CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 59-year-old man who
was transferred to the CMI Service on the [**7-21**] for
a cardiac catheterization after suffering a non Q wave
myocardial infarction at [**Hospital6 33**].  He has a long
history of coronary artery disease, status post multiple
interventions and multiple myocardial infarctions.  His most
recent catheterization was at [**Hospital6 1129**]
in [**2174-11-19**] and showed a 25% left main, 80% diagonal
1, 80% distal left anterior descending, 50% ramus, 40% OM1,
50% right coronary and 100% PVV.  Percutaneous transluminal
coronary angioplasty was done on the OM1 and left circumflex
arteries at that time.  In [**2176-8-19**], he was admitted
to an outside hospital for 12 hours of chest pain and ruled
in for an myocardial infarction with a peak CPK of 1800.  He
has been asymptomatic since that time until three weeks prior
to admission when he developed exertional angina that
progressed to unstable angina over two to three days.  His
primary care physician ordered an exercise treadmill test and
an echocardiogram on the [**9-13**] which showed a
fixed apical defect and a mid anterior defect with an
ejection fraction of 47%.  While driving on [**11-19**], he
noted chest pain and had incomplete relief with three
sublingual nitroglycerin.  At that point he called 911.  He
was admitted to [**Hospital6 33**] and ruled in for a
myocardial infarction with a CPK of 457.  He was given
aspirin and Lovenox.  He has been pain free for the past 24
hours and was transferred to [**Hospital6 2018**] for catheterization on [**2176-11-20**].

MEDICAL HISTORY: 1.  Coronary artery disease, status post multiple
catheterizations, status post stent times one, status post
multiple myocardial infarctions.
2.  Hypercholesterolemia.
3.  Hypertension.
4.  Cluster migraines.

MEDICATION ON ADMISSION: 

ALLERGIES: Beta-blocker causes bronchospasm.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for coronary disease and diabetes.

SOCIAL HISTORY: He is a divorced High School science teacher
with six children who does not smoke.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other complications due to other cardiac device, implant, and graft,Unspecified essential hypertension,Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosus
Subendo infarct, initial,Crnry athrscl natve vssl,Comp-oth cardiac device,Hypertension NOS,Vrnt mgrn wo ntr mgr NEC
Admission Date:  [**2176-11-20**]     Discharge Date:  [**2176-11-23**]

Date of Birth:   [**2117-9-30**]     Sex:  M

Service:  CCU

HISTORY OF PRESENT ILLNESS:  This is a 59-year-old man who
was transferred to the CMI Service on the [**7-21**] for
a cardiac catheterization after suffering a non Q wave
myocardial infarction at [**Hospital6 33**].  He has a long
history of coronary artery disease, status post multiple
interventions and multiple myocardial infarctions.  His most
recent catheterization was at [**Hospital6 1129**]
in [**2174-11-19**] and showed a 25% left main, 80% diagonal
1, 80% distal left anterior descending, 50% ramus, 40% OM1,
50% right coronary and 100% PVV.  Percutaneous transluminal
coronary angioplasty was done on the OM1 and left circumflex
arteries at that time.  In [**2176-8-19**], he was admitted
to an outside hospital for 12 hours of chest pain and ruled
in for an myocardial infarction with a peak CPK of 1800.  He
has been asymptomatic since that time until three weeks prior
to admission when he developed exertional angina that
progressed to unstable angina over two to three days.  His
primary care physician ordered an exercise treadmill test and
an echocardiogram on the [**9-13**] which showed a
fixed apical defect and a mid anterior defect with an
ejection fraction of 47%.  While driving on [**11-19**], he
noted chest pain and had incomplete relief with three
sublingual nitroglycerin.  At that point he called 911.  He
was admitted to [**Hospital6 33**] and ruled in for a
myocardial infarction with a CPK of 457.  He was given
aspirin and Lovenox.  He has been pain free for the past 24
hours and was transferred to [**Hospital6 2018**] for catheterization on [**2176-11-20**].

Catheterization showed severe three vessel disease and a left
ventricular ejection fraction of 38%.  He was transferred to
the Coronary Care Unit for close monitoring after
catheterization.

PAST MEDICAL HISTORY:
1.  Coronary artery disease, status post multiple
catheterizations, status post stent times one, status post
multiple myocardial infarctions.
2.  Hypercholesterolemia.
3.  Hypertension.
4.  Cluster migraines.

MEDICATIONS ON TRANSFER:
1.  Aspirin 325 mg.
2.  Lovenox 80 subcutaneously b.i.d.
3.  Cardizem CD 240 q.d.
4.  Lipitor 10 mg po q.d.
5.  Paxil 10 mg po q.d.
6.  Multivitamin.
7.  Sublingual nitroglycerin prn.
8.  Fiberall prn.
9.  Vitamin C 500 mg q.d.

ALLERGIES:  Beta-blocker causes bronchospasm.

FAMILY HISTORY:  Positive for coronary disease and diabetes.

SOCIAL HISTORY:  He is a divorced High School science teacher
with six children who does not smoke.

PHYSICAL EXAMINATION:  This is a groggy intermittently
arousable man in no acute distress with a blood pressure of
101/62 and a pulse of 73.  His oxygen saturation is 98% on
two liters nasal cannula.  He is afebrile.  His head, eyes,
ears, nose and throat exam is unremarkable and he has no
jugular venous distention.  His lungs are clear to
auscultation bilaterally.  His heart is regular with distant
heart sounds but no murmurs.  His abdomen is benign.  His
extremities are without edema and with 2+ distal pulses.  His
neurological exam reveals that he is awake and oriented to
person only.

LABORATORIES:  Showed a white blood cell count of 8.6,
hematocrit of 46.3 and platelet count of 227,000.  His Chem-7
was within normal limits, notable for a potassium of 3.9, BUN
of 13 and a creatinine of 1.0.  His glucose is 142.  His
coags are within normal limits.  His cardiac enzymes at the
outside hospital revealed CKs of 209 and 457.

Electrocardiogram at [**Hospital6 33**] revealed normal
sinus rhythm at 60 beats per minute with a normal axis and
normal intervals.  He had diffusely flattened T wave but no
acute ST changes.  He had Qs in III, aVR and aVF.  After
percutaneous transluminal coronary angioplasty, his
electrocardiogram here was unchanged.

Catheterization results revealed diffuse severe three vessel
coronary disease with mild systolic and diastolic dysfunction
and an ejection fraction of 38%.  He has moderate mitral
regurgitation.  He had anterolateral, apical and inferior
basal akinesis with preserved inferior and anterior basal
wall motion.  He underwent percutaneous transluminal coronary
angioplasty and stent times two to his OM1.  He underwent
percutaneous transluminal coronary angioplasty and stenting
of his mid left anterior descending and his distal left
anterior descending.  He had moderate Instent restenosis of a
right posterior descending artery stent that was unchanged
from his previous catheterization in [**2174**].  He underwent a
total of six percutaneous transluminal coronary angioplasties
and four stents.  Five of the percutaneous transluminal
coronary angioplasties were successful.

HOSPITAL COURSE:  Mr. [**Known lastname **] was observed in the Coronary Care
Unit overnight given the multiple nature of his interventions
and his diffuse coronary disease.  He did well and by the
next morning was arousable, alert and awake and oriented
times three.  He was continued on aspirin and Lipitor.  A
beta-blocker could not be started due to his adverse reaction
to them.  He was started on Plavix given the stents that he
received and Captopril.  He developed a cough on the
Captopril and so it was changed to Diovan.

His CKs peaked at 680 with an MB of 78 and an MB index of
11.5.  During his catheterization, he received 615 cc of
intravenous dye.  Despite this, his creatinine remained
stable during his hospital stay between 0.9 and 1.1.

A total cholesterol and HDL was checked upon admission to the
hospital which showed a total cholesterol of 149 and an HDL
of 46.

After catheterization, he suffered some nausea and bloating
that was without electrocardiogram changes and resolved after
he had a bowel movement.

Mr. [**Known lastname **] had two episodes of [**11-28**] chest pain, each lasting
five minutes which resolved without intervention two nights
after his catheterization.  Given this, he was started on
Isordil with no further ischemic pain.  The morning after he
had received Isordil, however, he did note some
lightheadedness.  He states in the past that he thinks
Isordil may have caused him lightheadedness previously, but
he is uncertain of this.

On exam the day after his catheterization, he was noted to
have bibasilar rales.  On his third hospital day when he
began to ambulate, he also noted some dyspnea on exertion.
He was gently diuresed with a low dose Lasix.  This improved
his symptoms.  However, the next morning, as stated above, he
noted some lightheadedness.  It was unclear whether this was
due to diuresis or preload reduction with Isordil.  He was
advised to use Lasix as needed for dyspnea on exertion and to
avoid it on a regular basis or if he became lightheaded.  He
was also changed to Imdur and advised to stop using it if he
began to have lightheadedness.  He has been on Cardizem in
the past and this was discontinued and he was switched to a
long acting nitrate.  A homocystine level was checked and was
pending at the time of discharge.  He was advised to start
taking folate 1 mg q.d.

CONDITION AT DISCHARGE:  Improved.

DISCHARGE STATUS:  To home to follow-up with Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **]
[**Last Name (NamePattern4) 16072**] in seven to ten days who will also set him up for
cardiac rehabilitation.

DISCHARGE DIAGNOSES:
1.  Status post non Q wave myocardial infarction.
2.  History of coronary artery disease with history of
multiple myocardial infarctions and multiple stent
placements.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Migraines.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 mg po q.d.
2.  Plavix 75 mg po q.d. until [**2176-12-22**].
3.  Lipitor 10 mg po q.h.s.
4.  Folate 1 mg po q.d.
5.  Diovan 80 mg po q.d.
6.  Imdur 60 mg po q.d.
7.  Paxil 10 mg po q.d.
8.  Nitrostat sublingual prn.






                          [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7169**]

Dictated By:[**Name8 (MD) 1552**]

MEDQUIST36

D:  [**2176-11-27**]  10:06
T:  [**2176-11-27**]  10:06
JOB#:  [**Job Number **]

cc:[**Hospital6 99684**]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other complications due to other cardiac device, implant, and graft,Unspecified essential hypertension,Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosus'}


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 a 59-year-old man who
was transferred to the CMI Service on the [**7-21**] for
a cardiac catheterization after suffering a non Q wave
myocardial infarction at [**Hospital6 33**].  He has a long
history of coronary artery disease, status post multiple
interventions and multiple myocardial infarctions.  His most
recent catheterization was at [**Hospital6 1129**]
in [**2174-11-19**] and showed a 25% left main, 80% diagonal
1, 80% distal left anterior descending, 50% ramus, 40% OM1,
50% right coronary and 100% PVV.  Percutaneous transluminal
coronary angioplasty was done on the OM1 and left circumflex
arteries at that time.  In [**2176-8-19**], he was admitted
to an outside hospital for 12 hours of chest pain and ruled
in for an myocardial infarction with a peak CPK of 1800.  He
has been asymptomatic since that time until three weeks prior
to admission when he developed exertional angina that
progressed to unstable angina over two to three days.  His
primary care physician ordered an exercise treadmill test and
an echocardiogram on the [**9-13**] which showed a
fixed apical defect and a mid anterior defect with an
ejection fraction of 47%.  While driving on [**11-19**], he
noted chest pain and had incomplete relief with three
sublingual nitroglycerin.  At that point he called 911.  He
was admitted to [**Hospital6 33**] and ruled in for a
myocardial infarction with a CPK of 457.  He was given
aspirin and Lovenox.  He has been pain free for the past 24
hours and was transferred to [**Hospital6 2018**] for catheterization on [**2176-11-20**].

MEDICAL HISTORY: 1.  Coronary artery disease, status post multiple
catheterizations, status post stent times one, status post
multiple myocardial infarctions.
2.  Hypercholesterolemia.
3.  Hypertension.
4.  Cluster migraines.

MEDICATION ON ADMISSION: 

ALLERGIES: Beta-blocker causes bronchospasm.

PHYSICAL EXAM: 

FAMILY HISTORY: Positive for coronary disease and diabetes.

SOCIAL HISTORY: He is a divorced High School science teacher
with six children who does not smoke. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other complications due to other cardiac device, implant, and graft,Unspecified essential hypertension,Variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosus'}
