CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 64-year-old male
with a known history of three vessel coronary artery disease
which was confirmed by cardiac catheterization in [**2123-6-3**]
who was referred for coronary artery bypass graft procedure.
The patient has an extensive history of dyspnea on exertion,
fatigue, and episodes of paroxysmal nocturnal dyspnea and
abnormal EKGs dating back to at least [**2120-10-4**].  The
patient first documented catheterization on [**2120-10-23**] which demonstrated three vessel coronary artery disease,
for which the patient elected to undergo medical therapy
only.  Follow-up cardiac catheterization in [**2122-12-4**]
demonstrated persistent and advancing coronary artery
disease; at this point, the patient again declined bypass
surgery, stating that he preferred to wait for the
introduction of coated stents.  Repeat cardiac
catheterization on [**2123-6-17**] demonstrated once again
persistent three vessel coronary artery disease with 60-70%
stenosis of the left anterior descending artery at its
origin, 40% proximal narrowing in the obtuse marginal, up to
70% stenosis in the midvessel portion of the right coronary
artery.  Calculated ejection fraction was noted to be 40%.

MEDICAL HISTORY: 1.  Coronary artery disease.
2.  Hypertension.
3.  Diabetes.
4.  Gastroesophageal reflux disease.
5.  Hepatitis as a child.
6.  Diabetic retinopathy.
7.  Anemia.
8.  History of alcohol abuse in the past.
9.  Extremity arthritis.
10. Prostate cancer, awaiting surgery.
11. Myelodysplasia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is single and lives alone.  The
patient works as a mechanical estimator.
Coronary atherosclerosis of native coronary artery,Thrombocytopenia, unspecified,Malignant neoplasm of prostate,Esophageal reflux,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Unspecified essential hypertension
Crnry athrscl natve vssl,Thrombocytopenia NOS,Malign neopl prostate,Esophageal reflux,DMII ophth nt st uncntrl,Diabetic retinopathy NOS,Hypertension NOS
Admission Date:  [**2123-6-29**]       Discharge Date:  [**2123-7-4**]

Date of Birth:   [**2058-7-31**]       Sex:  M

Service:  CARDIOTHORACIC SURGERY

HISTORY OF THE PRESENT ILLNESS:  This is a 64-year-old male
with a known history of three vessel coronary artery disease
which was confirmed by cardiac catheterization in [**2123-6-3**]
who was referred for coronary artery bypass graft procedure.
The patient has an extensive history of dyspnea on exertion,
fatigue, and episodes of paroxysmal nocturnal dyspnea and
abnormal EKGs dating back to at least [**2120-10-4**].  The
patient first documented catheterization on [**2120-10-23**] which demonstrated three vessel coronary artery disease,
for which the patient elected to undergo medical therapy
only.  Follow-up cardiac catheterization in [**2122-12-4**]
demonstrated persistent and advancing coronary artery
disease; at this point, the patient again declined bypass
surgery, stating that he preferred to wait for the
introduction of coated stents.  Repeat cardiac
catheterization on [**2123-6-17**] demonstrated once again
persistent three vessel coronary artery disease with 60-70%
stenosis of the left anterior descending artery at its
origin, 40% proximal narrowing in the obtuse marginal, up to
70% stenosis in the midvessel portion of the right coronary
artery.  Calculated ejection fraction was noted to be 40%.

Following this procedure, the patient subsequently changed
his mind regarding surgical intervention and consented to
undergo coronary artery bypass graft procedure on [**2123-6-29**].

PAST MEDICAL HISTORY:
1.  Coronary artery disease.
2.  Hypertension.
3.  Diabetes.
4.  Gastroesophageal reflux disease.
5.  Hepatitis as a child.
6.  Diabetic retinopathy.
7.  Anemia.
8.  History of alcohol abuse in the past.
9.  Extremity arthritis.
10. Prostate cancer, awaiting surgery.
11. Myelodysplasia.

ADMISSION MEDICATIONS:
1.  Aspirin, enteric coated 81 mg q.d.
2.  Lantus insulin 30 units q.p.m.
3.  Sliding scale Novalog insulin panel with meals.
4.  Cardia XT 240 mg q.d.
5.  Enalapril 20 mg p.o. q.d.
6.  Protonix 40 mg p.o. q.d.
7.  Roxicet t.i.d.
8.  MS Contin 15 mg p.o. b.i.d.
9.  Plavix 75 mg p.o. q.d.
10. Neurontin 300 mg p.o. q.d.

SOCIAL HISTORY:  The patient is single and lives alone.  The
patient works as a mechanical estimator.

HOSPITAL COURSE:  On [**2123-6-29**], the patient underwent a
quadruple coronary artery bypass graft procedure.
Anastomosis included from the LIMA to the LAD, from the aorta
via saphenous vein graft to the right PDA, and saphenous vein
graft to the distal LAD and saphenous vein graft to the OM.
Bypass time was noted to be 85 minutes and cross clamp time
was noted to be 71 minutes.  The patient's pericardium was
left open; lines placed included an arterial line and a
Swan-Ganz catheter; both ventricular and atrial wires were
placed; both mediastinal and left pleural tubes were placed.

The patient was subsequently transferred to the Cardiac
Surgery Recovery Unit, intubated, for further evaluation and
management.  On transfer, the patient's mean arterial
pressure was 85, P80 18, [**Doctor First Name 1052**] 25.  The patient was noted to be
in normal sinus rhythm with a heart rate of 88 beats per
minute.  Drips on transfer included propofol, Neo-Synephrine,
and aprotinin.  Shortly following arrival in the CSRU, the
patient was successfully weaned and extubated without
complication and was subsequently advanced to oral intake
without incident.

While in the CSRU, the patient was noted to demonstrate
progressively diminishing platelet counts, after which all
heparin products were ceased and the patient was sent for
heparin-induced thrombocytopenia antibody screen which
subsequently proved negative.  The patient thereafter
demonstrated a gradually increasing platelet count for the
duration of his stay without any further dips in his values.

On postoperative day number two, the patient's lines and
chest tubes were removed without complication and the patient
was subsequently cleared for transfer to the floor.  The
patient was thereafter admitted to the Cardiothoracic Service
under the direction of Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].

While on the floor, the patient progressed well clinically to
the time of his discharge.  The patient was evaluated by
Physical Therapy, who cleared the patient for eventual
discharge to home following resolution of the acute medical
issues.  The patient's Foley catheter was removed without
complication and he was subsequently noted to be
independently productive of urine for the duration of his
stay.  The patient's pacer wires were removed without
incident and the patient was noted to have adequate pain
control via oral pain medications following a consultation
from the Chronic Pain Service.

On postoperative day number four, the patient was noted to
demonstrate a gradual dip in his hematocrit to 22.7, for
which he received 1 unit of packed red blood cells which was
irradiated and rendered leukopoor.  Discussions were with the
Hematology/Oncology service.  The patient subsequently
demonstrated an adequate bump in his hematocrit and
demonstrated no evidence of active bleeding.

Following clearance by Physical Therapy, the patient was
subsequently cleared for discharge to home on postoperative
day number five, [**2123-7-9**], with instructions for
follow-up.

CONDITION ON DISCHARGE:  The patient is to be discharged to
home with instructions for follow-up.

STATUS AT DISCHARGE:  Stable.

DISCHARGE MEDICATIONS:
1.  Lopressor 25 mg p.o. b.i.d.
2.  Lasix 20 mg p.o. b.i.d. times ten days.
3.  Potassium chloride 20 mEq p.o. q.d. times ten days.
4.  Enteric coated aspirin 325 mg p.o. q.d.
5.  Colace 100 mg p.o. b.i.d.
6.  Percocet one to two tablets p.o. q. four to six hours
p.r.n. pain.
7.  Morphine sulfate 30 mg p.o. b.i.d.
8.  Vioxx 12.5 mg p.o. q.d.

DISCHARGE INSTRUCTIONS:  The patient is to maintain his
incisions clean and dry at all times.  The patient may shower
but should pat dry incisions afterwards; no bathing or
swimming until further notice.  The patient has been
instructed to resume a cardiac diet.  The patient has been
advised to limit physical activities; no heavy exertion.  No
driving while taking prescription pain medications.  The
patient is to follow-up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] in one to two
weeks; the patient is to call to schedule an appointment.
The patient is to follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in four
weeks; the patient is to call [**Telephone/Fax (1) 170**] to schedule an
appointment.



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

Dictated By:[**Last Name (NamePattern1) 1053**]
MEDQUIST36

D:  [**2123-7-3**]  04:43
T:  [**2123-7-3**]  17:24
JOB#:  [**Job Number 32637**]
{'Coronary atherosclerosis of native coronary artery,Thrombocytopenia, unspecified,Malignant neoplasm of prostate,Esophageal reflux,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,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: This is a 64-year-old male
with a known history of three vessel coronary artery disease
which was confirmed by cardiac catheterization in [**2123-6-3**]
who was referred for coronary artery bypass graft procedure.
The patient has an extensive history of dyspnea on exertion,
fatigue, and episodes of paroxysmal nocturnal dyspnea and
abnormal EKGs dating back to at least [**2120-10-4**].  The
patient first documented catheterization on [**2120-10-23**] which demonstrated three vessel coronary artery disease,
for which the patient elected to undergo medical therapy
only.  Follow-up cardiac catheterization in [**2122-12-4**]
demonstrated persistent and advancing coronary artery
disease; at this point, the patient again declined bypass
surgery, stating that he preferred to wait for the
introduction of coated stents.  Repeat cardiac
catheterization on [**2123-6-17**] demonstrated once again
persistent three vessel coronary artery disease with 60-70%
stenosis of the left anterior descending artery at its
origin, 40% proximal narrowing in the obtuse marginal, up to
70% stenosis in the midvessel portion of the right coronary
artery.  Calculated ejection fraction was noted to be 40%.

MEDICAL HISTORY: 1.  Coronary artery disease.
2.  Hypertension.
3.  Diabetes.
4.  Gastroesophageal reflux disease.
5.  Hepatitis as a child.
6.  Diabetic retinopathy.
7.  Anemia.
8.  History of alcohol abuse in the past.
9.  Extremity arthritis.
10. Prostate cancer, awaiting surgery.
11. Myelodysplasia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is single and lives alone.  The
patient works as a mechanical estimator. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Thrombocytopenia, unspecified,Malignant neoplasm of prostate,Esophageal reflux,Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled,Background diabetic retinopathy,Unspecified essential hypertension'}
