CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78-year-old
male who reported a 10-year history of vague exertional chest
pain.  He was then sent for ETT which revealing the patient
to be complaining of chest pain and also had abnormal
electrocardiogram with ST depressions in the inferolateral
leads.  He was then referred for cardiac catheterization
which showed three-vessel disease.  Cardiac surgery was done
consulted for possible coronary bypass graft surgery.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Diabetes mellitus type 2.  Prostate cancer in [**2115**].  Colon
cancer in [**2124**].

MEDICATION ON ADMISSION: Lisinopril 20 daily, Aspirin 162
mg daily, Vitamin C 500 mg daily, Norvasc 5 mg daily, Lipitor
10 mg daily, Niaspan 750 mg daily, Verapamil 240 mg daily,
Avandamet 1000/2 twice daily, Folic Acid 400 mg daily,
Multivitamin daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: General:  He was neurologically
alert and oriented with no focal deficits.  Lungs:  Clear
bilaterally.  Heart:  Regular, rate, and rhythm.  Abdomen:
Soft, nontender, nondistended.  Positive bowel sounds.
Extremities:  Warm, nonedematous. His leg incision was also
clean and dry.  Chest:  His sternal incision was clean, dry,
and intact with no drainage or erythema.

FAMILY HISTORY: Sister and brother had coronary artery
bypass graft at ages between 60 and 70.

SOCIAL HISTORY: The patient lives in [**Location 745**].  He is a
retired child psychiatrist.  Tobacco history revealed that he
quit smoking in [**2087**] after a less than 18-year pack-history.
He drinks wine occasionally on the weekends.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Hx-prostatic malignancy
Name: [**Known lastname **],[**Initials (NamePattern4) **] [**Last Name (NamePattern4) 399**]
Unit No:  [**Numeric Identifier 15234**]
Admission Date: [**2130-9-6**]
Discharge Date: [**2130-9-12**]
Date of Birth:  [**2052-4-28**]
Sex:  M
Service:  CSU


ADDENDUM:

DISCHARGE DIAGNOSES:  Coronary artery disease, status post
coronary artery bypass graft times three with grafts as
follows:  Left internal mammary artery to left anterior
descending coronary artery, saphenous vein graft to obtuse
marginal, saphenous vein graft to posterior descending
coronary artery.

Hypertension.

Hypercholesterolemia.

Diabetes mellitus type 2.

Peripheral vascular disease.

Status post right femoral popliteal in [**2122**].

Prostate cancer in [**2115**], status post prostatectomy in [**2115**],

Colon cancer in [**2124**], status post right hemicolectomy in
[**2124**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 7368**]

Dictated By:[**Last Name (NamePattern1) 15235**]
MEDQUIST36
D:  [**2130-10-18**] 11:02:27
T:  [**2130-10-18**] 18:12:16
Job#:  [**Job Number 15236**]






Admission Date: [**2130-9-6**]        Discharge Date: [**2130-9-12**]

Date of Birth:  [**2052-4-28**]        Sex:  M

Service:  CSU


HISTORY OF PRESENT ILLNESS:  The patient is a 78-year-old
male who reported a 10-year history of vague exertional chest
pain.  He was then sent for ETT which revealing the patient
to be complaining of chest pain and also had abnormal
electrocardiogram with ST depressions in the inferolateral
leads.  He was then referred for cardiac catheterization
which showed three-vessel disease.  Cardiac surgery was done
consulted for possible coronary bypass graft surgery.

PAST MEDICAL HISTORY:  Hypertension.  Hypercholesterolemia.
Diabetes mellitus type 2.  Prostate cancer in [**2115**].  Colon
cancer in [**2124**].

PAST SURGICAL HISTORY:  Prostatectomy in [**2115**].  Right femoral-
popliteal bypass in [**2122**].  Right hemicolectomy in [**2124**].
Right inguinal hernia repair in [**2124**].  Tonsillectomy.  Right
hip abscess excision.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Lisinopril 20 daily, Aspirin 162
mg daily, Vitamin C 500 mg daily, Norvasc 5 mg daily, Lipitor
10 mg daily, Niaspan 750 mg daily, Verapamil 240 mg daily,
Avandamet 1000/2 twice daily, Folic Acid 400 mg daily,
Multivitamin daily.

SOCIAL HISTORY:  The patient lives in [**Location 745**].  He is a
retired child psychiatrist.  Tobacco history revealed that he
quit smoking in [**2087**] after a less than 18-year pack-history.
He drinks wine occasionally on the weekends.

FAMILY HISTORY:  Sister and brother had coronary artery
bypass graft at ages between 60 and 70.

REVIEW OF SYMPTOMS:  The patient admits to a 10-pound weight
loss.  He otherwise said he eats well, sleeps well, and he is
generally healthy.  He denied any skin problems such as
eczema, psoriasis, or other lesions, but stated that he does
have dry skin.  He admits to cataracts but denied glaucoma,
and he also wears glasses.  The patient denied any history of
shortness of breath, dizziness, asthma history, bronchitis,
chronic obstructive pulmonary disease.  The patient also did
admit to edema in his lower extremities, right being greater
than the left, along with claudication, again right being
greater than the left, which comes on in about [**11-18**] blocks
when walking.  He denied any abdominal pain, nausea,
vomiting, diarrhea, or constipation.  He did admit to
nocturia, 2-3 times a night.  Rare incontinence.  He admits
to osteoarthritis in the hands.  He denied any fractures.  He
denied any history of cerebrovascular accident, transient
ischemic attacks, seizures.  He stated sometime in [**2115**] he
had a transient global amnesia.  He has had none since.  He
denied any anemia, bleeding disorder, but stated that he does
bleed easily.

PHYSICAL EXAMINATION:  Vital signs:  The patient is 5 feet 10
inches, weight 157.  Pulse 68, regular rhythm, blood pressure
173/81, oxygen saturation 97 percent on room air.  General:
He was laying flat in bed, in no acute distress .
Neurologic:  He was alert and oriented times three.  Cranial
nerves II-XII were intact.  He responded appropriately to all
questions.  Lungs:  Clear to auscultation bilaterally.
Heart:  Regular, rate, and rhythm.  Positive S1 and S2.  He
had a 2 out of 6 systolic ejection murmur.  Abdomen:  Soft,
flat, nontender, nondistended.  Positive bowel sounds.
Extremities:  Warm and well perfused.  He had trace edema in
the right leg.  The patient had no varicosities.  He had a
scar on his right leg from the femoral-popliteal bypass which
was well healed.  Pulses:  The right dorsalis pedis was 1
plus, left 1 plus, posterior tibial on right was 2 plus, left
1 plus, radials bilaterally were 2 plus.  He had bilateral
carotid bruits.

LABORATORY DATA:  Preoperatively his white count was 4.1,
hematocrit 33.9, platelet count 186; sodium 133, potassium
3.7, chloride 99, bicarb 26, BUN 14, creatinine 0.7, glucose
100; pt 12.3, PTT 28.2, INR 1; ALT 23, AST 24, alkaline
phosphatase 46, amylase 73, total bilirubin 0.3, albumin 3.8,
hemoglobin A1C 6.1; urinanalysis negative.

Preoperative chest x-ray showed left lower lobe atelectasis
and baseline chronic obstructive pulmonary disease.  His
carotid ultrasound, done because the patient had carotid
bruits, showed stenosis of the right internal carotid artery
and less than 40 percent stenosis of the left internal
carotid artery.

His cardiac catheterization revealed an ejection fraction of
65.  The patient had three-vessel disease.  His left anterior
descending coronary artery was 100 percent stenosis, left
circumflex was 50 percent, obtuse marginal 1 50 percent in
mid circumflex, and  90 percent obtuse marginal 2.  Right
coronary artery was 60 percent mid, 80 percent distal, and 90
percent posterolateral.  He also had normal systolic
ventricular function and mild diastolic left ventricular
dysfunction.

After discussion with Dr. [**Last Name (STitle) 70**], the patient agreed to
have bypass surgery.

HOSPITAL COURSE:  On [**2130-9-7**], the patient was
brought to the Operating Room and underwent general
anesthesia, and had coronary artery bypass surgery times
three.  Grafts were as follows:  Left internal mammary artery
to left anterior descending coronary artery, saphenous vein
graft to obtuse marginal, saphenous vein graft to posterior
descending coronary artery.  The patient tolerated the
procedure well.  Cardiopulmonary bypass time was 92 minutes.
Cross-clamp time was 44 minutes.

Following the procedure, the patient was brought to CSRU and
was titrated on Neo-Synephrine drip and Propofol.  His mean
arterial pressure was 66, CVP was __________ , diastolic was
14, PA mean was 21.

On postoperative day 2, the patient was successfully
extubated and appeared to be going well.  He was weaned from
all drips.  He was hemodynamically stable.  His temperature
was 99.9, and heart rate 79 in sinus rhythm.  Blood pressure
was 138/52.  His PA pressures were 26/11.  He was receiving 4
L nasal cannula.  His oxygen saturation was 98 percent.  His
physical examination was unremarkable besides 1 plus edema.

The plan was to start Lopressor and Lasix and get the patient
out of bed, have pulmonary toilet, and possibly discontinue
chest tubes.

On postoperative day 1, the patient continued to do well, and
he was transferred to FAR2 to the Telemetry Floor.

On postoperative day 2, the patient continued to do well.
His vital signs were stable.  His chest tubes were
discontinued.  The patient was seen by Physical Therapy and
encouraged to ambulate and continue with pulmonary toilet.

On postoperative day 3, the patient had no events over night.
He was hemodynamically stable.  Blood pressure was 120/66.
Heart rate was 88 in normal sinus rhythm.  The plan was to
increase the patient's Lopressor to 37.5 mg b.i.d. and to
discontinue his epicardial pacing wires.

On postoperative day 5, the patient was improving
significantly and appeared to be doing very well.  His pulse
was 56 in sinus rhythm.  His respiratory rate was 20.  Blood
pressure was 148/70.  His hematocrit was 27.9, potassium 3.6,
BUN 16, creatinine 0.7.

DISCHARGE PHYSICAL EXAM:  General:  He was neurologically
alert and oriented with no focal deficits.  Lungs:  Clear
bilaterally.  Heart:  Regular, rate, and rhythm.  Abdomen:
Soft, nontender, nondistended.  Positive bowel sounds.
Extremities:  Warm, nonedematous. His leg incision was also
clean and dry.  Chest:  His sternal incision was clean, dry,
and intact with no drainage or erythema.

DISPOSITION:  The patient was discharged today on [**2130-9-12**].  He was discharged in good condition to home with
services.

FOLLOW UP:  He was recommended to follow-up with Dr.
[**Last Name (STitle) 70**] in six weeks and with Dr. [**Last Name (STitle) 172**] in [**12-20**] weeks.

DISCHARGE MEDICATIONS:  Lasix 20 mg daily, KCl 10 mEq 2 cap
p.o. twice a day, Colace 100 mg b.i.d., Protonix 40 mg q.24,
Aspirin 325 mg daily, Lipitor 10 mg daily, Dilaudid 2 mg 1
tab p.o. q.4-6 hours as needed for pain, Lopressor 25 mg
b.i.d., Avandamet 2-1000 mg tab b.i.d., Niaspan 750 mg
b.i.d., Plavix 75 mg daily.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5662**], [**MD Number(1) 5663**]

Dictated By:[**Last Name (NamePattern1) 25060**]
MEDQUIST36
D:  [**2130-10-18**] 10:57:05
T:  [**2130-10-18**] 11:44:52
Job#:  [**Job Number 95977**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,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: The patient is a 78-year-old
male who reported a 10-year history of vague exertional chest
pain.  He was then sent for ETT which revealing the patient
to be complaining of chest pain and also had abnormal
electrocardiogram with ST depressions in the inferolateral
leads.  He was then referred for cardiac catheterization
which showed three-vessel disease.  Cardiac surgery was done
consulted for possible coronary bypass graft surgery.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Diabetes mellitus type 2.  Prostate cancer in [**2115**].  Colon
cancer in [**2124**].

MEDICATION ON ADMISSION: Lisinopril 20 daily, Aspirin 162
mg daily, Vitamin C 500 mg daily, Norvasc 5 mg daily, Lipitor
10 mg daily, Niaspan 750 mg daily, Verapamil 240 mg daily,
Avandamet 1000/2 twice daily, Folic Acid 400 mg daily,
Multivitamin daily.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: General:  He was neurologically
alert and oriented with no focal deficits.  Lungs:  Clear
bilaterally.  Heart:  Regular, rate, and rhythm.  Abdomen:
Soft, nontender, nondistended.  Positive bowel sounds.
Extremities:  Warm, nonedematous. His leg incision was also
clean and dry.  Chest:  His sternal incision was clean, dry,
and intact with no drainage or erythema.

FAMILY HISTORY: Sister and brother had coronary artery
bypass graft at ages between 60 and 70.

SOCIAL HISTORY: The patient lives in [**Location 745**].  He is a
retired child psychiatrist.  Tobacco history revealed that he
quit smoking in [**2087**] after a less than 18-year pack-history.
He drinks wine occasionally on the weekends. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate'}
