CHIEF COMPLAINT: Carotid Stenosis

PRESENT ILLNESS: 69yo M with HTN, Hyperlipidemia, diet controlled DM, ? TIA, now
s/p R carotid stent placement. Pt was well until 6months ago
where he reported an episode where a clock was shifting to the
right on the wall of his bedroom. He stood up and felt a little
"dizzy" or "unsteady." These symptoms resolved within 10
minutes. Pt also notes mild L sided hearing loss since [**Month (only) 404**],
however no tinnitus. He denies any transient visual loss or
scotomas. No tingling, numbness or weakness with these episodes.
Pt was told by opthalmologist several years ago that he had
"cholesterol in the back of his eye." Thus eliciting carotid
doppler evaluation revealing 71-90%stenosis in the mid right ICA
and a 50-70% stenosis in the left ICA. Pt was admitted for R ICA
stent placement.
Pt was without any complaints once brought the the CCU. SBP's
140's on Nitroglycerin drip. Denied any dysarthria, weakness,
numbness, paresthesias, HA, or visual changes.
ROS: denies F/C/NS, no wt loss, no cough, no SOB or CP, no
peripheral edema. no BRBPR/Melena, denies claudication, PND,
orthopnea. Can climb > 2 flights of stairs without difficulty at
baseline.

MEDICAL HISTORY: HTN
Hyperlipidemia
DM- diet controlled. am BG's 110 per pt report.
Traumatic glaucoma with cataract- s/p OS cataract removal.
s/p R shoulder basal cell carcinoma excision [**2149**]
.

MEDICATION ON ADMISSION: Lipitor 10 mg daily
Doxazosin 8 mg daily
Cozaar 100 mg daily
ASA 325 mg daily
MVI daily

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Vitals: T97, BP 153/90, HR 75, R 16, 98% RA
Ht: 6'2" Wt: 205 lbs
Gen: awake, alert, lying flat in bed, pleasant, conversant in
NAD.
HEENT: NCAT, EOM's full, smooth. R pupil 5-->3mm, afferent
pupillary defect. L 5-->4mm, no tonsillar exudates.
NECK: No bruits B, no thyromegaly
CV: nl S1 and S2, no MRG
PULM: CTA B
ABD: Soft, NT, ND, BS+, no HSM, non-pulsatile
Extrem: No CCE, 2+ DP, PT pulses
GROIN: no femoral bruit Bilat, no masses B, excellent peripheral
pulses.
NEURO: CN's II-XII intact, L APD as above, FST- [**4-21**] globally-
did not test hipflexors or knee F/E since pt is s/p femoral
artery cath. Sensory exam intact to light touch.

FAMILY HISTORY: brother- d.74 CAD, MI at 63yo
brother- d.60 CAD

SOCIAL HISTORY: Divorced, lives with girlfriend. Retired machinist. He has one
grown daughter who lives in [**Name (NI) 4565**]. Distant tobacco use >
25yrs ago. No ETOH. No illicits.
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of other malignant neoplasm of skin
Ocl crtd art wo infrct,Hypertension NOS,Pure hypercholesterolem,DMII wo cmp nt st uncntr,Hx-skin malignancy NEC
Admission Date:  [**2158-10-2**]              Discharge Date:   [**2158-10-3**]

Date of Birth:  [**2089-9-3**]             Sex:   M

Service: MEDICINE

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Carotid Stenosis

Major Surgical or Invasive Procedure:
Carotid Stent Placement


History of Present Illness:
69yo M with HTN, Hyperlipidemia, diet controlled DM, ? TIA, now
s/p R carotid stent placement. Pt was well until 6months ago
where he reported an episode where a clock was shifting to the
right on the wall of his bedroom. He stood up and felt a little
"dizzy" or "unsteady." These symptoms resolved within 10
minutes. Pt also notes mild L sided hearing loss since [**Month (only) 404**],
however no tinnitus. He denies any transient visual loss or
scotomas. No tingling, numbness or weakness with these episodes.
Pt was told by opthalmologist several years ago that he had
"cholesterol in the back of his eye." Thus eliciting carotid
doppler evaluation revealing 71-90%stenosis in the mid right ICA
and a 50-70% stenosis in the left ICA. Pt was admitted for R ICA
stent placement.
Pt was without any complaints once brought the the CCU. SBP's
140's on Nitroglycerin drip. Denied any dysarthria, weakness,
numbness, paresthesias, HA, or visual changes.
ROS: denies F/C/NS, no wt loss, no cough, no SOB or CP, no
peripheral edema. no BRBPR/Melena, denies claudication, PND,
orthopnea. Can climb > 2 flights of stairs without difficulty at
baseline.


Past Medical History:
HTN
Hyperlipidemia
DM- diet controlled. am BG's 110 per pt report.
Traumatic glaucoma with cataract- s/p OS cataract removal.
s/p R shoulder basal cell carcinoma excision [**2149**]
.


Social History:
Divorced, lives with girlfriend. Retired machinist. He has one
grown daughter who lives in [**Name (NI) 4565**]. Distant tobacco use >
25yrs ago. No ETOH. No illicits.

Family History:
brother- d.74 CAD, MI at 63yo
brother- d.60 CAD


Physical Exam:
Vitals: T97, BP 153/90, HR 75, R 16, 98% RA
Ht: 6'2" Wt: 205 lbs
Gen: awake, alert, lying flat in bed, pleasant, conversant in
NAD.
HEENT: NCAT, EOM's full, smooth. R pupil 5-->3mm, afferent
pupillary defect. L 5-->4mm, no tonsillar exudates.
NECK: No bruits B, no thyromegaly
CV: nl S1 and S2, no MRG
PULM: CTA B
ABD: Soft, NT, ND, BS+, no HSM, non-pulsatile
Extrem: No CCE, 2+ DP, PT pulses
GROIN: no femoral bruit Bilat, no masses B, excellent peripheral
pulses.
NEURO: CN's II-XII intact, L APD as above, FST- [**4-21**] globally-
did not test hipflexors or knee F/E since pt is s/p femoral
artery cath. Sensory exam intact to light touch.


Pertinent Results:
[**2158-9-14**]:
5.7> 15.3 < 178 140/ 105/ 17 INR=1.0
44 4.3/ 29 /1.0
.
EKG: NSR 60, nl axis, no q-waves, no ST segment changes.
.
Imaging:
.
[**2158-8-25**]: CT of the neck revealed an 80% stenosis of the
proximal
right ICA 16 mm from the origin and a 50% stenosis in the distal

left common carotid artery just before the bifurcation.
.
[**2158-8-1**]: Carotid Duplex series demonstrated heterogeneous
calcified plaquing in both carotid systems. There was a 71-90%
stenosis in the mid right ICA and a 50-70% stenosis in the left

ICA. Vertebral flow is antegrade bilaterally. And this was
significantly increased in the right ICA since a study done one

year previously.
.
Exercise Stress test- reportedly normal per pt. report
Head CT- "normal" per pt report, results not available- test was
ordered for L sided hearing loss.  \
.


Brief Hospital Course:
69yo M with HTN, Hyperlipidemia, diet controlled DM, ? TIA, now
s/p R carotid stent placement.
.
1) Carotid Stenosis-
Patient was given right ICA stent without complication. The
patient was monitored overnight in the CCU. Nitroglycerin drip
was used to maintain SBP's < 160, then titrated to off. Serial
neurological exams did not reveal any new deficits. L Afferent
pupillary defect is likely secondary to chronic low vision from
history of trauma-->cataract pt sustained as an adolescent.

The patient was started on clopidogrel 75mg daily and continued
on ASA 325 mg daily, Atorvastatin 10mg qhs, he was re-started on
losartan at time of discharge. A lipid panel was not drawn
during hospitalization and will be left to the discretion of the
patient's PCP if pt is at goal for lipid management.

The patient was scheduled to follow up with Dr. [**First Name (STitle) **] in 4
weeks with repeat carotid ultrasound and neurology follow-up.
.
2) Diabetes Mellitus-
Patient reported adequate control with diet, weight loss. He was
maintained on an insulin sliding scale and diabetic diet. We did
not check a hemoglobin A1C.
.
3) Cardiac- no known cardiac disease, reportedly normal cardiac
stress test. no anginal sx. However the patient has multiple
cardiac risk factors. He was continued on ASA, clopidogrel, [**Last Name (un) **],
atorvastatin, DM control.
.
4) Renal-
Patient had normal creatinine at baseline and was given
hydration for contrast (~125cc) periprocedure. Upon arrival in
the unit he was given 1 Liter NS.
Repeat creatinine the morning following procedure was stable.
.
5) Heme-
Normal baseline hct 44. Stable the morning post-procedure.


Medications on Admission:
Lipitor 10 mg daily
Doxazosin 8 mg daily
Cozaar 100 mg daily
ASA 325 mg daily
MVI daily


Discharge Medications:
1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
5. Doxazosin 8mg by mouth daily


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Carotid Stenosis

Secondary:
Hypertension
Hyperlipidemia


Discharge Condition:
Good.


Discharge Instructions:
You were diagnosed with carotid stenosis and had a carotid stent
placed.

You should take all of your medications as prescribed.
Especially aspirin and plavix- failure to do so could result in
a new clot forming in the stent, stroke, or even death.

Call Dr. [**Last Name (STitle) 17025**] or 911 if you experience any weakness,
numbness, tingling, slurred speech, chest pain or shortness of
breath.

Followup Instructions:
You should see Dr. [**First Name (STitle) **] in 4 weeks for follow up appointment.
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of other malignant neoplasm of skin'}


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: Carotid Stenosis

PRESENT ILLNESS: 69yo M with HTN, Hyperlipidemia, diet controlled DM, ? TIA, now
s/p R carotid stent placement. Pt was well until 6months ago
where he reported an episode where a clock was shifting to the
right on the wall of his bedroom. He stood up and felt a little
"dizzy" or "unsteady." These symptoms resolved within 10
minutes. Pt also notes mild L sided hearing loss since [**Month (only) 404**],
however no tinnitus. He denies any transient visual loss or
scotomas. No tingling, numbness or weakness with these episodes.
Pt was told by opthalmologist several years ago that he had
"cholesterol in the back of his eye." Thus eliciting carotid
doppler evaluation revealing 71-90%stenosis in the mid right ICA
and a 50-70% stenosis in the left ICA. Pt was admitted for R ICA
stent placement.
Pt was without any complaints once brought the the CCU. SBP's
140's on Nitroglycerin drip. Denied any dysarthria, weakness,
numbness, paresthesias, HA, or visual changes.
ROS: denies F/C/NS, no wt loss, no cough, no SOB or CP, no
peripheral edema. no BRBPR/Melena, denies claudication, PND,
orthopnea. Can climb > 2 flights of stairs without difficulty at
baseline.

MEDICAL HISTORY: HTN
Hyperlipidemia
DM- diet controlled. am BG's 110 per pt report.
Traumatic glaucoma with cataract- s/p OS cataract removal.
s/p R shoulder basal cell carcinoma excision [**2149**]
.

MEDICATION ON ADMISSION: Lipitor 10 mg daily
Doxazosin 8 mg daily
Cozaar 100 mg daily
ASA 325 mg daily
MVI daily

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Vitals: T97, BP 153/90, HR 75, R 16, 98% RA
Ht: 6'2" Wt: 205 lbs
Gen: awake, alert, lying flat in bed, pleasant, conversant in
NAD.
HEENT: NCAT, EOM's full, smooth. R pupil 5-->3mm, afferent
pupillary defect. L 5-->4mm, no tonsillar exudates.
NECK: No bruits B, no thyromegaly
CV: nl S1 and S2, no MRG
PULM: CTA B
ABD: Soft, NT, ND, BS+, no HSM, non-pulsatile
Extrem: No CCE, 2+ DP, PT pulses
GROIN: no femoral bruit Bilat, no masses B, excellent peripheral
pulses.
NEURO: CN's II-XII intact, L APD as above, FST- [**4-21**] globally-
did not test hipflexors or knee F/E since pt is s/p femoral
artery cath. Sensory exam intact to light touch.

FAMILY HISTORY: brother- d.74 CAD, MI at 63yo
brother- d.60 CAD

SOCIAL HISTORY: Divorced, lives with girlfriend. Retired machinist. He has one
grown daughter who lives in [**Name (NI) 4565**]. Distant tobacco use >
25yrs ago. No ETOH. No illicits. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified essential hypertension,Pure hypercholesterolemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of other malignant neoplasm of skin'}
