CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 76-year-old female
with a past medical history remarkable for coronary artery
disease, status post a four vessel coronary artery bypass
graft approximately ten years ago in which the LIMA to the
LAD, saphenous vein graft to the D1, saphenous vein graft to
the RCA, and a saphenous vein graft to the OM.

MEDICAL HISTORY: 1.  Coronary artery disease, status post a four vessel CABG
approximately ten years ago.
2.  Aortic valve replacement.
3.  Gastroesophageal reflux disease.
4.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Her father passed away from a drowning
accident.  Her mother passed away in her 70s from coronary
artery disease.

SOCIAL HISTORY: She lives at home.  She is a retired factory
worker with Ratheon.  She denied any smoking or alcohol use.
She is widowed with four children.
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Heart valve replaced by other means
Crnry athrscl natve vssl,Intermed coronary synd,Cardiac dysrhythmias NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Heart valve replac NEC
Admission Date:  [**2123-2-17**]     Discharge Date:  [**2123-2-19**]

Date of Birth:   [**2046-8-6**]     Sex:  F

Service:  CCU

HISTORY OF THE PRESENT ILLNESS:  This is a 76-year-old female
with a past medical history remarkable for coronary artery
disease, status post a four vessel coronary artery bypass
graft approximately ten years ago in which the LIMA to the
LAD, saphenous vein graft to the D1, saphenous vein graft to
the RCA, and a saphenous vein graft to the OM.

A catheterization in [**2122-6-25**] revealed complete
occlusion in her native coronaries along with a total
occlusion of her OM and RCA saphenous vein graft.  The LIMA
along with the saphenous vein graft to the D1 remained
patent.  She had been medically managed since that time.

Approximately two weeks ago, she started to develop severe
back pain, shortness of breath, along with intermittent
episodes of dizziness.  She also complained of paroxysmal
nocturnal dyspnea and increased dyspnea upon exertion.

She initially went to an outside hospital on [**2123-2-12**]
with these complaints but left against medical advice after
not being able to be served in a timely manner.  She
continued to have episodes of chest pain, at which time she
went to another outside hospital on [**2123-2-15**] and was
admitted.

While in the hospital, her cardiac enzymes were drawn.  She
was negative times three sets. An EKG there, however, showed
approximately [**Street Address(2) 49973**] depressions during her
three episodes of chest pain.

She was transferred to [**Hospital3 **] for further evaluation.  A
catheterization revealed known totally occluded native
vessels, along with a mild proximal disease of the LIMA to
the LAD.  She also had two lesions in her saphenous vein
graft to her SVG to D1, proximal 90% occluded, and the distal
being 70% occluded.  It was found that this graft filled the
left circumflex and distal RCA.

At that time, it was determined to place a stent in the SVG
to D1 graft.  The procedure was complicated by a transient
angiographic focal aortic dissection with the left main
ejection, and an iliac dissection during the initial wire
catheter insertion.  The patient also became hypotensive and
bradycardiac for which she received one dose of Atropine.
She was then transferred to the CCU for overnight
observation.

PAST MEDICAL HISTORY:
1.  Coronary artery disease, status post a four vessel CABG
approximately ten years ago.
2.  Aortic valve replacement.
3.  Gastroesophageal reflux disease.
4.  Hypertension.

MEDICATIONS AT-HOME:
1.  Lopressor 50 mg b.i.d.
2.  Pepcid 20 mg q.d.
3.  Aspirin 325 mg q.d.
4.  Imdur 60 mg q.d.
5.  Plavix 75 mg q.d.
6.  Lasix 20 mg q.d.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  She lives at home.  She is a retired factory
worker with Ratheon.  She denied any smoking or alcohol use.
She is widowed with four children.

FAMILY HISTORY:  Her father passed away from a drowning
accident.  Her mother passed away in her 70s from coronary
artery disease.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Her initial
blood pressure was 106/39 with a heart rate of 76, 02
saturation 95% on 2 liters, respiratory rate 20.  General:
This is an elderly pleasant female in no apparent distress.
She was alert and oriented to person, place, and time.  Neck:
She had approximately 9 cm JVP.  Her neck was supple without
lymphadenopathy.  Lungs:  Clear to auscultation bilaterally.
Heart:  There was a regular rate and rhythm, S1 with a loud
S2.  She had a grade II/VI holosystolic murmur heard best on
the left sternal border.  Abdomen:  Soft, nontender,
nondistended, with normal bowel sounds.  Extremities:  There
was +1 DP pulses in the lower extremities.  Neurologic:  Both
short and long-term memory were intact.  Cranial nerves II
through XII grossly intact.  There were no motor or sensory
deficits.

LABORATORY DATA:  The laboratories from the outside hospital
showed a total cholesterol of 518, LDL 397, HDL 28,
triglycerides 182.  Her Chem-10 showed a sodium of 139,
potassium 4.9, chloride 105, bicarbonate 29, BUN 11,
creatinine 0.8.  Her glucose was 105.  PTT 78.

EKG showed a heart with a normal sinus rhythm with a rate of
approximately 70 beats per minute.  It had normal axis with
normal intervals.  There were [**Street Address(2) 1766**] depressions in lead II,
V4 through V6.  She also had downsloping ST depressions in
lead I and aVL.

HOSPITAL COURSE:  This is a 76-year-old female with severe
coronary artery disease who presented to an outside hospital
complaining of chest pain.  She was referred to [**Hospital3 **]
for a catheterization and further evaluation.

Her catheterization revealed that a large majority of her
heart was being supplied by an SVG to D1 graft that had two
serial lesions.  She underwent PCI with stent placement.  The
procedure was complicated by a retrograde iliac dissection as
well as post balloon inflation hypotension/bradycardia which
resolved with Atropine.

She was transferred to the CCU in stable condition for
overnight monitoring.

1.  CARDIAC:  For her coronary artery disease, the patient
was placed on aspirin, Plavix (for her lifetime),
Pravastatin, a low-dose beta blocker and an ACE inhibitor.
She also remained on Integrelin for approximately 18 hours
following the procedure.

During her stay, she experienced no further episodes of chest
pain, shortness of breath, upper extremity or jaw pain.  An
echocardiogram was performed which revealed that the patient
had an left ventricular ejection fraction of approximately
60% with symmetrical hypertrophy.  She had a TR gradient of
43, she had +2 mitral regurgitation, and mild tricuspid
regurgitation.  She remained in sinus rhythm throughout her
stay.

2.  DYSLIPIDEMIA:  The patient was with an LDL of 397 and a
total cholesterol of 518.  She states that these numbers are
actually much better than in the past for her.  She had been
on Lipitor in the past but had discontinued it for unclear
reasons.

The patient was started on a high-dose of pravastatin and a
follow-up appointment was scheduled for the [**Hospital **] Clinic for
further evaluation of her dyslipidemia.

DISPOSITION:  The patient was discharged home in stable
condition.

DISCHARGE INSTRUCTIONS:
1.  Follow-up with the lipid clinic-information will be sent
to her concerning her appointment.
2.  Follow-up with her primary cardiologist to discuss when a
recatheterization will be performed to ensure that the graft
remains open.
3.  The patient should return to the Emergency Room if she
develops any chest pain, back pain, upper extremity pain, jaw
pain, or shortness of breath.

DISCHARGE MEDICATIONS:
1.  Lopressor 50 mg b.i.d.
2.  Pepcid 20 mg q.d.
3.  Aspirin 325 mg q.d.
4.  Plavix 75 mg q.d.
5.  Lasix 20 mg q.d.
6.  Pravastatin 80 mg q.d.
7.  Lisinopril 5 mg q.d.




                          [**First Name8 (NamePattern2) 2064**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(2) 2139**]

Dictated By:[**Name8 (MD) 6284**]

MEDQUIST36

D:  [**2123-2-19**]  12:54
T:  [**2123-2-20**]  19:43
JOB#:  [**Job Number 49974**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Heart valve replaced by other means'}


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 76-year-old female
with a past medical history remarkable for coronary artery
disease, status post a four vessel coronary artery bypass
graft approximately ten years ago in which the LIMA to the
LAD, saphenous vein graft to the D1, saphenous vein graft to
the RCA, and a saphenous vein graft to the OM.

MEDICAL HISTORY: 1.  Coronary artery disease, status post a four vessel CABG
approximately ten years ago.
2.  Aortic valve replacement.
3.  Gastroesophageal reflux disease.
4.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Her father passed away from a drowning
accident.  Her mother passed away in her 70s from coronary
artery disease.

SOCIAL HISTORY: She lives at home.  She is a retired factory
worker with Ratheon.  She denied any smoking or alcohol use.
She is widowed with four children. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Heart valve replaced by other means'}
