CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 26543**] was a 76-year-old
gentleman with a significant past medical history.  He
presented to an outside hospital prior to this
hospitalization complaining of one month of chest pain and
fatigue with exertion.  The patient was admitted to that
hospital and evaluated for coronary artery disease.  He
underwent a stress thallium test which was positive.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute vascular insufficiency of intestine,Hematoma complicating a procedure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Crnry athrscl natve vssl,Surg compl-heart,Ac vasc insuff intestine,Hematoma complic proc,Atrial fibrillation,Chr airway obstruct NEC,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2159-5-7**]     Discharge Date:  [**2159-5-16**]

Date of Birth:   [**2082-5-29**]     Sex:  M

Service:  Cardiothoracic Surgery

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 26543**] was a 76-year-old
gentleman with a significant past medical history.  He
presented to an outside hospital prior to this
hospitalization complaining of one month of chest pain and
fatigue with exertion.  The patient was admitted to that
hospital and evaluated for coronary artery disease.  He
underwent a stress thallium test which was positive.

He was transferred to the [**Hospital1 188**] for cardiac catheterization, and this study revealed
severe 3-vessel disease.  A Cardiology Surgery consultation
was performed, and the patient was found to be a suitable
candidate to undergo a coronary artery bypass graft.

HOSPITAL COURSE:  On [**2159-5-10**], Mr. [**Known lastname 26543**] was taken to
the operating room at the [**Hospital1 188**] by Dr. [**Last Name (STitle) 1537**] of the Cardiothoracic Surgery Service, and
he underwent an on-pump coronary artery bypass graft times
two with left internal mammary artery to the left anterior
descending artery and a right lesser saphenous to the obtuse
marginal.  The patient tolerated the procedure well, and he
was transferred in a stable condition to the Cardiothoracic
Surgery Recovery Unit.

Overnight, he was weaned off his pressors and was
successfully and uneventfully extubated by the next morning.
He required 2 units of packed red blood cells for a low
hematocrit.

His postoperative course was prolonged and complicated by
cardiac arrhythmias requiring amiodarone and diltiazem to
control his atrial fibrillation and rapid heart rate.  By
postoperative day two, his cardiac arrhythmia was not totally
controlled, and his creatinine started to rise.  He was noted
to have labored breathing, and by postoperative day three,
the nursing noticed that the patient was more confused than
usual and was having problems trying to find words as well as
moving his right side.

An emergent head CT was obtained, and it revealed an image
most consistent with a left posterior cerebral artery
infarction.  He was evaluated by the Stroke Service and
Neurology who recommended to keep his systolic blood
pressures at about 140 and to obtain a magnetic resonance
imaging with a stroke protocol.

By postoperative day five, Mr. [**Known lastname 26543**] continued to be in
rapid atrial fibrillation and on intravenous amiodarone drip
as well as a maximum diltiazem drip.  His neurologic status
did not improve, and later that day he became progressively
acidotic, and his white blood cell count became elevated.

At that point, there was a concern for this patient to be
having an ischemic bowel since he developed peritoneal signs.
An emergent Surgery consultation was obtained, and the
patient was taken to the operating room for an exploratory
laparotomy.  He was found to have an ischemic bowel, and a
small bowel resection times two with an ileocolectomy as well
as an aorta to superior mesenteric artery bypass with a
Dacron graft was performed since the patient was found to
have a thrombosed superior mesenteric artery.

The patient received 6 liters of crystalloid and 3 units of
packed red blood cells, and after the surgery he was
transferred in a critical condition back to the
Cardiothoracic Surgery Recovery Unit.

These findings were discussed in detail with the family, and
there were explained about the seriousness of this patient's
condition.  Overnight, he was kept on maximum Intensive Care
Unit support including amiodarone drip, diltiazem, as well as
pressors without significant improvement.  His white blood
cell count remained elevated, and his acidosis worsened.  He
was started on continuous venovenous hemofiltration since his
creatinine was 2.2.

By 6 o'clock in the afternoon, despite the continuous
venovenous hemofiltration and the full Intensive Care Unit
support, his condition worsened, and General Surgery decided
to take him back to the operating room for a second
exploratory laparotomy.  Once in the operating room, and upon
entering the abdominal cavity, the entire bowel was noted to
be ischemic.  There were no free perforations, and the bypass
graft was still patent.  The patient's abdomen was closed,
and he was transferred back to the Cardiothoracic Surgery
Recovery Unit to discuss the prognosis with the family.

The operating room findings were discussed with the wife, and
after she spoke with Dr. [**Last Name (STitle) **] from the General Surgery
Service, she wished to make the patient comfort measures only
in light of the global ischemic bowel disease.  Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 1537**] was informed, and all of the pressor support was
discontinued.  Shortly after the pressor support was stopped,
the patient expired in the Cardiothoracic Surgery Recovery
Unit.

The house officer was called to evaluate the patient and he
was found to have no pupil reflex, no corneal, no spontaneous
breathing, no gag reflex pulling the ET-tube, no palpable
pulse or audible heart sounds.  The patient was pronounced
dead at 10:06 p.m. on [**2159-5-16**].  His family was notified
as well as Dr. [**Last Name (STitle) 1537**].  The Medical Examiner was also notified,
and he declined the case.  The family did not want a
postmortem examination, and the patient will shortly be
transferred to the morgue to await further arrangements by
the family.




                          [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Last Name (NamePattern4) 26544**]

MEDQUIST36

D:  [**2159-5-17**]  00:35
T:  [**2159-5-17**]  10:40
JOB#:  [**Job Number **]
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute vascular insufficiency of intestine,Hematoma complicating a procedure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,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: Mr. [**Known lastname 26543**] was a 76-year-old
gentleman with a significant past medical history.  He
presented to an outside hospital prior to this
hospitalization complaining of one month of chest pain and
fatigue with exertion.  The patient was admitted to that
hospital and evaluated for coronary artery disease.  He
underwent a stress thallium test which was positive.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Cardiac complications, not elsewhere classified,Acute vascular insufficiency of intestine,Hematoma complicating a procedure,Atrial fibrillation,Chronic airway obstruction, not elsewhere classified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
