  Her additional complaints included chest
heaviness and an electrocardiogram was obtained, which showed
ST T wave changes.  Therefore she was transferred to the
[**Hospital1 1474**] Coronary Care Unit and was treated with heparin,
aspirin and nitropaste.  Subsequently she had an arterial
blood gases of 7.21 for a pH, 39 for a CO2 and a oxygen of 81
with progressive shortness of breath that ultimately led to
her intubation.  She was transferred to the [**Hospital1 346**] for cardiac catheterization.

MEDICAL HISTORY: Coronary artery disease status post
myocardial infarction in the past, asthma, chronic
obstructive pulmonary disease, type 2 diabetes,
gastroesophageal reflux disease, anxiety disorder, status
post right mastectomy, Parkinson's disease, osteoarthritis.

MEDICATION ON ADMISSION: Diltiazem CD 240 mg po q.d.,
Zantac 150 mg po b.i.d., Imdur 30 mg po q.d., Xanax .25 mg po
b.i.d., Captopril 25 mg po b.i.d., Sinemet 25/100 po q day,
[**Known lastname **] 60 mg po b.i.d., Insulin 70/30 14 units q.a.m. and an
unspecified amount q.p.m., Roxicet one tab po q 6 prn as well
as eye drops not otherwise specified for her glaucoma.  Also
she was on Albuterol nebulizers MDI prn.

ALLERGIES: Vancomycin, sulfa, Clindamycin and possibly a
fourth [**Doctor Last Name 360**] not otherwise specified.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Primary pulmonary hypertension,Unspecified pleural effusion,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified essential hypertension,Paralysis agitans
AMI anterior wall, init,Crnry athrscl natve vssl,Mitral valve disorder,Prim pulm hypertension,Pleural effusion NOS,DMII wo cmp nt st uncntr,Esophageal reflux,Hypertension NOS,Paralysis agitans
Admission Date:  [**2156-1-15**]       Discharge Date:  [**2156-1-26**]


Service:  CARDIOTHORACIC

HISTORY OF PRESENT ILLNESS:  This is an 81 year-old female
who was admitted to the Cardiac Critical Care Unit as a
transfer from an outside hospital.  She was intubated,
sedated and was being supported with an intra-aortic balloon
pump at that time.  The HPI for this patient is ascertained
from transfer records only.  By record it states that the
patient was experiencing approximately two days of increasing
shortness of breath and cough.  Initially she was seen by her
primary care physician in the [**Name9 (PRE) 1474**] Emergency Room and he
evaluated and thought this was secondary to an asthma
exacerbation.  Her additional complaints included chest
heaviness and an electrocardiogram was obtained, which showed
ST T wave changes.  Therefore she was transferred to the
[**Hospital1 1474**] Coronary Care Unit and was treated with heparin,
aspirin and nitropaste.  Subsequently she had an arterial
blood gases of 7.21 for a pH, 39 for a CO2 and a oxygen of 81
with progressive shortness of breath that ultimately led to
her intubation.  She was transferred to the [**Hospital1 346**] for cardiac catheterization.

In the catheterization laboratory she was shown to have
significant three vessel coronary artery disease and 3+
mitral regurgitation.  Therefore a cardiac thoracic surgery
consultation was obtained.  At this time her pulmonary artery
pressures were 47/27 with a wedge of 28.  Her cardiac output
was 8.1 with an index of 4.8 and a systemic vascular
resistance of 869.  Her arteriole saturation was 73.
Additionally the left ventriculography showed apical and
inferior hypokinesis.  She also had a 70% proximal right
coronary artery lesion and a 90% mid right coronary artery,
80% proximal left anterior descending coronary artery and 80%
mid left anterior descending coronary artery lesion
sequentially.  She additionally had a 60% proximal left
circumflex and a 70% left circumflex lesion that was noticed.
She had an 80% oblique marginal one with an EF of 46%.  She
was maintained on an anterior aortic balloon pump and was
being supported accordingly until cardiac surgery evaluated
the patient.

PAST MEDICAL HISTORY:  Coronary artery disease status post
myocardial infarction in the past, asthma, chronic
obstructive pulmonary disease, type 2 diabetes,
gastroesophageal reflux disease, anxiety disorder, status
post right mastectomy, Parkinson's disease, osteoarthritis.

MEDICATIONS ON ADMISSION:  Diltiazem CD 240 mg po q.d.,
Zantac 150 mg po b.i.d., Imdur 30 mg po q.d., Xanax .25 mg po
b.i.d., Captopril 25 mg po b.i.d., Sinemet 25/100 po q day,
[**Known lastname **] 60 mg po b.i.d., Insulin 70/30 14 units q.a.m. and an
unspecified amount q.p.m., Roxicet one tab po q 6 prn as well
as eye drops not otherwise specified for her glaucoma.  Also
she was on Albuterol nebulizers MDI prn.

ALLERGIES:  Vancomycin, sulfa, Clindamycin and possibly a
fourth [**Doctor Last Name 360**] not otherwise specified.

ADMISSION LABORATORY DATA:  Hematocrit 30, BUN and creatinine
of 34 and 1.4, pH 7.21, 39 and 81 with repeat gas of 7.39, 29
and 127.  Coagulations were PT/INR of 12.7 and 1.1 with a PTT
of 27.9.  Admission chest films showed vascular engorgement
and bilateral pleural effusions consistent with questionable
failure.  Electrocardiogram on admission showed mild ST
segment elevation with normal sinus rhythm at 99.  She had 1
to 1.5 mm ST segment elevations from V1 to V3 as well as 1 mm
ST segment depressions in V5 and 6.  She had no ST changes or
depressions over the other leads and this electrocardiogram
was markedly different then her [**2154-12-2**] electrocardiogram.

HO[**Last Name (STitle) **] COURSE:  She was supported on aspirin, beta blockade
as well as transfused 3 units for a hematocrit of 23.  She
was given Protonix and heparin for prophylaxis.  She remained
intubated and cardiac surgery evaluated the patient and
deemed her an appropriate candidate and therefore took her to
the Operating Room on [**2156-1-16**] where Dr. [**Last Name (Prefixes) **]
performed the coronary artery bypass graft times five
including left internal mammary coronary artery to left
anterior descending coronary artery, right saphenous vein
graft to the right posterior descending artery and then to
the OM3 sequentiality as well as the right saphenous vein
graft to the OM1 and diagonal sequentially.  This was done
under general anesthesia for unstable angina with slightly
decreased EF of 46.  As stated the pericardium was left open,
arteriole line was in her right radial artery.  She had a
right IJ Swan-Ganz catheter as well as an intra-aortic
balloon pump in the left femoral artery.  She had two atrial
wires that were placed.  Her chest tubes included two
mediastinal, one right pleural and one left pleural.  The
type for the removal of the vein graft was an endoscopic vein
harvest performed on the right with a hybrid right calf
technique.  Cardiopulmonary bypass and cross clamp times are
in the body of the dictated operative note.

She remained intubated and sedated with propofol.  She was
being supported with Milrinone and neo at .3 and .75
respectively.  She was in the Intensive Care Unit.  On postop
day number one she was weaned to extubation.  Her hematocrit
was 20.  She was transfused for this value.  Her BUN and
creatinine were 37 and 1.5.  Neurologically she was intact.
Cardiovascular she was transfused 2 units of packed cells.
Respiratory wise, she was weaned to extubate and her
mediastinal chest tubes were removed.  The pleural tubes were
kept for high output.  Gastrointestinal, her diet was
advanced once she was extubated.  Her milrinone and balloon
pumps and neo-synephrine were ultimately weaned off.  By
postop day number two she was tachy to 109 sinus, 124/54
blood pressure.  Gas was 7.37, 36, 174, 22, hematocrit 28.5,
her BUN and creatinine were 36 and 1.6 up from a baseline of
1.3.  Her Milrinone was removed at midnight.  She was started
on aspirin and Lopresor for blood pressure control.  She was
given aggressive pulmonary toilet.  She was tolerating a
cardiac diet.  She was put on b.i.d. intravenous Lasix as
well as chest tubes were inadvertently discontinued at this
time.

By postop day number three she was noted to have low O2 sats
and high nasal cannula requirements.  Chest x-ray showed
large bilateral pleural effusions.  She was subsequently kept
NPO for the following morning when she underwent
bronchoscopy. This showed minimal secretions.  As a
consequence it was felt that part of her respiratory
embarrassment may have been secondary to her pleural
effusions with the left being greater then right.  She
subsequently received a left sided pleural chest tube on
postop day number four.  This was achieved without any
difficulty.  Placement of the tube was confirmed by chest
x-ray showing the tip to be in the posterosuperior region of
the left lung.  Initially 200 cc of serosanguinous came out
of the thoracotomy site with another 250 aspirated
immediately into the jar collecting tube for the chest tube.
On postop day number [**Last Name (un) **] the patient was again continued on
respiratory therapy and pulmonary toilet.  29 was her
hematocrit, BUN and creatinine were 45 and 1.6, that was
decreasing.  She was kept on Lasix for her diuresis due to
her swelling difficulties.  She was evaluated by speech,
which determined that she was a high aspiration risk,
therefore a post bilateral nasoduodenal feeding tube was
subsequently placed.

The patient was started back on her oral regimen of home
medications including Sinemet.  Because of her intermittent
atrial fibrillation and supraventricular tachycardia that she
began to experience at this time of her postoperative course
and she was given beta blockade and Amiodarone therapy.  Over
the next couple of days her postoperative course was very
uncomplicated.  She was walking with physical therapy.  She
did have some low grade delirium that ultimately no
electrolytes or scenarios with the tube feeding became an
issue.  She was placed on Nepro half strength at a goal rate
of 30 cc an hour, however, this was not achieved secondary to
the patient's intolerance and persistent diarrhea on the tube
feedings.  Nutrition recommended to add fiber.  She was
evaluated by swallow times two on postop day number seven and
nine.  At both times the patient failed at bedside swallowing
evaluation.  Both times it was recommended that she continue
to utilize the tube feed system.

On discharge she was afebrile with a temperature of 95.8, 60
in sinus, 154/70, blood pressure 18, respiratory rate 97% on
room air.  She was incontinent of urine.  Her hematocrit on
discharge was 31.  BUN and creatinine were 51 and 1.4.  Her
heart was regular.  She had a stable sternum.  No exudate.
Her extremities were unremarkable.

FO[**Last Name (STitle) 996**]P INSTRUCTIONS:  She is to be seen by her
cardiologist or primary care physician in approximately three
to four weeks.  She should see Dr. [**Last Name (Prefixes) **] in six weeks
from surgery.  She will be maintained on tube feeds as
previously described with Nepro.  Final nutrition
recommendations are pending at the time of this discharge
summary.  She will work aggressively with physical therapy at
the rehabilitation facility.  They anticipate that she should
return to her normal state.  She has been accepted to the
[**Hospital3 245**] [**Location (un) 511**] Sanai for bed management care.  She
will receive aggressive pulmonary and physical rehabilitation
at this facility.

DISCHARGE MEDICATIONS:  Pilocarpine and D_________________
drops for her eyes b.i.d., Sinemet 25/100 po b.i.d.,
Ceftriaxone 1 gram intravenous q 24 to continue times six
days, Protonix 40 mg po q day, amiodarone 400 mg po b.i.d.,
Lopresor 75 mg po b.i.d., Hydralazine 15 mg intravenous q 6,
Lasix 20 mg po b.i.d., K-Dur 20 milliequivalents po q day as
well as Colace 100 mg po b.i.d.

It should be noted that this medication list is significantly
different from the patient's preoperative medication list.
She will be titrated back to her preoperative regimen once
she has follow up with her primary care physician.

On the day of discharge the patient is ambulating at a level
three with assistance with a nasoduodenal tube for feeding.
Strict aspiration precautions, head of bed to 40 degrees.
She is afebrile.  Vital signs are stable.  Sternum was stable
and unremarkable.  She had decreased breath sounds throughout
particularly at the plunting at the bases bilaterally.  She
will have the previously mentioned follow up.

DISCHARGE DIAGNOSES:
1.  Status post coronary artery bypass graft times five.  MR
resolved thought to be secondary to ischemic papillary muscle
dysfunction.
2.  Parkinson's disease.
3.  Diabetes mellitus.
4.  Gastroesophageal reflux disease.
5.  Asthma.
6.  Status post right mastectomy.






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

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2156-1-26**]  12:31
T:  [**2156-1-26**]  13:09
JOB#:  [**Job Number 27840**]
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Primary pulmonary hypertension,Unspecified pleural effusion,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified essential hypertension,Paralysis agitans'}


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 an 81 year-old female
who was admitted to the Cardiac Critical Care Unit as a
transfer from an outside hospital.  She was intubated,
sedated and was being supported with an intra-aortic balloon
pump at that time.  The HPI for this patient is ascertained
from transfer records only.  By record it states that the
patient was experiencing approximately two days of increasing
shortness of breath and cough.  Initially she was seen by her
primary care physician in the [**Name9 (PRE) 1474**] Emergency Room and he
evaluated and thought this was secondary to an asthma
exacerbation.  Her additional complaints included chest
heaviness and an electrocardiogram was obtained, which showed
ST T wave changes.  Therefore she was transferred to the
[**Hospital1 1474**] Coronary Care Unit and was treated with heparin,
aspirin and nitropaste.  Subsequently she had an arterial
blood gases of 7.21 for a pH, 39 for a CO2 and a oxygen of 81
with progressive shortness of breath that ultimately led to
her intubation.  She was transferred to the [**Hospital1 346**] for cardiac catheterization.

MEDICAL HISTORY: Coronary artery disease status post
myocardial infarction in the past, asthma, chronic
obstructive pulmonary disease, type 2 diabetes,
gastroesophageal reflux disease, anxiety disorder, status
post right mastectomy, Parkinson's disease, osteoarthritis.

MEDICATION ON ADMISSION: Diltiazem CD 240 mg po q.d.,
Zantac 150 mg po b.i.d., Imdur 30 mg po q.d., Xanax .25 mg po
b.i.d., Captopril 25 mg po b.i.d., Sinemet 25/100 po q day,
[**Known lastname **] 60 mg po b.i.d., Insulin 70/30 14 units q.a.m. and an
unspecified amount q.p.m., Roxicet one tab po q 6 prn as well
as eye drops not otherwise specified for her glaucoma.  Also
she was on Albuterol nebulizers MDI prn.

ALLERGIES: Vancomycin, sulfa, Clindamycin and possibly a
fourth [**Doctor Last Name 360**] not otherwise specified.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Acute myocardial infarction of other anterior wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Primary pulmonary hypertension,Unspecified pleural effusion,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Unspecified essential hypertension,Paralysis agitans'}
