CHIEF COMPLAINT: Elective admission for carotid angiography and possible
revascularization

PRESENT ILLNESS: (history given by daugther as pt is very hard of hearing)
83 y/o M w/ PMH of HTN, hyperlipidemia, DM type II
(diet-controlled), macular degeneration, hearing loss, and known
carotid disease w/ recent TIA who is being admitted for carotid
angiography tomorrow with likely revascularization. He was
diagnosed with carotid artery disease four years ago, described
as moderate on the right and mild on the left. He has been
asymptomatic until one month ago when he had a sudden onset of
disorientation and slurring of his speech that lasted several
minutes. He did not seek medical attention at the time. His wife
states that he went home, took a nap, and felt better when he
woke up. He has been free of neurological symptoms since this
event. He has no prior history of CAD, MI or claudication. He is
able to walk approximately one mile without difficulty. Denies
dizziness, lightheadedness or headaches. No h/o orthopnea, PND,
or SOB (per pt's daughter). By family report, he is AAOx3, and
very active and independent.

MEDICAL HISTORY: Tobacco use for 40 yrs
Hypertension
Hyperlipidemia
Diet controlled diabetes
Macular generation
Gout
Kyphoplasty for a compression fracture ([**12-8**])
Removal of skin cancer from behind his ear ([**9-8**])
Hard of hearing (bilateral hearing aids)

MEDICATION ON ADMISSION: Lipitor 10mg daily
Allopurinol 300mg daily
Nifedical 30mg daily
Lisinopril 20mg daily
Aspirin 81mg daily
Plavix 75mg daily - started Saturday
Colace
PreserVision two tablets daily
Fish oil 100mg two times a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.6, BP 116/66, HR 88, RR 20, sats 96% RA
Gen: Elderly male, hard of hearing, poor vision, in NAD.
HEENT: Sclera anicteric. MMM. Neck supple, no JVD. + carotid
bruit L vs radiating AS murmur (not heard on R though)
CV: RR, normal S1, S2. II/VI systolic murmur heard throughout
the precordium, but loudest at LUSB. ? radiates to carotid L vs.
carotid bruit.
Lungs: Fine crackles at bases bilaterally, otherwise clear
bilaterally.
Abd: Soft, NTND. + BS. No masses.
Ext: WWP, no c/c/e. 2+ DP/PT pulses bilaterally.
Skin: Tan, no rashes.
Neuro: CN II-XII grossly intact.

FAMILY HISTORY: Question of brothers having died of CAD/MI

SOCIAL HISTORY: Married, five children, 11 grandchildren. He and his wife live
half the year in [**Name (NI) 20338**], [**First Name3 (LF) 108**] and half the year in
[**Location (un) 14663**]. One of his daughters is a nurse [**First Name (Titles) **] [**Name (NI) 50345**].
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Aortic valve disorders,Anemia, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Gout, unspecified
Ocl crtd art wo infrct,Aortic valve disorder,Anemia NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Gout NOS
Admission Date:  [**2195-2-17**]              Discharge Date:   [**2195-2-20**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2704**]
Chief Complaint:
Elective admission for carotid angiography and possible
revascularization

Major Surgical or Invasive Procedure:
Catheterization with R ICA stent placement


History of Present Illness:
(history given by daugther as pt is very hard of hearing)
83 y/o M w/ PMH of HTN, hyperlipidemia, DM type II
(diet-controlled), macular degeneration, hearing loss, and known
carotid disease w/ recent TIA who is being admitted for carotid
angiography tomorrow with likely revascularization. He was
diagnosed with carotid artery disease four years ago, described
as moderate on the right and mild on the left. He has been
asymptomatic until one month ago when he had a sudden onset of
disorientation and slurring of his speech that lasted several
minutes. He did not seek medical attention at the time. His wife
states that he went home, took a nap, and felt better when he
woke up. He has been free of neurological symptoms since this
event. He has no prior history of CAD, MI or claudication. He is
able to walk approximately one mile without difficulty. Denies
dizziness, lightheadedness or headaches. No h/o orthopnea, PND,
or SOB (per pt's daughter). By family report, he is AAOx3, and
very active and independent.

Past Medical History:
Tobacco use for 40 yrs
Hypertension
Hyperlipidemia
Diet controlled diabetes
Macular generation
Gout
Kyphoplasty for a compression fracture ([**12-8**])
Removal of skin cancer from behind his ear ([**9-8**])
Hard of hearing (bilateral hearing aids)


Social History:
Married, five children, 11 grandchildren. He and his wife live
half the year in [**Name (NI) 20338**], [**First Name3 (LF) 108**] and half the year in
[**Location (un) 14663**]. One of his daughters is a nurse [**First Name (Titles) **] [**Name (NI) 50345**].


Family History:
Question of brothers having died of CAD/MI

Physical Exam:
VS: T 97.6, BP 116/66, HR 88, RR 20, sats 96% RA
Gen: Elderly male, hard of hearing, poor vision, in NAD.
HEENT: Sclera anicteric. MMM. Neck supple, no JVD. + carotid
bruit L vs radiating AS murmur (not heard on R though)
CV: RR, normal S1, S2. II/VI systolic murmur heard throughout
the precordium, but loudest at LUSB. ? radiates to carotid L vs.
carotid bruit.
Lungs: Fine crackles at bases bilaterally, otherwise clear
bilaterally.
Abd: Soft, NTND. + BS. No masses.
Ext: WWP, no c/c/e. 2+ DP/PT pulses bilaterally.
Skin: Tan, no rashes.
Neuro: CN II-XII grossly intact.


Pertinent Results:
Labs on admission:
WBC 6.0, Hgb 11.6*, Hct 33.6*, MCV 92, Plt 275
(DIFF: Neuts-51.0 Lymphs-41.1 Monos-5.8 Eos-1.9 Baso-0.2)
PT 12.1, PTT 26.4, INR(PT) 1.0
Fibrinogen 326
Na 138, K 4.8, Cl 102, HCO3 25, BUN 20, Cr 1.0, Glu 135
ALT 14, AST 22, AlkPhos 76
Calcium 9.5, Phos 3.8, Mg 1.7
.
Labs during hospitalization:
[**2195-2-18**] 09:50PM BLOOD CK(CPK)-45
[**2195-2-19**] 04:39AM BLOOD CK(CPK)-39
VitB12 236*, Folate 10.0
%HbA1c 6.4*
Triglyc 151*, HDL 42, CHOL/HD 4.2, LDLcalc 105, LDLmeas 127
TSH 3.8
.
Labs on discharge:
WBC 7.2, Hgb 9.4*, Hct 26.8*, MCV 93, Plt 223
Na 141, K 4.0, Cl 111, HCO3 23, BUN 16, Cr 0.9, Glu 102
Ca 8.5, Phos 3.4, Mg 2.0
.
Micro:
[**2195-2-19**] 01:39PM URINE Color-LtAmb Appear-Clear Sp [**Last Name (un) **]-1.020
Blood-LGE Nitrite-NEG Protein-30 Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-1 pH-5.0 Leuks-SM RBC-68* WBC-28*
Bacteri-FEW Yeast-NONE Epi-<1
.
[**2195-2-19**] 1:39 pm URINE

                            **FINAL REPORT [**2195-2-20**]**

   URINE CULTURE (Final [**2195-2-20**]):    NO GROWTH.
.
[**2195-2-18**] 7:00 am SEROLOGY/BLOOD
      RPR ADDED TO ACC#[**Serial Number 50346**]M [**2-18**] @ 13:00.

                            **FINAL REPORT [**2195-2-19**]**

   RAPID PLASMA REAGIN TEST (Final [**2195-2-19**]):
      NONREACTIVE.
      Reference Range: Non-Reactive.
.
Imaging:
[**2195-2-18**] MRI/MRA: 1) There is patency although significantly
decreased flow and diffuse narrowing within the entire right
internal carotid artery, with decreased flow also seen within
the right middle cerebral artery. 2) No evidence of acute
infarction. Diffuse white matter changes are present, consistent
with chronic microvascular infarctions.
.
[**2195-2-18**] CATH: XACT stent to R ICA (report pending)
.
[**2195-2-19**] ECHO: The left atrium is dilated. Left ventricular wall
thicknesses are normal. The left ventricular cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF 60-70%). No masses or thrombi are seen in the left
ventricle. There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
ascending aorta is moderately dilated. The aortic arch is mildly
dilated. There are focal calcifications in the aortic arch.
There are three aortic valve leaflets. The aortic valve leaflets
are moderately thickened. There is moderate aortic valve
stenosis. Moderate (2+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. Mild (1+) mitral regurgitation is seen. The tricuspid
valve leaflets are mildly thickened. There is mild pulmonary
artery systolic hypertension. There is no pericardial effusion.
Impression: moderate aortic stenosis; moderate aortic
regurgitation; normal left ventricular contractile function



Brief Hospital Course:
83yo M w/ known carotid artery disease and a recent TIA referred
for carotid angiography.
.
# CAROTID DISEASE: Mr. [**Known lastname 2970**] was electively admitted for carotid
angiography. He had carotid dopplers by his PCP which revealed
that he had an almost totally occluded R ICA, and
catheterization here confirmed that. He had a presumed TIA 1
month prior to his admission, which is what prompted the workup
for carotid stenosis. He had an MRI/MRA performed prior to his
procedure to r/o stroke and it showed diffuse white matter
changes, consistent with chronic microvascular infarctions, but
no acute stroke or bleed. Neuro followed him while he was in
house. On [**2195-2-18**], he had a R ICA stent placed. Post-procedure,
he required a neosynephrine gtt to keep his SBP >90. He was able
to be weaned from the neo gtt that evening, but his SBP dropped
to the 70s in the AM of [**2195-2-19**], and neo was restarted. He
remained on neo for another 24 hrs and was eventually weaned off
the neo gtt after receiving several boluses of IVF and
ambulating with nursing staff. He was never symptomatic with his
low BP. On day of discharge, his BP was in the 100s/60s at rest
and up to 130s with activity. He was discharged with the plan to
follow-up with Dr. [**First Name (STitle) **] next week, at which point his
anti-hypertensives will likely be restarted. Until then, he was
advised not to take any of his antihypertensives. He will
continue to take aspirin and plavix daily.
.
# ISCHEMIA: Mr. [**Known lastname 2970**] has no h/o MI or CAD by daughter's report.
He was continued on ASA and plavix for his carotid artery
disease.
.
# PUMP: Mr. [**Known lastname 2970**] had an ECHO by OSH records which showed an EF
of 65% with normal LV size and function. His ECHO report showed
moderate AS (peak 45, mean 27, valve area 1.0m2). An ECHO was
repeated during this admission to further evaluate his AS, as he
required IVF to help support his BP post-procedure. ECHO on
[**2195-2-19**] showed an EF of 60-70%, with a peak aortic gradient of
55mmHg and mean gradient of 29mmHg.
.
# RHYTHM: Post-procedure, Mr. [**Known lastname 2970**] remained in sinus
bradycardia, with mild prolongation of his PR interval (.210).
He was continually monitored on telemetry and had daily EKGs. He
had no arrhthymias, other than bradycardia at rest. His HR
increased appropriately with ambulation to the 80s-90s.
.
# HTN: His outpatient antihypertensive regimen of ACE-i and CCB
were held due to his hypotension post-procedure.
.
# DIABETES: He has a history of type II DM that he controls by
diet. He had not had a HgBA1C checked in years. He was put on FS
QID with HISS and his FS remained in good control, without a
need for insulin. A HgbA1C was checked and was 6.4%.
.
# ANEMIA: Mr. [**Known lastname 2970**] had anemia on admission (Hct of 33.6 on
admission -> 26 after IVF and his catheterization). He had no
source of active bleeding. His MCV was normal, B12 was slightly
low, and folate was normal. Iron studies were not checked. It
was recommended that he follow up with his PCP for [**Name Initial (PRE) **] workup of
his anemia. Without any previous labs on file here, it is
unclear if his anemia is chronic or acute. However, his Hct was
stable at 27 and he was asymptomatic from it, so an outpatient
workup was recommended.
.
# MACULAR DEGENERATION: He was continued on his outpatient dose
of PreserVision.
.
# GOUT: He was continued on his outpatient dose of allopurinol.

.
# FEN: He was given a regular cardiac, heart healthy diet. He
received IVF boluses to help keep his SBP >90. His electrolytes
were checked daily and were repleted to keep his K>4 and Mg>2.

.
# ACCESS: Peripheral IV
.
# PPX: Heparin SC, PPI, bowel regimen
.
# CODE: FULL (confirmed with wife, daughter on [**2195-2-17**]).
.
# DISPO: To home. Will follow-up with Dr. [**First Name (STitle) **] next week.


Medications on Admission:
Lipitor 10mg daily
Allopurinol 300mg daily
Nifedical 30mg daily
Lisinopril 20mg daily
Aspirin 81mg daily
Plavix 75mg daily - started Saturday
Colace
PreserVision two tablets daily
Fish oil 100mg two times a day


Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*90 Tablet(s)* Refills:*2*
6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*90 Tablet(s)* Refills:*2*
7. PreserVision 226-200-5 mg-unit-mg Capsule Sig: One (1)
Capsule PO QD ().
8. Omega-3 Fatty Acids 120-180-1.8 mg-mg-unit Capsule Sig: One
(1) Capsule PO BID (2 times a day).


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
R ICA stenosis
Anemia
.
Secondary diagnosis:
HTN
Hyperlipidemia
DM type II
Macular generation
Gout


Discharge Condition:
Good. Afebrile, BP 102/41, HR 50s at rest. BP 130s, HR 90s with
ambulation.


Discharge Instructions:
1. Please call your PCP or go to the nearest ER if you develop
fever, chills, shortness of breath, chest pain, chest pressure,
dizziness, lightheadedness, difficulty breathing, shortness of
breath, confusion, mental status changes, or any other worrisome
symptoms.
2. Please take all your new medications as prescribed.
3. Do not take your lisinopril or nifedipine (your blood
pressure medications) until further notice by Dr. [**First Name (STitle) **].
4. Please keep all your follow-up appointments.

Followup Instructions:
1. Please call Dr.[**Name (NI) 3101**] office to set up a follow-up
appointment next week. His office number is [**Telephone/Fax (1) 4022**].
2. Please follow-up with your PCP (either in [**State 108**] or here) in
[**2-7**] weeks. You are anemic and should have a workup for your
anemia, including a colonoscopy if you've never had one.
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Aortic valve disorders,Anemia, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Gout, unspecified'}


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 carotid angiography and possible
revascularization

PRESENT ILLNESS: (history given by daugther as pt is very hard of hearing)
83 y/o M w/ PMH of HTN, hyperlipidemia, DM type II
(diet-controlled), macular degeneration, hearing loss, and known
carotid disease w/ recent TIA who is being admitted for carotid
angiography tomorrow with likely revascularization. He was
diagnosed with carotid artery disease four years ago, described
as moderate on the right and mild on the left. He has been
asymptomatic until one month ago when he had a sudden onset of
disorientation and slurring of his speech that lasted several
minutes. He did not seek medical attention at the time. His wife
states that he went home, took a nap, and felt better when he
woke up. He has been free of neurological symptoms since this
event. He has no prior history of CAD, MI or claudication. He is
able to walk approximately one mile without difficulty. Denies
dizziness, lightheadedness or headaches. No h/o orthopnea, PND,
or SOB (per pt's daughter). By family report, he is AAOx3, and
very active and independent.

MEDICAL HISTORY: Tobacco use for 40 yrs
Hypertension
Hyperlipidemia
Diet controlled diabetes
Macular generation
Gout
Kyphoplasty for a compression fracture ([**12-8**])
Removal of skin cancer from behind his ear ([**9-8**])
Hard of hearing (bilateral hearing aids)

MEDICATION ON ADMISSION: Lipitor 10mg daily
Allopurinol 300mg daily
Nifedical 30mg daily
Lisinopril 20mg daily
Aspirin 81mg daily
Plavix 75mg daily - started Saturday
Colace
PreserVision two tablets daily
Fish oil 100mg two times a day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 97.6, BP 116/66, HR 88, RR 20, sats 96% RA
Gen: Elderly male, hard of hearing, poor vision, in NAD.
HEENT: Sclera anicteric. MMM. Neck supple, no JVD. + carotid
bruit L vs radiating AS murmur (not heard on R though)
CV: RR, normal S1, S2. II/VI systolic murmur heard throughout
the precordium, but loudest at LUSB. ? radiates to carotid L vs.
carotid bruit.
Lungs: Fine crackles at bases bilaterally, otherwise clear
bilaterally.
Abd: Soft, NTND. + BS. No masses.
Ext: WWP, no c/c/e. 2+ DP/PT pulses bilaterally.
Skin: Tan, no rashes.
Neuro: CN II-XII grossly intact.

FAMILY HISTORY: Question of brothers having died of CAD/MI

SOCIAL HISTORY: Married, five children, 11 grandchildren. He and his wife live
half the year in [**Name (NI) 20338**], [**First Name3 (LF) 108**] and half the year in
[**Location (un) 14663**]. One of his daughters is a nurse [**First Name (Titles) **] [**Name (NI) 50345**]. 

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Aortic valve disorders,Anemia, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Gout, unspecified'}
