CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78-year-old man
with a known history of three vessel coronary artery disease.
He had a cardiac catheterization in [**2100**] which showed three
vessel disease.  His ejection fraction at that time was
approximately 50%.  Recent echocardiogram demonstrates
current ejection fraction of between 20-25%, 80% intermediate
as well as diffuse disease in the proximal.

MEDICAL HISTORY: 1. Insulin dependent-diabetes mellitus.
2. Coronary artery disease, three vessel with an ejection
fraction of 20-25%.
3. Prostate cancer status post resection in [**2096**], no
chemotherapy and no XRT.
4. Paget's disease.
5. Ulcerative colitis.
6. Peripheral vascular disease.
7. Status post left first toe amputation in [**4-3**].
8. Right inguinal hernia repair.
9. Status post left carpal tunnel release in [**2088**].
10. Right carpal tunnel release in [**2100**].
11. Status post appendectomy in [**2053**].
12. Cerebrovascular accident of the thalamus 6-8 years ago
with no deficit.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes anaphylactic shock.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other and unspecified angina pectoris,Acidosis,Ulcerative colitis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ
Crnry athrscl natve vssl,CHF NOS,Angina pectoris NEC/NOS,Acidosis,Ulceratve colitis unspcf,DMII wo cmp nt st uncntr,Hypertension NOS,Status autm crd dfbrltr
Admission Date:  [**2103-12-31**]       Discharge Date:  [**2104-1-7**]


Service:

ADMISSION DIAGNOSIS:  Severe coronary artery disease,
ejection fraction of approximately 25%.

DISCHARGE DIAGNOSIS:  Severe coronary artery disease,
ejection fraction of approximately 25%, status post coronary
artery bypass graft x3.

HISTORY OF PRESENT ILLNESS:  The patient is a 78-year-old man
with a known history of three vessel coronary artery disease.
He had a cardiac catheterization in [**2100**] which showed three
vessel disease.  His ejection fraction at that time was
approximately 50%.  Recent echocardiogram demonstrates
current ejection fraction of between 20-25%, 80% intermediate
as well as diffuse disease in the proximal.

The patient has had a cardiac catheterization performed on
[**2103-12-12**] which showed a right dominant system and left main
and three vessel coronary artery disease, mild left
ventricular diastolic dysfunction, severe global left
ventricular systolic dysfunction, normal right ventricular
diastolic function.  The patient had a right lower lobe
pneumonia in early [**2103-12-5**] and was started and
treated on levofloxacin.  The patient also had congestive
heart failure at that time and was diuresed accordingly.  The
patient did have placed of an AICD pacer on [**2103-12-9**].  The
patient now comes to [**Hospital1 69**] for
revascularization of his heart.

PAST MEDICAL HISTORY:
1. Insulin dependent-diabetes mellitus.
2. Coronary artery disease, three vessel with an ejection
fraction of 20-25%.
3. Prostate cancer status post resection in [**2096**], no
chemotherapy and no XRT.
4. Paget's disease.
5. Ulcerative colitis.
6. Peripheral vascular disease.
7. Status post left first toe amputation in [**4-3**].
8. Right inguinal hernia repair.
9. Status post left carpal tunnel release in [**2088**].
10. Right carpal tunnel release in [**2100**].
11. Status post appendectomy in [**2053**].
12. Cerebrovascular accident of the thalamus 6-8 years ago
with no deficit.

ALLERGIES:  Penicillin causes anaphylactic shock.

MEDICATIONS:
1. Carvedilol 3.125 mg [**Hospital1 **].
2. Accupril 10 mg q day.
3. Aspirin 81 mg q day.
4. Protonix 40 mg q day.
5. NPH insulin 40 units q am/3 units q pm.
6. Regular insulin 4 units q am/18 units q pm.
7. Asacol 800 mg tid.
8. Actonel 35 mg q day.

PHYSICAL EXAMINATION:  The patient is an elderly male in no
acute distress.  Vital signs are stable.  His height is 5
foot 9.5 inches, weight 182 pounds.  HEENT:  Atraumatic,
normocephalic.  Extraocular movements are intact.  Pupils are
equal, round, and reactive to light, anicteric.  Throat is
clear.  Neck is supple, midline.  No masses, no
lymphadenopathy.  Chest was clear to auscultation
bilaterally.  Cardiovascular is regular, rate, and rhythm
without murmurs, rubs, or gallops.  Abdomen is soft,
nontender, nondistended with obesity.  Extremity examination
is significant for left first toe amputation, otherwise
nonedematous.  There is some hyperkeratosis and cyanosis of
the lower extremities.

PREOPERATIVE LABORATORIES:  Complete blood count:
12.1/15.4/46.6/169.  PT 13.9, INR 1.3, PTT 35.3.
Chemistries:  141/4.6/100/25/21/1.1/97.  Type and screen was
performed on [**2103-12-26**].

The patient had a preoperative chest x-ray performed on
[**2103-12-26**] which showed no evidence of congestive heart failure
or acute infiltrates.  As mentioned above, mild widening and
elongation of the thoracic aorta.  AICD in appropriate
position.

The patient was admitted for coronary artery bypass grafting
x3.  The patient had a LIMA to the left anterior descending
artery and a right saphenous vein graft to OM and right
coronary artery.  The patient tolerated the procedure well
without complication.  In the postoperative period, the
patient was eventually admitted to the Intensive Care Unit
and remained on a Neo and milrinone drip for blood pressure
support and a paced for an underlying heart rate in the low
100s.

The patient remained on the ventilator secondary to acidosis
and appropriate changes were made.  EP service did come by to
interrogate the AICD twice.  Resect the parameters back to
preoperative settings.  Patient was extubated on midnight on
postoperative day 0, and subsequently did well saturating on
99% on 3 liters of nasal cannula.  From cardiac perspective,
the pacer rate was turn down, and patient was briefly in
sinus rhythm with approximately 20% paced rhythm, but
returned to 100% A-paced.  The patient was continued on Neo,
milrinone, and insulin drips.

Patient was sent down to the floor on postoperative day #1
after weaning drips as appropriate.  Unfortunately, the
patient was readmitted back down to the Intensive Care Unit
on the evening of postoperative day one for an episode of
hypotensive, dizziness, nausea, and diaphoresis.  It was
noted that the patient had received Lasix and Lopressor prior
to the decrease in heart rate and blood pressure.  The
patient was bolused with normal saline and A-paced.

Patient was closely monitored in Intensive Care Unit setting
and transfused 1 unit of packed red blood cells for a
hematocrit of 26.1 on postoperative day #2.  The patient had
no other remarkable events on the remainder of his Intensive
Care Unit course and was transferred back down to the floor
on postoperative day #4.

Physical Therapy had been seeing the patient, but the patient
had not made much progress.  On postoperative day four, the
patient's chest tubes and pacing wires were discontinued.  He
had a mild O2 requirement at 97% on 2 liters and had some
significant sputum production, otherwise is doing well and
improving.  The patient was subsequently discharged on
postoperative day six to rehabilitation facility tolerating a
regular diet, and adequate pain control on Morphine SR and
having no anginal symptoms or ectopic events.

It was noted that 48 hours prior to his discharge, the
patient did have some mild serous drainage from his old chest
tube sites.  These sites appeared nonerythematous and without
evidence of gross infection.  No erythema or exudate.

Physical examination on discharge:  No acute distress.  The
patient is limited to the chair, and not ambulating well or
often.  Vital signs past 24 hours of 99.1, 99 in sinus,
110/50, respirations 20, and 93% on 2 liters.  Blood sugars
are well controlled, a little low subsequent to evening
insulin dose ranging 52 to 152 over the past 24 hours.  Chest
remains clear to auscultation with some fine crackles at the
base.  Cardiovascular:  Regular, rate, and rhythm without
murmurs, rubs, or gallops.  Sternal incision is clean and dry
without drainage.  There is some serous drainage from the
chest tube sites.  Abdomen is soft, nontender, nondistended
and obese.  Extremities:  Significant for 1+ edema in both
lower extremities.  Otherwise warm and well perfused.
Neurologically intact without focal motor or sensory
deficits.

LABORATORIES ON DISCHARGE:  Complete blood count:
9.7/31.1/192.  Chemistry:  136/4.9/97/31/22/0.9/120,
magnesium 2.0.

DISCHARGE MEDICATIONS:
1. Colace 100 mg [**Hospital1 **].
2. Aspirin 325 mg q day.
3. Tylenol 325-650 mg q4h prn.
4. Ibuprofen 400 mg po q6h prn.
5. Methalamine 800 mg tid.
6. Lopressor 12.5 mg [**Hospital1 **].
7. Morphine SR 30 mg po q12h.
8. Morphine immediate release 15 mg po q14h prn.
9. Milk of magnesia 15-30 mL q hs prn constipation.
10. Dulcolax 10 mg q day prn constipation.
11. Benadryl 25 mg q hs prn for insomnia.
12. NPH insulin 40 units q am and 3 units q pm.
13. Regular insulin 4 units q am and 18 units q pm.
14. Regular insulin-sliding scale as directed.

INSTRUCTIONS:  The patient is to be discharged to
rehabilitation facility and continue aggressive physical
rehabilitation.  He should receive fingersticks qid and
appropriate sliding scale.  He should also  have wound care
for both sternal incision as well as chest tube sites which
seem to be draining some serous fluid.  The patient is also
to have cardiopulmonary checks.  Diet should be cardiac and
diabetic.

DISPOSITION:  Rehab facility.

CONDITION ON DISCHARGE:  Good.




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

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

D:  [**2104-1-7**]  10:27
T:  [**2104-1-7**]  11:01
JOB#:  [**Job Number 34276**]
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other and unspecified angina pectoris,Acidosis,Ulcerative colitis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ'}


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 man
with a known history of three vessel coronary artery disease.
He had a cardiac catheterization in [**2100**] which showed three
vessel disease.  His ejection fraction at that time was
approximately 50%.  Recent echocardiogram demonstrates
current ejection fraction of between 20-25%, 80% intermediate
as well as diffuse disease in the proximal.

MEDICAL HISTORY: 1. Insulin dependent-diabetes mellitus.
2. Coronary artery disease, three vessel with an ejection
fraction of 20-25%.
3. Prostate cancer status post resection in [**2096**], no
chemotherapy and no XRT.
4. Paget's disease.
5. Ulcerative colitis.
6. Peripheral vascular disease.
7. Status post left first toe amputation in [**4-3**].
8. Right inguinal hernia repair.
9. Status post left carpal tunnel release in [**2088**].
10. Right carpal tunnel release in [**2100**].
11. Status post appendectomy in [**2053**].
12. Cerebrovascular accident of the thalamus 6-8 years ago
with no deficit.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin causes anaphylactic shock.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Other and unspecified angina pectoris,Acidosis,Ulcerative colitis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ'}
