CHIEF COMPLAINT: Asymptomatic with recent Stroke

PRESENT ILLNESS: 51 y/o male who had an embolic stroke in late [**2181-8-26**]. TEE
revealed an ASD, asc. aortic aneurysm with a bicuspid aortic
valve.

MEDICAL HISTORY: Stroke, Migraines, Depression, Hyprecholesterolemia, Psoriasis,
Cerv. Radiculopathy

MEDICATION ON ADMISSION: Tricor 145mg qd, Aspirin 81mg qd, Crestor 10mg qd, Effexor XR
150mg qd, Relpax 40mg prn, Diprosone and Nizoral cream, Fioricet
prn, Coumadin 6mg qd (last dose 2/21)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 74 12 120/8 71" 207#
General: WDWN female in NAD
Skin: Warm, Dry -c/c/e
HEENT: NCAT, PERRL, EOMI
Neck: Supple, FROM, -JVD, -bruit
Chest: CTAB -w/r/r
Heart: RRR, I/VI SEM
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: MAE, A&O x 3

FAMILY HISTORY: Fater with stroke

SOCIAL HISTORY: [**11-27**] ppd x 29 yrs. ETOH very rarely.
Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Cardiac complications, not elsewhere classified,Atrial fibrillation,Ostium secundum type atrial septal defect,Pure hypercholesterolemia
Thoracic aortic aneurysm,Cong aorta valv insuffic,Surg compl-heart,Atrial fibrillation,Secundum atrial sept def,Pure hypercholesterolem
Admission Date:  [**2182-1-20**]              Discharge Date:   [**2182-1-27**]

Date of Birth:  [**2130-4-29**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Asymptomatic with recent Stroke

Major Surgical or Invasive Procedure:
[**2182-1-21**] Asc. Aorta Replacement (26m Gelweave graft), PFO
Closure, Left Atrial Appendage Resection

History of Present Illness:
51 y/o male who had an embolic stroke in late [**2181-8-26**]. TEE
revealed an ASD, asc. aortic aneurysm with a bicuspid aortic
valve.

Past Medical History:
Stroke, Migraines, Depression, Hyprecholesterolemia, Psoriasis,
Cerv. Radiculopathy

Social History:
[**11-27**] ppd x 29 yrs. ETOH very rarely.

Family History:
Fater with stroke

Physical Exam:
VS: 74 12 120/8 71" 207#
General: WDWN female in NAD
Skin: Warm, Dry -c/c/e
HEENT: NCAT, PERRL, EOMI
Neck: Supple, FROM, -JVD, -bruit
Chest: CTAB -w/r/r
Heart: RRR, I/VI SEM
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: MAE, A&O x 3

Pertinent Results:
[**2182-1-21**] Echo: Prebypass: A secundum type atrial septal defect is
present with predominant left to right flow on Color Doppler.
Right ventricular chamber size and free wall motion are normal.
The ascending aorta is moderately dilated. There are simple
atheroma in the descending thoracic aorta. The aortic valve is
bicuspid. There is no aortic valve stenosis. Trace aortic
regurgitation is seen. The mitral valve appears structurally
normal with trivial mitral regurgitation. The mitral valve
leaflets are mildly thickened. NL LV systolic function. EF
55-60%.. There is no pericardial effusion. Postbypass: (not on
any ionotropes): ASD repaired with no flow noted across patch on
Color Doppler or with agitated Iv saline contrast at rest and
with Valsalva. Tube graft noted in ascending aorta. No aortic
dissection noted, AV unchanged, trace AI noted. Descending aorta
contours unchanged. Remaining structures unchanged from
prebypass exam.
[**2182-1-26**] 04:10AM BLOOD WBC-9.7 RBC-3.08* Hgb-9.1* Hct-27.2*
MCV-89 MCH-29.6 MCHC-33.4 RDW-14.7 Plt Ct-313
[**2182-1-27**] 05:15AM BLOOD PT-21.6* PTT-39.6* INR(PT)-2.1*
[**2182-1-26**] 04:10AM BLOOD Glucose-106* UreaN-17 Creat-0.8 Na-140
K-4.4 Cl-105 HCO3-24 AnGap-15
[**2182-1-20**] 03:16PM BLOOD %HbA1c-5.7 [Hgb]-DONE [A1c]-DONE

Brief Hospital Course:
Mr. [**Known lastname 16214**] was admitted one day prior to his surgery secondary
to being on Coumadin and for pre-operative work-up. On [**1-21**] he
was brought to the operating room where he underwent a asc.
aorta replacement, PFO closure and left atrial appendage
resection. Please see operative report for surgical details.
Following surgery he was transferred to the CSRU for invasive
monitoring in stable condition. Later on op day he was weaned
from sedation, awoke neurologically intact and extubated. On
post-op day one he was started on beta blocker and diuretics. He
was gently diuresed throughout hospital course. On this day he
was transferred to the telemetry floor. On post-op day two his
heart rhythm went into atrial fibrillation and he was started
Amiodarone. Pacing wires removed on POD #3 and coumadin started.
Heparin started as pt. still in Afib and history of embolic
stroke. Recurrence of baseline migraines 3-4x/day and fioricet
restarted. INR 2.1 on POD #6 and cleared for discharge to home
with services. Target INR 2.0- 2.5. Coumadin dosing/INR
follow-up with Dr. [**Last Name (STitle) **]. First blood draw Tuesday [**1-29**].

Medications on Admission:
Tricor 145mg qd, Aspirin 81mg qd, Crestor 10mg qd, Effexor XR
150mg qd, Relpax 40mg prn, Diprosone and Nizoral cream, Fioricet
prn, Coumadin 6mg qd (last dose 2/21)

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*1*
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:*1*
3. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
4. Venlafaxine 75 mg Capsule, Sust. Release 24HR Sig: Two (2)
Capsule, Sust. Release 24HR PO DAILY (Daily).
Disp:*60 Capsule, Sust. Release 24HR(s)* Refills:*1*
5. Fenofibrate Micronized 145 mg Tablet Sig: One (1) Tablet PO
daily ().
Disp:*30 Tablet(s)* Refills:*1*
6. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*1*
7. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*1*
8. Coumadin 5 mg Tablet Sig: Two (2) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
Caregroup VNA

Discharge Diagnosis:
Asc. Aortic Aneurysm, Patent Foramen Ovale s/p Asc. Aorta
Replacement, PFO Closure, Left Atrial Appendage Resection
Post-operative Atrial Fibrillation
PMH: Stroke, Migraines, Depression, Hyprecholesterolemia,
Psoriasis, Cerv. Radiculopathy

Discharge Condition:
Good

Discharge Instructions:
Patient may shower, no baths. No creams, lotions or ointments to
incisions. No driving for at least one month. No lifting more
than 10 lbs for at least 10 weeks from the date of surgery.
Monitor wounds for signs of infection. Please call with any
concerns or questions.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) **] in [**11-27**] weeks
first blood draw Tues [**1-29**]


Completed by:[**2182-1-28**]
{'Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Cardiac complications, not elsewhere classified,Atrial fibrillation,Ostium secundum type atrial septal defect,Pure hypercholesterolemia'}


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: Asymptomatic with recent Stroke

PRESENT ILLNESS: 51 y/o male who had an embolic stroke in late [**2181-8-26**]. TEE
revealed an ASD, asc. aortic aneurysm with a bicuspid aortic
valve.

MEDICAL HISTORY: Stroke, Migraines, Depression, Hyprecholesterolemia, Psoriasis,
Cerv. Radiculopathy

MEDICATION ON ADMISSION: Tricor 145mg qd, Aspirin 81mg qd, Crestor 10mg qd, Effexor XR
150mg qd, Relpax 40mg prn, Diprosone and Nizoral cream, Fioricet
prn, Coumadin 6mg qd (last dose 2/21)

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 74 12 120/8 71" 207#
General: WDWN female in NAD
Skin: Warm, Dry -c/c/e
HEENT: NCAT, PERRL, EOMI
Neck: Supple, FROM, -JVD, -bruit
Chest: CTAB -w/r/r
Heart: RRR, I/VI SEM
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -edema, -varicosities
Neuro: MAE, A&O x 3

FAMILY HISTORY: Fater with stroke

SOCIAL HISTORY: [**11-27**] ppd x 29 yrs. ETOH very rarely. 

### Response:
{'Thoracic aneurysm without mention of rupture,Congenital insufficiency of aortic valve,Cardiac complications, not elsewhere classified,Atrial fibrillation,Ostium secundum type atrial septal defect,Pure hypercholesterolemia'}
