CHIEF COMPLAINT: Transfer to CCU for hypotension status post elective peripheral
angiography

PRESENT ILLNESS: Ms. [**Known lastname 9164**] is a 76 year-old female with a complicated PMHx
that includes CAD s/p Lcx stenting, DM type 2, s/p dual
pacemaker placement for bradycardia, atrial fibrillation on
chronic Coumadin therapy, with severe PVD s/p multiple stents,
angioplasties and atherectomies, with claudication symptoms. She
recently developed a RLE ulcer, and was referred for RLE
angiography and PTCA of her right tibial anterior tibial artery.

MEDICAL HISTORY: 1. CAD s/p LCX stent in 2/[**2122**]. LM with 60% ostial stenosis,
total occlusion of RCA on last cardiac catheterization 05/[**2123**].
2. Congestive heart failure, mild LV systolic dysfunction with
EF 48% on last ventriculogram 05/[**2123**].
3. Peripheral [**Year (4 digits) 1106**] disease s/p left EIA and SFA stenting
[**3-/2123**], and s/p atherectomy/PTA of LSFA [**12/2123**] for instent
restenosis.
4. Bradycardia status post [**Company 1543**] dual chamber pacemaker
placement [**2123-12-29**].
5. Intermittent atrial fibrillation noted on PPM interrogation,
on chronic Coumadin therapy.
6. Hypercholesterolemia
7. Chronic ITP with [**Doctor First Name **]. BM bx normal in [**2113**].
8. Diabetes mellitus type 2, diet controlled
9. Peripheral neuropathy
10. Mild COPD
11. PUD
12. Gastritis, Barrett's esophagus
13. Multinodular goiter

MEDICATION ON ADMISSION: Atenolol 50 mg PO QD
Diovan 160 mg PO QD
Colace 200 mg PO QD
Ecotrin 81 mg PO QD
Effexor 150 mg PO QHS
HCTZ 12.5 mg PO QD
Lipitor 40 mg PO QD
Lisinopril 40 mg PO QD
MVI 1 tab PO QD
Prilosec 40 mg PO QD
Trazodone 200 mg PO QHS
Warfarin last dose on [**2125-1-20**]

ALLERGIES: Erythromycin Base / Nsaids / Adhesive Tape

PHYSICAL EXAM: Physical examination on admission to CCU:
VITALS: HR 65, V-paced, BP 120/46, RR 12, Sat 100% on 4L NC.
GEN: Alert, confused.
HEENT: PERRL.
NECK: JVP not elevated.
RESP: Limited to anterior chest. Clear to auscultation.
CVS: RRR. Normal S1, S2. No S3, S4. No murmur or rub.
GI: BS normoactive. RLQ firm to palpation, tender. No clear
palpable hematoma.
EXT: Right groin with dressing in place. Tender to palpation.
Pedal pulses present via Doppler.
NEURO: Limited examination, patient non-cooperative. Moves all 4
extremities.

FAMILY HISTORY: Family history positive for CAD: brother died of MI at age 44,
another brother died at age 53 of MI.

SOCIAL HISTORY: Widow. She lives with her son. She has 6 adult children.
Ex-smoker. She quit smoking 12 years ago; 120 pack-year smoking
history.
Atherosclerosis of native arteries of the extremities with ulceration,Atrial fibrillation,Hemorrhage complicating a procedure,Chronic systolic heart failure,Other emphysema,Drug-induced delirium,Ulcer of other part of lower limb,Cardiac pacemaker in situ,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Long-term (current) use of anticoagulants,Other opiates and related narcotics causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Ath ext ntv art ulcrtion,Atrial fibrillation,Hemorrhage complic proc,Chr systolic hrt failure,Emphysema NEC,Drug-induced delirium,Ulcer oth part low limb,Status cardiac pacemaker,DMII wo cmp nt st uncntr,Old myocardial infarct,Long-term use anticoagul,Adv eff opiates,Abn react-procedure NEC
Admission Date:  [**2125-1-24**]              Discharge Date:   [**2125-1-26**]

Date of Birth:  [**2048-3-4**]             Sex:   F

Service: MEDICINE

Allergies:
Erythromycin Base / Nsaids / Adhesive Tape

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Transfer to CCU for hypotension status post elective peripheral
angiography

Major Surgical or Invasive Procedure:
Right lower extremity angiography
Percutaneous coronary angioplasty of right anterior tibial
artery

History of Present Illness:
Ms. [**Known lastname 9164**] is a 76 year-old female with a complicated PMHx
that includes CAD s/p Lcx stenting, DM type 2, s/p dual
pacemaker placement for bradycardia, atrial fibrillation on
chronic Coumadin therapy, with severe PVD s/p multiple stents,
angioplasties and atherectomies, with claudication symptoms. She
recently developed a RLE ulcer, and was referred for RLE
angiography and PTCA of her right tibial anterior tibial artery.


One hour after the procedure, Ms. [**Known lastname 9164**] became hypotensive
with SBP down to 30s when the sheath was pulled, HR paced at 60.
She also complained of severe right groin pain at the cath site.
She was given Atropine X 2, IVF bolus, and transfused 2 units of
PRBCs. Her HR subsequently increased to 120s, then she went into
atrial fibrillation with RVR in 160s. She spontaneously
converted back to NSR with HR 88. Her BP improved with the above
resuscitation measures, and she was trasnferred to the CCU for
further management and care.

An emergent CT scan was performed on arrival to CCU, which
revealed a right-sided RP bleed.

Past Medical History:
1. CAD s/p LCX stent in 2/[**2122**]. LM with 60% ostial stenosis,
total occlusion of RCA on last cardiac catheterization 05/[**2123**].
2. Congestive heart failure, mild LV systolic dysfunction with
EF 48% on last ventriculogram 05/[**2123**].
3. Peripheral [**Year (4 digits) 1106**] disease s/p left EIA and SFA stenting
[**3-/2123**], and s/p atherectomy/PTA of LSFA [**12/2123**] for instent
restenosis.
4. Bradycardia status post [**Company 1543**] dual chamber pacemaker
placement [**2123-12-29**].
5. Intermittent atrial fibrillation noted on PPM interrogation,
on chronic Coumadin therapy.
6. Hypercholesterolemia
7. Chronic ITP with [**Doctor First Name **]. BM bx normal in [**2113**].
8. Diabetes mellitus type 2, diet controlled
9. Peripheral neuropathy
10. Mild COPD
11. PUD
12. Gastritis, Barrett's esophagus
13. Multinodular goiter

Past surgical history:
1. Status post cholecystectomy
2. s/p TAH-BSO
3. s/p right THR
4. s/p L4, L5 discectomy
5. s/p appendectomy

Social History:
Widow. She lives with her son. She has 6 adult children.
Ex-smoker. She quit smoking 12 years ago; 120 pack-year smoking
history.

Family History:
Family history positive for CAD: brother died of MI at age 44,
another brother died at age 53 of MI.

Physical Exam:
Physical examination on admission to CCU:
VITALS: HR 65, V-paced, BP 120/46, RR 12, Sat 100% on 4L NC.
GEN: Alert, confused.
HEENT: PERRL.
NECK: JVP not elevated.
RESP: Limited to anterior chest. Clear to auscultation.
CVS: RRR. Normal S1, S2. No S3, S4. No murmur or rub.
GI: BS normoactive. RLQ firm to palpation, tender. No clear
palpable hematoma.
EXT: Right groin with dressing in place. Tender to palpation.
Pedal pulses present via Doppler.
NEURO: Limited examination, patient non-cooperative. Moves all 4
extremities.


Pertinent Results:
Relevant laboratory data on admission to CCU:
CBC:
WBC-13.5*# RBC-3.39* HGB-11.4* HCT-32.8* MCV-97 MCH-33.6*
MCHC-34.6 RDW-16.3*

Chemistry:
GLUCOSE-153* UREA N-10 CREAT-0.8 SODIUM-140 POTASSIUM-3.4
CHLORIDE-107 TOTAL CO2-27 ANION GAP-9
CALCIUM-7.0* PHOSPHATE-4.5 MAGNESIUM-1.3*

Coagulation profile:
PT-13.8* PTT-23.5 INR(PT)-1.2

EKG: V-paced, rate 60 bpm, LBBB morphology.

[**2124-1-24**] RLE angiography: Initial angiography showed a severely
diseased AT. We planned to treat this vessel with PTA and
atherectomy. Heparin was given for anticoagulation. Access was
obtained in an antegrade fashion of the RCFA and a 7 French
Arrow sheath was advanced to the mid SFA. The AT was crossed
with great difficulties with numerous wires, including PT
[**Name (NI) 9165**], [**Name (NI) 9166**] and Shinobi. However, attempts to cross the
distal lesion with atherectomy or angioplasty devices failed.
Finally, a 2.0x20 mm Maverick crossed the lesion, which was
dilated at 12 Atm. Next, a 2.5x20 mm Quantum Maverick balloon
was used to dilate the entire AT at 12-22 Atm. Final angiography
showed no residual stenosis with flow to the foot through the PA
and AT. The patient left the lab in stable
condition.

[**2125-1-24**] CT OF THE ABDOMEN WITHOUT CONTRAST: Changes of
emphysema are seen at both lung bases. There is bibasilar
dependent atelectasis, without significant pleural effusion or
pneumothorax. Coronary artery calcifications and coronary
[**Month/Day/Year 1106**] calcifications are seen. Pacemaker wires are also
present.

There is residual contrast within the kidneys from recent
interventional procedure.

The liver, spleen, adrenal glands, kidneys, stomach, pancreas,
and small bowel are within normal limits. Marked [**Month/Day/Year 1106**]
calcifications are seen of the aorta, celiac axis, SMA, [**Female First Name (un) 899**], and
iliac/femoral arteries. The gallbladder is not identified, and
the patient may be status post cholecystectomy. There is a small
hiatal hernia present.

There is a large amount of retroperitoneal hemorrhage present,
tracking from the right groin to the right posterior pararenal
space. In the greatest axial dimensions, this measures
approximately 7.0 x 7.8 cm in size, and it extends a length of
approximately 20 cm in the SI dimension. There is no significant
abdominal lymph adenopathy present, and no ascites fluid is
present.

CT OF THE PELVIS WITHOUT CONTRAST: Diverticuli are seen, and the
large bowel is otherwise unremarkable in appearance. Hyperdense
free fluid is seen within the pelvis, possibly tracking from the
retroperitoneal hemorrhage. The bladder appears unremarkable,
with a Foley catheter in place.

A right-sided hip replacement is present. No significant osseous
abnormalities are seen aside from degenerative changes and
right-convex scoliosis centered at the thoracolumbar junction.

IMPRESSION:
1. Large right-sided retroperitoneal hemorrhage, extending from
the right groin to the right posterior pararenal space.
2. No significant hemorrhage is seen within the right groin or
extending into the right leg.

Brief Hospital Course:
76 year-old female with a complicated PMHX that includes CAD s/p
LCx stenting in [**2122**], DM type 2, s/p PPM placement for
bradycardia, atrial fibrillation on Coumadin, with severe PVD
s/p mutliple interventions, now s/p RLE angiography and right
anterior tibial artery PTCA with post-procedure hypotension and
RP bleed. Transferred to the CCU for further care.

1) Retroperitoneal bleed: Her hypotension was felt secondary to
her retroperitoneal bleed and likely vagal response at the time
of the sheath pull. As mentioned in the HPI, she was transfused
2 units of PRBCs in the cath lab, and was transfused an
additional unit in the CCU. She was also given IVF. She remained
hemodynamically stable throughout her stay in the CCU, without
need for pressors, and her HCT also remained stable following
the 3 units of PRBCs. Coumadin was held in the setting of her RP
bleed, to be restarted as an outpatient. Aspirin was resumed on
[**2125-1-25**] and well tolerated. Her hematocrit was 31.1 at
discharge.

2) s/p PTCA to right [**Doctor First Name **]: She was continued on aspirin while in
hospital. Pedal pulses were present via Doppler. She will
follow-up with Dr. [**First Name (STitle) **] in the week following discharge.

3) CAD: No acute issues in hospital. She was continued on
Lipitor. Aspirin, Atenolol, Diovan, and Lisinopril were
gradually resumed in hospital following the procedure.

4) Mental status change: On arrival to the CCU, Ms. [**Known lastname 9164**] was
noted to be confused, belligerent. Her acute mental status
change was felt most likely medication-related s/p
administration of Fentanyl in the cath lab, sedatives. No gross
electrolyte abnormalities, ABG unremarkable. She responded to
Haldol for acute agitation/confusion. She was alert and oriented
the following morning without recurrence of confusion.

5) Diabetes mellitus type 2: She was kept on a regular insulin
sliding scale in hospital. Her diabetes appears to be
diet-controlled as an out-patient.

Medications on Admission:
Atenolol 50 mg PO QD
Diovan 160 mg PO QD
Colace 200 mg PO QD
Ecotrin 81 mg PO QD
Effexor 150 mg PO QHS
HCTZ 12.5 mg PO QD
Lipitor 40 mg PO QD
Lisinopril 40 mg PO QD
MVI 1 tab PO QD
Prilosec 40 mg PO QD
Trazodone 200 mg PO QHS
Warfarin last dose on [**2125-1-20**]

Discharge Medications:
1. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Diovan 160 mg Tablet Sig: One (1) Tablet PO once a day.
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Venlafaxine HCl 75 mg Capsule, Sust. Release 24HR Sig: Two
(2) Capsule, Sust. Release 24HR PO DAILY (Daily).
6. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
7. Lipitor 40 mg Tablet Sig: One (1) Tablet PO once a day.
8. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
9. Multi-Vitamin     Tablet Sig: One (1) Tablet PO once a day.
10. Prilosec 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
11. Trazodone HCl 100 mg Tablet Sig: Two (2) Tablet PO at
bedtime.

Discharge Disposition:
Home

Discharge Diagnosis:
1. RLE Angiography and PTCA of right anterior tibial artery
2. Complicated by large retroperitoneal bleed


Discharge Condition:
Pt was in good condition, with a stable hematocrit, ambulating,
and good oxygen saturations on room air.

Discharge Instructions:
Please call Dr. [**First Name (STitle) **] or return to the hospital if you
experience bleeding, weakness, dizziness, shortness of breath,
chest pain, groin, abdomen or back pain.

Dr.[**Name (NI) 3101**] office will call you Monday for an appointment next
week.

Stop taking your Coumadin until Dr. [**First Name (STitle) **] tells you to resume
it.

Followup Instructions:
See Dr. [**First Name (STitle) **] in one week.  His office will call you Monday.

Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) 9119**] [**Name12 (NameIs) 9120**] MEDICINE (PRIVATE) Where: ADULT
MEDICINE UNIT [**Hospital3 **] HEALTHCARE - 1000 [**Location (un) **] - [**Location (un) 2352**],
[**Numeric Identifier 9121**] Phone:[**Pager number **] Date/Time:[**2125-2-21**] 2:00
Provider: [**Name10 (NameIs) **] STUDY Where: CC CLINICAL CENTER RADIOLOGY
Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2125-5-15**] 11:00



Completed by:[**2125-1-27**]
{'Atherosclerosis of native arteries of the extremities with ulceration,Atrial fibrillation,Hemorrhage complicating a procedure,Chronic systolic heart failure,Other emphysema,Drug-induced delirium,Ulcer of other part of lower limb,Cardiac pacemaker in situ,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Long-term (current) use of anticoagulants,Other opiates and related narcotics causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: Transfer to CCU for hypotension status post elective peripheral
angiography

PRESENT ILLNESS: Ms. [**Known lastname 9164**] is a 76 year-old female with a complicated PMHx
that includes CAD s/p Lcx stenting, DM type 2, s/p dual
pacemaker placement for bradycardia, atrial fibrillation on
chronic Coumadin therapy, with severe PVD s/p multiple stents,
angioplasties and atherectomies, with claudication symptoms. She
recently developed a RLE ulcer, and was referred for RLE
angiography and PTCA of her right tibial anterior tibial artery.

MEDICAL HISTORY: 1. CAD s/p LCX stent in 2/[**2122**]. LM with 60% ostial stenosis,
total occlusion of RCA on last cardiac catheterization 05/[**2123**].
2. Congestive heart failure, mild LV systolic dysfunction with
EF 48% on last ventriculogram 05/[**2123**].
3. Peripheral [**Year (4 digits) 1106**] disease s/p left EIA and SFA stenting
[**3-/2123**], and s/p atherectomy/PTA of LSFA [**12/2123**] for instent
restenosis.
4. Bradycardia status post [**Company 1543**] dual chamber pacemaker
placement [**2123-12-29**].
5. Intermittent atrial fibrillation noted on PPM interrogation,
on chronic Coumadin therapy.
6. Hypercholesterolemia
7. Chronic ITP with [**Doctor First Name **]. BM bx normal in [**2113**].
8. Diabetes mellitus type 2, diet controlled
9. Peripheral neuropathy
10. Mild COPD
11. PUD
12. Gastritis, Barrett's esophagus
13. Multinodular goiter

MEDICATION ON ADMISSION: Atenolol 50 mg PO QD
Diovan 160 mg PO QD
Colace 200 mg PO QD
Ecotrin 81 mg PO QD
Effexor 150 mg PO QHS
HCTZ 12.5 mg PO QD
Lipitor 40 mg PO QD
Lisinopril 40 mg PO QD
MVI 1 tab PO QD
Prilosec 40 mg PO QD
Trazodone 200 mg PO QHS
Warfarin last dose on [**2125-1-20**]

ALLERGIES: Erythromycin Base / Nsaids / Adhesive Tape

PHYSICAL EXAM: Physical examination on admission to CCU:
VITALS: HR 65, V-paced, BP 120/46, RR 12, Sat 100% on 4L NC.
GEN: Alert, confused.
HEENT: PERRL.
NECK: JVP not elevated.
RESP: Limited to anterior chest. Clear to auscultation.
CVS: RRR. Normal S1, S2. No S3, S4. No murmur or rub.
GI: BS normoactive. RLQ firm to palpation, tender. No clear
palpable hematoma.
EXT: Right groin with dressing in place. Tender to palpation.
Pedal pulses present via Doppler.
NEURO: Limited examination, patient non-cooperative. Moves all 4
extremities.

FAMILY HISTORY: Family history positive for CAD: brother died of MI at age 44,
another brother died at age 53 of MI.

SOCIAL HISTORY: Widow. She lives with her son. She has 6 adult children.
Ex-smoker. She quit smoking 12 years ago; 120 pack-year smoking
history. 

### Response:
{'Atherosclerosis of native arteries of the extremities with ulceration,Atrial fibrillation,Hemorrhage complicating a procedure,Chronic systolic heart failure,Other emphysema,Drug-induced delirium,Ulcer of other part of lower limb,Cardiac pacemaker in situ,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Old myocardial infarction,Long-term (current) use of anticoagulants,Other opiates and related narcotics causing adverse effects in therapeutic use,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
