CHIEF COMPLAINT: RLE pain

PRESENT ILLNESS: 68M with h/o hypertension, symptomatic SVTs controlled on
metoprolol, EtOH abuse, 80 pack year smoking history, presented
to [**Location (un) 56335**] Comm. Hosp in [**Location (un) 3844**] yesterday morning with
RLE pain, numbness to the toes, parasthesias, and pale/[**Doctor Last Name 352**]
appearing leg.  He denies any hisotry of PAD, claudication, or
rest pain.  He had no palpable pulses upon arrival to ED and his
leg was cold.  Patient had no chest pain, SOB, or palpitations.
Initial ECG showed SVT to 180s, broke with adenosine and 25 mg
diltiazem.  Subsequent ECG showed concerning STe in V3/V4, Trop
was .06 (indeterminate).  He was started on a Heparin drip and
was transferred to [**Hospital1 18**].
.
In [**Hospital1 18**] ED, initial VS were 97.4F 76/53, 84 16 96% on 2LNC.
Patient's pain was much improved.  ECG showed SR w/ RAD, < 0.5mm
STe V3-4 and new TwI in AVL, V2-6.  CT abd/pelv. with contrast
showed short segment occlusion of the right common femoral
artery but distally patent femorals. He was given 2L NS w/ SBP
increasing to mid 90s. He was continued on heparin gtt, received
Plavix 300mg, ASA 325mg, Levofloxacin 750mg, and zofran IV x1.
He was seen by vascular, felt to have acute RLE ischemia in
setting of "evolving MI", but since "the leg appears to be
improving clinically with the heparin drip...and foot does not
appear to be acutely threatened" recommended conservative
approach (heparin gtt).
.
On arrival to the floor, patient was afebrile with BP 98/60, HR
80, leg pain much improved.  He did not complain  of any chest
pain, SOB, palpitations.
.
On review of systems he reports chills. Pt denies any prior
history of stroke, TIA, deep venous thrombosis, pulmonary
embolism.
No excessive bleeding at the time of surgery.
No myalgias, joint pains, cough, hemoptysis, black stools or red
stools.
.
Pt denies recent fevers, chills or rigors.
Pt denies exertional buttock or calf pain, although does not
exert himself normally.
.
All of the other review of systems were negative.

MEDICAL HISTORY: ETOH abuse and withdrawal.
COPD
Pulmonary nodule
R tongue SCC dx [**3-/2161**] T1N0M0 s/p partial glossectomy [**6-/2161**]
HTN
GERD
isolated seizure in [**10-10**] (per OMR thought to be [**2-3**] EtOH)
SVT

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - 97.5F, 99/75 81 22 95% on 2LNC.
Gen: NAD, cachectic, awake, alert, able to maintain attn.
HEENT: NC/AT. Sclera anicteric. Conjunctiva pale. no cyanosis of
the oral mucosa. No xanthalesma.
Neck: Supple, unable to assess JVP 2/2 neck surgery.
CV: distant heart sounds. RR. No m/r/g. No S3 or S4.
Chest: barrel chested. resp unlabored. end exp. wheezes.
Abd: Soft, NT/ND. No abdominial bruits.
Ext: Right extremity without hair, warm to touch below the knee,
ashen colored, pulses detectable via dopllar, no edema,
sensation and movement intact.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: father died of CaP age 78
Mother died age [**Age over 90 **]
Two healthy brothers
no FH of H&N cancers

SOCIAL HISTORY: - Tobacco : 80 pack year history, quit 10 years ago
- ETOH: 1L vodka per week, last drink yeasterday
- Illicit drugs: none
Arterial embolism and thrombosis of lower extremity,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of tongue
Lower extremity embolism,Cardiac dysrhythmias NEC,Hypertension NOS,Chr airway obstruct NEC,Alcohol abuse-unspec,Other lung disease NEC,Hx of tongue malignancy
Admission Date:  [**2161-9-3**]              Discharge Date:   [**2161-9-11**]

Date of Birth:  [**2092-9-16**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2597**]
Chief Complaint:
RLE pain


Major Surgical or Invasive Procedure:
Cardiac and right lower extremity catheterization and
intervention
Right common femoral artery arteriotomy and embolectomy with
arteriotomy closure with saphenous vein patch.


History of Present Illness:
68M with h/o hypertension, symptomatic SVTs controlled on
metoprolol, EtOH abuse, 80 pack year smoking history, presented
to [**Location (un) 56335**] Comm. Hosp in [**Location (un) 3844**] yesterday morning with
RLE pain, numbness to the toes, parasthesias, and pale/[**Doctor Last Name 352**]
appearing leg.  He denies any hisotry of PAD, claudication, or
rest pain.  He had no palpable pulses upon arrival to ED and his
leg was cold.  Patient had no chest pain, SOB, or palpitations.
Initial ECG showed SVT to 180s, broke with adenosine and 25 mg
diltiazem.  Subsequent ECG showed concerning STe in V3/V4, Trop
was .06 (indeterminate).  He was started on a Heparin drip and
was transferred to [**Hospital1 18**].
.
In [**Hospital1 18**] ED, initial VS were 97.4F 76/53, 84 16 96% on 2LNC.
Patient's pain was much improved.  ECG showed SR w/ RAD, < 0.5mm
STe V3-4 and new TwI in AVL, V2-6.  CT abd/pelv. with contrast
showed short segment occlusion of the right common femoral
artery but distally patent femorals. He was given 2L NS w/ SBP
increasing to mid 90s. He was continued on heparin gtt, received
Plavix 300mg, ASA 325mg, Levofloxacin 750mg, and zofran IV x1.
He was seen by vascular, felt to have acute RLE ischemia in
setting of "evolving MI", but since "the leg appears to be
improving clinically with the heparin drip...and foot does not
appear to be acutely threatened" recommended conservative
approach (heparin gtt).
.
On arrival to the floor, patient was afebrile with BP 98/60, HR
80, leg pain much improved.  He did not complain  of any chest
pain, SOB, palpitations.
.
On review of systems he reports chills. Pt denies any prior
history of stroke, TIA, deep venous thrombosis, pulmonary
embolism.
No excessive bleeding at the time of surgery.
No myalgias, joint pains, cough, hemoptysis, black stools or red
stools.
.
Pt denies recent fevers, chills or rigors.
Pt denies exertional buttock or calf pain, although does not
exert himself normally.
.
All of the other review of systems were negative.

Past Medical History:
ETOH abuse and withdrawal.
COPD
Pulmonary nodule
R tongue SCC dx [**3-/2161**] T1N0M0 s/p partial glossectomy [**6-/2161**]
HTN
GERD
isolated seizure in [**10-10**] (per OMR thought to be [**2-3**] EtOH)
SVT

Social History:
- Tobacco : 80 pack year history, quit 10 years ago
- ETOH: 1L vodka per week, last drink yeasterday
- Illicit drugs: none

Family History:
father died of CaP age 78
Mother died age [**Age over 90 **]
Two healthy brothers
no FH of H&N cancers

Physical Exam:
VS - 97.5F, 99/75 81 22 95% on 2LNC.
Gen: NAD, cachectic, awake, alert, able to maintain attn.
HEENT: NC/AT. Sclera anicteric. Conjunctiva pale. no cyanosis of
the oral mucosa. No xanthalesma.
Neck: Supple, unable to assess JVP 2/2 neck surgery.
CV: distant heart sounds. RR. No m/r/g. No S3 or S4.
Chest: barrel chested. resp unlabored. end exp. wheezes.
Abd: Soft, NT/ND. No abdominial bruits.
Ext: Right extremity without hair, warm to touch below the knee,
ashen colored, pulses detectable via dopllar, no edema,
sensation and movement intact.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

Pertinent Results:
ADMISSION LABS:
.
[**2161-9-2**] 09:00PM BLOOD WBC-6.0 RBC-3.19* Hgb-10.7* Hct-32.7*
MCV-102* MCH-33.4* MCHC-32.7 RDW-17.7* Plt Ct-112*
[**2161-9-2**] 09:00PM BLOOD PT-12.8 PTT-64.8* INR(PT)-1.1
[**2161-9-2**] 09:00PM BLOOD Glucose-84 UreaN-29* Creat-0.8 Na-132*
K-3.8 Cl-97 HCO3-26 AnGap-13
[**2161-9-2**] 09:00PM BLOOD ALT-25 AST-67* CK(CPK)-72 AlkPhos-123
TotBili-0.7
[**2161-9-2**] 09:00PM BLOOD cTropnT-0.04*
[**2161-9-2**] 09:00PM BLOOD Calcium-8.1* Phos-4.7* Mg-1.8

PERTINENT RESULTS:
.
Trop .04>.04>.03
.
CT Contrast:
1. short segment occlusion of the right common femoral artery.
however the
visualized proximal right superficial and deep femoral arteries
are patent.
limited assessment of these arteries as this study only goes
down to the level
of the pubic symphysis.
2. extensive atherosclerotic disease of the intra-abdominal
vasculature.
.
CXR: Underlying obstructive lung disease. No acute pulmonary
process
.
DISCHARGE LABS:


Brief Hospital Course:
Mr. [**Known lastname **] was taken to the cardiac suite on [**2161-9-3**] to assess for
acute cardiac issues and was found to be negative for coronary
artery disease.  Cleared from a cardiac standpoint, he was taken
to the operating room on [**2161-9-4**] for a right common femoral
artery arteriotomy and embolectomy with arteriotomy closure with
saphenous vein
patch.  The operation proceeded without complication and Mr.
[**Known lastname **] was admitted to the floor thereafter.

His post-operative course was relatively uncomplicated.
Pertinent details, by system:

Neurologically, considering his heavy drinking history (up to 1
pint of hard liquor daily, as per patient and wife) he was put
on a [**Name (NI) 60563**] scale.  His vitals remained stable throughout his
hospitalization and showing only mild agitation which included
him attempting to climb out of bed at night in the first few
nights after his operation.  These episodes and his agitation
was treated at appropriate moments with ativan.  He was also
given a low-bed to prevent fall risk.  The [**Name (NI) 60563**] scale was
discontinued on POD 6 after several days of low score ratings,
no further episodes of agitation or acute symptoms of
withdrawal.

Cardiovascularly, he remained stable post-operatively.
Cardiology continued to follow his rythym abnormalities which
consisted of episodic runs of asymptomatic SVT.  They
recommended beta blocker therapy with metoprolol 25 mg daily.
He was also kept on heparin therapy post-operatively for a
bridge to coumadin.  This was eventually discontinued on POD 6
after TTE was negative for cardiac embolic source and patient
was deemed very high risk for anticoagulation therapy
considering his history of drinking and falls.  He was started
on high-dose aspirin daily.

From a rehabilitation standpoint, Mr. [**Known lastname **] was unsteady with
poor balance and a high fall risk during ambulation sessions
with physical therapy.  PT regarded it necessary for him to have
inpatient rehabilitation at a rehab hospital.  He was discharged
to rehab on POD 7 afebrile, vitals stable, in NAD, AAOx3 and
tolerating PO intake.

Discharge Medications:
1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain/fever.
7. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheeze / sob.
8. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
9. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
11. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic PRN
(as needed) as needed for dry eyes.
13. Augmentin 500-125 mg Tablet Sig: One (1) Tablet PO twice a
day for 5 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] health care center

Discharge Diagnosis:
1. Ischemic limb pain
2. Peripheral vascular disease


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were seen in the hospital for decreased blood flow to your
right foot because of a clot in one of your major leg arteries.


Your initial EKG showed some signs of a heart attack but a
cardiac catherization procedure did not show any evidence of
coronary disease.

You had surgery for the blood clot in your right leg, a
procedure called a femoral embolectomy.  The operation went well
and without complication.

In the coming days, please be sure to resume your home
medications and take any new medications as prescribed.  If you
have any questions, feel free to call the office.


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2161-9-28**] 11:15



Completed by:[**2161-9-11**]
{'Arterial embolism and thrombosis of lower extremity,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of tongue'}


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: RLE pain

PRESENT ILLNESS: 68M with h/o hypertension, symptomatic SVTs controlled on
metoprolol, EtOH abuse, 80 pack year smoking history, presented
to [**Location (un) 56335**] Comm. Hosp in [**Location (un) 3844**] yesterday morning with
RLE pain, numbness to the toes, parasthesias, and pale/[**Doctor Last Name 352**]
appearing leg.  He denies any hisotry of PAD, claudication, or
rest pain.  He had no palpable pulses upon arrival to ED and his
leg was cold.  Patient had no chest pain, SOB, or palpitations.
Initial ECG showed SVT to 180s, broke with adenosine and 25 mg
diltiazem.  Subsequent ECG showed concerning STe in V3/V4, Trop
was .06 (indeterminate).  He was started on a Heparin drip and
was transferred to [**Hospital1 18**].
.
In [**Hospital1 18**] ED, initial VS were 97.4F 76/53, 84 16 96% on 2LNC.
Patient's pain was much improved.  ECG showed SR w/ RAD, < 0.5mm
STe V3-4 and new TwI in AVL, V2-6.  CT abd/pelv. with contrast
showed short segment occlusion of the right common femoral
artery but distally patent femorals. He was given 2L NS w/ SBP
increasing to mid 90s. He was continued on heparin gtt, received
Plavix 300mg, ASA 325mg, Levofloxacin 750mg, and zofran IV x1.
He was seen by vascular, felt to have acute RLE ischemia in
setting of "evolving MI", but since "the leg appears to be
improving clinically with the heparin drip...and foot does not
appear to be acutely threatened" recommended conservative
approach (heparin gtt).
.
On arrival to the floor, patient was afebrile with BP 98/60, HR
80, leg pain much improved.  He did not complain  of any chest
pain, SOB, palpitations.
.
On review of systems he reports chills. Pt denies any prior
history of stroke, TIA, deep venous thrombosis, pulmonary
embolism.
No excessive bleeding at the time of surgery.
No myalgias, joint pains, cough, hemoptysis, black stools or red
stools.
.
Pt denies recent fevers, chills or rigors.
Pt denies exertional buttock or calf pain, although does not
exert himself normally.
.
All of the other review of systems were negative.

MEDICAL HISTORY: ETOH abuse and withdrawal.
COPD
Pulmonary nodule
R tongue SCC dx [**3-/2161**] T1N0M0 s/p partial glossectomy [**6-/2161**]
HTN
GERD
isolated seizure in [**10-10**] (per OMR thought to be [**2-3**] EtOH)
SVT

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - 97.5F, 99/75 81 22 95% on 2LNC.
Gen: NAD, cachectic, awake, alert, able to maintain attn.
HEENT: NC/AT. Sclera anicteric. Conjunctiva pale. no cyanosis of
the oral mucosa. No xanthalesma.
Neck: Supple, unable to assess JVP 2/2 neck surgery.
CV: distant heart sounds. RR. No m/r/g. No S3 or S4.
Chest: barrel chested. resp unlabored. end exp. wheezes.
Abd: Soft, NT/ND. No abdominial bruits.
Ext: Right extremity without hair, warm to touch below the knee,
ashen colored, pulses detectable via dopllar, no edema,
sensation and movement intact.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.

FAMILY HISTORY: father died of CaP age 78
Mother died age [**Age over 90 **]
Two healthy brothers
no FH of H&N cancers

SOCIAL HISTORY: - Tobacco : 80 pack year history, quit 10 years ago
- ETOH: 1L vodka per week, last drink yeasterday
- Illicit drugs: none 

### Response:
{'Arterial embolism and thrombosis of lower extremity,Other specified cardiac dysrhythmias,Unspecified essential hypertension,Chronic airway obstruction, not elsewhere classified,Alcohol abuse, unspecified,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of tongue'}
