CHIEF COMPLAINT: As per notes, Mr [**Known lastname **] is a 75-year-old man w a history of
hypertension, hyperlipidemia, diabetes and CAD, s/p CABG in the
[**2075**]??????s and stenting in [**2108**], who was recently diagnosed with
carotid artery disease after PCP detected [**Name Initial (PRE) **] bruit. Diagnostic
carotid angiography revealed stenosis. Admitted to [**Hospital1 18**] for
treatment, carotid angiography done and XACT carotid stent
placed in the R ICA w no residual stenosis in the stent, no
dissection and normla flow.
.
On transfer to the floor, pt comfortable no complaints. No
headache, dizziness, chest pain, shortness of breath, no groin
pain.
.
Pt denies any prior history of stroke or TIA, and denies any
specific neurologic symptoms. Pt describes occasional exertional
angina, relived with SL nitroglycerin. He also describes
bilateral leg discomfort with walking less than one mile.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.
.

PRESENT ILLNESS: As per notes, Mr [**Known lastname **] is a 75-year-old man w a history of
hypertension, hyperlipidemia, diabetes and CAD, s/p CABG in the
[**2075**]??????s and stenting in [**2108**], who was recently diagnosed with
carotid artery disease after PCP detected [**Name Initial (PRE) **] bruit. Diagnostic
carotid angiography revealed stenosis. Admitted to [**Hospital1 18**] for
treatment, carotid angiography done and XACT carotid stent
placed in the R ICA w no residual stenosis in the stent, no
dissection and normla flow.
.
On transfer to the floor, pt comfortable no complaints. No
headache, dizziness, chest pain, shortness of breath, no groin
pain.
.
Pt denies any prior history of stroke or TIA, and denies any
specific neurologic symptoms. Pt describes occasional exertional
angina, relived with SL nitroglycerin. He also describes
bilateral leg discomfort with walking less than one mile.
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

MEDICATION ON ADMISSION: Nifedipine 90mg one tablet every morning
Omeprazole 20mg daily every morning
Atenolol 25mg half a tablet every morning
Flomax 0.4mg daily every evening
Clonidine 0.1mg one tablet every morning, 2 tablets every
evening
Plavix 75mg daily every morning
Simvastatin 20mg daily every morning
Glipizide 5mg 2 tablets every morning, 1.5 tablets every evening

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 96.5, 95/45, 50, 14, 95% RA
GENERAL: Elderly
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother with heart problems- no specifics. Several siblings
also with heart issues- no details

SOCIAL HISTORY: Patient is married. and lives with his wife. [**Name (NI) **] one daughter
who works as a nurse [**First Name (Titles) **] [**Hospital6 **].
Occupation: Retired heavy equipment operator
Contact person upon discharge: [**Name (NI) **] [**Name (NI) 77002**] (son in law):
[**Telephone/Fax (1) 79911**]-home, cell: [**Telephone/Fax (1) 79912**].
No alcohol.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Peripheral vascular disease, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of urinary calculi,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Ocl crtd art wo infrct,Surg compl-heart,Cardiac dysrhythmias NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Esophageal reflux,Periph vascular dis NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Prsnl hst urnr dsrd calc,Abn react-surg proc NEC
Admission Date:  [**2114-2-19**]              Discharge Date:   [**2114-2-20**]

Date of Birth:  [**2039-1-16**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
As per notes, Mr [**Known lastname **] is a 75-year-old man w a history of
hypertension, hyperlipidemia, diabetes and CAD, s/p CABG in the
[**2075**]??????s and stenting in [**2108**], who was recently diagnosed with
carotid artery disease after PCP detected [**Name Initial (PRE) **] bruit. Diagnostic
carotid angiography revealed stenosis. Admitted to [**Hospital1 18**] for
treatment, carotid angiography done and XACT carotid stent
placed in the R ICA w no residual stenosis in the stent, no
dissection and normla flow.
.
On transfer to the floor, pt comfortable no complaints. No
headache, dizziness, chest pain, shortness of breath, no groin
pain.
.
Pt denies any prior history of stroke or TIA, and denies any
specific neurologic symptoms. Pt describes occasional exertional
angina, relived with SL nitroglycerin. He also describes
bilateral leg discomfort with walking less than one mile.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.
.


Major Surgical or Invasive Procedure:
right carotid artery stenting


History of Present Illness:
As per notes, Mr [**Known lastname **] is a 75-year-old man w a history of
hypertension, hyperlipidemia, diabetes and CAD, s/p CABG in the
[**2075**]??????s and stenting in [**2108**], who was recently diagnosed with
carotid artery disease after PCP detected [**Name Initial (PRE) **] bruit. Diagnostic
carotid angiography revealed stenosis. Admitted to [**Hospital1 18**] for
treatment, carotid angiography done and XACT carotid stent
placed in the R ICA w no residual stenosis in the stent, no
dissection and normla flow.
.
On transfer to the floor, pt comfortable no complaints. No
headache, dizziness, chest pain, shortness of breath, no groin
pain.
.
Pt denies any prior history of stroke or TIA, and denies any
specific neurologic symptoms. Pt describes occasional exertional
angina, relived with SL nitroglycerin. He also describes
bilateral leg discomfort with walking less than one mile.
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: [**2075**]
-PERCUTANEOUS CORONARY INTERVENTIONS: stenting in [**2108**]
-PACING/ICD: none
3. OTHER PAST MEDICAL HISTORY:
Myocarditis- age 28
MI age 61, s/p CABG in [**2079**] at [**Location (un) **] Hospital (no
specifics)
Coronary stenting at age 70 at [**Hospital1 2177**]
LE claudication
Hypertension
Bilateral Carotid artery disease
Diabetes Type II
Borderline elevated cholesterol
Remote bowel obstruction, s/p surgery
Remote Hemorrhoidectomy
Retrieval of kidney stones
GERD
Mild Prostatism
[**1-1**] Admit to [**Hospital1 18**] with small bowel obstruction
Mild emphysema per patient report
Abdominal hernia per patient report
Occasional vertigo


Social History:
Patient is married. and lives with his wife. [**Name (NI) **] one daughter
who works as a nurse [**First Name (Titles) **] [**Hospital6 **].
Occupation: Retired heavy equipment operator
Contact person upon discharge: [**Name (NI) **] [**Name (NI) 77002**] (son in law):
[**Telephone/Fax (1) 79911**]-home, cell: [**Telephone/Fax (1) 79912**].
No alcohol.


Family History:
Mother with heart problems- no specifics. Several siblings
also with heart issues- no details


Physical Exam:
VS: 96.5, 95/45, 50, 14, 95% RA
GENERAL: Elderly
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 7 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. 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. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits. Groin dressing c/d/i.

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+


Pertinent Results:
Admission labs:
[**2114-2-19**] 10:45AM   WBC-6.3 RBC-4.26* HGB-12.7* HCT-35.6* MCV-84
MCH-29.8 MCHC-35.7* RDW-14.9
[**2114-2-19**] 10:45AM   NEUTS-76.5* LYMPHS-16.5* MONOS-4.4 EOS-1.7
BASOS-0.8
[**2114-2-20**] 06:06AM BLOOD Glucose-116* UreaN-26* Creat-1.5* Na-139
K-3.7 Cl-103 HCO3-30 AnGap-10

Cardiac enzymes:
[**2114-2-19**] 10:03PM BLOOD CK-MB-2 cTropnT-<0.01
[**2114-2-19**] 10:45AM BLOOD CK-MB-2
[**2114-2-20**] 06:06AM BLOOD CK-MB-2 cTropnT-<0.01
[**2114-2-20**] 04:32PM BLOOD CK-MB-2 cTropnT-<0.01

Brief Hospital Course:
75M w DM2, HTN, HL, CAD (s/p CABG and PCI), and carotid artery
dz, now s/p R ICA stenting for carotid stenosis.
.
# Carotid stenosis:  The patient was enrolled in the EMPIRE
trial prior to uncomplicated R ICA stent placement. There was an
80% proximal R ICA stenosis immediately after the bifurcation.
Final angiography revealed no residual stenosis in the stent, no
dissection and normal flow. The right femoral arteriotomy site
was closed with a Perclose device. He was subsequently on a
nitroglycerin gtt titrated to SBP < 130.  Other blood pressure
medications were held overnight for brief hypotension after the
procedure and restarted in the morning.  Aspirin was increased
to 325 mg daily and clopidogrel was continued.  There were no
neurologic deficits noted.
.
# Bradycardia:  Patient was bradycardic to 40.  Atenolol was
held.  In conversation with his primary care physician, [**Name10 (NameIs) **]
[**Name11 (NameIs) 5901**] restarting the atenolol every other day, as the
patient had been stable with this heart rate for years.
.
# CORONARIES: Known coronary artery disease.  Aspirin and
simvastatin were continued.  Cardiac enzymes were cycled and
were negative.  Nifedipine, atenolol, and clonidine were resumed
upon discharge.
.
# PUMP: Patient was apparently euvolemic.
.
# RHYTHM: He remained in sinus rhythm on telemetry.
.
# DM2: Oral hypoglycemics were held and insulin sliding scale
begun.  Home regimen was restarted prior to discharge.
.
# Hypertension:  Patient had a history of hypertension, was
initially slighltly hypotensive to SBP 90s after the procedure,
but was hypertensive to SBP 140 the next day.  Nitroglycerin gtt
was given and titrated to SBP <130. This was discontinued and
his outpatient regimen restarted prior to discharge with SBP
120-130.
.
# Hyperlipidemia: Simvastatin was continued.



Medications on Admission:
Nifedipine 90mg one tablet every morning
Omeprazole 20mg daily every morning
Atenolol 25mg half a tablet every morning
Flomax 0.4mg daily every evening
Clonidine 0.1mg one tablet every morning, 2 tablets every
evening
Plavix 75mg daily every morning
Simvastatin 20mg daily every morning
Glipizide 5mg 2 tablets every morning, 1.5 tablets every evening

Aspirin 81mg daily every morning
Meclizine 25mg as needed
Nitroglycerin SL as needed


Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Nifedipine 90 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO once a day.
4. Glipizide 5 mg Tablet Sig: Two (2) Tablet PO QAM (once a day
(in the morning)).
5. Glipizide 5 mg Tablet Sig: 1.5 Tablets PO QPM (once a day (in
the evening)).
6. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO QAM (once a
day (in the morning)).
9. Clonidine 0.1 mg Tablet Sig: Two (2) Tablet PO QPM (once a
day (in the evening)).
10. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
11. Atenolol 25 mg Tablet Sig: .5 Tablet PO every other day.


Discharge Disposition:
Home

Discharge Diagnosis:
primary:  carotid artery stenosis
secondary:  coronary artery disease, claudication, hypertension,
type 2 diabetes mellitus


Discharge Condition:
stable, with bradycardia HR 40-45


Discharge Instructions:
You were admitted to the hospital to have a stent placed in your
carotid artery.  You had a successful procedure and stent
placement.  You heart rate was low after the procedure, so your
atenolol was stopped.  Also, your kidney function was slightly
affected by the dye in the procedure.  Your primary care
physician will need to check your blood test in a week to be
sure that your kidney function is improving.

Your aspirin dose was increased.  We spoke with Dr. [**First Name (STitle) **] who
would like you to continue taking atenolol every other day.
Otherwise, none of your medications was changed.  Please resume
all of your home medications.

Please return to the emergency room if you have chest pain,
shortness of breath, weakness or difficulty speaking, or other
symptoms that are concerning to you.

Followup Instructions:
Dr.[**Name (NI) 79913**] office will be calling you on the morning of [**2114-2-21**]
to arrange follow-up.  If you don't hear from them that day,
please call [**Telephone/Fax (1) 6699**] to arrange an appointment.

We also made an appointment with Dr. [**Last Name (STitle) 7047**] for you:
Tuesday, [**3-13**] at 12:40 pm, [**Telephone/Fax (1) 8725**]



Completed by:[**2114-2-20**]
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Peripheral vascular disease, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of urinary calculi,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: As per notes, Mr [**Known lastname **] is a 75-year-old man w a history of
hypertension, hyperlipidemia, diabetes and CAD, s/p CABG in the
[**2075**]??????s and stenting in [**2108**], who was recently diagnosed with
carotid artery disease after PCP detected [**Name Initial (PRE) **] bruit. Diagnostic
carotid angiography revealed stenosis. Admitted to [**Hospital1 18**] for
treatment, carotid angiography done and XACT carotid stent
placed in the R ICA w no residual stenosis in the stent, no
dissection and normla flow.
.
On transfer to the floor, pt comfortable no complaints. No
headache, dizziness, chest pain, shortness of breath, no groin
pain.
.
Pt denies any prior history of stroke or TIA, and denies any
specific neurologic symptoms. Pt describes occasional exertional
angina, relived with SL nitroglycerin. He also describes
bilateral leg discomfort with walking less than one mile.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.
.

PRESENT ILLNESS: As per notes, Mr [**Known lastname **] is a 75-year-old man w a history of
hypertension, hyperlipidemia, diabetes and CAD, s/p CABG in the
[**2075**]??????s and stenting in [**2108**], who was recently diagnosed with
carotid artery disease after PCP detected [**Name Initial (PRE) **] bruit. Diagnostic
carotid angiography revealed stenosis. Admitted to [**Hospital1 18**] for
treatment, carotid angiography done and XACT carotid stent
placed in the R ICA w no residual stenosis in the stent, no
dissection and normla flow.
.
On transfer to the floor, pt comfortable no complaints. No
headache, dizziness, chest pain, shortness of breath, no groin
pain.
.
Pt denies any prior history of stroke or TIA, and denies any
specific neurologic symptoms. Pt describes occasional exertional
angina, relived with SL nitroglycerin. He also describes
bilateral leg discomfort with walking less than one mile.
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

MEDICATION ON ADMISSION: Nifedipine 90mg one tablet every morning
Omeprazole 20mg daily every morning
Atenolol 25mg half a tablet every morning
Flomax 0.4mg daily every evening
Clonidine 0.1mg one tablet every morning, 2 tablets every
evening
Plavix 75mg daily every morning
Simvastatin 20mg daily every morning
Glipizide 5mg 2 tablets every morning, 1.5 tablets every evening

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 96.5, 95/45, 50, 14, 95% RA
GENERAL: Elderly
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother with heart problems- no specifics. Several siblings
also with heart issues- no details

SOCIAL HISTORY: Patient is married. and lives with his wife. [**Name (NI) **] one daughter
who works as a nurse [**First Name (Titles) **] [**Hospital6 **].
Occupation: Retired heavy equipment operator
Contact person upon discharge: [**Name (NI) **] [**Name (NI) 77002**] (son in law):
[**Telephone/Fax (1) 79911**]-home, cell: [**Telephone/Fax (1) 79912**].
No alcohol. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Cardiac complications, not elsewhere classified,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux,Peripheral vascular disease, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of urinary calculi,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
