CHIEF COMPLAINT: 

PRESENT ILLNESS: This 71 year-old diabetic female
with a history of exertional angina and a positive stress
test referred to [**Hospital1 69**] for
cardiac catheterization.  The patient reports chest tightness
and shortness of breath after climbing one flight of stairs.

MEDICAL HISTORY: 1.  Hypertension.  2.
Hypercholesterolemia.  3.  Noninsulin dependent diabetes
mellitus.  4.  Status post hysterectomy.  5.  Status post
spinal fusion.  6.  Status post cervical disc surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Accidental puncture or laceration during a procedure, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension
Crnry athrscl natve vssl,Intermed coronary synd,Accidental op laceration,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2137-1-11**]       Discharge Date:  [**2137-1-18**]

Date of Birth:   [**2065-8-14**]       Sex:  F

Service:  CARDIAC SURGERY

HISTORY OF PRESENT ILLNESS:  This 71 year-old diabetic female
with a history of exertional angina and a positive stress
test referred to [**Hospital1 69**] for
cardiac catheterization.  The patient reports chest tightness
and shortness of breath after climbing one flight of stairs.

PAST MEDICAL HISTORY:  1.  Hypertension.  2.
Hypercholesterolemia.  3.  Noninsulin dependent diabetes
mellitus.  4.  Status post hysterectomy.  5.  Status post
spinal fusion.  6.  Status post cervical disc surgery.

PREOPERATIVE MEDICATIONS:  1.  Norvasc 5 mg po q day.  2.
Calor 20 mg po q.d.  3.  Hydrochlorothiazide 25 mg po q day.
4.  Glucovance 5/500 one po b.i.d.  5.  Captopril 25 mg po
b.i.d.  6.  Ecotrin 325 mg po q day.  7.  Vitamin E 800
international units q day.  8.  Centrum multi vitamins q.d.

ALLERGIES:  No known drug allergies.

INITIAL PHYSICAL EXAMINATION:  Pulse 80.  Blood pressure
160/90.  Neck without JVD.  Carotids 2+ without bruits.
Chest is clear to auscultation.  Heart is regular rate and
rhythm.  S1 and S2 without murmur.  Abdomen is nontender,
positive bowel sounds.  Peripheral vascular, femoral pulses
are 2+ without bruits.  Dorsalis pedis pulses 1 to 2+.  No
lower extremity edema.  Neurological alert and oriented times
three, anxious.

LABORATORY DATA:  White blood cell count 5.9, hematocrit 44,
platelet count 159, sodium 144, potassium 4.2, chloride 101,
bicarb 29, BUN 17, creatinine 0.6.

HOSPITAL COURSE:  The patient underwent cardiac
catheterization on [**2137-1-11**].  Cardiac catheterization showed a
left ventricular ejection fraction of 50% with anterolateral
hypokinesis.  Total occlusion of left anterior descending
coronary artery at trifurcation of S1 and D2, 70% proximal
left circumflex lesion, diffuse obtuse marginal two lesion 60
to 70%, 70% distal posterior descending coronary artery
lesion.  There was an attempted percutaneous transluminal
coronary angioplasty to the left anterior descending coronary
artery lesion, which resulted in a small perforation of
second diagonal.  Percutaneous transluminal coronary
angioplasty was aborted.  Post catheterization echocardiogram
showed no effusion.  The patient was referred to Cardiac
Surgery.

The patient underwent repeat echocardiogram on [**2137-1-12**], which
again demonstrated no pericardial effusion.  The patient was
taken to the Operating Room on [**2137-1-14**] with Dr. [**Last Name (STitle) **] for a
coronary artery bypass graft times three, left internal
mammary coronary artery to left anterior descending coronary
artery, saphenous vein graft to obtuse marginal two,
saphenous vein graft to diagonal.  The patient was
transferred to the Intensive Care Unit in stable condition on
neo-synephrine.  Please see operative note for further
details.  The patient was weaned and extubated from
mechanical ventilation on her first postoperative night.  The
patient remained hemodynamically stable.  Neo-synephrine drip
was discontinued after crystalloid bolus.  Cardiac index was
stable.  On postoperative day one the patient was
hemodynamically stable.  The patient's chest tubes were
removed and the patient was transferred to the Intensive Care
Unit to the floor.

The patient was requiring regular insulin sliding scale
coverage for hyperglycemia.  The patient was restarted on her
oral hypoglycemic medications.  The patient began ambulating
with physical therapy.  The patient was noted to have
increasing anxiety during her postoperative course with
episodes of being tearful and agitated.  The patient was
treated with Ativan with no relief of symptoms.  On
postoperative day number three a psychiatry consult was
obtained to aid in the management of the patient's anxiety.
The Psychiatry Service felt that the patient was suffering
from mild delirium and mood disorder, depression versus
anxiety.  Recommendations were to discontinue Ativan, avoid
benzodiazepines, avoid narcotics and start the patient on
Risperdal prn for anxiety/agitation and recommended follow up
outpatient therapy.  With the discontinuation of the Ativan
on the evening of postoperative day number three the
patient's symptoms improved dramatically.  The patient did
not report any symptoms of disorientation or hallucinations.
The patient has not received any narcotic pain medication.

On the morning of postoperative day number four the patient
was awake and alert.  No evidence of anxiety or agitation.
The patient was oriented to person, place, situation and time
and it was felt the patient was appropriate for discharge to
a rehabilitation facility.

CONDITION AT DISCHARGE:  Temperature max 98.6.  Pulse 71
sinus rhythm.  Blood pressure 110/74.  Oxygen saturation on 2
liters nasal cannula 98%.  Blood sugar 163.  The patient is
awake, alert and oriented to person, place, situation and
time.  Neurologically nonfocal.  Ambulating with assist.
Cardiovascular regular rate and rhythm.  No rub or murmur.
Extremities are warm, dry and well perfuse.  Respiratory
breath sounds are clear bilaterally.  Breathing is
nonlabored.  No audible wheezing or rales.  Gastrointestinal,
abdomen is obese, positive bowel sounds, soft, nontender,
tolerating diabetic diet.  Sternal incision, staples are
intact.  No erythema or drainage noted.  Sternum is stable.
Right upper extremity vein harvest site, Steri-Strips are
intact.  No erythema or drainage noted.  There is a moderate
amount of ecchymosis on the posterior thigh of right
extremity.  Left lower extremity noted to have some chronic
venostasis changes.  The patient has an old burn to right
upper thigh with skin graft.

LABORATORY DATA:  White blood cell count 8.5, hematocrit
24.7, platelet count 190, sodium 144, potassium 4.0, chloride
104, bicarb 31, BUN 34, creatinine 0.7.  The patient's weight
today is 113.5 kilograms.  Preoperative the patient was 108.8
kilograms.

DISCHARGE MEDICATIONS:  1.  Lasix 20 mg po b.i.d. times one
week and then q.d. times one week.  2.  K-Ciel 20
milliequivalents po b.i.d. times one week and then q.d. times
one week.  3.  Colace 100 mg po b.i.d.  4.  Enteric coated
aspirin 325 mg po q day.  5.  Glyburide 5 mg po b.i.d.  6.
Glucophage 500 mg po b.i.d.  7.  Regular insulin sliding
scale for blood sugar 150 to 200 give 3 units subQ.  For
blood sugar 201 to 250 give 6 units subQ.  For blood sugar
251 to 300 give 9 units subQ.  8.  Lopresor 100 mg po b.i.d.
9.  Protonix 40 mg po q day.  10.  Risperdal 0.5 mg po b.i.d.
prn for anxiety.  Risperdal 0.5 mg po q.h.s. prn for sleep.
11.  Ibuprofen 600 mg po q 6 hours prn for pain.  12.
Tylenol 650 mg po pr q 4 to 6 hours prn pain and fever.

INSTRUCTIONS:  The patient is to wear a surgical bra at all
times.  The patient may shower or bathe as desired.  The
patient is not to apply any lotions, creams or powders to
incisions.

DIET:  1800 calorie [**Doctor First Name **].

FOLLOW UP:  The patient is to follow up with Dr. [**Last Name (STitle) **] in
three to four weeks.  The patient is to call his office upon
discharge from rehab.  The patient is to follow up with her
primary care physician in three to four weeks.  The patient
is to follow up for wound check and staple removal in three
weeks.






                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 3870**]
MEDQUIST36

D:  [**2137-1-18**]  09:23
T:  [**2137-1-18**]  09:28
JOB#:  [**Job Number **]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Accidental puncture or laceration during a procedure, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension'}


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 71 year-old diabetic female
with a history of exertional angina and a positive stress
test referred to [**Hospital1 69**] for
cardiac catheterization.  The patient reports chest tightness
and shortness of breath after climbing one flight of stairs.

MEDICAL HISTORY: 1.  Hypertension.  2.
Hypercholesterolemia.  3.  Noninsulin dependent diabetes
mellitus.  4.  Status post hysterectomy.  5.  Status post
spinal fusion.  6.  Status post cervical disc surgery.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Accidental puncture or laceration during a procedure, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified essential hypertension'}
