CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 66-year-old male who
developed chest pain and shortness of breath while he was
shoveling snow [**2151-4-1**] for which he was admitted to
[**Hospital1 69**] and found to have an
acute myocardial infarction status post unsuccessful
thrombolytics and rescue PCI with an intra-aortic balloon
pump placement.  He was in the CCU for eight days which was
complicated by paracarditis, atrial fibrillation and atrial
flutter, and a right pleural effusion status post
thoracentesis as well as pneumonia, status post a 10 day
course of Levaquin.  He now presented for coronary artery
bypass grafting.

MEDICAL HISTORY: 1. Prostate cancer.
2. Atrial fibrillation and atrial flutter.
3. Pericarditis.
4. Pneumonia.
5. Right pleural effusion [**2151-3-20**] status post right
thoracentesis, and status post an anterior wall myocardial
infarction in [**2151-3-20**].

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a former smoker 1-2 packs per
day history for 40 years, discontinued six months prior to
surgery.  The patient is also a former alcohol abuser
drinking about a quart of alcohol or a case of beer per day
for 20 years.  However, he has been sober for 29 years.
Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Acute myocardial infarction of unspecified site, subsequent episode of care,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of prostate
Crnry athrscl natve vssl,Atrial fibrillation,AMI NOS, subsequent,Long-term use anticoagul,Hx-prostatic malignancy
Admission Date:  [**2151-5-5**]     Discharge Date:  [**2151-5-16**]

Date of Birth:   [**2084-9-21**]     Sex:  M

Service:  Cardiothoracic Surgery

PAST MEDICAL HISTORY:
1. Prostate cancer.
2. Atrial fibrillation and atrial flutter.
3. Pericarditis.
4. Pneumonia.
5. Right pleural effusion [**2151-3-20**] status post right
thoracentesis, and status post an anterior wall myocardial
infarction in [**2151-3-20**].

PAST SURGICAL HISTORY:  Patient's past surgical history is
significant for left inguinal hernia repair and prostatectomy
[**10-21**].

ALLERGIES:  The patient has no known drug allergies.

PREOPERATIVE MEDICATIONS:
1. Aspirin 325 mg q day.
2. Plavix 75 mg which was discontinued on [**2151-5-2**].
3. Levofloxacin 500 mg q24h which was discontinued [**4-19**].
4. Pravachol 20 mg po q day.
5. Toprol XL 25 mg po q day.
6. Lisinopril 5 mg which was discontinued [**2151-4-10**].
7. Coumadin 2.5 mg which was discontinued [**2151-3-30**].
8. Lovenox injections [**Hospital1 **], which was discontinued [**2151-4-3**].

SOCIAL HISTORY:  The patient is a former smoker 1-2 packs per
day history for 40 years, discontinued six months prior to
surgery.  The patient is also a former alcohol abuser
drinking about a quart of alcohol or a case of beer per day
for 20 years.  However, he has been sober for 29 years.

HISTORY OF PRESENT ILLNESS:  This is a 66-year-old male who
developed chest pain and shortness of breath while he was
shoveling snow [**2151-4-1**] for which he was admitted to
[**Hospital1 69**] and found to have an
acute myocardial infarction status post unsuccessful
thrombolytics and rescue PCI with an intra-aortic balloon
pump placement.  He was in the CCU for eight days which was
complicated by paracarditis, atrial fibrillation and atrial
flutter, and a right pleural effusion status post
thoracentesis as well as pneumonia, status post a 10 day
course of Levaquin.  He now presented for coronary artery
bypass grafting.

Cardiac catheterization was performed on [**2151-4-1**] which
revealed an unsuccessful intervention of the right coronary
artery.  Successful placement of a temporary pacing wire
which was placed for Wenckebach and bradycardia.  Left main
coronary artery disease, mildly diffuse, 70-80% left anterior
descending artery stenosis, and the mid right coronary artery
with 70% stenosis, distal right totally occluded.

Cardiac echocardiogram was done on [**2151-4-8**] which
revealed an ejection fraction of 30% with left ventricular
systolic function moderately-to-severely depressed secondary
to hypokinesis of the inferior septum and the inferior free
wall and moderate hypokinesis of the posterior wall.  There
is no A.I, no mitral valve prolapse, and 1+ mitral
regurgitation.

Patient underwent coronary artery bypass grafting x3 with the
left internal mammary artery to the left anterior descending,
saphenous vein graft to the obtuse marginal and saphenous
vein graft to the diagonal branch of the left circumflex on
[**2151-5-6**] as well as paracardial patch of the inferior
ventricular aneurysm.  Total cross-clamp time 44 minutes.
Total cardiopulmonary bypass time 89 minutes.

Patient was transferred to the Cardiac Surgery Recovery Unit
in stable condition in normal sinus rhythm at 87 beats per
minute on Neo-Synephrine at 0.9, milrinone at 0.25, and
propofol at 0.15.  The patient was extubated the same day of
surgery around 4 o'clock in the afternoon without
complication.  Postoperative day one, 24 hour events included
increased chest tube output draining 1500 cc over the last 24
hours.  The patient received 6 units of packed red blood
cells as well as 4 units of fresh-frozen plasma and
platelets.  The patient was still on a Neo-Synephrine drip of
0.75 and milrinone drip of 0.25.

Hemodynamically stable being A-paced, heart rate 90 with an
index of 2.28 and a CPP of 18.  Patient was afebrile with a
hematocrit that came up from 21 to 33.2.

Postoperative day two, the patient's chest tube output
decreasing with a 24 hour total of 1400 hematocrit stable at
33.  The patient went into atrial fibrillation overnight, and
was administered Lopressor as well as an amiodarone drip, and
because the patient's cardiac index continued to be on the
low side at 1.96, the patient continued to receive milrinone
at 0.25.

Postoperative day three, patient was administered a 150 mg IV
bolus of IV milrinone for the atrial fibrillation with a rate
of 90 to 100's.  He blocked down to sinus bradycardic, and
was continued to be A-paced at 80.  Still with an index
hovering around 2.0 on the milrinone drip at 0.125.

Patient's chest tubes drained 675 over the last 24 hours with
a hematocrit of 29.9.  Patient continued to go in and out of
atrial fibrillation for which she was administered amiodarone
boluses as well as Lopressor with good effect, converted back
to sinus with a good ventricular rate.  The patient was taken
off the milrinone with a stable cardiac index ranging between
1.9-2.

The patient was transferred to the floor on postoperative day
#5 in stable condition in normal sinus rhythm in the 70's
with a pacer off, however, attached.  Postoperative day six
24 hour events included the patient going in and out of
atrial fibrillation again while on the floor.  However,
converting back to sinus rhythm with a stable heart rate of
80.  The patient white count up [**Last Name (un) 5720**] 14 to 15.6, hematocrit
stable at 34.3.

Postoperative day six, the patient with complaints of an
anxiety attack, and patient was given 0.5 mg of Ativan with
good affect.  Patient remained in normal sinus rhythm over
the next few days still on an amiodarone drip at 400 with a
good heart rate in the 60's.  White count coming down to 13
and hematocrit stable at 29.6.

The patient did have two episodes of nausea and vomiting for
which an abdominal x-ray was performed which was negative.
Patient was administered Dulcolax suppository as well as a
Fleets enema, and the patient was discharged later on that
day, which was postoperative day 10 to home with visiting
nurse services in good condition.

Patient was in sinus rhythm with a heart rate of 68.  Vital
signs were stable.  Physical examination was benign.

DISCHARGE MEDICATIONS:
1. Lasix 20 mg po q day for seven days.
2. Potassium chloride 20 mEq po q day for seven days.
3. Coumadin 2.5 mg po q day.
4. Tylenol 3 prn pain.
5. Zantac [**Hospital1 **].
6. Colace [**Hospital1 **] prn.
7. Amiodarone 400 mg po q day.

DISCHARGE INSTRUCTIONS:  Follow up with Dr. [**Last Name (STitle) 70**] in six
weeks.  Follow up with PCP [**Last Name (NamePattern4) **] [**2-23**] weeks.

DISCHARGE DIAGNOSIS:  Coronary artery disease status post
coronary artery bypass grafting x3.



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

Dictated By:[**Doctor Last Name 2011**]

MEDQUIST36

D:  [**2151-6-3**]  11:51
T:  [**2151-6-7**]  10:39
JOB#:  [**Job Number 49433**]
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Acute myocardial infarction of unspecified site, subsequent episode of care,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of prostate'}


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 is a 66-year-old male who
developed chest pain and shortness of breath while he was
shoveling snow [**2151-4-1**] for which he was admitted to
[**Hospital1 69**] and found to have an
acute myocardial infarction status post unsuccessful
thrombolytics and rescue PCI with an intra-aortic balloon
pump placement.  He was in the CCU for eight days which was
complicated by paracarditis, atrial fibrillation and atrial
flutter, and a right pleural effusion status post
thoracentesis as well as pneumonia, status post a 10 day
course of Levaquin.  He now presented for coronary artery
bypass grafting.

MEDICAL HISTORY: 1. Prostate cancer.
2. Atrial fibrillation and atrial flutter.
3. Pericarditis.
4. Pneumonia.
5. Right pleural effusion [**2151-3-20**] status post right
thoracentesis, and status post an anterior wall myocardial
infarction in [**2151-3-20**].

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a former smoker 1-2 packs per
day history for 40 years, discontinued six months prior to
surgery.  The patient is also a former alcohol abuser
drinking about a quart of alcohol or a case of beer per day
for 20 years.  However, he has been sober for 29 years. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Acute myocardial infarction of unspecified site, subsequent episode of care,Long-term (current) use of anticoagulants,Personal history of malignant neoplasm of prostate'}
