CHIEF COMPLAINT: elective admission for right coronary artery stent

PRESENT ILLNESS: 81 year old female with carotid artery stenosis, CAD, severe
PVD,
h/o bilateral CEA who presents with recurrent right carotid
artery stenosis, s/p ICA stent in [**2157**], now here for repeat
stent.
Pt is s/p bilateral CEA in [**2139**] (done at [**Hospital6 1130**]) following episode of right eye amaurosis fugax and
left
hand numbness/paresthesias.  Following CEAs, pt was followed
with
routine ultrasounds.  Patient underwent a right ICA stent for
re-stenosis in [**4-1**] without complication.  A routine CT done
this
past [**Month (only) 547**] revealed an 80-90% stenosis of the proximal right ICA
at or just distal to the stent tip.  The stent was otherwise
patent.  Her left proximal ICA had a 50% stenosis which was
virtually unchanged from [**2158-6-2**].  She is referred for a repeat
right carotid angiogram with possible intervention.
She was admitted today for angiography. She underwent repeat
stent to R ICA today.
Pt currently has no complaints. Specifically she denies any
neurologic deficits, including no weakness or numbness, no
lightheadedness/dizziness, pain, shortness of breath, chest
pain,
or other complaints.
REVIEW OF SYSTEMS:
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.
Denies recent fevers, chills or rigors. Denies exertional
buttock
or calf pain.  All of the other review of systems were negative.
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: 1. Carotid artery stenosis status post bilateral endarterectomy
in [**2139**] now with recurrent stenosis.
2. Chronic Obstructive Pulmonary Disease on home oxygen at 2.5L
at night.
3. Severe peripheral vascular disease.
4. Hypertension
5. Hyperlipidemia
6. Right renal artery stenosis
7. Abdominal aortic aneurysm
8. Status post left eye cataract surgery.
9. Right eye cataract (untreated)
10. History of panic attacks

MEDICATION ON ADMISSION: Celexa 30 mg daily
Nortriptyline 50 mg daily
Lopressor 25 mg [**Hospital1 **]
Cardizem 120 mg daily
Quinapril 40 mg daily
Zocor 20 mg daily
Spiriva 18 mcg 1 puff daily
Albuterol 90 mcg 2 puffs q 6 hours
ASA 325 mg daily

ALLERGIES: Amoxicillin

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: T 97.5, HR 90, BP 142/72, RR 20, O2 98% 2L
Gen: WDWN middle aged female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with no elevated JVP on exam.  Positive for
bilateral carotid bruits.
CV: PMI located in 5th intercostal space, midclavicular line.
RR,
normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.  Dopplerable DP and PT pulses
bilaterally.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 2+  Femoral 2+  Popliteal 2+  DP dop   PT dop
Left:  Carotid 2+  Femoral 2+  Popliteal 2+  DP dop   PT dop

FAMILY HISTORY: Her father died of a myocardial infarction at the age of 59.

SOCIAL HISTORY: She is widowed with five adult children.  She lives alone with
family nearby.  She used to smoke 2 packs per day for 40 years
and quit 18 years ago.  She also has a history of heavy alcohol
use and belongs to AA.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified cataract,Personal history of tobacco use,Family history of ischemic heart disease
Ocl crtd art wo infrct,Chr airway obstruct NEC,Periph vascular dis NOS,Crnry athrscl natve vssl,Hypertension NOS,Hyperlipidemia NEC/NOS,Cataract NOS,History of tobacco use,Fam hx-ischem heart dis
Admission Date:  [**2159-4-16**]              Discharge Date:   [**2159-4-17**]

Date of Birth:  [**2077-4-8**]             Sex:   F

Service: MEDICINE

Allergies:
Amoxicillin

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
elective admission for right coronary artery stent

Major Surgical or Invasive Procedure:
right coronary artery stent

History of Present Illness:
81 year old female with carotid artery stenosis, CAD, severe
PVD,
h/o bilateral CEA who presents with recurrent right carotid
artery stenosis, s/p ICA stent in [**2157**], now here for repeat
stent.
Pt is s/p bilateral CEA in [**2139**] (done at [**Hospital6 1130**]) following episode of right eye amaurosis fugax and
left
hand numbness/paresthesias.  Following CEAs, pt was followed
with
routine ultrasounds.  Patient underwent a right ICA stent for
re-stenosis in [**4-1**] without complication.  A routine CT done
this
past [**Month (only) 547**] revealed an 80-90% stenosis of the proximal right ICA
at or just distal to the stent tip.  The stent was otherwise
patent.  Her left proximal ICA had a 50% stenosis which was
virtually unchanged from [**2158-6-2**].  She is referred for a repeat
right carotid angiogram with possible intervention.
She was admitted today for angiography. She underwent repeat
stent to R ICA today.
Pt currently has no complaints. Specifically she denies any
neurologic deficits, including no weakness or numbness, no
lightheadedness/dizziness, pain, shortness of breath, chest
pain,
or other complaints.
REVIEW OF SYSTEMS:
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.
Denies recent fevers, chills or rigors. Denies exertional
buttock
or calf pain.  All of the other review of systems were negative.
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:
1. Carotid artery stenosis status post bilateral endarterectomy
in [**2139**] now with recurrent stenosis.
2. Chronic Obstructive Pulmonary Disease on home oxygen at 2.5L
at night.
3. Severe peripheral vascular disease.
4. Hypertension
5. Hyperlipidemia
6. Right renal artery stenosis
7. Abdominal aortic aneurysm
8. Status post left eye cataract surgery.
9. Right eye cataract (untreated)
10. History of panic attacks


Social History:
She is widowed with five adult children.  She lives alone with
family nearby.  She used to smoke 2 packs per day for 40 years
and quit 18 years ago.  She also has a history of heavy alcohol
use and belongs to AA.


Family History:
Her father died of a myocardial infarction at the age of 59.

Physical Exam:
PHYSICAL EXAMINATION:
VS: T 97.5, HR 90, BP 142/72, RR 20, O2 98% 2L
Gen: WDWN middle aged female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with no elevated JVP on exam.  Positive for
bilateral carotid bruits.
CV: PMI located in 5th intercostal space, midclavicular line.
RR,
normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.  Dopplerable DP and PT pulses
bilaterally.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 2+  Femoral 2+  Popliteal 2+  DP dop   PT dop
Left:  Carotid 2+  Femoral 2+  Popliteal 2+  DP dop   PT dop


Pertinent Results:
Pre Procedure labs dated [**2158-3-27**]:
WBC 6.6, HGB 13.9, HCT 42.0, PLT 186, INR 0.97, NA 140, K 4.0,
CL
99, CO2 33, BUN 9, CR 1.0

Brief Hospital Course:
Patient is an 81 year-old female with carotid artery stenosis,
CAD, severe PVD, h/o bilateral CEA who presents with recurrent
right carotid artery stenosis, now s/p right ICA stent without
complications.
.
1. Carotid Stenosis s/p ICA stent: Currently clinically stable
without any neurological deficits, with stable BP. All
hypertensive medications were initially held. They were
restarted on discharge. A cholesterol panel was sent and was
pending at time of discharge. Pt. was given fluids for renal
protection post-cath and for borderline low blood pressure. She
did not require pressors.
.
2. Htn - on quinapril, lopressor, cardizem at home.  These were
held for low BP after cath. Her BP stabalized and she was
restarted on her home meds on discharge.
.
3. CAD - continue outpt ASA, zocor, betablocker.
.
4. Depression - continue outpatient celexa, nortryptiline.
.
5. COPD - Continue outpt albuterol, spiriva, O2 PRN.
.
6. FEN - cardiac diet. Replete lytes.
.
7. Contact - [**Name (NI) **], [**Name (NI) **], phone # [**Telephone/Fax (1) 65888**].

Medications on Admission:
Celexa 30 mg daily
Nortriptyline 50 mg daily
Lopressor 25 mg [**Hospital1 **]
Cardizem 120 mg daily
Quinapril 40 mg daily
Zocor 20 mg daily
Spiriva 18 mcg 1 puff daily
Albuterol 90 mcg 2 puffs q 6 hours
ASA 325 mg daily


Discharge Medications:


1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily). Tablet, Delayed
Release (E.C.)(s)
2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 months: you must take this medication every day.
Disp:*30 Tablet(s)* Refills:*0*
3. Citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).
4. Nortriptyline 25 mg Capsule Sig: Two (2) Capsule PO DAILY
(Daily).
5. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
8. Quinapril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Cardizem 120 mg Tablet Sig: One (1) Tablet PO once a day.
10. Albuterol 90 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation Q6H (every 6 hours).


Discharge Disposition:
Home

Discharge Diagnosis:
primary:
carotid artery stenosis status post right carotid stent
Severe peripheral vascular disease.
Hypertension
Hyperlipidemia
carotid artery stenosis status post bilateral endarterectomy in
[**2139**]
Chronic Obstructive Pulmonary Disease on home oxygen at 2.5L at
night.
Right renal artery stenosis
.
secondary:
Abdominal aortic aneurysm
Status post left eye cataract surgery.
Right eye cataract (untreated)
History of panic attacks


Discharge Condition:
good.


Discharge Instructions:
You were admitted for an elective stent placement in your
carotid artery.
.
Please follow up with your appointments as below.
.
please take your medications as prescribed.
It is very important that you continue to take your plavix
everyday for 1 month
.
If you experience any lightheadness, fevers or chills or other
worrisome symptoms please seek medical attention.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1244**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2159-9-11**] 1:00
.
Please follow up with your primary care physician [**Last Name (NamePattern4) **] 2 weeks.
[**Last Name (LF) **],[**First Name3 (LF) 1575**] J. [**Telephone/Fax (1) 14655**]
.
You have an appointment with [**First Name8 (NamePattern2) 402**] [**Last Name (NamePattern1) 3100**] (Dr.[**Name (NI) 3101**]
nurse) on [**2159-4-26**] at 1pm. [**Last Name (LF) **],[**First Name3 (LF) **] A. [**Telephone/Fax (1) 4022**]
.



Completed by:[**2159-4-17**]
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified cataract,Personal history of tobacco use,Family history of ischemic heart disease'}


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: elective admission for right coronary artery stent

PRESENT ILLNESS: 81 year old female with carotid artery stenosis, CAD, severe
PVD,
h/o bilateral CEA who presents with recurrent right carotid
artery stenosis, s/p ICA stent in [**2157**], now here for repeat
stent.
Pt is s/p bilateral CEA in [**2139**] (done at [**Hospital6 1130**]) following episode of right eye amaurosis fugax and
left
hand numbness/paresthesias.  Following CEAs, pt was followed
with
routine ultrasounds.  Patient underwent a right ICA stent for
re-stenosis in [**4-1**] without complication.  A routine CT done
this
past [**Month (only) 547**] revealed an 80-90% stenosis of the proximal right ICA
at or just distal to the stent tip.  The stent was otherwise
patent.  Her left proximal ICA had a 50% stenosis which was
virtually unchanged from [**2158-6-2**].  She is referred for a repeat
right carotid angiogram with possible intervention.
She was admitted today for angiography. She underwent repeat
stent to R ICA today.
Pt currently has no complaints. Specifically she denies any
neurologic deficits, including no weakness or numbness, no
lightheadedness/dizziness, pain, shortness of breath, chest
pain,
or other complaints.
REVIEW OF SYSTEMS:
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.
Denies recent fevers, chills or rigors. Denies exertional
buttock
or calf pain.  All of the other review of systems were negative.
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: 1. Carotid artery stenosis status post bilateral endarterectomy
in [**2139**] now with recurrent stenosis.
2. Chronic Obstructive Pulmonary Disease on home oxygen at 2.5L
at night.
3. Severe peripheral vascular disease.
4. Hypertension
5. Hyperlipidemia
6. Right renal artery stenosis
7. Abdominal aortic aneurysm
8. Status post left eye cataract surgery.
9. Right eye cataract (untreated)
10. History of panic attacks

MEDICATION ON ADMISSION: Celexa 30 mg daily
Nortriptyline 50 mg daily
Lopressor 25 mg [**Hospital1 **]
Cardizem 120 mg daily
Quinapril 40 mg daily
Zocor 20 mg daily
Spiriva 18 mcg 1 puff daily
Albuterol 90 mcg 2 puffs q 6 hours
ASA 325 mg daily

ALLERGIES: Amoxicillin

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VS: T 97.5, HR 90, BP 142/72, RR 20, O2 98% 2L
Gen: WDWN middle aged female in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Neck: Supple with no elevated JVP on exam.  Positive for
bilateral carotid bruits.
CV: PMI located in 5th intercostal space, midclavicular line.
RR,
normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.
Chest: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by
palpation. No abdominial bruits.
Ext: No c/c/e. No femoral bruits.  Dopplerable DP and PT pulses
bilaterally.
Skin: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 2+  Femoral 2+  Popliteal 2+  DP dop   PT dop
Left:  Carotid 2+  Femoral 2+  Popliteal 2+  DP dop   PT dop

FAMILY HISTORY: Her father died of a myocardial infarction at the age of 59.

SOCIAL HISTORY: She is widowed with five adult children.  She lives alone with
family nearby.  She used to smoke 2 packs per day for 40 years
and quit 18 years ago.  She also has a history of heavy alcohol
use and belongs to AA. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Chronic airway obstruction, not elsewhere classified,Peripheral vascular disease, unspecified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Unspecified cataract,Personal history of tobacco use,Family history of ischemic heart disease'}
