CHIEF COMPLAINT: 

PRESENT ILLNESS: This 55 year old gentleman had
the recent onset of chest pressure.  He developed chest pain
on [**11-7**], took one sublingual Nitroglycerin at this time with
temporary improvement of chest pain that returned.  He came
in to the [**Hospital1 69**] to be
evaluated.

MEDICAL HISTORY: 1.  In [**2089**], the patient developed a large cell gastric
lymphoma.  He was treated with surgery, chemotherapy and
radiation to the lower mediastinum.
2.  In [**2099-7-12**], the patient underwent an echocardiogram.
Ejection fraction at that time was 55 with plus one mitral
regurgitation.  There was a question of mobile aortic
atheroma.  Subsequent transesophageal echocardiogram revealed
some atherosclerosis in the aorta and a strand in one of the
aortic cusps of unknown significance.  The patient remained
asymptomatic.
3.  In [**2104-2-12**], the patient began to use his
treadmill at home to exercise and did well.
4.  In [**2104-7-12**], after a vacation in [**Country 6607**], the patient
noted decrease in his exercise tolerance when using his
treadmill and he stopped exercising at that time and remained
asymptomatic.  Recently, when he was walking after eating, he
reports classical angina pressure which abated after two
minutes of rest.  He went to his primary care practitioner
[**First Name (Titles) **] [**Last Name (Titles) 2742**] of this new onset angina and was started on
aspirin and atenolol at that time.  He underwent a stress
test that was strongly positive for multi-vessel disease and
was recommended for cardiac catheterization follow-up.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of an myocardial infarction at
81.  Mother and siblings have no identifiable cardiac risk
factors.

SOCIAL HISTORY: The patient is married and lives with wife.
[**Name (NI) **] denies smoking.
Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Personal history of other lymphatic and hematopoietic neoplasms
Subendo infarct, initial,Crnry athrscl natve vssl,Chr pulmon heart dis NEC,Hx-lymphatic malign NEC
Admission Date:  [**2104-11-7**]       Discharge Date:  [**2104-11-12**]

Date of Birth:   [**2049-1-2**]       Sex:  M

Service:  CARDIOTHOR

HISTORY OF PRESENT ILLNESS:  This 55 year old gentleman had
the recent onset of chest pressure.  He developed chest pain
on [**11-7**], took one sublingual Nitroglycerin at this time with
temporary improvement of chest pain that returned.  He came
in to the [**Hospital1 69**] to be
evaluated.

PAST MEDICAL HISTORY:
1.  In [**2089**], the patient developed a large cell gastric
lymphoma.  He was treated with surgery, chemotherapy and
radiation to the lower mediastinum.
2.  In [**2099-7-12**], the patient underwent an echocardiogram.
Ejection fraction at that time was 55 with plus one mitral
regurgitation.  There was a question of mobile aortic
atheroma.  Subsequent transesophageal echocardiogram revealed
some atherosclerosis in the aorta and a strand in one of the
aortic cusps of unknown significance.  The patient remained
asymptomatic.
3.  In [**2104-2-12**], the patient began to use his
treadmill at home to exercise and did well.
4.  In [**2104-7-12**], after a vacation in [**Country 6607**], the patient
noted decrease in his exercise tolerance when using his
treadmill and he stopped exercising at that time and remained
asymptomatic.  Recently, when he was walking after eating, he
reports classical angina pressure which abated after two
minutes of rest.  He went to his primary care practitioner
[**First Name (Titles) **] [**Last Name (Titles) 2742**] of this new onset angina and was started on
aspirin and atenolol at that time.  He underwent a stress
test that was strongly positive for multi-vessel disease and
was recommended for cardiac catheterization follow-up.

The patient denied anemia, asthma, congestive heart failure,
chronic obstructive pulmonary disease, stroke, diabetes
mellitus, GI bleed, hepatitis, hypertension, liver failure,
prior stroke, pancreatitis.  The patient does have a history
of high cholesterol.

SOCIAL HISTORY:  The patient is married and lives with wife.
[**Name (NI) **] denies smoking.

FAMILY HISTORY:  Father died of an myocardial infarction at
81.  Mother and siblings have no identifiable cardiac risk
factors.

MEDICATIONS UPON ADMISSION:
1.  Atenolol.
2.  Aspirin.
3.  Lipitor.
4.  Vitamin E.

REVIEW OF SYSTEMS:  On admission were unremarkable.

PHYSICAL EXAMINATION:  On admission revealed a blood pressure
of 112/70; a heart rate of 65.  HEENT were benign.  Neck were
without carotid bruits.  Chest:  Heart was regular.  No
murmurs.  Respiratory:  Lungs were clear.  Abdomen was soft,
nontender, no masses.  Extremities were warm with normal
pulses.

LABORATORY:  The patient underwent a cardiac catheterization
on [**11-7**]; please refer to catheterization report for specific
details.  In summary findings revealed severe left main
disease with a two-vessel coronary artery disease,
biventricular diastolic dysfunction, moderate pulmonary
arterial hypertension.  An intra-aortic balloon pump was
placed and the patient went for emergent coronary artery
revascularization times five with a left internal mammary
artery and a saphenous vein graft.  Please refer to the
operative report for details of surgery.

The patient was transferred to the Intensive Care Unit
postoperative with the preoperative intra-aortic balloon pump
in place on Nitroglycerin and Propofol.  The patient remained
hemodynamically stable.

On [**11-8**], the patient's balloon pump was weaned and
discontinued and the intravenous Nitroglycerin was weaned
off.  On [**11-9**], the patient was extubated, beta blockade
initiated and he transferred out to the Floor on
postoperative day two.

On postoperative day three, the patient began increasing his
activity and remained hemodynamically stable.  At that time,
his epicardial wires and Foley catheter were discontinued.
Ambulation and pulmonary toilet was encouraged.  On
postoperative day five, the patient remains hemodynamically
stable.  He is ambulating successfully and able to climb a
flight of stairs and is being evaluated for discharge.

The patient is hemodynamically stable.

DISCHARGE PHYSICAL EXAMINATION:  Temperature 99.5 F.; heart
rate 71 and regular; blood pressure 118/65; respiratory rate
20 with a saturation of 93 on room air.  HEENT:  Grossly
intact.  Neurologic:  Alert and oriented times three and
moving equally with steady gait.  Cardiac:  S1, S2 regular.
No rub, no murmur appreciated.  Respiratory:  No dyspnea,
respiratory rate 20's.  He does present with rales 2 cm down
on the left and PA down on the right.  He denies dyspnea.
There is no wheezing, no cough.  He was treated with Lasix 40
intravenously times one prior to discharge.  Vascular:  He is
warm and dry.  He has palpable pulses bilaterally.  Wound,
chest and right leg incisions are open to air and they are
dry and intact with Steri-Strips.  There is no erythema and
there is no drainage.  On GI assessment, the patient has had
no nausea or vomiting.  Abdomen was soft, positive bowel
sounds, nontender.

DISCHARGE STATUS:   The patient's discharge status is stable.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease status post coronary artery
bypass grafting times five.

MEDICATIONS UPON DISCHARGE:
1.  Lopressor 50 mg p.o. twice a day.
2.  Enteric coated aspirin 325 mg p.o. q. day.
3.  Lasix 40 mg q. a.m. times two weeks; Lasix 20 mg p.o. q.
p.m. times two weeks.
4.  [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mEq p.o. twice a day times two weeks.
5.  Ibuprofen 400 mg p.o. q. six p.r.n. pain and discomfort.

DISCHARGE MEDICATIONS:
Note, preoperative Lipitor was not resumed due to an elevated
ALT on [**11-7**] of 88 and an AST of 138 and a total bilirubin of
1.9.  The patient is to follow-up with his primary care
provider in three weeks.

Further, labs from [**11-3**], white blood cell count was 13.6
with a hemoglobin of 9.1, and hematocrit of 26.5 with a
platelet count of 110.

Labs on [**11-11**], sodium of 139, potassium of 4.1, BUN of 28 and
a creatinine of 1.2 which remained stable and a glucose of
112.

DISCHARGE INSTRUCTIONS:
1.  The patient will increase activity.
2.  He will follow-up in the [**Hospital 409**] Clinic in two weeks.
3.  He will follow-up with his primary care physician in
three weeks post discharge and he will be re-evaluated by Dr.
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 70**] four weeks postoperatively.


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

Dictated By:[**Last Name (NamePattern1) 110709**]
MEDQUIST36

D:  [**2104-11-12**]  14:01
T:  [**2104-11-12**]  15:49
JOB#:  [**Job Number **]


Admission Date:  [**2104-11-7**]       Discharge Date:  [**2104-11-12**]

Date of Birth:   [**2049-1-2**]       Sex:  M

Service:  CARDIOTHOR








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

Dictated By:[**Last Name (NamePattern1) 110709**]
MEDQUIST36

D:  [**2104-11-12**]  14:01
T:  [**2104-11-12**]  15:49
JOB#:  [**Job Number **]
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Personal history of other lymphatic and hematopoietic neoplasms'}


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 55 year old gentleman had
the recent onset of chest pressure.  He developed chest pain
on [**11-7**], took one sublingual Nitroglycerin at this time with
temporary improvement of chest pain that returned.  He came
in to the [**Hospital1 69**] to be
evaluated.

MEDICAL HISTORY: 1.  In [**2089**], the patient developed a large cell gastric
lymphoma.  He was treated with surgery, chemotherapy and
radiation to the lower mediastinum.
2.  In [**2099-7-12**], the patient underwent an echocardiogram.
Ejection fraction at that time was 55 with plus one mitral
regurgitation.  There was a question of mobile aortic
atheroma.  Subsequent transesophageal echocardiogram revealed
some atherosclerosis in the aorta and a strand in one of the
aortic cusps of unknown significance.  The patient remained
asymptomatic.
3.  In [**2104-2-12**], the patient began to use his
treadmill at home to exercise and did well.
4.  In [**2104-7-12**], after a vacation in [**Country 6607**], the patient
noted decrease in his exercise tolerance when using his
treadmill and he stopped exercising at that time and remained
asymptomatic.  Recently, when he was walking after eating, he
reports classical angina pressure which abated after two
minutes of rest.  He went to his primary care practitioner
[**First Name (Titles) **] [**Last Name (Titles) 2742**] of this new onset angina and was started on
aspirin and atenolol at that time.  He underwent a stress
test that was strongly positive for multi-vessel disease and
was recommended for cardiac catheterization follow-up.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of an myocardial infarction at
81.  Mother and siblings have no identifiable cardiac risk
factors.

SOCIAL HISTORY: The patient is married and lives with wife.
[**Name (NI) **] denies smoking. 

### Response:
{'Subendocardial infarction, initial episode of care,Coronary atherosclerosis of native coronary artery,Other chronic pulmonary heart diseases,Personal history of other lymphatic and hematopoietic neoplasms'}
