CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 53-year-old male,
former IV drug abuser, with a history of hypertension,
hypercholesterolemia, insulin-dependent diabetes mellitus,
diagnosed with hepatitis B and C as well as HIV in the [**2089**],
who has had a history of coronary artery disease since [**2099**].
The patient underwent PTCA to his RCA in [**2099-6-25**]
following an MI and symptoms which included the inability to
catch his breath, in-stent restenosis of the RCA, presented
with the patient having similar symptoms which were relieved
by sublingual nitroglycerin.  The patient reports shortness
of breath with exertion and left arm numbness and mild
diaphoresis at the time of the restenosis.  He underwent a
catheterization and was restented at that time.

MEDICAL HISTORY: 1.  CAD, status post RCA stent in [**2099-6-25**], [**2100-6-25**] with positive stress test in [**2102-5-25**].
2.  Hypertension.
3.  Hypercholesterolemia.
4.  NIDDM.
5.  Hepatitis B.
6.  Hepatitis C.
7.  HIV.
8.  TB.
9.  PVD.
10. Anemia.
11. GERD.
12. Right ocular stroke.
13. Status post left arm surgery for necrotizing fasciitis.
14. Status post left hip surgery for abscess.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states allergies to sulfa and
Zithromax.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant in that he had a mother who
died at 32 of CAD.

SOCIAL HISTORY: He lives with his son in [**Name (NI) 5110**].  Drug
counselor in [**Location (un) 18293**].  Former IV drug abuser of
heroin.  Stopped 2 1/2 years ago.  Abused for 30 plus years.
Former ETOH use, stopped 2 1/2 years ago, rarely before then.
Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Other specified complications of procedures not elsewhere classified,Acute hepatitis C without mention of hepatic coma,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Eosinophilia
Crnry athrscl natve vssl,Acute kidney failure NOS,Oth spcf cmplc procd NEC,Hpt C acute wo hpat coma,Nephritis NOS in oth dis,DMII renl nt st uncntrld,Eosinophilia
Admission Date:  [**2102-11-15**]       Discharge Date: [**2102-11-24**]

Date of Birth:   [**2049-4-13**]       Sex:  M

Service:  CARDIOTHORACIC SURGERY

HISTORY OF THE PRESENT ILLNESS:  This is a 53-year-old male,
former IV drug abuser, with a history of hypertension,
hypercholesterolemia, insulin-dependent diabetes mellitus,
diagnosed with hepatitis B and C as well as HIV in the [**2089**],
who has had a history of coronary artery disease since [**2099**].
The patient underwent PTCA to his RCA in [**2099-6-25**]
following an MI and symptoms which included the inability to
catch his breath, in-stent restenosis of the RCA, presented
with the patient having similar symptoms which were relieved
by sublingual nitroglycerin.  The patient reports shortness
of breath with exertion and left arm numbness and mild
diaphoresis at the time of the restenosis.  He underwent a
catheterization and was restented at that time.

The patient began experiencing angina at rest, waking him
from his sleep in [**2102-4-25**] for which the patient
underwent a stress MIBI which revealed partially reversible
inferior wall defect with an EF of 385.  Catheterization done
in [**2102-9-25**] revealed a 60% left main and two vessel
disease with in-stent restenosis of the RCA.  The patient was
referred to CT Surgery for coronary artery bypass grafting.

At this time, the patient still complains of occasional chest
pain and shortness of breath at rest and with exertion.
Currently, he is pain-free.

PAST MEDICAL HISTORY:
1.  CAD, status post RCA stent in [**2099-6-25**], [**2100-6-25**] with positive stress test in [**2102-5-25**].
2.  Hypertension.
3.  Hypercholesterolemia.
4.  NIDDM.
5.  Hepatitis B.
6.  Hepatitis C.
7.  HIV.
8.  TB.
9.  PVD.
10. Anemia.
11. GERD.
12. Right ocular stroke.
13. Status post left arm surgery for necrotizing fasciitis.
14. Status post left hip surgery for abscess.

FAMILY HISTORY:   Significant in that he had a mother who
died at 32 of CAD.

SOCIAL HISTORY:  He lives with his son in [**Name (NI) 5110**].  Drug
counselor in [**Location (un) 18293**].  Former IV drug abuser of
heroin.  Stopped 2 1/2 years ago.  Abused for 30 plus years.
Former ETOH use, stopped 2 1/2 years ago, rarely before then.

ALLERGIES:  The patient states allergies to sulfa and
Zithromax.

ADMISSION MEDICATIONS:
1.  Kaletra.
2.  Aspirin 325 mg p.o. q.d.
3.  Viread.
4.  Diovan.
5.  Dapsone.
6.  Pletal.
7.  Atenolol 100 mg q.d.
8.  Lipitor 10 mg q.d.
9.  Isosorbide 120 mg q.d.
10. Videx.
11. Protonix 40 mg q.d.
12. Lasix 80 mg q.d.
13. Epivir.
14. Insulin 70/30, 38 units q.a.m., 28 units q.p.m.

LABORATORY/RADIOLOGIC DATA:  White count 6.2, hematocrit
30.9, platelets 151,000.  PT 12.7, INR 1.1.  Sodium 138,
potassium 3.2, chloride 106, C02 26, BUN 18, creatinine 1.1,
glucose 246, ALT 38, AST 30, alkaline phosphatase 76, amylase
33, total bilirubin 1.5, albumin 3.5.

Cardiac catheterization done on [**2102-10-18**] showed
left main 60% LAD with diffuse disease, left circumflex with
60-70% lesion with 90% takeoff from disease, distal left main
RCA 40% with 30% in-stent restenosis, moderate to severe left
ventricular heart failure, anomalous left main.

PHYSICAL EXAMINATION ON ADMISSION:  General:  The patient was
a pleasant man in no acute distress, appearing stated age,
alert and oriented times three.  HEENT:  The pupils were
equally round and reactive to light.  The extraocular
movements were intact.  Normal buccal mucosa.  Neck:  Supple
with no JVD, no lymphadenopathy.  No thyromegaly.  No carotid
bruits.  Chest:  Clear to auscultation bilaterally.  Cardiac:
Regular rate and rhythm.  S1, S2, with a II/VI systolic
ejection murmur.  Abdomen:  Obese, nontender, nondistended,
normoactive bowel sounds.  Extremities:  Warm with no edema
and no varicosities.  Positive venostasis color changes
bilaterally, right thigh graft from a graft obtained for his
left arm necrotizing fasciitis surgery.  Pulses:  Carotids 2+
bilaterally, radial 2+ bilaterally, femoral 2+ bilaterally,
dorsalis pedis 2+ bilaterally and posterior tibial 1+
bilaterally.

HOSPITAL COURSE:  The patient was a postoperative admission.
He was admitted directly to the Operating Room on [**2102-11-15**].  At that time, he underwent coronary artery bypass
grafting times two.  Please see the OR report for full
details.  In summary, the patient had a CABG times two with a
LIMA to the LAD and saphenous vein graft to OM.  His bypass
time was 59 minutes with a cross clamp time of 35 minutes.
He tolerated the operation well and was transferred from the
Operating Room to the Cardiothoracic Intensive Care Unit.

At the time of transfer, the patient had a mean arterial
pressure of 91, CVP 17.  He was in a normal sinus rhythm at
80 beats per minute.  He had propofol at 10 micrograms per
kilogram in the immediate postoperative period.  The patient
did well.  He did have some significant drainage from his
chest tubes for that.  He was transfused with 2 units of FFP
and one packed platelets.  Following the resolution of his
chest tube drainage, the patient's anesthesia was reversed.
He was weaned from the ventilator and successfully extubated.

On the morning of postoperative day number one, the patient's
PA line was discontinued.  He was started on Lasix and
Lopressor as well as all his antiviral medications.  He was
seen by the ID Service for assistance with management of his
HIV, hepatitis B and C.  He was also seen by the [**Hospital **]
Clinic for assistance with management of his diabetes.
Following these consults, the patient was transferred to [**Hospital Ward Name 121**]
II for continuing postoperative care and cardiac
rehabilitation.

The patient was noted to have a low-grade fever.  He was pan
cultured and was kept on vancomycin as well as Levaquin as
per the recommendations of the Infectious Disease Department.
 The low-grade fever persisted with a normal to slightly
elevated white blood cell count.  A differential done at that
time showed an eosinophilia.  It was, therefore, felt by the
primary team as well as that of Infectious Disease that
eosinophilia and fever were drug-induced.  Therefore, the
patient's vancomycin and Levaquin were discontinued at that
time following which the patient defervesced.  At the same
time, the patient was noted to have somewhat elevated
creatinine with a BUN of 28 and creatinine of 1.8 as well as
significant bilateral pedal edema.

On postoperative day number seven, the Renal Service was also
consulted to weigh in on the patient's elevated creatinine as
well as his pedal edema.  Following their consultation, the
patient was sodium restricted and he was continued on his
Lasix.

On postoperative day number nine, it was felt that the
patient was stable and ready to be discharged home.  At the
time of discharge, the patient's physical examination is as
follows.  Vital signs:  Temperature 99, heart rate 80, sinus
rhythm, blood pressure 140/70, respiratory rate 18, 02
saturation 95% on room air.  Weight preoperatively 102
kilograms, at discharge 108.9 kilograms.

The laboratory data revealed a white count of 9.9, hematocrit
30.2, platelets 356,000.  Sodium 136, potassium 3.8, chloride
104, C02 20, BUN 29, creatinine 1.7, glucose 114.

The patient was alert and oriented times three, moves all
extremities.  The patient follows commands.  Respiratory:
Clear to auscultation bilaterally.  Cardiac:  Regular rate
and rhythm, S1, S2.  The sternum is stable.  The incision
with Steri-Strips, open to air, clean and dry.  Abdomen:
Soft, nontender, nondistended, normoactive bowel sounds.
Extremities:  Warm and well perfused with 2-3+ edema.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 q.d.
2.  Ritonavir three capsules b.i.d.
3.  Tenofovir 300 mg q.d.
4.  Prilosec 40 mg q.d.
5.  Lamivudine 150 mg b.i.d.
6.  .................... EL 250 mg p.o. q.d.
7.  Dapsone 100 mg q.d.
8.  Pletal 100 mg b.i.d.
9.  Metoprolol 100 mg b.i.d.
10. Lasix 80 mg q.d. times seven days and then 40 mg q.d.
11. Potassium chloride 20 mEq q.d.
12. Insulin, resume preoperative doses.
13. Percocet 5/325 one to two tablets q. four hours p.r.n.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease, status post coronary artery
bypass grafting times two with left internal mammary artery
to left anterior descending and saphenous vein graft to
obtuse marginal.
2.  Hypertension.
3.  Hypercholesterolemia.
4.  Insulin-dependent diabetes mellitus.
5.  Hepatitis B and C.
6.  HIV.
7.  Tuberculosis.
8.  Peripheral vascular disease.
9.  Gastroesophageal reflux disease.
10. Ocular stroke.
11. Necrotizing fasciitis.
12. Left hip surgery.

DISPOSITION:  The patient is to be discharged to home.

FOLLOW-UP:  The patient is to have follow-up in the [**Hospital 409**]
Clinic in two weeks.  The patient is to follow-up with Dr.
[**Last Name (STitle) 70**] in six weeks.  The patient is to call the office
for an appointment.  The patient is to follow-up with his
primary care in one to two weeks, at which time the patient
is to have his BUN, creatinine, and potassium levels checked.




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

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2102-11-24**]  07:10
T:  [**2102-11-24**]  19:41
JOB#:  [**Job Number 42343**]
{'Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Other specified complications of procedures not elsewhere classified,Acute hepatitis C without mention of hepatic coma,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Eosinophilia'}


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 is a 53-year-old male,
former IV drug abuser, with a history of hypertension,
hypercholesterolemia, insulin-dependent diabetes mellitus,
diagnosed with hepatitis B and C as well as HIV in the [**2089**],
who has had a history of coronary artery disease since [**2099**].
The patient underwent PTCA to his RCA in [**2099-6-25**]
following an MI and symptoms which included the inability to
catch his breath, in-stent restenosis of the RCA, presented
with the patient having similar symptoms which were relieved
by sublingual nitroglycerin.  The patient reports shortness
of breath with exertion and left arm numbness and mild
diaphoresis at the time of the restenosis.  He underwent a
catheterization and was restented at that time.

MEDICAL HISTORY: 1.  CAD, status post RCA stent in [**2099-6-25**], [**2100-6-25**] with positive stress test in [**2102-5-25**].
2.  Hypertension.
3.  Hypercholesterolemia.
4.  NIDDM.
5.  Hepatitis B.
6.  Hepatitis C.
7.  HIV.
8.  TB.
9.  PVD.
10. Anemia.
11. GERD.
12. Right ocular stroke.
13. Status post left arm surgery for necrotizing fasciitis.
14. Status post left hip surgery for abscess.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient states allergies to sulfa and
Zithromax.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant in that he had a mother who
died at 32 of CAD.

SOCIAL HISTORY: He lives with his son in [**Name (NI) 5110**].  Drug
counselor in [**Location (un) 18293**].  Former IV drug abuser of
heroin.  Stopped 2 1/2 years ago.  Abused for 30 plus years.
Former ETOH use, stopped 2 1/2 years ago, rarely before then. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Acute kidney failure, unspecified,Other specified complications of procedures not elsewhere classified,Acute hepatitis C without mention of hepatic coma,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Eosinophilia'}
