CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 83-year-old
woman whose problems began with chronic back pain usually
controlled with Tylenol.  She noted an exacerbation on
[**2141-2-12**] and was admitted to the [**Hospital1 **]
[**First Name (Titles) 620**] [**Last Name (Titles) **] for low back pain.  During her work-up there
she received an x-ray which confirmed a compression fracture
at the L3 level.  She was managed conservatively with
physical therapy.  The patient did, however, develop chest
pain and shortness of breath on [**2141-2-15**].  Ultimately, the
patient ruled in for a myocardial infarction with a peak CPK
of 120 and a peak troponin of 5.0.  The patient was treated
per their protocol with Lovenox and Plavix, given her allergy
to aspirin.  She was continued on her other cardiac
medications including nitrates, beta blockade and ACE
inhibitor.  The patient was diuresed and symptomatically
improved within 12 hours.  There was discussion about cardiac
catheterization but given resolution of symptoms, the patient
deferred the option of cardiac catheterization.  The patient
was transferred back to her [**Hospital3 **] facility and was
otherwise asymptomatic until [**2141-2-24**] when the patient
developed persistent severe chest pain in the morning.  The
patient also had palpitations.  She was brought in at that
time for probable cardiac catheterization and evaluation of
her chest pain.

MEDICAL HISTORY: 1. Congestive heart failure.  2.
Osteoporosis, lumbar fracture.  3. Celiac sprue.  4. Atrial
fibrillation.  5. History of urinary retention.  6. History
of syndrome of inappropriate diuretic hormone.  7. History of
pneumonia.  8. Myocardial infarction.

MEDICATION ON ADMISSION: 1. Plavix 75 mg q.d.  2. Magnesium
oxide 400 mg b.i.d.  3. Digoxin 0.125 mg q.d.  4. Colace 100
mg b.i.d.  5. Multivitamin q.d.  6. Vitamin C 250 mg q.d.  7.
Tums 500 mg t.i.d.  8. Lisinopril 40 mg q.d.  9. Iron sulfate
325 mg q.d.  10. Macrobid 100 mg p.o. q.h.s.  11. Coumadin 2
mg q.d.  12. Aldactone 45 mg q.d.  13. Fosamax 70 mg q. week.
14. Lopressor 75 mg b.i.d.  15. Isordil 40 mg t.i.d.  16.
Salt tablets one gram t.i.d.  17. Lasix 20 mg Monday,
Wednesday, and Friday.  18. Percocet p.r.n.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Urinary complications, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Atrial fibrillation,Congestive heart failure, unspecified,Hyposmolality and/or hyponatremia
Crnry athrscl natve vssl,Intermed coronary synd,Comp-oth cardiac device,Surg compl-urinary tract,Ac kidny fail, tubr necr,Atrial fibrillation,CHF NOS,Hyposmolality
Admission Date:  [**2141-2-24**]       Discharge Date:  [**2141-3-13**]


Service:  Cardiothoracic Surgery

ADMISSION DIAGNOSES:
1. Myocardial infarction.
2. Unstable angina.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Status post coronary artery bypass grafting x 3
([**2141-2-28**]).
3. Take back, reexploration for left internal mammary artery
kink/torsion ([**2141-3-2**]).
4. Persistent atrial fibrillation.
5. Acute renal failure, resolved.
6. Right-sided cerebrovascular accident with left arm
weakness.

HISTORY OF PRESENT ILLNESS:  The patient is an 83-year-old
woman whose problems began with chronic back pain usually
controlled with Tylenol.  She noted an exacerbation on
[**2141-2-12**] and was admitted to the [**Hospital1 **]
[**First Name (Titles) 620**] [**Last Name (Titles) **] for low back pain.  During her work-up there
she received an x-ray which confirmed a compression fracture
at the L3 level.  She was managed conservatively with
physical therapy.  The patient did, however, develop chest
pain and shortness of breath on [**2141-2-15**].  Ultimately, the
patient ruled in for a myocardial infarction with a peak CPK
of 120 and a peak troponin of 5.0.  The patient was treated
per their protocol with Lovenox and Plavix, given her allergy
to aspirin.  She was continued on her other cardiac
medications including nitrates, beta blockade and ACE
inhibitor.  The patient was diuresed and symptomatically
improved within 12 hours.  There was discussion about cardiac
catheterization but given resolution of symptoms, the patient
deferred the option of cardiac catheterization.  The patient
was transferred back to her [**Hospital3 **] facility and was
otherwise asymptomatic until [**2141-2-24**] when the patient
developed persistent severe chest pain in the morning.  The
patient also had palpitations.  She was brought in at that
time for probable cardiac catheterization and evaluation of
her chest pain.

PAST MEDICAL HISTORY:  1. Congestive heart failure.  2.
Osteoporosis, lumbar fracture.  3. Celiac sprue.  4. Atrial
fibrillation.  5. History of urinary retention.  6. History
of syndrome of inappropriate diuretic hormone.  7. History of
pneumonia.  8. Myocardial infarction.

MEDICATIONS ON ADMISSION:  1. Plavix 75 mg q.d.  2. Magnesium
oxide 400 mg b.i.d.  3. Digoxin 0.125 mg q.d.  4. Colace 100
mg b.i.d.  5. Multivitamin q.d.  6. Vitamin C 250 mg q.d.  7.
Tums 500 mg t.i.d.  8. Lisinopril 40 mg q.d.  9. Iron sulfate
325 mg q.d.  10. Macrobid 100 mg p.o. q.h.s.  11. Coumadin 2
mg q.d.  12. Aldactone 45 mg q.d.  13. Fosamax 70 mg q. week.
14. Lopressor 75 mg b.i.d.  15. Isordil 40 mg t.i.d.  16.
Salt tablets one gram t.i.d.  17. Lasix 20 mg Monday,
Wednesday, and Friday.  18. Percocet p.r.n.

PHYSICAL EXAMINATION:  On admission in general the patient
was an elderly woman in no acute distress.  Vital signs:
Temperature 97.8, heart rate 82, blood pressure 140/80,
respiratory rate 18, saturating 98% on two liters nasal
cannula.  HEENT were normocephalic, atraumatic, extraocular
movements intact, pupils were equal, round, and reactive to
light, anicteric, normal sclerae.  Neck was supple, midline
without masses or lymphadenopathy.  Chest was clear to
auscultation bilaterally.  Cardiovascular was irregularly
irregular.  Abdomen was soft, nontender, nondistended without
masses or organomegaly.  Extremities were warm, noncyanotic,
nonedematous x 4.  Neurologic examination was alert and
oriented with no gross defect.

LABORATORY DATA:  Complete blood count was 6.7/30.2/322.
Chemistries were 124/4.6/92/25/11/0.3/100.  INR was 1.8.

HOSPITAL COURSE:  The patient was admitted for work-up of her
chest pain and history of non-ST elevation myocardial
infarction.  The patient underwent a cardiac catheterization
on [**2141-2-24**] which revealed the ejection fraction of 45%, a
right dominant coronary artery system with severe
three-vessel disease.  Also noted was mild mitral
regurgitation as well.  The patient at that time had
evaluation by the cardiothoracic surgery team.  It was
decided to proceed with coronary artery bypass grafting.  On
[**2141-2-27**] the patient was taken to the operating room for
coronary artery bypass grafting x 3 with left internal
mammary artery to the left anterior descending coronary
artery, left radial to the obtuse marginal and right radial
to the RPL.  The patient tolerated the procedure well.  She
was subsequently extubated on postoperative day one.  The
patient was maintained on multiple drips including insulin,
Milrinone, Neo-Synephrine, nitroglycerin and propofol.  The
patient was in persistent atrial fibrillation in the CSRU.
She did have a low urine output for which the renal service
was consulted.  They came up with an assessment of oliguria
with hyponatremia and acute renal failure.  This may be due
to the dye load.  In addition, the patient's low cardiac
output and congestive heart failure picture prompted
recatheterization.  Upon recatheterization, the left internal
mammary artery anastomosis distally appeared to be kinked.
The patient was taken back to the operating room on [**2141-3-2**]
for reexploration of left internal mammary artery torsion.
The anastomosis was repositioned to the left anterior
descending coronary artery.  Again, the patient was
subsequently taken to the CSRU for close monitoring.

The renal service continued to follow for renal failure and
Mucomyst was initiated.  The ultimate etiology for renal
failure was thought to be ATN, multifactorial, with prerenal
component due to congestive heart failure, contrast
nephropathy, ischemic ATN from intraoperative hypoperfusion.

In the evening of [**2141-3-3**] the patient was found to have a
focal neurologic deficit with difficulty moving the left
upper extremity.  Stroke service was consulted for likely
embolic event given the patient's atrial fibrillation and
occasional conversion to sinus rhythm.  Head CT revealed a
hypodensity over the right frontoparietal area in the
posterior watershed distribution.  The stroke service
recommended anticoagulation with Coumadin, keeping the blood
pressure greater than 130/80, MRI and carotid ultrasound.

Throughout this period the patient remained in atrial
fibrillation with occasional rapid response.  The patient did
respond to amiodarone and electrical cardioversion x 3.
However, the patient ultimately remained in atrial
fibrillation.

The remainder of her hospital stay was largely unremarkable.
She was transferred to the floor on postoperative days 11 and
eight.  Nutrition was consulted in regards to her p.o. intake
and swallowing studies were obtained which the patient
passed.  There was a recommendation for a soft solid diet
with thin liquids.  The patient also was thought to benefit
from supplemental nutrition.  During her period on the floor
the patient's main issues were simply diuresis as well as
anticoagulation for atrial fibrillation.  Ultimately, the
patient was discharged on postoperative days 13 and 11
tolerating a regular diet, cardiac, and gluten free, with
adequate pain control on p.o. pain medications and having a
therapeutic INR.  The patient reported no more symptoms of
chest pain or angina.  She had some residual left upper arm
weakness with recommended follow up as an outpatient by
neurology.  The patient's creatinine returned to [**Location 213**]
levels.

Physical examination on discharge, in general she was in no
acute distress, pleasant.  Her chest was clear to
auscultation bilaterally.  Cardiovascular was irregularly
irregular.  Abdomen was soft, nontender, nondistended.
Extremities were warm, noncyanotic, with 2+ edema.  There was
some noted left upper extremity proximal weakness.
Neurologic examination was alert and oriented x 3.

Laboratory studies on discharge were complete blood count
12.6/11.5/35.6/280.  PT was 22.6, INR 3.4, PTT 35.7.
Chemistries were 143/5.0/109/28/26/0.5/107.  Calcium was 7.9,
magnesium 1.8, phosphorous 1.9.

DISCHARGE MEDICATIONS:
1. Lopressor 12.5 mg b.i.d.
2. Lasix 20 mg b.i.d.
3. Percocet 5/325 [**1-19**] q. 4 hours p.r.n.
4. Colace 100 mg b.i.d.
5. Plavix 75 mg q.d.
6. Imdur 60 mg q.d.
7. Nystatin 5 mL q.i.d.
8. Miconazole powder t.i.d. p.r.n.
9. Coumadin 1 mg q.d., titrate as necessary for INR of
between 2 and 3.

DISCHARGE CONDITION:  Stable.

DISPOSITION:  To rehabilitation.

DIET:  Cardiac, gluten free.

DISCHARGE INSTRUCTIONS:
1. The patient should follow up with cardiology within 1-2
weeks and address the need for continued diuresis as well as
adjustment of cardiac medications at that time.
2. The patient should follow up with the neurology service in
between 2-4 weeks for evaluation of her right-sided
cerebrovascular accident.
3. The patient should follow up with Dr. [**Last Name (STitle) 1537**] in four weeks'
time.  The patient should also have INR checks at least twice
weekly with a goal INR of between [**2-20**].  Her anticipated
Coumadin dosage will probably be 1-2 mg q.d.
4. The patient will also require aggressive physical therapy
with transfer and balance training, eventual gait training,
and ambulation strengthening.  The patient may ultimately
need a walker.
5. The patient should also adhere to a cardiac and
gluten-free diet supplemented by Boost or equivalent t.i.d.





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

Dictated By:[**Last Name (NamePattern1) 5745**]
MEDQUIST36

D:  [**2141-3-13**]  10:16
T:  [**2141-3-13**]  10:28
JOB#:  [**Job Number 20735**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Urinary complications, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Atrial fibrillation,Congestive heart failure, unspecified,Hyposmolality and/or hyponatremia'}


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 an 83-year-old
woman whose problems began with chronic back pain usually
controlled with Tylenol.  She noted an exacerbation on
[**2141-2-12**] and was admitted to the [**Hospital1 **]
[**First Name (Titles) 620**] [**Last Name (Titles) **] for low back pain.  During her work-up there
she received an x-ray which confirmed a compression fracture
at the L3 level.  She was managed conservatively with
physical therapy.  The patient did, however, develop chest
pain and shortness of breath on [**2141-2-15**].  Ultimately, the
patient ruled in for a myocardial infarction with a peak CPK
of 120 and a peak troponin of 5.0.  The patient was treated
per their protocol with Lovenox and Plavix, given her allergy
to aspirin.  She was continued on her other cardiac
medications including nitrates, beta blockade and ACE
inhibitor.  The patient was diuresed and symptomatically
improved within 12 hours.  There was discussion about cardiac
catheterization but given resolution of symptoms, the patient
deferred the option of cardiac catheterization.  The patient
was transferred back to her [**Hospital3 **] facility and was
otherwise asymptomatic until [**2141-2-24**] when the patient
developed persistent severe chest pain in the morning.  The
patient also had palpitations.  She was brought in at that
time for probable cardiac catheterization and evaluation of
her chest pain.

MEDICAL HISTORY: 1. Congestive heart failure.  2.
Osteoporosis, lumbar fracture.  3. Celiac sprue.  4. Atrial
fibrillation.  5. History of urinary retention.  6. History
of syndrome of inappropriate diuretic hormone.  7. History of
pneumonia.  8. Myocardial infarction.

MEDICATION ON ADMISSION: 1. Plavix 75 mg q.d.  2. Magnesium
oxide 400 mg b.i.d.  3. Digoxin 0.125 mg q.d.  4. Colace 100
mg b.i.d.  5. Multivitamin q.d.  6. Vitamin C 250 mg q.d.  7.
Tums 500 mg t.i.d.  8. Lisinopril 40 mg q.d.  9. Iron sulfate
325 mg q.d.  10. Macrobid 100 mg p.o. q.h.s.  11. Coumadin 2
mg q.d.  12. Aldactone 45 mg q.d.  13. Fosamax 70 mg q. week.
14. Lopressor 75 mg b.i.d.  15. Isordil 40 mg t.i.d.  16.
Salt tablets one gram t.i.d.  17. Lasix 20 mg Monday,
Wednesday, and Friday.  18. Percocet p.r.n.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other complications due to other cardiac device, implant, and graft,Urinary complications, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Atrial fibrillation,Congestive heart failure, unspecified,Hyposmolality and/or hyponatremia'}
