CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78 year-old
male with a past medical history of coronary artery disease
status post coronary artery bypass graft, congestive heart
failure, diabetes, and chronic renal insufficiency who is
admitted for asymptomatic right carotid stenosis now here for
stenting.  As an outpatient the patient underwent ultrasound
on [**2141-9-22**], which showed a 40 to 60% stenosis and
his right carotid artery and a 20 to 40% stenosis in his left
carotid artery.  The patient reports no associated symptoms
with this and denies any weakness or neurological defects.
He did have a left CEA in [**2131**].  He also reports a previous
MRI that showed "old tiny strokes," but otherwise has no
neurological history.  The patient was admitted for an
elective stenting of his right carotid artery.  The patient
underwent stenting of his right coronary artery without any
complications.  He was then admitted to the Coronary Care
Unit for close monitoring following this procedure.  At the
time of his admission to the Coronary Care Unit the patient
denies any concurrent complaints and confirms the above
history.

MEDICAL HISTORY: 1.  Coronary artery disease status post coronary artery
bypass graft in [**2131**] four vessel disease.  Cardiac
catheterization in [**2141-7-11**].
2.  Congestive heart failure.
3.  Diabetes mellitus type 2.
4.  Peripheral neuropathy.
5.  Chronic renal insufficiency.
6.  Hypertension.
7.  Hypercholesterolemia.
8.  History of basal cell carcinoma status post resection.
9.  History of diverticulosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He lives at home with wife.  [**Name (NI) **] tobacco or
alcohol use.  Retired accountant.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Intermediate coronary syndrome,Congestive heart failure, unspecified,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Pure hypercholesterolemia
Ocl crtd art wo infrct,Intermed coronary synd,CHF NOS,Mitral valve disorder,Crnry athrscl natve vssl,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2141-10-16**]     Discharge Date:  [**2141-10-23**]

Date of Birth:                  Sex:  M

Service:  [**Hospital Unit Name 196**]

HISTORY OF PRESENT ILLNESS:  The patient is a 78 year-old
male with a past medical history of coronary artery disease
status post coronary artery bypass graft, congestive heart
failure, diabetes, and chronic renal insufficiency who is
admitted for asymptomatic right carotid stenosis now here for
stenting.  As an outpatient the patient underwent ultrasound
on [**2141-9-22**], which showed a 40 to 60% stenosis and
his right carotid artery and a 20 to 40% stenosis in his left
carotid artery.  The patient reports no associated symptoms
with this and denies any weakness or neurological defects.
He did have a left CEA in [**2131**].  He also reports a previous
MRI that showed "old tiny strokes," but otherwise has no
neurological history.  The patient was admitted for an
elective stenting of his right carotid artery.  The patient
underwent stenting of his right coronary artery without any
complications.  He was then admitted to the Coronary Care
Unit for close monitoring following this procedure.  At the
time of his admission to the Coronary Care Unit the patient
denies any concurrent complaints and confirms the above
history.

PAST MEDICAL HISTORY:
1.  Coronary artery disease status post coronary artery
bypass graft in [**2131**] four vessel disease.  Cardiac
catheterization in [**2141-7-11**].
2.  Congestive heart failure.
3.  Diabetes mellitus type 2.
4.  Peripheral neuropathy.
5.  Chronic renal insufficiency.
6.  Hypertension.
7.  Hypercholesterolemia.
8.  History of basal cell carcinoma status post resection.
9.  History of diverticulosis.

HOME MEDICATIONS:
1.  NPH insulin b.i.d.
2.  Lasix.
3.  Atenolol.
4.  Altace.
5.  Lipitor.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  He lives at home with wife.  [**Name (NI) **] tobacco or
alcohol use.  Retired accountant.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs temperature
96.5.  Blood pressure 158/58.  Pulse 67.  Respirations 18.
Satting 100% on room air.  Physical examination older
gentleman in no acute distress, conversant.  Alert and
oriented times three.  HEENT bilateral surgical pupils.
Extraocular movements intact.  Oropharynx is clear.  Neck no
JVD.  Cardiovascular regular rate.  2 out of 6 systolic
murmur at the apex.  Lungs clear to auscultation bilaterally.
Abdomen positive bowel sounds, soft and nontender.
Extremities no edema or cyanosis.  Pulses intact in
extremities times four.  Cranial nerves II through XII
intact.  Strength and sensation grossly intact.

LABORATORIES ON ADMISSION:  White blood cell count 8.4,
hematocrit 31, platelets 160, BUN 39, creatinine 2.8.  Chest
x-ray cardiomegaly, large pericardial fat pad, no acute
infiltrates.  Electrocardiogram sinus rhythm at a rate of 68,
PR interval .256, right bundle, no acute ST changes.

HOSPITAL COURSE:  1.  Right ICA stent:  The patient was
admitted for elective stenting of his right ICA.  This was
following a carotid duplex in [**Month (only) **], which showed
significant occlusion in his right ICA with moderate to
severe disease with 40 to 60% stenosis on the right.  The
patient did undergo a right ICA stent without any
intraoperative complications.  He was subsequently started on
aspirin.   Initially Plavix was held given plans for mitral
valve replacement in the near future, however, later in the
hospitalization following discussion with CT surgery staff he
was started on Plavix.  The patient was closely monitored
after the surgery and remained neurologically intact.
Initially his systolic blood pressures were kept elevated to
ensure cerebral perfusion several days postop.  These were
slowly lowered as he was restarted on his outpatient
antihypertensive medications.

2.  Cardiovascular:  Coronary artery disease, the patient
with a history of coronary artery disease status post
coronary artery bypass graft.  He had a recent cardiac
catheterization prior to admission at an outside hospital,
however, this was a technically complicated procedure and his
grafts were thought to not be well visualized during this
catheterization.  Additionally the patient had no symptoms of
ischemia at admission.  Several days into his hospitalization
he did develop acute angina and had minor electrocardiogram
changes, which did resolve with nitroglycerin.  Given the
patient's new unstable angina and his recent catheterization,
which showed poor visualization of his grafts the patient did
undergo coronary catheterization.  The catheterization
revealed three vessel coronary artery disease.  His LMCA was
without any significant stenosis.  His proximal left anterior
descending coronary artery was 50% stenosed and was totally
occluded in the mid left anterior descending coronary artery.
His left circumflex had a 50% stenosis at the origin, 70%
stenosis proximally and 80% stenosis in the portion supplying
collaterals to his right coronary artery.  He was already
known to have total occlusion of his right coronary artery
graft and this was not further explored.  His left internal
mammary coronary artery left anterior descending coronary
artery graft was widely patent.  His saphenous vein grafts
were already known to be occluded and were not further
explored.  The patient underwent percutaneous transluminal
coronary angioplasty in the AV groove branch of the LCX and
also in the proximal LCX.  Subsequent repeat angiography
showed these vessels to now be patent.  The patient was
maintained on a regimen of aspirin, Plavix, statin and beta
blocker.  He did have occasional pauses on telemetry, thus
his beta blocker was unable to be titrated up.  The patient
was briefly on heparin prior to catheterization given his
unstable angina.  Following the catheterization with
successful angioplasty he was taken off his heparin.

Pump, the patient admitted with diagnosis of congestive heart
failure.  He had no echocardiogram reports on file, but
reportedly had an EF of approximately 30%.  The patient had
no active symptoms of heart failure throughout the
hospitalization.  He was maintained on ace inhibitor for
after load reduction as per his outpatient regimen.

Valve, the patient with known mitral valve disease who was
thought to need a mitral valve repair in the future.  This
surgery had been delayed until his right ICA could be
stented.  The patient was maintained on an ace inhibitor for
after load reduction.  He had no acute symptoms related to
his mitral disease.  The patient was to follow up with CT
surgery following discharge to formulate plans for mitral
valve repair.

Rhythm, the patient maintained on telemetry throughout the
hospitalization.  He did have brief sinus pauses on
telemetry, but related to nodal blockade.  His beta blocker
was titrated down and these symptoms resolved.  The patient
had no acute symptoms related to this and remained
hemodynamically stable throughout the hospitalization.

2.  Renal:  Patient with chronic renal insufficiency with a
baseline creatinine of approximately 2.1.  He did have a mild
bump in his creatinine at this admission thought to be due to
dye nephropathy.  He received intravenous fluids and Mucomyst
with his catheterization and his creatinine stabilized and
returned to his baseline prior to discharge.

3.  FEN:  The patient maintained on cardiac diet.  His
electrolytes were followed and his potassium and magnesium
were maintained.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  To home with services.

DISCHARGE DIAGNOSES:
1.  Right ICA stenosis status post stent placement.
2.  Coronary artery disease status post catheterization with
percutaneous transluminal coronary angioplasty to his left
circumflex.
3.  Urinary tract infection.

DISCHARGE MEDICATIONS:
1.  Multivitamin q day.
2.  Atorvastatin 20 q day.
3.  Loperamide 2 mg q.i.d. prn.
4.  Aspirin 325 mg q.d.
5.  Ramipril 10 mg q.d.
6.  Plavix 75 mg q day.
7.  Metoprolol 37.5 mg b.i.d.
8.  Epo injections two times per week.
9.  NPH insulin 10 units b.i.d.
10.  Sliding scale regular insulin as directed per sliding
scale.
11.  Ciprofloxacin 250 mg q day times seven days.

DI[**Last Name (STitle) 408**]E FOLLOW UP:
1.  Follow up with CT surgery Dr. [**Last Name (Prefixes) **] on [**11-2**]
at 1:30 p.m. with plans for MVR in approximately one month as
per Dr. [**Last Name (STitle) **] [**Last Name (Prefixes) 2546**] evaluations.
2.  Follow up with Dr. [**First Name (STitle) **] on [**11-10**] at 9:00 a.m.
3.  Follow up with Dr. [**First Name (STitle) **] in approximately three months
with a carotid ultrasound at this point.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 5211**]

Dictated By:[**Last Name (NamePattern1) 5212**]

MEDQUIST36

D:  [**2142-1-18**]  08:41
T:  [**2142-1-19**]  10:07
JOB#:  [**Job Number 50578**]
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Intermediate coronary syndrome,Congestive heart failure, unspecified,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,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: 

PRESENT ILLNESS: The patient is a 78 year-old
male with a past medical history of coronary artery disease
status post coronary artery bypass graft, congestive heart
failure, diabetes, and chronic renal insufficiency who is
admitted for asymptomatic right carotid stenosis now here for
stenting.  As an outpatient the patient underwent ultrasound
on [**2141-9-22**], which showed a 40 to 60% stenosis and
his right carotid artery and a 20 to 40% stenosis in his left
carotid artery.  The patient reports no associated symptoms
with this and denies any weakness or neurological defects.
He did have a left CEA in [**2131**].  He also reports a previous
MRI that showed "old tiny strokes," but otherwise has no
neurological history.  The patient was admitted for an
elective stenting of his right carotid artery.  The patient
underwent stenting of his right coronary artery without any
complications.  He was then admitted to the Coronary Care
Unit for close monitoring following this procedure.  At the
time of his admission to the Coronary Care Unit the patient
denies any concurrent complaints and confirms the above
history.

MEDICAL HISTORY: 1.  Coronary artery disease status post coronary artery
bypass graft in [**2131**] four vessel disease.  Cardiac
catheterization in [**2141-7-11**].
2.  Congestive heart failure.
3.  Diabetes mellitus type 2.
4.  Peripheral neuropathy.
5.  Chronic renal insufficiency.
6.  Hypertension.
7.  Hypercholesterolemia.
8.  History of basal cell carcinoma status post resection.
9.  History of diverticulosis.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: He lives at home with wife.  [**Name (NI) **] tobacco or
alcohol use.  Retired accountant. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Intermediate coronary syndrome,Congestive heart failure, unspecified,Mitral valve disorders,Coronary atherosclerosis of native coronary artery,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Pure hypercholesterolemia'}
