CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 73-year-old
female who originally presented with a persistent cough.  At
the time, a chest x-ray was performed, which showed an
abnormal mediastinum.  A suspicion was raised about a
possible ascending aortic aneurysm.  A follow-up CT scan was
performed, which showed a 5.2 x 5.4 cm in diameter aneurysm
that appeared to taper at the level of the innominate artery.
The patient's echocardiogram showed good left ventricular
function with mild left ventricular hypertrophy.  In
addition, the patient was noted to have a moderately dilated
aortic root and 2+ aortic insufficiency with mild aortic
stenosis, mitral regurgitation, and tricuspid regurgitation.
In addition, the patient underwent cardiac catheterization
preoperatively, which showed two vessel disease with disease
in the left anterior descending artery, first diagonal, and a
large obtuse marginal.  The patient presented to Cardiac
Surgery for a possible surgical intervention.

MEDICAL HISTORY: 1.  Coronary artery disease
2.  Hypertension
3.  Peptic ulcer disease
4.  Depression
5.  Valvular disease

MEDICATION ON ADMISSION: 1.  Zestril 40 mg by mouth once daily
2.  Imipramine 100 mg once daily
3.  Trazodone 100 mg daily at bedtime
4.  Atenolol 25 mg once daily
5.  Nexium as needed

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Aortic valve disorders,Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Hemorrhage complicating a procedure,Unspecified essential hypertension,Unspecified pleural effusion
Aortic valve disorder,Thoracic aortic aneurysm,Crnry athrscl natve vssl,Hemorrhage complic proc,Hypertension NOS,Pleural effusion NOS
Admission Date:  [**2200-9-5**]     Discharge Date:  [**2200-9-28**]

Date of Birth:   [**2127-2-9**]     Sex:  F

Service:  CARDIOTHORACIC SURGERY






                          [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Doctor Last Name 182**]

MEDQUIST36

D:  [**2200-11-20**]  09:39
T:  [**2200-11-23**]  17:51
JOB#:  [**Job Number 10099**]


Admission Date:  [**2200-9-5**]       Discharge Date:  [**2200-9-28**]

Date of Birth:   [**2127-2-9**]       Sex:  F

Service:  CARDIAC SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is a 73-year-old
female who originally presented with a persistent cough.  At
the time, a chest x-ray was performed, which showed an
abnormal mediastinum.  A suspicion was raised about a
possible ascending aortic aneurysm.  A follow-up CT scan was
performed, which showed a 5.2 x 5.4 cm in diameter aneurysm
that appeared to taper at the level of the innominate artery.
The patient's echocardiogram showed good left ventricular
function with mild left ventricular hypertrophy.  In
addition, the patient was noted to have a moderately dilated
aortic root and 2+ aortic insufficiency with mild aortic
stenosis, mitral regurgitation, and tricuspid regurgitation.
In addition, the patient underwent cardiac catheterization
preoperatively, which showed two vessel disease with disease
in the left anterior descending artery, first diagonal, and a
large obtuse marginal.  The patient presented to Cardiac
Surgery for a possible surgical intervention.

PAST MEDICAL HISTORY:
1.  Coronary artery disease
2.  Hypertension
3.  Peptic ulcer disease
4.  Depression
5.  Valvular disease

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Zestril 40 mg by mouth once daily
2.  Imipramine 100 mg once daily
3.  Trazodone 100 mg daily at bedtime
4.  Atenolol 25 mg once daily
5.  Nexium as needed

LABORATORY DATA:  Hematocrit 30.8, white blood cell count
9.1, platelets 72.  Glucose 110, BUN 23, creatinine 1.4,
sodium 137, potassium 4.5.

HOSPITAL COURSE:  The patient was admitted to the Cardiac
Surgery service.  Given the history of ascending aortic
aneurysm and coronary artery disease, the patient underwent:
1.  Resection and repair of ascending aortic and proximal
aortic arch aneurysm
2.  Coronary artery bypass graft x 1
3.  Aortic valve replacement

The patient tolerated the procedure well, which was performed
on [**2200-9-5**].  There were no complications.  The resection and
repair of the ascending and proximal arch aortic aneurysm was
performed with hemi-arch-type repair using 26 mm gel-weave
Dacron tube graft.  The aortic valve replacement was done
with a 21 [**Last Name (un) 3843**]-[**Doctor Last Name **] pericardial bioprosthesis.  The
patient remained intubated and was transferred to the
Intensive Care Unit in stable condition.

She remained intubated.  The patient was diuresed
appropriately.  The patient was started on several
medications to maintain her systolic blood pressure at 120 or
below.

On postoperative day one, the patient was noted to have
decreased bowel sounds and dark-colored drainage from the
mouth.  Vancomycin and levofloxacin were added empirically.
The patient was continued on nitro drip to help maintain her
pressures.  She was also continued on Lopressor and
Hydralazine, as well as labetalol.

The patient was extubated on [**2200-9-9**].  She tolerated
extubation well, without any complications.  The patient was
noted to have periods of confusion.  Of note is that the
patient had to go back to the operating room for a chest
evacuation of a hematoma and suturing of a bleeding vessel.
Cardiology was consulted to assist with blood pressure
control.  Cardiology recommendation was to initiate more
aggressive diuresis, to continue labetalol, Captopril and
Hydralazine.  Her antidepressant medication (imipramine) was
discontinued.

The patient was transferred to the regular floor in stable
condition.  On [**2200-9-14**], the patient appeared to be in
increased respiratory distress.  She had crackles on
examination bilaterally.  She was thought to be fluid
overloaded.  A chest x-ray done at the time showed bilateral
pleural effusions, left significantly greater than right,
with associated left lower lobe collapse/consolidation.  The
patient was diuresed more.  An electrocardiogram was
obtained, which showed no change.  In addition, left
thoracentesis was performed, with significant amount of fluid
drained.  In addition, a pigtail catheter was placed by
bedside and fluid was drained with suction.

A follow-up chest x-ray obtained on the following day showed
significant improvement in the amount of fluid present in the
lungs.  Consequently, the pigtail catheter was removed on
[**2200-9-17**].

The other issue was the patient's decreased appetite, which
has been going on for the last week or so.  The patient was
restarted on her outpatient dose of imipramine.  She was
encouraged to eat and also to ambulate.  Physical Therapy was
following her during the hospitalization course.  The patient
remained afebrile.  She was improving her oxygenation.

The patient was discharged to a rehabilitation facility in
stable condition.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DISPOSITION:  Rehabilitation facility.

DISCHARGE DIAGNOSIS:
1.  Ascending aortic aneurysm status post resection and
repair of the ascending aortic and proximal aortic arch
aneurysm
2.  Coronary artery disease status post coronary artery
bypass graft x 1
3.  Aortic valve replacement
4.  Hypertension
5.  Depression

DI[**Last Name (STitle) 408**]E INSTRUCTIONS:
1.  The patient is to follow up with her surgeon, Dr. [**Last Name (Prefixes) 411**] in approximately four weeks.
2.  The patient is to follow up with her primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], in approximately one to two weeks.
3.  The patient is to follow up with the cardiologist in
approximately three to four weeks.

DISCHARGE MEDICATIONS:  Will be dictated separately.




                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Last Name (NamePattern1) 10097**]
MEDQUIST36

D:  [**2200-9-18**]  02:35
T:  [**2200-9-18**]  03:13
JOB#:  [**Job Number 10098**]


Name:  [**Known lastname 1385**], [**Known firstname **]                      Unit No:  [**Numeric Identifier 1386**]

Admission Date:  [**2200-9-5**]     Discharge Date:  [**2200-9-28**]

Date of Birth:   [**2127-2-9**]     Sex:  F

Service:  CARDIAC S.

ADDENDUM TO DISCHARGE SUMMARY DICTATED PREVIOUSLY.

The patient was actually discharged on [**2200-9-26**].  The main
reason was that the patient continued to have decreased
appetite.  The caloric intake was less than 10% to 15%.  The
Psychiatric Service was consulted to evaluate the patient for
a possible depression.  The patient was started on
Imipramine, which was her outpatient medication, as well
Remeron.  However, the patient continued to do poorly, as far
as her diet was concerned.  With the consent of the patient,
gastroenterology service placed a PEG on [**2200-9-24**].  The
procedure was without complications.  Tube feeds (Ultracal)
was started on [**2200-9-25**] with the goal of 65 cc an hour.
The patient tolerated tube feeds well.  The patient continued
to have minimal oral intake.  The patient was discharged to
the rehabilitation facility on [**2200-9-26**].

CONDITION ON DISCHARGE:  Good.

DISCHARGE DESTINATION:  Rehabilitation Facility.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease.
2.  Hypertension.
3.  Aortic aneurysm, status post coronary artery bypass
grafting.  Aortic valve replacement.  Aortic arch aneurysm
repair.
4.  Poor PO intake status post PEG placement.
5.  Depression.

DISCHARGE INSTRUCTIONS:
1.  The patient is to follow up with the surgeon, [**Last Name (Prefixes) **]
in approximately four weeks.
2.  The patient is to follow up with her primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1387**] in approximately one to two weeks.
3.  The patient is to follow up with her cardiologist in
approximately three to four weeks to adjust her outpatient
medication regimen.
4.  The patient is to receive tube feeds via gastric tube.
The patient is to be assessed by a nutritionist regularly.

DISCHARGE MEDICATIONS:
1.  Imipramine 50 mg h.s.q.d. (to be decreased to 25 mg q.d.
next week).
2.  Albuterol nebulizers, one nebulizer every six hours
p.r.n..
3.  Labetalol 600 mg PO t.i.d.
4.  Captopril 6.26 mg PO t.i.d. (suggest as tolerated by
blood pressure).
5.  Lansoprazole 30 mg PO q.d.
6.  Percocet 1 to 2 tablets PO q.4h. to
6h.p.r.n.post-auricular incision.
7.  Tylenol 650 mg PO q.6h.p.r.n.pain.
8.  Aspirin 325 mg PO q.d.
9.  Colace 100 mg PO b.i.d.
10. Lactulose 30 ml PO t.i.d.
11. Remeron 15 mg PO h.s.q.d. (to be increased to 30 mg next
week).

ADDITIONAL INSTRUCTIONS:  The patient is to receive tube
feeds as described above.




  [**Last Name (STitle) 1383**]             DR.[**Last Name (Prefixes) **],[**First Name3 (LF) **] 02-351

Dictated By:[**Last Name (NamePattern1) 1388**]

MEDQUIST36

D:  [**2200-9-25**]  10:26
T:  [**2200-9-25**]  12:16
JOB#:  [**Job Number 1389**]


Name:  [**Known lastname 1385**], [**Known firstname **]           Unit No:  [**Numeric Identifier 1386**]

Admission Date:  [**2200-9-5**]     Discharge Date:  [**2200-9-28**]

Date of Birth:   [**2127-2-9**]     Sex:  F

Service:  Cardiothoracic Surgery

ADDENDUM:  This is an addendum to a Discharge Summary
previously dictated.

The patient was actually discharged to rehabilitation on
[**2200-9-28**].  The main reason was the patient continued
to have a decreased appetite.  His caloric intake was less
than 10% to 15%.

The Psychiatry Service was consulted to evaluate the patient
for possible increased depression.  The patient was then
started imipramine (which was her outpatient medication) as
well as Remeron.  However, the patient continued to do poorly
as far as her diet concerned.  After consent from the patient
the Gastroenterology Service placed a percutaneous endoscopic
gastrostomy tube on [**2200-9-24**].  The procedure was
without complications.  The patient was then started on tube
feeds.  The patient had minimal oral intake.

The patient was seen on [**9-26**] by Psychiatry who felt she
was now stable enough to be transferred to rehabilitation,
but they would like see her followup.  Nutrition saw her and
felt that she could go to rehabilitation.  At that time, her
tube feeds were up to 50 cc per hour.  She was out of bed and
from bed to chair.  She was stable to be transferred to the
rehabilitation hospital on [**2200-9-28**].

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  Discharge status was to a rehabilitation
facility.

DISCHARGE DIAGNOSES:
1.  Coronary artery disease.
2.  Hypertension.
3.  Aortic aneurysm.
4.  Status post coronary artery bypass graft surgery.
5.  Aortic valve replacement.
6.  Aortic arch aneurysm repair.
7.  Poor dietary intake; status post percutaneous endoscopic
gastrostomy tube placement (currently on tube feeds).
8.  History of depression (currently on antidepressant
medications).

DI[**Last Name (STitle) 1390**]E INSTRUCTIONS/FOLLOWUP:
1.  The patient was to follow up with Dr. [**Last Name (Prefixes) **] in
approximately four weeks from the time of discharge.
2.  The patient was to follow up with her primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1387**], two weeks from the time of discharge.
3.  The patient was to follow up with her cardiologist in
approximately three to four weeks.
4.  The patient was to receive her tube feeds via her
percutaneous endoscopic gastrostomy tube.

MEDICATIONS ON DISCHARGE:  (Discharge medications were as
follows)
 1.  Albuterol nebulizer one nebulizer q.4-6h. as needed.
 2.  Labetalol 600 mg p.o. t.i.d.
 3.  Captopril 6.25 mg p.o. t.i.d. (as tolerated by blood
pressure).
 4.  Lansoprazole 30 mg p.o. q.d.
 5.  Percocet one to two tablets p.o. q.3-4h. as needed (for
pain).
 6.  Tylenol 650 mg p.o. q.4-6h. as needed (for pain).
 7.  Aspirin 325 mg p.o. q.d.
 8.  Colace 100 mg p.o. b.i.d.
 9.  Lactulose 30 mL p.o. t.i.d.
10.  Remeron 15 mg p.o. q.h.s. (to be increased to 30 mg in
the following week).
11.  Imipramine 50 mg p.o. q.h.s. (to be decreased to 25 mg
in the next week from the time of discharge).





                          [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D.  [**MD Number(1) 681**]

Dictated By:[**Last Name (NamePattern1) 1391**]

MEDQUIST36

D:  [**2201-2-6**]  14:33
T:  [**2201-2-7**]  08:10
JOB#:  [**Job Number 1392**]
{'Aortic valve disorders,Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Hemorrhage complicating a procedure,Unspecified essential hypertension,Unspecified pleural effusion'}


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: The patient is a 73-year-old
female who originally presented with a persistent cough.  At
the time, a chest x-ray was performed, which showed an
abnormal mediastinum.  A suspicion was raised about a
possible ascending aortic aneurysm.  A follow-up CT scan was
performed, which showed a 5.2 x 5.4 cm in diameter aneurysm
that appeared to taper at the level of the innominate artery.
The patient's echocardiogram showed good left ventricular
function with mild left ventricular hypertrophy.  In
addition, the patient was noted to have a moderately dilated
aortic root and 2+ aortic insufficiency with mild aortic
stenosis, mitral regurgitation, and tricuspid regurgitation.
In addition, the patient underwent cardiac catheterization
preoperatively, which showed two vessel disease with disease
in the left anterior descending artery, first diagonal, and a
large obtuse marginal.  The patient presented to Cardiac
Surgery for a possible surgical intervention.

MEDICAL HISTORY: 1.  Coronary artery disease
2.  Hypertension
3.  Peptic ulcer disease
4.  Depression
5.  Valvular disease

MEDICATION ON ADMISSION: 1.  Zestril 40 mg by mouth once daily
2.  Imipramine 100 mg once daily
3.  Trazodone 100 mg daily at bedtime
4.  Atenolol 25 mg once daily
5.  Nexium as needed

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Aortic valve disorders,Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of native coronary artery,Hemorrhage complicating a procedure,Unspecified essential hypertension,Unspecified pleural effusion'}
