CHIEF COMPLAINT: claudication

PRESENT ILLNESS: Pt is a [**Age over 90 **] yo man with htn, hyperlipidemia, PVD, experienced as
pain in both calves when walking one block and resolving with
rest, who presented for stenting of his femoral artery. He had
ABIs which were also diminished bilaterally
(0.82 right ankle, 0.66 left ankle).  Lower extremity doppler
evaluation
showed triphasic waveforms in bilateral common femoral arteries
and
evidence of a left SFA occlusion.

MEDICAL HISTORY: 1. PVD-s/p atherectomy and stenting of left SFA
2. Bilateral Renal Artery Stenosis
3. Hyperlipidemia
4. Hypertension
5. Knee and hip replacement surgeries
6. s/p PPM

MEDICATION ON ADMISSION: 1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual Q5MIN () as needed for chest pain.
2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile 145/60 64 12 99% on RA
NAD. Alert.   OP clear with MMM.
L carotid upstroke diminished with bilateral bruits.
RRR soft S1, normal S2. Soft systolic murmurs at RUSB and LLSB.
No rubs or gallops
Lungs clear to auscultation
Abd is soft NTND. Normal BS. No bruits
R groin without minimal ecchymoses no hematoma. No bruit and 1+
pulse.
No peripheral edema. Bilateral LE warm.

FAMILY HISTORY: Mother with MI in 40's.

SOCIAL HISTORY: Lives alone in [**Location 8391**] in [**Hospital3 **]. One son. 50 pack
year history of smoking quit 50 yrs ago. Drinks accasional
highball.  Retired from construction work.
Atherosclerosis of native arteries of the extremities with intermittent claudication,Congestive heart failure, unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Hip joint replacement,Unspecified disorder of kidney and ureter
Ath ext ntv at w claudct,CHF NOS,Periph vascular dis NOS,Pure hypercholesterolem,Hypertension NOS,Joint replaced hip,Renal & ureteral dis NOS
Admission Date:  [**2156-1-8**]              Discharge Date:   [**2156-1-10**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
claudication

Major Surgical or Invasive Procedure:
peripheral angiography and stent placement in Left Superficial
Femoral Artery

History of Present Illness:
Pt is a [**Age over 90 **] yo man with htn, hyperlipidemia, PVD, experienced as
pain in both calves when walking one block and resolving with
rest, who presented for stenting of his femoral artery. He had
ABIs which were also diminished bilaterally
(0.82 right ankle, 0.66 left ankle).  Lower extremity doppler
evaluation
showed triphasic waveforms in bilateral common femoral arteries
and
evidence of a left SFA occlusion.


Past Medical History:
1. PVD-s/p atherectomy and stenting of left SFA
2. Bilateral Renal Artery Stenosis
3. Hyperlipidemia
4. Hypertension
5. Knee and hip replacement surgeries
6. s/p PPM


Social History:
Lives alone in [**Location 8391**] in [**Hospital3 **]. One son. 50 pack
year history of smoking quit 50 yrs ago. Drinks accasional
highball.  Retired from construction work.

Family History:
Mother with MI in 40's.

Physical Exam:
Afebrile 145/60 64 12 99% on RA
NAD. Alert.   OP clear with MMM.
L carotid upstroke diminished with bilateral bruits.
RRR soft S1, normal S2. Soft systolic murmurs at RUSB and LLSB.
No rubs or gallops
Lungs clear to auscultation
Abd is soft NTND. Normal BS. No bruits
R groin without minimal ecchymoses no hematoma. No bruit and 1+
pulse.
No peripheral edema. Bilateral LE warm.


Pertinent Results:
Catheterization:
BRIEF HISTORY:   [**Age over 90 **] yo man with hypertension and dyslipidemia
referred
for peripheral arteriography to evaluate significant bilateral
leg
claudication (L>R).  He had ABIs which were also diminished
bilaterally
(0.82 right ankle, 0.66 left ankle).  Lower extremity doppler
evaluation
showed triphasic waveforms in bilateral common femoral arteries
and
evidence of a left SFA occlusion.

INDICATIONS FOR CATHETERIZATION:
Peripheral vascular disease, claudication, positive noninvasive
ischemia
evaluation

PROCEDURE:
Peripheral Catheter placement was performed via the RFA.
Peripheral Imaging was performed of the AA and bilateral LE.
Peripheral PTA was performed of the R SFA.
Peripheral Stenting was performed of the R SFA.
Peripheral Atherectomy was performed of the R SFA.





**PTCA RESULTS
  LSFA
**BASELINE
STENOSIS PRE-PTCA 100
**TECHNIQUE
PTCA SEQUENCE 1
GUIDING CATH [**Last Name (un) **]
GUIDEWIRES SPATRACO
INITIAL BALLOON (mm) 3.0
FINAL BALLOON (mm) 6.0
# INFLATIONS 7
MAX PRESSURE (PSI) 120
**RESULT
STENOSIS POST-PTCA 0
SUCCESS? (Y/N) Y

PTCA COMMENTS:     Initial angiography revealed a 70% lesion at
the
origin of the SFA and a mid-segment occlusion of the SFA in the
left
lower extremity. Heparin was started prophylactically. A 7
French [**Last Name (un) 12297**]
sheath was advanced into the left CFA. The total occlusion of
the left
SFA was crossed with moderate difficuly using a Shinobi wire
followed by
an angled stiff Glidewire. Atherectomy was performed on th
eproximal SFA
using a Silverhawk LS device with good result. We were unable to
deliver
the Silverhawk device distal to the total occlusion, so the
occlusion
was dilated with a 3.0 x 20 mm Saavy balloon using 3 inflations
of 6
ATM. We were still unable to deliver the atherectomy device so
the
diecsion was made to proceed with stenting of the left SFA. A
7.0 x 56
mm Dynalink stent was deployed across the lesion and a 4.0 x 60
mm Saavy
balloon was used to dilate the stent at 120 ATM. Angiography
demonstrated a filling defect at the proximal edge of the stent
so a 7.0
x 100 mm Dynalink stent was deployed proximal to the first stent
in
overlapping fashion and both stents were dilated with the 4.0 x
60 mm
balloon using 3 inflations of 6 ATM. Final angiography revealed
no
residual stenosis, no apparent dissection, and normal flow.


TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 1 hour 13 minutes.
Arterial time = 1 hour 13 minutes.
Fluoro time = 29 minutes.
Contrast:
          Non-ionic low osmolar (isovue, optiray...), vol 214 ml

Premedications:
          ASA 325 mg P.O.
Anesthesia:
          1% Lidocaine subq.
Anticoagulation:
          Heparin 5000 units IV
Other medication:
          Fentanyl 50 mcg iv
Cardiac Cath Supplies Used:
          - [**Company **], ANGLED GLIDEWIRE, 180
          .014 GUIDANT, [**Location (un) **]/CORE, 130CM
          .014 CORDIS, SHINOBI, 300CM
          7F COOK, [**Last Name (un) 28712**], 55
          7F FOXHOLLOW, SILVERHAWK ES
          7 GUIDANT, DYNALINK 56, 80
          7 GUIDANT, DYNALINK .018, 100


COMMENTS:
1. Access was obtained in retrograde fashion via the RFA using a
6
French short sheath.
2. Resting hemodynamics revealed no significant pressure
gradient
between AO and either common femoral artery.
3. Abdominal aortography revealed nild diffuse athersclerotic
disease.
4. The renal arteries were single bilaterally. The left renal
artery had
a 70% proximal stenosis and minimal blush was noted in the left
kidney.
The right renal artery had a proximal 70% stenosis.
5. Selective angiography of the right lower extremity revealed
no
significant disease in the CIA or EIA. The SFA was subtotally
occluded
at the adductor. The popliteal had no significant disease. The
AT and PT
were occluded with the PA filling the foot.
6. Selective angiography of the left lower extremity revealed no

significant disease in the CIA or EIA. There were mild luminal
irreguarities in the CFA. The SFA was totally occluded in its
mid
segment and reconstituted just above the popliteal artery. The
popliteal
artery was not obstructed.
7. Successful atherectomy of the proximal left SFA (see PTA
comments).
8. Successful PTA and stenting of the mid SFA with overlapping
7.0 x 100
mm and 7.0 x 56 mm Dynalink stents which were postdilated with a
6.0 mm
balloon. Final angiography revealed no residual stenosis, no
apparent
dissection and normal flow (see PTA comments).

FINAL DIAGNOSIS:
1. Bilateral SFA and infrapopliteal disease.
2. Bilateral renal artery stenosis.
3. Successful atherectomy, PTA, and stenting of the left SFA.
.
.
Right femoral vascular ultrasound:
Right common femoral artery and common femoral vein are widely
patent, without pseudoaneurysm or AV fistula. No large hematoma
is identified within the soft tissues of the right groin.

IMPRESSION:

No evidence of pseudoaneurysm, AV fistula or hematoma within the
right groin.


Brief Hospital Course:
Pt was taken to the catheterization lab and a stent was placed
in the left superficial femoral artery.  At the end of the
procedure it was very difficult to attain hemostasis at the
right groin access site.  As there was concern for development
of hematoma or pseudoaneurysm, pt was admitted to the CCU where
he was monitored closely and had multiple stable hematocrit
checks.  A femoral vascular ultrasound was performed at the
right groins site and showed neither pseudoaneurysm or hematoma.
 Pt was stable and was discharged to home with plan to return at
a later date for stenting of the right femoral artery.

Medications on Admission:
1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual Q5MIN () as needed for chest pain.
2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
10. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).


Discharge Medications:
1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual Q5MIN () as needed for chest pain.
2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 30 days.
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
12. Outpatient Lab Work
please check potassium, BUN, creatinine and call into nurse
practitioner [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **] at [**Hospital1 336**] ([**State 59677**]) -
[**Telephone/Fax (1) 59678**].

1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual Q5MIN () as needed for chest pain.
2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
7. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

8. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 30 days.
Disp:*30 Tablet(s)* Refills:*3*
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

11. Tolterodine Tartrate 2 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
12. Outpatient Lab Work
please check potassium, BUN, creatinine and call into nurse
practitioner [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **] at [**Hospital1 336**] ([**State 59677**]) -
[**Telephone/Fax (1) 59678**].


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Peripheral Vascular Disease
Hyperlipidemia
Hypertension

Discharge Condition:
Good, stable.

Discharge Instructions:
Continue your medications as directed.  We have started one new
medication called Plavix (clopidogrel) that you should take
everyday from now on.

You will have the other leg fixed on [**2156-1-22**].  You do not need
to see Dr. [**First Name (STitle) **] prior to this.  You will see [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **]
at your primary care doctor's office this Tuesday for a blood
check.

Drink plenty of fluids at home.

Followup Instructions:
You have an appointment with [**First Name4 (NamePattern1) 1743**] [**Last Name (NamePattern1) **] (Nurse
Practitioner) on Tuesday, [**1-13**], at 10:40 a.m. at your
Primary Care Doctor's office at [**Hospital1 336**] ([**State 59677**]).
You should have your blood drawn at that time to check on your
kidney.

You will also need to see Dr. [**First Name (STitle) **] as directed.  You are
scheduled to have the same procedure on your other leg on
[**2156-1-22**].


Completed by:[**2156-1-28**]
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Congestive heart failure, unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Hip joint replacement,Unspecified disorder of kidney and ureter'}


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: claudication

PRESENT ILLNESS: Pt is a [**Age over 90 **] yo man with htn, hyperlipidemia, PVD, experienced as
pain in both calves when walking one block and resolving with
rest, who presented for stenting of his femoral artery. He had
ABIs which were also diminished bilaterally
(0.82 right ankle, 0.66 left ankle).  Lower extremity doppler
evaluation
showed triphasic waveforms in bilateral common femoral arteries
and
evidence of a left SFA occlusion.

MEDICAL HISTORY: 1. PVD-s/p atherectomy and stenting of left SFA
2. Bilateral Renal Artery Stenosis
3. Hyperlipidemia
4. Hypertension
5. Knee and hip replacement surgeries
6. s/p PPM

MEDICATION ON ADMISSION: 1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual Q5MIN () as needed for chest pain.
2. Amlodipine Besylate 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
3. Prazosin HCl 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
4. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
5. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile 145/60 64 12 99% on RA
NAD. Alert.   OP clear with MMM.
L carotid upstroke diminished with bilateral bruits.
RRR soft S1, normal S2. Soft systolic murmurs at RUSB and LLSB.
No rubs or gallops
Lungs clear to auscultation
Abd is soft NTND. Normal BS. No bruits
R groin without minimal ecchymoses no hematoma. No bruit and 1+
pulse.
No peripheral edema. Bilateral LE warm.

FAMILY HISTORY: Mother with MI in 40's.

SOCIAL HISTORY: Lives alone in [**Location 8391**] in [**Hospital3 **]. One son. 50 pack
year history of smoking quit 50 yrs ago. Drinks accasional
highball.  Retired from construction work. 

### Response:
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Congestive heart failure, unspecified,Peripheral vascular disease, unspecified,Pure hypercholesterolemia,Unspecified essential hypertension,Hip joint replacement,Unspecified disorder of kidney and ureter'}
