CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85 year old
female with a past medical history of bilateral carotid
stenosis, coronary artery disease, status post left anterior
descending percutaneous intervention, hypertension,
hypercholesterolemia, who was admitted to the CCU for
monitoring following elective right internal carotid artery
percutaneous intervention.  The patient has initially been
evaluated in [**7-22**], for word finding difficulty and a left
facial droop and was found to have bilateral internal carotid
artery stenosis.  The patient has a history of significant
coronary artery disease, multiple medical problems and her
age.  She was referred for elective stent intervention of her
carotids as opposed to endarterectomy.  She had a magnetic
resonance scan - MRA of head and neck on [**2186-2-22**], which
showed a two right hemispheric microhemorrhages and right
subcortical small vessel ischemic disease.  During the stent
procedure, the patient required a Neo-Synephrine drip for
decreased blood pressure and Atropine times two for decreased
heart rate.  During the procedure, the patient was noted to
have an right posterior carotid AV fistula.

MEDICAL HISTORY: 1.  Peripheral vascular disease.
2.  Carotid stenosis bilaterally, ultrasound [**2-20**], bilateral
internal carotid artery stenosis of 70 to 90%.
3.  Cerebrovascular accident with small vessel disease. Known
facial droop, right hemispheric microhemorrhages.
4.  Coronary artery disease, [**11-20**], catheterization with a
left main 20% ostial stenosis, left anterior descending 80%
midstenosis, status post stent, diagonal 90% stenosis status
post stent, left circumflex 40% lesion at the OM1.  Ejection
fraction estimated to be 67% on a MUGA, ETT MIBI, that she
had in [**12-23**].  There was no nuclear defect, perfusion
defects, during the test.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Osteoporosis.
8.  Status post cataract surgery.
9.  Status post Zenker's diverticular repair.
10. Questionable history of dementia.

MEDICATION ON ADMISSION: 1.  Lopressor 12.5 mg p.o. twice a day.
2.  Aspirin 81 mg once daily.
3.  Univasc 7.5 mg one once daily and 15 mg q.p.m.
4.  Dyazide 12.5 mg once daily.
5.  Lipitor 10 mg once daily.
6.  Plavix 75 mg once daily.
7.  Fosamax 70 mg q.week.
8.  Multivitamin one once daily.
9.  Lactulose.

ALLERGIES: Intravenous pyelogram dye causes her to have
anaphylaxis.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone.  No tobacco use and rare
ETOH use.
Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Other late effects of cerebrovascular disease, facial weakness,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Peripheral vascular disease, unspecified,Anemia, unspecified
Ocl mlt bi art wo infrct,Facial weakness,Crnry athrscl natve vssl,Status-post ptca,Hypertension NOS,Pure hypercholesterolem,Osteoporosis NOS,Periph vascular dis NOS,Anemia NOS
Admission Date:  [**2186-4-6**]       Discharge Date:  [**2159-2-19**]


Service:

HISTORY OF PRESENT ILLNESS:  The patient is an 85 year old
female with a past medical history of bilateral carotid
stenosis, coronary artery disease, status post left anterior
descending percutaneous intervention, hypertension,
hypercholesterolemia, who was admitted to the CCU for
monitoring following elective right internal carotid artery
percutaneous intervention.  The patient has initially been
evaluated in [**7-22**], for word finding difficulty and a left
facial droop and was found to have bilateral internal carotid
artery stenosis.  The patient has a history of significant
coronary artery disease, multiple medical problems and her
age.  She was referred for elective stent intervention of her
carotids as opposed to endarterectomy.  She had a magnetic
resonance scan - MRA of head and neck on [**2186-2-22**], which
showed a two right hemispheric microhemorrhages and right
subcortical small vessel ischemic disease.  During the stent
procedure, the patient required a Neo-Synephrine drip for
decreased blood pressure and Atropine times two for decreased
heart rate.  During the procedure, the patient was noted to
have an right posterior carotid AV fistula.

PAST MEDICAL HISTORY:
1.  Peripheral vascular disease.
2.  Carotid stenosis bilaterally, ultrasound [**2-20**], bilateral
internal carotid artery stenosis of 70 to 90%.
3.  Cerebrovascular accident with small vessel disease. Known
facial droop, right hemispheric microhemorrhages.
4.  Coronary artery disease, [**11-20**], catheterization with a
left main 20% ostial stenosis, left anterior descending 80%
midstenosis, status post stent, diagonal 90% stenosis status
post stent, left circumflex 40% lesion at the OM1.  Ejection
fraction estimated to be 67% on a MUGA, ETT MIBI, that she
had in [**12-23**].  There was no nuclear defect, perfusion
defects, during the test.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Osteoporosis.
8.  Status post cataract surgery.
9.  Status post Zenker's diverticular repair.
10. Questionable history of dementia.

ALLERGIES:  Intravenous pyelogram dye causes her to have
anaphylaxis.

MEDICATIONS ON ADMISSION:
1.  Lopressor 12.5 mg p.o. twice a day.
2.  Aspirin 81 mg once daily.
3.  Univasc 7.5 mg one once daily and 15 mg q.p.m.
4.  Dyazide 12.5 mg once daily.
5.  Lipitor 10 mg once daily.
6.  Plavix 75 mg once daily.
7.  Fosamax 70 mg q.week.
8.  Multivitamin one once daily.
9.  Lactulose.

SOCIAL HISTORY:  She lives alone.  No tobacco use and rare
ETOH use.

PHYSICAL EXAMINATION:  At the time of presentation, she was
afebrile with a heart rate of 63, blood pressure 120/50 to
160/60, respiratory rate 16, oxygen saturation 99% on two
liters.  She is in no acute distress lying in bed.
Extraocular movements are intact.  The pupils are equal,
round, and reactive to light and accommodation.  Anicteric.
No bruit or jugular venous distention appreciated.  Heart is
regular rate and rhythm, S1 and S2, no murmurs, rubs or
gallops.  Her lungs are clear to auscultation bilaterally
posteriorly.  Abdomen with normoactive bowel sounds, soft,
nontender, nondistended.  Extremities - no cyanosis, clubbing
or edema.  Right leg immobilizer placed.  Her dorsalis pedis
were [**1-22**].  Her neurologic examination revealed cranial nerves
with the exception of her facial nerve were intact.  She has
flat nasolabial fold on the left side.  Normal upper and
lower extremity strength.

LABORATORY DATA:  On the day of admission, white blood cell
count 6.6, hematocrit 32.6, platelet count 291,000.  Total
cholesterol was 173, HDL 45, LDL 109.

ASSESSMENT:  This is an 81 year old female with a history of
coronary artery disease, peripheral vascular disease, carotid
artery stenosis, bilaterally, hypertension,
hypercholesterolemia, admitted to the CCU status post right
internal carotid artery stent.

1.  Neurology - The patient had stent, status post right
internal carotid artery stent.  She initially was on
Neo-Synephrine to maintain a blood pressure goal between 110
and 150.  She had q1hour neurological checks and then q2hour
neurological checks.  Initially, her Neo-Synephrine was
weaned off and the patient's blood pressure gradually rose to
approximately 160 to 170.  As a result, some very low dose
Nitroglycerin drip was started to try to keep her blood
pressure between 150 and 110.  The patient had hypotension
with blood pressure down to 70.  The Nitroglycerin drip was
stopped and Neo-Synephrine drip was started with blood
pressure up to as high as 200s. When all drips were stopped,
her blood pressure gradually came down to 120 to 130
systolic.  This was fairly soon after the stent had been
placed and the patient arriving in the CCU.  Overnight the
first hospital night, the patient was placed on a low dose of
Neo-Synephrine 0.1 to maintain her blood pressure between 110
to 120 with gradually being able to be weaned off the drip
and on the second hospital day, the Neo-Synephrine drip was
turned off.  The patient did not require any Atropine in the
CCU, however, she did have a symptomatic bradycardia going
down to mid 30s while she is sleeping, coming up to mid 40s
to 50s when being awakened.  On the neurologic examination,
there was no focality or any change in her examination from
her baseline which had the left nasolabial fold flattening.
However, the patient did seem to be confused the evening
status post the procedure and on day two on the [**2186-4-6**], the
patient had a CT of the head without contrast which showed no
definite hemorrhage. The results were reviewed with the
neurologist following along with the team, Dr. [**Last Name (STitle) 1774**].  On the
second day postprocedure, the patient was acting more
oriented and less confused.  Her confusion seemed to coincide
with the onset of night fall and possible disturbance of her
sleep/wake cycle.  The rest of her stay the patient had blood
pressure near goal being consistently in the 120s to 130s.
She was transferred to the floor and Step-Down Unit on [**Hospital Ward Name 121**]
Two for further monitoring.  The patient was seen by physical
therapy who felt the patient was a fall risk and recommended
for both feet physical therapy and occupational therapy and a
short term rehabilitation to optimize her functional capacity
before returning to living alone at home.

2.  Hematology - The night after the procedure the patient
had a right arterial and venous sheath in place for her
arterial line that was monitoring her blood pressure.  The
patient, despite having a leg immobilizer and numerous
discussions and explanations and exhortations to stay in bed,
attempted to get out of bed on the first night of her
admission, and was seen by house staff.  House staff and
nursing staff got the patient into bed.  Her groin
examination was stable with no bruit or hematoma, however, on
the next day, her hematocrit dropped to 26.3.  The patient
had two units of packed red blood cells transfused with her
hematocrit being 34.9 on the day of discharge.  Her CT of her
abdomen and pelvis showed no retroperitoneal hematoma.  This
examination was done on [**2186-4-7**].

3.  Blood pressure control - The patient will be discharged
on Univasc 7.5 mg twice a day and will follow-up with Dr.
[**First Name (STitle) **] in four to six weeks to have her blood pressure
medications adjusted possibly placing her back on her beta
blocker as well.

4.  Coronary artery disease - The patient was continued on
her Aspirin and now will be on Plavix for life long therapy.

5.  Infectious disease - The patient had a low grade
temperature maximizing at 100.5 on the day prior to
discharge.  She had urine and blood cultures sent, all of
which are no growth at the time of discharge.  As well, her
urinalysis was unremarkable.  She had no localizing symptoms
of temperature or fever. Her temperature is 100 temperature
maximum on the day of discharge.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1.  Bilateral carotid artery stenosis, status post right
internal carotid artery stenting.
2.  Significant coronary artery disease, status post left
anterior descending stenting.
3.  Hypertension.
4.  Hypercholesterolemia.
5.  Peripheral vascular disease.
6.  Mild dementia.
7.  Right facial droop seemingly due to an old stroke.

PROCEDURE:  Right internal carotid artery stent.

MEDICATIONS ON DISCHARGE:
1.  Univasc 7.5 mg p.o. twice a day.
2.  Artificial Tears one to two drops O.U. p.rn.
3.  Lactulose.
4.  Multivitamin.
5.  Lipitor 10 mg p.o. once daily.
6.  Plavix 75 mg p.o. once daily.
7.  Aspirin 325 mg p.o. once daily.
8.  Fosamax 70 mg q.week.

FOLLOW-UP:  The patient is to see Dr. [**First Name (STitle) **] in approximately
four weeks in follow-up appointment for this procedure and at
the same time to see her primary care physician.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3184**], M.D.  [**MD Number(1) 5211**]

Dictated By:[**Last Name (NamePattern1) 1659**]
MEDQUIST36

D:  [**2186-4-9**]  12:07
T:  [**2186-4-9**]  13:27
JOB#:  [**Job Number 105355**]
{'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Other late effects of cerebrovascular disease, facial weakness,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Peripheral vascular disease, unspecified,Anemia, 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: 

PRESENT ILLNESS: The patient is an 85 year old
female with a past medical history of bilateral carotid
stenosis, coronary artery disease, status post left anterior
descending percutaneous intervention, hypertension,
hypercholesterolemia, who was admitted to the CCU for
monitoring following elective right internal carotid artery
percutaneous intervention.  The patient has initially been
evaluated in [**7-22**], for word finding difficulty and a left
facial droop and was found to have bilateral internal carotid
artery stenosis.  The patient has a history of significant
coronary artery disease, multiple medical problems and her
age.  She was referred for elective stent intervention of her
carotids as opposed to endarterectomy.  She had a magnetic
resonance scan - MRA of head and neck on [**2186-2-22**], which
showed a two right hemispheric microhemorrhages and right
subcortical small vessel ischemic disease.  During the stent
procedure, the patient required a Neo-Synephrine drip for
decreased blood pressure and Atropine times two for decreased
heart rate.  During the procedure, the patient was noted to
have an right posterior carotid AV fistula.

MEDICAL HISTORY: 1.  Peripheral vascular disease.
2.  Carotid stenosis bilaterally, ultrasound [**2-20**], bilateral
internal carotid artery stenosis of 70 to 90%.
3.  Cerebrovascular accident with small vessel disease. Known
facial droop, right hemispheric microhemorrhages.
4.  Coronary artery disease, [**11-20**], catheterization with a
left main 20% ostial stenosis, left anterior descending 80%
midstenosis, status post stent, diagonal 90% stenosis status
post stent, left circumflex 40% lesion at the OM1.  Ejection
fraction estimated to be 67% on a MUGA, ETT MIBI, that she
had in [**12-23**].  There was no nuclear defect, perfusion
defects, during the test.
5.  Hypertension.
6.  Hypercholesterolemia.
7.  Osteoporosis.
8.  Status post cataract surgery.
9.  Status post Zenker's diverticular repair.
10. Questionable history of dementia.

MEDICATION ON ADMISSION: 1.  Lopressor 12.5 mg p.o. twice a day.
2.  Aspirin 81 mg once daily.
3.  Univasc 7.5 mg one once daily and 15 mg q.p.m.
4.  Dyazide 12.5 mg once daily.
5.  Lipitor 10 mg once daily.
6.  Plavix 75 mg once daily.
7.  Fosamax 70 mg q.week.
8.  Multivitamin one once daily.
9.  Lactulose.

ALLERGIES: Intravenous pyelogram dye causes her to have
anaphylaxis.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone.  No tobacco use and rare
ETOH use. 

### Response:
{'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Other late effects of cerebrovascular disease, facial weakness,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified essential hypertension,Pure hypercholesterolemia,Osteoporosis, unspecified,Peripheral vascular disease, unspecified,Anemia, unspecified'}
