CHIEF COMPLAINT: CC:[**CC Contact Info 65907**]
Major Surgical or Invasive Procedure:
Femoral catheterization and successful recanalization, PTA,
cryoplasty and stenting of the left
SFA

PRESENT ILLNESS: HPI: 71 yo F with h/o porcine AVR, CABG (LIMA->LAD), PVD
presenting for elective angioplasty of Left SFA lesion.
Previously, she was found by her cardiologist, to have a R ABI
of 0.59 and a left ABI of 0.5 after complaining of BL
claudication.  She presented for elective angiography and PCI of
the left and was to return in 2 weeks for treatment of the R.
This AM, angiography revealed a Left distal SFA lesion with
diffuse disease to the proximal popliteal and proximal occlusion
of the AT and PT with reconstitution distally from collaterals.
She received angioplasty, cryoplasty and stenting of the left
SFA lesion from Right femoral artery access.  Her sheath was
subsequently removed at 11 AM with minor oozing at the site of
the wound.  An ACT at the time was found to be 220, an EKG
showed NSR with frequent PACs but no acute changes from prior to
procedure.  Pressure was held for 30 minutes by the
interventional fellow with attainment of hemostasis.  30 minutes
later, the patient felt wet, and noticed bleeding at the site of
the wound.  Pressure was again held at the site of the wound for
30 minutes.  While holding pressure, she became persistently
hypotensive HR 40s, SBP 60s.  1 amp of atropine was given and
dopamine was given transiently.  She became tachycardic to the
130s and developed [**11-23**] sharp pain below her breasts R>L
without radiation associated with nausea (no SOB, diaphoresis).
She denied having felt this pain before.  She was given wide
open fluids x 2 L, a hct was checked and found to be 33 (from
her baseline of 40), and she was given a bolus of 1 unit of
blood.  Her BP stabilized at 103/49 and her HR decreased to 104.
 Her temp was 94, likely due to the IVF, and she was given warm
blankets.  Her RUQ abdominal/chest pain gradually resolved and
she was subsequently transferred to the CCU.  In the CCU, she
reported resolution of her CP.  No back pain.

MEDICAL HISTORY: [**2123-3-4**] AVR porcine, LIMA-LAD
[**2107**] colon Ca remote
high cholesterol
right hernia

MEDICATION ON ADMISSION: Admission meds:
metoprolol XL 25 mg QD
digoxin 125 mcg QD
ECASA 325 mg QD
MVI
Lipitor 10 mg QD
Plavix 75 mg QD
.
Transfer meds:
Toprol XL 25 QD
Dig 125 mcg QD
ECASA 325 mg QD
Plavix 75 mg QD
MVI
Lipitor 10 mg QD
Tylenol PRN
NTG SL PRN
Simethicone PRN

ALLERGIES: Sulfa (Sulfonamides) / Codeine

PHYSICAL EXAM: PE:T 97.3 HR 79 RR 19 100% RA BP 108/52
Gen: WDWN woman lying flat in NAD
HEENT: PERRL, OP clear, MM dry
Neck: no carotid bruits
CV: RRR, nl s1, s2, 2/6 systolic murmur best heard at LUSB
without radiation to apex or carotids
Lungs: CTAB from chest
Abd: BS+, soft, NT, ND, no organomegaly
Ext: R femoral hematoma within marked space (~10x10 cm), 1+ R
femoral pulse, dressing C/D/I, no bruit, L femoral pulse 2+,
dopplerable DP and PT pulses bilaterally, DP>PT, no edema,
warmth or swelling

FAMILY HISTORY: no hx of CAD

SOCIAL HISTORY: Widowed 2 years ago, lives alone.  Has no help at home.  Her
son-in-law and daughter are close.  Remote occasional smoking
history (40 years ago).  No EtOH.
Atherosclerosis of native arteries of the extremities with intermittent claudication,Emphysema (subcutaneous) (surgical) resulting from procedure,Heart valve replaced by transplant,Other iatrogenic hypotension,Chest pain, unspecified,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Personal history of malignant neoplasm of large intestine
Ath ext ntv at w claudct,Emphysema rsult frm proc,Heart valve transplant,Iatrogenc hypotnsion NEC,Chest pain NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Aortocoronary bypass,Hx of colonic malignancy
Admission Date:  [**2134-4-16**]              Discharge Date:   [**2134-4-17**]

Date of Birth:  [**2055-1-19**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides) / Codeine

Attending:[**First Name3 (LF) 7055**]
Chief Complaint:
CC:[**CC Contact Info 65907**]
Major Surgical or Invasive Procedure:
Femoral catheterization and successful recanalization, PTA,
cryoplasty and stenting of the left
SFA


History of Present Illness:
HPI: 71 yo F with h/o porcine AVR, CABG (LIMA->LAD), PVD
presenting for elective angioplasty of Left SFA lesion.
Previously, she was found by her cardiologist, to have a R ABI
of 0.59 and a left ABI of 0.5 after complaining of BL
claudication.  She presented for elective angiography and PCI of
the left and was to return in 2 weeks for treatment of the R.
This AM, angiography revealed a Left distal SFA lesion with
diffuse disease to the proximal popliteal and proximal occlusion
of the AT and PT with reconstitution distally from collaterals.
She received angioplasty, cryoplasty and stenting of the left
SFA lesion from Right femoral artery access.  Her sheath was
subsequently removed at 11 AM with minor oozing at the site of
the wound.  An ACT at the time was found to be 220, an EKG
showed NSR with frequent PACs but no acute changes from prior to
procedure.  Pressure was held for 30 minutes by the
interventional fellow with attainment of hemostasis.  30 minutes
later, the patient felt wet, and noticed bleeding at the site of
the wound.  Pressure was again held at the site of the wound for
30 minutes.  While holding pressure, she became persistently
hypotensive HR 40s, SBP 60s.  1 amp of atropine was given and
dopamine was given transiently.  She became tachycardic to the
130s and developed [**11-23**] sharp pain below her breasts R>L
without radiation associated with nausea (no SOB, diaphoresis).
She denied having felt this pain before.  She was given wide
open fluids x 2 L, a hct was checked and found to be 33 (from
her baseline of 40), and she was given a bolus of 1 unit of
blood.  Her BP stabilized at 103/49 and her HR decreased to 104.
 Her temp was 94, likely due to the IVF, and she was given warm
blankets.  Her RUQ abdominal/chest pain gradually resolved and
she was subsequently transferred to the CCU.  In the CCU, she
reported resolution of her CP.  No back pain.

Past Medical History:
[**2123-3-4**] AVR porcine, LIMA-LAD
[**2107**] colon Ca remote
high cholesterol
right hernia

Social History:
Widowed 2 years ago, lives alone.  Has no help at home.  Her
son-in-law and daughter are close.  Remote occasional smoking
history (40 years ago).  No EtOH.

Family History:
no hx of CAD

Physical Exam:
PE:T 97.3 HR 79 RR 19 100% RA BP 108/52
Gen: WDWN woman lying flat in NAD
HEENT: PERRL, OP clear, MM dry
Neck: no carotid bruits
CV: RRR, nl s1, s2, 2/6 systolic murmur best heard at LUSB
without radiation to apex or carotids
Lungs: CTAB from chest
Abd: BS+, soft, NT, ND, no organomegaly
Ext: R femoral hematoma within marked space (~10x10 cm), 1+ R
femoral pulse, dressing C/D/I, no bruit, L femoral pulse 2+,
dopplerable DP and PT pulses bilaterally, DP>PT, no edema,
warmth or swelling

Pertinent Results:
[**10-18**] TTE
LVEF 60%, LA mild dilation, bioprosthetic aortic valve with
normal function and mean gradient of 15 mm Hg and peak of 27 mm
Hg with 1+ AR, severe mitral annular calcification with 2+ MR,
2+ TR , estimated PAP of 29 mm Hg.  Doppler evidence of
diastolic dysfunction.
.
EKG pre-cath [**4-16**] 0731
SR with PACs at 72, left anterior fascicular block, LVH, TWI in
I and aVL, borderline LBBB with QRS 118
.
EKG 14:22
NSR at 76, LAFB, LVH, TWI in I and aVL, borderline LBBB with QRS
116

Femoral Cath Report [**2134-4-16**]
PROCEDURE:
Peripheral Catheter placement was performed.
Peripheral Imaging was performed.
Peripheral PTA was performed.
Peripheral Stenting was performed.
Conscious Sedation:  was provided with appropriate monitoring
performed by
a member of the nursing staff.

HEMODYNAMICS RESULTS BODY SURFACE AREA:  m2
  HEMOGLOBIN: gms %
  FICK
**PRESSURES
AORTA {s/d/m} 144/60/90




**PTCA RESULTS


PTCA COMMENTS:     Initial angiography showed a distally
occluded left
SFA. We planned to recanalize the vessel. Heparin was used for
anticoagulation. A 7 French [**Last Name (un) 12297**] sheath was advanced around the
[**Doctor Last Name 534**]
into the left SFA. The lesion was crossed with an angled
GlideWire which
was then exchanged for a FilterWire. The lesion was dilated with
a
4.0x80 mm Amphirion balloon at 2-4 atm. Next, the lesion was
treated
with Cryoplasty using a 5.0x60 mm Polar catheter for multiple
inflations. Angiography showed a residual dissection which was
covered
with a 6.0x56 mm Dynalink stent, post-dilated with a 5.0x40 mm
Submarine
balloon at 8 atm. Final angiography showed a 20% residual
stenosis, no
dissection and normal flow. The patient left the lab in stable
condition.


TECHNICAL FACTORS:
Total time (Lidocaine to test complete) = 1 hour 31 minutes.
Arterial time = 1 hour 31 minutes.
Fluoro time = 20 minutes.
Contrast:
          Non-ionic low osmolar (isovue, optiray...), vol 175
ml, Indications - Hemodynamic
Anesthesia:
          1% Lidocaine subq.
Anticoagulation:
          Heparin 2500 units IV
Other medication:
          Benadryl 25 mg iv
          Fentanyl 25 mcg IV
          Midazolam 0.5 mg IV
Cardiac Cath Supplies Used:
          7F COOK, [**Last Name (un) 28712**], 55
          200CC MALLINCRODT, OPTIRAY 200CC
          150CC MALLINCRODT, OPTIRAY 150CC
          4 EV3, AMPHIRION, 80
          5 EV3, SUBMARINE PLUS, 40
          6 GUIDANT, DYNALINK .018, 100
          - [**Company **], FILTER WIRE EZ 300 CM
          5 [**Company **], POLARCATH BALLOON .014, 20
          - [**Company **], POLARCATH INFLATION UNIT


COMMENTS:
1.  Access was obtained via the right CFA in a retrograde
fashion.
2.  Resting hemodynamics showed mild central aortic
hypertension.
3.  Abdominal aorta: Diffuse moderate disease.
4.  Renal arteries: Single bilaterally without lesions.
5.  Right lower extremity: The CIA, EIA, IIA and CFA were widely
patent.
6.  Left lower extremity: The CIA, EIA, IIA and CFA were widely
patent.
The distal SFA had diffuse disease and was occluded at [**Doctor Last Name 26971**]
canal up
to the proximal popliteal. The PA was the principle vessel to
the foot
with the AT and PT proximally occluded and reconstitution
distally via
collaterals.
7.  Successful recanalization, PTA, cryoplasty and stenting of
the left
SFA with a 6.0 mm Dynalink stent, post-dilated to 5.0 mm.

[**2134-4-16**] Femoral Vascular Ultrasound
REPORT: There is normal flow on color flow from the right common
femoral vein and artery. No evidence of hematoma, pseudoaneurysm
or AV fistula is identified.


Brief Hospital Course:
71 yo F with h/o porcine AVR, CABG (LIMA->LAD), PVD s/p PCI of
Left distal SFA lesion complicated by R groin bleed/hematoma
with hct drop of 7.
.
#. Hct drop with groin bleed - Patient with rapid hct drop of 7
from 40 to 33 in the setting of R groin bleed and development of
hematoma.  Received 2 L of NS and 2 units of blood, and was
hemodynamically stable on transfer to the MICU.  Her metoprolol
and digoxin were held.  No evidence of RP bleed.  A right
femoral ultrasound showed no evidence of hematoma,
pseudoaneurysm or AV fistula.  Her hematocrit remained stable
and there was no evidence of repeat bleeding with serial exams.
She was restarted on her metoprolol XL 25 mg QD and tolerated it
well.  Her digoxin was held as her heart rate was well
controlled and she had no evidence of heart failure.
.
#. Chest/RUQ and epigastric Abdominal pain (burning) with
nausea- this was in the setting of the dopamine drip and hct
drop and may have been demand ischemia, though her cardiac
enzymes were flat x 3 and there were no EKG changes.  She was
given protonix, maalox, anzemet and tums, and the pain resolved.

- start on omeprazole 40 QD
.
#. PVD - Following her intervention, her distal pulses remained
dopplerable bilaterally.  She is scheduled to return in [**3-20**]
weeks for angiography and possible intervention in her RLE.
- continue ASA and plavix indefinitely
.
#. Ischemia - patient s/p CABG (LIMA-> LAD 10 years ago).  No
recent cath.  No EKG changes with her chest/abdominal pain.  Her
cardiac enzymes were cycled and were flat x 3.
- continue ASA and plavix indefinitely
- restart metoprolol XL 25 mg QD
.
#. Pump - last TTE in [**10-18**] showed LVEF 60%, 1+ AR with porcine
valve, 2+ MR and 2+ TR, and evidence of diastolic dysfunction.
- continue metoprolol 25 mg PO QD
- hold digoxin with no evidence of failure and well-controlled
heart rate
.
#. Rhythm - SR, occasional PACs on telemetry


Medications on Admission:
Admission meds:
metoprolol XL 25 mg QD
digoxin 125 mcg QD
ECASA 325 mg QD
MVI
Lipitor 10 mg QD
Plavix 75 mg QD
.
Transfer meds:
Toprol XL 25 QD
Dig 125 mcg QD
ECASA 325 mg QD
Plavix 75 mg QD
MVI
Lipitor 10 mg QD
Tylenol PRN
NTG SL PRN
Simethicone PRN

Discharge Medications:
1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*0 Tablet(s)* Refills:*0*
4. Metoprolol Succinate 25 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO once a day.
5. Multi-Vitamin     Tablet Sig: One (1) Tablet PO once a day.
6. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Peripheral vascular disease s/p revascularization and stenting
of Left SFA/popliteal lesion
Right femoral bleed


Discharge Condition:
Patient is doing well, hemodynamically stable, no chest pain,
ambulating without difficulty


Discharge Instructions:
1. Please take all medications as prescribed.  You MUST take
your Aspirin and Plavix EVERY DAY.
2. Please keep all follow-up appointments.
3. Please seek medical attention if you develop chest pain,
shortness of breath, abdominal pain, recurrent or worsened
claudication of the left foot, a larger hematoma, bleeding,
lightheadedness or have any other concerning symptoms.
4. Please refrain from heavy lifting or vigorous activity for 2
weeks.
5. Please refrain from driving until at least 3 days after
discharge from the hospital (after Wednesday, [**4-21**]).

Followup Instructions:
Return in [**3-20**] weeks for angiography and intervention on the
right leg.
Please follow-up with Dr. [**Last Name (STitle) **] at ([**Telephone/Fax (1) 16005**] in [**2-15**]
weeks.
Please follow-up with Dr. [**Last Name (STitle) 911**] at ([**Telephone/Fax (1) 7236**] in [**7-22**] weeks.



Completed by:[**2134-4-18**]
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Emphysema (subcutaneous) (surgical) resulting from procedure,Heart valve replaced by transplant,Other iatrogenic hypotension,Chest pain, unspecified,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Personal history of malignant neoplasm of large intestine'}


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: CC:[**CC Contact Info 65907**]
Major Surgical or Invasive Procedure:
Femoral catheterization and successful recanalization, PTA,
cryoplasty and stenting of the left
SFA

PRESENT ILLNESS: HPI: 71 yo F with h/o porcine AVR, CABG (LIMA->LAD), PVD
presenting for elective angioplasty of Left SFA lesion.
Previously, she was found by her cardiologist, to have a R ABI
of 0.59 and a left ABI of 0.5 after complaining of BL
claudication.  She presented for elective angiography and PCI of
the left and was to return in 2 weeks for treatment of the R.
This AM, angiography revealed a Left distal SFA lesion with
diffuse disease to the proximal popliteal and proximal occlusion
of the AT and PT with reconstitution distally from collaterals.
She received angioplasty, cryoplasty and stenting of the left
SFA lesion from Right femoral artery access.  Her sheath was
subsequently removed at 11 AM with minor oozing at the site of
the wound.  An ACT at the time was found to be 220, an EKG
showed NSR with frequent PACs but no acute changes from prior to
procedure.  Pressure was held for 30 minutes by the
interventional fellow with attainment of hemostasis.  30 minutes
later, the patient felt wet, and noticed bleeding at the site of
the wound.  Pressure was again held at the site of the wound for
30 minutes.  While holding pressure, she became persistently
hypotensive HR 40s, SBP 60s.  1 amp of atropine was given and
dopamine was given transiently.  She became tachycardic to the
130s and developed [**11-23**] sharp pain below her breasts R>L
without radiation associated with nausea (no SOB, diaphoresis).
She denied having felt this pain before.  She was given wide
open fluids x 2 L, a hct was checked and found to be 33 (from
her baseline of 40), and she was given a bolus of 1 unit of
blood.  Her BP stabilized at 103/49 and her HR decreased to 104.
 Her temp was 94, likely due to the IVF, and she was given warm
blankets.  Her RUQ abdominal/chest pain gradually resolved and
she was subsequently transferred to the CCU.  In the CCU, she
reported resolution of her CP.  No back pain.

MEDICAL HISTORY: [**2123-3-4**] AVR porcine, LIMA-LAD
[**2107**] colon Ca remote
high cholesterol
right hernia

MEDICATION ON ADMISSION: Admission meds:
metoprolol XL 25 mg QD
digoxin 125 mcg QD
ECASA 325 mg QD
MVI
Lipitor 10 mg QD
Plavix 75 mg QD
.
Transfer meds:
Toprol XL 25 QD
Dig 125 mcg QD
ECASA 325 mg QD
Plavix 75 mg QD
MVI
Lipitor 10 mg QD
Tylenol PRN
NTG SL PRN
Simethicone PRN

ALLERGIES: Sulfa (Sulfonamides) / Codeine

PHYSICAL EXAM: PE:T 97.3 HR 79 RR 19 100% RA BP 108/52
Gen: WDWN woman lying flat in NAD
HEENT: PERRL, OP clear, MM dry
Neck: no carotid bruits
CV: RRR, nl s1, s2, 2/6 systolic murmur best heard at LUSB
without radiation to apex or carotids
Lungs: CTAB from chest
Abd: BS+, soft, NT, ND, no organomegaly
Ext: R femoral hematoma within marked space (~10x10 cm), 1+ R
femoral pulse, dressing C/D/I, no bruit, L femoral pulse 2+,
dopplerable DP and PT pulses bilaterally, DP>PT, no edema,
warmth or swelling

FAMILY HISTORY: no hx of CAD

SOCIAL HISTORY: Widowed 2 years ago, lives alone.  Has no help at home.  Her
son-in-law and daughter are close.  Remote occasional smoking
history (40 years ago).  No EtOH. 

### Response:
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Emphysema (subcutaneous) (surgical) resulting from procedure,Heart valve replaced by transplant,Other iatrogenic hypotension,Chest pain, unspecified,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Aortocoronary bypass status,Personal history of malignant neoplasm of large intestine'}
