CHIEF COMPLAINT: Ischemic left foot rest pain.

PRESENT ILLNESS: Obtained from the patient's wife
and computer records.  She was a reliable historian.

MEDICAL HISTORY: Coronary artery disease.  He had a
stress test done in [**Month (only) 216**] of this year, which was positive.
He underwent angioplasty with stent placement times two to
the left anterior descending coronary artery and angioplasty
with stent to the right coronary artery in [**Month (only) 216**] of this
year.  He was recatheterized on [**2146-9-20**] for elevated cardiac
enzymes.  He had patent stents at that time.  He has been a
diabetic since the age of 32 with triopathy.  Hypertension,
history of hip fractures secondary to motor vehicle accident
in [**2140**], osteomyelitis of the right fifth metatarsal head in
[**Month (only) **] of this year.  Hyponatremia, SIADH in [**Month (only) **] of
this year treated.  Peripheral vascular disease.

MEDICATION ON ADMISSION: Lantus 6 units q.h.s., Prandin 2
mg t.i.d. with meals, Humalog sliding scale at lunch,
Atenolol 25 mg q.d., aspirin 325 mg q.d. last dose was
stopped prior to his arteriogram.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is a fisherman, lobsterman.  He has had
transfusions in the past.  He has never smoked.  Occasional
beer.  He is married and lives with his wife.
Atherosclerosis of native arteries of the extremities with rest pain,Acute myocardial infarction of unspecified site, initial episode of care,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status
Ath ext ntv at w rst pn,AMI NOS, initial,Surg compl-heart,Crnry athrscl natve vssl,DMI wo cmp nt st uncntrl,Hypertension NOS,Status-post ptca
Admission Date:  [**2147-1-2**]       Discharge Date:  [**2147-1-14**]

Date of Birth:   [**2092-8-16**]       Sex:  M

Service:  VASCULAR

CHIEF COMPLAINT:  Ischemic left foot rest pain.

HISTORY OF PRESENT ILLNESS:  Obtained from the patient's wife
and computer records.  She was a reliable historian.

The patient is a 54 year-old white male with known coronary
artery disease, angioplasty and stent placement in [**Month (only) 216**] of
this year with diabetes, hypertension and history of SIADH.
He has known peripheral vascular disease and underwent a
right femoral AT bypass with flap in [**Month (only) **] of this year
who returns now with increasing left calf claudication and
rest pain times one week.  The patient was seen by Dr.
[**Last Name (STitle) 1391**] and Dr. [**Last Name (STitle) **] podiatry on [**2146-12-30**].  The patient is
scheduled for an outpatient arteriogram on [**2147-1-3**], but
because of increasing symptoms the patient is now admitted
for further evaluation and treatment.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  Lantus 6 units q.h.s., Prandin 2
mg t.i.d. with meals, Humalog sliding scale at lunch,
Atenolol 25 mg q.d., aspirin 325 mg q.d. last dose was
stopped prior to his arteriogram.

PAST MEDICAL HISTORY:  Coronary artery disease.  He had a
stress test done in [**Month (only) 216**] of this year, which was positive.
He underwent angioplasty with stent placement times two to
the left anterior descending coronary artery and angioplasty
with stent to the right coronary artery in [**Month (only) 216**] of this
year.  He was recatheterized on [**2146-9-20**] for elevated cardiac
enzymes.  He had patent stents at that time.  He has been a
diabetic since the age of 32 with triopathy.  Hypertension,
history of hip fractures secondary to motor vehicle accident
in [**2140**], osteomyelitis of the right fifth metatarsal head in
[**Month (only) **] of this year.  Hyponatremia, SIADH in [**Month (only) **] of
this year treated.  Peripheral vascular disease.

PAST SURGICAL HISTORY:  Open reduction and internal fixation
of hip in [**2140**], right superficial femoral artery to posterior
tibial with right saphenous vein graft in [**Month (only) **] of this
year.  Right fifth metatarsal head resection in [**Month (only) **] of
this year.  Right foot primary closure with advancement flap
in [**Month (only) **] of this year.

SOCIAL HISTORY:  He is a fisherman, lobsterman.  He has had
transfusions in the past.  He has never smoked.  Occasional
beer.  He is married and lives with his wife.

PHYSICAL EXAMINATION:  Temperature 100.7.  Pulse 90.
Respirations 16.  Blood pressure 140/90.  O2 sat 97% on room
air.  General appearence, alert, cooperative male in no acute
distress.  HEENT examination is unremarkable.  Pulse
examination shows intact carotids bilaterally.  The right
radial pulse is palpable.  The left is palpable, but
diminished in intensity.  The abdominal aorta is
nonprominent.  The femoral pulses are palpable bilaterally.
There are no carotid or femoral bruits.  Popliteals are
absent.  The dorsalis pedis and posterior tibial on the right
have dopplerable signal.  On the left absent signal.  Chest
examination lungs are clear to auscultation.  Heart is a
regular rate and rhythm without murmur.  Abdominal
examination is unremarkable.  Bone joint examination shows no
ankle edema.  The right foot is warm, pink with a yield fifth
metatarsal head incision.  The left foot is significantly
cooler from ankle distally with multiple red skin
discolorations on the dorsum of the foot.  There is severe
dependent ruber.  There is a dry gangrenous lesion on the
medial aspect of the first metatarsal head.

HOSPITAL COURSE:  The patient was prehydrated and Mucomyst
protocol was begun.  He underwent arteriogram on [**2147-1-3**],
which demonstrated normal aorta, iliac without significant
disease on the left, mild diffuse disease of the superficial
femoral artery and PFA.  The superficial femoral artery
occludes at the adductor canal, reconstitutes as AK popliteal
with moderate disease, BK popliteal has moderate disease with
significant proximal AT disease.  There is no proximal PT or
peroneal.  The AT occludes at the calf.  The PT reconstructs
above the ankle and continues at the arch.  Pulmonary consult
was placed prior to surgery to assess pulmonary risks with
chest x-ray findings of left lower lobe pneumonia.  They felt
that he had appropriate coverage with Levofloxacin and Flagyl
and there was a low suspicion for pulmonary embolus and there
was an effusion that should be tapped and cultured otherwise
was to proceed with planned surgery.  [**Last Name (un) **] was consulted to
follow the patient for his diabetic management during his
perioperative period.  The Prandin was discontinued and his
Lantus insulin was increased to 6 to 8 units at h.s. and
sliding scale premeals and at supper time were written for.

The patient's admitting sodium was 127, which was stabilized,
but he was covered perioperatively with Dexamethasone 4 mg
pre 2 mg post surgical procedure.  His insulin requirements
continued to require adjustment.  The patient underwent on
[**2147-1-6**] a right common femoral artery to posterior tibial
bypass graft in situ saphenous vein and angioscopy.  He
underwent an intraoperative TE, which showed global right
ventricular and left ventricular hypokinesis, moderate MR to
severe MR [**First Name (Titles) 151**] [**Last Name (Titles) 13223**].  The patient was transferred to
the PACU with a monophasic dorsalis pedis pulse in stable
condition.  His immediate postoperative electrocardiogram was
without changes, but cycled CKs were obtained.  The patient's
total CK peaked at 271 and defervesced in the next 48 hours
to 123.  His MB fractions were flat and were not done, but
his troponin levels peaked at 45 and defervesced 48 hours
later to 20.4.  During this period of time the patient
required inotropic support and nitroglycerin for after load
reduction.  Cardiology was consulted regarding elevated
enzymes and diminished cardiac index.  Their recommendations
were to diurese to keep the pulmonary wedge pressure less
then equal to 18.  Titrate dobutamine to maintain an adequate
cardiac output and index, hold beta blockers while on
Dobutamine, aspirin, continue intravenous heparin, cycle
electrocardiograms and CPK MBs.  Postoperative hematocrit was
37.2, BUN 47, creatinine 1.4, K 4.2.

The patient was transferred to the CICU for continued
hemodynamic inotropic support.  He required 2 units of packed
cells perioperatively.  He maintained his hematocrit above
30.  He is continued on perioperative Vancomycin, Levo and
Flagyl.  He remained in the CICU.  He was extubated on
postoperative day two.  His blood gas was 7.4, 42, 83, 27 and
0.  Hematocrit remained stable at 36.3 after transfusion.
BUN and creatinine remained stable.  The patient was
transferred to the regular nursing floor on [**2147-1-11**],
antibiotics were discontinued.  He was slow with ambulation
limited for weight bear.  He required adjustment in his
heparin dosing and Lopressor for adequate blood pressure
control and anticoagulation.  Prednisone was instituted 10 mg
q.a.m. and 5 q.p.m.  Anticoagulation was continued.
Coumadinization was begun on [**2147-1-11**].  The patient required
3 to 6 months of anticoagulation secondary to his myocardial
events.  He will require an echocardiogram in three months.
He was started on Lisinopril 2.5 mg q.d. for after load
reduction.  Physical therapy saw the patient.

At the time of discharge the patient was in stable condition.
Wounds were clean, dry and intact.  The patient is to follow
up with Dr. [**Last Name (STitle) 1391**] in two weeks time.  He should follow up
with his endocrinologist for continued management of his
adrenal insufficiency and his cardiologist regarding his
cardiac follow up.  Echocardiogram was done on [**1-10**], which
demonstrated ejection fraction of 20 to 25%.  Left atrium was
elongated, the right atrium and intraatrial septum was
moderately dilated.  The left ventricle was mild, symmetric
left ventricular hypertrophy, overall left ventricular
systolic function is severely depressed.  There is a large
thrombus seen in the left ventricle.  The resting regional
left ventricular wall motion abnormalities are seen in the
basilar anterior, which is hypokinetic, mid anterior, which
is hypokinetic.  Basal anteroseptal, which is hypokinetic.
Mid anteroseptal, which is hypokinetic.  Basal inferior
septal, which is hypokinetic.  Mid inferior septal, which is
hypokinetic.  Basal inferior, which is akinetic.  Mid
inferior was akinetic.  Basal infralateral, which is
akinetic.  Mid infralateral, which is akinetic.  Septal apex
is akinetic, inferior apex is akinetic, lateral apex is
akinetic and apex is dyskinetic.  Right ventricle shows
severe global right ventricular free wall hypokinesis.

DISCHARGE MEDICATIONS:  Lisinopril 2.5 mg q.d., Miconazole
powder 2% to peri area b.i.d. and prn.  Prednisone 5 mg po
q.p.m. 10 mg q.a.m., Propofol 50 mg b.i.d., insulin sliding
scale and fixed insulin please see enclosed flow sheet.
Slugrocortisone acetate 0.1 mg b.i.d., Darvocet N 100 one q 6
hours prn for pain, acetominophen 325 to 650 mg q 4 to 6
hours prn for pain, aspirin 325 mg q.d., Warfarin dose will
be adjusted and maintain an INR between 2.5 and 3.5.

DISCHARGE DIAGNOSES:
1.  Ischemic left foot status post left common femoral to
posterior tibial bypass in situ saphenous vein.
2.  Perioperative myocardial infarction treated, ejection
fraction 20 to 25%.
3.  Adrenal insufficiency treated on maintenance minimal
corticosteroids.
4.  Diabetes insulin dependent, stable.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4417**]

Dictated By:[**Last Name (NamePattern1) 1479**]
MEDQUIST36

D:  [**2147-1-13**]  08:55
T:  [**2147-1-13**]  09:06
JOB#:  [**Job Number 43866**]
{'Atherosclerosis of native arteries of the extremities with rest pain,Acute myocardial infarction of unspecified site, initial episode of care,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,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 left foot rest pain.

PRESENT ILLNESS: Obtained from the patient's wife
and computer records.  She was a reliable historian.

MEDICAL HISTORY: Coronary artery disease.  He had a
stress test done in [**Month (only) 216**] of this year, which was positive.
He underwent angioplasty with stent placement times two to
the left anterior descending coronary artery and angioplasty
with stent to the right coronary artery in [**Month (only) 216**] of this
year.  He was recatheterized on [**2146-9-20**] for elevated cardiac
enzymes.  He had patent stents at that time.  He has been a
diabetic since the age of 32 with triopathy.  Hypertension,
history of hip fractures secondary to motor vehicle accident
in [**2140**], osteomyelitis of the right fifth metatarsal head in
[**Month (only) **] of this year.  Hyponatremia, SIADH in [**Month (only) **] of
this year treated.  Peripheral vascular disease.

MEDICATION ON ADMISSION: Lantus 6 units q.h.s., Prandin 2
mg t.i.d. with meals, Humalog sliding scale at lunch,
Atenolol 25 mg q.d., aspirin 325 mg q.d. last dose was
stopped prior to his arteriogram.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: He is a fisherman, lobsterman.  He has had
transfusions in the past.  He has never smoked.  Occasional
beer.  He is married and lives with his wife. 

### Response:
{'Atherosclerosis of native arteries of the extremities with rest pain,Acute myocardial infarction of unspecified site, initial episode of care,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Unspecified essential hypertension,Percutaneous transluminal coronary angioplasty status'}
