CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 57-year-old woman who
was referred for outpatient cardiac catheterization due to
recent complaints of chest discomfort and shortness of
breath.

MEDICAL HISTORY: 1.  Hypertension.
 2.  Hyperlipidemia.
 3.  Diabetes.
 4.  Human T cell leukemia-lymphoma virus.
 5.  Elevated C-reactive protein.
 6.  Environmental allergies.
 7.  Macular degeneration.
 8.  Eosinophilia.
 9.  Lupus.
10.  Severe degenerative joint disease of both knees.
11.  Positive Lyme titer.
12.  Positive toxoplasmosis.
13.  Sleep apnea; on CPAP at home.
14.  Status post thyroidectomy.
15.  Status post appendectomy.
16.  Status post tonsillectomy.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
 2.  Actos 30 mg p.o. q.d.
 3.  [**Doctor First Name **] 60 mg p.o. b.i.d.
 4.  Atenolol 50 mg p.o. q.d.
 5.  Prozac 50 mg p.o. q.d.
 6.  Glyburide 10 mg p.o. b.i.d.
 7.  Ibuprofen 800 mg p.o. t.i.d.
 8.  Levoxyl 175 mcg p.o. q.d.
 9.  Lipitor 10 mg p.o. q.a.m. and 20 mg p.o. q.p.m.
10.  Glucophage 500 mg p.o. t.i.d.
11.  Minocycline 100 mg p.o. t.i.d.
12.  Lisinopril/hydrochlorothiazide 12/12.5 two tablets p.o.
q.a.m.
13.  Lasix 40 mg p.o. q.a.m.
14.  Potassium 20 mEq p.o. q.d.
15.  Multivitamin.
16.  Calcium supplements.

ALLERGIES: TETRACYCLINE which results in vaginal
candidiasis.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified sleep apnea,Unspecified essential hypertension,Pure hypercholesterolemia,Postsurgical hypothyroidism
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Chr pulmon heart dis NEC,DMII wo cmp nt st uncntr,Sleep apnea NOS,Hypertension NOS,Pure hypercholesterolem,Postsurgical hypothyroid
Admission Date:  [**2166-11-27**]       Discharge Date:[**2166-12-5**]

Date of Birth:   [**2109-10-4**]       Sex:  F

Service:  Cardiac Surgery

HISTORY OF PRESENT ILLNESS:  This is a 57-year-old woman who
was referred for outpatient cardiac catheterization due to
recent complaints of chest discomfort and shortness of
breath.

The patient reports that she has been under increased stress
since late [**Month (only) 216**] and has noticed intermittent symptoms of
chest pressure and shortness of breath.  These symptoms are
now recurring on a daily basis, and these symptoms resolve
with rest.

On [**2166-10-21**] she was admitted to [**Hospital3 3583**] for
increasing symptoms of congestive heart failure.  She ruled
out for a myocardial infarction.  She underwent further
cardiac testing that suggested that she had coronary artery
disease, and she was referred to [**Hospital1 190**] for cardiac catheterization.

PAST MEDICAL HISTORY:
 1.  Hypertension.
 2.  Hyperlipidemia.
 3.  Diabetes.
 4.  Human T cell leukemia-lymphoma virus.
 5.  Elevated C-reactive protein.
 6.  Environmental allergies.
 7.  Macular degeneration.
 8.  Eosinophilia.
 9.  Lupus.
10.  Severe degenerative joint disease of both knees.
11.  Positive Lyme titer.
12.  Positive toxoplasmosis.
13.  Sleep apnea; on CPAP at home.
14.  Status post thyroidectomy.
15.  Status post appendectomy.
16.  Status post tonsillectomy.

ALLERGIES:  TETRACYCLINE which results in vaginal
candidiasis.

MEDICATIONS ON ADMISSION:
 1.  Aspirin 325 mg p.o. q.d.
 2.  Actos 30 mg p.o. q.d.
 3.  [**Doctor First Name **] 60 mg p.o. b.i.d.
 4.  Atenolol 50 mg p.o. q.d.
 5.  Prozac 50 mg p.o. q.d.
 6.  Glyburide 10 mg p.o. b.i.d.
 7.  Ibuprofen 800 mg p.o. t.i.d.
 8.  Levoxyl 175 mcg p.o. q.d.
 9.  Lipitor 10 mg p.o. q.a.m. and 20 mg p.o. q.p.m.
10.  Glucophage 500 mg p.o. t.i.d.
11.  Minocycline 100 mg p.o. t.i.d.
12.  Lisinopril/hydrochlorothiazide 12/12.5 two tablets p.o.
q.a.m.
13.  Lasix 40 mg p.o. q.a.m.
14.  Potassium 20 mEq p.o. q.d.
15.  Multivitamin.
16.  Calcium supplements.

PERTINENT LABORATORY DATA ON PRESENTATION:  Blood urea
nitrogen was 21, creatinine was 0.9.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs revealed
pulse was 50 and blood pressure was 117/45.  Head, eyes,
ears, nose, and throat examination was unremarkable.  The
neck was without bruits.  Heart was regular in rate and
rhythm.  No murmurs.  The lungs were clear.  Extremities
revealed normal peripheral pulses.  No vascular disease.

HOSPITAL COURSE:  The patient underwent cardiac
catheterization on [**2166-11-27**] which showed a left
ventricular ejection fraction of 40%, with mild diffuse
hypokinesis, a 60% to 70% distal left main occlusion, a 70%
proximal left anterior descending artery occlusion, a 70%
left circumflex occlusion, a 90% first obtuse marginal
occlusion, 70% ostial right coronary artery occlusion.

The patient was taken to the operating room on [**2166-11-28**] for a coronary artery bypass graft times four; left
internal mammary artery to left anterior descending artery,
left radial to posterior descending artery, saphenous vein
graft to obtuse marginal, with a sequential graft to the
first diagonal.  Please see the Operative Note for further
details.

The patient was transferred to the Intensive Care Unit in
stable condition.  The patient was weaned and extubated from
mechanical ventilation on the first postoperative night.  The
patient required some volume resuscitation as well as a
Neo-Synephrine infusion to maintain an adequate blood
pressure.

On postoperative day one, the patient's hematocrit was noted
to be 21.8.  The patient was transfused 2 units of packed red
blood cells.  The patient was on an insulin infusion to
maintain adequate blood glucose control.  The patient
remained in the Intensive Care Unit due to labile blood
pressures.  The patient required aggressive pulmonary toilet,
and the patient was placed on her nocturnal CPAP settings
which she tolerated well.

On postoperative day three, the patient was transferred from
the Intensive Care Unit to the floor in stable condition.
The patient required some aggressive diuresis and aggressive
pulmonary toilet.  The patient began ambulating with Physical
Therapy, and it was determined that the patient would need
[**Hospital 3058**] rehabilitation.  The patient was intermittently
complaining of shortness of breath which she stated was at
her baseline.  This shortness of breath was improved with
diuresis and the use of nocturnal CPAP which she was on at
home.  The patient's chest tubes and epicardial pacing wires
were discontinued without complications.

A chest x-ray showed small bilateral pleural effusions as
well as bilateral atelectasis.  The patient was cleared for
discharge on [**2166-12-5**] to a rehabilitation facility.

CONDITION AT DISCHARGE:  Temperature maximum was 97.2, pulse
was 69 (in sinus rhythm), blood pressure was 145/68, oxygen
saturation was 94% on room air, respiratory rate was 25.
Neurologically, grossly intact.  Heart had a regular rate and
rhythm.  Positive rub.  No murmur.  Lungs revealed breath
sounds were clear anteriorly; posteriorly with minimal
crackles at the bases.  The abdomen was obese.  Positive
bowel sounds.  Nontender and nondistended.  The extremities
were warm with 1+ edema.  The sternal incision was clean and
dry without erythema.  Left radial artery harvest site was
clean and dry with Steri-Strips intact.  There was no
erythema or drainage.  The vein harvest site in the right
thigh was clean and dry and without erythema or drainage.

PERTINENT LABORATORY DATA ON DISCHARGE:  On [**2166-12-5**]
hematocrit was 31.8.  Potassium was 4.3, blood urea nitrogen
was 19, and creatinine was 0.7.

DISCHARGE DIAGNOSES:
 1.  Status post coronary artery bypass graft.
 2.  Hypertension.
 3.  Hyperlipidemia.
 4.  Diabetes.
 5.  Human T cell leukemia-lymphoma virus.
 6.  Elevated C-reactive protein.
 7.  Environmental allergies.
 8.  Macular degeneration.
 9.  Eosinophilia.
10.  Lupus.
11.  Severe degenerative joint disease of both knees.
12.  Positive Lyme titer.
13.  Positive toxoplasmosis.
14.  Sleep apnea; on CPAP at home.
15.  Status post thyroidectomy.
16.  Status post appendectomy.
17.  Status post tonsillectomy.

MEDICATIONS ON DISCHARGE:
 1.  Lopressor 12.5 mg p.o. b.i.d.
 2.  Lasix 40 mg p.o. q.12h.
 3.  Potassium chloride 20 mEq p.o. q.12h.
 4.  Enteric-coated aspirin 325 mg p.o. q.d.
 5.  Colace 100 mg p.o. b.i.d.
 6.  Percocet 5/325 one to two tablets p.o. q.4-6h. as
needed.
 7.  Ibuprofen 400 mg p.o. q.4-6h. as needed.
 8.  Imdur 60 mg p.o. q.d. (times three months).
 9.  Actos 30 mg p.o. q.d.
10.  Glyburide 10 mg p.o. b.i.d.
11.  Prozac 50 mg p.o. q.d.
12.  Levoxyl 175 mcg p.o. q.d.
13.  Lipitor 30 mg p.o. q.d.
14.  Minocycline 100 mg p.o. t.i.d.
15.  [**Doctor First Name **] 60 mg p.o. b.i.d.
16.  Heparin 5000 units subcutaneous q.8h. (until fully
ambulatory).
17.  A regular insulin sliding-scale; for blood sugars of
120 to 150 give 2 units subcutaneous, for blood sugars of 151
to 170 give 3 units subcutaneous, for blood sugars of 171 to
190 give 4 units subcutaneous, for blood sugars of 191 to 210
give 5 units subcutaneous, for blood sugars of 211 to 230
give 6 units subcutaneous, for blood sugars of 231 to 250
give 7 units subcutaneous, for blood sugars of 251 to 270
give 8 units subcutaneous, for blood sugars of 271 to 290
give 9 units subcutaneous, for blood sugars of 291 to 310
give 10 units subcutaneous, for blood sugars of 311 to 330
give 11 units subcutaneous, for blood sugars of 331 to 350
give 12 units subcutaneous.

DISCHARGE INSTRUCTIONS:
1.  The patient was to have her blood sugar checked before
meals and at bedtime; covered with her regular insulin
sliding-scale.
2.  The patient was to be placed on nocturnal CPAP with 7 cm
of water with 3 liters nasal cannula.
3.  Diet is 1800 American Diabetes Association.

DISCHARGE FOLLOWUP:
1.  The patient was to follow up with her primary care
physician upon discharge from rehabilitation.
2.  The patient was to follow up with Dr. [**Last Name (STitle) 70**] in four
to six weeks.
3.  The patient was to follow up with cardiologist in four to
six weeks.





                            [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 7169**]

Dictated By:[**Last Name (NamePattern1) 3870**]
MEDQUIST36

D:  [**2166-12-5**]  11:45
T:  [**2166-12-5**]  14:13
JOB#:  [**Job Number 24178**]


Name:  [**Known lastname 4119**], [**Known firstname **]                    Unit No:  [**Numeric Identifier 4120**]

Admission Date:  [**2166-11-27**]     Discharge Date:  [**2166-12-9**]

Date of Birth:   [**2109-10-4**]     Sex:  F

Service:

ADDENDUM:  (Covering period [**2166-12-5**] through [**2166-12-9**])  Refer to previously dictated discharge summary for
[**Hospital 1325**] hospital course from [**2166-11-27**] through
[**2166-12-5**].

HISTORY OF PRESENT ILLNESS:  This was a 57 year old female
who was referred for operating table cardiac catheterization
due to recent complaints of chest discomfort and shortness of
breath.  The patient reported that she had been under
increased stress since late [**Month (only) **] and had noticed
intermittent symptoms of chest pressure and shortness of
breath.  These symptoms were now recurring on a daily basis,
and these symptoms resolved with rest.  On [**2166-10-21**], the patient was admitted to [**Hospital3 4121**] for
increasing symptoms of congestive heart failure.  She ruled
out for myocardial infarction at that time.  She underwent
further cardiac testing which suggested that she had coronary
artery disease, and was referred to [**Hospital6 4122**] for cardiac catheterization.

HOSPITAL COURSE:  (From [**2166-12-5**] through [**2166-12-9**])  The patient's discharge was delayed by four days due
to the nonavailability of bed at a rehabilitation facility.
By [**2166-12-9**], the patient's physical condition had
improved to the point where she no longer needed discharge to
a rehabilitation facility.  Arrangements were therefore made
to discharge the patient home.  During the period of delay in
the patient's discharge she continued to do well from a
cardiac standpoint.  Her surgical incision continued to heal
well without any evidence of infection.

FOLLOW UP:  The patient was to follow up with Dr. [**Last Name (STitle) 71**]
in clinic four weeks following discharge as originally
planned.




                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 2728**]

Dictated By:[**Name8 (MD) 4123**]

MEDQUIST36

D:  [**2166-12-10**]  15:27
T:  [**2166-12-10**]  16:01
JOB#:  [**Job Number 4124**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified sleep apnea,Unspecified essential hypertension,Pure hypercholesterolemia,Postsurgical hypothyroidism'}


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 woman who
was referred for outpatient cardiac catheterization due to
recent complaints of chest discomfort and shortness of
breath.

MEDICAL HISTORY: 1.  Hypertension.
 2.  Hyperlipidemia.
 3.  Diabetes.
 4.  Human T cell leukemia-lymphoma virus.
 5.  Elevated C-reactive protein.
 6.  Environmental allergies.
 7.  Macular degeneration.
 8.  Eosinophilia.
 9.  Lupus.
10.  Severe degenerative joint disease of both knees.
11.  Positive Lyme titer.
12.  Positive toxoplasmosis.
13.  Sleep apnea; on CPAP at home.
14.  Status post thyroidectomy.
15.  Status post appendectomy.
16.  Status post tonsillectomy.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
 2.  Actos 30 mg p.o. q.d.
 3.  [**Doctor First Name **] 60 mg p.o. b.i.d.
 4.  Atenolol 50 mg p.o. q.d.
 5.  Prozac 50 mg p.o. q.d.
 6.  Glyburide 10 mg p.o. b.i.d.
 7.  Ibuprofen 800 mg p.o. t.i.d.
 8.  Levoxyl 175 mcg p.o. q.d.
 9.  Lipitor 10 mg p.o. q.a.m. and 20 mg p.o. q.p.m.
10.  Glucophage 500 mg p.o. t.i.d.
11.  Minocycline 100 mg p.o. t.i.d.
12.  Lisinopril/hydrochlorothiazide 12/12.5 two tablets p.o.
q.a.m.
13.  Lasix 40 mg p.o. q.a.m.
14.  Potassium 20 mEq p.o. q.d.
15.  Multivitamin.
16.  Calcium supplements.

ALLERGIES: TETRACYCLINE which results in vaginal
candidiasis.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other chronic pulmonary heart diseases,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified sleep apnea,Unspecified essential hypertension,Pure hypercholesterolemia,Postsurgical hypothyroidism'}
