CHIEF COMPLAINT: Left leg pain

PRESENT ILLNESS: Patient is a 52yo male with history of PVD, COPD, DM and
hyperlipidemia admitted to the CCU after undergoing left iliac
stent placement x 2 for total occlusion of said vessel.
Post-procedure saturations were noted to be in the mid-80s so he
was sent to the CCU for further care.
.
The patient reported a recent history of worsened left lower
extremity claudication.  Per recent cardiology note, he states
after walking his son to the bus stop which is [**2139**] yards from
home he has to stop and rest in the middle of the walk due to
left leg pain.  He states both of legs hurt, left > right and
after resting for 10 minutes the pain will go away. Patient
states he has to stop multiple times on his way to his son's bus
stop every morning.  This pain has been occurring for the past
ten years.
.
He underwent a CT angio of his abdomen and bilateral lower
extremities on [**2149-9-16**], which demonstrated "lower abdominal
aorta irregularity and vascular consultation.  Left side of the
common iliac artery 4-cm total occlusion with the distal portion
reconstitution.  Right sided common iliac artery distal portion
calcification with mild narrowing mid-portion of right sided
superficial femoral artery focal calcification with 50% focal
narrowing is also noted."
.
The patient has COPD most likely secondary to extensive tobacco
history.  Per his wife, he has a poor baseline secondary to
dyspnea and leg claudication.  His baseline oxygen saturations
are in the high 80s/low 90s at rest.  He uses 2L NC oxygen
during exertion.  He also has a history of OSA but did not
complete sleep study.
.
After the procedure this evening, he oxygen saturations were
noted to be in the mid-80s.  Patient denied shortness of
breath/chest pain/dizziness/light-headedness.  He was otherwise
hemodynamically stable.  There were no post-procedure
complications.  Given his low saturations, he was sent to the
CCU for closer monitoring and possible positive pressure
ventilation.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, cough, hemoptysis, black stools or red stools.
He denies recent fevers, chills or rigors.  Positive for
exertional buttock and calf pain. All of the other review of
systems were negative.
.
He denies chest pain, worsened dyspnea, edema, orthopnea, PND,
lightheadedness, or syncope.  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: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
-CABG: -
-PERCUTANEOUS CORONARY INTERVENTIONS: -
-PACING/ICD: -
3. OTHER PAST MEDICAL HISTORY:

MEDICATION ON ADMISSION: BUDESONIDE-FORMOTEROL [SYMBICORT] 160 mcg-4.5 mcg/Actuation HFA
Aerosol Inhaler - 2 puffs twice daily
GLYBURIDE 5 mg Tablet qd
LISINOPRIL 40 mg Tablet qd
METFORMIN  1,000 mg Tablet po bid
PRAMIPEXOLE 0.5 mg Tablet qd
SIMVASTATIN 20 mg Tablet qd
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] 18 mcg Capsule,
w/Inhalation Device one daily
VERAPAMIL 180 mg Cap SR qd
ASPIRIN -  (Prescribed by Other Provider) - 325 mg Tablet - one
Tablet(s) by mouth daily
FAMOTIDINE [PEPCID AC] -  (Prescribed by Other Provider) - 10 mg
Tablet - one Tablet(s) by mouth daily as needed

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals on discharge: 98.7, 98, 108/91, RR 20, 92% on 2L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple with normal JVP.
CARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3
or S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

FAMILY HISTORY: Mother and [**Name2 (NI) **] sister had [**Name2 (NI) 499**] cancer.  Father died of CAD
s/p CABG and had diabetes, Mother has HTN, Older brother has DM
and CABG.

SOCIAL HISTORY: Lives with his wife and six year old son.
-Tobacco history:  1/2ppd x 40 years
-ETOH:  Denies
-Illicit drugs:  Denies
Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of other specified arteries,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Insomnia, unspecified,Restless legs syndrome (RLS),Obesity, unspecified,Arthropathy, unspecified, site unspecified,Pure hypercholesterolemia,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of prostate
DMII circ nt st uncntrld,Atherosclerosis NEC,Hypertension NOS,Chr airway obstruct NEC,Tobacco use disorder,Insomnia NOS,Restless legs syndrome,Obesity NOS,Arthropathy NOS-unspec,Pure hypercholesterolem,Hx of irradiation,Hx-prostatic malignancy
Admission Date:  [**2149-10-16**]              Discharge Date:   [**2149-10-17**]

Date of Birth:  [**2097-2-24**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Left leg pain

Major Surgical or Invasive Procedure:
Peripheral catheterization- abdominal aorta and bilateral distal
extremity run-offf, bilateral limb angiography, PTA/stent left
iliac


History of Present Illness:
Patient is a 52yo male with history of PVD, COPD, DM and
hyperlipidemia admitted to the CCU after undergoing left iliac
stent placement x 2 for total occlusion of said vessel.
Post-procedure saturations were noted to be in the mid-80s so he
was sent to the CCU for further care.
.
The patient reported a recent history of worsened left lower
extremity claudication.  Per recent cardiology note, he states
after walking his son to the bus stop which is [**2139**] yards from
home he has to stop and rest in the middle of the walk due to
left leg pain.  He states both of legs hurt, left > right and
after resting for 10 minutes the pain will go away. Patient
states he has to stop multiple times on his way to his son's bus
stop every morning.  This pain has been occurring for the past
ten years.
.
He underwent a CT angio of his abdomen and bilateral lower
extremities on [**2149-9-16**], which demonstrated "lower abdominal
aorta irregularity and vascular consultation.  Left side of the
common iliac artery 4-cm total occlusion with the distal portion
reconstitution.  Right sided common iliac artery distal portion
calcification with mild narrowing mid-portion of right sided
superficial femoral artery focal calcification with 50% focal
narrowing is also noted."
.
The patient has COPD most likely secondary to extensive tobacco
history.  Per his wife, he has a poor baseline secondary to
dyspnea and leg claudication.  His baseline oxygen saturations
are in the high 80s/low 90s at rest.  He uses 2L NC oxygen
during exertion.  He also has a history of OSA but did not
complete sleep study.
.
After the procedure this evening, he oxygen saturations were
noted to be in the mid-80s.  Patient denied shortness of
breath/chest pain/dizziness/light-headedness.  He was otherwise
hemodynamically stable.  There were no post-procedure
complications.  Given his low saturations, he was sent to the
CCU for closer monitoring and possible positive pressure
ventilation.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, cough, hemoptysis, black stools or red stools.
He denies recent fevers, chills or rigors.  Positive for
exertional buttock and calf pain. All of the other review of
systems were negative.
.
He denies chest pain, worsened dyspnea, edema, orthopnea, PND,
lightheadedness, or syncope.  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: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
-CABG: -
-PERCUTANEOUS CORONARY INTERVENTIONS: -
-PACING/ICD: -
3. OTHER PAST MEDICAL HISTORY:

COPD
Sleep Apnea has not done sleep study
Restless leg syndrome
Prostate Cancer  s/p radiation treatment [**3-26**]
Carpal Tunnel Syndrome s/p left hand operation
Obesity
Arthritis
S/p broken jaw in MVA at the age of 17
Small benign tumor removal from right jaw [**2145**]
Tobacco Abuse


Social History:
Lives with his wife and six year old son.
-Tobacco history:  1/2ppd x 40 years
-ETOH:  Denies
-Illicit drugs:  Denies

Family History:
Mother and [**Name2 (NI) **] sister had [**Name2 (NI) 499**] cancer.  Father died of CAD
s/p CABG and had diabetes, Mother has HTN, Older brother has DM
and CABG.

Physical Exam:
Vitals on discharge: 98.7, 98, 108/91, RR 20, 92% on 2L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple with normal JVP.
CARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3
or S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

EXTREMITIES: No c/c/e. No femoral bruits.  Cath sites are clean,
dry and dressed.  No bruits heard.  DT/PT- 2+ bilaterally.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+  DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+  DP 2+ PT 2+


Pertinent Results:
[**2149-10-16**] 07:25PM BLOOD Type-ART O2 Flow-2 pO2-60* pCO2-80*
pH-7.27* calTCO2-38* Base XS-6 Intubat-NOT INTUBA Comment-NASAL
[**Last Name (un) 154**]
[**2149-10-16**] 08:03PM BLOOD O2 Flow-1 pO2-51* pCO2-67* pH-7.30*
calTCO2-34* Base XS-3 Comment-NASAL [**Last Name (un) 154**]
[**2149-10-16**] 08:03PM BLOOD O2 Sat-79 COHgb-8.3*
[**2149-10-16**] 11:41PM   GLUCOSE-231* UREA N-14 CREAT-0.9 SODIUM-137
POTASSIUM-4.4 CHLORIDE-97 TOTAL CO2-29 ANION GAP-15
[**2149-10-16**] 11:41PM   CK-MB-5 cTropnT-<0.01
[**2149-10-16**] 11:41PM   CK(CPK)-123
[**2149-10-16**] 11:41PM   PT-12.6 PTT-23.6 INR(PT)-1.1

CXR [**2149-10-16**]: The lungs are clear. Heart size is within normal
limits. The slight fullness of the right mediastinum is likely
vascular as there is prservation of the right paratracheal
stripe. No concerning bone findings.

Iliac Stent placement [**2149-10-16**]: Angio showed L CIA occlusion.
Bilateral access and stenting with 2 stents. Perclose to both
groins.


Brief Hospital Course:
# HYPOXIA- Patient with known COPD (baseline sats in the
mid-high 80s/low 90s) who was found to have sat of 85%
post-procedure.  He denies shortness of breath, chest pain, or
lightheadedness.  Etiology seems to be COPD.  Given body
habitus, he most likely has some degree of OSA also but is not
on CPAP at home.  Most recent ABG consistent with CO2 retaining-
7.30/67/51, consistent with chronic respiratory acidosis.
Patient sat'ed in low 90s on 2L NC throughout admission; prior
to discharge his O2 sat at rest was 85% off O2 but the patient
was completely asymptomatic and said that he felt like he was at
his baseline. Of note the patient has home O2 2L which he will
continue using prn at home. Patient was continued on home
inhalers.
.
# CORONARIES:  Patient with known DM, hyperlipidemia, and
hypertension.  He denies chest pain or shortness of breath at
this time and EKG was normal.  Given his risk factors and known
PVD, patient most likely has some degree of CAD but is currently
asymptomatic.  Remained hemodynamically stable throughout
hospitalization. Patient started on Plavix 75mg daily for iliac
stent placement and continued on home aspirin and simvastatin.
.
# PUMP:  Patient had ETT in [**2149-1-17**] demonstrating EF of
70%.  Patient is not showing signs of fluid overload on exam-
normal JVD, no peripheral edema, chest clear to ausculatation
bilaterally. CXR was normal.
.
# RHYTHM:  Patient in normal sinus rhythm throughout admission.
.
#  Left iliac occlusion s/p stent- Site was clean and dry with
no signs of bleed.  Patient started on plavix 75mg daily,
continued on aspirin 325 mg daily.
.
#  DM- Patient instructed to hold Metformin and re-start 48
hours after procedure.


Medications on Admission:
BUDESONIDE-FORMOTEROL [SYMBICORT] 160 mcg-4.5 mcg/Actuation HFA
Aerosol Inhaler - 2 puffs twice daily
GLYBURIDE 5 mg Tablet qd
LISINOPRIL 40 mg Tablet qd
METFORMIN  1,000 mg Tablet po bid
PRAMIPEXOLE 0.5 mg Tablet qd
SIMVASTATIN 20 mg Tablet qd
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] 18 mcg Capsule,
w/Inhalation Device one daily
VERAPAMIL 180 mg Cap SR qd
ASPIRIN -  (Prescribed by Other Provider) - 325 mg Tablet - one
Tablet(s) by mouth daily
FAMOTIDINE [PEPCID AC] -  (Prescribed by Other Provider) - 10 mg
Tablet - one Tablet(s) by mouth daily as needed

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*5*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every six (6) hours as needed for pain.
Disp:*12 Tablet(s)* Refills:*0*
3. Famotidine 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for indigestion.
4. Verapamil 180 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q24H (every 24 hours).
5. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
7. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Pramipexole 0.5 mg Tablet Sig: One (1) Tablet PO daily ().
9. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
10. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Symbicort 160-4.5 mcg/Actuation HFA Aerosol Inhaler Sig: One
(1) puff Inhalation twice a day.
12. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a
day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:  Peripheral vascular disease (left iliac artery
occlusion s/p stent placement), COPD.

Secondary:  Hyperlipidemia, hypertension. diabetes mellitus,


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


Discharge Instructions:
You were admitted to the hospital with leg pain.  While here,
you had a stent placed in your left leg artery for the occlusion
there.  You had relatively low oxygen saturations after the
procedure so you were sent to the CCU for close monitoring.
While here, you did very well and remained at your baseline
oxygen requirement.  You are being discharged home.

The following changes were made to your medications:
1.  START taking plavix 75mg daily.
2.  CONTINUE taking aspirin 325mg daily.
You should continue taking these medications until you followup
with Dr. [**Last Name (STitle) 7047**].

Resume your other home medications as your had been taking them.

Followup Instructions:
Please follow-up with your cardiologist, Dr. [**Last Name (STitle) 7047**], [**11-11**] at
8:40 AM. ([**Telephone/Fax (1) 8725**])

Please follow-up with your primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 17918**]
in one week ([**Telephone/Fax (1) 17919**])

Please return to the ED if you have any pain in your groin,
numbness or tingling in your legs, chest pain, increasing
shortness of breath or any other concerning symptoms.
{'Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of other specified arteries,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Insomnia, unspecified,Restless legs syndrome (RLS),Obesity, unspecified,Arthropathy, unspecified, site unspecified,Pure hypercholesterolemia,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of prostate'}


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: Left leg pain

PRESENT ILLNESS: Patient is a 52yo male with history of PVD, COPD, DM and
hyperlipidemia admitted to the CCU after undergoing left iliac
stent placement x 2 for total occlusion of said vessel.
Post-procedure saturations were noted to be in the mid-80s so he
was sent to the CCU for further care.
.
The patient reported a recent history of worsened left lower
extremity claudication.  Per recent cardiology note, he states
after walking his son to the bus stop which is [**2139**] yards from
home he has to stop and rest in the middle of the walk due to
left leg pain.  He states both of legs hurt, left > right and
after resting for 10 minutes the pain will go away. Patient
states he has to stop multiple times on his way to his son's bus
stop every morning.  This pain has been occurring for the past
ten years.
.
He underwent a CT angio of his abdomen and bilateral lower
extremities on [**2149-9-16**], which demonstrated "lower abdominal
aorta irregularity and vascular consultation.  Left side of the
common iliac artery 4-cm total occlusion with the distal portion
reconstitution.  Right sided common iliac artery distal portion
calcification with mild narrowing mid-portion of right sided
superficial femoral artery focal calcification with 50% focal
narrowing is also noted."
.
The patient has COPD most likely secondary to extensive tobacco
history.  Per his wife, he has a poor baseline secondary to
dyspnea and leg claudication.  His baseline oxygen saturations
are in the high 80s/low 90s at rest.  He uses 2L NC oxygen
during exertion.  He also has a history of OSA but did not
complete sleep study.
.
After the procedure this evening, he oxygen saturations were
noted to be in the mid-80s.  Patient denied shortness of
breath/chest pain/dizziness/light-headedness.  He was otherwise
hemodynamically stable.  There were no post-procedure
complications.  Given his low saturations, he was sent to the
CCU for closer monitoring and possible positive pressure
ventilation.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, cough, hemoptysis, black stools or red stools.
He denies recent fevers, chills or rigors.  Positive for
exertional buttock and calf pain. All of the other review of
systems were negative.
.
He denies chest pain, worsened dyspnea, edema, orthopnea, PND,
lightheadedness, or syncope.  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: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
2. CARDIAC HISTORY:
-CABG: -
-PERCUTANEOUS CORONARY INTERVENTIONS: -
-PACING/ICD: -
3. OTHER PAST MEDICAL HISTORY:

MEDICATION ON ADMISSION: BUDESONIDE-FORMOTEROL [SYMBICORT] 160 mcg-4.5 mcg/Actuation HFA
Aerosol Inhaler - 2 puffs twice daily
GLYBURIDE 5 mg Tablet qd
LISINOPRIL 40 mg Tablet qd
METFORMIN  1,000 mg Tablet po bid
PRAMIPEXOLE 0.5 mg Tablet qd
SIMVASTATIN 20 mg Tablet qd
TIOTROPIUM BROMIDE [SPIRIVA WITH HANDIHALER] 18 mcg Capsule,
w/Inhalation Device one daily
VERAPAMIL 180 mg Cap SR qd
ASPIRIN -  (Prescribed by Other Provider) - 325 mg Tablet - one
Tablet(s) by mouth daily
FAMOTIDINE [PEPCID AC] -  (Prescribed by Other Provider) - 10 mg
Tablet - one Tablet(s) by mouth daily as needed

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals on discharge: 98.7, 98, 108/91, RR 20, 92% on 2L
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
NECK: Supple with normal JVP.
CARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3
or S4.
LUNGS: Resp were unlabored, no accessory muscle use. CTAB, no
crackles, wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

FAMILY HISTORY: Mother and [**Name2 (NI) **] sister had [**Name2 (NI) 499**] cancer.  Father died of CAD
s/p CABG and had diabetes, Mother has HTN, Older brother has DM
and CABG.

SOCIAL HISTORY: Lives with his wife and six year old son.
-Tobacco history:  1/2ppd x 40 years
-ETOH:  Denies
-Illicit drugs:  Denies 

### Response:
{'Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled,Atherosclerosis of other specified arteries,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Tobacco use disorder,Insomnia, unspecified,Restless legs syndrome (RLS),Obesity, unspecified,Arthropathy, unspecified, site unspecified,Pure hypercholesterolemia,Personal history of irradiation, presenting hazards to health,Personal history of malignant neoplasm of prostate'}
