CHIEF COMPLAINT: Syncope; fatigue; decreased exercise tolerance

PRESENT ILLNESS: 52 year old male with heart murmur for years and serial echos
showing functional vs. anatomic bicuspid Aortic valve. Has had
increasing symptoms in past 1-2 years. First CT scan done
recently shows 4.9 cm ascending aorta. Referred for surgical
second opinion. Today presents for surgical work-up. Of note
patient went to [**Hospital1 1774**] last Monday after feeling ill with upper
abdominal/lower chest pain that radiated to back. Work-up
revealed was negative. During visit patient had cardiac cath,
which was also negative for CAD.

MEDICAL HISTORY: Aortic aneurysm s/p ascending aorta replacement
Past medical history:
Hypertension
Hyperlipidemia
Syncope
Anemia
Bicuspid Aortic Valve
Benign Prostatic Hypertrophy
Chonic Renal Insufficiency (1.8)
Ocular Migraines
Anxiety
Gastroesophageal reflux disease/Barrett's esophagus
Hypothyroid
Separated Left shoulder
Skin Cancer
Past Surgical History:
Testicular torsion Repair
Ligament repair Right wrist
Left facial skin Cancer removal/Chest
Bilateral eye [**Last Name (un) 8509**] Surgery

MEDICATION ON ADMISSION: Nexium 40mg po BID
Atenolol 12.5mg po daily
Gemfibrozil 600mg po BID
Lipitor 20mg po daily
Flomax 0.4mg po daily
Levoxyl 50 mcg po daily
Sertraline 50mg po daily
Aranesp 60mg q monthly
Saw [**Location (un) **] daily

ALLERGIES: Mucolytic / IV Dye, Iodine Containing

PHYSICAL EXAM: Pulse: 57  O2 sat: 100%
B/P Left: 126/77
Height: 5'8"     Weight: 174 LBS

FAMILY HISTORY: Father died with CABG age 79

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: last month
Lives with: wife and 2 kids and mother in law
Occupation: Supervisor for TSA
Tobacco: never
ETOH: denies
Rec drugs: denies
Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Anemia, unspecified,Other iatrogenic hypotension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anxiety state, unspecified,Esophageal reflux,Unspecified acquired hypothyroidism
Thoracic aortic aneurysm,Cong aorta valv insuffic,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hyperlipidemia NEC/NOS,Anemia NOS,Iatrogenc hypotnsion NEC,BPH w/o urinary obs/LUTS,Anxiety state NOS,Esophageal reflux,Hypothyroidism NOS
Admission Date:  [**2180-2-1**]              Discharge Date:   [**2180-2-5**]

Date of Birth:  [**2127-7-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Mucolytic / IV Dye, Iodine Containing

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Syncope; fatigue; decreased exercise tolerance

Major Surgical or Invasive Procedure:
[**2180-2-1**] Acending aorta replacement with 28mm gelweave graft

History of Present Illness:
52 year old male with heart murmur for years and serial echos
showing functional vs. anatomic bicuspid Aortic valve. Has had
increasing symptoms in past 1-2 years. First CT scan done
recently shows 4.9 cm ascending aorta. Referred for surgical
second opinion. Today presents for surgical work-up. Of note
patient went to [**Hospital1 1774**] last Monday after feeling ill with upper
abdominal/lower chest pain that radiated to back. Work-up
revealed was negative. During visit patient had cardiac cath,
which was also negative for CAD.

Past Medical History:
Aortic aneurysm s/p ascending aorta replacement
Past medical history:
Hypertension
Hyperlipidemia
Syncope
Anemia
Bicuspid Aortic Valve
Benign Prostatic Hypertrophy
Chonic Renal Insufficiency (1.8)
Ocular Migraines
Anxiety
Gastroesophageal reflux disease/Barrett's esophagus
Hypothyroid
Separated Left shoulder
Skin Cancer
Past Surgical History:
Testicular torsion Repair
Ligament repair Right wrist
Left facial skin Cancer removal/Chest
Bilateral eye [**Last Name (un) 8509**] Surgery

Social History:
Race: Caucasian
Last Dental Exam: last month
Lives with: wife and 2 kids and mother in law
Occupation: Supervisor for TSA
Tobacco: never
ETOH: denies
Rec drugs: denies

Family History:
Father died with CABG age 79

Physical Exam:
Pulse: 57  O2 sat: 100%
B/P Left: 126/77
Height: 5'8"     Weight: 174 LBS

General: No acute distress
Skin: Dry [X] intact [X]WELL HEALED RIGHT ARM SCARS. small,
pinpoint papules on hands (?rxn to medication received at cath)
HEENT: PERRLA [X] EOMI [X]ANICTERIC SCLERA; OP UNREMARKABLE
Neck:  Supple [X] Full ROM [X]NO JVD
Chest: Lungs clear bilaterally [X]HEALED SM.SCAR AT XIPHOID
Heart: RRR [X]  Irregular []  Murmur FAINT SEM
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X] NO HSM/CVA TENDERNESS
Extremities: Warm [X], well-perfused [X] Edema/Varicosities:
None [X]
Neuro: Grossly intact
Pulses:
Femoral      Right:2+   Left:2+
DP           Right:2+   Left:2+
PT           [**Name (NI) 167**]:NP   Left:NP
Radial       Right:2+   Left:2+

Carotid Bruit        Right:0    Left:0

Pertinent Results:
[**2180-2-1**] Echo: PRE-BYPASS: No spontaneous echo contrast or
thrombus is seen in the body of the left atrium or left atrial
appendage. No atrial septal defect is seen by 2D or color
Doppler. Left ventricular wall thicknesses and cavity size are
normal. The right ventricular cavity is mildly dilated with
borderline normal free wall function. The ascending aorta is
moderately dilated. The aortic valve is bicuspid. Tthere is a
median fibrous raphe in the anterior aortic cusp and causing
limited leaflet excursion. here is no aortic valve stenosis.
Trace aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no pericardial effusion. Aoritc valve area by planimetry (2D and
3D) was consistently obtained to be 3.4 cm2
POST CPB: 1. Preserved [**Hospital1 **]-ventricular systolci function 2. The
aoritc valve leaflets are freely mobile 3. Aortic valve area by
planimetry was consistentlyu obtained to be > 4 cm2 4. There is
no aortic regurgitation 5. A tube graft is visualized in the
ascending aortic position.

[**2180-2-1**] 01:21PM BLOOD WBC-18.7*# RBC-3.15*# Hgb-8.2*#
Hct-25.0*# MCV-80* MCH-26.0* MCHC-32.7 RDW-14.0 Plt Ct-288
[**2180-2-3**] 05:50AM BLOOD WBC-14.9* RBC-3.34* Hgb-9.2* Hct-27.1*
MCV-81* MCH-27.6 MCHC-34.0 RDW-14.1 Plt Ct-214
[**2180-2-1**] 01:21PM BLOOD PT-15.3* PTT-31.2 INR(PT)-1.3*
[**2180-2-1**] 02:56PM BLOOD UreaN-16 Creat-1.4* Cl-115* HCO3-23
[**2180-2-3**] 05:50AM BLOOD Glucose-109* UreaN-22* Creat-1.6* Na-140
K-4.2 Cl-104 HCO3-26 AnGap-14

Brief Hospital Course:
Mr. [**Known lastname 31102**] was a same day admit after undergoing pre-operative
work-up as an outpatient. On [**2180-2-1**] she was brought to the
operating room where he underwent replacement of his ascending
aorta. Please see operative report for surgical details.
Following surgery he was transferred to the CVICU for invasive
monitoring in stable condition. Within 24 hours he was weaned
from sedation, awoke neurologically intact and extubated. On
post-op day one his chest tubes were removed and he was
transferred to the telemetry floor for further care. pain
control was a major issue requiring 4-6 mg dilaudid every 3hrs.
Pain improved once his chest tubes were removed. The temporary
pacing wires were removed on POD#3. He was evaluated by physical
therapy for strength and conditioning and cleared for discharge
to home on POD#4 by Dr. [**Last Name (STitle) **].

Medications on Admission:
Nexium 40mg po BID
Atenolol 12.5mg po daily
Gemfibrozil 600mg po BID
Lipitor 20mg po daily
Flomax 0.4mg po daily
Levoxyl 50 mcg po daily
Sertraline 50mg po daily
Aranesp 60mg q monthly
Saw [**Location (un) **] daily

Discharge Medications:
1. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*80 Tablet(s)* Refills:*0*
2. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
7. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day for 10
days.
Disp:*10 Tablet(s)* Refills:*0*
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 hours)
for 10 days.
Disp:*20 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
9. Levoxyl 50 mcg Tablet Sig: One (1) Tablet PO once a day.
10. Sertraline 50 mg Tablet Sig: One (1) Tablet PO once a day.
11. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO twice a
day.
12. Lipitor 20 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
All Care VNA of Greater [**Location (un) **]

Discharge Diagnosis:
Aortic aneurysm s/p ascending aorta replacement
Past medical history:
Hypertension
Hyperlipidemia
Syncope
Anemia
Bicuspid Aortic Valve
Benign Prostatic Hypertrophy
Chonic Renal Insufficiency (1.8)
Ocular Migraines
Anxiety
Gastroesophageal reflux disease/Barrett's esophagus
Hypothyroid
Separated Left shoulder
Skin Cancer
Past Surgical History:
Testicular torsion Repair
Ligament repair Right wrist
Left facial skin Cancer removal/Chest
Bilateral eye [**Last Name (un) 8509**] Surgery

Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with dilaudid prn

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

Followup Instructions:
Please call to schedule appointments
Surgeon Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 170**]
Primary Care Dr. [**First Name8 (NamePattern2) 1169**] [**Last Name (NamePattern1) **] in [**11-27**] weeks
Cardiologist Dr. [**Last Name (STitle) **] in [**11-27**] weeks
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will schedule


Completed by:[**2180-2-5**]
{'Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Anemia, unspecified,Other iatrogenic hypotension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anxiety state, unspecified,Esophageal reflux,Unspecified acquired hypothyroidism'}


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: Syncope; fatigue; decreased exercise tolerance

PRESENT ILLNESS: 52 year old male with heart murmur for years and serial echos
showing functional vs. anatomic bicuspid Aortic valve. Has had
increasing symptoms in past 1-2 years. First CT scan done
recently shows 4.9 cm ascending aorta. Referred for surgical
second opinion. Today presents for surgical work-up. Of note
patient went to [**Hospital1 1774**] last Monday after feeling ill with upper
abdominal/lower chest pain that radiated to back. Work-up
revealed was negative. During visit patient had cardiac cath,
which was also negative for CAD.

MEDICAL HISTORY: Aortic aneurysm s/p ascending aorta replacement
Past medical history:
Hypertension
Hyperlipidemia
Syncope
Anemia
Bicuspid Aortic Valve
Benign Prostatic Hypertrophy
Chonic Renal Insufficiency (1.8)
Ocular Migraines
Anxiety
Gastroesophageal reflux disease/Barrett's esophagus
Hypothyroid
Separated Left shoulder
Skin Cancer
Past Surgical History:
Testicular torsion Repair
Ligament repair Right wrist
Left facial skin Cancer removal/Chest
Bilateral eye [**Last Name (un) 8509**] Surgery

MEDICATION ON ADMISSION: Nexium 40mg po BID
Atenolol 12.5mg po daily
Gemfibrozil 600mg po BID
Lipitor 20mg po daily
Flomax 0.4mg po daily
Levoxyl 50 mcg po daily
Sertraline 50mg po daily
Aranesp 60mg q monthly
Saw [**Location (un) **] daily

ALLERGIES: Mucolytic / IV Dye, Iodine Containing

PHYSICAL EXAM: Pulse: 57  O2 sat: 100%
B/P Left: 126/77
Height: 5'8"     Weight: 174 LBS

FAMILY HISTORY: Father died with CABG age 79

SOCIAL HISTORY: Race: Caucasian
Last Dental Exam: last month
Lives with: wife and 2 kids and mother in law
Occupation: Supervisor for TSA
Tobacco: never
ETOH: denies
Rec drugs: denies 

### Response:
{'Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Anemia, unspecified,Other iatrogenic hypotension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anxiety state, unspecified,Esophageal reflux,Unspecified acquired hypothyroidism'}
