CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 36243**] is a 67-year-old male
with a history of hypertension, diabetes, cerebrovascular
accident x 2, coronary artery disease status post myocardial
infarction with residual ejection fraction of 20%, with
severe shortness of breath on [**2152-6-26**].  Shortly
thereafter.

MEDICAL HISTORY: 1.  Coronary artery disease; status post myocardial
infarction.
2.  Congestive heart failure.
3.  Upper gastrointestinal bleed.
4.  Non-insulin-dependent diabetes mellitus.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Cerebrovascular accident times two.
8.  Right foot drop.

MEDICATION ON ADMISSION: (Medications at home included)
1.  Aspirin 325 mg p.o. once per day.
2.  Plavix 75 mg p.o. once per day.
3.  Carvedilol 3.125 mg p.o. once per day.
4.  Captopril.
5.  Lasix (as titrated by cardiologist).
6.  Lipitor.

ALLERGIES: PERTINENT LABORATORY VALUES ON PRESENTATION:  As of [**2152-7-25**], white blood cell count was 12.7, hematocrit was 32.5,
and platelets were 384.  Sodium was 135, potassium was 5.1,
chloride was 99, bicarbonate was 28, blood urea nitrogen was
49, creatinine was 1.8, and blood glucose was 78.  Calcium
was 8.4, magnesium was 2.1, and phosphate was 4.3.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Cardiogenic shock,Other complications due to other cardiac device, implant, and graft,Atrioventricular block, complete,Bacteremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Subendo infarct, initial,CHF NOS,Cardiogenic shock,Comp-oth cardiac device,Atriovent block complete,Bacteremia,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2152-6-26**]       Discharge Date:  [**2152-7-19**]

Date of Birth:   [**2084-7-14**]       Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 36243**] is a 67-year-old male
with a history of hypertension, diabetes, cerebrovascular
accident x 2, coronary artery disease status post myocardial
infarction with residual ejection fraction of 20%, with
severe shortness of breath on [**2152-6-26**].  Shortly
thereafter.

INCOMPLETE DICTATION - DICTATOR CANCELED.





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

Dictated By:[**Name8 (MD) 11079**]
MEDQUIST36

D:  [**2152-7-19**]  10:13
T:  [**2152-7-19**]  10:34
JOB#:  [**Job Number 49366**]


Admission Date:  [**2152-6-26**]       Discharge Date:  [**2152-7-26**]

Date of Birth:   [**2084-7-14**]       Sex:  M

Service:

NOTE:  This job put with job #[**Numeric Identifier 49367**] which was cut off.






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

Dictated By:[**Name8 (MD) 11079**]
MEDQUIST36

D:  [**2152-7-25**]  19:54
T:  [**2152-7-25**]  19:57
JOB#:  [**Job Number 49368**]


Admission Date:  [**2152-6-26**]       Discharge Date:  [**2152-7-26**]

Date of Birth:   [**2084-7-14**]       Sex:  M

Service:  CTS

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 36243**] is a 67-year-old male
with a history of hypertension, diabetes, cerebrovascular
accident times two, and coronary artery disease (status post
a myocardial infarction with residual ejection fraction of
20%) presenting with severe shortness of breath on [**2152-6-26**].  The patient also had shortness of breath and chest
tightness which was very typical for the patient's prior
angina.

Because the patient's blood pressure became labile and became
refractory to boluses, the patient was originally rushed to
the [**Hospital1 69**] Catheterization
Laboratory for a cardiovascular evaluation.

Coronary angiography revealed left anterior descending artery
with 90% stent restenosis, 90% stenosis in the first
diagonal, serial 80% stenosis beyond the stent, along with an
ostial lesion and the right coronary artery with diffuse
disease.

Given the severe nature of this 3-vessel disease, including
the stent restenosis, urgent surgical consultation was
obtained.

PAST MEDICAL HISTORY:
1.  Coronary artery disease; status post myocardial
infarction.
2.  Congestive heart failure.
3.  Upper gastrointestinal bleed.
4.  Non-insulin-dependent diabetes mellitus.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Cerebrovascular accident times two.
8.  Right foot drop.

MEDICATIONS ON ADMISSION:  (Medications at home included)
1.  Aspirin 325 mg p.o. once per day.
2.  Plavix 75 mg p.o. once per day.
3.  Carvedilol 3.125 mg p.o. once per day.
4.  Captopril.
5.  Lasix (as titrated by cardiologist).
6.  Lipitor.

ALLERGIES:

PERTINENT LABORATORY VALUES ON PRESENTATION:  As of [**2152-7-25**], white blood cell count was 12.7, hematocrit was 32.5,
and platelets were 384.  Sodium was 135, potassium was 5.1,
chloride was 99, bicarbonate was 28, blood urea nitrogen was
49, creatinine was 1.8, and blood glucose was 78.  Calcium
was 8.4, magnesium was 2.1, and phosphate was 4.3.

HOSPITAL COURSE:  The patient is a 68-year-old male with a
history of hypertension, status post extensive anterior
myocardial infarction, presenting to [**Hospital1 190**] in cardiogenic shock.

The patient was initiated in an intra-aortic balloon pump on
1:1 and Plavix was discontinued.  The patient was also
initiated on heparinization with a prothrombin time target of
60 to 80 and maintained ins-and-outs even with intravenous
Lasix as needed.

On [**2152-6-29**], the patient developed a complete heart block
with no ventricular escape rhythm.  A temporary pacemaker
were placed via right internal jugular and pulmonary artery
catheter was discontinued.

Given this finding, and urgent Electrophysiology Service
consultation was obtained for a potential placement of
biventricular pacemaker.  Electrophysiology recommendations
maintained that since no further heart block occurred and the
patient continued to have sinus tachycardia with a left
bundle-branch block (which existed previously), the patient's
pacing threshold was readjusted and a temporary wire was
maintained.  Daily threshold checks were also continued, and
further evaluation for implantable cardioverter-defibrillator
implantable cardioverter-defibrillator placement would be
considered in the future.

By [**2152-7-5**], a temporary screw was placed in the right
internal jugular with pacemaker programmed VVI at 40.  If the
patient was to have a prolonged bradycardia, the pacing would
initiate.

By [**2152-7-9**] the patient had become sufficiently
stabilized for surgical intervention.  At this time, the
patient was successfully prepared for operation for a
coronary artery bypass graft and mitral valve repair.

On [**2152-7-10**], the patient underwent an uncomplicated
coronary artery bypass graft times four with intra-aortic
balloon pump (with left internal mammary artery to left
anterior descending artery, saphenous vein graft to diagonal,
saphenous vein graft to obtuse marginal, and saphenous vein
graft to posterior descending artery).

Postoperatively, the patient was maintained intubated and
sedated with heart rate ventricularly paced on pressors as
well as on an amiodarone drip.

By postoperative day four, the patient was extubated and
maintained good oxygenation with minimal supplemental oxygen
support.

By postoperative day eight, the patient was transitioned to
the floor following successful weaning off from the
intra-aortic balloon pump as well as being maintained on room
air with good oxygenation.

At this point, the patient was continued on vancomycin for a
methicillin-resistant Staphylococcus aureus culture which
developed from the intra-aortic balloon pump site.

By [**2152-7-20**], with the dramatic clinical improvement in
the patient, Electrophysiology was consulted again along with
Infectious Disease for evaluation of the patient for a
possible biventricular pacemaker.

Because of the prior history of infection, the patient was
discontinued after a 20-day course of vancomycin and
recultured at that time.  The culture results remained
negative throughout the remainder of the patient's
hospitalization; however, the patient developed a right lower
extremity erythema near the incision site along with mild
serosanguineous drainage from the sternotomy incision site at
this time.  Additionally, as the patient had accumulated
approximately 10 kilograms of fluids throughout the
hospitalization, it was decided that aggressive diuresis was
necessary in order to maintain the patient in a supine
position for the placement of the implantable
cardioverter-defibrillator.

Given these factors, as well as the fact that the patient had
not had any further recurrence of complete heart block, the
patient was evaluated again by the Electrophysiology Service.
The study by the Electrophysiology Service revealed that
there was a noncritical His-Purkinje system disease as well
as inducible ventricular tachycardia during the procedure.

It was decided at this time that a dual-chamber implantable
cardioverter-defibrillator would be best once the patient had
received further diuresis as well as further time for any
infectious process to declare themselves.

By postoperative day sixteen, the decision was made to
discharge the patient in good condition to a rehabilitation
facility where the patient's cardiac status would be
continuously monitored.

Prior to being discharged to home from the rehabilitation
facility the patient would return to [**Hospital1 190**] for the implantable cardioverter-defibrillator
placement.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  Discharge status was to a rehabilitation
facility.

DISCHARGE DIAGNOSES:
1.  Status post coronary artery bypass graft (with left
internal mammary artery to left anterior descending artery,
saphenous vein graft to diagonal, saphenous vein graft to
obtuse marginal, saphenous vein graft to posterior descending
artery).
2.  Status post placement of temporary pacemaker.
3.  Complete heart block.
4.  Left bundle-branch block.
5.  Cardiogenic shock.
6.  Congestive heart failure.

MEDICATIONS ON ADMISSION:
 1.  Levofloxacin 500 mg p.o. once per day.
 2.  Amiodarone 400 mg p.o. once per day.
 3.  Bumex 1 mg p.o. once per day.
 4.  Metoprolol 12.5 mg p.o. twice per day.
 5.  Hydralazine 25 mg p.o. four times per day.
 6.  Plavix 75 mg p.o. once per day.
 7.  Aspirin 81 mg p.o. once per day.
 8.  NPH 22 units subcutaneously q.a.m. and 22 units
subcutaneously q.p.m.
 9.  Lipitor 10 mg p.o. once per day.
10.  Atorvastatin 10 mg p.o. once per day.
11.  Percocet as needed.
12.  Colace 100 mg p.o. twice per day.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to follow up with the
Electrophysiology Service prior to being discharged from
rehabilitation facility for a implantable
cardioverter-defibrillator placement.  The patient can reach
the Electrophysiology facility at telephone number
[**Telephone/Fax (1) 5518**].
2.  Additionally, the patient was to follow up with Dr. [**First Name (STitle) **]
[**Last Name (Prefixes) **] in four weeks after discharge.
3.  The patient was also to follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 174**]
for issues pertaining to diuresis and titration of cardiac
medications.






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

Dictated By:[**Name8 (MD) 11079**]
MEDQUIST36

D:  [**2152-7-25**]  19:21
T:  [**2152-7-25**]  19:30
JOB#:  [**Job Number 49367**]
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Cardiogenic shock,Other complications due to other cardiac device, implant, and graft,Atrioventricular block, complete,Bacteremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: Mr. [**Known lastname 36243**] is a 67-year-old male
with a history of hypertension, diabetes, cerebrovascular
accident x 2, coronary artery disease status post myocardial
infarction with residual ejection fraction of 20%, with
severe shortness of breath on [**2152-6-26**].  Shortly
thereafter.

MEDICAL HISTORY: 1.  Coronary artery disease; status post myocardial
infarction.
2.  Congestive heart failure.
3.  Upper gastrointestinal bleed.
4.  Non-insulin-dependent diabetes mellitus.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Cerebrovascular accident times two.
8.  Right foot drop.

MEDICATION ON ADMISSION: (Medications at home included)
1.  Aspirin 325 mg p.o. once per day.
2.  Plavix 75 mg p.o. once per day.
3.  Carvedilol 3.125 mg p.o. once per day.
4.  Captopril.
5.  Lasix (as titrated by cardiologist).
6.  Lipitor.

ALLERGIES: PERTINENT LABORATORY VALUES ON PRESENTATION:  As of [**2152-7-25**], white blood cell count was 12.7, hematocrit was 32.5,
and platelets were 384.  Sodium was 135, potassium was 5.1,
chloride was 99, bicarbonate was 28, blood urea nitrogen was
49, creatinine was 1.8, and blood glucose was 78.  Calcium
was 8.4, magnesium was 2.1, and phosphate was 4.3.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Congestive heart failure, unspecified,Cardiogenic shock,Other complications due to other cardiac device, implant, and graft,Atrioventricular block, complete,Bacteremia,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
