CHIEF COMPLAINT: Abdominal aortic aneurysm.

PRESENT ILLNESS: The patient is a 72-year-old
male with a past medical history significant for atrial
fibrillation and cerebrovascular accident causing aphasia who
presented with a 5 cm abdominal aortic aneurysm that was
infrarenal in nature.  This has been monitored for
approximately two years and was noted to be increasing in
size, and he was admitted for elective repair.  This was
initially to be performed in [**2110-11-22**]; however, on the
day of admission, the patient developed vomiting after his
admission, and his heart rate was noted to be approximately
140.  He was then transferred to Telemetry and ruled out by
cardiac enzymes.  Cardiology ordered a cardiac
catheterization which did not show any significant disease,
and he was subsequently cleared for surgery.  After that,
upon entering the abdomen, a very enlarged inflamed
gallbladder was found and removed.  The patient was then
discharged and readmitted on [**2-4**] for a final elective
abdominal aortic aneurysm repair.

MEDICAL HISTORY: Significant for atrial fibrillation on
chronic anticoagulation, ejection fraction noted to be
approximately 35%, cerebrovascular accident in [**2107**] with
residual aphasia and right upper extremity weakness,
hypertension, increased cholesterol, hypothyroidism, chronic
obstructive pulmonary disease, migraine headaches, and
depression.

MEDICATION ON ADMISSION: Coumadin 3 mg p.o. q.d., Digoxin
0.125 mg p.o. q.d., Toprol XL 100 mg p.o. q.d., Synthroid
0.05 mg p.o. q.d., Lipitor 10 mg p.o. q.d., Zoloft 25 mg p.o.
q.h.s.

ALLERGIES: HE ADMITS TO HAVING AN ALLERGY TO SEAFOOD WHICH
CAUSES SEVERE SWELLING IN HIS FACE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Abdominal aneurysm without mention of rupture,Atrial fibrillation,Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Anemia, unspecified,Late effects of cerebrovascular disease, aphasia
Abdom aortic aneurysm,Atrial fibrillation,Pneumonia, organism NOS,Obs chr bronc w(ac) exac,Anemia NOS,Late eff CV dis-aphasia
Admission Date:  [**2111-2-4**]       Discharge Date:  [**2111-2-18**]

Date of Birth:   [**2038-7-9**]       Sex:  M

Service:  VASCULAR SURGERY

CHIEF COMPLAINT:  Abdominal aortic aneurysm.

HISTORY OF PRESENT ILLNESS:  The patient is a 72-year-old
male with a past medical history significant for atrial
fibrillation and cerebrovascular accident causing aphasia who
presented with a 5 cm abdominal aortic aneurysm that was
infrarenal in nature.  This has been monitored for
approximately two years and was noted to be increasing in
size, and he was admitted for elective repair.  This was
initially to be performed in [**2110-11-22**]; however, on the
day of admission, the patient developed vomiting after his
admission, and his heart rate was noted to be approximately
140.  He was then transferred to Telemetry and ruled out by
cardiac enzymes.  Cardiology ordered a cardiac
catheterization which did not show any significant disease,
and he was subsequently cleared for surgery.  After that,
upon entering the abdomen, a very enlarged inflamed
gallbladder was found and removed.  The patient was then
discharged and readmitted on [**2-4**] for a final elective
abdominal aortic aneurysm repair.

PAST MEDICAL HISTORY:  Significant for atrial fibrillation on
chronic anticoagulation, ejection fraction noted to be
approximately 35%, cerebrovascular accident in [**2107**] with
residual aphasia and right upper extremity weakness,
hypertension, increased cholesterol, hypothyroidism, chronic
obstructive pulmonary disease, migraine headaches, and
depression.

PAST SURGICAL HISTORY:  Significant for cholecystectomy in
[**2110-11-22**].

MEDICATIONS ON ADMISSION:  Coumadin 3 mg p.o. q.d., Digoxin
0.125 mg p.o. q.d., Toprol XL 100 mg p.o. q.d., Synthroid
0.05 mg p.o. q.d., Lipitor 10 mg p.o. q.d., Zoloft 25 mg p.o.
q.h.s.

ALLERGIES:  HE ADMITS TO HAVING AN ALLERGY TO SEAFOOD WHICH
CAUSES SEVERE SWELLING IN HIS FACE.

PHYSICAL EXAMINATION:  General:  At the time of admission,
the patient appeared to be a well-developed, well-nourished
male appearing somewhat older than his stated age of 72.  He
was alert, awake, and oriented with expressive aphasia.
Neck:  Supple.  No evidence of jugular venous distention.  No
carotid bruits.  Heart:  Irregular, rate, and rhythm.  Rate
approximately 100.  Lungs:  Clear to auscultation
bilaterally.  No wheezes, rales, or rhonchi.  Abdomen:  Soft,
nontender, nondistended.  There was a well-healed surgical
scar present in the midline.  There was a nontender pulsatile
mass.  Extremities:  There were 2+ pulses, femoral through
dorsalis pedis and posterior tibial bilaterally.
Neurological:  The patient was able to speak clearly in short
sentences but has difficulty with normal length
conversations.  His face was symmetric.  Tongue was midline.
He had equal grips bilaterally.

HOSPITAL COURSE:  The patient was admitted to [**Hospital6 1760**] on [**2111-2-4**], where
an abdominal aortic aneurysm repair was performed with the
use of a Dacron tube graft, details of which are dictated as
separate operative note.  The patient tolerated this
procedure quite well and was subsequently transferred up to
the Vascular Intensive Care Unit.

Upon arrival to the VICU, the patient was noted to be
somewhat unresponsive and was being bagged by the nursing
staff.  He was able to arouse with voice and able to follow
commands; however, he appeared to be in somewhat moderate
respiratory distress.  Chest x-ray was obtained and revealed
plate-like atelectasis and a possible collapsed right middle
lobe, but no pneumothorax was noted.  The patient improved
somewhat with Narcan and became more alert and oriented.  He
was monitored very closely throughout the next several hours
with q.4 hour nebulizer treatments.

He was maintained in the Vascular Intensive Care Unit with a
pulmonary artery catheter.  He continued to have rhonchi for
the next several days.  For his heart rate and atrial
fibrillation, as he was tachycardiac on admission, he was
maintained on a Diltiazem drip, as well as intravenous
Lopressor q.4 hours, and he had good response to this.

He did somewhat well over the next few days; however, he did
have occasional problems with shortness of breath that would
respond to Lasix and nebulizer treatments.  It was on
postoperative day #5 when the patient began experiencing
increasing shortness of breath without response to Lasix or
nebulizer treatments, and he was subsequently intubated on
the floor.  He was then transferred down to the Surgical
Intensive Care Unit where he was monitored.  Chest x-ray was
performed at that time which revealed a right-sided
consolidation and possible increased effusion on the right
side.  Sputum cultures were obtained, and the patient was
started on Levofloxacin.

He did quite well and remained stable while he was intubated.
On postoperative day #6, he was started on Zosyn IV for
greater gram-negative coverage.  The cultures were obtained
and revealed yeast, as well as gram-negative rods that
eventually grew out Enterobacter.  He remained on intravenous
Zosyn throughout his stay in the Intensive Care Unit and was
also started on intravenous Fluconazole for the yeast in his
sputum.  He remained in the Intensive Care Unit for
approximately four days, however was able to be extubated on
postoperative day #8.

He was then transferred up to the floor and monitored
closely. It should be noted that during this time frame, he
was also started on TPN, as he had been without nutrition
oral replacement since the 13th.  His Coumadin and INR dosing
were also monitored and maintained daily.  He was eventually
switched back over to oral Levaquin, as the Enterobacter was
sensitive to this, and he was able to take oral diet.  He was
started on a clear liquid diet on postoperative day #12 and
tolerated this quite well.

At this time he is doing quite well.  He is ambulating
without difficulty and without the use of assistance.  He is
tolerating a regular diet without any nausea, vomiting, or
abdominal pain.  He has remained afebrile with stable vitals
signs.  He has been cleared by Physical Therapy for home
discharge.  His INR has been somewhat elevated for the last
two days at 3.7 and 3.8.  His Coumadin on hold for the last
two days and will be restarted tomorrow.  He is to have the
INR checked by visiting nurse tomorrow, and his dose is to be
changed by his regular cardiologist Dr. [**Last Name (STitle) 7659**].  He has
been advised to follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1391**] in
approximately two weeks or call should he have any
difficulty.

DISCHARGE MEDICATIONS:  Coumadin 2.5 mg p.o. q.d. to start
[**2-19**], Lopressor 100 mg p.o. b.i.d., Digoxin 0.125 mg
p.o. q.d., Synthroid 50 mcg p.o. q.d., Diltiazem CD 240 mg
p.o. q.d., Zantac 150 mg p.o. b.i.d., Lipitor 10 mg p.o. q.d.

DISCHARGE DIAGNOSIS:
1.  Abdominal aortic aneurysm status post repair with Dacron
tube graft.
2.  Pneumonia, currently resolved and off antibiotics.
3.  Cerebrovascular accident with residual aphasia that is
stable.
4.  Rapid atrial fibrillation that is currently well
controlled on p.o. Lopressor and Diltiazem.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4417**]

Dictated By:[**Doctor First Name 22875**]
MEDQUIST36

D:  [**2111-2-18**]  10:14
T:  [**2111-2-18**]  10:25
JOB#:  [**Job Number 36640**]
{'Abdominal aneurysm without mention of rupture,Atrial fibrillation,Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Anemia, unspecified,Late effects of cerebrovascular disease, aphasia'}


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: Abdominal aortic aneurysm.

PRESENT ILLNESS: The patient is a 72-year-old
male with a past medical history significant for atrial
fibrillation and cerebrovascular accident causing aphasia who
presented with a 5 cm abdominal aortic aneurysm that was
infrarenal in nature.  This has been monitored for
approximately two years and was noted to be increasing in
size, and he was admitted for elective repair.  This was
initially to be performed in [**2110-11-22**]; however, on the
day of admission, the patient developed vomiting after his
admission, and his heart rate was noted to be approximately
140.  He was then transferred to Telemetry and ruled out by
cardiac enzymes.  Cardiology ordered a cardiac
catheterization which did not show any significant disease,
and he was subsequently cleared for surgery.  After that,
upon entering the abdomen, a very enlarged inflamed
gallbladder was found and removed.  The patient was then
discharged and readmitted on [**2-4**] for a final elective
abdominal aortic aneurysm repair.

MEDICAL HISTORY: Significant for atrial fibrillation on
chronic anticoagulation, ejection fraction noted to be
approximately 35%, cerebrovascular accident in [**2107**] with
residual aphasia and right upper extremity weakness,
hypertension, increased cholesterol, hypothyroidism, chronic
obstructive pulmonary disease, migraine headaches, and
depression.

MEDICATION ON ADMISSION: Coumadin 3 mg p.o. q.d., Digoxin
0.125 mg p.o. q.d., Toprol XL 100 mg p.o. q.d., Synthroid
0.05 mg p.o. q.d., Lipitor 10 mg p.o. q.d., Zoloft 25 mg p.o.
q.h.s.

ALLERGIES: HE ADMITS TO HAVING AN ALLERGY TO SEAFOOD WHICH
CAUSES SEVERE SWELLING IN HIS FACE.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Abdominal aneurysm without mention of rupture,Atrial fibrillation,Pneumonia, organism unspecified,Obstructive chronic bronchitis with (acute) exacerbation,Anemia, unspecified,Late effects of cerebrovascular disease, aphasia'}
