CHIEF COMPLAINT: Bilateral carotid stenosis.

PRESENT ILLNESS: History of present illness
was obtained from the patient, who was reliable.

MEDICAL HISTORY: 1.  Hypertension.
2.  Coronary artery disease.
3.  Hyperlipidemia.
4.  Degenerative joint disease.

MEDICATION ON ADMISSION: 1.  Lopressor 50 mg.
2.  Nitro tabs 6.5 mg t.i.d.
3.  Cardia 180 mg q.d.
4.  Lipitor 20 mg q.d.
5.  Alprazolam 0.5 mg p.r.n.
6.  Cyclobenzaprine 10 mg h.s.
7.  Ibuprofen 600 mg b.i.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a 58-year-old male who is
married, former smoker, rate alcohol intake.  The patient
ambulates independently.
Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Ocl mlt bi art wo infrct,Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2168-11-7**]       Discharge Date:  [**2168-11-11**]

Date of Birth:   [**2110-2-26**]       Sex:  M

Service:  VASCULAR

CHIEF COMPLAINT:  Bilateral carotid stenosis.

HISTORY OF THE PRESENT ILLNESS:  History of present illness
was obtained from the patient, who was reliable.

[**Known firstname **] [**Known lastname 6955**] is a right-handed 58-year-old white male
with a history of hypertension and hyperlipidemia.  The
patient is a former smoker, who presents with a six-month
history of near syncopal episodes with positional changes and
visual changes bilaterally, "like water on oil effect."  They
are not associated with any other symptoms and the visual
symptoms are not associated with the near-syncopal episodes.
The patient saw his primary care physician, [**Name10 (NameIs) 1023**] auscultated
bilateral bruits.  He had a workup on the outside done and
MRI on [**2168-8-22**], which demonstrated disease bilaterally.
He was referred Dr. [**Last Name (STitle) 1391**] for surgical evaluation.  He
underwent an arteriogram on [**2168-11-7**], which demonstrated
the right internal carotid artery at the origin of 60% to 70%
and the left internal carotid artery had a 70% to 80% at the
origin.

REVIEW OF SYSTEMS:  Review of systems was positive for new
left frontal parietal headaches.  He denies syncope,
seizures, amaurosis, paresis, paralysis, or aphasia.  He has
a history of coronary artery disease with rare effort angina.
This usually describes anterior chest discomfort, relieved
with nitroglycerin times one.  The patient denies any
episodes of congestive heart failure, myocardial infarction,
murmur, shortness of breath, dyspnea on exertion, paroxysmal
nocturnal dyspnea, orthopnea, or edema.  The patient does
have occasional palpitations.  The patient denies DVT,
thrombophlebitis or claudication.

ALLERGIES:  The patient has no known drug allergies.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Coronary artery disease.
3.  Hyperlipidemia.
4.  Degenerative joint disease.

PAST SURGICAL HISTORY:  Previous surgeries included the
following:  Coronary angioplasty times two in [**2162**], and
angioplasty in [**2159**], tonsillectomy as a child.

The patient's cardiologist is Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] at [**Location (un) 1475**].
Phone #[**Telephone/Fax (1) 3183**].

MEDICATIONS ON ADMISSION:
1.  Lopressor 50 mg.
2.  Nitro tabs 6.5 mg t.i.d.
3.  Cardia 180 mg q.d.
4.  Lipitor 20 mg q.d.
5.  Alprazolam 0.5 mg p.r.n.
6.  Cyclobenzaprine 10 mg h.s.
7.  Ibuprofen 600 mg b.i.d.

SOCIAL HISTORY:  The patient is a 58-year-old male who is
married, former smoker, rate alcohol intake.  The patient
ambulates independently.

PHYSICAL EXAMINATION:  The patient is an alert and oriented
white male in no acute distress.  HEENT:  Examination was
unremarkable.  The right groin was clean, dry, and intact;
there was no hematoma.  Pulse examination shows intact pulses
bilaterally, carotid, brachial, radial, femoral, DP and PT.
The abdominal aorta is nonprominent.  He had a [**12-27**] bruit on
the right and a ??????% on the left.  He had no femoral bruits.
CHEST:  Chest was clear to auscultation.  HEART:  Heart
revealed regular rate and rhythm with normal S1 and S2; no
murmurs, gallops or rubs or extra heart sounds.  ABDOMEN:
Abdomen was benign.  BONE AND JOINT:  Examination was
unremarkable.  NEUROLOGICAL:  Examination was intact.

LABORATORY DATA:  Preoperative laboratory work included a CBC
with a white count of 8.2, hematocrit 43.6, platelet count
288, BUN 11, creatinine 0.9, potassium 3.9, PT/INR, PTT
normal.  The EKG showed a normal sinus rhythm with a normal
axis and a right bundle branch block with Q-waves in 3.
Chest x-ray showed right 6th and 7th rib fractures, old and
left 7th rib fracture, old.  There was no congestive heart
failure or infiltrates.

HOSPITAL COURSE:  The patient was admitted post angiogram to
the Vascular Unit.  The Department of Cardiology was
requested to see the patient for a preoperative evaluation
prior to undergoing elective endarterectomy.

Recommendations were to change metoprolol to 75 b.i.d.; begin
aspirin 325 mg q.d.; discontinue Cartia, begin Zestril 5 mg
q.d.; folate 800 mg q.d.  The patient underwent an exercise
Persantine thallium, which showed a large reversible defect
at the inferior wall.  He then underwent a cardiac
catheterization, revealing the following:  left ventricle
with EF 60%, no mitral regurgitation; left main trunk normal;
left anterior descending artery showed minimal luminal
irregularities; left circumflex showed minimal luminal
irregularities; right coronary artery was occluded with left
to right collaterization, same as previous cardiac
catheterization.

The patient was cleared for surgery.  He went on [**2168-11-10**].
He underwent a right carotid endarterectomy, without
complications.  He was transferred to the PACU in stable
condition.  He required Neo-Synephrine support.
Postoperatively, he was weaned overnight and on postoperative
day #1, he was transferred to the regular nursing floor.  He
was allowed to ambulate and Foley catheter was discontinued.
The patient was discharge in stable condition.  The wound was
clean, dry, and intact.  The patient was neurologically
intact.

DISCHARGE MEDICATIONS:
1.  Zestril 5 mg q.d.
2.  Lopressor 75 mg b.i.d.
3.  Aspirin 325 mg daily.
4.  Lipitor 40 mg q.d.

DISCHARGE DIAGNOSES:  Bilateral carotid disease, status post
right carotid endarterectomy, hypotension, perioperatively
corrected.  Coronary artery disease, status post left heart
catheterization.  No intervention.  Catheterization unchanged
from previous catheterization.




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

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

D:  [**2168-11-11**]  10:10
T:  [**2168-11-11**]  11:27
JOB#:  [**Job Number 36845**]
{'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: Bilateral carotid stenosis.

PRESENT ILLNESS: History of present illness
was obtained from the patient, who was reliable.

MEDICAL HISTORY: 1.  Hypertension.
2.  Coronary artery disease.
3.  Hyperlipidemia.
4.  Degenerative joint disease.

MEDICATION ON ADMISSION: 1.  Lopressor 50 mg.
2.  Nitro tabs 6.5 mg t.i.d.
3.  Cardia 180 mg q.d.
4.  Lipitor 20 mg q.d.
5.  Alprazolam 0.5 mg p.r.n.
6.  Cyclobenzaprine 10 mg h.s.
7.  Ibuprofen 600 mg b.i.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a 58-year-old male who is
married, former smoker, rate alcohol intake.  The patient
ambulates independently. 

### Response:
{'Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
