CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 49-year-old
female with known coronary artery disease, status post
myocardial infarction, status post coronary artery bypass
graft times three in [**2193**], angioplasty in [**2197-1-31**],
peripheral vascular disease, status post aortofemoral bypass,
and axillobifemoral bypass, hypercholesterolemia, recent
subdural hematoma in [**2197-3-31**] who presented to [**Hospital3 33594**] Center on the morning of admission with anginal chest
pain refractory to medications, lateral ST segment
depressions, and negative cardiac enzymes.

MEDICAL HISTORY: 1.  Coronary artery disease; status post myocardial
infarction in [**2195**] (as per patient), multiple
catheterizations (the last in [**2197-1-31**] when she
received a stent of her saphenous vein graft to first
diagonal and underwent a percutaneous transluminal coronary
angioplasty of her first obtuse marginal).  She is status
post coronary artery bypass graft times three with saphenous
vein graft to both her right coronary artery and first
diagonal.
2.  Peripheral vascular disease; status post aortofemoral
bypass in [**2194**].  Also status post axillofemoral bypass.
3.  Hypercholesterolemia.
4.  Hypothyroidism.
5.  Seizure disorder.
6.  Heparin-induced thrombocytopenia.
7.  Subdural hematoma in [**2197-3-31**].
8.  Of note, the patient has anti-K alloantibodies.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
 2.  Zocor 80 mg p.o. q.d.
 3.  Lopressor 100 mg p.o. t.i.d.
 4.  Accupril 5 mg p.o. q.d.
 5.  TriCor 108 mg p.o. q.d.
 6.  Pepcid 20 mg p.o. q.d.
 7.  Synthroid 125 mcg p.o. q.d.
 8.  Depakote 500 mg p.o.
 9.  Folic acid 1 mg p.o. q.d.
10.  Isosorbide 10 mg p.o. t.i.d.

ALLERGIES: HEPARIN, CODEINE, SULFA, CECLOR.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is remarkable for peripheral
vascular disease and coronary artery disease.

SOCIAL HISTORY: The patient is a reformed smoker after
smoking one and a half packs times 20 years.  The patient
denies any current alcohol use.  The patient lives in [**Location (un) 7498**] with her husband.
Acute myocardial infarction of other lateral wall, initial episode of care,Other and unspecified coagulation defects,Other convulsions,Coronary atherosclerosis of unspecified type of vessel, native or graft,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Old myocardial infarction
AMI lateral NEC, initial,Coagulat defect NEC/NOS,Convulsions NEC,Cor ath unsp vsl ntv/gft,Pure hypercholesterolem,Hypothyroidism NOS,Aortocoronary bypass,Old myocardial infarct
Admission Date:  [**2197-9-29**]     Discharge Date:  [**2197-10-3**]

Date of Birth:   [**2148-4-6**]     Sex:  F

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 49-year-old
female with known coronary artery disease, status post
myocardial infarction, status post coronary artery bypass
graft times three in [**2193**], angioplasty in [**2197-1-31**],
peripheral vascular disease, status post aortofemoral bypass,
and axillobifemoral bypass, hypercholesterolemia, recent
subdural hematoma in [**2197-3-31**] who presented to [**Hospital3 33594**] Center on the morning of admission with anginal chest
pain refractory to medications, lateral ST segment
depressions, and negative cardiac enzymes.

The patient was transferred to the [**Hospital1 190**] for cardiac catheterization.  Upon admission,
the patient reports waking up from her sleep at 5 a.m. on the
morning of admission with 7/10 substernal chest pain with
radiation of the pain to the jaw and both arms, accompanied
by diaphoresis.  The patient reports similar symptoms in the
past with relief from nitroglycerin; however, this morning
the pain was unrelieved with nitroglycerin tablets times
three.

At the time, the patient went to [**Hospital3 25150**] where she
was put on a nitroglycerin drip, received 5 mg p.o. of
Lopressor times two, and morphine sulfate without relief.
Her cardiac enzymes were negative times one, and an
electrocardiogram relieved lateral ST segment depressions.
Given the patient's history of coronary artery disease,
vasculopathy, and multiple cardiac catheterizations in the
past, the patient was transferred to [**Hospital1 190**] for cardiac catheterization.

At the [**Hospital1 69**], the patient's
cardiac catheterization revealed occlusion of her saphenous
vein graft to first diagonal artery with 100% acute
thrombotic occlusion, 70% occlusion of the lower pole of her
first obtuse marginal, percutaneous transluminal coronary
angioplasty that was opened; 100% right coronary artery
proximal occlusion with collateral filling.  Given the small
caliber of the diagonal graft and small amount of myocardium
provided, and the patient's extremely high risk for
reocclusion, percutaneous transluminal coronary angioplasty
was deferred at this time and conservative medical management
was initiated.

The patient was continued on medications and transferred to
the floor.  Upon arrival, the patient continued to complain
of substernal chest pain described to be [**6-9**] and was
somewhat relieved with morphine.  At the time of arrival to
the Coronary Care Unit, the patient denied shortness of
breath, palpitations, orthopnea, paroxysmal nocturnal
dyspnea, and edema.  The patient denies any recent fevers,
chills, diarrhea, melena, and headaches.  The patient does
report numbness in the left lower arm since intervention on
the day of admission.

PAST MEDICAL HISTORY:
1.  Coronary artery disease; status post myocardial
infarction in [**2195**] (as per patient), multiple
catheterizations (the last in [**2197-1-31**] when she
received a stent of her saphenous vein graft to first
diagonal and underwent a percutaneous transluminal coronary
angioplasty of her first obtuse marginal).  She is status
post coronary artery bypass graft times three with saphenous
vein graft to both her right coronary artery and first
diagonal.
2.  Peripheral vascular disease; status post aortofemoral
bypass in [**2194**].  Also status post axillofemoral bypass.
3.  Hypercholesterolemia.
4.  Hypothyroidism.
5.  Seizure disorder.
6.  Heparin-induced thrombocytopenia.
7.  Subdural hematoma in [**2197-3-31**].
8.  Of note, the patient has anti-K alloantibodies.

PAST SURGICAL HISTORY:
1.  Coronary artery bypass graft.
2.  Aortofemoral bypass with right subclavian to femoral
bypass.
3.  Craniotomy; status post subdural hematoma.
4.  Spinal surgery.

MEDICATIONS ON ADMISSION:
 1.  Aspirin 325 mg p.o. q.d.
 2.  Zocor 80 mg p.o. q.d.
 3.  Lopressor 100 mg p.o. t.i.d.
 4.  Accupril 5 mg p.o. q.d.
 5.  TriCor 108 mg p.o. q.d.
 6.  Pepcid 20 mg p.o. q.d.
 7.  Synthroid 125 mcg p.o. q.d.
 8.  Depakote 500 mg p.o.
 9.  Folic acid 1 mg p.o. q.d.
10.  Isosorbide 10 mg p.o. t.i.d.

ALLERGIES:  HEPARIN, CODEINE, SULFA, CECLOR.

SOCIAL HISTORY:  The patient is a reformed smoker after
smoking one and a half packs times 20 years.  The patient
denies any current alcohol use.  The patient lives in [**Location (un) 7498**] with her husband.

FAMILY HISTORY:  Family history is remarkable for peripheral
vascular disease and coronary artery disease.

PHYSICAL EXAMINATION ON PRESENTATION:  On admission, the
patient's vital signs were as follows; the patient was
afebrile, heart rate was 98, blood pressure was 132/61,
respiratory rate was 17, with an oxygen saturation of 100% on
2.5 liters of nasal cannula.  In general, she was alert and
awake, in no acute distress.  Head, eyes, ears, nose, and
throat revealed pupils were equally round and reactive to
light.  Her oropharynx was clear.  No lymphadenopathy.  No
jugular venous distention.  Remarkable for bilateral carotid
bruits.  Chest examination was clear to auscultation
bilaterally.  Cardiovascular examination revealed second
heart sound and second heart sound, tachycardic, a [**4-5**]
decrescendo murmur at her left sternal border.  There were no
rubs or gallops appreciated on examination.  The abdomen was
obese, soft, nontender, and nondistended.  Decreased bowel
sounds in all four quadrants.  Extremities revealed there was
no clubbing, no cyanosis, and no edema.  Pulses were 3+ by
Doppler in her dorsalis pedis, posterior tibialis, and her
left radial arteries; however, the patient had no right
radial pulse.  On neurologic examination, cranial nerves II
through XII were intact.  Normal speech.  Moved all
extremities.  5/5 strength in extremities, decreased pinprick
sensation at a median distribution of the left hand notable
for flexion contracture of left forearm, and her right palate
drop.

PERTINENT LABORATORY DATA ON PRESENTATION:   Laboratories on
admission showed sodium was 138, potassium was 3.8, chloride
was 99, bicarbonate was 25, blood urea nitrogen was 9,
creatinine was 0.5, blood glucose was 135.  White blood cell
count was 8.7, hematocrit was 31.8, platelets were 274.  On
admission to [**Hospital1 69**], her
creatine kinase was 335, and she had a troponin of 11.2.

RADIOLOGY/IMAGING:   Electrocardiogram revealed a normal
sinus rhythm at 80 beats per minute, normal axis, and normal
intervals.  No chamber abnormalities.  There were 1-mm ST
depressions in leads I, II, aVL, and V3 through V6.  T wave
flattening in I, aVL, and aVF which were consistent compared
to baseline electrocardiogram in [**2197-3-31**].

Cardiac catheterization on the day of admission revealed a
proximal left anterior descending artery lesion of 50% with
the first diagonal occluded, the left main coronary artery
with a 30% lesion, left circumflex was patent with the prior
first obtuse marginal, status post percutaneous transluminal
coronary angioplasty, lower first obtuse marginal with a 70%
lesion, right coronary artery with known occlusion with
collateral filling.  The saphenous vein graft of first
diagonal had a freshly occluded proximal thrombus.  Her left
internal mammary artery was patent, and the left subclavian
stent patent with 20% to 30% in-stent restenosis and normal
central aortic pressures.

HOSPITAL COURSE:  The patient was admitted to the Coronary
Care Unit for conservative management of her acute bilateral
myocardial infarction.

1.  CARDIOVASCULAR:  The patient was continued on aspirin,
beta blocker, ACE inhibitor, statin, and received a
nitroglycerin drip, and was given morphine as needed for
pain.  Anticoagulants were held secondary to her recent
history of subdural hematoma and known heparin-induced
thrombocytopenia.

Creatine kinase levels were followed throughout the course of
her hospital stay and peaked at a level of 910.  The patient
remained on a medical regimen throughout her hospital course,
and remained on telemetry throughout the remainder of her
hospital stay.  The patient was examined by Cardiothoracic
Surgery for any possibility of revascularization.  The
patient was told to follow up with Cardiothoracic Surgery as
an outpatient upon discharge.

The patient was weaned off her nitroglycerin drip on hospital
day three and remained off the nitroglycerin drip for the
remainder of her hospital stay, and the patient remained
hemodynamically stable throughout her hospital admission.

(b)  Myocardial function:  The patient underwent an
echocardiogram on the day of discharge which revealed the
following; the left atrium was mildly dilated, left
ventricular wall thickness was normal, left ventricular
cavity size was normal, overall left ventricular systolic
function was normal with a left ventricular ejection fraction
of 50%; the mid ventricular apical segments of inferior free
wall and anterior free wall were hypokinetic.  Right
ventricular chamber size and free wall motion were normal.
The aortic valve leaflets were structurally normal with good
excursion and no aortic regurgitation.  The mitral valve
leaflets were structurally normal.  There was no mitral valve
prolapse.  Moderate 2+ mitral regurgitation was seen.  The
mitral regurgitation was extrinsic.  There were no
pericardial effusions.  Compared with a previous study in [**2196-5-31**], focal left ventricular hypokinesis was now present.

(c)  Rhythm:  There were no events on telemetry throughout
the time while the patient had a acute myocardial infarction.

(d)  Hyperlipidemia:  Of note, the patient has a history of
hypercholesterolemia and was referred to the [**Hospital **] Clinic as
an outpatient for evaluation and management of her
hypercholesterolemia as it was believed that this may be a
contributing factor to her severe vascular disease.

2.  HEMATOLOGY:  The patient has a known history of
heparin-induced thrombocytopenia.  Heparin and other
anticoagulants were held throughout this hospital stay.

3.  NEUROLOGY:  The patient has a history of seizure disorder
and subdural hematoma in [**2197-3-31**].  The patient was
continued on her usual outpatient regimen of Depakote
throughout this stay.  The patient had remained
neurologically stable throughout her hospital stay with no
seizure activity noted.

4.  ENDOCRINE:  The patient has a history of hypothyroidism
and was continued on her Synthroid medication throughout her
hospital stay.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  Discharged to home with physical therapy
as needed.

DISCHARGE DIAGNOSES:  Acute myocardial infarction.

MEDICATIONS ON DISCHARGE:  (Medication regimen at discharge
is the same as outpatient medications on admission with the
exception of a change in her dose of Lopressor from 100 mg
p.o. t.i.d. to 50 mg p.o. b.i.d. as the patient's blood
pressure remained systolically around 95 throughout the
remainder of her hospital stay).
 1.  Aspirin 325 mg p.o. q.d.
 2.  Zocor 80 mg p.o. q.d.
 3.  Lopressor 50 mg p.o. b.i.d.
 4.  Accupril 5 mg p.o. q.d.
 5.  TriCor 108 mg p.o. q.d.
 6.  Pepcid 20 mg p.o. q.d.
 7.  Synthroid 125 mcg p.o. q.d.
 8.  Depakote 500 mg p.o.
 9.  Folic acid 1 mg p.o. q.d.
10.  Isosorbide 10 mg p.o. t.i.d.

DISCHARGE INSTRUCTIONS:
1.  The patient was told to follow up with her primary care
physician within the next two weeks.
2.  The patient was to follow up with Dr. [**Last Name (STitle) **] of Cardiology
within the next few weeks.
3.  The patient was given the number to follow up with
Cardiothoracic Surgery with regard to revascularization.




                  DR [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] 12.749

Dictated By:[**Last Name (NamePattern4) 33595**]

MEDQUIST36

D:  [**2197-10-4**]  16:15
T:  [**2197-10-11**]  06:46
JOB#:  [**Job Number **]
{'Acute myocardial infarction of other lateral wall, initial episode of care,Other and unspecified coagulation defects,Other convulsions,Coronary atherosclerosis of unspecified type of vessel, native or graft,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Old myocardial infarction'}


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 49-year-old
female with known coronary artery disease, status post
myocardial infarction, status post coronary artery bypass
graft times three in [**2193**], angioplasty in [**2197-1-31**],
peripheral vascular disease, status post aortofemoral bypass,
and axillobifemoral bypass, hypercholesterolemia, recent
subdural hematoma in [**2197-3-31**] who presented to [**Hospital3 33594**] Center on the morning of admission with anginal chest
pain refractory to medications, lateral ST segment
depressions, and negative cardiac enzymes.

MEDICAL HISTORY: 1.  Coronary artery disease; status post myocardial
infarction in [**2195**] (as per patient), multiple
catheterizations (the last in [**2197-1-31**] when she
received a stent of her saphenous vein graft to first
diagonal and underwent a percutaneous transluminal coronary
angioplasty of her first obtuse marginal).  She is status
post coronary artery bypass graft times three with saphenous
vein graft to both her right coronary artery and first
diagonal.
2.  Peripheral vascular disease; status post aortofemoral
bypass in [**2194**].  Also status post axillofemoral bypass.
3.  Hypercholesterolemia.
4.  Hypothyroidism.
5.  Seizure disorder.
6.  Heparin-induced thrombocytopenia.
7.  Subdural hematoma in [**2197-3-31**].
8.  Of note, the patient has anti-K alloantibodies.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
 2.  Zocor 80 mg p.o. q.d.
 3.  Lopressor 100 mg p.o. t.i.d.
 4.  Accupril 5 mg p.o. q.d.
 5.  TriCor 108 mg p.o. q.d.
 6.  Pepcid 20 mg p.o. q.d.
 7.  Synthroid 125 mcg p.o. q.d.
 8.  Depakote 500 mg p.o.
 9.  Folic acid 1 mg p.o. q.d.
10.  Isosorbide 10 mg p.o. t.i.d.

ALLERGIES: HEPARIN, CODEINE, SULFA, CECLOR.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history is remarkable for peripheral
vascular disease and coronary artery disease.

SOCIAL HISTORY: The patient is a reformed smoker after
smoking one and a half packs times 20 years.  The patient
denies any current alcohol use.  The patient lives in [**Location (un) 7498**] with her husband. 

### Response:
{'Acute myocardial infarction of other lateral wall, initial episode of care,Other and unspecified coagulation defects,Other convulsions,Coronary atherosclerosis of unspecified type of vessel, native or graft,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Aortocoronary bypass status,Old myocardial infarction'}
