CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 63-year-old
male with a history of diabetes, hypertension, high
cholesterol and status post cerebrovascular accident ten
years ago.  The patient had an inferior myocardial infarction
on Saturday, [**2177-3-8**].  Cardiac catheterization showed
three-vessel disease of the right coronary artery, stented
with three stents.  This was performed at [**Hospital6 1760**].

MEDICAL HISTORY: Left lower lobectomy for lung cancer
ten years ago.  Cerebrovascular accident.  Confusion lasting
about one month, about ten years ago.  Carotid studies at
that time showed bilateral carotid blockage.  Angiography one
year ago showed blockage of the right iliac artery.  The
patient also had diabetic neuropathy and bilateral
claudication, symptomatic at 50 yds.  The patient uses a
wheelchair at his house.

MEDICATION ON ADMISSION: Lipitor,
Glyburide, Coumadin.

ALLERGIES: NKDA.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient is divorced with five children.
He is a single parent looking after an 11-year-old son.  His
mother died of diabetes.  The patient smoked two packs per
day until 12 years ago.  The patient used excessive alcohol
until ten years ago.  He also used multiple illicit drugs
until ten years ago. He has hepatitis C chronically.

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Other postoperative infection,Cellulitis and abscess of leg, except foot,Long-term (current) use of anticoagulants,Acute myocardial infarction of other inferior wall, subsequent episode of care,Pure hypercholesterolemia,Personal history of other diseases of circulatory system
Crnry athrscl natve vssl,Surg compl-urinary tract,Ac kidny fail, tubr necr,Other postop infection,Cellulitis of leg,Long-term use anticoagul,AMI inferior wall,subseq,Pure hypercholesterolem,Hx-circulatory dis NEC
Admission Date:  [**2177-4-4**]       Discharge Date:  [**2177-4-14**]

Date of Birth:   [**2113-11-9**]       Sex:  M

Service: cardiac surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 63-year-old
male with a history of diabetes, hypertension, high
cholesterol and status post cerebrovascular accident ten
years ago.  The patient had an inferior myocardial infarction
on Saturday, [**2177-3-8**].  Cardiac catheterization showed
three-vessel disease of the right coronary artery, stented
with three stents.  This was performed at [**Hospital6 1760**].

The patient was referred to Cardiac Surgery for coronary
artery bypass grafting evaluation.  The patient is currently
pain free.

Regarding his myocardial infarction on Saturday, the patient
woke up at 10 a.m. with severe chest pain.  He was admitted
to [**Hospital 2079**] Hospital for inferior myocardial infarction.
He was treated with Heparin drip, as well as Nitroglycerin
drip.

PAST MEDICAL HISTORY:  Left lower lobectomy for lung cancer
ten years ago.  Cerebrovascular accident.  Confusion lasting
about one month, about ten years ago.  Carotid studies at
that time showed bilateral carotid blockage.  Angiography one
year ago showed blockage of the right iliac artery.  The
patient also had diabetic neuropathy and bilateral
claudication, symptomatic at 50 yds.  The patient uses a
wheelchair at his house.

MEDICATIONS ON ADMISSION:   Lipitor,
Glyburide, Coumadin.

ALLERGIES: NKDA.

FAMILY HISTORY:  The patient is divorced with five children.
He is a single parent looking after an 11-year-old son.  His
mother died of diabetes.  The patient smoked two packs per
day until 12 years ago.  The patient used excessive alcohol
until ten years ago.  He also used multiple illicit drugs
until ten years ago. He has hepatitis C chronically.

PHYSICAL EXAMINATION:  The patient was an obese, elderly
gentleman.  Blood pressure 110/90, heart rate 70.  All pulses
were felt.  There was a bruit in the right carotid.  There
was no ankle edema.  Chest was clear.  Heart sounds normal.

STUDIES:  Cardiac catheterization showed right coronary
artery stented, left anterior descending 70%, OM 80%,
ejection fraction of 50%.

HOSPITAL COURSE:  The patient was admitted on [**2177-4-4**],
and taken directly to the operating room for coronary artery
bypass grafting times three.  This was performed with LIMA to
left anterior descending, saphenous vein graft to OM,
saphenous vein graft to right coronary artery and posterior
descending artery.

Postoperatively the patient had chest tubes and pacing wires
in place.  He required a Neo-Synephrine, Propofol and Insulin
drip.  He postoperatively also had an issue with acidosis
requiring bicarbonate therapy.

The patient initially did well and was transferred to the
regular Cardiothoracic Floor on postoperative day #1, off all
of his drips.  On postoperative day #2, the patient's chest
tubes were removed.  He was started on Lopressor and
Captopril, as well as Lasix.

The patient postoperatively had an acute change in his mental
status with confusion.  He was seen by the Stroke Service.
The patient also had an acute increase in his creatinine for
which the Renal Team was consulted.  It was believed that the
patient suffered from acute tubular necrosis and
 perioperative hypertension, and it was the
opinion of the Stroke Service that this may be the cause of
his change in mental status.
The patient was sent back to the Intensive Care Unit post
mental status change.  CT scan was performed which did not
show new stroke.  All narcotics and benzodiazepines were
stopped.  The patient was given Haldol.

Over the next couple of days, the patient's renal status and
neurological status improved; however, on [**2177-4-9**], at
11:10 p.m., a Psychiatric Code was called, as the patient was
trying to pull his various lines and was trying to leave the
hospital, and Security was alerted.  Haldol was given, and
the patient responded to verbal direction.

The patient was thereafter sent back to the Intensive Care
Unit for increased agitation and need for close monitoring.
His Coumadin was restarted, and Heparin was restarted for
stroke prophylaxis.

Over the course of the next few days, the patient began to
improve.  Over the course of his stay, he was seen by
Physical Therapy and Occupational Therapy.  Over the length
of his stay.  He was able to reach a point where he was
fairly well functional.

On the day before discharge, the patient developed erythema
around his leg incision for which Kefzol was started the
following day.  The erythema did not appear to advance and
appeared to be contained.

On [**2177-4-14**], the patient is in good condition.  He is
at a point where he can be discharged to rehabilitation
safely.  The patient should not drive while on pain
medication.  He should avoid strenuous activity.  He may
shower but should not take baths.  She should follow-up with
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 14323**] in [**12-19**] weeks.  He should also follow-up with
Cardiology in [**1-20**] weeks.  He should follow-up with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] in 3 weeks.

DISCHARGE MEDICATIONS:  Coumadin to keep INR 2, Lopressor 100
mg p.o.  b.i.d., Cephazolin 1 g q.8, Lasix 20 mg p.o. b.i.d.,
Potassium 20 mEq p.o. q.12, Captopril 25 mg p.o. t.i.d.,
Glyburide 10 mg p.o. b.i.d., Insulin, Haldol 5 mg p.o.
q.p.m., 2 mg q.a.m., Albuterol and Ipratropium 1-2 puffs q.6,
as well as q.6 p.r.n., Atorvastatin 10 mg p.o. q.d., enteric
coated Aspirin 325 mg p.o. q.d., Protonix 40 mg p.o. q.24,
Folic Acid 1 mg p.o. q.d., Thiamin 100 mg p.o. q.d.,
Multivitamin 1 tab p.o. q.d., Colace 100 mg p.o. b.i.d.
p.r.n.




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

Dictated By:[**Last Name (NamePattern4) 12487**]
MEDQUIST36

D:  [**2177-4-14**]  11:10
T:  [**2177-4-14**]  11:20
JOB#:  [**Job Number 49912**]
{'Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Other postoperative infection,Cellulitis and abscess of leg, except foot,Long-term (current) use of anticoagulants,Acute myocardial infarction of other inferior wall, subsequent episode of care,Pure hypercholesterolemia,Personal history of other diseases of circulatory system'}


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 63-year-old
male with a history of diabetes, hypertension, high
cholesterol and status post cerebrovascular accident ten
years ago.  The patient had an inferior myocardial infarction
on Saturday, [**2177-3-8**].  Cardiac catheterization showed
three-vessel disease of the right coronary artery, stented
with three stents.  This was performed at [**Hospital6 1760**].

MEDICAL HISTORY: Left lower lobectomy for lung cancer
ten years ago.  Cerebrovascular accident.  Confusion lasting
about one month, about ten years ago.  Carotid studies at
that time showed bilateral carotid blockage.  Angiography one
year ago showed blockage of the right iliac artery.  The
patient also had diabetic neuropathy and bilateral
claudication, symptomatic at 50 yds.  The patient uses a
wheelchair at his house.

MEDICATION ON ADMISSION: Lipitor,
Glyburide, Coumadin.

ALLERGIES: NKDA.

PHYSICAL EXAM: 

FAMILY HISTORY: The patient is divorced with five children.
He is a single parent looking after an 11-year-old son.  His
mother died of diabetes.  The patient smoked two packs per
day until 12 years ago.  The patient used excessive alcohol
until ten years ago.  He also used multiple illicit drugs
until ten years ago. He has hepatitis C chronically.

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Urinary complications, not elsewhere classified,Acute kidney failure with lesion of tubular necrosis,Other postoperative infection,Cellulitis and abscess of leg, except foot,Long-term (current) use of anticoagulants,Acute myocardial infarction of other inferior wall, subsequent episode of care,Pure hypercholesterolemia,Personal history of other diseases of circulatory system'}
