CHIEF COMPLAINT: 66yo male found to have Asc Ao aneurysm by CT done for workup of
several month complaint of cough.
Direct admit to operating room after preop evaluation in CT [**Doctor First Name **]
clinic

PRESENT ILLNESS: found to have ascendin aortic aneurysm by chest CT done to w/u
complaint of cough x several months. History of previous
Aorto-bifem bypass graft

MEDICAL HISTORY: 2+AI,6.4 cm Aortic aneurysm
hypertention
^cholesterol
Mitral valve prolapse
Basal cell skin CA
L hernia repair
Aorto-bifem graft-[**2162**]
Elbow ORIF

MEDICATION ON ADMISSION: Diltiazem 420 QD
Pravachol 20 QD
Amoxicillin PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pre operative:
Vitals: Blood pressure 176/80, Heart Rate 64, Weight 184 pounds

FAMILY HISTORY: Father deceased at 62 "blood clot"
Brother deceased at 62 myocardial infarction

SOCIAL HISTORY: Maintenance worker part time
Married lives with wife
[**Name (NI) 1139**]: 40 pack years, currently 6 cigarettes/day
Alcohol: 1 drink/month
Thoracic aneurysm without mention of rupture,Cerebral embolism with cerebral infarction,Aortic valve disorders,Urinary tract infection, site not specified,Iatrogenic cerebrovascular infarction or hemorrhage,Unspecified essential hypertension,Atrial fibrillation,Tobacco use disorder,Personal history of other malignant neoplasm of skin,Peripheral vascular disease, unspecified,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Staphylococcus infection in conditions classified elsewhere and of unspecified site, staphylococcus, unspecified
Thoracic aortic aneurysm,Crbl emblsm w infrct,Aortic valve disorder,Urin tract infection NOS,Iatrogen CV infarc/hmrhg,Hypertension NOS,Atrial fibrillation,Tobacco use disorder,Hx-skin malignancy NEC,Periph vascular dis NOS,Late ef-hemplga side NOS,Staphylococcus unspcfied
Admission Date:  [**2165-7-30**]              Discharge Date:   [**2165-8-16**]

Date of Birth:  [**2098-12-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
66yo male found to have Asc Ao aneurysm by CT done for workup of
several month complaint of cough.
Direct admit to operating room after preop evaluation in CT [**Doctor First Name **]
clinic

Major Surgical or Invasive Procedure:
s/p Ascending aortic hemiarch replacement(32mm
Gelweave)/AVR(27mm CE Magna pericardial) [**2165-7-30**]


History of Present Illness:
found to have ascendin aortic aneurysm by chest CT done to w/u
complaint of cough x several months. History of previous
Aorto-bifem bypass graft

Past Medical History:
2+AI,6.4 cm Aortic aneurysm
hypertention
^cholesterol
Mitral valve prolapse
Basal cell skin CA
L hernia repair
Aorto-bifem graft-[**2162**]
Elbow ORIF


Social History:
Maintenance worker part time
Married lives with wife
[**Name (NI) 1139**]: 40 pack years, currently 6 cigarettes/day
Alcohol: 1 drink/month


Family History:
Father deceased at 62 "blood clot"
Brother deceased at 62 myocardial infarction

Physical Exam:
Pre operative:
Vitals: Blood pressure 176/80, Heart Rate 64, Weight 184 pounds

General: well developed male in no acute distress
HEENT: oropharynx benign
Neck: supple
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds, well healed
scar
Ext: well perfused, no edema, no varicosities
Pulses: +2 dorsal pedal, +1 posterior tibial, +2 radial
Neuro: nonfocal
Skin: well healed basal cell scars left anterior chest wall
Discharge:
VS: T98.4  HR79SR  BP110/60  RR18 Sat95%RA
Gen: NAD
Neuro: A+O, nonfocal exam
Pulm: CTA
CV: RRR, Sternum stable, incision CDI
Abdm: soft, NT/ND/NABS
Ext warm and well perfused, no edema

Pertinent Results:
[**2165-7-30**] 01:15PM   WBC-19.9* RBC-3.75* HGB-12.0* HCT-33.8*
MCV-90 MCH-32.0 MCHC-35.6* RDW-13.5
[**2165-7-30**] 01:15PM   PLT COUNT-226
[**2165-7-30**] 12:09PM   GLUCOSE-134* NA+-140 K+-5.2
[**2165-8-12**] 05:30AM BLOOD WBC-15.2* RBC-3.68* Hgb-11.5* Hct-33.7*
MCV-92 MCH-31.1 MCHC-34.0 RDW-13.8 Plt Ct-627*
[**2165-8-11**] 09:54PM BLOOD PT-17.3* PTT-61.2* INR(PT)-1.6*
[**2165-8-12**] 05:30AM BLOOD Glucose-71 UreaN-14 Creat-0.9 Na-141
K-4.8 Cl-104 HCO3-27 AnGap-15

Brief Hospital Course:
Mr [**Known lastname 1637**] was a direct admission to the operating room for
Aortic aneurysm repair on [**7-30**]. At that time he had an Ascending
Aorta and Hemiarch replacement with #32 Gelweave graft and
Aorticvalve replacement with #27 CE magna pericardial tissue
valve. His bypass time was 140 minutes and crossclamp was 87
minutes with circulatory arrest of 8 minutes. PLease see
operating room report for full details.
He tolerated the operation and was transferred from the OR to
cardiac surgery intensive care on Epinephrine, Neosynephrine and
Propofol infusions. The patient was hemodynamically stable once
in the ICU and the Epinephrine was weaned off. He was slow to
wake and therefore was not extubated until the morning after
surgery. Additional he was noted to have right sided hemiparesis
for which Neurology was consulted. The patient also suffered
episodes of intermittent confusion most exagerated during the
nightime hours.
HE also ahd intermittent episode of post-op Atrial fibrillation
that was not well controlled with beta blockers and he was
started on Amiodarone as well as Heparin and Coumadin. He stayed
in the ICU to monitor his hemodynamic/pulmonary and neurologic
status until POD 8 at which time he was transferred to the step
down floor for continuing post-op care. Once on the floor the
patients post-op course was largely uneventful. He continued to
make slow progress in his physical therapy, he was slowly
anticoagulated and continued to have intermittent episodes of
atrial fibrillation but was generally in sinus rhythm, and he
only had rare episodes of disorientation that were easily
corrected with reminders.
On POD 12 it was decided that the patient was stable and ready
to be discharged to rehabilitation at [**Hospital 69348**] Rehabilitation
Center.

Medications on Admission:
Diltiazem 420 QD
Pravachol 20 QD
Amoxicillin PRN

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily): 400mg QD x 7days then 200mg QD.
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO every
eight (8) hours.
9. Warfarin 1 mg Tablet Sig: 1-10 mg PO DAILY (Daily): Adjust
dose QD to
Target INR 2.0-2.5.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
s/p Asc Ao and Hemiarch replacement(#32Gelweave)AVR(#27 CE Magna
pericardial)
cva, post-op Afib
PMH: HTN,^chol,MVP,Aorto-Fem BPG, L hernia repair, ORIF elbow,
removal Basal cell CA


Discharge Condition:
Good.


Discharge Instructions:
Keep wounds clean and dry. ok to shower, no bathing or swimming.
Take all medications as prescribed.
Call for any fever, redness or drainage from wounds.

Followup Instructions:
Make an appointment with Dr. [**Name (NI) 23019**] 1-2 weeks after d/c
from rehab.
Make an appointment with Dr. [**Last Name (STitle) 1290**] for 4 weeks.



Completed by:[**2165-8-12**]

Name:  [**Known lastname 5990**],[**Known firstname 3206**] F             Unit No:   [**Numeric Identifier 11828**]

Admission Date:  [**2165-7-30**]              Discharge Date:   [**2165-8-16**]

Date of Birth:  [**2098-12-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 674**]
Addendum:
Mr. [**Known lastname **] did not receive a rehab bed placement until Thursday
[**8-15**]. He also remained for an elevated WBC and treatment of a
UTI. Therapy was adjusted based on culture sensitivities.
Discharged to rehab on POD # 16. Coumadin dose today only is
3mg. Target INR is 2.0 - 2.5.

Pertinent Results:
[**2165-8-15**] 05:50AM BLOOD WBC-15.1* RBC-3.93* Hgb-12.2* Hct-35.5*
MCV-90 MCH-31.0 MCHC-34.3 RDW-14.0 Plt Ct-604*
[**2165-8-15**] 05:50AM BLOOD Plt Ct-604*
[**2165-8-15**] 05:50AM BLOOD PT-26.4* PTT-40.9* INR(PT)-2.7*

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily): 400mg QD x 2 days then 200mg QD.
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
7. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).
8. Warfarin 1 mg Tablet Sig: 1-10 mg PO DAILY (Daily): Adjust
dose QD to
Target INR 2.0-2.5
Dose today only [**8-15**] is  3 mg.
9. Lopressor 50 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Tetracycline 250 mg Capsule Sig: Two (2) Capsule PO Q6H
(every 6 hours) for 7 days: complete course on [**8-22**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 41**] - [**Location (un) 42**]

                             [**Doctor Last Name **] [**Last Name (Prefixes) **] MD [**MD Number(1) 681**]

Completed by:[**2165-8-15**]
{'Thoracic aneurysm without mention of rupture,Cerebral embolism with cerebral infarction,Aortic valve disorders,Urinary tract infection, site not specified,Iatrogenic cerebrovascular infarction or hemorrhage,Unspecified essential hypertension,Atrial fibrillation,Tobacco use disorder,Personal history of other malignant neoplasm of skin,Peripheral vascular disease, unspecified,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Staphylococcus infection in conditions classified elsewhere and of unspecified site, staphylococcus, 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: 66yo male found to have Asc Ao aneurysm by CT done for workup of
several month complaint of cough.
Direct admit to operating room after preop evaluation in CT [**Doctor First Name **]
clinic

PRESENT ILLNESS: found to have ascendin aortic aneurysm by chest CT done to w/u
complaint of cough x several months. History of previous
Aorto-bifem bypass graft

MEDICAL HISTORY: 2+AI,6.4 cm Aortic aneurysm
hypertention
^cholesterol
Mitral valve prolapse
Basal cell skin CA
L hernia repair
Aorto-bifem graft-[**2162**]
Elbow ORIF

MEDICATION ON ADMISSION: Diltiazem 420 QD
Pravachol 20 QD
Amoxicillin PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Pre operative:
Vitals: Blood pressure 176/80, Heart Rate 64, Weight 184 pounds

FAMILY HISTORY: Father deceased at 62 "blood clot"
Brother deceased at 62 myocardial infarction

SOCIAL HISTORY: Maintenance worker part time
Married lives with wife
[**Name (NI) 1139**]: 40 pack years, currently 6 cigarettes/day
Alcohol: 1 drink/month 

### Response:
{'Thoracic aneurysm without mention of rupture,Cerebral embolism with cerebral infarction,Aortic valve disorders,Urinary tract infection, site not specified,Iatrogenic cerebrovascular infarction or hemorrhage,Unspecified essential hypertension,Atrial fibrillation,Tobacco use disorder,Personal history of other malignant neoplasm of skin,Peripheral vascular disease, unspecified,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Staphylococcus infection in conditions classified elsewhere and of unspecified site, staphylococcus, unspecified'}
