CHIEF COMPLAINT: 

PRESENT ILLNESS: This 83-year-old female has had
seven to 10 days of stuttering chest pain prior to admission
with shortness of breath.  She was seen at an outside
hospital and had anteroseptal and inferior ST-T wave changes.
Her troponin was 54.  She was taken to the catheterization
laboratory at [**Hospital1 **] emergently and had a balloon placed, and
cardiothoracic surgery was consulted for an emergency
coronary artery bypass graft.  She received Aggrastat,
heparin and aspirin in the catheterization laboratory.

MEDICAL HISTORY: 1. History of noninsulin dependent
diabetes mellitus.  2. History of peripheral vascular disease
status post left lower extremity below the knee amputation.
3. History of depression.  4. History of hypertension.  5.
History of cataracts.  6. Status post cholecystectomy.  7.
Status post thyroidectomy.  8. Status post total abdominal
hysterectomy.  9. Status post appendectomy.  10. Status post
bladder suspension.

MEDICATION ON ADMISSION: 1. Nitroglycerin drip.  2.
Aggrastat.  3. Aspirin.  4. Lopressor.  5. Heparin drip.  6.
Synthroid.  7. Lipitor.  8. Oxazepam.  9. Morphine.  10.
Colace.

ALLERGIES: Zocor and Pravachol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Cardiogenic shock,Peripheral vascular complications, not elsewhere classified,Arterial embolism and thrombosis of lower extremity,Other postoperative infection,Cellulitis and abscess of leg, except foot,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of native coronary artery
Subendo infarct, initial,Cardiogenic shock,Surg comp-peri vasc syst,Lower extremity embolism,Other postop infection,Cellulitis of leg,Rheumatic heart failure,Mitral insuf/aort stenos,Crnry athrscl natve vssl
Admission Date:  [**2146-7-14**]       Discharge Date:  [**2146-7-25**]


Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  This 83-year-old female has had
seven to 10 days of stuttering chest pain prior to admission
with shortness of breath.  She was seen at an outside
hospital and had anteroseptal and inferior ST-T wave changes.
Her troponin was 54.  She was taken to the catheterization
laboratory at [**Hospital1 **] emergently and had a balloon placed, and
cardiothoracic surgery was consulted for an emergency
coronary artery bypass graft.  She received Aggrastat,
heparin and aspirin in the catheterization laboratory.

PAST MEDICAL HISTORY:  1. History of noninsulin dependent
diabetes mellitus.  2. History of peripheral vascular disease
status post left lower extremity below the knee amputation.
3. History of depression.  4. History of hypertension.  5.
History of cataracts.  6. Status post cholecystectomy.  7.
Status post thyroidectomy.  8. Status post total abdominal
hysterectomy.  9. Status post appendectomy.  10. Status post
bladder suspension.

MEDICATIONS ON ADMISSION:  1. Nitroglycerin drip.  2.
Aggrastat.  3. Aspirin.  4. Lopressor.  5. Heparin drip.  6.
Synthroid.  7. Lipitor.  8. Oxazepam.  9. Morphine.  10.
Colace.

ALLERGIES:  Zocor and Pravachol.

PHYSICAL EXAMINATION:  She was an anxious female in no
apparent distress.  Her vital signs were stable.  HEENT:
normocephalic, atraumatic, extraocular movements intact.
Neck:  Supple, full range of motion, no lymphadenopathy or
thyromegaly.  Carotids were 2+ and equal bilaterally without
bruits.  Lungs:  Bilateral crackles.  Cardiovascular:
Regular rate and rhythm, normal S1 and S2 with no murmurs,
gallops, or rubs.  Abdomen:  Multiple well-healed surgical
incisions.  Positive bowel sounds, no masses or
hepatosplenomegaly.  Extremities:  She was status post left
below the knee amputation.  The right side had a balloon pump
in place.  She had palpable pulses on the right and her leg
was warm.

HO[**Last Name (STitle) **] COURSE:  She underwent cardiac catheterization on
[**2146-7-14**].  The left ventricle revealed moderate mitral
regurgitation with an ejection fraction of 30%.  The
coronaries were right dominant.  The left main had a 90%
distal thrombotic lesion that extended into the proximal left
anterior descending coronary artery.  The left anterior
descending coronary artery had an ostial thrombotic 90%
lesion, long mid 80% lesion at diagonal 1, and an ostial 60%
lesion.  The left circumflex had a thrombus at the ostium.
The right coronary artery had a proximal 80% lesion and the
left internal mammary artery was widely patent, that was shot
as well.  Dr. [**Last Name (Prefixes) **] was consulted and the patient was
taken to the operating room and underwent an emergency aortic
valve replacement, coronary artery bypass grafting x 3 with a
#23 mm [**Last Name (un) 3843**]-[**Doctor Last Name **] pericardial valve; saphenous vein
graft to the left anterior descending coronary artery,
saphenous vein graft to the obtuse marginal, and saphenous
vein graft to the right coronary artery.  Cross-clamp time
was 129 minutes.  Total bypass time was 149 minutes.  He was
transferred to the cardiac surgery recovery unit in stable
condition on milrinone, nitroglycerin, propofol and insulin
drips.  She remained intubated and her balloon was being
weaned on the following day, and she was intubated that
evening, but had lost her pulses on her right leg.  The
balloon was removed without difficulty, but the leg remained
cool and mottled.  Vascular surgery was consulted and that
day she had a right femoral and popliteal exploration and
embolectomy by vascular surgery and she was started on
heparin.  She tolerated that well.  She remained intubated.

On postoperative day three she had some increased secretions.
She was started on Levaquin.  She continued to improve.  Her
drips were weaned off.  She did remain intubated.  She was
slowly weaned off her milrinone.  She was started on
hydralazine.  She was extubated on postoperative day number
five and her milrinone was discontinued on postoperative day
number six.  She continued to slowly improve.  She did have
some difficulty with swallowing.  She had a Dobbhoff inserted
and was being treated with tube feeds.  Eventually she had a
swallowing study which revealed she had no aspiration and she
was started on p.o.  Her tube feeds were discontinued.  She
continued to progress and on postoperative day number 11 she
did have some slight cellulitis on the right lower extremity
saphenectomy site, but this was treated with vancomycin and
resolved in one day, so she will be treated with one week of
vancomycin for that.  She was discharged to [**Hospital **]
Rehabilitation on [**2146-7-25**], postoperative days number 11 and
10 for further work with ambulation.  She does have a
prosthesis and reportedly walks with that at home.

Her laboratory studies on discharge were hematocrit 28.5,
white count 13,700, platelet count 293, sodium 137, potassium
3.9, chloride 97, CO2 32, BUN 21, creatinine 0.7, PT 18.5
with an INR of 2.3.  She had received Coumadin for the two
nights prior to discharge and should receive 3 mg tonight at
the rehabilitation center.

DISCHARGE MEDICATIONS:
1. Tylenol [**1-13**] p.o. q. 4-6 hours p.r.n. pain.
2. Aspirin 325 mg p.o. q. day.
3. Colace 100 mg p.o. b.i.d.
4. Nystatin oral suspension 5 cc q.i.d.
5. Levothyroxine 125 mcg p.o. q. day.
6. Lopressor 25 mg p.o. b.i.d.
7. Glipizide 5 mg p.o. b.i.d.
8. Captopril 6.25 mg p.o. t.i.d.
9. Percocet [**1-13**] p.o. q. 4-6 hours p.r.n. pain.
10. Prilosec 30 mg p.o. q. day.
11. Lasix 40 mg IV t.i.d.
12. Vancomycin 1 gram IV q. 12 hours for seven days.
13. Coumadin 3 mg p.o. tonight and check coagulation studies
q. day to achieve an INR of 2 to 2.5.





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

Dictated By:[**Last Name (NamePattern1) 11726**]
MEDQUIST36

D:  [**2146-7-25**]  10:17
T:  [**2146-7-25**]  10:33
JOB#:  [**Job Number 52257**]
{'Subendocardial infarction, initial episode of care,Cardiogenic shock,Peripheral vascular complications, not elsewhere classified,Arterial embolism and thrombosis of lower extremity,Other postoperative infection,Cellulitis and abscess of leg, except foot,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of native coronary artery'}


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 83-year-old female has had
seven to 10 days of stuttering chest pain prior to admission
with shortness of breath.  She was seen at an outside
hospital and had anteroseptal and inferior ST-T wave changes.
Her troponin was 54.  She was taken to the catheterization
laboratory at [**Hospital1 **] emergently and had a balloon placed, and
cardiothoracic surgery was consulted for an emergency
coronary artery bypass graft.  She received Aggrastat,
heparin and aspirin in the catheterization laboratory.

MEDICAL HISTORY: 1. History of noninsulin dependent
diabetes mellitus.  2. History of peripheral vascular disease
status post left lower extremity below the knee amputation.
3. History of depression.  4. History of hypertension.  5.
History of cataracts.  6. Status post cholecystectomy.  7.
Status post thyroidectomy.  8. Status post total abdominal
hysterectomy.  9. Status post appendectomy.  10. Status post
bladder suspension.

MEDICATION ON ADMISSION: 1. Nitroglycerin drip.  2.
Aggrastat.  3. Aspirin.  4. Lopressor.  5. Heparin drip.  6.
Synthroid.  7. Lipitor.  8. Oxazepam.  9. Morphine.  10.
Colace.

ALLERGIES: Zocor and Pravachol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Cardiogenic shock,Peripheral vascular complications, not elsewhere classified,Arterial embolism and thrombosis of lower extremity,Other postoperative infection,Cellulitis and abscess of leg, except foot,Rheumatic heart failure (congestive),Mitral valve insufficiency and aortic valve stenosis,Coronary atherosclerosis of native coronary artery'}
