CHIEF COMPLAINT: Asymptomatic

PRESENT ILLNESS: Mrs. [**Known lastname 18806**] is an 81 year old female found to have a newly
discovered thoracic aortic aneurysm during preoperative
evaluation for possible D&C for questionable uterine bleeding. A
CT scan in [**2196-3-9**] revealed two areas of fusiform aneurysmal
dilatation of descending thoracic aorta up to 6.6 centimeters.
The CT scan was also notable for an infrarenal abdominal aortic
aneurysm, measuring 6.7 centimeters. Given the above results,
she was referred to the cardiac and vascular services for
endovascular stent grafting. Of note, the etiology of her
bleeding turned out to be hemorrhoids, not uterine.

MEDICAL HISTORY: Thoracic and Abdominal Aortic Aneurysms
Hypertension
Diverticulosis
Chronic Back Pain(L1 collapse)
Arthritis
s/p Cataract Surgery
s/p Appendectomy
s/p Cholecystectomy
s/p Mole removals
s/p D&C

MEDICATION ON ADMISSION: HCTZ 50 qd
Lopressor 25 qd
Ecotrin 81 qd
Crestor 10 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 127/81, HR 90, RR 14, SAT 98% on room air
General: obese elderly female in no acute distress, smelled of
smoke
HEENT: oropharynx benign, edentulous
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds, pulsatile
mass noted
Ext: warm, trace edema L>R, no varicosities
Pulses: 1+ distally, no femoral or carotid bruits
Neuro: nonfocal

FAMILY HISTORY: Denies history of premature coronary disease.

SOCIAL HISTORY: Active smoker, 50 pack year history. Denies ETOH. She is
widowed, currently lives with her 22 year old granddaughter. She
is retired.
Thoracoabdominal aneurysm, without mention of rupture,Accidental puncture or laceration during a procedure, not elsewhere classified,Mechanical complication of other vascular device, implant, and graft,Acute posthemorrhagic anemia,Other iatrogenic hypotension,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diverticulosis of colon (without mention of hemorrhage)
Thracabd anurysm wo rupt,Accidental op laceration,Malfunc vasc device/graf,Ac posthemorrhag anemia,Iatrogenc hypotnsion NEC,Hypertension NOS,Osteoarthros NOS-unspec,Dvrtclo colon w/o hmrhg
Admission Date:  [**2196-7-20**]              Discharge Date:   [**2196-7-27**]

Date of Birth:  [**2115-2-9**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2196-7-20**] Endovascular repair of Thoracic aortic aneurysm with a
TAG modular [**Last Name (LF) 96989**], [**First Name3 (LF) 1092**] aortography and Right femoral
artery repair


History of Present Illness:
Mrs. [**Known lastname 18806**] is an 81 year old female found to have a newly
discovered thoracic aortic aneurysm during preoperative
evaluation for possible D&C for questionable uterine bleeding. A
CT scan in [**2196-3-9**] revealed two areas of fusiform aneurysmal
dilatation of descending thoracic aorta up to 6.6 centimeters.
The CT scan was also notable for an infrarenal abdominal aortic
aneurysm, measuring 6.7 centimeters. Given the above results,
she was referred to the cardiac and vascular services for
endovascular stent grafting. Of note, the etiology of her
bleeding turned out to be hemorrhoids, not uterine.

Past Medical History:
Thoracic and Abdominal Aortic Aneurysms
Hypertension
Diverticulosis
Chronic Back Pain(L1 collapse)
Arthritis
s/p Cataract Surgery
s/p Appendectomy
s/p Cholecystectomy
s/p Mole removals
s/p D&C

Social History:
Active smoker, 50 pack year history. Denies ETOH. She is
widowed, currently lives with her 22 year old granddaughter. She
is retired.

Family History:
Denies history of premature coronary disease.

Physical Exam:
Vitals: BP 127/81, HR 90, RR 14, SAT 98% on room air
General: obese elderly female in no acute distress, smelled of
smoke
HEENT: oropharynx benign, edentulous
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds, pulsatile
mass noted
Ext: warm, trace edema L>R, no varicosities
Pulses: 1+ distally, no femoral or carotid bruits
Neuro: nonfocal


Pertinent Results:
[**2196-7-27**] 06:10AM BLOOD Hct-28.2*
[**2196-7-26**] 05:55AM BLOOD WBC-12.2* RBC-3.46* Hgb-9.9* Hct-28.3*
MCV-82 MCH-28.5 MCHC-34.9 RDW-16.2* Plt Ct-213
[**2196-7-27**] 06:10AM BLOOD Glucose-97 UreaN-35* Creat-1.5* Na-139
K-4.0 Cl-99 HCO3-30 AnGap-14

[**2196-7-26**] Chest CTA ************


Brief Hospital Course:
On the day of admission, Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) 1290**] performed
an endovascular repair of her thoracic aortic aneurysm.
Arteriography following stent placement revealed no endo leak at
the proximal attachment site, with a small endo leak seen at the
distal attachment site. The endo leak did not appear to
communicate with the aneurysm sac. The operation was otherwise
uneventful and there were no complications. She was brought to
the CSRU for invasive monitoring. On postoperative day one, she
experienced hypotension. Subsequent CT scan showed a moderate
amount retroperitoneal hemorrhage. Serial hematocrits remained
stable and she transiently required pressors for hemodynamic
support. Over the next 24 hours, her hemodynamics improved and
she successfully weaned from pressors without difficulty. She
was extubated without incident and the lumbar drain was removed
without complication. She made clinical improvements and
transferred to the SDU on postoperative day two. She was
intermittently transfused to maintain hematocrit near 30%. She
maintained stable hemodynamics and tolerated resumption of beta
blockade. She remained in a normal sinus rhythm. She had a
transient decline in renal function with creatinine peaking to
1.8 but by discharge, her renal function improved. Creatinine at
discharge was 1.5. Prior to discharge, a chest CTA was obtained
to re-evaluate the small endo leak at the distal attachement
site. The CTA was reviewed by both the vascular and cardiac
surgery services and it was determined that intervention was not
required at this time.  She was discharged in stable condition
to home.

Medications on Admission:
HCTZ 50 qd
Lopressor 25 qd
Ecotrin 81 qd
Crestor 10 qd

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
3. 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:*0*
4. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*0*
7. Lasix 20 mg Tablet Sig: One (1) Tablet PO twice a day for 5
days.
Disp:*10 Tablet(s)* Refills:*0*
8. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 5
days.
Disp:*10 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Thoracic Aortic Aneurysm
Postop Anemia with Retroperitoneal Bleed
Abdominal Aortic Aneurysm
HTN
Arthritis


Discharge Condition:
Good.


Discharge Instructions:
Keep incisions clean and dry.
Call with fever, redness or drainage from incisions, or weight
gain more than 2 pounds in one day or five in one week.
Shower, no baths.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] & Dr. [**Last Name (STitle) **] 4 weeks
Dr. [**Last Name (STitle) 5456**] 2 weeks
Dr. [**Last Name (STitle) **] 2 weeks


Completed by:[**2196-7-27**]
{'Thoracoabdominal aneurysm, without mention of rupture,Accidental puncture or laceration during a procedure, not elsewhere classified,Mechanical complication of other vascular device, implant, and graft,Acute posthemorrhagic anemia,Other iatrogenic hypotension,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diverticulosis of colon (without mention of hemorrhage)'}


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

PRESENT ILLNESS: Mrs. [**Known lastname 18806**] is an 81 year old female found to have a newly
discovered thoracic aortic aneurysm during preoperative
evaluation for possible D&C for questionable uterine bleeding. A
CT scan in [**2196-3-9**] revealed two areas of fusiform aneurysmal
dilatation of descending thoracic aorta up to 6.6 centimeters.
The CT scan was also notable for an infrarenal abdominal aortic
aneurysm, measuring 6.7 centimeters. Given the above results,
she was referred to the cardiac and vascular services for
endovascular stent grafting. Of note, the etiology of her
bleeding turned out to be hemorrhoids, not uterine.

MEDICAL HISTORY: Thoracic and Abdominal Aortic Aneurysms
Hypertension
Diverticulosis
Chronic Back Pain(L1 collapse)
Arthritis
s/p Cataract Surgery
s/p Appendectomy
s/p Cholecystectomy
s/p Mole removals
s/p D&C

MEDICATION ON ADMISSION: HCTZ 50 qd
Lopressor 25 qd
Ecotrin 81 qd
Crestor 10 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: BP 127/81, HR 90, RR 14, SAT 98% on room air
General: obese elderly female in no acute distress, smelled of
smoke
HEENT: oropharynx benign, edentulous
Neck: supple, no JVD,
Heart: regular rate, normal s1s2, no murmur or rub
Lungs: clear bilaterally
Abdomen: soft, nontender, normoactive bowel sounds, pulsatile
mass noted
Ext: warm, trace edema L>R, no varicosities
Pulses: 1+ distally, no femoral or carotid bruits
Neuro: nonfocal

FAMILY HISTORY: Denies history of premature coronary disease.

SOCIAL HISTORY: Active smoker, 50 pack year history. Denies ETOH. She is
widowed, currently lives with her 22 year old granddaughter. She
is retired. 

### Response:
{'Thoracoabdominal aneurysm, without mention of rupture,Accidental puncture or laceration during a procedure, not elsewhere classified,Mechanical complication of other vascular device, implant, and graft,Acute posthemorrhagic anemia,Other iatrogenic hypotension,Unspecified essential hypertension,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Diverticulosis of colon (without mention of hemorrhage)'}
