CHIEF COMPLAINT: Carotid stenosis

PRESENT ILLNESS: This 65 year old woman with a history of CAD, s/p two PCIs with
stenting of the RCA and LAD who was found to have a carotid
bruit on routine physical exam.  She was referred for a duplex
ultrasound carotid scan which showed 40% rt ICA stenosis and
80-99% lt ICA stenosis.  A MRA showed the same degree of ICA
stenosis.  She was referred to Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] for carotid
artery stenting.  She had her left carotid artery stented today
and is admitted to the CCU for observation overnight.
She reports that she is feeling well and has been free of any
neurological symptoms.  No TIA, No CVA, No melena/GIB

MEDICAL HISTORY: 1. Diabetes Melitis type 2, well controlled on Prandin
2. Hypertension
3. Hypercholesterolemia
4. Breast cancer s/p lumpectomy five years prior, s/p XRT,
previously on Tamoxifen
5. CAD s/p stenting of RCA and LAD in [**4-27**] and [**5-27**] respectively

MEDICATION ON ADMISSION: Mavik 2mg daily
Toprol 100mg daily
ASA 325mg daily
Plavix 75 mg daily
lipitor 40 mg qhs
Prandin 1mg TID

ALLERGIES: Codeine

PHYSICAL EXAM: BP 103/43
Pulse 49
Resp 97% on RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes moist
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally
Neuro - Alert and oriented x 3, cranial nerves [**3-6**] intact,
upper and lower extremity strength 5/5 bilaterally (left leg not
tested secondary to need to remain stationary), sensation
grossly intact
Skin - No rash

FAMILY HISTORY: No family history of CAD

SOCIAL HISTORY: Married with three children, retired.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other iatrogenic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia
Ocl crtd art wo infrct,Iatrogenc hypotnsion NEC,Cor ath unsp vsl ntv/gft,Cardiac dysrhythmias NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem
Admission Date:  [**2155-12-25**]              Discharge Date:   [**2155-12-26**]

Date of Birth:  [**2089-6-17**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

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

Major Surgical or Invasive Procedure:
Carotid catheterization with stent placement in lt internal
carotid artery.


History of Present Illness:
This 65 year old woman with a history of CAD, s/p two PCIs with
stenting of the RCA and LAD who was found to have a carotid
bruit on routine physical exam.  She was referred for a duplex
ultrasound carotid scan which showed 40% rt ICA stenosis and
80-99% lt ICA stenosis.  A MRA showed the same degree of ICA
stenosis.  She was referred to Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] for carotid
artery stenting.  She had her left carotid artery stented today
and is admitted to the CCU for observation overnight.
She reports that she is feeling well and has been free of any
neurological symptoms.  No TIA, No CVA, No melena/GIB

Past Medical History:
1. Diabetes Melitis type 2, well controlled on Prandin
2. Hypertension
3. Hypercholesterolemia
4. Breast cancer s/p lumpectomy five years prior, s/p XRT,
previously on Tamoxifen
5. CAD s/p stenting of RCA and LAD in [**4-27**] and [**5-27**] respectively

Social History:
Married with three children, retired.

Family History:
No family history of CAD

Physical Exam:
BP 103/43
Pulse 49
Resp 97% on RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes moist
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally
Neuro - Alert and oriented x 3, cranial nerves [**3-6**] intact,
upper and lower extremity strength 5/5 bilaterally (left leg not
tested secondary to need to remain stationary), sensation
grossly intact
Skin - No rash


Brief Hospital Course:
1. Carotid stent - This 66 year old female s/p IMI with recent
catheterizations s/p RCA and LAD stents presenting with
asymptomatic left ICA stenosis.  She had carotid angiography
with stenting of left internal carotid artery.  She tolerated
the proceedure well.  She was transfered to the CCU for care
after the proceedure where her SBP was maintained >100 and <140
with Neosynephrine drip.  She had some symptomatic bradycardia
overnight which was treated with Atropine.  All BP meds were
held and neuro checks were performed q1hour X 4, then q2hour X3,
then per routine.  She was continued on ASA, Plavix, and
Lipitor.  The following morning she was still requiring Neo drip
for hypotension.  She was given multiple fluid boluses and the
Neo was weaned off.  She was discharged when she was no longer
hyptensive.
2. CAD - She was continued on ASA, Plavix, Lipitor. All BP meds
were held, as mentioned above she had some bradycardia treated
with Atropine but was otherwise asymptomatic.


Medications on Admission:
Mavik 2mg daily
Toprol 100mg daily
ASA 325mg daily
Plavix 75 mg daily
lipitor 40 mg qhs
Prandin 1mg TID

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily) for 300 days.
Disp:*30 Tablet(s)* Refills:*9*
3. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Prandin 1 mg Tablet Sig: One (1) Tablet PO twice a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Carotid stenosis s/p stent placement
Secondary diagnosis:
Coronary artery disease
Hypertension
Hypercholesterolemia

Discharge Condition:
Good

Discharge Instructions:
Continue to take all medications as prescribed.  Plavix should
be taken daily.
Return to the hospital for any neurological symptoms including
but not limited to: changes in vision, changes in sensation,
changes in movement or strength.
Return to [**Hospital1 **] [**First Name (Titles) **] [**Last Name (Titles) **] on Monday [**12-29**] and have
Dr. [**First Name (STitle) **] check your blood pressure.
Return to the hospital for any shortness of breath or chest
pain.
Pt should not take any of blood prssure medication until she
sees Dr. [**First Name (STitle) **].

Followup Instructions:
Follow up with Dr. [**First Name (STitle) **].
Provider: [**Name10 (NameIs) **] STUDY Where: CC CLINICAL CENTER RADIOLOGY
Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2156-2-10**] 3:30
Provider: [**Name10 (NameIs) **] STUDY Where: CC CLINICAL CENTER RADIOLOGY
Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2156-6-15**] 3:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D. Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 920**] Date/Time:[**2156-6-15**] 4:00
Return to [**Hospital3 **] [**Hospital3 **] [**Hospital3 **] on [**12-29**] to have Dr. [**First Name (STitle) **]
measure blood pressure





Name:  [**Known lastname 2242**],[**Known firstname 2243**]                   Unit No:   [**Numeric Identifier 2244**]

Admission Date:  [**2155-12-25**]              Discharge Date:   [**2155-12-26**]

Date of Birth:  [**2089-6-17**]             Sex:   F

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 2129**]
Addendum:
Secondary Diagnosis
Hypotension
Hypovolemia

Discharge Disposition:
Home

                             [**First Name11 (Name Pattern1) 448**] [**Last Name (NamePattern4) 2130**] MD [**MD Number(1) 2131**]

Completed by:[**2156-3-1**]
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other iatrogenic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}


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: Carotid stenosis

PRESENT ILLNESS: This 65 year old woman with a history of CAD, s/p two PCIs with
stenting of the RCA and LAD who was found to have a carotid
bruit on routine physical exam.  She was referred for a duplex
ultrasound carotid scan which showed 40% rt ICA stenosis and
80-99% lt ICA stenosis.  A MRA showed the same degree of ICA
stenosis.  She was referred to Dr. [**First Name8 (NamePattern2) 487**] [**Last Name (NamePattern1) **] for carotid
artery stenting.  She had her left carotid artery stented today
and is admitted to the CCU for observation overnight.
She reports that she is feeling well and has been free of any
neurological symptoms.  No TIA, No CVA, No melena/GIB

MEDICAL HISTORY: 1. Diabetes Melitis type 2, well controlled on Prandin
2. Hypertension
3. Hypercholesterolemia
4. Breast cancer s/p lumpectomy five years prior, s/p XRT,
previously on Tamoxifen
5. CAD s/p stenting of RCA and LAD in [**4-27**] and [**5-27**] respectively

MEDICATION ON ADMISSION: Mavik 2mg daily
Toprol 100mg daily
ASA 325mg daily
Plavix 75 mg daily
lipitor 40 mg qhs
Prandin 1mg TID

ALLERGIES: Codeine

PHYSICAL EXAM: BP 103/43
Pulse 49
Resp 97% on RA
Gen - Alert, no acute distress
HEENT - PERRL, extraocular motions intact, anicteric, mucous
membranes moist
Neck - no JVD, no cervical lymphadenopathy
Chest - Clear to auscultation bilaterally
CV - Normal S1/S2, RRR, no murmurs, rubs, or gallops
Abd - Soft, nontender, nondistended, with normoactive bowel
sounds
Back - No costovertebral angle tendernes
Extr - No clubbing, cyanosis, or edema. 2+ DP pulses bilaterally
Neuro - Alert and oriented x 3, cranial nerves [**3-6**] intact,
upper and lower extremity strength 5/5 bilaterally (left leg not
tested secondary to need to remain stationary), sensation
grossly intact
Skin - No rash

FAMILY HISTORY: No family history of CAD

SOCIAL HISTORY: Married with three children, retired. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Other iatrogenic hypotension,Coronary atherosclerosis of unspecified type of vessel, native or graft,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia'}
