CHIEF COMPLAINT: ASA desensitization

PRESENT ILLNESS: 67yo F with h/o HTN, HL, R carotid stenosis, s/p recent echo
revealing anterior ischemia presenting for ASA desensitization
for cardiac catheterization.  Patient has a h/o anaphylaxis with
aspirin.  She reports that she first developed symptoms in
response to a midol, and developed hives, her throat closed and
her tongue and lips swelled.  Her symptoms resolved with
benadryl.  Several years later, she again tried half of a baby
aspirin, and again developed similar symptoms, relieved again
with benadryl.
<br>
Patient reports that she had a recent carotid artery doppler
which indicated 40-59% stenosis of the right carotid artery.
Given her family history of CAD and patient's h/o HTN and recent
fatigue with exercise, PCP ordered [**Name Initial (PRE) **] stress echocardiogram which
indicated an anterior infarct.  Patient was then referred for
cardiac catheterization.
<br>
Patient reports that she has never experienced frank chest pain
or pressure.  She endorses occasional chest "pinch" which last
5-10minutes and only occurs at rest.  She plays tennis 4-5 times
a week for 2 hours at a time.  She has been feeling
progressively more fatigued recently after completing her games,
but denies shortness or breath, lightheadedness or chest pain
while playing.
<br>
Of note, patient completed 33 cycles of radiation therapy in
[**2108-1-24**] for relapse of meningioma.
<br>
On review of systems, she denies any prior history of stroke,
TIA, pulmonary embolism, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. She denies recent
fevers, chills or rigors. She denies exertional buttock or calf
pain. She denies abdominal pain, nausea/vomiting, diarrhea or
constipation. She denies dysuria, hematuria, or urinary
incontinence.
<br>
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Hypertension, hyperlipidemia
2. CARDIAC HISTORY:
-  Stress echo indicating anterior ischemia
3. OTHER PAST MEDICAL HISTORY:
-  Asthma
-  h/o TB, untreated
-  relapse of meningioma, s/p resection [**4-/2105**], s/p 33 cycles
radiation ending [**2108-1-26**]
-  Factor V Leiden
-  Glaucoma
-  Depression
-  mild-moderate right carotid artery stenosis
-  h/o DVT in left leg ([**2099**])
-  s/p appendectomy [**2104**]
-  s/p tubal ligation ([**2065**])

MEDICATION ON ADMISSION: -  Beclomethasone 42mcg INH two sprays to each nostril daily
-  Bimatoprost 0.01% 1 drop to each eye qHS
-  Brimonidine 0.1% drops to each eye [**Hospital1 **]
-  Clopidogrel 75mg po daily
-  Lisinopril-hydrochlorothiazide 10-12.5mg po daily
-  Montelukast 10mg po daily
-  Fluticasone 11mcg INH [**Hospital1 **]
-  Flaxseed 1 tbs po qAM
-  Myocalm 25mg-50mg-20mg-10mg 1tab qAM, 2tab po qPM
-  Cod liver oil 1 tbs po qAM
-  MVI 1tab po daily

ALLERGIES: aspirin / moxifloxacin

PHYSICAL EXAM: ADMISSION EXAM
VS: T= 96.5 BP= 136/64 HR= 80 RR= 12 O2 sat= 99%RA
GENERAL: Well appearing female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - Mother:  Peripheral vascular disease, CAD, h/o TIAs, DM
- Father:  CAD h/o CABG, ALL

SOCIAL HISTORY: Patient lives in [**Location 11252**], NH
- Tobacco history: Quit 40 years ago, smoked for approximately 7
yrs
- ETOH:  [**11-28**] glasses of wine per day
- Illicit drugs:  Denies current or history of use.
Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs,Need for desensitization to allergens,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Family history of ischemic heart disease,Personal history of tobacco use,Personal history of allergy to analgesic agent,Other malaise and fatigue
Nonsp abn intrathor NEC,Desensitiza to allergens,Hypertension NOS,Hyperlipidemia NEC/NOS,Ocl crtd art wo infrct,Fam hx-ischem heart dis,History of tobacco use,Hx-analgesic allergy,Malaise and fatigue NEC
Admission Date:  [**2108-6-28**]              Discharge Date:   [**2108-6-29**]

Date of Birth:  [**2041-6-1**]             Sex:   F

Service: MEDICINE

Allergies:
aspirin / moxifloxacin

Attending:[**Last Name (NamePattern1) 1167**]
Chief Complaint:
ASA desensitization

Major Surgical or Invasive Procedure:
Cardiac catheterization

History of Present Illness:
67yo F with h/o HTN, HL, R carotid stenosis, s/p recent echo
revealing anterior ischemia presenting for ASA desensitization
for cardiac catheterization.  Patient has a h/o anaphylaxis with
aspirin.  She reports that she first developed symptoms in
response to a midol, and developed hives, her throat closed and
her tongue and lips swelled.  Her symptoms resolved with
benadryl.  Several years later, she again tried half of a baby
aspirin, and again developed similar symptoms, relieved again
with benadryl.
<br>
Patient reports that she had a recent carotid artery doppler
which indicated 40-59% stenosis of the right carotid artery.
Given her family history of CAD and patient's h/o HTN and recent
fatigue with exercise, PCP ordered [**Name Initial (PRE) **] stress echocardiogram which
indicated an anterior infarct.  Patient was then referred for
cardiac catheterization.
<br>
Patient reports that she has never experienced frank chest pain
or pressure.  She endorses occasional chest "pinch" which last
5-10minutes and only occurs at rest.  She plays tennis 4-5 times
a week for 2 hours at a time.  She has been feeling
progressively more fatigued recently after completing her games,
but denies shortness or breath, lightheadedness or chest pain
while playing.
<br>
Of note, patient completed 33 cycles of radiation therapy in
[**2108-1-24**] for relapse of meningioma.
<br>
On review of systems, she denies any prior history of stroke,
TIA, pulmonary embolism, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. She denies recent
fevers, chills or rigors. She denies exertional buttock or calf
pain. She denies abdominal pain, nausea/vomiting, diarrhea or
constipation. She denies dysuria, hematuria, or urinary
incontinence.
<br>
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
1. CARDIAC RISK FACTORS: Hypertension, hyperlipidemia
2. CARDIAC HISTORY:
-  Stress echo indicating anterior ischemia
3. OTHER PAST MEDICAL HISTORY:
-  Asthma
-  h/o TB, untreated
-  relapse of meningioma, s/p resection [**4-/2105**], s/p 33 cycles
radiation ending [**2108-1-26**]
-  Factor V Leiden
-  Glaucoma
-  Depression
-  mild-moderate right carotid artery stenosis
-  h/o DVT in left leg ([**2099**])
-  s/p appendectomy [**2104**]
-  s/p tubal ligation ([**2065**])


Social History:
Patient lives in [**Location 11252**], NH
- Tobacco history: Quit 40 years ago, smoked for approximately 7
yrs
- ETOH:  [**11-28**] glasses of wine per day
- Illicit drugs:  Denies current or history of use.


Family History:
- Mother:  Peripheral vascular disease, CAD, h/o TIAs, DM
- Father:  CAD h/o CABG, ALL


Physical Exam:
ADMISSION EXAM
VS: T= 96.5 BP= 136/64 HR= 80 RR= 12 O2 sat= 99%RA
GENERAL: Well appearing female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 3 cm.  No carotid bruits
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RRR, normal S1, S2. Grade [**1-1**] holosystolic murmur best
heard at apex, radiating to axilla.  No rubs or gallops. No
thrills, lifts. No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: Warm and well perfused without edema or cyanosis.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
.
DISCHARGE EXAM
XXXXXXXXX


Pertinent Results:
Admission labs:
WBC-4.0 RBC-3.98* HGB-12.7 HCT-36.0 MCV-91
PT-11.4 PTT-24.2 INR(PT)-0.9

GLUCOSE-191* UREA N-18 CREAT-1.0 SODIUM-133 POTASSIUM-3.5
CHLORIDE-96 TOTAL CO2-25 ANION GAP-16

ALT(SGPT)-19 AST(SGOT)-23 ALK PHOS-55 TOT BILI-0.3

Chol 222  HDL 117 LDL 96  TGs 43

Studies:
Stress echocardiogram ([**2108-6-15**] at [**Location (un) 11252**] Cardiology):
Questionable anterior septal ischemia, mild to moderate aortic
insufficiency, aortic sclerosis without significant aortic
stenosis, mild mitral insufficiency and tricuspid insufficiency,
borderline pulmonary hypertension.  Patient exercised for 10min,
reached 11 METS, with no angina.
.
CXR ([**2108-6-28**]): No acute cardiopulmonary process.
.
ECG ([**2108-6-28**] on admission):  Normal sinus rhythm, normal axis,
normal intervals. P wave inversions in V1 concerning for left
atrial enlargement.
.
Cardiac Catheterization:
1. Selective coronary angiography of this right dominant system
demonstrated no angiographically flow limiting stenoses. The
Left Main
and LAD were normal.  The mid LCX had a discrete 40% lesion.
The RCA
had mild diffuse non-obstructive disease.
2. Limited resting hemodynamics revealed a normal LVEDP and
normal
central aortic pressures.


Brief Hospital Course:
REASON FOR ADMISSION
67 yo F with HTN, HL, recent stress echo evidence of anterior
iscemia and h/o anaphylaxis to ASA presenting for aspirin
desensitization prior to cardiac catheterization.

ACTIVE ISSUES
# Aspirin allergy:  Patient has a known history of angioedema
with aspirin intake.  Prior to cardiac catheterization, she was
desensitized in case she required daily aspirin following this
procedure. Aspirin desensitization protocol was followed.
Patient received montelukast 1 hour prior to begining aspirin.
One hour following the final aspirin dose, patient developed lip
tingling and swelling and was given diphenhydramine 25mg x1
which resolved her symptoms.  Symptoms did not return on HD1 and
patient was discharged on aspirin 81mg po daily.  Patient was
encouraged to take diphenhydramine in the future if similar
symptoms developed.

# Abnormal stress echo: Patient has no history of chest pain
with exercise or at rest. However, recent stress echo showed
question of anterior septal ischemia.  Patient has been on
clopidogrel for carotid stenosis in the setting of an aspirin
allergy. Catheterization on [**2108-6-29**] showed no significant
stenosis or lesions.  Patient was discharged on daily aspirin
81mg.  Clopidogrel was discontinued.

#Fatigue- Patient complains of new onset of fatigue, beginning
at the end of her 2nd set of tennis.  However, she is able to
complete a third set.  She denies chest pain, shortness of
breath.  Differential diagnosis includes coronary artery
disease, effect of recent radiation, anemia, hypothyroidism,
pulmonary disease (asthma, pulmonary hypertension).  Hemoglobin
was normal during recent outpatient labs.  Patient has known
asthma and recent echo did show mild pulmonary hypertension.

# HTN: Blood pressure controlled at home with lisinopril-HCTZ.
HCTZ was held prior to catheterization, and restarted after.  BP
was stable throughout admission.

CHRONIC ISSUES
#Asthma: She was continued on her home fluticasone and
montelukast. Respiratory status was stable throughout admission.


#Glaucoma: She was continued on her home alphagan, lumigan eye
drops

TRANSITIONAL ISSUES:
1.  Follow-up with PCP regarding recent onset of increased
fatigue.

Medications on Admission:
-  Beclomethasone 42mcg INH two sprays to each nostril daily
-  Bimatoprost 0.01% 1 drop to each eye qHS
-  Brimonidine 0.1% drops to each eye [**Hospital1 **]
-  Clopidogrel 75mg po daily
-  Lisinopril-hydrochlorothiazide 10-12.5mg po daily
-  Montelukast 10mg po daily
-  Fluticasone 11mcg INH [**Hospital1 **]
-  Flaxseed 1 tbs po qAM
-  Myocalm 25mg-50mg-20mg-10mg 1tab qAM, 2tab po qPM
-  Cod liver oil 1 tbs po qAM
-  MVI 1tab po daily


Discharge Medications:
1. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. beclomethasone dipropionate 40 mcg/Actuation Aerosol Sig: One
(1)  Inhalation 2 sprays to each nostril once daily ().
3. bimatoprost 0.01 % Drops Sig: One (1) drop Ophthalmic qHS ().

4. brimonidine 0.1 % Drops Sig: One (1)  Ophthalmic [**Hospital1 **] (2 times
a day).
5. fluticasone 110 mcg/Actuation Aerosol Sig: One (1) Puff
Inhalation [**Hospital1 **] (2 times a day).
6. lisinopril-hydrochlorothiazide 10-12.5 mg Tablet Sig: One (1)
Tablet PO once a day.
7. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
Disp:*30 Tablet, Chewable(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:  Aspirin allergy

Secondary diagnosis:
1.  Hypertension
2.  Asthma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
It was a pleasure taking care of you during your recent
admission to [**Hospital1 69**].  You were
admitted for aspirin desensitization and cardiac
catheterization.  You were successfully desensitized to aspirin,
and should take a baby aspirin every day. You no longer need to
take clopidogrel. If you experience any lip swelling or rash or
itching, take one benadryl 25 mg by mouth, as this relieved your
symptoms while you were in the hospital.

Your cardiac catheterization did not show any significant
lesions in the arteries surrounding the heart.  You can resume
your normal activities.  You should follow up with your primary
care physician regarding your recent increase in fatigue.


Followup Instructions:
Department: Primary Care/ Cardiology
Name: Dr. [**First Name8 (NamePattern2) **] [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 11250**]
When: Dr. [**Last Name (STitle) 11250**] has walk in appointments for you to attend.
You do not need to call or schedule an appointment. You need to
be seen in the office 4-8 days after your hospital discharge.
There are no walk in appointments Friday [**7-6**]. Please
call the office if you have questions.
Location: [**Location (un) **] CARDIOLOGY
Address: [**Apartment Address(1) 64797**], GILFORD,[**Numeric Identifier 64798**]
Phone: [**Telephone/Fax (1) 11254**]
{'Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs,Need for desensitization to allergens,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Family history of ischemic heart disease,Personal history of tobacco use,Personal history of allergy to analgesic agent,Other malaise and fatigue'}


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: ASA desensitization

PRESENT ILLNESS: 67yo F with h/o HTN, HL, R carotid stenosis, s/p recent echo
revealing anterior ischemia presenting for ASA desensitization
for cardiac catheterization.  Patient has a h/o anaphylaxis with
aspirin.  She reports that she first developed symptoms in
response to a midol, and developed hives, her throat closed and
her tongue and lips swelled.  Her symptoms resolved with
benadryl.  Several years later, she again tried half of a baby
aspirin, and again developed similar symptoms, relieved again
with benadryl.
<br>
Patient reports that she had a recent carotid artery doppler
which indicated 40-59% stenosis of the right carotid artery.
Given her family history of CAD and patient's h/o HTN and recent
fatigue with exercise, PCP ordered [**Name Initial (PRE) **] stress echocardiogram which
indicated an anterior infarct.  Patient was then referred for
cardiac catheterization.
<br>
Patient reports that she has never experienced frank chest pain
or pressure.  She endorses occasional chest "pinch" which last
5-10minutes and only occurs at rest.  She plays tennis 4-5 times
a week for 2 hours at a time.  She has been feeling
progressively more fatigued recently after completing her games,
but denies shortness or breath, lightheadedness or chest pain
while playing.
<br>
Of note, patient completed 33 cycles of radiation therapy in
[**2108-1-24**] for relapse of meningioma.
<br>
On review of systems, she denies any prior history of stroke,
TIA, pulmonary embolism, myalgias, joint pains, cough,
hemoptysis, black stools or red stools. She denies recent
fevers, chills or rigors. She denies exertional buttock or calf
pain. She denies abdominal pain, nausea/vomiting, diarrhea or
constipation. She denies dysuria, hematuria, or urinary
incontinence.
<br>
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Hypertension, hyperlipidemia
2. CARDIAC HISTORY:
-  Stress echo indicating anterior ischemia
3. OTHER PAST MEDICAL HISTORY:
-  Asthma
-  h/o TB, untreated
-  relapse of meningioma, s/p resection [**4-/2105**], s/p 33 cycles
radiation ending [**2108-1-26**]
-  Factor V Leiden
-  Glaucoma
-  Depression
-  mild-moderate right carotid artery stenosis
-  h/o DVT in left leg ([**2099**])
-  s/p appendectomy [**2104**]
-  s/p tubal ligation ([**2065**])

MEDICATION ON ADMISSION: -  Beclomethasone 42mcg INH two sprays to each nostril daily
-  Bimatoprost 0.01% 1 drop to each eye qHS
-  Brimonidine 0.1% drops to each eye [**Hospital1 **]
-  Clopidogrel 75mg po daily
-  Lisinopril-hydrochlorothiazide 10-12.5mg po daily
-  Montelukast 10mg po daily
-  Fluticasone 11mcg INH [**Hospital1 **]
-  Flaxseed 1 tbs po qAM
-  Myocalm 25mg-50mg-20mg-10mg 1tab qAM, 2tab po qPM
-  Cod liver oil 1 tbs po qAM
-  MVI 1tab po daily

ALLERGIES: aspirin / moxifloxacin

PHYSICAL EXAM: ADMISSION EXAM
VS: T= 96.5 BP= 136/64 HR= 80 RR= 12 O2 sat= 99%RA
GENERAL: Well appearing female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: - Mother:  Peripheral vascular disease, CAD, h/o TIAs, DM
- Father:  CAD h/o CABG, ALL

SOCIAL HISTORY: Patient lives in [**Location 11252**], NH
- Tobacco history: Quit 40 years ago, smoked for approximately 7
yrs
- ETOH:  [**11-28**] glasses of wine per day
- Illicit drugs:  Denies current or history of use. 

### Response:
{'Nonspecific (abnormal) findings on radiological and other examination of other intrathoracic organs,Need for desensitization to allergens,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Family history of ischemic heart disease,Personal history of tobacco use,Personal history of allergy to analgesic agent,Other malaise and fatigue'}
