CHIEF COMPLAINT: Transferred for carotid stenting

PRESENT ILLNESS: 75M h/o PVD, small cell lung CA with left neck mass s/p
radiation, and symptomatic bilateral carotid stenoses (90% left,
totally occluded right) transferred from OSH for percutaneous
carotid stenting. He has had several recent "drop attacks"
considered to be TIAs. He has had several months of transient
light-headedness associated with a feeling of his 'legs giving
out' followed by syncope. These episodes have been becoming more
frequent recently. Last week he underwent carotid U/S which
revealed progression of left carotid disease to >70%. The
patient was scheduled for an elective carotid endarterectomy
today at [**Hospital6 33**] that was cancelled as he was
deemed a poor surgical candidate due to multiple comorbidities.
He was started on plavix, given IVFs and mucomyst for renal
protection, and transferred to [**Hospital1 18**] for percutaneous carotid
stenting.

MEDICAL HISTORY: h/o metastatic small cell lung CA s/p left neck lymph node
dissection, chemotherapy (6 cycles VP-16 and platinol), and
radiation (436 [**Doctor Last Name 352**], [**2171**])
h/o colon CA s/p right hemicolectomy and chemotherapy (5-FU and
levamisole, [**2174**])
CRI (baseline Cre 2.0)
Bilateral carotid stenoses (90% left, totally occluded right)
h/o TIAs
PVD s/p left fem-[**Doctor Last Name **] bypass and right-to-left fem/fem bypass
Early dementia (short term memory loss)
HTN
PAF
GERD
s/p cataract surgery
DJD
h/o difficult intubation [**3-7**] radiation and neck resection

MEDICATION ON ADMISSION: HOME MEDICATIONS:
Amoxicillin 500mg [**Hospital1 **]
Zocor 20mg daily
Aricept 10mg qhs
Toprol XL 50mg daily
Aspirin 325mg daily
.
TRANSFER MEDICATIONS:
Plavix 300mg once
Mucomyst 600mg po once
Aspirin 325mg daily
Amoxicillin 500mg [**Hospital1 **] (2 more days for dental abscess)
Toprol XL 50mg daily
Aricept 10mg daily
Zocor 20mg daily

ALLERGIES: Sulfa (Sulfonamides) / Lorazepam

PHYSICAL EXAM: VS -  T 95.1 HR 60 BP left 203/64 right 121/91 RR 16 SpO2 96%/RA
Gen: Weathered elderly male, NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Poor dentition. No pain on palpation of oral mucosa or jaw and
no palpable fluid collection.
Neck: Supple with JVP of 8 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits. Well-healed midline abdominal
scar.
Ext: No c/c/e. Warm.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Neuro: Strength 5/5 in upper a lower extremities, sensation
intact to light touch throughout, no dysmetria, CN II-XII intact
.
Pulses:
Right: Carotid absent Radial 1+ Popliteal absent DP dopp
Left: Carotid 2+ Radial 2+ Popliteal absent DP dopp

FAMILY HISTORY: There is a family history of premature coronary artery disease
in his father at age 50. There is also a history of diabetes in
his father, mother, and sister.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use although he is a former smoker (quit 20 years prior). There
is no history of alcohol abuse. Married, lives with his wife. [**Name (NI) **]
is active at baseline.
Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Atrial fibrillation,Chronic kidney disease, unspecified,Esophageal reflux,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of bronchus and lung,Personal history of irradiation, presenting hazards to health,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of large intestine,Peripheral vascular disease, unspecified
Ocl mlt bi art wo infrct,Atrial fibrillation,Chronic kidney dis NOS,Esophageal reflux,Mental disor NEC oth dis,Hx-bronchogenic malignan,Hx of irradiation,Hy kid NOS w cr kid I-IV,Hx of colonic malignancy,Periph vascular dis NOS
Admission Date:  [**2183-9-8**]              Discharge Date:   [**2183-9-12**]

Date of Birth:  [**2108-1-7**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides) / Lorazepam

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Transferred for carotid stenting

Major Surgical or Invasive Procedure:
Percutaneous placement of stent in left internal carotid


History of Present Illness:
75M h/o PVD, small cell lung CA with left neck mass s/p
radiation, and symptomatic bilateral carotid stenoses (90% left,
totally occluded right) transferred from OSH for percutaneous
carotid stenting. He has had several recent "drop attacks"
considered to be TIAs. He has had several months of transient
light-headedness associated with a feeling of his 'legs giving
out' followed by syncope. These episodes have been becoming more
frequent recently. Last week he underwent carotid U/S which
revealed progression of left carotid disease to >70%. The
patient was scheduled for an elective carotid endarterectomy
today at [**Hospital6 33**] that was cancelled as he was
deemed a poor surgical candidate due to multiple comorbidities.
He was started on plavix, given IVFs and mucomyst for renal
protection, and transferred to [**Hospital1 18**] for percutaneous carotid
stenting.

Past Medical History:
h/o metastatic small cell lung CA s/p left neck lymph node
dissection, chemotherapy (6 cycles VP-16 and platinol), and
radiation (436 [**Doctor Last Name 352**], [**2171**])
h/o colon CA s/p right hemicolectomy and chemotherapy (5-FU and
levamisole, [**2174**])
CRI (baseline Cre 2.0)
Bilateral carotid stenoses (90% left, totally occluded right)
h/o TIAs
PVD s/p left fem-[**Doctor Last Name **] bypass and right-to-left fem/fem bypass
Early dementia (short term memory loss)
HTN
PAF
GERD
s/p cataract surgery
DJD
h/o difficult intubation [**3-7**] radiation and neck resection

Social History:
Social history is significant for the absence of current tobacco
use although he is a former smoker (quit 20 years prior). There
is no history of alcohol abuse. Married, lives with his wife. [**Name (NI) **]
is active at baseline.

Family History:
There is a family history of premature coronary artery disease
in his father at age 50. There is also a history of diabetes in
his father, mother, and sister.

Physical Exam:
VS -  T 95.1 HR 60 BP left 203/64 right 121/91 RR 16 SpO2 96%/RA
Gen: Weathered elderly male, NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Poor dentition. No pain on palpation of oral mucosa or jaw and
no palpable fluid collection.
Neck: Supple with JVP of 8 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits. Well-healed midline abdominal
scar.
Ext: No c/c/e. Warm.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Neuro: Strength 5/5 in upper a lower extremities, sensation
intact to light touch throughout, no dysmetria, CN II-XII intact
.
Pulses:
Right: Carotid absent Radial 1+ Popliteal absent DP dopp
Left: Carotid 2+ Radial 2+ Popliteal absent DP dopp

Pertinent Results:
Admission labs:
[**2183-9-8**] 05:30PM BLOOD WBC-8.0 RBC-4.08* Hgb-13.2* Hct-38.0*
MCV-93 MCH-32.2* MCHC-34.7 RDW-14.2 Plt Ct-192
[**2183-9-8**] 05:30PM BLOOD PT-11.7 PTT-28.6 INR(PT)-1.0
[**2183-9-8**] 05:30PM BLOOD Glucose-89 UreaN-27* Creat-1.9* Na-140
K-4.1 Cl-107 HCO3-25 AnGap-12
[**2183-9-8**] 05:30PM BLOOD Calcium-8.8 Phos-3.3 Mg-2.3
.
Discharge labs:
.
EKG demonstrated NSR, Q-waves III/aVF, <1mm ST depression V5-6
with no significant change compared with prior dated [**2182-8-28**].
.
2D-ECHOCARDIOGRAM performed on [**5-/2180**] demonstrated:  EF 60-65%,
trace MR, 2+ TR
.
ETT performed on [**2182-8-24**] demonstrated: No chest pain or
significant ECG changes.
.
Bilateral duplex carotid U/S ([**2183-9-5**]): Right total occlusion,
Left >70% stenosis.
.

Brief Hospital Course:
The patient is a 75 y/o man w/ bilateral critical carotid
stenosis (Right completely occluded and left>70% occluded) who
had a history oif multiple TIAs and drop attacks, who was
transferred from an outside hospital for percutaneous carotid
stenting. He was transfered for percutaneous intervention as he
was a poor operative candidate secondary to multiple medical
comorbidities. He was initially admitted to the floor prior to
the procedure. Post-procedure, he was transfered to the CCU. He
had a drug eluuting stent placed in his left ICA without
complications. On his first night post procedure, he was put on
a neo drip for SBP in the 90s. The neo was discontinued 24 hours
later. He also received fluid boluses with good response.

   The patient had a bruit in his right groin area and an
ultrasound was obtained, which showed no pseudoaneurysm or
hematoma. This bruit might have been old and related to his
extensive atherosclerotic disease.

   His hematocrit dropped during his hospitalization by about 8
points. Hemolysis laboratories were negative and he was guaiac
negative. CT abdomen and pelvis was negative for bleed. He
received one unit PRBCs and did well post transfusion. His
hematocrit was stable prior to discharge.

  For two days after his stent, he was somewhat bradycardic and
hypotensive. This might have been due to autonomic disregulation
due to carotid barorreceptor manipulation. By the third day, his
compensatory responses had normalized. Physical therapy
evaluated him and he was discharged home with PT services and
VNA services. His neurologic exam remained normal throughout
hospitalization. His Aricept was discontinued as it is a drug
known to cause bradycardia and orthostasis. It was recommended
that he undergo posterior circulation evaluation as an
outpatient.

Medications on Admission:
HOME MEDICATIONS:
Amoxicillin 500mg [**Hospital1 **]
Zocor 20mg daily
Aricept 10mg qhs
Toprol XL 50mg daily
Aspirin 325mg daily
.
TRANSFER MEDICATIONS:
Plavix 300mg once
Mucomyst 600mg po once
Aspirin 325mg daily
Amoxicillin 500mg [**Hospital1 **] (2 more days for dental abscess)
Toprol XL 50mg daily
Aricept 10mg daily
Zocor 20mg daily

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
4. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day: Start taking this
medication [**2183-9-14**].
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 **] VNA

Discharge Diagnosis:
Carotid stenosis (bilateral)
S/p stenting left internal carotid


Discharge Condition:
Good. No pain. No weakness or dizziness. Ambulatory.


Discharge Instructions:
You were transferred to this hospital because the blood vessel
that carries blood to your brain was critically narrow. The
blood vessel was kept open by means of a stent. The procedure
had no complications.

   Please note that you should not take the medicine called
metoprolol (toprol XL) for 2 days. After that, you must begin
taking it as before. You must also take the rest of your
medications as prescribed from the moment of discharge. You are
taking a new medication called plavix (clopidogrel)

  Please see your primary care doctor within 4 days of
discharge. Also, call your doctor or return to the Emergency
Department if you experience any more drop attacks, chest pain,
shortness of breatth, bleeding, weakness, or any other
concerning symptoms.

Followup Instructions:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 4022**]  Follow-up
appointment [**9-23**], 3PM [**Hospital Ward Name 23**]-7, [**Hospital1 18**]

Provider: [**Name10 (NameIs) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]  [**Telephone/Fax (1) 18368**]  Call to schedule
appointment, [**2187-9-23**]:10 AM ([**Street Address(1) **], Waymouth)
{'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Atrial fibrillation,Chronic kidney disease, unspecified,Esophageal reflux,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of bronchus and lung,Personal history of irradiation, presenting hazards to health,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of large intestine,Peripheral vascular disease, unspecified'}


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: Transferred for carotid stenting

PRESENT ILLNESS: 75M h/o PVD, small cell lung CA with left neck mass s/p
radiation, and symptomatic bilateral carotid stenoses (90% left,
totally occluded right) transferred from OSH for percutaneous
carotid stenting. He has had several recent "drop attacks"
considered to be TIAs. He has had several months of transient
light-headedness associated with a feeling of his 'legs giving
out' followed by syncope. These episodes have been becoming more
frequent recently. Last week he underwent carotid U/S which
revealed progression of left carotid disease to >70%. The
patient was scheduled for an elective carotid endarterectomy
today at [**Hospital6 33**] that was cancelled as he was
deemed a poor surgical candidate due to multiple comorbidities.
He was started on plavix, given IVFs and mucomyst for renal
protection, and transferred to [**Hospital1 18**] for percutaneous carotid
stenting.

MEDICAL HISTORY: h/o metastatic small cell lung CA s/p left neck lymph node
dissection, chemotherapy (6 cycles VP-16 and platinol), and
radiation (436 [**Doctor Last Name 352**], [**2171**])
h/o colon CA s/p right hemicolectomy and chemotherapy (5-FU and
levamisole, [**2174**])
CRI (baseline Cre 2.0)
Bilateral carotid stenoses (90% left, totally occluded right)
h/o TIAs
PVD s/p left fem-[**Doctor Last Name **] bypass and right-to-left fem/fem bypass
Early dementia (short term memory loss)
HTN
PAF
GERD
s/p cataract surgery
DJD
h/o difficult intubation [**3-7**] radiation and neck resection

MEDICATION ON ADMISSION: HOME MEDICATIONS:
Amoxicillin 500mg [**Hospital1 **]
Zocor 20mg daily
Aricept 10mg qhs
Toprol XL 50mg daily
Aspirin 325mg daily
.
TRANSFER MEDICATIONS:
Plavix 300mg once
Mucomyst 600mg po once
Aspirin 325mg daily
Amoxicillin 500mg [**Hospital1 **] (2 more days for dental abscess)
Toprol XL 50mg daily
Aricept 10mg daily
Zocor 20mg daily

ALLERGIES: Sulfa (Sulfonamides) / Lorazepam

PHYSICAL EXAM: VS -  T 95.1 HR 60 BP left 203/64 right 121/91 RR 16 SpO2 96%/RA
Gen: Weathered elderly male, NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Poor dentition. No pain on palpation of oral mucosa or jaw and
no palpable fluid collection.
Neck: Supple with JVP of 8 cm.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits. Well-healed midline abdominal
scar.
Ext: No c/c/e. Warm.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Neuro: Strength 5/5 in upper a lower extremities, sensation
intact to light touch throughout, no dysmetria, CN II-XII intact
.
Pulses:
Right: Carotid absent Radial 1+ Popliteal absent DP dopp
Left: Carotid 2+ Radial 2+ Popliteal absent DP dopp

FAMILY HISTORY: There is a family history of premature coronary artery disease
in his father at age 50. There is also a history of diabetes in
his father, mother, and sister.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use although he is a former smoker (quit 20 years prior). There
is no history of alcohol abuse. Married, lives with his wife. [**Name (NI) **]
is active at baseline. 

### Response:
{'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Atrial fibrillation,Chronic kidney disease, unspecified,Esophageal reflux,Other persistent mental disorders due to conditions classified elsewhere,Personal history of malignant neoplasm of bronchus and lung,Personal history of irradiation, presenting hazards to health,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Personal history of malignant neoplasm of large intestine,Peripheral vascular disease, unspecified'}
