CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 84-year-old
female with coronary artery disease discovered on cardiac
catheterization on [**2151-3-22**].  Procedure revealed severe left
main disease.  Cardiac surgery was consulted on [**2151-3-22**]
regarding surgical revascularization.  The patient presented
initially earlier in the month on [**2151-3-19**] to an outside
hospital with symptoms of angina and dyspnea.  The patient
was found at the outside hospital to be in congestive heart
failure.  However, cardiac enzymes were negative x 2.  The
patient was transferred to [**Hospital1 18**] for cardiac cath which was
mentioned prior, and further treatment.

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. COPD.
4. Insulin dependent diabetes.
5. History of CVA.
6. Urinary incontinence.
7. Prolapsed bladder.
8. Sciatica.
9. Status post right carotid endarterectomy approximately 2-3
years ago.
10.Status post hysterectomy in [**2126**].

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Iodine.
2. Adhesive tape.
3. Ceclor.
4. Zestril.

PHYSICAL EXAM: The patient was afebrile.  Vital signs
stable.  Satting 96% on 2 liter nasal cannula.  The patient
was in no apparent distress.  Alert and oriented x 3.  Head
was atraumatic, normocephalic.  No scleral icterus noted.
Neck was soft and supple with no masses.  The patient did
have positive carotid bruits bilaterally.  Chest was clear to
auscultation bilaterally.  Heart was regular rate and rhythm
with S1, S2 present.  Grade II/VI systolic ejection murmur.
The abdomen was soft, nontender, nondistended with positive
bowel sounds.  Extremities were warm, no edema, no
varicosities.  Neurological exam was unremarkable.

FAMILY HISTORY: Significant for a brother who had multiple
MIs and a mother with diabetes mellitus.

SOCIAL HISTORY: The patient quit smoking tobacco
approximately 5 months ago, however has an extensive pack
year history.  The patient denies drugs or alcohol use.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of tobacco use
Crnry athrscl natve vssl,Intermed coronary synd,CHF NOS,Chr airway obstruct NEC,Ocl mlt bi art wo infrct,DMII neuro nt st uncntrl,Hypertension NOS,Pure hypercholesterolem,History of tobacco use
Admission Date:  [**2151-3-22**]       Discharge Date:  [**2151-4-5**]


Service:  CARDIAC SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is an 84-year-old
female with coronary artery disease discovered on cardiac
catheterization on [**2151-3-22**].  Procedure revealed severe left
main disease.  Cardiac surgery was consulted on [**2151-3-22**]
regarding surgical revascularization.  The patient presented
initially earlier in the month on [**2151-3-19**] to an outside
hospital with symptoms of angina and dyspnea.  The patient
was found at the outside hospital to be in congestive heart
failure.  However, cardiac enzymes were negative x 2.  The
patient was transferred to [**Hospital1 18**] for cardiac cath which was
mentioned prior, and further treatment.

PAST MEDICAL HISTORY:
1. Hypertension.
2. Hypercholesterolemia.
3. COPD.
4. Insulin dependent diabetes.
5. History of CVA.
6. Urinary incontinence.
7. Prolapsed bladder.
8. Sciatica.
9. Status post right carotid endarterectomy approximately 2-3
years ago.
10.Status post hysterectomy in [**2126**].

PAST SURGICAL HISTORY:  As stated in the past medical
history.

MEDICATIONS ON TRANSFER FROM OUTSIDE HOSPITAL:
1. Aspirin 325 mg po qd.
2. Tums 500 mg po qd.
3. Plavix 75 mg po qd.
4. Colace 100 mg po bid.
5. Lasix 60 mg po qd.
6. Lantus insulin 8 U subcu q hs.
7. Regular insulin sliding scale.
8. Prevacid 30 mg po qd.
9. Levaquin 500 mg po qd.
10.Cozaar 50 mg po qd.
11.Toprol 50 mg po qd.
12.Multivitamins.
13.Nitroglycerin prn.
14.Vioxx 25 mg po qd.
15.Detrol 0.4 mg po q hs.
16.Zocor 40 mg po qd.

ALLERGIES:
1. Iodine.
2. Adhesive tape.
3. Ceclor.
4. Zestril.

SOCIAL HISTORY:  The patient quit smoking tobacco
approximately 5 months ago, however has an extensive pack
year history.  The patient denies drugs or alcohol use.

FAMILY HISTORY:  Significant for a brother who had multiple
MIs and a mother with diabetes mellitus.

PHYSICAL EXAM:  The patient was afebrile.  Vital signs
stable.  Satting 96% on 2 liter nasal cannula.  The patient
was in no apparent distress.  Alert and oriented x 3.  Head
was atraumatic, normocephalic.  No scleral icterus noted.
Neck was soft and supple with no masses.  The patient did
have positive carotid bruits bilaterally.  Chest was clear to
auscultation bilaterally.  Heart was regular rate and rhythm
with S1, S2 present.  Grade II/VI systolic ejection murmur.
The abdomen was soft, nontender, nondistended with positive
bowel sounds.  Extremities were warm, no edema, no
varicosities.  Neurological exam was unremarkable.

PERTINENT IMAGING:  The patient had a chest x-ray at the
outside hospital that showed mild congestive heart failure.
In addition, the patient had a carotid ultrasound at the
outside hospital that showed 70-80% stenosis at the origin of
the left internal carotid artery, and a mild irregularity at
the origin of the right internal carotid artery.  The patient
had calcific plaque at the origin of the right vertebral
artery causing moderate stenosis.

SUMMARY OF HOSPITAL COURSE:  The patient was an 84-year-old
woman, with severe left main disease, who presented to the
cardiac surgery service for surgical revascularization.  The
patient was initially on the medical service.  On hospital
day #2, the patient went for repeat carotid ultrasound which
showed 40-59% stenosis in the right internal carotid artery,
and 60-69% stenosis in the left internal carotid artery.

A neurology consult was obtained to determine stroke risk for
patient prior to going to the OR.  Neurology recommended the
carotid ultrasound which was already performed, as well as an
MRI/MRA which displayed focal narrowing of the left vertebral
artery just before the confluence with the right vertebral
artery.  Otherwise, no signs of any other abnormality at this
time.  On [**2151-3-24**], it was decided by the cardiology staff
that the patient would proceed to the OR without the need for
any carotid stents.  MRA of the brain was unremarkable.

On [**2151-3-25**], the patient became acutely short of breath and
hypertensive into the 170s-180s.  The patient was treated
with IV Nitro and was diuresed with IV lasix, as well.  The
patient was transferred to the CCU for further monitoring.
The patient stabilized overnight.  Tentative diagnosis at
that time was flash pulmonary edema and unstable angina.

The patient was finally taken to the OR on [**2151-3-26**] for CABG
x 2 off-pump.  The surgeon was Dr. [**Last Name (STitle) 70**], assisted by Dr.
[**Last Name (STitle) 1537**].  For more details, please see operative report.
Postoperatively, the patient was transferred to the CSRU on
epinephrine drip, as well as a Neo-Synephrine drip.  The
patient was being atrially paced to a heart rate of 95 on
postoperative day #1.  The patient was started on Plavix 75
mg po qd per off-pump protocol.  In addition, on
postoperative day #1, the patient was transfused 1 unit of
packed red blood cells and was weaned to extubate.

On postoperative day #3, the patient was still on a small
amount of Neo IV for a systolic pressure in the 100s.  The
patient converted to normal sinus rhythm without the need for
pacing. The patient's Swan was DC'd on this day.  On
postoperative day #3, the chest tube was DC'd, and the
patient was transfused another unit of packed red blood
cells.  In addition, pacing pericardial wires were DC'd.

The patient was seen by psychiatry on [**2151-3-31**] for evaluation
and treatment of depression.  An assessment was made that the
patient should be treated as an outpatient with no
pharmacotherapy at this time.  The patient was transferred to
the floor on [**2151-4-1**] in stable condition.  In addition, on
[**2151-4-1**], the patient was seen by the [**Last Name (un) **] staff who
adjusted her fixed and sliding scale insulin accordingly.

On postoperative day #7 to postoperative day #8, the patient
was given diamox 250 mg IV x 3 doses.  The remainder of the
patient's postoperative course was unremarkable.  On
postoperative day #10, the patient was deemed well enough and
was recommended by physical therapy to go to rehabilitation.
Labs were all within normal limits.

DISCHARGE DISPO:  To rehab.

DISCHARGE CONDITION:  Good.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Congestive heart failure.
3. Insulin dependent diabetes mellitus.
4. Arthritis.
5. Hypertension.
6. Chronic obstructive pulmonary disease.
7. History of smoking.

FOLLOW-UP:
1. The patient is to follow-up with the Wound Care Clinic in
[**1-15**] weeks.
2. PCP [**Name Initial (PRE) **]/or cardiologist in [**2-16**] weeks.
3. Dr. [**Last Name (STitle) 70**] in 6 weeks.

DISCHARGE MEDICATIONS:
1. Lasix 20 mg po bid x 7 days.
2. Potassium chloride 20 mEq po bid x 7 days.
3. Colace 100 mg po bid.
4. Tylenol 325 mg to 650 mg po q 4-6 h prn.
5. Percocet 1-2 tabs po q 4-6 h prn pain.
6. Dulcolax suppository PR qd prn constipation.
7. Milk of Magnesia 30 cc po q hs prn constipation.
8. Aspirin 325 mg po qd.
9. Plavix 75 mg po qd x 3 months.
10.Miconazole powder 1 application tid prn.
11.Protonix 40 mg po qd.
12.Metoprolol 37.5 mg po bid.
13.Tolterodine 1 mg po qd.
14.Vioxx 12.5 mg po qd.
15.Benadryl 25 mg po q hs prn insomnia.
16.Glargine insulin 6 U subcu q dinnertime.
17.Regular insulin sliding scale 1-10 U subcu as directed.




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

Dictated By:[**Name8 (MD) 7190**]
MEDQUIST36

D:  [**2151-4-5**]  11:33
T:  [**2151-4-5**]  11:38
JOB#:  [**Job Number 33814**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of tobacco use'}


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
female with coronary artery disease discovered on cardiac
catheterization on [**2151-3-22**].  Procedure revealed severe left
main disease.  Cardiac surgery was consulted on [**2151-3-22**]
regarding surgical revascularization.  The patient presented
initially earlier in the month on [**2151-3-19**] to an outside
hospital with symptoms of angina and dyspnea.  The patient
was found at the outside hospital to be in congestive heart
failure.  However, cardiac enzymes were negative x 2.  The
patient was transferred to [**Hospital1 18**] for cardiac cath which was
mentioned prior, and further treatment.

MEDICAL HISTORY: 1. Hypertension.
2. Hypercholesterolemia.
3. COPD.
4. Insulin dependent diabetes.
5. History of CVA.
6. Urinary incontinence.
7. Prolapsed bladder.
8. Sciatica.
9. Status post right carotid endarterectomy approximately 2-3
years ago.
10.Status post hysterectomy in [**2126**].

MEDICATION ON ADMISSION: 

ALLERGIES: 1. Iodine.
2. Adhesive tape.
3. Ceclor.
4. Zestril.

PHYSICAL EXAM: The patient was afebrile.  Vital signs
stable.  Satting 96% on 2 liter nasal cannula.  The patient
was in no apparent distress.  Alert and oriented x 3.  Head
was atraumatic, normocephalic.  No scleral icterus noted.
Neck was soft and supple with no masses.  The patient did
have positive carotid bruits bilaterally.  Chest was clear to
auscultation bilaterally.  Heart was regular rate and rhythm
with S1, S2 present.  Grade II/VI systolic ejection murmur.
The abdomen was soft, nontender, nondistended with positive
bowel sounds.  Extremities were warm, no edema, no
varicosities.  Neurological exam was unremarkable.

FAMILY HISTORY: Significant for a brother who had multiple
MIs and a mother with diabetes mellitus.

SOCIAL HISTORY: The patient quit smoking tobacco
approximately 5 months ago, however has an extensive pack
year history.  The patient denies drugs or alcohol use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of tobacco use'}
