CHIEF COMPLAINT: descending thoracic aortic aneurysm

PRESENT ILLNESS: The patient is a 64-year old male who has a penetrating aortic
ulcer or a focal dissection that has become aneurysm which has
increased in size. He was not a candidate for open surgery. He
was admitted for descending thoracic aortic aneurysm repair.

MEDICAL HISTORY: PMH: thoracic aortic aneurysm, history of pulmonary emboli (s/p
IVC filter), h/o infected infrarenal aortic aneurysm/aortitis,
bacterial meningitis (S. pneumoniae), anterior spinal artery
infarct, colonic diverticulosis, diabetes mellitus,
hypertension, hyperlipidemia, thoracic vertebral fracture

MEDICATION ON ADMISSION: Amitryptiline 10 mg', Gabapentin 900 mg''', Glipizide 5 mg'',
Metoprolol 50 mg'', Simvastatin 20 mg', Warfarin 4 mg', Zolpidem
5 mg', Docusate 100 mg', Ferrous gluconate 325 mg''', Senna 8.6
mg''

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VITALS: Afebrile, vitals signs stable.
HEENT: Normocephalic, atraumatic. EOMI. PERRL. Nares clear.
Mucous membranes moist. Neck supple without lymphadenopathy.
CVS: Regular rate and rhythm, without murmurs, rubs or gallops.
S1 and S2. No evidence of carotid bruits.
RESP: Clear to auscultation bilaterally without adventitious
sounds. No wheezing, rhonchi or crackles.
ABD: soft, non-tender, non-distended, with normoactive bowel
sounds. No masses or peritoneal signs.
EXTR: The right lower extremity is warm well-perfused and is
without erythema, drainage or edema. The left lower extremity is
warm well-perfused and is without erythema, drainage or edema.
Percutaneously closed groin incisions clean, dry and intact
without hematoma or drainage.
PULSE EXAM: weakly palpable DP pulses bilaterally

FAMILY HISTORY: no history of premature coronary artery disease

SOCIAL HISTORY: From the [**Country 13622**] Republic, lives alone but his daughter lives
nearby; retired from work, ceased smoking 20-years prior, denies
alcohol use
Dissection of aorta, thoracic,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Wheelchair dependence,Postprocedural fever,Other specified retention of urine,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Personal history of infections of the central nervous system,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia
Dsct of thoracic aorta,Hypertension NOS,DMII wo cmp nt st uncntr,Wheelchair dependence,Postprocedural fever,Oth spcf retention urine,Long-term use anticoagul,Hx-ven thrombosis/embols,Personl hx infection CNS,Dvrtclo colon w/o hmrhg,Hyperlipidemia NEC/NOS
Admission Date:  [**2157-5-5**]              Discharge Date:   [**2157-5-9**]

Date of Birth:  [**2092-8-26**]             Sex:   M

Service: SURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1234**]
Chief Complaint:
descending thoracic aortic aneurysm

Major Surgical or Invasive Procedure:
[**2157-5-5**] - Total percutaneous thoracic aneurysm stent graft
repair, with Zenith TX2 30-120, bilateral femoral artery access
using ultrasound guidance, bilateral catheter in the aorta,
stent graft repair of descending thoracic aortic aneurysm,
thoracic and abdominal aortography


History of Present Illness:
The patient is a 64-year old male who has a penetrating aortic
ulcer or a focal dissection that has become aneurysm which has
increased in size. He was not a candidate for open surgery. He
was admitted for descending thoracic aortic aneurysm repair.


Past Medical History:
PMH: thoracic aortic aneurysm, history of pulmonary emboli (s/p
IVC filter), h/o infected infrarenal aortic aneurysm/aortitis,
bacterial meningitis (S. pneumoniae), anterior spinal artery
infarct, colonic diverticulosis, diabetes mellitus,
hypertension, hyperlipidemia, thoracic vertebral fracture

PSH: s/p IVC filter, s/p infrarenal aortobiiliac reconstruction
([**4-/2155**]), s/p umbilical hernia repair, s/p eye laser surgery for
macular edema


Social History:
From the [**Country 13622**] Republic, lives alone but his daughter lives
nearby; retired from work, ceased smoking 20-years prior, denies
alcohol use

Family History:
no history of premature coronary artery disease


Physical Exam:
VITALS: Afebrile, vitals signs stable.
HEENT: Normocephalic, atraumatic. EOMI. PERRL. Nares clear.
Mucous membranes moist. Neck supple without lymphadenopathy.
CVS: Regular rate and rhythm, without murmurs, rubs or gallops.
S1 and S2. No evidence of carotid bruits.
RESP: Clear to auscultation bilaterally without adventitious
sounds. No wheezing, rhonchi or crackles.
ABD: soft, non-tender, non-distended, with normoactive bowel
sounds. No masses or peritoneal signs.
EXTR: The right lower extremity is warm well-perfused and is
without erythema, drainage or edema. The left lower extremity is
warm well-perfused and is without erythema, drainage or edema.
Percutaneously closed groin incisions clean, dry and intact
without hematoma or drainage.
PULSE EXAM: weakly palpable DP pulses bilaterally


Pertinent Results:
[**2157-5-7**] 02:39AM BLOOD WBC-7.7 RBC-3.06* Hgb-9.7* Hct-28.5*
MCV-93 MCH-31.5 MCHC-33.8 RDW-13.6 Plt Ct-255

[**2157-5-7**] 02:39AM BLOOD PT-13.9* PTT-25.2 INR(PT)-1.2*

[**2157-5-7**] 02:39AM BLOOD Glucose-154* UreaN-9 Creat-1.0 Na-137
K-3.9 Cl-104 HCO3-22 AnGap-15

[**2157-5-7**] 02:39AM BLOOD Calcium-8.6 Phos-2.6* Mg-1.9

Brief Hospital Course:
NEURO/PAIN: The patient was maintained on IV pain medication in
the immediate post-operative period and transitioned to PO
narcotic medication with adequate pain control on POD#0-1. The
patient remained neurologically intact and without change from
baseline during their stay. The patient remained alert and
oriented to person, location and place. His neurologic exam
following the procedure was assessed frequently and was
reassuring. A lumbar drain was placed pre-op to maintain
cerebral perfusion pressures for neurologic cord protection. The
patient had CSF removed to maintain 10 cmH20 of pressure. The
lumbar drain was removed on POD#2 without issue. Initially the
patient was maintained in the cardiovascular ICU with transfer
to the VICU when stable.

CARDIOVASCULAR: The patient remained hemodynamically stable
intra-op and in the immediate post-operative period. The patient
was maintained on IV anti-hypertensive medication (Nitroglycerin
IV gtt) in the immediate post-op period to maintain SBP between
120-160 mmHg, with transition to their oral home
anti-hypertensives on POD#[**1-27**]. Their vitals signs were closely
monitored with telemetry. A beta-blocker was initiated, as well
as a statin medication upon admission,

The patient did well following their vascular procedure. The
patient was closely monitored with serial pulse exams in the
post-op period. If appropriate, doppler signaling was frequently
assessed in the involved extremity. Their post-op pulse exam
demonstrated bilaterally dopplerable DP pulses. The patient's
cardioprotective dose of Aspirin was continued post-op. The
patient was restarted on his home dosing of Coumadin of 2.5-5 mg
PO daily on POD#2. His PCP will [**Name9 (PRE) 702**] his INR in clinic on
discharge and he will continue his Coumadin medication.

RESPIRATORY: The patient was extubated in the immediate post-op
period successfully. The patient had no episodes of desaturation
or pulmonary concerns. The patient denied cough or respiratory
symptoms. Pulse oximetry was monitored closely and the patient
maintained adequate oxygenation.

GASTROINTESTINAL: The patient was NPO following their procedure
and transitioned to sips and a clear liquid diet on POD#2. The
patient experienced no nausea or vomiting. The patient was
transitioned to a regular/cardiac healthy diet on POD#3 and IV
fluids were discontinued once adequate PO intake was
established.

GENITOURINARY: The patient's urine output was closely monitored
in the immediate post-operative period. A Foley catheter was
placed intra-operatively and removed on POD#2, at which time the
patient was able to successfully void without issue. The
patient's intake and output was closely monitored for UOP > 30
mL per hour output. The patient's creatinine was stable. The
Foley catheter was replaced for some mild urinary retention on
POD#3 and he was sent with a Foley leg bag with PCP [**Name9 (PRE) 702**]
for [**Name Initial (PRE) **] void trial.

HEME: The patient's post-op hematocrit was stable and trended
closely. The patient remained hemodynamically stable and did not
require transfusion. The patient's coagulation profile remained
stable, patient was on Coumadin. The patient had no evidence of
bleeding from their incision.

ID: The patient showed no signs of infection and remained
afebrile in the post-op period, with the exception of a
low-grade temperature on POD#1. Blood cultures were unrevealing.
Their white count was stable post-operatively and their incision
was closely monitored for any evidence of infection or erythema.
The patient received only standard peri-operative antibiotics,
and did not require further antibiotics post-op.

ENDOCRINE: The patient's blood glucose was closely monitored in
the post-op period with Q6 hour glucose checks. Blood glucose
levels greater than 120 mg/dL were addressed with an insulin
sliding scale. Home hypoglycemic medications were held while the
patient was NPO--these medications were resumed with a sliding
insulin scale once oral intake was tolerated.

PROPHYLAXIS: The patient was maintained on heparin 5000 units SQ
TID for DVT/PE prophylaxis and encouraged to ambulate
immediately post-op once cleared by physical therapy. The
patient also had sequential compression boot devices in place
during immobilization to promote circulation. GI prophylaxis was
sustained with Protonix/Famotidine when necessary. The patient
was encouraged to utilize incentive spirometry, ambulate early
and was discharged in stable condition. He will continue with
outpatient PT services.


Medications on Admission:
Amitryptiline 10 mg', Gabapentin 900 mg''', Glipizide 5 mg'',
Metoprolol 50 mg'', Simvastatin 20 mg', Warfarin 4 mg', Zolpidem
5 mg', Docusate 100 mg', Ferrous gluconate 325 mg''', Senna 8.6
mg''

Discharge Medications:
1. 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:*2*
2. amitriptyline 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
4. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*45 Tablet(s)* Refills:*0*
5. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

6. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
8. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever/pain.
9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
10. hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
11. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

12. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
Disp:*30 Capsule, Ext Release 24 hr(s)* Refills:*2*
13. warfarin 2.5 mg Tablet Sig: 1-2 Tablets PO once a day: 2.5
mg daily (Monday, Tuesday and Wednesday), 5 mg daily (Thursday
through Sunday).
Disp:*50 Tablet(s)* Refills:*2*
14. Outpatient Lab Work
Please have Foley catheter/leg bag removed by your PCP for void
trial
15. Outpatient Physical Therapy


Discharge Disposition:
Home

Discharge Diagnosis:
Descending thoracic aortic aneurysm


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
THORACIC AORTIC STENT GRAFT:

Medications:
?????? Take Aspirin 325mg (enteric coated) once daily
?????? Do not stop Aspirin unless your Vascular Surgeon instructs you
to do so.
?????? Continue all other medications you were taking before surgery,
unless otherwise directed
?????? You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort

What to expect when you go home:
It is normal to have slight swelling of the legs:
?????? Elevate your leg above the level of your heart (use [**1-27**]
pillows or a recliner) every 2-3 hours throughout the day and at
night
?????? Avoid prolonged periods of standing or sitting without your
legs elevated
It is normal to feel tired and have a decreased appetite, your
appetite will return with time
?????? Drink plenty of fluids and eat small frequent meals
?????? It is important to eat nutritious food options (high fiber,
lean meats, vegetables/fruits, low fat, low cholesterol) to
maintain your strength and assist in wound healing
?????? To avoid constipation: eat a high fiber diet and use stool
softener while taking pain medication

What activities you can and cannot do:
?????? When you go home, you may walk and go up and down stairs
?????? You may shower (let the soapy water run over groin incision,
rinse and pat dry)
?????? Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal)
?????? After 1 week, you may resume sexual activity
?????? After 1 week, gradually increase your activities and distance
walked as you can tolerate
?????? No driving until you are no longer taking pain medications
?????? Call and schedule an appointment to be seen in [**3-30**] weeks for
post procedure check and CTA

What to report to office:
?????? Numbness, coldness or pain in lower extremities
?????? Temperature greater than 101.5F for 24 hours
?????? New or increased drainage from incision or white, yellow or
green drainage from incisions
?????? Bleeding from groin puncture site

SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site or
incision)
?????? Lie down, keep leg straight and have someone apply firm
pressure to area for 10 minutes. If bleeding stops, call
vascular office. If bleeding does not stop, call 911 for
transfer to closest Emergency Room.


Followup Instructions:
Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2157-6-14**] 1:15

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1244**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2157-6-14**] 2:15

You have an appointment with your PCP, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on
Tuesday, [**2157-5-10**] at 11:15 AM. Your INR will be checked and
a voiding trial will commence.
{'Dissection of aorta, thoracic,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Wheelchair dependence,Postprocedural fever,Other specified retention of urine,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Personal history of infections of the central nervous system,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia'}


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: descending thoracic aortic aneurysm

PRESENT ILLNESS: The patient is a 64-year old male who has a penetrating aortic
ulcer or a focal dissection that has become aneurysm which has
increased in size. He was not a candidate for open surgery. He
was admitted for descending thoracic aortic aneurysm repair.

MEDICAL HISTORY: PMH: thoracic aortic aneurysm, history of pulmonary emboli (s/p
IVC filter), h/o infected infrarenal aortic aneurysm/aortitis,
bacterial meningitis (S. pneumoniae), anterior spinal artery
infarct, colonic diverticulosis, diabetes mellitus,
hypertension, hyperlipidemia, thoracic vertebral fracture

MEDICATION ON ADMISSION: Amitryptiline 10 mg', Gabapentin 900 mg''', Glipizide 5 mg'',
Metoprolol 50 mg'', Simvastatin 20 mg', Warfarin 4 mg', Zolpidem
5 mg', Docusate 100 mg', Ferrous gluconate 325 mg''', Senna 8.6
mg''

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VITALS: Afebrile, vitals signs stable.
HEENT: Normocephalic, atraumatic. EOMI. PERRL. Nares clear.
Mucous membranes moist. Neck supple without lymphadenopathy.
CVS: Regular rate and rhythm, without murmurs, rubs or gallops.
S1 and S2. No evidence of carotid bruits.
RESP: Clear to auscultation bilaterally without adventitious
sounds. No wheezing, rhonchi or crackles.
ABD: soft, non-tender, non-distended, with normoactive bowel
sounds. No masses or peritoneal signs.
EXTR: The right lower extremity is warm well-perfused and is
without erythema, drainage or edema. The left lower extremity is
warm well-perfused and is without erythema, drainage or edema.
Percutaneously closed groin incisions clean, dry and intact
without hematoma or drainage.
PULSE EXAM: weakly palpable DP pulses bilaterally

FAMILY HISTORY: no history of premature coronary artery disease

SOCIAL HISTORY: From the [**Country 13622**] Republic, lives alone but his daughter lives
nearby; retired from work, ceased smoking 20-years prior, denies
alcohol use 

### Response:
{'Dissection of aorta, thoracic,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Wheelchair dependence,Postprocedural fever,Other specified retention of urine,Long-term (current) use of anticoagulants,Personal history of venous thrombosis and embolism,Personal history of infections of the central nervous system,Diverticulosis of colon (without mention of hemorrhage),Other and unspecified hyperlipidemia'}
