CHIEF COMPLAINT: Right leg ischemic pain.

PRESENT ILLNESS: The patient is well known to
our  service.    She  is  an  85-year-old  white  female with
non-insulin-dependent   diabetes   mellitus,  chronic  atrial
fibrillation,  history  of  congestive  heart  failure.   She
underwent  a right femoral popliteal with revision leading to
a  right  CVA to distal AT with PTFE in [**Month (only) 404**] of last year.
She  has  been  doing  well  until this morning, when she was
awakened  with  sudden onset of lower anterior right leg foot
and  toe  pain.  The patient also noticed that her right foot
was  significantly  colder than the left.  She denies fevers,
chills,  cough,  and shortness of breath.  She was brought to
the emergency room for evaluation, where she underwent urgent
arteriography   and   then   admitted  for  further  vascular
intervention and care.

MEDICAL HISTORY: 1.  Type II diabetes mellitus, diet controlled.
2.  Chronic atrial fibrillation.
3.  History of congestive heart failure, compensated.
4.  Known mitral regurgitation.

MEDICATION ON ADMISSION: 1.  Enteric coated aspirin 81 mg q.d.
2.  Colace 100 mg b.i.d.
3.  Digoxin 0.25 mg q.d.
4.  Lisinopril 10 mg q.d.
5.  Lopressor 25 mg b.i.d.
6.  Coumadin 1 mg q.h.s.
7.  Pravachol 20 mg q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is nondrinker and nonsmoker.
Other complications due to other vascular device, implant, and graft,Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Comp-oth vasc dev/graft,Atrial fibrillation,CHF NOS,Mitral valve disorder,DMII wo cmp nt st uncntr
Service:                            Date:  [**2140-8-15**]


Surgeon:  [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], M.D.  [**MD Number(1) 6223**]

HISTORY  OF  THE  PRESENT  ILLNESS:    This is an 86-year-old
female   admitted  to  the  Vascular  Service  on  [**2140-8-9**].
Discharge date:  Pending.

CHIEF COMPLAINT:  Right leg ischemic pain.

HISTORY OF THE PRESENT ILLNESS:  The patient is well known to
our  service.    She  is  an  85-year-old  white  female with
non-insulin-dependent   diabetes   mellitus,  chronic  atrial
fibrillation,  history  of  congestive  heart  failure.   She
underwent  a right femoral popliteal with revision leading to
a  right  CVA to distal AT with PTFE in [**Month (only) 404**] of last year.
She  has  been  doing  well  until this morning, when she was
awakened  with  sudden onset of lower anterior right leg foot
and  toe  pain.  The patient also noticed that her right foot
was  significantly  colder than the left.  She denies fevers,
chills,  cough,  and shortness of breath.  She was brought to
the emergency room for evaluation, where she underwent urgent
arteriography   and   then   admitted  for  further  vascular
intervention and care.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Enteric coated aspirin 81 mg q.d.
2.  Colace 100 mg b.i.d.
3.  Digoxin 0.25 mg q.d.
4.  Lisinopril 10 mg q.d.
5.  Lopressor 25 mg b.i.d.
6.  Coumadin 1 mg q.h.s.
7.  Pravachol 20 mg q.d.

PAST MEDICAL HISTORY:
1.  Type II diabetes mellitus, diet controlled.
2.  Chronic atrial fibrillation.
3.  History of congestive heart failure, compensated.
4.  Known mitral regurgitation.

PAST  SURGICAL  HISTORY:      Right  bilateral knee pain with
nonreverse saphenous vein graft in [**2138-1-15**].  Right common
femoral  to AT bypass graft in [**2138-5-17**].  Right revision of
CVA to AT with patch angioplasty and interposition jump graft
of [**2138-7-18**].  Revision of the right SFA distal AT with
PTFE and balloon angioplasty of the proximal anastomosis done
on 6/[**2138**].

SOCIAL HISTORY:  The patient is nondrinker and nonsmoker.

PHYSICAL  EXAMINATION:    Examination revealed the following:
Vital   signs:     96.7,  70,  atrial  fibrillation,  172/66,
respiratory  rate  18,  oxygen  saturation  97%  on room air.
GENERAL:    This is a well appearing, thin, elderly female in
no acute distress.  Head, eyes, ears, nose, throat:  Positive
for  right  carotid  bruit.  Chest was clear to auscultation.
HEART:   Irregularly irregular rhythm.  ABDOMEN:  Examination
was  unremarkable.   EXTREMITIES:  Right foot colder than the
left.   Right foot has erythema and delayed capillary refill.
There  was  minimal  mottling.    PULSE:   Examination showed
palpable  femoral pulses bilaterally with absent pulses below
the  femorals  on  the right.  Palpable popliteal on the left
with triphasic DP and PT on the left.

LABORATORY  DATA:    Laboratory  data included the following:
White count was 10.2, hematocrit 44.1.

HOSPITAL  COURSE:  The patient was evaluated in the emergency
room  and  underwent  urgent  arteriogram, which demonstrated
aortoiliac  vessels  patent,  severe  disease in the profunda
with  segmental occlusion of the SFA on the right.  There was
no  filling  of the grafts.  The collaterals filled below the
knee  popliteal  and  there is filling of the tibial peroneal
trunk  and  collaterals  filling the entire tibial artery and
DP.    The insertion site of the graft is seen.  However, the
limb  is  not  threatened.  The patient was reversed with FFP
for  INR  of  3.0.  She was then placed on IV heparinization.
She  underwent,  on [**2140-8-11**], thrombectomy of the femoral AT
graft  and  jump  graft  to the AT with 6 mm PTFE.  She had a
palpable  right DP at the end of the procedure.  She was seen
by  the  Department  of  Cardiology prior to surgery and they
felt that no cardiac evaluation was indicated at this time.

Postoperatively,  she  was  transferred to the PACU in stable
condition.      She   was   hemodynamically  stable.    Pulse
examination   showed   a  palpable  DP  and  PT  bilaterally.
Incisions  were  clean, dry, and intact.  She continued to do
well,  and  she  was  transferred  to  the VICU for continued
monitoring and care.

On  postoperative  day  #1,  there  were no overnight events.
Pain  was well controlled.  Vital signs remained stable.  The
pulse   examination   remained   unchanged.     Postoperative
hematocrit  was  19.8.  The INR was 1.6 with PTT of 32.3, BUN
21,  creatinine  0.7.    The  IV  fluids  were  discontinued.
Overall  diet  was  begun.   The coagulations were monitored.
The  patient  began ambulation with a walker.  The Department
of Physical Therapy will evaluate the patient in anticipation
of discharge planning.

The remaining hospital course was unremarkable.

DISCHARGE   INSTRUCTIONS:    The  patient  will  continue  on
Coumadin.    Dosing  goal  INR for 2.5.  She should follow up
with Dr. [**Last Name (STitle) **] in two weeks' time.

DISCHARGE MEDICATIONS:
1.  Darvocet N 100 tablets one to two q.6h.p.r.n. pain.
2.  Vioxx 12.5 mg q.d. for heel pain.
3.  Ferrous sulfate 325 mg q.d.
4.  Colace 100 mg b.i.d.
5.  Pletal 100 mg b.i.d.
6.    Lopressor  12.5  mg  b.i.d.,  hold  for  systolic blood
pressure less than 100, heart rate less than 55.
7.  Lisinopril 10 mg q.d.
8.  Digoxin 0.25 mg q.d.
9.  Aspirin 81 mg q.d.
10. Pravastatin 20 mg q.d.

DISCHARGE DIAGNOSES:  Failed graft status post revision.




                          [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], M.D.  [**MD Number(1) 6223**]

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

MEDQUIST36

D:  [**2140-8-15**]  10:53
T:  [**2140-8-15**]  11:02
JOB#:  [**Job Number 30733**]


Name:  [**Known lastname 2703**], [**Known firstname 1911**]                         Unit No:  [**Numeric Identifier 5363**]

Admission Date:  [**2140-8-9**]       Discharge Date:  [**2140-8-17**]

Date of Birth:   [**2054-1-1**]       Sex:  F

Service:  VASCULAR S

ADENDUM:  The patient's discharge was held for arrhythmia,
rapid atrial fibrillation requiring adjustment in the cardiac
medications.  Digoxin was discontinued and Lopressor 12.5 mg
b.i.d. was begun with improvement in the rate control.  At
the time of discharge, the patient's ventricular was 80.  She
will be discharged on anticoagulation for her graft.  This
will be followed by Dr. [**First Name (STitle) **]; Email will be sent to him.
The patient will follow up with Dr. [**Last Name (STitle) **] in two weeks'
time.  At the time of discharge, the patient was in stable
condition.  The INR was 1.9.  She was on 1 mg Coumadin q.d.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1548**], M.D.  [**MD Number(1) 1549**]

Dictated By:[**Last Name (NamePattern1) 145**]
MEDQUIST36

D:  [**2140-8-17**]  10:56
T:  [**2140-8-17**]  11:26
JOB#:  [**Job Number 5364**]
{'Other complications due to other vascular device, implant, and graft,Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Right leg ischemic pain.

PRESENT ILLNESS: The patient is well known to
our  service.    She  is  an  85-year-old  white  female with
non-insulin-dependent   diabetes   mellitus,  chronic  atrial
fibrillation,  history  of  congestive  heart  failure.   She
underwent  a right femoral popliteal with revision leading to
a  right  CVA to distal AT with PTFE in [**Month (only) 404**] of last year.
She  has  been  doing  well  until this morning, when she was
awakened  with  sudden onset of lower anterior right leg foot
and  toe  pain.  The patient also noticed that her right foot
was  significantly  colder than the left.  She denies fevers,
chills,  cough,  and shortness of breath.  She was brought to
the emergency room for evaluation, where she underwent urgent
arteriography   and   then   admitted  for  further  vascular
intervention and care.

MEDICAL HISTORY: 1.  Type II diabetes mellitus, diet controlled.
2.  Chronic atrial fibrillation.
3.  History of congestive heart failure, compensated.
4.  Known mitral regurgitation.

MEDICATION ON ADMISSION: 1.  Enteric coated aspirin 81 mg q.d.
2.  Colace 100 mg b.i.d.
3.  Digoxin 0.25 mg q.d.
4.  Lisinopril 10 mg q.d.
5.  Lopressor 25 mg b.i.d.
6.  Coumadin 1 mg q.h.s.
7.  Pravachol 20 mg q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is nondrinker and nonsmoker. 

### Response:
{'Other complications due to other vascular device, implant, and graft,Atrial fibrillation,Congestive heart failure, unspecified,Mitral valve disorders,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
