CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 67-year-old
male with diabetes, history of PVD, left CVA in [**2098**] and
bilateral calf claudication.  The patient reported no
discomfort or shortness of breath on admission.  On [**2103-8-28**]
the patient underwent ETT which showed a moderate inferior
defect and reversible anterior wall defect.  Ejection
fraction at the time was 34%.

MEDICAL HISTORY: Hypertension, hypercholesterolemia,
insulin dependent diabetes, PVD, diabetes retinopathy,
chronic renal insufficiency, benign prostatic hypertrophy,
chronic bronchiectasis, lower extremity claudication, carotid
disease status post CEA, left colon polypectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: 1.  Sulfa.  2.  Calcium channel blockers.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other postoperative infection,Cellulitis and abscess of leg, except foot,Hyperpotassemia,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Unspecified disorder of kidney and ureter
Crnry athrscl natve vssl,Surg compl-heart,Atrial fibrillation,Other postop infection,Cellulitis of leg,Hyperpotassemia,DMI ophth nt st uncntrld,Diabetic retinopathy NOS,Renal & ureteral dis NOS
Admission Date:  [**2103-10-15**]       Discharge Date:

Date of Birth:   [**2036-8-7**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 67-year-old
male with diabetes, history of PVD, left CVA in [**2098**] and
bilateral calf claudication.  The patient reported no
discomfort or shortness of breath on admission.  On [**2103-8-28**]
the patient underwent ETT which showed a moderate inferior
defect and reversible anterior wall defect.  Ejection
fraction at the time was 34%.

PAST MEDICAL HISTORY:  Hypertension, hypercholesterolemia,
insulin dependent diabetes, PVD, diabetes retinopathy,
chronic renal insufficiency, benign prostatic hypertrophy,
chronic bronchiectasis, lower extremity claudication, carotid
disease status post CEA, left colon polypectomy.

MEDICATIONS:  Included Aspirin 81 mg po q d, Lasix 40 mg po q
d, Folic Acid, Lozar 100 mg po q d, Tandamine 75 mg po q d,
Claritin 10 mg po q d, Lipitor 10 mg po q d, Cardura 80 mg po
q d, NPH 42 units q a.m. and 10 units q p.m. subcu, Vitamin
E, Vitamin C, Multivitamins and Rocaltrol .25 mg po q d.

HOSPITAL COURSE:  The patient was taken to the operating room
by Dr. [**Last Name (STitle) 70**] where he underwent CABG times three on
[**2103-10-15**].  He had LIMA to LAD, right saphenous vein to OM and
ramus.  Postoperatively the patient did well, was extubated
and weaned of all drips in the Intensive Care Unit without
any incidents.  The patient was transferred to the floor on
postoperative day #2.  However, after transfer onto the floor
the patient went into atrial fibrillation.  Rate was
controlled using beta blocker, Lopressor and patient was IV
loaded with Amiodarone and started off on po Amiodarone
subsequently.  Since then patient has recovered well and was
able to work with PT, was able to ambulate more than 500 feet
and climbed a flight of stairs before discharge home.  Upon
discharge the patient's vital signs were stable, condition
was afebrile, chest was clear, regular rate and rhythm,
normal sinus, sternum was stable, incision was clean, dry and
intact.  The patient will be discharged home and told to
follow-up with Dr. [**Last Name (STitle) 70**] in [**2-25**] weeks.  Patient had
chronic renal insufficiency with baseline creatinine of 2.4.
Upon discharge creatinine was 2.3 and patient's creatinine
postoperatively was stable at around 2.3 to 2.5.  Upon
discharge electrolytes were within normal limits and
patient's condition was stable, afebrile.

The patient was told to follow-up with Dr. [**Last Name (STitle) 70**] in [**2-25**]
weeks.

DISCHARGE MEDICATIONS:  Lopressor 75 mg po bid, Lasix 40 mg
po q d times 7 days, Aspirin 81 mg po q d, NPH 42 units q
a.m. subcu and 10 units q p.m. subcu, Amiodarone 400 mg po
tid times one day, then 400 mg po bid times one week, then
400 mg po q d, Percocet 1-2 tablets po q 4-6 hours prn,
Colace 200 mg po q d.




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

Dictated By:[**Name8 (MD) 186**]
MEDQUIST36

D:  [**2103-10-19**]  18:23
T:  [**2103-10-19**]  21:41
JOB#:  [**Job Number **]


Admission Date:  [**2103-10-15**]       Discharge Date:  [**2103-10-23**]

Date of Birth:   [**2036-8-7**]       Sex:  M

Service:  CARDIAC SURGERY

HISTORY OF PRESENT ILLNESS:  This 67 year-old diabetic
patient with significant history of peripheral vascular
disease with no history of chest discomfort or shortness of
breath.  In [**2103-8-25**] he underwent an exercise treadmill
thallium test, which was positive.  The patient was referred
for cardiac catheterization.  Cardiac catheterization showed
moderate pulmonary hypertension, three vessel disease.
Exercise treadmill thallium test showing an ejection fraction
of 34%.  The patient was referred to cardiac surgery for
operative procedure.

PAST MEDICAL HISTORY:  1.  Coronary artery disease.  2.
Peripheral vascular disease.  3.  Hypertension.  4.
Hypercholesterolemia.  5. Insulin dependent diabetes
mellitus.  6.  Diabetic retinopathy status post bilateral
laser ablation.  7.  Chronic renal insufficiency.  8.  Benign
prostatic hypertrophy.  9.  Chronic bronchiectasis.  10.
History of lower extremity claudication.  11.  Status post
left CEA [**2098**].  12.  Status post excision of right facial
skin cancer.  13.  Status post resection of colonic polyps.
14.  Status post resection of nasal polyps.

ALLERGIES:  1.  Sulfa.  2.  Calcium channel blockers.

PREOPERATIVE MEDICATIONS:  1.  Aspirin 18 mg po q day.  2.
Lasix 40 mg po q day.  3.  Folic acid 1 mg po q day.  4.
Cozaar 100 mg po q day.  5.  Tenormin 75 mg po q day.  6.
Claritin 10 mg po q day.  7.  Lipitor 10 mg po q day.  8.
Cardura 8 mg po q day.  9.  NPH insulin 42 units subQ q.a.m.,
10 units subQ q.p.m.  10.  Humalog insulin sliding scale
before meals.  11.  Rocaltrol 0.25 mg q day.

INITIAL PHYSICAL EXAMINATION:  Temperature 97.6.  Pulse 64
sinus rhythm.  Blood pressure 128/70.  Cardiovascular S1 and
S2.  S4 present.  Lungs bibasilar crackles.  Abdomen soft,
positive bowel sounds.  Extremities no carotid bruits.
Positive left femoral bruit.  Trace distal pulses
bilaterally.

LABORATORY DATA:  CBC white blood cell count 7.3, hematocrit
34.5, platelet count 161, sodium 141, potassium 5.0, chloride
103, bicarb 26, BUN 54, creatinine 5.4, blood sugar 279.

HOSPITAL COURSE:  The patient was taken to the Operating Room
on [**2103-10-15**] by Dr. [**Last Name (STitle) 70**] for a coronary artery bypass
graft times three, left internal mammary coronary artery to
left anterior descending coronary artery, saphenous vein
graft to obtuse marginal to ramus.  Please see operative note
for further details.  The patient was transferred to the
Intensive Care Unit in stable condition on Levophed to
maintain blood pressure.  The patient was weaned and
extubated from mechanical ventilation on his first
postoperative night.  The patient required neosinephrine and
insulin drip on postoperative day one.  The patient was
weaned from these medications and started on regular insulin
sliding scale as well as NPH and transferred to the floor.
Chest tubes were removed on postoperative day one and on
postoperative day number two the patient went into atrial
fibrillation with rapid ventricular response.  The patient
was treated with intravenous Lopressor, intravenous and oral
Amiodarone.  The patient remained hemodynamically stable
throughout.  The patient converted into sinus rhythm the
night of postoperative day number two.  The patient had
multiple episodes of paroxysmal atrial fibrillation, which
responded to intravenous Lopressor converted to sinus rhythm.

The patient experienced hyperkalemia on postoperative day
number six.  His potassium was 5.6.  The patient was given a
dose of Kayexalate and subsequent potassium were less then 5.
 The patient's creatinine rose to 2.7 on postoperative day
number 7, but returned down to the low baseline on
postoperative day number eight to 2.3.  The patient
ambulating with the help of physical therapy.  The patient
experiencing oxygen desaturation with ambulation.  On
postoperative day number seven it was noted that the
patient's left lower extremity saphenectomy site at the knee
medial portion to be erythematous, warm to touch and painful.
The patient was started on Dicloxacillin po times ten days
due to his history of diabetes.  On postoperative day number
eight the patient was cleared for discharge for a
rehabilitation facility.

CONDITION AT DISCHARGE:  Temperature max 98.9.  Pulse 63
sinus rhythm.  The patient has been in sinus rhythm for over
24 hours.  Blood pressure 136/60.  Room air oxygen saturation
94%.  Weight 83.7 kilograms.  Preoperative weight 77
kilograms.  Neurologically the patient is awake, alert and
intact.  Cardiovascular regular rate and rhythm.  No murmurs
or rubs.  Extremities are warm and well profuse.  Respiratory
breath sounds are clear bilaterally, decreased posteriorly at
the bases.  Gastrointestinal, positive bowel sounds.  Abdomen
is softly distended, nontender.  The patient has been
complaining of mild constipation.  Positive flatus.  Sternal
incision is clean, dry and intact.  No erythema or drainage.
Sternum is stable.  Left lower extremity saphenectomy at the
knee, has minimal to moderate erythema edema, warm to touch.
Steri-Strips are intact.  No drainage is noted.

CBC white blood cell count 8.6, hematocrit 29.0, platelet
count 271, sodium 140, potassium 4.0, chloride 100, bicarb
31, BUN 59, creatinine 2.3.  PT 13.1, INR 1.2.  The patient
is on Coumadin and Lovenox for atrial fibrillation.

DISCHARGE STATUS:  The patient is to be discharged to a
rehabilitation facility in stable condition.

DISCHARGE DIAGNOSES:
1.  Status post coronary artery bypass graft.
2.  Postoperative atrial fibrillation.
3.  Postoperative left lower extremity saphenectomy wound
infection.
4.  Hypertension.
5.  Hypercholesterolemia.
6.  Peripheral vascular disease.
7.  Diabetic retinopathy.
8.  Insulin dependent diabetes mellitus.
9.  Chronic renal insufficiency.
10.  Benign prostatic hypertrophy.
11.  Chronic bronchiectasis.
12.  Lower extremity claudication.
13.  Status post left CEA.
14.  Status post excision of right facial skin cancer.
15.  Status post resection of colon polyps.
16.  Status post resection of nasal polyps.

MEDICATIONS ON DISCHARGE:  1.  Lopressor 100 mg po b.i.d.  2.
Lasix 40 mg po q day.  3.  Amiodarone 400 mg po t.i.d. times
two days and then 400 mg po b.i.d. times seven days and then
400 mg po q day.  4.  Lovenox 70 mg subQ b.i.d., discontinue
when INR greater then 2.0.  5.  Coumadin 2 mg po on [**10-23**] and
then check PT/INR [**10-24**] and adjust Coumadin for INR 2.0 to
2.5.  6.  Dicloxacillin 500 mg po q.i.d. times ten days.  7.
Colace 100 mg po b.i.d.  8.  Lipitor 10 mg po q.h.s.  9.
Aspirin 81 mg po q day.  10.  NPH insulin 42 units subQ
q.a.m., 10 units subQ q.p.m.  11.  Dulcolax 1 po pr q day
prn.  12.  Percocet 5/325 one to two tabs po q 4 to 6 hours
prn.  13.  Regular insulin sliding scale for blood sugar 150
to 200 give 3 units subQ, blood sugar 201 to 250 give 6 units
subQ, blood sugar 251 to 300 give 9 units subQ, blood sugar
301 to 350 give 12 units subQ.  The patient is to have
Coumadin adjusted by the rehab facility for a PT/INR 2.0 to
2.5.  Upon discharge from the rehab facility the patient's
primary care physician is to dose his Coumadin.

The patient is to be placed on an 1800 [**Doctor First Name **] renal low fat
diet.  The patient is to have his blood sugars checked before
meals and at bedtime.






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

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

D:  [**2103-10-23**]  11:14
T:  [**2103-10-23**]  11:57
JOB#:  [**Job Number 30600**]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other postoperative infection,Cellulitis and abscess of leg, except foot,Hyperpotassemia,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Unspecified disorder of kidney and ureter'}


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 67-year-old
male with diabetes, history of PVD, left CVA in [**2098**] and
bilateral calf claudication.  The patient reported no
discomfort or shortness of breath on admission.  On [**2103-8-28**]
the patient underwent ETT which showed a moderate inferior
defect and reversible anterior wall defect.  Ejection
fraction at the time was 34%.

MEDICAL HISTORY: Hypertension, hypercholesterolemia,
insulin dependent diabetes, PVD, diabetes retinopathy,
chronic renal insufficiency, benign prostatic hypertrophy,
chronic bronchiectasis, lower extremity claudication, carotid
disease status post CEA, left colon polypectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: 1.  Sulfa.  2.  Calcium channel blockers.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other postoperative infection,Cellulitis and abscess of leg, except foot,Hyperpotassemia,Diabetes with ophthalmic manifestations, type I [juvenile type], not stated as uncontrolled,Background diabetic retinopathy,Unspecified disorder of kidney and ureter'}
