CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 87-year-old
woman with a history of diabetes, hypertension, and a high
cholesterol with a history of previous tobacco smoking who
had a recent history of left humeral fracture who presented
to an outside hospital with substernal chest discomfort and
nausea from home.  She was found to have EKG changes
consistent with myocardial ischemia and was transferred to
the [**Hospital6 256**] for further
evaluation.  She was found to have a non-Q wave myocardial
infarction and was admitted to the Cardiology service, where
further workup was performed.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Pneumonia, organism unspecified,Other complications due to other cardiac device, implant, and graft,Cardiogenic shock,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension
Subendo infarct, initial,Parox ventric tachycard,Pneumonia, organism NOS,Comp-oth cardiac device,Cardiogenic shock,CHF NOS,Crnry athrscl natve vssl,Abn react-anastom/graft,Hypertension NOS
Admission Date:  [**2111-8-16**]     Discharge Date:  [**2111-8-22**]


Service:  [**First Name9 (NamePattern2) **] [**Last Name (un) **]

HISTORY OF PRESENT ILLNESS:  The patient is an 87-year-old
woman with a history of diabetes, hypertension, and a high
cholesterol with a history of previous tobacco smoking who
had a recent history of left humeral fracture who presented
to an outside hospital with substernal chest discomfort and
nausea from home.  She was found to have EKG changes
consistent with myocardial ischemia and was transferred to
the [**Hospital6 256**] for further
evaluation.  She was found to have a non-Q wave myocardial
infarction and was admitted to the Cardiology service, where
further workup was performed.

PHYSICAL EXAMINATION:  The patient is a pleasant, elderly
woman who had extensive ecchymosis of the left upper
extremity.  She had some decreased breath sounds at the right
base consistent with question of consolidation on her x-ray.
She had regular cardiac rhythm.  Pulses were diminished in
both lower extremities with an absent right femoral pulse and
a weak left femoral pulse.  EKG showed diffuse S-T
depressions with 1 mm S-T elevation in AVR.

HOSPITAL COURSE:  The patient underwent cardiac cath on
[**2111-8-18**] which showed 80% stenosis of the left main
coronary artery and occluded right coronary artery and
diffuse disease of the other vessels.  The patient had poor
ventricular dysfunction with an ejection fraction of 25 to
30% on echo.  However, at that cardiac cath her right iliac
artery was found to be occluded so a balloon pump could not
be placed.

Post procedure the patient also had some coffee ground emesis
and was also found to have an elevated white blood cell count
of 20,000 and a question of a left lower lobe infiltrate as
well as white blood cells on her urinalysis.  She was felt to
be a high risk operative candidate, but given her good
functional status and her diffuse coronary vascular disease,
it was felt that operation was really her only option.

On [**2111-8-19**] she underwent coronary artery bypass times
three with left internal mammary artery graft to a proximal
diag. and saphenous vein graft to obtuse marginal and right
coronary artery.  Postoperatively the patient remained on
Dobutamine for inotropy and was generally stable postop day
zero.

Around 4 a.m. on postoperative day number one she developed
unstable dysrhythmias with both supraventricular narrow
complex dysrhythmias as well as a brief run of ventricular
tachycardia.  She was defibrillated and afterward remained
hemodynamically stable.  She was started on an Amiodarone
drip.

On postoperative day number two she was substantially more
stable with no real further rhythm problems.  She was
extubated on the afternoon of postoperative day number two
and was progressing in her post CABG recovery.

On the morning of postoperative day number three the patient,
however, took a turn for the worse.  She was in some
respiratory distress and her cardiac numbers began to
deteriorate with a reduced cardiac index.  Her Dobutamine was
increased and started on epinephrine.  Cardiac echo was
obtained at the bedside which did not show any focal
dyskinetic myocardial segments.  She was then taken for a
cardiac cath for diagnostic purposes and to possibly
revascularize her percutaneously in the event that her bypass
grafts were down.

At Angio she indeed was found to have occluded saphenous vein
grafts times two.  Revascularization of the obtuse marginal
was attempted, but the circumflex could not be traversed.
Patient during this intervention became progressively more
hypotensive and eventually developed electromechanical
dissociation.  Resuscitation was attempted, unfortunately,
without success, and the patient expired in the Cardiac Cath
Lab.

DISCHARGE CONDITION:  Death.

DISCHARGE STATUS:  As above.

DISCHARGE DIAGNOSES:
1.  Hypertension.
2.  Diabetes.
3.  Hypercholesterolemia.
4.  Status post humeral fracture.
5.  Status post coronary artery bypass graft times three on
[**2111-8-19**] with diffuse coronary artery disease.
6.  Postoperative dysrhythmias.
7.  Occlusion of saphenous vein grafts with death on cardiac
catheterization.

DISCHARGE MEDICATIONS:  Not applicable.

DISCHARGE INSTRUCTIONS:  Not applicable.



                          [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern4) 51711**]

MEDQUIST36

D:  [**2111-8-24**]  10:52
T:  [**2111-8-25**]  12:53
JOB#:  [**Job Number 51712**]
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Pneumonia, organism unspecified,Other complications due to other cardiac device, implant, and graft,Cardiogenic shock,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,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 87-year-old
woman with a history of diabetes, hypertension, and a high
cholesterol with a history of previous tobacco smoking who
had a recent history of left humeral fracture who presented
to an outside hospital with substernal chest discomfort and
nausea from home.  She was found to have EKG changes
consistent with myocardial ischemia and was transferred to
the [**Hospital6 256**] for further
evaluation.  She was found to have a non-Q wave myocardial
infarction and was admitted to the Cardiology service, where
further workup was performed.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subendocardial infarction, initial episode of care,Paroxysmal ventricular tachycardia,Pneumonia, organism unspecified,Other complications due to other cardiac device, implant, and graft,Cardiogenic shock,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension'}
