CHIEF COMPLAINT: S/p Carotid Stent

PRESENT ILLNESS: Mr. [**Known lastname **] is a pleasant 77yo gentleman with h/o HTN, DM, and
hyperlipidemia who was incidentally found to have a carotid
bruit on routine examination by his PCP.  [**Name10 (NameIs) **] [**Name11 (NameIs) 8019**]
revealed total occlusion of his left proximal ICA and severe
stenosis of right proximal ICA.  CTA neck confirmed these
findings.  The patient denies any symptoms of transient
weakness, dysarthria, or numbness.  He does note a chronic
weakness in his left hand that has been present x years.
.
Mr. [**Known lastname **] [**Last Name (Titles) 1834**] stenting of his Right ICA earlier today.  He
received benadryl 25 IV, pepcid 20mg IV, solumedrol 60mg IV
prior to his procedure given his history of allergy to IV
contrast dye.  He is currently feeling well and without
complaints.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative except as noted above.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: Hypertension--borderline, recently diagnosed at Dr.[**Name (NI) 3101**]
office, not on any meds.
Hyperlipidemia.
Diabetes--no A1C available
Spinal stenosis status post repair with chronic back pain
History of bladder cancer.
History of appendectomy.
Peripheral [**Name (NI) 1106**] disease, asymptomatic carotid artery
disease.
Aortic stenosis, mild.
.
Cardiac Risk Factors: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
.
Cardiac History: CABG:  none
.
Percutaneous coronary intervention:  none
.
Pacemaker/ICD:  none

MEDICATION ON ADMISSION: Admits to poor compliance with his meds:
Plavix 75mg daily
Ultram 50mg PRN
Lescol 40mg daily
Protonix 40mg daily
Glipizide 5mg daily (rarely taking)
Metformin 500mg [**Hospital1 **] (often taking daily)
ASA 81mg daily
Robaxin 400mg daily

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: VS: T 98.5   81   165/80->131/66   19   96% RA
Gen: Pleasant elderly man in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of [**5-13**] cm.  No carotid bruits.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. +Systolic murmur at base. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is a questionable family history of premature coronary
artery disease or sudden death; reports his mother had heart
trouble, though she passed away in her 70s.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use; he admits to smoking in the distant past.  There is no
history of alcohol abuse.  He lives with his wife of 58 years
and his 21yo grandson.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Examination of participant in clinical trial,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Aortic valve disorders,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Esophageal reflux,Backache, unspecified,Other chronic pain,Personal history of malignant neoplasm of bladder
Ocl crtd art wo infrct,Exam-clincal trial,DMII wo cmp nt st uncntr,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Aortic valve disorder,Hyperlipidemia NEC/NOS,Periph vascular dis NOS,Esophageal reflux,Backache NOS,Chronic pain NEC,Hx of bladder malignancy
Admission Date:  [**2166-7-7**]              Discharge Date:   [**2166-7-9**]

Date of Birth:  [**2088-8-25**]             Sex:   M

Service: MEDICINE

Allergies:
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
S/p Carotid Stent

Major Surgical or Invasive Procedure:
Angiography with placement of carotid stent


History of Present Illness:
Mr. [**Known lastname **] is a pleasant 77yo gentleman with h/o HTN, DM, and
hyperlipidemia who was incidentally found to have a carotid
bruit on routine examination by his PCP.  [**Name10 (NameIs) **] [**Name11 (NameIs) 8019**]
revealed total occlusion of his left proximal ICA and severe
stenosis of right proximal ICA.  CTA neck confirmed these
findings.  The patient denies any symptoms of transient
weakness, dysarthria, or numbness.  He does note a chronic
weakness in his left hand that has been present x years.
.
Mr. [**Known lastname **] [**Last Name (Titles) 1834**] stenting of his Right ICA earlier today.  He
received benadryl 25 IV, pepcid 20mg IV, solumedrol 60mg IV
prior to his procedure given his history of allergy to IV
contrast dye.  He is currently feeling well and without
complaints.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative except as noted above.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
Hypertension--borderline, recently diagnosed at Dr.[**Name (NI) 3101**]
office, not on any meds.
Hyperlipidemia.
Diabetes--no A1C available
Spinal stenosis status post repair with chronic back pain
History of bladder cancer.
History of appendectomy.
Peripheral [**Name (NI) 1106**] disease, asymptomatic carotid artery
disease.
Aortic stenosis, mild.
.
Cardiac Risk Factors: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
.
Cardiac History: CABG:  none
.
Percutaneous coronary intervention:  none
.
Pacemaker/ICD:  none

Social History:
Social history is significant for the absence of current tobacco
use; he admits to smoking in the distant past.  There is no
history of alcohol abuse.  He lives with his wife of 58 years
and his 21yo grandson.

Family History:
There is a questionable family history of premature coronary
artery disease or sudden death; reports his mother had heart
trouble, though she passed away in her 70s.

Physical Exam:
VS: T 98.5   81   165/80->131/66   19   96% RA
Gen: Pleasant elderly man in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of [**5-13**] cm.  No carotid bruits.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. +Systolic murmur at base. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Left: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

Neuro: Language intact, appropriate.  EOMI, face symmetric,
tongue midline.  Strength 5/5 in UE proximally but distal UE
strength is mildly diminished (4+/5 in LUE) as compared with 5/5
in RUE.  Has muscle wasting of his left hand.  Distal strength
intact in LE b/l.  Sensation intact in UE and LE b/l.

Pertinent Results:
[**2166-7-8**] 04:55AM BLOOD Glucose-209* UreaN-24* Creat-1.5* Na-133
K-4.6 Cl-95* HCO3-26 AnGap-17
[**2166-7-9**] 06:30AM BLOOD Glucose-163* UreaN-31* Creat-1.7* Na-137
K-4.5 Cl-99 HCO3-30 AnGap-13

[**2166-7-8**] 01:00AM BLOOD CK(CPK)-47
[**2166-7-8**] 04:55AM BLOOD CK(CPK)-53

ECG ([**2166-7-7**])
Sinus rhythm. Non-specific lateral ST-T wave changes. Compared
to the
previous tracing of [**2162-7-19**] there is ST-T wave flattening in
lead I and
biphasic T wave in lead aVL. Otherwise, no diagnostic interim
change.

Carotid Cath ([**2166-7-7**])
COMMENTS:
1. Access: Retro RFA with catheter selective in RCCA
2. Aorta: Aortography revealed a Type 1 arch with anomalous
take-off of
the RSCA (posterior).
3. Carotid/vertebrals: The left CCA is patent. The [**Doctor First Name 3098**] is
occluded. The
RCCA is normal. The [**Country **] has an eccentric 90% lesion. The [**Country **]
fills the
ipsilateral ACA and MCA with noted cross filling of the
contralateral
ACA and MCA.
4. Successful PTA/stent of right ICA with a 6-8mm Protege RX
stent and
posted with a 4.0mm balloon. Excellent result with normal flow
down
vessel and no residual stenosis. No neurological symptoms during
procedure.  Patient left cathlab in stable condition.
FINAL DIAGNOSIS:
1. Severe 90% stenosis of right ICA.
2. Successful PTA/stent of right ICA with a 6-8mm
self-expandable stent
posted with a 4.5mm balloon.


Brief Hospital Course:
77yo man incidentally found to have severe carotid
atherosclerosis admitted following elective stenting of his
right ICA.

1. Carotid atherosclerosis:
Pt tolerated the procedure well.  His ASA (increased to 325 mg),
plavix, and statin (atorvastatin used in-house) were continued.
He was started on a low dose beta blocker and ACE I, and his
blood pressure was maintained at a goal of SBP 100-160.  Neuro
checks throughout hospital course were unremarkable, and pt
remained asymptomatic.

2. Diabetes [**Name (NI) **]
Pt reports poor compliance with oral hypoglycemics at baseline.
He was given 2 doses of solumedrol, once before and once after
the procedure, for his dye allergy.  The following morning, his
fingerstick glucoses spiked into the 400s.  Insulin by IV was
given and sliding scale tightened with substantial improvement
in his FSGs by evening.  He was kept overnight for monitoring
with subsequent FSGs in the 100s.  Pt to resume oral
hypoglycemics on [**2166-7-10**], 48 hours after the dye load.

3. Chronic renal insufficiency.
Pt has a baseline Cr of 1.4, increased after dye load.  He
reported good urine output during hospital stay and will have
f/u labs done at his next PCP appointment to check his renal
function.

Medications on Admission:
Admits to poor compliance with his meds:
Plavix 75mg daily
Ultram 50mg PRN
Lescol 40mg daily
Protonix 40mg daily
Glipizide 5mg daily (rarely taking)
Metformin 500mg [**Hospital1 **] (often taking daily)
ASA 81mg daily
Robaxin 400mg daily

Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Ultram  Oral
3. Lescol 40 mg Capsule Sig: One (1) Capsule PO once a day.
4. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Robaxin  Oral
7. Glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.
8. Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day:
***Please do not start again until Thursday, [**7-10**]***.
9. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Disp:*30 Tablet Sustained Release 24 hr(s)* Refills:*2*
11. Outpatient Lab Work
Please draw patient's potassium, BUN, and creatinine at his
office visit with Dr. [**Last Name (STitle) 17025**] on [**2166-7-16**].


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:  Carotid atherosclerosis
Secondary Diagnoses:  Hypertension, diabetes [**Date Range **], chronic
renal insufficiency, iodine allergy


Discharge Condition:
Vital signs stable with appropriate follow-up arranged.


Discharge Instructions:
You were admitted for an elective placement of a stent to keep
open one of the arteries to your head.  You tolerated the
procedure well.

1. Please take all medications as prescribed.  Note that the
following medication changes were made during your stay:
- you were started on lisinopril 5mg daily
- you were started on metoprolol succinate 25mg daily
- we gave you a prescription for aspirin 325mg daily
- you should not take your metformin or glipizide until Thursday
morning, [**7-10**]

2. Please attend all follow-up appointments listed below.

3. Please call your doctor or return to the hospital if you
develop chest pain, shortness of breath, sudden weakness or
numbness or difficulty speaking, lightheadedness, fevers, or any
other concerning symptom.

Followup Instructions:
We scheduled you an appointment to see Dr. [**Last Name (STitle) 17025**] on
Wednesday, [**7-16**] at 2:15pm.  Be sure to bring your medications
with you.  You should also bring the prescription for lab work
with you so that Dr. [**Last Name (STitle) 17025**] knows to draw your blood to
check your kidney function and potassium levels.

We also scheduled you to see Dr.[**Name (NI) 3101**] nurse practitioner on
[**2166-7-22**] at 11am.  [**Hospital Ward Name 23**] building, [**Location (un) 436**].  Call
[**Telephone/Fax (1) 62**] with questions.

Please be sure to attend all previously scheduled appointments:
Provider: [**Name10 (NameIs) **] STUDY Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2166-9-2**]
9:30
Provider: [**Last Name (NamePattern5) 7224**], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 62**] Date/Time:[**2166-9-2**]
10:30 ***This is Dr.[**Name (NI) 3101**] nurse practitioner**
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Examination of participant in clinical trial,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Aortic valve disorders,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Esophageal reflux,Backache, unspecified,Other chronic pain,Personal history of malignant neoplasm of bladder'}


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: S/p Carotid Stent

PRESENT ILLNESS: Mr. [**Known lastname **] is a pleasant 77yo gentleman with h/o HTN, DM, and
hyperlipidemia who was incidentally found to have a carotid
bruit on routine examination by his PCP.  [**Name10 (NameIs) **] [**Name11 (NameIs) 8019**]
revealed total occlusion of his left proximal ICA and severe
stenosis of right proximal ICA.  CTA neck confirmed these
findings.  The patient denies any symptoms of transient
weakness, dysarthria, or numbness.  He does note a chronic
weakness in his left hand that has been present x years.
.
Mr. [**Known lastname **] [**Last Name (Titles) 1834**] stenting of his Right ICA earlier today.  He
received benadryl 25 IV, pepcid 20mg IV, solumedrol 60mg IV
prior to his procedure given his history of allergy to IV
contrast dye.  He is currently feeling well and without
complaints.
.
On review of symptoms, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative except as noted above.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

MEDICAL HISTORY: Hypertension--borderline, recently diagnosed at Dr.[**Name (NI) 3101**]
office, not on any meds.
Hyperlipidemia.
Diabetes--no A1C available
Spinal stenosis status post repair with chronic back pain
History of bladder cancer.
History of appendectomy.
Peripheral [**Name (NI) 1106**] disease, asymptomatic carotid artery
disease.
Aortic stenosis, mild.
.
Cardiac Risk Factors: (+)Diabetes, (+)Dyslipidemia,
(+)Hypertension
.
Cardiac History: CABG:  none
.
Percutaneous coronary intervention:  none
.
Pacemaker/ICD:  none

MEDICATION ON ADMISSION: Admits to poor compliance with his meds:
Plavix 75mg daily
Ultram 50mg PRN
Lescol 40mg daily
Protonix 40mg daily
Glipizide 5mg daily (rarely taking)
Metformin 500mg [**Hospital1 **] (often taking daily)
ASA 81mg daily
Robaxin 400mg daily

ALLERGIES: Iodine; Iodine Containing

PHYSICAL EXAM: VS: T 98.5   81   165/80->131/66   19   96% RA
Gen: Pleasant elderly man in NAD, resp or otherwise. Oriented
x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple with JVP of [**5-13**] cm.  No carotid bruits.
CV: PMI located in 5th intercostal space, midclavicular line.
RR, normal S1, S2. +Systolic murmur at base. No S4, no S3.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. No crackles, wheeze,
rhonchi.
Abd: Obese, soft, NTND, No HSM or tenderness. No abdominial
bruits.
Ext: No c/c/e. No femoral bruits.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
Pulses:
Right: Carotid 2+ without bruit; Femoral 2+ without bruit; 2+ DP

FAMILY HISTORY: There is a questionable family history of premature coronary
artery disease or sudden death; reports his mother had heart
trouble, though she passed away in her 70s.

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use; he admits to smoking in the distant past.  There is no
history of alcohol abuse.  He lives with his wife of 58 years
and his 21yo grandson. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Examination of participant in clinical trial,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Aortic valve disorders,Other and unspecified hyperlipidemia,Peripheral vascular disease, unspecified,Esophageal reflux,Backache, unspecified,Other chronic pain,Personal history of malignant neoplasm of bladder'}
