CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 84-year-old
male with a history of hypertension, hypercholesterolemia and
a long history of angina with a normal exercise tolerance
test earlier this year, who developed substernal chest pain
at home radiating to the left shoulder.  He had no
palpitations or shortness of breath.

MEDICAL HISTORY: The past medical history included
hypertension, hypercholesterolemia, angina times six years
and glaucoma.

MEDICATION ON ADMISSION: Toprol.
Zestril 40 mg p.o. q.d.
Colchicine 0.6 mg p.o. q.d.
Cardura 4 mg p.o. q.d.
Lipitor 10 mg p.o. q.d.
Imdur.
Xalatan.
Timoptic.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified essential hypertension,Pure hypercholesterolemia
Crnry athrscl natve vssl,Intermed coronary synd,Surg compl-heart,Atrial fibrillation,Urin tract infection NOS,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2125-9-11**]       Discharge Date:  [**2125-9-21**]


Service:  CT SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is an 84-year-old
male with a history of hypertension, hypercholesterolemia and
a long history of angina with a normal exercise tolerance
test earlier this year, who developed substernal chest pain
at home radiating to the left shoulder.  He had no
palpitations or shortness of breath.

An electrocardiogram showed a diffuse 2 to [**Street Address(2) 2051**] depression
in the precordial leads.  A CK showed an elevation of 475
with a positive MB and a positive troponin.  A cardiac
catheterization showed a tight left main coronary artery and
60% right coronary artery occlusion with a right to left
collateral filling left anterior descending artery and left
circumflex coronary artery.  The ejection fraction was
estimated to be 40%.  The patient was placed on an
intra-aortic balloon pump on [**2125-9-11**].

PAST MEDICAL HISTORY:  The past medical history included
hypertension, hypercholesterolemia, angina times six years
and glaucoma.

MEDICATIONS ON ADMISSION:
Toprol.
Zestril 40 mg p.o. q.d.
Colchicine 0.6 mg p.o. q.d.
Cardura 4 mg p.o. q.d.
Lipitor 10 mg p.o. q.d.
Imdur.
Xalatan.
Timoptic.

HOSPITAL COURSE:  The patient was taken to the operating room
by Dr. [**Last Name (STitle) 1537**] on [**2125-9-12**] and underwent coronary artery bypass
graft times three with a left internal mammary artery graft
to the left anterior descending artery, a saphenous vein
graft to the obtuse marginal artery and a saphenous vein
graft to the posterior descending artery.  Postoperatively,
the patient's recovery was complicated by respiratory issues.
The patient failed extubation several times, but was
eventually extubated and transferred to the floor on
[**2125-9-19**].

While on the floor, the patient developed confusion and
pulled out the Foley catheter with the balloon inflated.
Also, on the same day, the patient subsequently became
confused, got out of bed and had an unwitnessed fall.  He
underwent a CT scan of the head without contrast, which did
not show any hemorrhage; no acute infarct or stroke was seen
and this was a negative head CT scan.

A Foley catheter was then replaced in the patient and
initially revealed some bloody drainage, but then the urine
color was clear and returned to [**Location 213**].  We opted to leave
the Foley catheter in for three days.  The Foley catheter
will be taken out at the rehabilitation center.

Also, the patient's recovery was complicated by Clostridium
difficile that was positive by stool culture.  The patient
was started off on Flagyl 500 mg p.o. t.i.d. on [**2125-9-18**].

Upon discharge, the patient's vital signs were stable.  The
patient was off sitter for 24 hours.  Postoperatively, the
patient also had developed atrial fibrillation on [**2125-9-19**]
and was subsequently started on amiodarone.  Upon discharge,
he was in normal sinus rhythm.

DISCHARGE MEDICATIONS:
Flagyl 500 mg p.o. t.i.d. times seven days.
Amiodarone 400 mg p.o. t.i.d. times one week, 400 mg p.o.
b.i.d. times one week and then 400 mg p.o. q.d.
Lopressor 25 mg p.o. b.i.d.
Lasix 20 mg p.o. b.i.d. times five days.
[**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o. b.i.d. times five days.
Lipitor 10 mg p.o. q.d.

FOLLOWUP:  The patient was told to follow up with Dr. [**Last Name (STitle) 1537**] in
three to four weeks.  He is to have his Foley catheter taken
out on Sunday, [**2125-9-23**].




                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Name8 (MD) 186**]
MEDQUIST36

D:  [**2125-9-21**]  08:25
T:  [**2125-9-21**]  08:56
JOB#:  [**Job Number 36430**]


Admission Date:  [**2125-9-11**]     Discharge Date:  [**2125-9-22**]


Service:  CT Surgery

ADDENDUM:  The patient was admitted on [**2125-9-11**] for
coronary artery bypass grafting times three.  The patient was
scheduled to leave the hospital to transfer to a
rehabilitation center on [**2125-9-21**], however, prior to
transfer, the patient spiked a fever to 101.  Subsequently,
the patient was cultured, a chest x-ray was obtained and a
urinalysis was sent off.  The urinalysis was positive and the
patient was started on oral ciprofloxacin 500 mg twice a day
times seven days.  The chest x-ray showed some pleural
effusion in the left chest.  This was subsequently tapped and
500 cc of serosanguinous fluid was drawn and sent for
cytology and culture.  The cell count and pH indicated that
the fluid was sterile and the patient reported that his
respiratory status was improved.  The patient was to be
transferred to a rehabilitation facility on [**2125-9-22**].
The patient has been afebrile times 24 hours with stable
vital signs.  His incision was clean, dry and intact without
drainage or pus.  His sternum was stable.  Chest was clear.
The patient was in normal sinus rhythm.







Dictated By:[**Name8 (MD) 186**]

MEDQUIST36

D:  [**2125-9-22**]  10:21
T:  [**2125-9-22**]  10:24
JOB#:  [**Job Number 36431**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified essential hypertension,Pure hypercholesterolemia'}


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 an 84-year-old
male with a history of hypertension, hypercholesterolemia and
a long history of angina with a normal exercise tolerance
test earlier this year, who developed substernal chest pain
at home radiating to the left shoulder.  He had no
palpitations or shortness of breath.

MEDICAL HISTORY: The past medical history included
hypertension, hypercholesterolemia, angina times six years
and glaucoma.

MEDICATION ON ADMISSION: Toprol.
Zestril 40 mg p.o. q.d.
Colchicine 0.6 mg p.o. q.d.
Cardura 4 mg p.o. q.d.
Lipitor 10 mg p.o. q.d.
Imdur.
Xalatan.
Timoptic.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Cardiac complications, not elsewhere classified,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified essential hypertension,Pure hypercholesterolemia'}
