CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 88 year old
man with known coronary artery disease and recently, three
weeks ago, an increase in dyspnea on exertion with minimal
exertion.  Patient was cathed today which showed three vessel
disease and 3+ mitral regurgitation with a preserved ejection
fraction.  OM 50, LAD 80, left circumflex 70, right coronary
artery 50, 2 to 3+ MR, ejection fraction 58%.

MEDICAL HISTORY: Glaucoma.  Atrial arrhythmia.  Chronic
renal insufficiency.  Shingles.  Permanent pacemaker placed
in [**10-14**].  Hypertension.  High cholesterol.

MEDICATION ON ADMISSION: 

ALLERGIES: Vasotec, Pronestyl.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Retention of urine, unspecified,Intermediate coronary syndrome,Cardiac pacemaker in situ,Pure hypercholesterolemia,Unspecified essential hypertension
Crnry athrscl natve vssl,Mitral valve disorder,Retention urine NOS,Intermed coronary synd,Status cardiac pacemaker,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2148-2-12**]       Discharge Date:  [**2148-2-21**]


Service:

HISTORY OF PRESENT ILLNESS:  The patient is an 88 year old
man with known coronary artery disease and recently, three
weeks ago, an increase in dyspnea on exertion with minimal
exertion.  Patient was cathed today which showed three vessel
disease and 3+ mitral regurgitation with a preserved ejection
fraction.  OM 50, LAD 80, left circumflex 70, right coronary
artery 50, 2 to 3+ MR, ejection fraction 58%.

PAST MEDICAL HISTORY:  Glaucoma.  Atrial arrhythmia.  Chronic
renal insufficiency.  Shingles.  Permanent pacemaker placed
in [**10-14**].  Hypertension.  High cholesterol.

PAST SURGICAL HISTORY:  Cholecystectomy.  Appendectomy.
Prostatectomy.  Left inguinal hernia repair.

OUTPATIENT MEDICATIONS:  Aspirin 325 mg q.d., Diovan 160 mg
q.d., Lipitor 10 mg q.d., Toprol XL 50 mg q.d., Imdur 60 mg
q.d., Alphagan eyedrops 0.2% one drop OU b.i.d., Betagan 0.5%
one drop OU q.d.

ALLERGIES:  Vasotec, Pronestyl.

PHYSICAL EXAMINATION:  In general, patient was alert and
oriented times three.  Moved all extremities and followed
commands.  HEENT pupils equally round and reactive to light.
Extraocular movements intact.  Anicteric, noninjected.
Mucous membranes moist, no erythema or exudate in the
oropharynx.  Neck was supple without lymphadenopathy, no JVD,
no bruits.  Respiratory clear to auscultation bilaterally.
Cardiac regular rate and rhythm, 2/6 systolic ejection
murmur.  Well healed pacer site in the left shoulder.
Abdomen soft, nondistended, nontender, no hepatosplenomegaly.
Extremities warm, well perfused, no cyanosis, clubbing or
edema, no varicosities.  Patient had bilateral 2+ carotid
pulses without bruits, 2+ radial pulses, 2+ femoral pulses,
1+ dorsalis pedis pulses.

HOSPITAL COURSE:  The patient was admitted on [**2148-2-12**] and
pre-oped for surgery.  He was also seen by the ENT staff
regarding decreasing left ear hearing.  They recommended
VoSol HC drops three times a day and indicated that he could
follow up with them in two weeks.  Patient was taken to the
operating room on [**2148-2-15**] for coronary artery disease and
mitral regurgitation.  Coronary artery bypass graft was
performed with LIMA to LAD, SVG to OM, SVG to D, SVG to RPDA.
Mitral valve replacement was also performed.  Postoperatively
patient was transferred to the cardiothoracic surgery ICU.
He was initially unresponsive and required Neo-Synephrine and
milrinone drip.  Patient improved quickly, however, and was
able to have his drips weaned.  Patient was slowly aroused
and was able to be extubated.  Patient received four doses of
vancomycin perioperatively.  Chest tubes in place and cardiac
pacing wires in place.

Physical therapy evaluated the patient while in the ICU and
patient will require rehabilitation.  Also while in the ICU
patient was started on a beta blocker and Lasix.  Patient
experienced urinary retention for a period of time while in
the ICU.  Patient was transferred to the regular
cardiothoracic surgical floor on [**2148-2-19**].  He was started on
Flomax and his Foley catheter was subsequently removed.
Patient's chest tubes and cardiac pacing wires were removed
at the appropriate times.  Physical therapy continued to work
with patient and case management was involved to aid in
placement of patient for rehabilitation purposes.

It is now [**2148-2-20**] and patient is doing well.  It is believed
that patient will be discharged in the morning to rehab.
Patient is in good condition.  He may observe a heart healthy
diet.  Patient may shower.  Patient should follow up with Dr.
[**Last Name (STitle) 1537**] in four weeks.  He should follow up with his primary
care physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) 2472**], in one to two weeks
and his cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], in two to three
weeks.  Patient should avoid strenuous activity.  He should
also not drive while on pain medications.  It is our
intention to send him out on the following
medications.

DISCHARGE MEDICATIONS:
1.  Lopressor 25 mg p.o. b.i.d.
2.  Ambien 5 mg p.o. q.h.s., p.r.n.
3.  Protonix 40 mg p.o. q.24 hours
4.  Atorvastatin 10 mg p.o. q.h.s.
5.  Tamsulosin 0.4 mg p.o. q.h.s.
6.  Levobunolol 0.5% one drop OU q.d.
7.  Brimonidine 0.15% one drop OU q.eight
8.  Percocet one to two tabs q.four p.r.n. pain.
9.  Tylenol 650 mg p.o. q.four p.r.n.
10. Enteric coated aspirin 325 mg p.o. q.d.
11. Colace 100 mg p.o. b.i.d.
12. Lasix 20 mg p.o. q.12 for seven days.
13. Potassium 20 mEq p.o. q.12 for seven days.






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

Dictated By:[**Last Name (NamePattern4) 5919**]
MEDQUIST36

D:  [**2148-2-20**]  11:53
T:  [**2148-2-20**]  11:59
JOB#:  [**Job Number 15143**]
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Retention of urine, unspecified,Intermediate coronary syndrome,Cardiac pacemaker in situ,Pure hypercholesterolemia,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: The patient is an 88 year old
man with known coronary artery disease and recently, three
weeks ago, an increase in dyspnea on exertion with minimal
exertion.  Patient was cathed today which showed three vessel
disease and 3+ mitral regurgitation with a preserved ejection
fraction.  OM 50, LAD 80, left circumflex 70, right coronary
artery 50, 2 to 3+ MR, ejection fraction 58%.

MEDICAL HISTORY: Glaucoma.  Atrial arrhythmia.  Chronic
renal insufficiency.  Shingles.  Permanent pacemaker placed
in [**10-14**].  Hypertension.  High cholesterol.

MEDICATION ON ADMISSION: 

ALLERGIES: Vasotec, Pronestyl.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Mitral valve disorders,Retention of urine, unspecified,Intermediate coronary syndrome,Cardiac pacemaker in situ,Pure hypercholesterolemia,Unspecified essential hypertension'}
