CHIEF COMPLAINT: 

PRESENT ILLNESS: 48-year-old female with
extremely severe vasculopathy.  Known left subclavian
stenosis, previous aorto-bifemoral bypass, complicated
cardiac disease with multiple interventions.  She was
transferred for elective catheterization with known left main
bypass grafting.  The patient complains of right leg numbness
post cardiac catheterization.

MEDICAL HISTORY: Coronary artery disease with
angioplasty to the circumflex in [**2192**], stent placement to the
right coronary artery secondary to re-stenosis in [**2192-10-1**], coronary artery bypass grafting with saphenous vein
grafts to the right coronary artery and diagonal coronary
artery in [**2193**].  She had a repeat catheterization in [**2195-12-2**] for unstable angina.  Her graft was patent to the
diagonal.  She had severely diseased right coronary artery
graft and required stenting of the right coronary artery
graft.  A follow up catheterization in [**2196-1-1**]
showed patent diagonal and right coronary artery grafts with
a 50% stenosis of the diagonal.  She was treated medically.
She underwent a repeat cardiac catheterization in [**Month (only) 956**] of
this year which showed distal left main trunk mildly tapered,
irregular left anterior descending artery with diagonal
saphenous vein graft patent but graft with a 70% stenosis
The circumflex was a non-dominant system with 50% stenosis of
the first obtuse marginal.  The right coronary artery was
dominant.  The vein graft to the right coronary artery was
patent with stents x2.  There was a 95% in stent stenosis and
a 60-70% stenosis at the anastomosis.
Medical history includes hypothyroidism on Synthroid therapy,
history of seizure disorder, trauma related to motor vehicle
accident in [**2181**] on medical therapy, history of HIT,
bilateral carotid disease.  She has a history of heparin
induced thrombocytopenia which was complicated by thrombosis.
She also has allergies to Codeine, Sulfa and Ceclor,
reactions unknown.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atherosclerosis of autologous vein bypass graft of the extremities,Cellulitis and abscess of leg, except foot,Stricture of artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other convulsions,Unspecified acquired hypothyroidism,Aortocoronary bypass status
Crnry athrscl natve vssl,Intermed coronary synd,Ath ext autologs bps gft,Cellulitis of leg,Stricture of artery,Accidental op laceration,Convulsions NEC,Hypothyroidism NOS,Aortocoronary bypass
Admission Date:  [**2196-6-23**]       Discharge Date:  [**2196-7-7**]

Date of Birth:   [**2148-4-6**]       Sex:  F

Service:
HISTORY OF PRESENT ILLNESS:  48-year-old female with
extremely severe vasculopathy.  Known left subclavian
stenosis, previous aorto-bifemoral bypass, complicated
cardiac disease with multiple interventions.  She was
transferred for elective catheterization with known left main
bypass grafting.  The patient complains of right leg numbness
post cardiac catheterization.

Cardiac catheterization of [**2196-6-23**] demonstrates right
coronary artery graft and native vessel totally occluded,
left main trunk disease of 50%, anterior descending native
vessel totally occluded and bypass graft with a proximal and
marginal shows an 81% stenosis, second obtuse marginal with a
50% stenosis.  Left ventricle shows inferior akinesis.  There
is a left subclavian total occlusion.

Vascular was requested to evaluate the patient for right leg
numbness post cardiac catheterization.

PAST MEDICAL HISTORY:  Coronary artery disease with
angioplasty to the circumflex in [**2192**], stent placement to the
right coronary artery secondary to re-stenosis in [**2192-10-1**], coronary artery bypass grafting with saphenous vein
grafts to the right coronary artery and diagonal coronary
artery in [**2193**].  She had a repeat catheterization in [**2195-12-2**] for unstable angina.  Her graft was patent to the
diagonal.  She had severely diseased right coronary artery
graft and required stenting of the right coronary artery
graft.  A follow up catheterization in [**2196-1-1**]
showed patent diagonal and right coronary artery grafts with
a 50% stenosis of the diagonal.  She was treated medically.
She underwent a repeat cardiac catheterization in [**Month (only) 956**] of
this year which showed distal left main trunk mildly tapered,
irregular left anterior descending artery with diagonal
saphenous vein graft patent but graft with a 70% stenosis
The circumflex was a non-dominant system with 50% stenosis of
the first obtuse marginal.  The right coronary artery was
dominant.  The vein graft to the right coronary artery was
patent with stents x2.  There was a 95% in stent stenosis and
a 60-70% stenosis at the anastomosis.
Medical history includes hypothyroidism on Synthroid therapy,
history of seizure disorder, trauma related to motor vehicle
accident in [**2181**] on medical therapy, history of HIT,
bilateral carotid disease.  She has a history of heparin
induced thrombocytopenia which was complicated by thrombosis.
She also has allergies to Codeine, Sulfa and Ceclor,
reactions unknown.

Previous surgery includes the coronary artery surgery,
aorto-bifemoral bypass grafting in [**2194**], left shoulder
surgery for Erb's palsy at the age of 12, appendectomy in
[**2166**], cervical spine surgery in [**2175**], lumbosacral spine
surgery in [**2195-12-2**], bladder suspension in [**2174**].

Medications at the time of admission included aspirin 1 q
day, Nitro-Patch .4 mg q day, Ultrase 2.5 mg q day, Atenolol
50 mg q day, Plavix 75 mg q day, Lipitor 40 mg q day,
Tri-Chlor 20 mg q day, Depakote 500 mg q a.m., 500 mg at noon
and 750 mg q p.m., Neurontin 300 mg b.i.d., Synthroid .15 mg
q day, Prevacid 15 mg q day, Darvocet p.r.n., Flexeril 10 mg
b.i.d., Celebrex 200 mg q day, Microcide 12.5 mg q day,
Premphase 1 q day, Zovirax lip ointment on a p.r.n. basis.

PHYSICAL EXAMINATION:  Vital Signs:  Temperature 99.1, heart
rate 71 and blood pressure 120/64.  Oxygen saturation 100% on
1 liter by nasal cannula.  The patient is in no acute
distress but complains of right leg numbness and discomfort
in the supine position in bed.  HEENT exam was unremarkable.
There is no jugular venous distention.  Chest is clear to
auscultation bilaterally.  Heart has a regular rate and
rhythm with no murmurs, rubs or gallops.  Abdomen is benign.
Extremities show a mottled, cool right lower extremity
distally with Dopplerable dorsalis pedis pulses bilaterally.
She has an atrophied right upper extremity related to her
palsy.  Neurologically, she is intact.

LABORATORIES:  White count 8.4, hematocrit 30.2.  Coagulation
studies were normal.  BUN 16, creatinine 0.7, potassium 4.0,
TSA 0.20, FT4 1.41.

HOSPITAL COURSE:  Initially after catheterization she could
not move her leg at all which was not a vascular problem.
However, she had sever underlying vascular disease that
appeared to be acutely worse.The patient was begun on a Hirudin
drip and she improved back to her perceived baseline and
recommendations were for long term anticoagulation.  It was
determined, from the cardiac standpoint, with cardiology and
cardiothoracic surgery, that the patient's coronary artery
disease would be treated medically.  Further evaluation of
her peripheral vascular disease was going to be done with a
MRA.

However, her right leg symptoms worsened and she started to
show signs of muscle damage in her right leg.She underwent a MRA
on [**2196-6-28**] which demonstrated that the
ascending aorta was of normal caliber.  The innominate artery
is normal and gives rise to the right subclavian which is
also normal with a low grade, mild stenosis at the junction
of the right subclavian and axillary artery.  The left common
carotid origin is normal.  The left subclavian shows a high
grade stenosis at its take-off but is normal in the remainder
of its course.  The descending thoracic aorta is normal.  The
right common femoral artery has retrograde filling of the
external iliac artery and the right hypogastric artery.  The
right common femoral is normal and gives rise to normal
profunda branches.  The right superficial femoral artery is
widely patent and communicates with a normal caliber
popliteal.  The left common femoral shows reconstitution via
collaterals.  There is focal stenosis to a 1.7 cm normal
segment above the origin of the superficial femoral and
profunda arteries.  The left superficial femoral artery is
widely patent and there is a normal appearing trifurcation.

On [**2196-6-29**], the patient underwent a right axillo-bifemoral
bypass graft.  She tolerated the procedure well and was
transferred to the SICU for continued care.  The Hirudin drip
was continued for a goal PTT of 50 to 70.  The patient was
extubated on postoperative day two.  Coumadin was begun and
she was transferred from the SICU to the VICU.

The patient was evaluated by physical therapy who felt that
the patient will need some rehabilitation for gait training
and strengthening prior to being discharged to home.  Her
Swan-Ganz was converted to a CVL on postoperative day number
three.  She was followed by Cardiology and remained stable
cardiac-wise.  Kefzol was started for right pretibial
erythema.  On postoperative day five, she was transferred to
the regular nursing floor for continued care.  Goal INR was
[**3-5**].

On postoperative day number six, physical therapy was
requested to re-evaluate the patient and rehabilitation
screening was begun.  A brace was applied to the right foot.
Aspirin was added to her drug regimen and the Kefzol was
converted to Keflex.
MEDICATIONS AT DISCHARGE:  Neurontin 300 mg b.i.d., Synthroid
1.25 mcg q day, Nitro-Patch 0.4 mg q day, Atenolol 50 mg
b.i.d. (hold for systolic blood pressure of less than 110,
heart rate of less than 60), Colace 100 mg b.i.d., Depakote
500 mg q a.m., 500 mg q lunch and 750 mg q h.s., Ranitidine
150 mg q12 hours, Coumadin 5 mg q h.s., Lipitor 40 mg q day,
Percocet 1-2 tablets q4-6 hours p.r.n. pain, Flexeril 10 mg
q8 hours p.r.n., Benadryl 50 mg intravenously q4-6 hours
p.r.n. pruritus, Morphine Sulfate 2-4 mg subcutaneously q6
hours p.r.n., Hydrochlorothiazide 12.5 mg q day, Keflex
400 mg q.i.d., aspirin 325 mg q day.

DISCHARGE DIAGNOSES:  1.  Coronary artery disease, status
post left heart catheterization.  2.  Ischemic right lower
extremity, status post right axillo-bifemoral bypass.
3.  Hypothyroidism with medication adjustment.  4.  Seizure
disorder, controlled.

The patient should follow up with Dr. [**Last Name (STitle) **] as requested.





                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3409**]

Dictated By:[**Last Name (NamePattern1) 17652**]
MEDQUIST36

D:  [**2196-7-6**]  09:29
T:  [**2196-7-6**]  09:53
JOB#:  [**Job Number 3842**]
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atherosclerosis of autologous vein bypass graft of the extremities,Cellulitis and abscess of leg, except foot,Stricture of artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other convulsions,Unspecified acquired hypothyroidism,Aortocoronary bypass status'}


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: 48-year-old female with
extremely severe vasculopathy.  Known left subclavian
stenosis, previous aorto-bifemoral bypass, complicated
cardiac disease with multiple interventions.  She was
transferred for elective catheterization with known left main
bypass grafting.  The patient complains of right leg numbness
post cardiac catheterization.

MEDICAL HISTORY: Coronary artery disease with
angioplasty to the circumflex in [**2192**], stent placement to the
right coronary artery secondary to re-stenosis in [**2192-10-1**], coronary artery bypass grafting with saphenous vein
grafts to the right coronary artery and diagonal coronary
artery in [**2193**].  She had a repeat catheterization in [**2195-12-2**] for unstable angina.  Her graft was patent to the
diagonal.  She had severely diseased right coronary artery
graft and required stenting of the right coronary artery
graft.  A follow up catheterization in [**2196-1-1**]
showed patent diagonal and right coronary artery grafts with
a 50% stenosis of the diagonal.  She was treated medically.
She underwent a repeat cardiac catheterization in [**Month (only) 956**] of
this year which showed distal left main trunk mildly tapered,
irregular left anterior descending artery with diagonal
saphenous vein graft patent but graft with a 70% stenosis
The circumflex was a non-dominant system with 50% stenosis of
the first obtuse marginal.  The right coronary artery was
dominant.  The vein graft to the right coronary artery was
patent with stents x2.  There was a 95% in stent stenosis and
a 60-70% stenosis at the anastomosis.
Medical history includes hypothyroidism on Synthroid therapy,
history of seizure disorder, trauma related to motor vehicle
accident in [**2181**] on medical therapy, history of HIT,
bilateral carotid disease.  She has a history of heparin
induced thrombocytopenia which was complicated by thrombosis.
She also has allergies to Codeine, Sulfa and Ceclor,
reactions unknown.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Coronary atherosclerosis of native coronary artery,Intermediate coronary syndrome,Atherosclerosis of autologous vein bypass graft of the extremities,Cellulitis and abscess of leg, except foot,Stricture of artery,Accidental puncture or laceration during a procedure, not elsewhere classified,Other convulsions,Unspecified acquired hypothyroidism,Aortocoronary bypass status'}
