CHIEF COMPLAINT: Mr. [**Known lastname 61807**] was found to have a 9.5cm ascending aortic aneurysm
and was refered to Dr. [**Last Name (STitle) **] for operative treatement

PRESENT ILLNESS: Mr. [**Known lastname 61807**] was found to have a 9.5 cm ascending aortic
anneurysm on workup for abdominal pain.

MEDICAL HISTORY: chronic atrial fibrillation
renal insufficiency
h/o bilat LE cellulitis
chronic anemia
dwarfism
Paget's disease
h/o MI
s/p multiple dental extractions

MEDICATION ON ADMISSION: digoxin 0.125 qd
oxybutin 10mg qam, 5mg qpm
lasix 40mg [**Hospital1 **]
colace
allopurinol 100mg qd
protonix 40mg qd
lisinopril 2.5mg qd
toprol XL 25mg qd

ALLERGIES: Aspirin / Bactrim

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Mr. [**Known lastname 61807**] is retired and lives alone.  He denies tobacco and
admits to rare alcohol
Dissection of aorta, thoracic,Aortic valve disorders,Atrial fibrillation,Acquired coagulation factor deficiency,Other primary cardiomyopathies,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acidosis,Pressure ulcer, buttock,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Long-term (current) use of anticoagulants,Abnormal coagulation profile,Anemia of other chronic disease,Dwarfism, not elsewhere classified,Osteitis deformans without mention of bone tumor,Other anomalies of upper limb, including shoulder girdle,Gout, unspecified,Acquired absence of teeth, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Right bundle branch block,Unspecified acquired hypothyroidism
Dsct of thoracic aorta,Aortic valve disorder,Atrial fibrillation,Acq coagul factor defic,Prim cardiomyopathy NEC,CHF NOS,Pneumonia, organism NOS,Acidosis,Pressure ulcer, buttock,Unilat ing hernia w obst,Hyp kid NOS w cr kid V,Long-term use anticoagul,Abnrml coagultion prfile,Anemia-other chronic dis,Dwarfism NEC,Osteitis deformans NOS,Upper limb anomaly NEC,Gout NOS,Acq absence of teeth NOS,Crnry athrscl natve vssl,Old myocardial infarct,Rt bundle branch block,Hypothyroidism NOS
Admission Date:  [**2195-6-2**]              Discharge Date:   [**2195-7-3**]

Date of Birth:  [**2121-2-27**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Aspirin / Bactrim

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Mr. [**Known lastname 61807**] was found to have a 9.5cm ascending aortic aneurysm
and was refered to Dr. [**Last Name (STitle) **] for operative treatement

Major Surgical or Invasive Procedure:
s/p AVR w/23mm homograft and coronary reimplantation [**6-9**]

History of Present Illness:
Mr. [**Known lastname 61807**] was found to have a 9.5 cm ascending aortic
anneurysm on workup for abdominal pain.

Past Medical History:
chronic atrial fibrillation
renal insufficiency
h/o bilat LE cellulitis
chronic anemia
dwarfism
Paget's disease
h/o MI
s/p multiple dental extractions


Social History:
Mr. [**Known lastname 61807**] is retired and lives alone.  He denies tobacco and
admits to rare alcohol

Pertinent Results:
[**2195-7-2**] 03:20AM BLOOD WBC-8.9 RBC-2.47* Hgb-7.6* Hct-24.2*
MCV-98 MCH-30.9 MCHC-31.5 RDW-17.2* Plt Ct-118*
[**2195-7-2**] 08:21AM BLOOD Hct-27.8*
[**2195-7-2**] 03:20AM BLOOD Plt Ct-118*
[**2195-7-2**] 03:20AM BLOOD PT-13.3 PTT-47.7* INR(PT)-1.2
[**2195-7-2**] 03:20AM BLOOD Glucose-106* UreaN-22* Creat-1.3* Na-135
K-4.5 Cl-100 HCO3-29 AnGap-11

Brief Hospital Course:
Mr. [**Known lastname 61807**] was admitted on [**2195-6-2**] for preoperative evaluation.
 He was noted to have an elevated INR at 1.5, which was
consistent with previous data. A hematology consult was obtained
and it was decided that the patient had vitamin K deficiency and
there was no need for further intervention.  His INR decreased
to 1.3 and he was taken to the operating room with Dr. [**Last Name (STitle) **]
on [**2195-6-9**] for AVR and replacement of his ascending aorta with
a 23mm aortic valve homograft with coronary reimplantation.
Please see operative note for full details.  He was transferred
to the ICU in stable condition.  He was slow to awake but was
following commands on POD#1, and was extubated on POD#2. He was
transferred to the regular floor on POD#3.  He developed rapid
atrial fibrillation on POD#4.  He was found to be hypoxic with
labored breathing.  He was transferred back to the ICU and
required reintubation.  Bronchoscopy showed copious secretions
which showed oropharyngeal flora.  He was extubated on POD#6.  A
pulmonary consult was obtained and it was recommended to use
intermittent BiPAP and diuresis.  He underwent therapeutic
thoracentesis of the right chest on POD#8, and still required
intermittent BiPAP to maintain adequate ventilation. On POD# 9
he was noted to have a swollen left upper extremity and an
ultrasound showed thrombus in the left internal jugular and left
subclavian.  He was started on heparin for anticoagulation.  He
underwent thoracentesis of the left chest on POD#10.  On POD#12
he was re intubated for worsening respiratory status and
respiratory acidosis with mental status changes.  A neurology
consult was obtained and he had a CT scan and MRI which were
negative for any acute process, as well as an EEG which was
negative for any seizure activity, and showed mild diffuse
slowing consistent with encephalopathy.  It was thought that the
mental status changes were due to metabolic encephalopathy, he
was started on Coumadin.  On POD#15 a pulmonary medicine consult
was again obtained and it was recommended that the patient be
allowed to have a compensatory metabolic alkalosis, and continue
BiPAP and aggressive pulmonary toilet.  He was again extubated
and required almost continuous BiPAP to maintain adequate
ventilation.  It was determined that the patient would benefit
from a tracheostomy and he was electively re intubated prior to
the procedure and underwent percutaneous tracheostomy on POD#20.
 Pulmonary medicine recommended continuing empiric antibiotics
for a presumed ventilator associated pneumonia. He was noted to
have a L inguinal hernia that was un reducible.  A general
surgery consult was obtained and and it was decided that no
intervention was needed at this time.  He was cleared for
discharge to rehab

Medications on Admission:
digoxin 0.125 qd
oxybutin 10mg qam, 5mg qpm
lasix 40mg [**Hospital1 **]
colace
allopurinol 100mg qd
protonix 40mg qd
lisinopril 2.5mg qd
toprol XL 25mg qd


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] - [**Location (un) 86**]

Discharge Diagnosis:
s/p replacement of ascending aortic anneurysm
CRI
anemia
dwarfism
paget's disease
respriatory failure
chronic atrial fibrillation

Discharge Condition:
good

Followup Instructions:
See Dr. [**Last Name (STitle) **] (Cardiac Surgery) in [**3-25**] weeks. ([**Telephone/Fax (1) 1504**]
See Dr. [**First Name (STitle) **] (General Surgery for hernia) in 2 weeks. ([**Telephone/Fax (1) 10248**]
See Dr. [**Last Name (STitle) 5456**] (PCP) within two weeks.  [**Telephone/Fax (1) 34605**]
See Dr. [**Last Name (STitle) **] (Cardiology) within two weeks ([**Telephone/Fax (1) 5455**]



Completed by:[**2195-7-3**]
{'Dissection of aorta, thoracic,Aortic valve disorders,Atrial fibrillation,Acquired coagulation factor deficiency,Other primary cardiomyopathies,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acidosis,Pressure ulcer, buttock,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Long-term (current) use of anticoagulants,Abnormal coagulation profile,Anemia of other chronic disease,Dwarfism, not elsewhere classified,Osteitis deformans without mention of bone tumor,Other anomalies of upper limb, including shoulder girdle,Gout, unspecified,Acquired absence of teeth, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Right bundle branch block,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: Mr. [**Known lastname 61807**] was found to have a 9.5cm ascending aortic aneurysm
and was refered to Dr. [**Last Name (STitle) **] for operative treatement

PRESENT ILLNESS: Mr. [**Known lastname 61807**] was found to have a 9.5 cm ascending aortic
anneurysm on workup for abdominal pain.

MEDICAL HISTORY: chronic atrial fibrillation
renal insufficiency
h/o bilat LE cellulitis
chronic anemia
dwarfism
Paget's disease
h/o MI
s/p multiple dental extractions

MEDICATION ON ADMISSION: digoxin 0.125 qd
oxybutin 10mg qam, 5mg qpm
lasix 40mg [**Hospital1 **]
colace
allopurinol 100mg qd
protonix 40mg qd
lisinopril 2.5mg qd
toprol XL 25mg qd

ALLERGIES: Aspirin / Bactrim

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Mr. [**Known lastname 61807**] is retired and lives alone.  He denies tobacco and
admits to rare alcohol 

### Response:
{'Dissection of aorta, thoracic,Aortic valve disorders,Atrial fibrillation,Acquired coagulation factor deficiency,Other primary cardiomyopathies,Congestive heart failure, unspecified,Pneumonia, organism unspecified,Acidosis,Pressure ulcer, buttock,Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Long-term (current) use of anticoagulants,Abnormal coagulation profile,Anemia of other chronic disease,Dwarfism, not elsewhere classified,Osteitis deformans without mention of bone tumor,Other anomalies of upper limb, including shoulder girdle,Gout, unspecified,Acquired absence of teeth, unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Right bundle branch block,Unspecified acquired hypothyroidism'}
