CHIEF COMPLAINT: Three-vessel disease.

PRESENT ILLNESS: This is a 65-year-old male with
a [**5-12**] month history of exertional dyspnea and shortness of
breath.  The patient had an ETT in [**2158-7-31**] which was
positive and was treated medically at that time, but the
exertional angina persisted, and the patient had a cardiac
catheterization that showed three-vessel disease with a
normal ejection fraction.

MEDICAL HISTORY: Status post right knee surgery.
Hypercholesterolemia.  Coronary artery disease.

MEDICATION ON ADMISSION: Aspirin 81 mg p.o. q.d., Lipitor
10 mg p.o. q.d., Atenolol 25 mg p.o. q.d., Lorazepam 0.5 mg
q.h.s. p.r.n., Nitroglycerin p.r.n.

ALLERGIES: PERCOCET.

PHYSICAL EXAM: 

FAMILY HISTORY: Uncle had a history of myocardial infarction
in his 60s.  Brother died in his 50s from diabetes.

SOCIAL HISTORY: He is retired and lives alone.  He denied
tobacco.  Occasional alcohol, approximately [**5-7**] drinks per
week.
Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other specified complications of procedures not elsewhere classified,Unspecified transient mental disorder in conditions classified elsewhere,Pure hypercholesterolemia
Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Oth spcf cmplc procd NEC,Transient mental dis NOS,Pure hypercholesterolem
Admission Date:  [**2159-1-15**]       Discharge Date:  [**2159-1-23**]

Date of Birth:   [**2093-8-8**]       Sex:  M

Service:  CARDIAC SURGERY

CHIEF COMPLAINT:  Three-vessel disease.

HISTORY OF PRESENT ILLNESS:  This is a 65-year-old male with
a [**5-12**] month history of exertional dyspnea and shortness of
breath.  The patient had an ETT in [**2158-7-31**] which was
positive and was treated medically at that time, but the
exertional angina persisted, and the patient had a cardiac
catheterization that showed three-vessel disease with a
normal ejection fraction.

PAST MEDICAL HISTORY:  Status post right knee surgery.
Hypercholesterolemia.  Coronary artery disease.

SOCIAL HISTORY:  He is retired and lives alone.  He denied
tobacco.  Occasional alcohol, approximately [**5-7**] drinks per
week.

FAMILY HISTORY:  Uncle had a history of myocardial infarction
in his 60s.  Brother died in his 50s from diabetes.

ALLERGIES:  PERCOCET.

MEDICATIONS ON ADMISSION:  Aspirin 81 mg p.o. q.d., Lipitor
10 mg p.o. q.d., Atenolol 25 mg p.o. q.d., Lorazepam 0.5 mg
q.h.s. p.r.n., Nitroglycerin p.r.n.

CATHETERIZATION RESULTS:  Left anterior descending with
subostial occlusion, left circumflex proximal 30%, 70% in
obtuse marginal 2, and 70% in obtuse marginal 3.  Right
coronary artery with high-rising posterior descending artery
80% ostial, 70% proximal posterior lateral.

ETT showed 70% maximal PHR.  Electrocardiogram showed [**Street Address(2) 4793**]
depression inferior in V4-6, resolved at rest.  Anterior
septal and apical ischemia.  Ejection fraction of 60%.

REVIEW OF SYSTEMS:  The patient denied diabetes,
cerebrovascular accident, transient ischemic attack,
seizures, and hypertension.  He denied asthma, chronic
obstructive pulmonary disease, upper respiratory infection,
cough, orthopnea.  The patient did complain of dyspnea on
exertion.  He denied peptic ulcer disease, hematochezia,
melena, blood in stool.  He denied claudication, edema,
peripheral vascular disease, vein stripping.  He denied
nausea, vomiting, diarrhea, or constipation.  He denied
voiding difficulties, benign prostatic hypertrophy, or
hematuria.

LABORATORY DATA:  On [**1-9**] white count was 6.1,
hematocrit 42.7, platelet count 170; sodium 140, potassium
5.1, chloride 103, bicarb 28, BUN 14, creatinine 0.7; INR
1.0,  PT 12.5.

Electrocardiogram showed sinus rhythm at 72, there were
T-waves in III, Q-waves in AVF and III.

Chest x-ray showed no pulmonary congestion, infiltrates, or
nodules, no effusions.

PHYSICAL EXAMINATION:  Vital signs:  Heart rate 78 in sinus
rhythm, blood pressure 122/72, respirations 18, oxygen
saturation 96% on room air.  General:  The patient was
resting in bed in no apparent distress.  He was alert and
oriented times three.  The patient followed commands.
Neurological:  Grossly intact.  HEENT:  Pupils equal, round
and reactive to light.  Extraocular movements intact.
Anicteric.  Noninjected eyes.  Moist mucous membranes.
Normal mucosa.  Nasopharynx:  Supple.  No lymphadenopathy.
No bruits.  Lungs:  Clear to auscultation bilaterally.
Heart:  Regular, rate and rhythm.  Normal S1 and S2.  No
murmurs, rubs, or gallops.  Abdomen:  Soft, nontender,
nondistended.  No masses.  Extremities:  Warm and well
perfused extremities.  No clubbing, cyanosis, or edema.  No
varicosities.  Pulses:  Carotid 2+ bilaterally, dorsalis
pedis and posterior tibial were 2+ bilaterally.

HOSPITAL COURSE:  The patient was admitted to the Cardiac
Surgery Service and underwent coronary artery bypass grafting
times four with LIMA to left anterior descending, saphenous
vein graft to obtuse marginal 2 and obtuse marginal 3, and
saphenous vein graft to posterior descending artery.

The patient had a mean arterial pressure of 68, CVP of 8, and
atrial paced at 88 on Propofol drip and Neo-Synephrine at 0.5
pressure support.

The patient was transferred to the CSRU on postoperative day
#1.  The patient had a dose of Lasix for a low urine output,
and the patient was extubated.  The patient was continued on
Neo-Synephrine drip at 0.5 for pressure support and was on
prophylactic antibiotics.

The patient's T-max was 101.8??????.  He had good blood pressure
and good pulse.  He was in normal sinus rhythm.  He was
positive at 1.6 L.  White count was 15.3, hematocrit was
31.5, creatinine 0.8.  He otherwise was doing well.

The patient was started on Lasix b.i.d., and the patient's
medial chest tube was removed.

On postoperative day #2, the patient was on the floor.  The
patient remained afebrile with a heart rate of 104 in sinus
rhythm.  Blood pressure was 140s/80s.  The patient otherwise
had good p.o. intake and making good urine.

The patient's chest tube was removed, and JP was removed.  He
was placed on Lopressor 25 b.i.d. to control his blood
pressure.

On postoperative day #3, the patient was paranoid in the
hospital and became confused.  The patient locked himself in
the bathroom and refused all services.  Psychiatry was
[**Name (NI) 653**], and the patient was given Haldol which relieved
the symptoms.

The patient remained afebrile with a pulse of 106, white
count 23.3.  The patient was pancultured, and ABG and chest
x-ray was obtained, as well as contacting [**Name (NI) **] for elevated
blood sugar.

Psychiatry stated that the patient had an acute episode of
confusion and paranoia and was consistent with delirium, and
they recommended to minimize narcotics, which were
subsequently stopped, and to obtain a head CT, which was
obtained.  Head CT showed no acute infarction, hemorrhage, or
masses.

The Haldol was started on a standing dose at night and p.r.n.
dose and to monitor the patient for alcohol withdraw
symptoms.

On postoperative day #4, the patient had a temperature of
101.4??????.  He otherwise was doing well.  White count came down
to 15.5.  The patient's paranoia had slightly improved, and
the patient was more cooperative with the staff and was less
confused.

On postoperative day #5, the patient had continued to
improve.  The patient's T-max was 100.9??????.  He was in sinus
rhythm and tachycardiac up to 140-150s.  Lopressor was
increased to control blood pressure and the heart rate.

The patient's white count went down to 10.8.  Psychiatry
recommended adding Trazodone p.r.n. and at night for sleep,
and the patient was also placed on Metformin for blood
glucose control and to stop the Insulin [**First Name8 (NamePattern2) **] [**Last Name (un) **].

On postoperative day #6, the patient had a temperature of
102.4??????.  He otherwise was doing well.

The patient complained of increased breathing.  The patient's
ABG was 7.48, 35, 70, 27, and 2, in room air.  The patient
was taking good p.o. and making good urine.  The patient
continued to have a white count of 10.6.  No other cultures
came back positive.  The patient continued to improve.

On postoperative day #7, the patient had a low-grade
temperature of 100.4??????, but otherwise was taking good p.o.,
making good urine, and the patient's white count continued to
stay low at 10.4

On postoperative day #7, Psychiatry recommended that the
patient obtain an Occupational Therapy consult for safety at
home.  They also recommended to stop the Haldol.

On postoperative day #8, the patient continued to improve.
The patient had a white count of 11.9, which had been stable.
Occupational Therapy cleared the patient to go home, and
Psychiatry felt that the patient was safe to go home.

CONDITION ON DISCHARGE:  Good.

DISPOSITION:  Home with VNA.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease.
2.  Delirium.
3.  Hypercholesterolemia.
4.  Status post right knee surgery.
5.  Status post coronary artery bypass grafting times four.

FOLLOW-UP:  Please follow-up with Dr. [**Last Name (STitle) 70**] in six weeks;
please call for a follow-up appointment.  Follow-up with Dr.
.................. in [**12-1**] weeks.  Follow-up with
endocrinologist in [**12-1**] weeks.  Follow-up with cardiolgoist in
[**12-1**] weeks.




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

Dictated By:[**Last Name (NamePattern1) 3118**]
MEDQUIST36

D:  [**2159-1-23**]  11:48
T:  [**2159-1-23**]  12:22
JOB#:  [**Job Number 35334**]


Admission Date:  [**2159-1-15**]       Discharge Date:  [**2159-1-23**]

Date of Birth:   [**2093-8-8**]       Sex:  M

Service:  CARDIAC SURGERY

CHIEF COMPLAINT:  Three-vessel disease.

HISTORY OF PRESENT ILLNESS:  This is a 65-year-old male with
a [**5-12**] month history of exertional dyspnea and shortness of
breath.  The patient had an ETT in [**2158-7-31**] which was
positive and was treated medically at that time, but the
exertional angina persisted, and the patient had a cardiac
catheterization that showed three-vessel disease with a
normal ejection fraction.

PAST MEDICAL HISTORY:  Status post right knee surgery.
Hypercholesterolemia.  Coronary artery disease.

SOCIAL HISTORY:  He is retired and lives alone.  He denied
tobacco.  Occasional alcohol, approximately [**5-7**] drinks per
week.

FAMILY HISTORY:  Uncle had a history of myocardial infarction
in his 60s.  Brother died in his 50s from diabetes.

ALLERGIES:  PERCOCET.

MEDICATIONS ON ADMISSION:  Aspirin 81 mg p.o. q.d., Lipitor
10 mg p.o. q.d., Atenolol 25 mg p.o. q.d., Lorazepam 0.5 mg
q.h.s. p.r.n., Nitroglycerin p.r.n.

CATHETERIZATION RESULTS:  Left anterior descending with
subostial occlusion, left circumflex proximal 30%, 70% in
obtuse marginal 2, and 70% in obtuse marginal 3.  Right
coronary artery with high-rising posterior descending artery
80% ostial, 70% proximal posterior lateral.

ETT showed 70% maximal PHR.  Electrocardiogram showed [**Street Address(2) 4793**]
depression inferior in V4-6, resolved at rest.  Anterior
septal and apical ischemia.  Ejection fraction of 60%.

REVIEW OF SYSTEMS:  The patient denied diabetes,
cerebrovascular accident, transient ischemic attack,
seizures, and hypertension.  He denied asthma, chronic
obstructive pulmonary disease, upper respiratory infection,
cough, orthopnea.  The patient did complain of dyspnea on
exertion.  He denied peptic ulcer disease, hematochezia,
melena, blood in stool.  He denied claudication, edema,
peripheral vascular disease, vein stripping.  He denied
nausea, vomiting, diarrhea, or constipation.  He denied
voiding difficulties, benign prostatic hypertrophy, or
hematuria.

LABORATORY DATA:  On [**1-9**] white count was 6.1,
hematocrit 42.7, platelet count 170; sodium 140, potassium
5.1, chloride 103, bicarb 28, BUN 14, creatinine 0.7; INR
1.0,  PT 12.5.

Electrocardiogram showed sinus rhythm at 72, there were
T-waves in III, Q-waves in AVF and III.

Chest x-ray showed no pulmonary congestion, infiltrates, or
nodules, no effusions.

PHYSICAL EXAMINATION:  Vital signs:  Heart rate 78 in sinus
rhythm, blood pressure 122/72, respirations 18, oxygen
saturation 96% on room air.  General:  The patient was
resting in bed in no apparent distress.  He was alert and
oriented times three.  The patient followed commands.
Neurological:  Grossly intact.  HEENT:  Pupils equal, round
and reactive to light.  Extraocular movements intact.
Anicteric.  Noninjected eyes.  Moist mucous membranes.
Normal mucosa.  Nasopharynx:  Supple.  No lymphadenopathy.
No bruits.  Lungs:  Clear to auscultation bilaterally.
Heart:  Regular, rate and rhythm.  Normal S1 and S2.  No
murmurs, rubs, or gallops.  Abdomen:  Soft, nontender,
nondistended.  No masses.  Extremities:  Warm and well
perfused extremities.  No clubbing, cyanosis, or edema.  No
varicosities.  Pulses:  Carotid 2+ bilaterally, dorsalis
pedis and posterior tibial were 2+ bilaterally.

HOSPITAL COURSE:  The patient was admitted to the Cardiac
Surgery Service and underwent coronary artery bypass grafting
times four with LIMA to left anterior descending, saphenous
vein graft to obtuse marginal 2 and obtuse marginal 3, and
saphenous vein graft to posterior descending artery.

The patient had a mean arterial pressure of 68, CVP of 8, and
atrial paced at 88 on Propofol drip and Neo-Synephrine at 0.5
pressure support.

The patient was transferred to the CSRU on postoperative day
#1.  The patient had a dose of Lasix for a low urine output,
and the patient was extubated.  The patient was continued on
Neo-Synephrine drip at 0.5 for pressure support and was on
prophylactic antibiotics.

The patient's T-max was 101.8??????.  He had good blood pressure
and good pulse.  He was in normal sinus rhythm.  He was
positive at 1.6 L.  White count was 15.3, hematocrit was
31.5, creatinine 0.8.  He otherwise was doing well.

The patient was started on Lasix b.i.d., and the patient's
medial chest tube was removed.

On postoperative day #2, the patient was on the floor.  The
patient remained afebrile with a heart rate of 104 in sinus
rhythm.  Blood pressure was 140s/80s.  The patient otherwise
had good p.o. intake and making good urine.

The patient's chest tube was removed, and JP was removed.  He
was placed on Lopressor 25 b.i.d. to control his blood
pressure.

On postoperative day #3, the patient was paranoid in the
hospital and became confused.  The patient locked himself in
the bathroom and refused all services.  Psychiatry was
[**Name (NI) 653**], and the patient was given Haldol which relieved
the symptoms.

The patient remained afebrile with a pulse of 106, white
count 23.3.  The patient was pancultured, and ABG and chest
x-ray was obtained, as well as contacting [**Name (NI) **] for elevated
blood sugar.

Psychiatry stated that the patient had an acute episode of
confusion and paranoia and was consistent with delirium, and
they recommended to minimize narcotics, which were
subsequently stopped, and to obtain a head CT, which was
obtained.  Head CT showed no acute infarction, hemorrhage, or
masses.

The Haldol was started on a standing dose at night and p.r.n.
dose and to monitor the patient for alcohol withdraw
symptoms.

On postoperative day #4, the patient had a temperature of
101.4??????.  He otherwise was doing well.  White count came down
to 15.5.  The patient's paranoia had slightly improved, and
the patient was more cooperative with the staff and was less
confused.

On postoperative day #5, the patient had continued to
improve.  The patient's T-max was 100.9??????.  He was in sinus
rhythm and tachycardiac up to 140-150s.  Lopressor was
increased to control blood pressure and the heart rate.

The patient's white count went down to 10.8.  Psychiatry
recommended adding Trazodone p.r.n. and at night for sleep,
and the patient was also placed on Metformin for blood
glucose control and to stop the Insulin [**First Name8 (NamePattern2) **] [**Last Name (un) **].

On postoperative day #6, the patient had a temperature of
102.4??????.  He otherwise was doing well.

The patient complained of increased breathing.  The patient's
ABG was 7.48, 35, 70, 27, and 2, in room air.  The patient
was taking good p.o. and making good urine.  The patient
continued to have a white count of 10.6.  No other cultures
came back positive.  The patient continued to improve.

On postoperative day #7, the patient had a low-grade
temperature of 100.4??????, but otherwise was taking good p.o.,
making good urine, and the patient's white count continued to
stay low at 10.4

On postoperative day #7, Psychiatry recommended that the
patient obtain an Occupational Therapy consult for safety at
home.  They also recommended to stop the Haldol.

On postoperative day #8, the patient continued to improve.
The patient had a white count of 11.9, which had been stable.
Occupational Therapy cleared the patient to go home, and
Psychiatry felt that the patient was safe to go home.

CONDITION ON DISCHARGE:  Good.

DISPOSITION:  Home with VNA.

DISCHARGE DIAGNOSIS:
1.  Coronary artery disease.
2.  Delirium.
3.  Hypercholesterolemia.
4.  Status post right knee surgery.
5.  Status post coronary artery bypass grafting times four.

FOLLOW-UP:  Please follow-up with Dr. [**Last Name (STitle) 70**] in six weeks;
please call for a follow-up appointment.  Follow-up with Dr.
.................. in [**12-1**] weeks.  Follow-up with
endocrinologist in [**12-1**] weeks.  Follow-up with cardiolgoist in
[**12-1**] weeks.




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

Dictated By:[**Last Name (NamePattern1) 3118**]
MEDQUIST36

D:  [**2159-1-23**]  11:48
T:  [**2159-1-23**]  12:22
JOB#:  [**Job Number 35335**]
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other specified complications of procedures not elsewhere classified,Unspecified transient mental disorder in conditions classified elsewhere,Pure hypercholesterolemia'}


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: Three-vessel disease.

PRESENT ILLNESS: This is a 65-year-old male with
a [**5-12**] month history of exertional dyspnea and shortness of
breath.  The patient had an ETT in [**2158-7-31**] which was
positive and was treated medically at that time, but the
exertional angina persisted, and the patient had a cardiac
catheterization that showed three-vessel disease with a
normal ejection fraction.

MEDICAL HISTORY: Status post right knee surgery.
Hypercholesterolemia.  Coronary artery disease.

MEDICATION ON ADMISSION: Aspirin 81 mg p.o. q.d., Lipitor
10 mg p.o. q.d., Atenolol 25 mg p.o. q.d., Lorazepam 0.5 mg
q.h.s. p.r.n., Nitroglycerin p.r.n.

ALLERGIES: PERCOCET.

PHYSICAL EXAM: 

FAMILY HISTORY: Uncle had a history of myocardial infarction
in his 60s.  Brother died in his 50s from diabetes.

SOCIAL HISTORY: He is retired and lives alone.  He denied
tobacco.  Occasional alcohol, approximately [**5-7**] drinks per
week. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Other specified complications of procedures not elsewhere classified,Unspecified transient mental disorder in conditions classified elsewhere,Pure hypercholesterolemia'}
