CHIEF COMPLAINT: Increased fatigue/Palpitations

PRESENT ILLNESS: This 49 year-old patient with vague symptoms was investigated
and was found to have a dilated aortic root with moderate aortic
regurgitation with a dilatation of the proximal third of the
ascending aorta. This has grown bigger since the previous
investigation and he was electively admitted for aortic root
replacement. Given his history of inflammatory bowel disease,
the decision was made to use the homograft.

MEDICAL HISTORY: Ulcerative colitis
Crohn's disease
GERD
Depression
Scoliosis
Degenerative joint disease
s/p colostomy/ileostomy
Ventral hernia

MEDICATION ON ADMISSION: Aspirin 81mg daily
Zoloft 100mg daily
Doxycycline 100 daily
Zanatac 150mg twice daily
Magnesium oxide 400mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 68 Irreg  18 134/76
GEN: WDWN , flat affect, HOH
SKIN: Some facial acne, no c/c/e
HEENT: NCAT, PERRL, EOMI, Anicteric sclera, OP benign
NECK: Supple, slight neck tilt to right, no JVD
LUNGS: CTA, Mild scoliosis
HEART: Irregular, I-II/VI diastolic murmur
ABD: Benign. Ileostomy bag in place RLQ. Ventral hernia
EXT: warm, well perfused. Nonpalpable PT pulse.
NEURO: CN III-XII intact, MAE, 5/5 strength

FAMILY HISTORY: Father with MI at age 52.
Mother with HF/MI at age 79

SOCIAL HISTORY: Disabled. Quit smoking in [**2128**] after smoking a few cigarettes
daily. Stopped drinking in [**2128**]. Lives with wife and 2 children.
Aortic valve disorders,Iatrogenic pneumothorax,Thoracic aneurysm without mention of rupture,Atrial fibrillation,Ulcerative colitis, unspecified,Ileostomy status,Scoliosis [and kyphoscoliosis], idiopathic,Ventral, unspecified, hernia without mention of obstruction or gangrene,Spondylosis of unspecified site, without mention of myelopathy
Aortic valve disorder,Iatrogenic pneumothorax,Thoracic aortic aneurysm,Atrial fibrillation,Ulceratve colitis unspcf,Ileostomy status,Idiopathic scoliosis,Ventral hernia NOS,Spondylos NOS w/o myelop
Admission Date:  [**2132-3-31**]              Discharge Date:   [**2132-4-8**]

Date of Birth:  [**2082-6-7**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Increased fatigue/Palpitations

Major Surgical or Invasive Procedure:
[**2132-3-31**] - Bentall procedure with 25mm homograft


History of Present Illness:
This 49 year-old patient with vague symptoms was investigated
and was found to have a dilated aortic root with moderate aortic
regurgitation with a dilatation of the proximal third of the
ascending aorta. This has grown bigger since the previous
investigation and he was electively admitted for aortic root
replacement. Given his history of inflammatory bowel disease,
the decision was made to use the homograft.


Past Medical History:
Ulcerative colitis
Crohn's disease
GERD
Depression
Scoliosis
Degenerative joint disease
s/p colostomy/ileostomy
Ventral hernia


Social History:
Disabled. Quit smoking in [**2128**] after smoking a few cigarettes
daily. Stopped drinking in [**2128**]. Lives with wife and 2 children.


Family History:
Father with MI at age 52.
Mother with HF/MI at age 79

Physical Exam:
68 Irreg  18 134/76
GEN: WDWN , flat affect, HOH
SKIN: Some facial acne, no c/c/e
HEENT: NCAT, PERRL, EOMI, Anicteric sclera, OP benign
NECK: Supple, slight neck tilt to right, no JVD
LUNGS: CTA, Mild scoliosis
HEART: Irregular, I-II/VI diastolic murmur
ABD: Benign. Ileostomy bag in place RLQ. Ventral hernia
EXT: warm, well perfused. Nonpalpable PT pulse.
NEURO: CN III-XII intact, MAE, 5/5 strength

Pertinent Results:
[**2132-3-31**] - ECHO
POST CPB The patient is receiving epinephrine by infusion. Echo
windows again offer only limited view of the left ventricle and
mitral valve. There is normal RV systolic function. The LV
displays a dysynchronous septum consistent with ventricular
pacing. The overall LV systolic function is mildly improved from
pre-CPB findings. EF is about 40-45%. No focal wall motion
abnormalities are seen but can not completely exclude. Can not
assess the mitral valve. The left atrium still appears
compressed. An aortic homograft is in situ. The aortic leaflets
open normally. No AI is seen. The thoracic aorta appears intact.


[**2132-4-7**] 07:40AM BLOOD WBC-7.8 RBC-3.30* Hgb-10.2* Hct-30.3*
MCV-92 MCH-30.9 MCHC-33.5 RDW-14.9 Plt Ct-254
[**2132-4-4**] 07:05AM BLOOD PT-12.9 INR(PT)-1.1
[**2132-4-7**] 07:40AM BLOOD Glucose-105 UreaN-8 Creat-0.8 Na-139
K-4.6 Cl-104 HCO3-29 AnGap-11
RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2132-4-5**] 9:07 AM

CHEST (PA & LAT)

Reason: evaluate pneumothorax

[**Hospital 93**] MEDICAL CONDITION:
49 year old man s/p Bentall with homograft
REASON FOR THIS EXAMINATION:
evaluate pneumothorax
PA AND LATERAL CHEST, [**2132-4-5**] AT 0927 HOURS.

HISTORY: Status post Bentall with homograft.

COMPARISON: Multiple priors, the most recent dated [**2132-4-3**].

FINDINGS: Paired mediastinal drains are again identified.
Bilateral pleural effusions are evident with a portion of the
left effusion extending over the lung apex. There is a
persistent right apical pneumothorax with approximately 8 mm of
maximal visceral and parietal pleural separation. This may have
enlarged slightly since the prior examination. The mediastinum
remains widened, likely secondary to postop edema. There is left
basilar atelectasis. No new focal consolidations are seen.

IMPRESSION: Stable right hydropneumothorax as above. Left
pleural effusion.

DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 7411**]





Brief Hospital Course:
Mr. [**Known lastname 12101**] was admitted to the [**Hospital1 18**] on [**2132-3-31**] for elective
surgical management of his aortic valve insufficiency and
dilated ascending aorta. He was taken directly to the operating
room where he underwent a bentall procedure utilizing a 25mm
homograft. Postoperatively he was taken to the cardiac surgical
intensive care unit for monitoring. By postoperative day one,
Mr. [**Known lastname 12101**] had awoke neurologically intact and was extubated.
Beta blocakde and an ace inhibitor were started. He was t hen
transferred to the step down unit for further recovery. He had
some atrial fibrillation which was treated with an increase in
his beta blockade and amiodarone, however he then had some short
pauses and bradycardia. EP was consulted and ultimately
recommended a decrease in amiodarone and low dose beta blockade.
Mr. [**Known lastname 12101**] continued to make steady progress and was discharged
home on postoperative day #8.


Medications on Admission:
Aspirin 81mg daily
Zoloft 100mg daily
Doxycycline 100 daily
Zanatac 150mg twice daily
Magnesium oxide 400mg daily

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. 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:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Sertraline 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. Captopril 12.5 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
Disp:*45 Tablet(s)* Refills:*0*
7. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 1 weeks.
Disp:*14 Tablet(s)* Refills:*0*
8. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 1
weeks.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
9. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO q3-4h as
needed.
Disp:*50 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 486**]

Discharge Diagnosis:
Aortic insufficiency/Dilated ascending aorta s/p Bentall w/ 25mm
homograft.
Crohn's Disease
Ulcerative colitis
Depression
Ileostomy
GERD
Scoliosis
Ventral hernia


Discharge Condition:
Good.


Discharge Instructions:
1) Monitor wounds for signs of infection. These include redness,
drainage or increased pain.
2) Report any fever greater then 100.5.
3) Report any weight gain of 2 pounds in 24 hours or 5 pounds in
1 week.
4) No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. No bathing or swimming
for 1 month. Use sunscreen on incision if exposed to sun.
5)No lifting greater then 10 pounds for 10 weeks.
6)No driving for 1 month.

Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) 1290**] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with cardiologist Dr. [**Last Name (STitle) **] in [**1-15**] weeks.
[**Telephone/Fax (1) 6197**]
Follow-up with primary care physician [**Last Name (NamePattern4) **] [**2-17**] weeks. Dr.
[**Last Name (STitle) 41364**] [**Telephone/Fax (1) 133**]
Please call all providers for appointments.



Completed by:[**2132-4-8**]
{'Aortic valve disorders,Iatrogenic pneumothorax,Thoracic aneurysm without mention of rupture,Atrial fibrillation,Ulcerative colitis, unspecified,Ileostomy status,Scoliosis [and kyphoscoliosis], idiopathic,Ventral, unspecified, hernia without mention of obstruction or gangrene,Spondylosis of unspecified site, without mention of myelopathy'}


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: Increased fatigue/Palpitations

PRESENT ILLNESS: This 49 year-old patient with vague symptoms was investigated
and was found to have a dilated aortic root with moderate aortic
regurgitation with a dilatation of the proximal third of the
ascending aorta. This has grown bigger since the previous
investigation and he was electively admitted for aortic root
replacement. Given his history of inflammatory bowel disease,
the decision was made to use the homograft.

MEDICAL HISTORY: Ulcerative colitis
Crohn's disease
GERD
Depression
Scoliosis
Degenerative joint disease
s/p colostomy/ileostomy
Ventral hernia

MEDICATION ON ADMISSION: Aspirin 81mg daily
Zoloft 100mg daily
Doxycycline 100 daily
Zanatac 150mg twice daily
Magnesium oxide 400mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 68 Irreg  18 134/76
GEN: WDWN , flat affect, HOH
SKIN: Some facial acne, no c/c/e
HEENT: NCAT, PERRL, EOMI, Anicteric sclera, OP benign
NECK: Supple, slight neck tilt to right, no JVD
LUNGS: CTA, Mild scoliosis
HEART: Irregular, I-II/VI diastolic murmur
ABD: Benign. Ileostomy bag in place RLQ. Ventral hernia
EXT: warm, well perfused. Nonpalpable PT pulse.
NEURO: CN III-XII intact, MAE, 5/5 strength

FAMILY HISTORY: Father with MI at age 52.
Mother with HF/MI at age 79

SOCIAL HISTORY: Disabled. Quit smoking in [**2128**] after smoking a few cigarettes
daily. Stopped drinking in [**2128**]. Lives with wife and 2 children. 

### Response:
{'Aortic valve disorders,Iatrogenic pneumothorax,Thoracic aneurysm without mention of rupture,Atrial fibrillation,Ulcerative colitis, unspecified,Ileostomy status,Scoliosis [and kyphoscoliosis], idiopathic,Ventral, unspecified, hernia without mention of obstruction or gangrene,Spondylosis of unspecified site, without mention of myelopathy'}
