CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 57 year old man with a
history of smoking, hypercholesterolemia, who started
noticing some fluttering sensation in his chest over the past
several years but no chest pain, syncope or chest tightness.
About two weeks ago, the patient had a presyncopal episode
with exertion.  Evaluation by his primary care provider
showed hypercholesterolemia.  He was also sent for exercise
tolerance test on [**7-18**], which demonstrated inferior septal
apical ischemia.  Following his exercise tolerance test he
was referred for cardiac catheterization, and on [**7-29**], the
patient underwent cardiac catheterization which showed 100%
proximal right coronary artery, 30% left main, 50 to 90% left
anterior descending, 60% proximal circumflex and an ejection
fraction of 61%.  Following cardiac catheterization the
patient was referred for cardiothoracic surgery.

MEDICAL HISTORY: Significant for smoking and
hypercholesterolemia.

MEDICATION ON ADMISSION: Only Aspirin once a day.

ALLERGIES: He has no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No known coronary artery disease.

SOCIAL HISTORY: Positive tobacco use, occasional alcohol
use, no intravenous or other drug use.
Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Pure hypercholesterolemia,Enlargement of lymph nodes,Tobacco use disorder,Backache, unspecified
Crnry athrscl natve vssl,Atrial fibrillation,Pure hypercholesterolem,Enlargement lymph nodes,Tobacco use disorder,Backache NOS
Admission Date:  [**2140-8-12**]       Discharge Date:  [**2140-8-15**]

Date of Birth:   [**2082-8-9**]       Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  This is a 57 year old man with a
history of smoking, hypercholesterolemia, who started
noticing some fluttering sensation in his chest over the past
several years but no chest pain, syncope or chest tightness.
About two weeks ago, the patient had a presyncopal episode
with exertion.  Evaluation by his primary care provider
showed hypercholesterolemia.  He was also sent for exercise
tolerance test on [**7-18**], which demonstrated inferior septal
apical ischemia.  Following his exercise tolerance test he
was referred for cardiac catheterization, and on [**7-29**], the
patient underwent cardiac catheterization which showed 100%
proximal right coronary artery, 30% left main, 50 to 90% left
anterior descending, 60% proximal circumflex and an ejection
fraction of 61%.  Following cardiac catheterization the
patient was referred for cardiothoracic surgery.

PAST MEDICAL HISTORY:  Significant for smoking and
hypercholesterolemia.

ALLERGIES:  He has no known allergies.

MEDICATIONS ON ADMISSION:  Only Aspirin once a day.

SOCIAL HISTORY:  Positive tobacco use, occasional alcohol
use, no intravenous or other drug use.

FAMILY HISTORY:  No known coronary artery disease.

PHYSICAL EXAMINATION:  Afebrile, heartrate 55, blood pressure
105/58, respiratory rate 20, oxygen saturation 97% on room
air.  Head, eyes, ears, nose and throat, pupils equally round
and reactive to light with extraocular movements intact,
uninjected, anicteric.  Mucous membranes were moist, no
erythema, no bruits.  Neck was supple.  Heart regular rate
and rhythm with some sinus irregularity.  S1 and S2 with a
Grade II/VI systolic ejection murmur.  Lungs, coarse
breathsounds on the left with no crackles.  Abdomen was soft,
nontender, nondistended.  Positive bowel sounds.
Extremities, decreased capillary refill bilaterally with
[**Doctor Last Name 6237**] test.  No lower extremity edema.  Feet are warm
bilaterally, 2+ dorsalis pedis pulses bilaterally.
Neurological, alert and oriented times three.  Cranial nerves
II through XII grossly intact.  Motor is [**5-9**] in the upper and
lower extremities.  Sensation is intact bilaterally.

LABORATORY DATA:  White count 9.4, hematocrit 37.5, platelets
253, sodium 134, potassium 3.7, chloride 102, carbon dioxide
24, BUN 20, creatinine 0.7, glucose 185, PT 12.8, PTT 28.2,
INR 1.0.  Urinalysis is negative.

HOSPITAL COURSE:  The patient was discharged home following
cardiac catheterization and returned as a postoperative admit
on [**8-8**].  At that time he was brought directly to the
Operating Room.  Please see the operative report for full
details.  He had coronary artery bypass grafting times three
with left internal mammary artery to the left anterior
descending, saphenous vein graft to the obtuse marginal and
saphenous vein graft to the posterior left ventricular,
bypass time was 127 minutes with a crossclamp time of 81
minutes.  The patient tolerated the operation well and was
transferred from the Operating Room to the Cardiothoracic
Intensive Care Unit.  At the time of transfer the patient's
mean arterial pressure was 93.  He was atrially paced at 88
beats/minute and he had Neo-Synephrine at 0.3 mcg/kg/minute
and Propofol at 10 mcg/kg/minute.  The patient did well in
the immediate postoperative period.  His anesthesia was
reversed.  He was weaned from the ventilator and successfully
extubated.  He remained hemodynamically stable throughout the
day of his surgery.  On postoperative day #1 the patient
remained hemodynamically stable, however, he continued to
require Neo-Synephrine at 1 mcg/kg/min in order to maintain
adequate blood pressure.  For that reason he remained in the
Intensive Care Unit.  His chest tubes were discontinued on
postoperative day #1 as was his Foley catheter.  On
postoperative day #2 the patient continued to be
hemodynamically stable.  He had weaned off of his
Neo-Synephrine over the past 24 hours and he was transferred
to the floor for continuing postoperative care and cardiac
rehabilitation.  After arrival on the Cardiothoracic Surgery
floor the patient was worked with by the nursing staff and
physical therapist.  His activity level was gradually
increased.  On postoperative day #4 he was noted to have a
single episode of atrial fibrillation with a heartrate up to
140.  He was treated with intravenous Lopressor and converted
back to normal sinus rhythm.  The patient continued to
gradually increase his activity level and on postoperative
day #7 it was decided that the patient was stable and ready
to be discharged to home.

At the time of discharge the patient's physical examination
revealed temperature 99.1, heartrate 66, sinus rhythm, blood
pressure 112/70, respiratory rate 20, oxygen saturations 96%
on room air.  Weight preoperatively 88.6 kg, at discharge
82.6 kg.  Laboratory data revealed white count 12, hematocrit
27, platelets 387, sodium 145, potassium 4.7, chloride 106,
carbon dioxide 29, BUN 17, creatinine 0.9, glucose 96,
magnesium 2.3.  Neurologically alert and oriented times
three, moves all extremities, follows commands.  Respiratory
clear to auscultation bilaterally.  Heartsounds regular rate
and rhythm, S1 and S2, no murmurs.  Sternum stable.  Incision
with Steri-Strips, open to air, clean and dry.  Abdomen soft,
nontender, nondistended with normoactive bowel sounds.
Extremities, warm and well perfused with no edema.  Right
saphenous vein graft site incision with Steri-Strips open to
air, clean and dry.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease, status post coronary artery
bypass grafting times three with left internal mammary artery
to the left anterior descending, saphenous vein graft to the
obtuse marginal and saphenous vein graft to the posterior
left ventricular
2.  Hypercholesterolemia
3.  Low back pain

CONDITION ON DISCHARGE:  Good.

DISCHARGE MEDICATIONS:
Aspirin 325 q.d.
Niferex 150 q.d.
Ascorbic acid 500 b.i.d.
Metoprolol 50 b.i.d.
Atorvastatin 10 q.d.
Lasix 20 q.d. times seven days
Potassium chloride 20 q.d. times seven days
Dilaudid 2 to 4 mg q. 4 hours prn

FOLLOW UP:  The patient is to be discharged home.  He is to
have follow up in the [**Hospital 409**] Clinic in two weeks, follow up
with Dr. [**Last Name (STitle) **] in four weeks and follow up with his
primary care provider, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 51650**] in four weeks.


                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

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

D:  [**2140-8-15**]  11:29
T:  [**2140-8-15**]  11:39
JOB#:  [**Job Number 51651**]
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Pure hypercholesterolemia,Enlargement of lymph nodes,Tobacco use disorder,Backache, unspecified'}


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 57 year old man with a
history of smoking, hypercholesterolemia, who started
noticing some fluttering sensation in his chest over the past
several years but no chest pain, syncope or chest tightness.
About two weeks ago, the patient had a presyncopal episode
with exertion.  Evaluation by his primary care provider
showed hypercholesterolemia.  He was also sent for exercise
tolerance test on [**7-18**], which demonstrated inferior septal
apical ischemia.  Following his exercise tolerance test he
was referred for cardiac catheterization, and on [**7-29**], the
patient underwent cardiac catheterization which showed 100%
proximal right coronary artery, 30% left main, 50 to 90% left
anterior descending, 60% proximal circumflex and an ejection
fraction of 61%.  Following cardiac catheterization the
patient was referred for cardiothoracic surgery.

MEDICAL HISTORY: Significant for smoking and
hypercholesterolemia.

MEDICATION ON ADMISSION: Only Aspirin once a day.

ALLERGIES: He has no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No known coronary artery disease.

SOCIAL HISTORY: Positive tobacco use, occasional alcohol
use, no intravenous or other drug use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Atrial fibrillation,Pure hypercholesterolemia,Enlargement of lymph nodes,Tobacco use disorder,Backache, unspecified'}
