CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 72-year-old woman
with a history of hypertension, peripheral vascular disease,
and left face and arm weakness, who presents for elective
right carotid stenting.

MEDICAL HISTORY: 1.  Hypertension.
2.  Peripheral vascular disease
3.  Degenerative joint disease.
4.  Breast cancer status post XRT.
5.  Hypothyroidism.
6.  Depression.
7.  Psoriasis.

MEDICATION ON ADMISSION: 1.  Levoxyl 175 mcg q.d.
2.  Celexa 10 mg q.d.
3.  HCTZ 25 mg q.d.
4.  Folate 1 mg q.d.
5.  Ranitidine 150 mg PO b.i.d.
6.  Tamoxifen 10 mg PO b.i.d.
7.  Plavix 75 mg PO q.d.
8.  Aspirin 325 mg PO q.d.
9.  Trazodone 60 mg PO q.h.s.p.r.n.
10. Asacol 800 mg PO t.i.d.
11. Atenolol 25 mg PO q.d.
12. Neurontin 300 mg PO t.i.d.
13. Celebrex 100 mg PO b.i.d.
14. Imdur 30 mg PO q.d.
15. Caltrate D 600 mg PO b.i.d.
16. Sublingual nitroglycerin p.r.n. chest pain.
17. ....................as needed for pain.

ALLERGIES: The patient is allergic to PENICILLIN AND
CODEINE.

PHYSICAL EXAM: 

FAMILY HISTORY: History was significant for hypertension,
diabetes mellitus, and coronary artery disease.

SOCIAL HISTORY: The patient lives with her daughter, with
very good social support.  She does not smoke.  She drinks
only occasionally.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hematoma complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Acidosis,Acute posthemorrhagic anemia,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified,Unspecified essential hypertension
Ocl crtd art wo infrct,Hematoma complic proc,Ac kidny fail, tubr necr,Acidosis,Ac posthemorrhag anemia,Hypothyroidism NOS,Periph vascular dis NOS,Hypertension NOS
Admission Date:  [**2154-8-8**]       Discharge Date:  [**2154-8-12**]

Date of Birth:   [**2081-9-9**]       Sex:  F

Service:  NEUROLOGY/ICU
DIAGNOSIS:  Status post right internal carotid artery stent
placement.

HISTORY OF THE PRESENT ILLNESS:  This is a 72-year-old woman
with a history of hypertension, peripheral vascular disease,
and left face and arm weakness, who presents for elective
right carotid stenting.

History included the following:  Right siphon stenosis
discovered in [**2151**], which was treated with antiplatelet
agents.  Subsequent MR imaging on [**2153-12-25**] revealed 40%
to 60% stenosis in the right ICA.  The patient has a one year
history of TIA characterized by left hand and face
weakness/numbness and dysarthria. A Carotid ultrasound, in
[**2154-4-24**], revealed 80% to 90% stenosis in the same vessel.
Angiogram at this time revealed severe right ICA stenosis ( >95%)
at the bifurcation with right siphon stenosis and 4 mm aneurysm
at the anterior communicating artery.

The patient underwent right carotid stent without
complications.  The patient tolerated the procedure well
Post-procedure the patient was admitted to the Neurology
Intensive Care Unit for postoperative procedural observation with
the neurosurgical Intensive Care House Staff following.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Peripheral vascular disease
3.  Degenerative joint disease.
4.  Breast cancer status post XRT.
5.  Hypothyroidism.
6.  Depression.
7.  Psoriasis.

ALLERGIES:  The patient is allergic to PENICILLIN AND
CODEINE.

MEDICATIONS ON ADMISSION:
1.  Levoxyl 175 mcg q.d.
2.  Celexa 10 mg q.d.
3.  HCTZ 25 mg q.d.
4.  Folate 1 mg q.d.
5.  Ranitidine 150 mg PO b.i.d.
6.  Tamoxifen 10 mg PO b.i.d.
7.  Plavix 75 mg PO q.d.
8.  Aspirin 325 mg PO q.d.
9.  Trazodone 60 mg PO q.h.s.p.r.n.
10. Asacol 800 mg PO t.i.d.
11. Atenolol 25 mg PO q.d.
12. Neurontin 300 mg PO t.i.d.
13. Celebrex 100 mg PO b.i.d.
14. Imdur 30 mg PO q.d.
15. Caltrate D 600 mg PO b.i.d.
16. Sublingual nitroglycerin p.r.n. chest pain.
17. ....................as needed for pain.

SOCIAL HISTORY:  The patient lives with her daughter, with
very good social support.  She does not smoke.  She drinks
only occasionally.

FAMILY HISTORY:  History was significant for hypertension,
diabetes mellitus, and coronary artery disease.

PHYSICAL EXAMINATION:  Examination revealed the following:
Temperature 97, blood pressure 145/85, heart rate 59, SPO2
99% to 100% SPO2 on a couple of liters.  GENERAL:  Intubated
patient in no acute distress.  HEENT:  Normocephalic,
atraumatic, supple, no bruits, no lymphadenopathy.
CARDIOVASCULAR;  Regular rhythm, normal rate.  PULMONARY:
Clear to auscultation bilaterally.  ABDOMEN:  Positive bowel
sounds, soft, nontender, nondistended.  GROIN:  Left sheath
in place with no bruits.  No evidence of hematoma or bruits.
NEUROLOGICAL:  The patient awake, alert, and following
commands.  Pupils are reactive and equal.  Extraocular
motions are full.  There is a horizontal-gaze nystagmus
bilaterally; moves symmetrically.  Sensation was intact to
touch.  MOTOR:  The patient moves the extremities equally
well with normal bulk and tone.  EXTREMITIES:  The left leg,
however, is immobilized with sheath in place and, therefore,
not fully tested.  REFLEXES:  2+ and symmetrical, with toes
downgoing.

LABORATORY DATA:  Laboratory data revealed the following:
White count 8.5, hematocrit 25, MCV 86, platelet count
160,000, sodium 141, creatinine 1.2, BUN 31, chloride 108,
bicarbonate 19.  ABG was 7.29, 50, and 215.

HOSPITAL COURSE:  Mrs. [**Known lastname 49013**] was admitted to the
Neurointensive Care Service for further postoperative care.
She was found to be anemic postoperatively, therefore, she
was given two units of packed red blood cells with initial
appropriate increase in the hematocrit.  She was extubated
uneventfully.  The hospital course was complicated by a
moderate left groin hematoma in the setting of heparin
anticoagulation post procedure.  The anticoagulation was
discontinued and the sheath removed with pressure applied for
an hour.

She remained stable hemodynamically, however, she required a
total of four units of packed red blood cells before the
hematocrit stabilized in the low 30s, which is her baseline.
While in house, we also note a metabolic acidosis consistent
with elevated lactic acid.  This is likely partially
secondary to hypovolemia and, therefore, she was transfused
and the volume status corrected.  The lactic acidosis
improved.

Mrs.[**Last Name (STitle) 101641**] also had mild elevation in creatinine likely
secondary to her dye load during the procedure. As the volume
status improved, creatinine returned to baseline within the
hospital stay.

At the time of this dictation, the patient is stable for
discharge home.  She is safe from a physical therapy and
occupational therapy perspective.  She is able to ambulate
both on a level plane and up and down stairs without
problems.  She will follow up with Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) 5730**].
She will also follow up with her primary physician and
cardiologist while in house.  We note that she has a few
episodes of bradycardia down to the low 40s, which are not
sustained.  We should further state that she had no evidence
of chronotropic incompetence.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is discharged to home with
follow up.

DISCHARGE DIAGNOSES:
1.  Right carotid artery stenting.
2.  Left groin hematoma.
3.  Previous diagnoses as indicated in the past medical
history above.
4.  The patient continued to have an aneurysm in the anterior
communicating artery, which will be monitored by
Drs.  [**Last Name (STitle) **] and [**Name5 (PTitle) 5730**] and [**Name5 (PTitle) **] considered as
necessary.

DISCHARGE MEDICATIONS:  The patient is to continue all of her
outpatient medications with the exception of Zantac b.i.d.,
which is discontinued and the patient was put on
Pantoprazole.  This was done as the patient has evidence of
increased creatinine and, therefore, decreased creatinine
clearance.

MEDICATIONS:
1.  Levoxyl 175 mcg PO q.d.
2.  Celexa 10 mg PO q.d.
3.  HCTZ 25 mg PO q.d.
4.  Folate 1 mg PO q.d.
5.  Pantoprazole 40 mg PO q.d.
6.  Tamoxifen 10 mg PO b.i.d.
7.  Plavix 75 mg PO q.d.
8.  Enteric coated aspirin 325 mg PO q.d.
9.  Trazodone 50 mg PO q.h.s.p.r.n.
10. Asacol 800 mg PO t.i.d.
11. Atenolol 25 mg PO q.d.
12. Neurontin 300 mg PO t.i.d.
13. Celebrex 100 mg PO b.i.d.
14. Imdur 30 mg PO q.d.
15. Caltrate D 600 mg p.o.b.i.d.
16. Sublingual nitroglycerin p.r.n.
17. Fioricet as needed for pain.

FOLLOW-UP CARE:  The patient is to follow up with
Dr.  [**Last Name (STitle) **] and [**Doctor Last Name 5730**].  The patient will also follow up
with her primary physician and cardiologist.




                            [**Name6 (MD) 725**] [**Name8 (MD) 726**], M.D.  [**MD Number(1) 727**]

Dictated By:[**Last Name (NamePattern4) 39653**]
MEDQUIST36

D:  [**2154-8-12**]  11:41
T:  [**2154-8-12**]  12:11
JOB#:  [**Job Number 101642**]
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hematoma complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Acidosis,Acute posthemorrhagic anemia,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified,Unspecified essential hypertension'}


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: This is a 72-year-old woman
with a history of hypertension, peripheral vascular disease,
and left face and arm weakness, who presents for elective
right carotid stenting.

MEDICAL HISTORY: 1.  Hypertension.
2.  Peripheral vascular disease
3.  Degenerative joint disease.
4.  Breast cancer status post XRT.
5.  Hypothyroidism.
6.  Depression.
7.  Psoriasis.

MEDICATION ON ADMISSION: 1.  Levoxyl 175 mcg q.d.
2.  Celexa 10 mg q.d.
3.  HCTZ 25 mg q.d.
4.  Folate 1 mg q.d.
5.  Ranitidine 150 mg PO b.i.d.
6.  Tamoxifen 10 mg PO b.i.d.
7.  Plavix 75 mg PO q.d.
8.  Aspirin 325 mg PO q.d.
9.  Trazodone 60 mg PO q.h.s.p.r.n.
10. Asacol 800 mg PO t.i.d.
11. Atenolol 25 mg PO q.d.
12. Neurontin 300 mg PO t.i.d.
13. Celebrex 100 mg PO b.i.d.
14. Imdur 30 mg PO q.d.
15. Caltrate D 600 mg PO b.i.d.
16. Sublingual nitroglycerin p.r.n. chest pain.
17. ....................as needed for pain.

ALLERGIES: The patient is allergic to PENICILLIN AND
CODEINE.

PHYSICAL EXAM: 

FAMILY HISTORY: History was significant for hypertension,
diabetes mellitus, and coronary artery disease.

SOCIAL HISTORY: The patient lives with her daughter, with
very good social support.  She does not smoke.  She drinks
only occasionally. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Hematoma complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Acidosis,Acute posthemorrhagic anemia,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified,Unspecified essential hypertension'}
