CHIEF COMPLAINT: Planned admission of aspirin desensitization.

PRESENT ILLNESS: 81 yo M being admitted to CCU for aspirin desensitization prior
to RLE angiogram scheduled for [**5-9**]. He has been having
worsening RLE pain with ambulation that is partially relieved by
rest. A CT angiogram was performed showing significant arterial
disease. Given his PAD and CAD, it is important for him to be on
aspirin, but he has been resistant to this. He was reportedly
told by his physicians in [**Country 532**] to never again take aspirin,
and this is for unclear reasons. Given his need for
intervention, as well as worsening CAD and PAD, he is electively
admitted to the CCU for aspirin desensitization.
.
On arrival to the floor, patient is feeling well and has no
complaints.

MEDICAL HISTORY: # PAD
# Chronic LLE DVT
# Chronic venous insufficiency
# S/P LCFV stenting
# CAD s/p LAD stenting
# Systolic and diastolic heart failure (EF 45-50%)
# HTN
# ICD for VF during stress test
# PAF (on dabigatran)
# Severe COPD
# SDH s/p craniotomy
# BPH
# Chronic LBP with lumbar DJD, s/p multiple injections
# OA

MEDICATION ON ADMISSION: ALBUTEROL SULFATE - (Prescribed by Other Provider) - 90 mcg HFA
Aerosol Inhaler - 1-2 puffs INH Q 6 hours as needed for SOB,
wheezing
ALPRAZOLAM - 0.25 mg Tablet - 1 Tablet(s) by mouth daily
AMITRIPTYLINE - 25 mg Tablet - 1 Tablet(s) by mouth daily at
bedtime
DABIGATRAN ETEXILATE [PRADAXA] - 150 mg Capsule - 1 Capsule(s)
by mouth twice daily
FLUTICASONE-SALMETEROL [ADVAIR HFA] - (Prescribed by Other
Provider: [**Name Initial (NameIs) **]) - 230 mcg-21 mcg/Actuation HFA Aerosol
Inhaler - 2 puffs inhaled twice daily
FUROSEMIDE - 20 mg Tablet - 1 Tablet(s) by mouth once a day as
needed for as needed for edema
GABAPENTIN - 300 mg Capsule - [**1-20**] Capsule(s) by mouth three
times daily
LISINOPRIL - (On Hold from [**2194-3-25**] to unknown for pt reports
low BP at home, lisinopril on hold due to this, he will discuss
with cardiology next month) - 2.5 mg Tablet - 1 Tablet(s) by
mouth once a day
MECLIZINE - 12.5 mg Tablet - 1 Tablet(s) by mouth daily
MONTELUKAST [SINGULAIR] - 10 mg Tablet - 1 Tablet(s) by mouth
once a day
NITROGLYCERIN [NITROSTAT] - 0.3 mg Tablet, Sublingual - 1
Tablet(s) sublingually for chest pain, repeat x2 with 5 minute
interval if needed
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 (One)
Capsule(s) by mouth once a day
OXYCODONE - 5 mg Tablet - 1-1.5 Tablet(s) by mouth up to four
times daily as needed for pain ** may cause sedation; 28 day
supply
PREDNISONE - 10 mg Tablet - 1 Tablet(s) by mouth once a day
SIMVASTATIN - 80 mg Tablet - 1 Tablet(s) by mouth daily at
bedtime
TRAZODONE - 50 mg Tablet - 1 Tablet(s) by mouth once a day
B COMPLEX VITAMINS - Capsule - 1 Capsule(s) by mouth daily
DOCUSATE SODIUM - 100 mg Capsule - 3 Capsule(s) by mouth daily
MAGNESIUM OXIDE - 420 mg Tablet - 1 Tablet(s) by mouth daily
SENNOSIDES - 8.6 mg Tablet - [**1-20**] Tablet(s) by mouth daily as
needed for constipation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission-
GEN: well-appearing male in no acute distress
HEENT: Moist mucus membranes, PERRL
NECK: supple, no JVD
CV: RRR no murmurs, rubs, gallops
LUNGS: clear to auscultation bilaterally
ABD: soft, non tender, multiple palpable masses throught the
upper abdomen, non distended
EXT: no edema, varicose veins present
SKIN: warm and dry

FAMILY HISTORY: Father - lung cancer
Brother - lung cancer
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Retired grocery store manager. Married, with two children.
Smoked for about a year in the [**2142**]. Drinks alcohol socially.
Atherosclerosis of native arteries of the extremities with intermittent claudication,Chronic combined systolic and diastolic heart failure,Venous (peripheral) insufficiency, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Atrial fibrillation,Long-term (current) use of anticoagulants,Chronic airway obstruction, not elsewhere classified,Lumbosacral spondylosis without myelopathy,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Automatic implantable cardiac defibrillator in situ,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Personal history of venous thrombosis and embolism,Family history of malignant neoplasm of trachea, bronchus, and lung
Ath ext ntv at w claudct,Chr syst/diastl hrt fail,Venous insufficiency NOS,Crnry athrscl natve vssl,Status-post ptca,Hypertension NOS,Atrial fibrillation,Long-term use anticoagul,Chr airway obstruct NEC,Lumbosacral spondylosis,Osteoarthros NOS-unspec,Status autm crd dfbrltr,BPH w/o urinary obs/LUTS,History of tobacco use,Hx-ven thrombosis/embols,Fm hx-trach/bronchog mal
Admission Date:  [**2194-5-8**]              Discharge Date:   [**2194-5-10**]

Date of Birth:  [**2113-3-13**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1711**]
Chief Complaint:
Planned admission of aspirin desensitization.

Major Surgical or Invasive Procedure:
Right lower extremity angiogram and stent of anterior tibial
artery

History of Present Illness:
81 yo M being admitted to CCU for aspirin desensitization prior
to RLE angiogram scheduled for [**5-9**]. He has been having
worsening RLE pain with ambulation that is partially relieved by
rest. A CT angiogram was performed showing significant arterial
disease. Given his PAD and CAD, it is important for him to be on
aspirin, but he has been resistant to this. He was reportedly
told by his physicians in [**Country 532**] to never again take aspirin,
and this is for unclear reasons. Given his need for
intervention, as well as worsening CAD and PAD, he is electively
admitted to the CCU for aspirin desensitization.
.
On arrival to the floor, patient is feeling well and has no
complaints.

Past Medical History:
# PAD
# Chronic LLE DVT
# Chronic venous insufficiency
# S/P LCFV stenting
# CAD s/p LAD stenting
# Systolic and diastolic heart failure (EF 45-50%)
# HTN
# ICD for VF during stress test
# PAF (on dabigatran)
# Severe COPD
# SDH s/p craniotomy
# BPH
# Chronic LBP with lumbar DJD, s/p multiple injections
# OA

Social History:
Retired grocery store manager. Married, with two children.
Smoked for about a year in the [**2142**]. Drinks alcohol socially.

Family History:
Father - lung cancer
Brother - lung cancer
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.


Physical Exam:
Admission-
GEN: well-appearing male in no acute distress
HEENT: Moist mucus membranes, PERRL
NECK: supple, no JVD
CV: RRR no murmurs, rubs, gallops
LUNGS: clear to auscultation bilaterally
ABD: soft, non tender, multiple palpable masses throught the
upper abdomen, non distended
EXT: no edema, varicose veins present
SKIN: warm and dry

Discharge-
GEN: well-appearing male in no acute distress
HEENT: Moist mucus membranes, PERRL
NECK: supple, no JVD
CV: RRR no murmurs, rubs, gallops
LUNGS: clear to auscultation bilaterally
ABD: soft, non tender, multiple palpable masses throught the
upper abdomen, non distended
EXT: no edema, varicose veins present. Warm feet
SKIN: warm and dry
PULSE: good pedal pulses


Pertinent Results:
Admission-
[**2194-5-8**] 01:04PM BLOOD WBC-10.2 RBC-4.67 Hgb-14.4 Hct-44.6
MCV-96 MCH-30.9 MCHC-32.4# RDW-13.2 Plt Ct-187
[**2194-5-8**] 01:04PM BLOOD Neuts-86.3* Lymphs-9.2* Monos-3.2 Eos-0.8
Baso-0.5
[**2194-5-8**] 06:33PM BLOOD PT-10.8 PTT-23.4* INR(PT)-1.0
[**2194-5-8**] 01:04PM BLOOD Glucose-179* UreaN-16 Creat-1.1 Na-139
K-4.7 Cl-102 HCO3-29 AnGap-13
[**2194-5-8**] 01:04PM BLOOD Calcium-8.6 Phos-2.4*# Mg-2.1

Discharge-
[**2194-5-10**] 06:54AM BLOOD WBC-7.7 RBC-4.48* Hgb-13.7* Hct-41.7
MCV-93 MCH-30.5 MCHC-32.8 RDW-13.0 Plt Ct-195
[**2194-5-10**] 06:54AM BLOOD Glucose-103* UreaN-12 Creat-0.9 Na-142
K-4.2 Cl-104 HCO3-31 AnGap-11
[**2194-5-10**] 06:54AM BLOOD Calcium-8.7 Phos-3.0 Mg-2.0


Brief Hospital Course:
81 yo M with CAD and PAD, admitted electively to the CCU for an
aspirin desensitization prior to RLE angiogram.

# PAD
The patient has been having worsening right leg pain which is
likely multifactorial. He underwent LE angiogram with stent
placement on [**2194-5-9**].  He is to continue on his pradaxa and
begin taking plavix (for 1 month) and aspirin (indefinitely).
He tolerated the procedure well other than some RLE discomfort
prior to discharge.  His exam was wnl.

# Aspirin desensitization:
Pt underwent suggessful aspirin desensitization as per protocol
without reaction.  He is to continue aspirin daily.

# CAD
Pt is was continued on his home lisinopril and simvastatin (dose
adjusted).  Following his desensitization as above, the patient
is to begin taking aspirin daily.


Medications on Admission:
ALBUTEROL SULFATE - (Prescribed by Other Provider) - 90 mcg HFA
Aerosol Inhaler - 1-2 puffs INH Q 6 hours as needed for SOB,
wheezing
ALPRAZOLAM - 0.25 mg Tablet - 1 Tablet(s) by mouth daily
AMITRIPTYLINE - 25 mg Tablet - 1 Tablet(s) by mouth daily at
bedtime
DABIGATRAN ETEXILATE [PRADAXA] - 150 mg Capsule - 1 Capsule(s)
by mouth twice daily
FLUTICASONE-SALMETEROL [ADVAIR HFA] - (Prescribed by Other
Provider: [**Name Initial (NameIs) **]) - 230 mcg-21 mcg/Actuation HFA Aerosol
Inhaler - 2 puffs inhaled twice daily
FUROSEMIDE - 20 mg Tablet - 1 Tablet(s) by mouth once a day as
needed for as needed for edema
GABAPENTIN - 300 mg Capsule - [**1-20**] Capsule(s) by mouth three
times daily
LISINOPRIL - (On Hold from [**2194-3-25**] to unknown for pt reports
low BP at home, lisinopril on hold due to this, he will discuss
with cardiology next month) - 2.5 mg Tablet - 1 Tablet(s) by
mouth once a day
MECLIZINE - 12.5 mg Tablet - 1 Tablet(s) by mouth daily
MONTELUKAST [SINGULAIR] - 10 mg Tablet - 1 Tablet(s) by mouth
once a day
NITROGLYCERIN [NITROSTAT] - 0.3 mg Tablet, Sublingual - 1
Tablet(s) sublingually for chest pain, repeat x2 with 5 minute
interval if needed
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 (One)
Capsule(s) by mouth once a day
OXYCODONE - 5 mg Tablet - 1-1.5 Tablet(s) by mouth up to four
times daily as needed for pain ** may cause sedation; 28 day
supply
PREDNISONE - 10 mg Tablet - 1 Tablet(s) by mouth once a day
SIMVASTATIN - 80 mg Tablet - 1 Tablet(s) by mouth daily at
bedtime
TRAZODONE - 50 mg Tablet - 1 Tablet(s) by mouth once a day
B COMPLEX VITAMINS - Capsule - 1 Capsule(s) by mouth daily
DOCUSATE SODIUM - 100 mg Capsule - 3 Capsule(s) by mouth daily
MAGNESIUM OXIDE - 420 mg Tablet - 1 Tablet(s) by mouth daily
SENNOSIDES - 8.6 mg Tablet - [**1-20**] Tablet(s) by mouth daily as
needed for constipation

Discharge Medications:
1. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q6H (every 6 hours) as needed for
sob/wheezing.
2. alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
3. amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
4. dabigatran etexilate 150 mg Capsule Sig: One (1) Capsule PO
BID (2 times a day).
5. fluticasone-salmeterol 230-21 mcg/actuation HFA Aerosol
Inhaler Sig: Two (2) puffs Inhalation twice a day.
6. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
7. gabapentin 300 mg Capsule Sig: [**1-20**] Capsules PO TID (3 times a
day).
8. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
9. meclizine 12.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual once a day as needed for chest pain.
12. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
13. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every four (4)
hours as needed for pain.
14. prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day.
15. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.

16. trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed for insomnia.
17. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
18. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
19. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
20. magnesium oxide 420 mg Tablet Sig: One (1) Tablet PO once a
day.
21. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*5*
22. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 1952**], [**Location (un) 86**]

Discharge Diagnosis:
Peripheral Artery Disease

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

Discharge Instructions:
Mr. [**Known lastname 10816**],

You were admitted to the hospital to have an angiogram and stent
performed on your right leg. You were also in the Cardiac ICU so
that we could monitor you while you start aspirin. Your leg pain
will hopefully improve over time, but you should take some pain
medications to treat it until it improves.

Medication Changes:
START aspirin 325mg daily
START clopidogrel 75mg daily for one month
START oxycodone 5mg every four hours as needed for pain

Followup Instructions:
Department: [**Hospital3 249**]
When: MONDAY [**2194-5-19**] at 2:20 PM
With: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in the [**Company 191**] POST [**Hospital 894**] CLINIC Phone:
[**Telephone/Fax (1) 2010**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: CARDIAC SERVICES
When: WEDNESDAY [**2194-5-21**] at 11:40 AM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Chronic combined systolic and diastolic heart failure,Venous (peripheral) insufficiency, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Atrial fibrillation,Long-term (current) use of anticoagulants,Chronic airway obstruction, not elsewhere classified,Lumbosacral spondylosis without myelopathy,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Automatic implantable cardiac defibrillator in situ,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Personal history of venous thrombosis and embolism,Family history of malignant neoplasm of trachea, bronchus, and lung'}


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: Planned admission of aspirin desensitization.

PRESENT ILLNESS: 81 yo M being admitted to CCU for aspirin desensitization prior
to RLE angiogram scheduled for [**5-9**]. He has been having
worsening RLE pain with ambulation that is partially relieved by
rest. A CT angiogram was performed showing significant arterial
disease. Given his PAD and CAD, it is important for him to be on
aspirin, but he has been resistant to this. He was reportedly
told by his physicians in [**Country 532**] to never again take aspirin,
and this is for unclear reasons. Given his need for
intervention, as well as worsening CAD and PAD, he is electively
admitted to the CCU for aspirin desensitization.
.
On arrival to the floor, patient is feeling well and has no
complaints.

MEDICAL HISTORY: # PAD
# Chronic LLE DVT
# Chronic venous insufficiency
# S/P LCFV stenting
# CAD s/p LAD stenting
# Systolic and diastolic heart failure (EF 45-50%)
# HTN
# ICD for VF during stress test
# PAF (on dabigatran)
# Severe COPD
# SDH s/p craniotomy
# BPH
# Chronic LBP with lumbar DJD, s/p multiple injections
# OA

MEDICATION ON ADMISSION: ALBUTEROL SULFATE - (Prescribed by Other Provider) - 90 mcg HFA
Aerosol Inhaler - 1-2 puffs INH Q 6 hours as needed for SOB,
wheezing
ALPRAZOLAM - 0.25 mg Tablet - 1 Tablet(s) by mouth daily
AMITRIPTYLINE - 25 mg Tablet - 1 Tablet(s) by mouth daily at
bedtime
DABIGATRAN ETEXILATE [PRADAXA] - 150 mg Capsule - 1 Capsule(s)
by mouth twice daily
FLUTICASONE-SALMETEROL [ADVAIR HFA] - (Prescribed by Other
Provider: [**Name Initial (NameIs) **]) - 230 mcg-21 mcg/Actuation HFA Aerosol
Inhaler - 2 puffs inhaled twice daily
FUROSEMIDE - 20 mg Tablet - 1 Tablet(s) by mouth once a day as
needed for as needed for edema
GABAPENTIN - 300 mg Capsule - [**1-20**] Capsule(s) by mouth three
times daily
LISINOPRIL - (On Hold from [**2194-3-25**] to unknown for pt reports
low BP at home, lisinopril on hold due to this, he will discuss
with cardiology next month) - 2.5 mg Tablet - 1 Tablet(s) by
mouth once a day
MECLIZINE - 12.5 mg Tablet - 1 Tablet(s) by mouth daily
MONTELUKAST [SINGULAIR] - 10 mg Tablet - 1 Tablet(s) by mouth
once a day
NITROGLYCERIN [NITROSTAT] - 0.3 mg Tablet, Sublingual - 1
Tablet(s) sublingually for chest pain, repeat x2 with 5 minute
interval if needed
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 (One)
Capsule(s) by mouth once a day
OXYCODONE - 5 mg Tablet - 1-1.5 Tablet(s) by mouth up to four
times daily as needed for pain ** may cause sedation; 28 day
supply
PREDNISONE - 10 mg Tablet - 1 Tablet(s) by mouth once a day
SIMVASTATIN - 80 mg Tablet - 1 Tablet(s) by mouth daily at
bedtime
TRAZODONE - 50 mg Tablet - 1 Tablet(s) by mouth once a day
B COMPLEX VITAMINS - Capsule - 1 Capsule(s) by mouth daily
DOCUSATE SODIUM - 100 mg Capsule - 3 Capsule(s) by mouth daily
MAGNESIUM OXIDE - 420 mg Tablet - 1 Tablet(s) by mouth daily
SENNOSIDES - 8.6 mg Tablet - [**1-20**] Tablet(s) by mouth daily as
needed for constipation

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission-
GEN: well-appearing male in no acute distress
HEENT: Moist mucus membranes, PERRL
NECK: supple, no JVD
CV: RRR no murmurs, rubs, gallops
LUNGS: clear to auscultation bilaterally
ABD: soft, non tender, multiple palpable masses throught the
upper abdomen, non distended
EXT: no edema, varicose veins present
SKIN: warm and dry

FAMILY HISTORY: Father - lung cancer
Brother - lung cancer
No family history of early MI, arrhythmia, cardiomyopathies, or
sudden cardiac death; otherwise non-contributory.

SOCIAL HISTORY: Retired grocery store manager. Married, with two children.
Smoked for about a year in the [**2142**]. Drinks alcohol socially. 

### Response:
{'Atherosclerosis of native arteries of the extremities with intermittent claudication,Chronic combined systolic and diastolic heart failure,Venous (peripheral) insufficiency, unspecified,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Atrial fibrillation,Long-term (current) use of anticoagulants,Chronic airway obstruction, not elsewhere classified,Lumbosacral spondylosis without myelopathy,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Automatic implantable cardiac defibrillator in situ,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Personal history of tobacco use,Personal history of venous thrombosis and embolism,Family history of malignant neoplasm of trachea, bronchus, and lung'}
