CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 51-year-old man
with a two-year history of exertional chest discomfort that
is always resolved with rest.  It has been increasing in
frequency and severity and is currently occurring with as
little as walking from the house to his car.  He seems to
notice most of these symptoms in the evening with exertion or
when he lies down at night.  Discomfort is described as mid
and left-sided chest aching/pressure accompanied by shortness
of breath, relieved with rest and four sublingual
nitroglycerin tablets.  The patient had a positive ETT with a
reversed wall inferoapical defect.  He is now referred for
cardiac catheterization.

MEDICAL HISTORY: 1. Hyperlipidemia.  2. Rheumatoid
arthritis.  3. Seasonal allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Pure hypercholesterolemia,Rheumatoid arthritis
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Pure hypercholesterolem,Rheumatoid arthritis
Admission Date:  [**2107-3-30**]       Discharge Date:  [**2107-4-6**]

Date of Birth:   [**2055-11-16**]       Sex:  M

Service:  Cardiothoracic Surgery

ADMISSION DIAGNOSIS:
Coronary artery disease.

DISCHARGE DIAGNOSES:
1. Two-vessel coronary artery disease, ejection fraction of
60%.
2. Coronary artery bypass grafting x 3 ([**2107-3-31**]).

HISTORY OF PRESENT ILLNESS:  The patient is a 51-year-old man
with a two-year history of exertional chest discomfort that
is always resolved with rest.  It has been increasing in
frequency and severity and is currently occurring with as
little as walking from the house to his car.  He seems to
notice most of these symptoms in the evening with exertion or
when he lies down at night.  Discomfort is described as mid
and left-sided chest aching/pressure accompanied by shortness
of breath, relieved with rest and four sublingual
nitroglycerin tablets.  The patient had a positive ETT with a
reversed wall inferoapical defect.  He is now referred for
cardiac catheterization.

PAST MEDICAL HISTORY:  1. Hyperlipidemia.  2. Rheumatoid
arthritis.  3. Seasonal allergies.

PAST SURGICAL HISTORY:  Appendectomy.

MEDICATIONS:  1. Aspirin 325 mg q.d.  2. Plavix 75 mg q.d.,
first dose on [**2107-3-30**].  3. Lipitor 10 mg q.d.  4. Toprol 25
mg b.i.d.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION:  On admission the patient was a
middle-aged man in no acute distress.  Vital signs were
stable, afebrile.  Height was 5'[**15**]", weight was 220 pounds.
HEENT:  Normocephalic, atraumatic.  Extraocular movements
intact, pupils were equal, round, and reactive to light,
anicteric.  Throat was clear.  Neck:  Supple, midline,
without masses or lymphadenopathy.  Chest:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rate and
rhythm without murmur, rub or gallop.  Abdomen:  Soft,
nontender, nondistended with no masses or organomegaly.
Extremities:  Warm, noncyanotic, nonedematous x 4.
Neurologic:  Grossly intact.

LABORATORY DATA:  Complete blood count was 5.7/15.1/42.4/342.
Chemistries were 140/4.1/101/29/15/101.  INR was 1.0.

HOSPITAL COURSE:  The patient was admitted for cardiac
catheterization secondary to his increasing anginal symptoms.
Cardiac catheterization was performed on [**2107-3-30**] and
revealed severe two-vessel coronary artery disease with an
ejection fraction of 60%.  Subsequent to this finding the
patient had evaluation by the cardiac surgery team.  It was
felt that the patient would benefit from revascularization
procedure.

The patient was appropriately preoperatively prepared and on
[**2107-3-31**] the patient was taken to the operating room for
coronary artery bypass grafting x 3 with left internal
mammary artery to the left anterior descending coronary
artery, right internal mammary artery to the descending right
coronary artery, saphenous vein graft to the diagonal artery.

The patient was extubated on the evening of postoperative day
zero with Precedex given for anxiety and to help with
extubation.  The patient also received 500 cc of Hespan.

The patient subsequently seemed to be doing well and was
later transferred to the floor on postoperative day one.  His
floor course was largely unremarkable without significant
events.  He did have some mild serosanguinous staining from
his sternal wound.  This was seen to stop within 12-24 hours.
Ultimately the patient was discharged on postoperative day
six tolerating a regular diet and adequate pain control with
p.o. pain medications and having been cleared for home by
physical therapy.  The patient had no further anginal
symptoms and the sternal drainage had stopped for greater
than 24 hours prior to discharge.

Physical examination on discharge:  General in no acute
distress.  Vital signs were temperature 99.4, heart rate 70
and sinus, blood pressure 120/72, respiratory rate 20, 96% on
room air.  Chest was clear to auscultation bilaterally.
There was no sternal click and no sternal discharge.  The
sternum was stable.  Cardiovascular was regular rate and
rhythm.  Extremities were significant for 1+ peripheral
edema.  Neurological examination was grossly intact.

Laboratory studies on discharge were hematocrit of 27.1.
Chemistries were 139/5.1/102/28/13/0.9/116.  Magnesium was
2.2.

DISCHARGE CONDITION:  Good.

DISPOSITION:  To home.

DIET:  Cardiac.

MEDICATIONS:
1. Aspirin 325 mg q.d.
2. Lipitor 10 mg q.d.
3. Lopressor 75 mg b.i.d.
4. Lasix 20 mg b.i.d. x 7 days.
5. Potassium chloride 20 mEq b.i.d. x 7 days.
6. Percocet 5/325 1-2 tablets q. 4 hours p.r.n.
7. Colace 100 mg b.i.d.

DISCHARGE INSTRUCTIONS:
1. The patient should follow up closely with his cardiologist
in one to two weeks' time.  He should address the need for
diuresis as well as adjustment of cardiac medications at that
time.
2. The patient should follow up with Dr. [**Last Name (STitle) 70**] in six
weeks.
3. Continue incentive spirometry and ambulation.





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

Dictated By:[**Last Name (NamePattern1) 5745**]
MEDQUIST36

D:  [**2107-4-6**]  09:58
T:  [**2107-4-6**]  10:10
JOB#:  [**Job Number 46269**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Pure hypercholesterolemia,Rheumatoid arthritis'}


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 51-year-old man
with a two-year history of exertional chest discomfort that
is always resolved with rest.  It has been increasing in
frequency and severity and is currently occurring with as
little as walking from the house to his car.  He seems to
notice most of these symptoms in the evening with exertion or
when he lies down at night.  Discomfort is described as mid
and left-sided chest aching/pressure accompanied by shortness
of breath, relieved with rest and four sublingual
nitroglycerin tablets.  The patient had a positive ETT with a
reversed wall inferoapical defect.  He is now referred for
cardiac catheterization.

MEDICAL HISTORY: 1. Hyperlipidemia.  2. Rheumatoid
arthritis.  3. Seasonal allergies.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Pure hypercholesterolemia,Rheumatoid arthritis'}
