CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 58-year-old
gentleman who was admitted with chest pain on [**2184-1-22**].  The patient has a history of hypertension,
hypercholesterolemia, diabetes, and has had intermittent
chest pain for two months.

MEDICAL HISTORY: (The patient's past medical history is
significant for)
1.  Non-insulin-dependent diabetes mellitus.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Peripheral vascular disease with claudication.

MEDICATION ON ADMISSION: (Medications on admission
included)
1.  Atenolol 100 mg by mouth once per day.
2.  Lipitor 10 mg by mouth once per day.
3.  Glucovance 1.25/250 mg by mouth every day.
4.  Hydrochlorothiazide 50 mg by mouth once per day.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is significant for his
mother who had a myocardial infarction at the age of 65.

SOCIAL HISTORY: Social history is significant for being a
smoker of one pack per day for 40 years.  The patient denies
any alcohol use.  The patient lives with his wife in [**Name (NI) 1456**],
[**State 350**].
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atherosclerosis of renal artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia
Subendo infarct, initial,CHF NOS,Chr airway obstruct NEC,Crnry athrscl natve vssl,Renal artery atheroscler,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS
Admission Date:  [**2184-1-22**]       Discharge Date:  [**2184-2-5**]

Date of Birth:   [**2125-2-24**]       Sex:  M

Service:

PRIMARY DIAGNOSIS:  Coronary artery disease.

PRIMARY PROCEDURE:  Coronary artery bypass graft times four.

HISTORY OF PRESENT ILLNESS:  The patient is a 58-year-old
gentleman who was admitted with chest pain on [**2184-1-22**].  The patient has a history of hypertension,
hypercholesterolemia, diabetes, and has had intermittent
chest pain for two months.

The patient had a non-ST-elevation myocardial infarction at
an outside hospital and was transferred to [**Hospital1 346**] for cardiac catheterization.  The
patient has had a prior episode last [**Month (only) 547**] that manifested as
burning chest pain and was told at that time that he had
gastroesophageal reflux disease.

One week prior to admission, the patient developed substernal
pressure with burning.  This was intermittent but was
recurrent.

On [**1-19**], the patient presented to the Emergency
Department and was given sublingual nitroglycerin which
resolved his chest pain and then left against medical advice
after his treatment at that time.

On the day prior to admission, the patient was awakened from
sleep with substernal chest pressure which radiated down both
arms and into his hands.  He had nausea and diaphoresis at
this time.  The patient denied palpitations or shortness of
breath.  The patient admitted to dizziness.  He took two
sublingual nitroglycerin and the pressure improved but did
not fully resolve.

At the outside hospital Emergency Department, the patient
received Lovenox, morphine, aspirin, Plavix, a nitroglycerin
drip, and Lopressor.  His pain decreased but did not resolve.

The patient was transferred to the [**Hospital1 190**].  On arrival, he was chest pain free.  His
electrocardiogram changes at that time had resolved.  He
underwent cardiac catheterization upon arrival.

PAST MEDICAL HISTORY:  (The patient's past medical history is
significant for)
1.  Non-insulin-dependent diabetes mellitus.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Peripheral vascular disease with claudication.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON ADMISSION:  (Medications on admission
included)
1.  Atenolol 100 mg by mouth once per day.
2.  Lipitor 10 mg by mouth once per day.
3.  Glucovance 1.25/250 mg by mouth every day.
4.  Hydrochlorothiazide 50 mg by mouth once per day.

FAMILY HISTORY:   Family history is significant for his
mother who had a myocardial infarction at the age of 65.

SOCIAL HISTORY:  Social history is significant for being a
smoker of one pack per day for 40 years.  The patient denies
any alcohol use.  The patient lives with his wife in [**Name (NI) 1456**],
[**State 350**].

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
upon admission revealed the patient's blood pressure was
148/71, his heart rate was 61, his respiratory rate was 20,
and his oxygen saturation 97% on room air.  On general
examination, the patient was pleasant and in no apparent
distress.  Head, eyes, ears, nose, and throat examination was
significant for the sclerae being anicteric.  There was no
jugular venous distention.  Cardiovascular examination
revealed the heart was regular in rate and rhythm.  There was
a normal first heart sounds and second heart sounds.  Lung
examination was significant for bilateral basilar crackles.
The abdomen was soft and nontender.  There were positive
bowel sounds.  There was no hepatosplenomegaly.  Extremity
examination revealed there were 1+ dorsalis pedis pulses.
The extremities were warm and well perfused and without
edema.  Neurologic examination revealed the patient was alert
and oriented times three.  The pupils were equal, round, and
reactive to light and accommodation.   The extraocular
movements were intact.

PERTINENT RADIOLOGY/IMAGING:  An electrocardiogram revealed a
normal sinus rhythm.  There were Q waves in leads II, III,
and aVF.  In addition, the electrocardiogram revealed T wave
flattening in V4 through V6 and ST depressions in leads V4
through V6 which had resolved on a follow-up
electrocardiogram done in the Emergency Department.

A chest x-ray on admission revealed borderline enlarged heart
without infiltrates or effusions.

Cardiac catheterization revealed an ejection fraction of 50%
with moderate inferoapical hypokinesis.  Left main coronary
artery with 30%, left anterior descending artery with 40% mid
and 40% diagonal, left circumflex with 95% origin involving
origin of first obtuse marginal and 80% mid, right coronary
artery 70% proximal and 50% mid occlusion posterolateral
filling via left-to-right collaterals.  Saphenous vein graft
nothing.  Left internal mammary artery to left anterior
descending artery nothing.

Descending aortography performed because of an inability to
pass wire from either femoral artery revealed occluded distal
aorta with huge lumbar collaterals to legs, 80% right renal
artery, and 60% left renal artery.

PERTINENT LABORATORY VALUES ON PRESENTATION:  The patient's
white blood cell count was 19.6, his hematocrit was 48.1, and
his platelets were 223.  The patient's Chemistry-7 revealed
sodium was 135, potassium was 3.9, chloride was 98,
bicarbonate was 28, blood urea nitrogen was 14, creatinine
was 1.2, and his blood glucose was 170.  His creatine kinase
was 156.  MB was 5.6.  Troponin was 2.23.  Index was 3.5.

ASSESSMENT:  Assessment at this time was to have the
Cardiology team consult for question coronary artery bypass
graft.

CONCISE SUMMARY OF HOSPITAL COURSE:  The patient was admitted
onto the Cardiology Service and was followed.  The patient
was managed medically at that time.

On [**2184-1-23**] the patient returned to the
Catheterization Laboratory for selective renal angiography.
A percutaneous transluminal angioplasty stent times one to
the right renal artery, and a percutaneous transluminal
angioplasty stent times two the left renal artery was
performed.  This procedure was successful, resulting in a
final residual of 0% with normal flow in the right renal
artery and final residual was 0% with normal flow in the left
renal artery.

The patient was prepared by the Cardiology Service and was
taken to the operating room on [**2184-1-27**] for coronary
artery bypass graft with a left internal mammary artery to
the left anterior descending artery, saphenous vein graft to
the first obtuse marginal, saphenous vein graft to the third
obtuse marginal, and saphenous vein graft to the right
coronary artery.  The surgeon was Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] and
assisted by Dr. [**Last Name (STitle) **].

The patient tolerated the procedure well and was taken to the
Coronary Care Unit with an arterial line, a Swan-Ganz
catheter, atrial and ventricular wires, and a mediastinal and
left pleural chest tube.  The patient was on a milrinone drip
at 0.5, Neo-Synephrine at 7.5, and propofol at 10 upon
transfer.

The patient did well and was extubated.  He was weaned down
to Neo-Synephrine 1.25 on postoperative day one.  At that
time, the patient was on aspirin and Plavix.  He was
neurologically intact.  The patient was out of bed.  His
Neo-Synephrine was weaned to off.  He was started on
Lopressor.  He had adequate urine output.

On postoperative day two, he was on Neo-Synephrine at 0.5
with a temperature maximum of 100.6 degrees Fahrenheit.  The
patient was given Toradol for pain control, and his
perioperative vancomycin was continued.  His chest tubes were
discontinued.

On [**2184-1-29**] the patient was transferred to the
floor.  On postoperative day three, he was doing well.  His
pacing wires were discontinued, and he was ambulatory.  He
was also afebrile at that time.

On postoperative day four (on [**2184-2-2**]), the patient
was continued on Lasix, Kefzol, Plavix, and metoprolol at 25
twice per day.  He continued to have an uneventful
hospitalization; although, he did have drainage from the
distal aspect of his sternotomy wound.  This drainage did
decrease, and none was noted on the final two days of his
hospitalization.

On [**2184-2-2**] the patient was found to be tearful and
depressed.  A Psychiatry consultation was obtained.  The plan
from the psychiatrist was reassurance that he would be safe
at the hospital and that he was in good control of his care.
They also felt that he needed to evaluate his life in the
context of his major surgery and that this was a normal
feeling.  If he continued to feel overwhelmed by these
emotions in three months, they suggested a referral to
Psychiatry at that time.  The consulting physician was Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1693**] (pager #39-333).  Their feeling was that he did
not have a depressive or anxiety disorder at their time of
seeing the patient.

On [**2-3**], given his continued drainage from his
sternum, he was started on vancomycin and was pan-cultured.
These cultures were negative with negative blood cultures
after 72 hours, and a sternal culture which had no growth and
no organisms.  For that reason, the vancomycin was
discontinued and the patient was placed on Keflex for a
period of ten days starting on the day of discharge.
Otherwise, he was stable.  He was tolerating activity.  He
was to be discharged with home therapy for physical
assessment and assistance with his medications.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease.
2.  Diabetes.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Peripheral vascular disease.
6.  Gastroesophageal reflux disease (GERD).

CONDITION AT DISCHARGE:  Condition on discharge was stable.

DISCHARGE INSTRUCTIONS/FOLLOWUP:  The patient was instructed
to follow up with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**], and primary care
physician, [**Name10 (NameIs) **] his cardiologist.

MEDICATIONS ON DISCHARGE:  (The patient's discharge
medications included)
1.  Aspirin 325 mg by mouth once per day.
2.  Plavix 75 mg by mouth once per day.
3.  Lopressor 75 mg by mouth twice per day.
4.  Glucovance 1.25/250 mg by mouth once per day.
5.  Hydrochlorothiazide 50 mg by mouth once per day.
6.  Lipitor 10 mg by mouth once per day.
7.  Keflex 500 mg by mouth four times per day (times seven
days).

DISCHARGE DIET:  Discharge diet was a cardiac diet.

DISCHARGE STATUS:  The patient was to be discharged with home
services from [**Hospital6 407**] of Middle Sexton
East.




                            [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 75**]

Dictated By:[**Dictator Info 31934**]
MEDQUIST36

D:  [**2184-2-5**]  12:21
T:  [**2184-2-5**]  12:32
JOB#:  [**Job Number 53453**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atherosclerosis of renal artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}


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 58-year-old
gentleman who was admitted with chest pain on [**2184-1-22**].  The patient has a history of hypertension,
hypercholesterolemia, diabetes, and has had intermittent
chest pain for two months.

MEDICAL HISTORY: (The patient's past medical history is
significant for)
1.  Non-insulin-dependent diabetes mellitus.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Peripheral vascular disease with claudication.

MEDICATION ON ADMISSION: (Medications on admission
included)
1.  Atenolol 100 mg by mouth once per day.
2.  Lipitor 10 mg by mouth once per day.
3.  Glucovance 1.25/250 mg by mouth every day.
4.  Hydrochlorothiazide 50 mg by mouth once per day.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is significant for his
mother who had a myocardial infarction at the age of 65.

SOCIAL HISTORY: Social history is significant for being a
smoker of one pack per day for 40 years.  The patient denies
any alcohol use.  The patient lives with his wife in [**Name (NI) 1456**],
[**State 350**]. 

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Atherosclerosis of renal artery,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia'}
