CHIEF COMPLAINT: 

PRESENT ILLNESS: Mrs. [**Known lastname 39648**] is an 82 year-old
woman with a history of coronary artery disease and
angioplasty in [**2172**], diabetes mellitus and hypertension who
presents to the [**Hospital3 1443**] Hospital after a routine
check up at her primary care physician's office revealed
supraventricular tachycardia and some T wave changes
concerning for ischemic disease.  There she was evaluated for
acute myocardial infarction and cardioverted for her
dysrhythmia, although it was unclear whether the dysrhythmia
represented supraventricular tachycardia or atrial flutter
and fibrillation.  She was subsequently sent to the [**Hospital1 1444**] for cardiac catheterization.

MEDICAL HISTORY: 1.  Hypertension.  2.  Diabetes
mellitus.  3.  Percutaneous transluminal coronary angioplasty
in [**2172**] for coronary artery disease.  4.  Asthma and
bronchitis.  5.  Anemia.  6.  Scheduled for colonoscopy
shortly.  7.  Chronic renal insufficiency.  8.  Status post
appendectomy and cholecystectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Mrs. [**Known lastname 39648**] does not drink or smoke.  She
lives in [**Location 39649**] with her husband.  She has three children
with one daughter living nearby in the [**Name (NI) 86**] area.
Coronary atherosclerosis of native coronary artery,Iatrogenic cerebrovascular infarction or hemorrhage,Other specified cardiac dysrhythmias,Hemiplegia, unspecified, affecting unspecified side,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Iron deficiency anemia, unspecified,Asthma, unspecified type, unspecified,Family history of ischemic heart disease
Crnry athrscl natve vssl,Iatrogen CV infarc/hmrhg,Cardiac dysrhythmias NEC,Unsp hemiplga unspf side,DMII neuro nt st uncntrl,Neuropathy in diabetes,Iron defic anemia NOS,Asthma NOS,Fam hx-ischem heart dis
Admission Date:  [**2182-10-11**]       Discharge Date:  [**2182-10-16**]


Service:  NEUROLOGIC MEDICINE

NOTE:  The following admission history and physical is as
noted by Dr. [**First Name (STitle) **] with the Cardiovascular Service.  His
pager is [**Numeric Identifier 39647**].

HISTORY OF PRESENT ILLNESS:  Mrs. [**Known lastname 39648**] is an 82 year-old
woman with a history of coronary artery disease and
angioplasty in [**2172**], diabetes mellitus and hypertension who
presents to the [**Hospital3 1443**] Hospital after a routine
check up at her primary care physician's office revealed
supraventricular tachycardia and some T wave changes
concerning for ischemic disease.  There she was evaluated for
acute myocardial infarction and cardioverted for her
dysrhythmia, although it was unclear whether the dysrhythmia
represented supraventricular tachycardia or atrial flutter
and fibrillation.  She was subsequently sent to the [**Hospital1 1444**] for cardiac catheterization.

During the examination she had no chest pain, shortness of
breath, palpitations, nausea, vomiting or diarrhea.  There is
no abdominal pain or problems with her bowel control.

PAST MEDICAL HISTORY:  1.  Hypertension.  2.  Diabetes
mellitus.  3.  Percutaneous transluminal coronary angioplasty
in [**2172**] for coronary artery disease.  4.  Asthma and
bronchitis.  5.  Anemia.  6.  Scheduled for colonoscopy
shortly.  7.  Chronic renal insufficiency.  8.  Status post
appendectomy and cholecystectomy.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  1.  Lisinopril 20 mg po q day.  2.  Labetalol
100 mg po b.i.d.  3.  Verapamil SR 120 mg po q day.  4.
Dyazide 37.5/2.5 Monday and Thursday.  5.  Glipizide 10 po q
day.  6.  Somantadine 400 b.i.d.  7.  Fexofenadine 60 b.i.d.
 8.  Iron sulfate 325 mg b.i.d.  9.  Azthmacort b.i.d.  10.
Antevert 12.5 mg po b.i.d.  11.  Quinapril 150 po b.i.d. prn.
 12.  Enteric coated aspirin 325 mg po q day.  13.  Colace
100 mg po b.i.d.

SOCIAL HISTORY:  Mrs. [**Known lastname 39648**] does not drink or smoke.  She
lives in [**Location 39649**] with her husband.  She has three children
with one daughter living nearby in the [**Name (NI) 86**] area.

PHYSICAL EXAMINATION:  Vital signs weight 165.  Blood
pressure 148/54 to 167/62.  Heart rate between 83 and 95.
94% on room air.  Finger stick 109.  General, the patient is
a pleasant, elderly woman in no acute distress.  Head and
neck showed mucous membranes are moist.  Extraocular
movements intact.  Neck no JVD.  No lymphadenopathy.  Chest
with some bibasilar rales right greater then left.
Cardiovascular regular rhythm, regular rate, no murmurs.
Abdomen nontender, nondistended.  No organomegaly.
Extremities no clubbing, cyanosis or edema.  No carotid or
femoral bruits.  Neurological nonfocal.  Pupils are equal,
round and reactive to light.  Extraocular movements intact.

HOSPITAL COURSE:  Mrs. [**Known lastname 39648**] was admitted to the
Cardiovascular Service for cardiac catheterization.  Cardiac
catheterization revealed a 50% stenosis in the proximal right
coronary artery and a 30% stenosis in the distal circumflex
with diffusely diseased distal left anterior descending
coronary artery.  However, there was no flow limiting
stenoses appreciated.

Mrs.[**Hospital 39650**] hospital course was complicated by some left
sided weakness one day post cardiac catheterization.  This
history began on the [**5-13**] where she awoke at 2:00
a.m. after having gone to bed several hours earlier with new
onset of left sided weakness and left sided facial droop and
left sided neglect.  MR imaging study of the head revealed a
small diffusion signal increase in the right basal ganglia
internal capsule area without flow distal to the take off of
the right MCA from the ICA.  As part of a experimental study
here at the [**Hospital1 69**] caused
DIFUSE, she was given intravenous tissue plasminogen
activator.  At that time her [**Hospital1 18246**] was 12.  After the
treatment a follow up MR imaging study revealed
recannulization of the right MCA with distal flow.  There is
a larger area of a diffusion flowing appreciated on diffusion
sensitive sequences.  Over the next several days Mrs.[**Initials (NamePattern4) 39651**] [**Last Name (NamePattern4) 18246**] improved to 4.  Her left sided neglect
improved significantly.

She reports no problems with her vision, numbness and
tingling, although she can now appreciate that she has
weakness on her left side.

Mrs. [**Known lastname 39648**] suffered what appears to be a post
catheterization ischemic stroke.  The complicating feature is
that she had this event two days prior to cardioversion.
Token together we cannot be certain that this stroke was not
secondary to some Cardioembolic disease.  However, what is
clear is that a transesophageal echocardiogram done at the
time of cardioversion revealed no evidence of atrial disease
or thrombus present.  To evaluate for any changes post
cardioversion and catheterization Mrs. [**Known lastname 39648**] is undergoing
a surface cardiac echocardiogram today the results of which
are still pending.

After extensive discussion with the Stroke Service we have
decided to continue Mrs. [**Known lastname 39648**] on an aspirin a day to
protect both her heart and brain.  Depending upon the results
of this cardiac echocardiogram we may consider
anticoagulation although in the absence of any evidence of
thrombus formation it is unlikely that anticoagulation is of
any benefit.  One may also consider the addition of Aggrenox
via the extended release formulation of aspirin and
Dipridamole and this will be considered at her next visit
with her neurology physicians as well as the Stroke Service.

At the time of this dictation Mrs. [**Known lastname 39648**] is clinically
stable and appropriate for transfer to a rehabilitation
facility for an emphasis on improving her hemiparesis after
her right sided MCA infarction.  Although her left sided
neglect has improved significantly, she would benefit from
education with regard to compensatory mechanisms to deal with
neglect.  This is important as although she may not have any
significant left sided neglect in the setting of any
infection in the future, any stress of any sort in future
days to years and may bring out this old left sided neglect
and present as a problem for Mrs. [**Known lastname 39648**].

DISCHARGE CONDITION:  Markedly improved.

DISCHARGE STATUS:  Discharged to a rehabilitation facility.

DISCHARGE DIAGNOSES:
1.  Supraventricular tachycardia status post cardioversion.
2.  Right MCA ischemic infarction status post IVTPA as part
of the DIFUSE study.  She has had significant clinical
improvement after treatment.

SECONDARY DIAGNOSES:
1.  Coronary artery disease status post percutaneous
transluminal coronary angioplasty in [**2172**].
2.  Hypertension.
3.  Diabetes mellitus.
4.  Chronic renal insufficiency.
5.  Appendectomy.
6.  Cholecystectomy.
7.  Asthma.
8.  Iron deficiency anemia with colonoscopy as scheduled.

DISCHARGE MEDICATIONS:  1.  Enteric coated aspirin 325 mg po
q day.  2.  Lisinopril 20 mg po q day.  3.  Verapamil SR 120
mg po q day.  4.  Labetalol 100 mg po b.i.d.  5.  Dyazide
37.5/2.5 po q Monday and Thursday.  6.  Glipizide 10 mg po q
day.  7.  Fexofenadine 60 mg po q day.  8.  Ferrous sulfate
325 mg po q day.  9.  Azthmacort b.i.d.  10.  Antevert 12.5
mg po b.i.d.  11.  Protonix 40 mg po q day.  12.  Colace 100
mg po b.i.d.  13.  Dulcolax 10 mg po prn q day.

FOLLOW UP:  1.  Mrs. [**Known lastname 39648**] should follow up with her
primary care physician.  2.  She should also follow up with
neurology Dr. [**First Name11 (Name Pattern1) 333**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **] at [**Telephone/Fax (1) 541**].  3.  She
should also follow up with Stroke Neurology Dr. [**First Name4 (NamePattern1) 1399**] [**Last Name (NamePattern1) 39652**] at
[**Telephone/Fax (1) 1694**].  4.  Follow up with Neurology and Stroke can be
done in a couple of months time.

OUTSTANDING STUDIES:  Cardiac echocardiogram is still pending
at the time of this dictation, but we expect the results will
be available before discharge and any changes in medication
will be noted.






                            [**Doctor Last Name **] [**Name8 (MD) 8346**], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern4) 39653**]
MEDQUIST36

D:  [**2182-10-16**]  12:18
T:  [**2182-10-16**]  12:52
JOB#:  [**Job Number 37836**]
{'Coronary atherosclerosis of native coronary artery,Iatrogenic cerebrovascular infarction or hemorrhage,Other specified cardiac dysrhythmias,Hemiplegia, unspecified, affecting unspecified side,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Iron deficiency anemia, unspecified,Asthma, unspecified type, unspecified,Family history of ischemic heart disease'}


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: 

PRESENT ILLNESS: Mrs. [**Known lastname 39648**] is an 82 year-old
woman with a history of coronary artery disease and
angioplasty in [**2172**], diabetes mellitus and hypertension who
presents to the [**Hospital3 1443**] Hospital after a routine
check up at her primary care physician's office revealed
supraventricular tachycardia and some T wave changes
concerning for ischemic disease.  There she was evaluated for
acute myocardial infarction and cardioverted for her
dysrhythmia, although it was unclear whether the dysrhythmia
represented supraventricular tachycardia or atrial flutter
and fibrillation.  She was subsequently sent to the [**Hospital1 1444**] for cardiac catheterization.

MEDICAL HISTORY: 1.  Hypertension.  2.  Diabetes
mellitus.  3.  Percutaneous transluminal coronary angioplasty
in [**2172**] for coronary artery disease.  4.  Asthma and
bronchitis.  5.  Anemia.  6.  Scheduled for colonoscopy
shortly.  7.  Chronic renal insufficiency.  8.  Status post
appendectomy and cholecystectomy.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Mrs. [**Known lastname 39648**] does not drink or smoke.  She
lives in [**Location 39649**] with her husband.  She has three children
with one daughter living nearby in the [**Name (NI) 86**] area. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Iatrogenic cerebrovascular infarction or hemorrhage,Other specified cardiac dysrhythmias,Hemiplegia, unspecified, affecting unspecified side,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Iron deficiency anemia, unspecified,Asthma, unspecified type, unspecified,Family history of ischemic heart disease'}
