CHIEF COMPLAINT: Ischemic right hand.

PRESENT ILLNESS: The patient was initially
evaluated in the Emergency Room.  He is a 63-year-old male
with blue index finger for three days.  He reports onset of
pain without changes in his index finger and right hand.  The
patient denies chest pain.

MEDICAL HISTORY: Coronary artery disease status post
angioplasty ten years ago, hypercholesterolemia.  Denies
diabetes, hypertension or stroke.

MEDICATION ON ADMISSION: 

ALLERGIES: Denied.

PHYSICAL EXAM: 

FAMILY HISTORY: There is a strong family history of
myocardial disease.  Father with a myocardial infarction
after the age of 50.

SOCIAL HISTORY: He is divorced.  He has four grown children.
He admits to two drinks per day and has smoked for 40 pack
years.
Arterial embolism and thrombosis of upper extremity,Pneumonia, organism unspecified,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Upper extremity embolism,Pneumonia, organism NOS,Pure hypercholesterolem,Crnry athrscl natve vssl,Status-post ptca
Admission Date: [**2140-6-28**]        Discharge Date:

Date of Birth:  [**2078-1-10**]        Sex:  M

Service:  VSU


CHIEF COMPLAINT:  Ischemic right hand.

HISTORY OF PRESENT ILLNESS:  The patient was initially
evaluated in the Emergency Room.  He is a 63-year-old male
with blue index finger for three days.  He reports onset of
pain without changes in his index finger and right hand.  The
patient denies chest pain.

PAST MEDICAL HISTORY:  Coronary artery disease status post
angioplasty ten years ago, hypercholesterolemia.  Denies
diabetes, hypertension or stroke.

FAMILY HISTORY:  There is a strong family history of
myocardial disease.  Father with a myocardial infarction
after the age of 50.

ALLERGIES:  Denied.

MEDICATIONS:  None.

SOCIAL HISTORY:  He is divorced.  He has four grown children.
He admits to two drinks per day and has smoked for 40 pack
years.

PHYSICAL EXAMINATION:  In the Emergency Room, 97.7, 88, 16,
149/96.  Oxygen saturation 96 percent on room air.  General
appearance:  Elderly white male in no acute distress.  HEENT
examination was unremarkable.  Neck supple.  Heart was a
regular rate and rhythm without murmur, rub or gallop.  Chest
with occasional wheeze with bronchial sounds in the left mid
lung fields.  Abdominal examination is benign.  Rectal
examination is guaiac negative.  Peripheral vascular
examination:  No edema.  Right hand with blue index finger.
Palpable radial pulse.

LABORATORY:  CBC 9.5, hematocrit 48.3, platelet count
231,000.  BUN 12, creatinine 0.8.  CK 87, troponin-I 0.01.

RADIOLOGY:  Chest x-ray:  Possible hazy opacity in the right
lower lobe likely represents early pneumonia.

ELECTROCARDIOGRAM:  Normal sinus rhythm without acute
ischemic changes.

HOSPITAL COURSE:  Patient's pulse examination showed a
palpable radial and palpable upper atrial pulse bilaterally
with sensation and motor intact.  Strength was [**5-25**].  Distal
pulses:  Femorals were 2 plus bilaterally with palpable
dorsalis pedis pulses bilaterally.  The right index finger
was bluish and tender on palpation.  Intravenous
heparinization was instituted which was negative for
intracardiac mass or thrombus.  The patient's left
ventricular cavity was normal in size and systolic function.
He underwent arteriogram with a right femoral approach.  A
thoracic aortogram demonstrated non-visualized right
vertebral artery.  The left vertebral artery was dominant and
enlarged.  Otherwise, the aortic arch had a normal
appearance, specifically without evidence for atherosclerotic
disease involving the right subclavian or innominate
arteries.  Attempts were made to access the innominate artery
and this was unsuccessful.  Eventually using a 5 French SOS
cath, access was obtained.  A guide wire was placed in the
axillary artery which catheter was advanced over the guide
wire which was removed.  The upper extremity arteriogram
demonstrated normal appearance of the subclavian and proximal
axillary artery.  The catheter was then advanced to the
axillary artery.  The remainder of the upper extremity was
interrogated which demonstrated two arteriovenous shunts at
about the site of the elbow, one involving the cephalic vein
and the other involving the brachial vein.  The remainder of
the upper extremity run-off demonstrated abrupt occlusion 11
cm before the radiocarpal joint.  This had an appearance of
an involved occlusion in the palmar arch field via the ulnar
artery which was without significant disease.  There was no
aneurysm or atherosclerotic disease identified to suggest a
source of embolus.

After reviewing these findings with Dr. [**Last Name (STitle) 1391**], it was
decided that a TPA infusion would be beneficial; therefore,
infusion was instituted.  The patient was transferred to the
Medical Intensive Care Unit for continued monitoring and care
while receiving his TPA infusion.  During the first 24 hours
of TPA therapy the groin wire was displaced and TPA was
stopped.  This showed improvement in the index finger.  The
patient continued to show improvement in the wound.  He was
continued on intravenous heparin.  Coumadization was
instituted on [**2140-6-30**], and he was transferred to the
regular nursing floor.  The patient was discharged to home in
stable condition when INR was therapeutic.  The patient was
discharged on post procedure five.  His heparin was
discontinued.  His INR was at 1.8.  He was discharged on a
Coumadin dose of 7.5 mg q. day.  He will follow up as
directed for continuing monitoring of his coags and
adjustment of his anticoagulation.

DISCHARGE MEDICATIONS:
1. Pentamidine 20 mg b.i.d.
2. Atorvastatin 10 mg q. day.
3. Metoprolol 25 mg b.i.d.
4. Coumadin 7.5 mg q. day.


DISCHARGE DIAGNOSES:  Ischemic right index finger secondary
to embolus, source not identified.

Status post radial artery lysis and angiogram.

FOLLOW UP:  Follow up with Dr. [**Last Name (STitle) 1391**] in two weeks.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2380**], [**MD Number(1) 2381**]

Dictated By:[**Last Name (NamePattern1) 2382**]
MEDQUIST36
D:  [**2140-7-4**] 12:53:25
T:  [**2140-7-4**] 13:43:08
Job#:  [**Job Number **]
{'Arterial embolism and thrombosis of upper extremity,Pneumonia, organism unspecified,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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: Ischemic right hand.

PRESENT ILLNESS: The patient was initially
evaluated in the Emergency Room.  He is a 63-year-old male
with blue index finger for three days.  He reports onset of
pain without changes in his index finger and right hand.  The
patient denies chest pain.

MEDICAL HISTORY: Coronary artery disease status post
angioplasty ten years ago, hypercholesterolemia.  Denies
diabetes, hypertension or stroke.

MEDICATION ON ADMISSION: 

ALLERGIES: Denied.

PHYSICAL EXAM: 

FAMILY HISTORY: There is a strong family history of
myocardial disease.  Father with a myocardial infarction
after the age of 50.

SOCIAL HISTORY: He is divorced.  He has four grown children.
He admits to two drinks per day and has smoked for 40 pack
years. 

### Response:
{'Arterial embolism and thrombosis of upper extremity,Pneumonia, organism unspecified,Pure hypercholesterolemia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
