CHIEF COMPLAINT: cough

PRESENT ILLNESS: This is a seventy-eight year old female with multiple cardiac
risk factors who presents to clinic today following an
incidental finding of an aortic root/ascending aortic aneurysm.
She recently underwent chest CT scan in [**2130-7-30**] for a
persistent cough which is now much improved following a course
of Prednisone and Advair inhaler. Aneurysm now measures
approximately 5.8 centimeters. Currently she feels well. She
admits to mild dyspnea on exertion,
otherwise denies chest/back pain, orthopnea, PND, syncope,
hoarseness and pedal edema.

MEDICAL HISTORY: Ascending Aortic Aneurysm, Hypertension, Type II Diabetes,
Dyslipidemia, Hypothyroidism, Asthma, Polymyalgia Rheumatica,
GERD,  History of SVT s/p ablation, Post Herpetic Neuralgia,
History of PNA, Appendectomy, Thyroid surgery

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Metoprolol Succinate XL 50 mg PO DAILY
2. Simvastatin 40 mg PO DAILY
3. Pantoprazole 40 mg PO Q24H
4. Levothyroxine Sodium 125 mcg PO DAILY
5. Gabapentin Dose is Unknown  PO Frequency is Unknown
6. Pioglitazone 45 mg PO DAILY
7. GlipiZIDE XL 10 mg PO DAILY
8. Aspirin 81 mg PO DAILY
9. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: Pulse: 74  Resp: 16  O2 sat: 97%
B/P  Right: 150/91   Left: 160/90
Height: 63 inches    Weight: 156 lbs

FAMILY HISTORY: Denies premature coronary artery disease

SOCIAL HISTORY: Ms. [**Known lastname 41757**] lives alone.  she denies cigarette, alcohol, or
illicit drug use.
Thoracic aneurysm without mention of rupture,Cerebral artery occlusion, unspecified with cerebral infarction,Central nervous system complication,Anoxic brain damage,Atrial fibrillation,Unspecified visual loss,Other ill-defined conditions,Other acquired deformities of forearm, excluding fingers,Unspecified disorder of muscle, ligament, and fascia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Esophageal reflux,Rheumatoid arthritis
Thoracic aortic aneurysm,Crbl art ocl NOS w infrc,Surg complication - cns,Anoxic brain damage,Atrial fibrillation,Visual loss NOS,Ill-define condition NEC,Forearm deformity NEC,Muscle/ligament dis NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Asthma NOS,Esophageal reflux,Rheumatoid arthritis
Admission Date:  [**2130-10-6**]              Discharge Date:   [**2130-10-17**]

Date of Birth:  [**2052-7-8**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Erythromycin Base

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
cough

Major Surgical or Invasive Procedure:
ascending aorta replacement (30mm gelweave tube graft) [**2130-10-6**]


History of Present Illness:
This is a seventy-eight year old female with multiple cardiac
risk factors who presents to clinic today following an
incidental finding of an aortic root/ascending aortic aneurysm.
She recently underwent chest CT scan in [**2130-7-30**] for a
persistent cough which is now much improved following a course
of Prednisone and Advair inhaler. Aneurysm now measures
approximately 5.8 centimeters. Currently she feels well. She
admits to mild dyspnea on exertion,
otherwise denies chest/back pain, orthopnea, PND, syncope,
hoarseness and pedal edema.


Past Medical History:
Ascending Aortic Aneurysm, Hypertension, Type II Diabetes,
Dyslipidemia, Hypothyroidism, Asthma, Polymyalgia Rheumatica,
GERD,  History of SVT s/p ablation, Post Herpetic Neuralgia,
History of PNA, Appendectomy, Thyroid surgery


Social History:
Ms. [**Known lastname 41757**] lives alone.  she denies cigarette, alcohol, or
illicit drug use.


Family History:
Denies premature coronary artery disease


Physical Exam:
Pulse: 74  Resp: 16  O2 sat: 97%
B/P  Right: 150/91   Left: 160/90
Height: 63 inches    Weight: 156 lbs

General: Well-developed female in no acute distress
Skin: Warm [X] Dry [X] intact [X]
HEENT: NCAT [X] PERRLA [X] EOMI [X]
Neck: Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] Irregular [] Murmur [] grade ______
Abdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds
+
[X]
Extremities: Warm [X], well-perfused [X] Edema [] _____
Varicosities: None [X]
Neuro: Grossly intact [X]
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit:     Right: -   Left: -


Pertinent Results:
[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 41758**] (Complete)
Done [**2130-10-6**] at 10:18:26 AM      FINAL
Conclusions
Prebypass
No atrial septal defect is seen by 2D or color Doppler. Left
ventricular wall thicknesses are normal. The left ventricular
cavity size is normal. Regional left ventricular wall motion is
normal. Overall left ventricular systolic function is normal
(LVEF>55%). Right ventricular chamber size and free wall motion
are normal. The ascending aorta is severely dilated. The aortic
arch is moderately dilated. The descending thoracic aorta is
mildly dilated. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. Mild (1+) aortic
regurgitation is seen. Mild (1+) mitral regurgitation is seen.
There is no pericardial effusion. Dr. [**Last Name (STitle) **] was notified in
person of the results on [**2130-10-6**] at 900 am.
Post bypass
Patient is AV paced and receiving a infusion of phenylephrine.
Biventricular systolic function is unchanged. Graft material
seen in the ascending aorta. Mild aortic insufficiency persists.
Rest of examination is unchanged from prebypass. Aorta is
intact.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
.


[**2130-10-16**] 01:55AM BLOOD WBC-12.1* RBC-3.52* Hgb-11.2* Hct-34.5*
MCV-98 MCH-31.7 MCHC-32.4 RDW-13.5 Plt Ct-481*
[**2130-10-15**] 05:52AM BLOOD WBC-10.9 RBC-3.41* Hgb-11.0* Hct-33.0*
MCV-97 MCH-32.1* MCHC-33.3 RDW-13.7 Plt Ct-373
[**2130-10-14**] 05:35AM BLOOD WBC-11.9* RBC-3.38* Hgb-10.7* Hct-33.0*
MCV-97 MCH-31.6 MCHC-32.4 RDW-13.5 Plt Ct-381
[**2130-10-16**] 01:55AM BLOOD Glucose-125* UreaN-19 Creat-0.9 Na-142
K-3.2* Cl-104 HCO3-28 AnGap-13
[**2130-10-15**] 05:52AM BLOOD Glucose-203* UreaN-22* Creat-1.1 Na-138
K-3.9 Cl-104 HCO3-23 AnGap-15
[**2130-10-17**] 06:10AM BLOOD WBC-12.2* RBC-3.30* Hgb-10.6* Hct-32.3*
MCV-98 MCH-32.1* MCHC-32.8 RDW-13.8 Plt Ct-434
[**2130-10-16**] 01:55AM BLOOD WBC-12.1* RBC-3.52* Hgb-11.2* Hct-34.5*
MCV-98 MCH-31.7 MCHC-32.4 RDW-13.5 Plt Ct-481*
[**2130-10-15**] 05:52AM BLOOD WBC-10.9 RBC-3.41* Hgb-11.0* Hct-33.0*
MCV-97 MCH-32.1* MCHC-33.3 RDW-13.7 Plt Ct-373
[**2130-10-16**] 01:55AM BLOOD PT-18.9* PTT-40.8* INR(PT)-1.8*
[**2130-10-15**] 05:52AM BLOOD PT-16.4* INR(PT)-1.5*
[**2130-10-17**] 06:10AM BLOOD Glucose-133* UreaN-25* Creat-1.0 Na-140
K-3.3 Cl-103 HCO3-27 AnGap-13
[**2130-10-16**] 01:55AM BLOOD Glucose-125* UreaN-19 Creat-0.9 Na-142
K-3.2* Cl-104 HCO3-28 AnGap-13

Brief Hospital Course:
Ms. [**Known lastname 41757**] was admitted with an incidental finding of an
ascending aortic aneurysm during work-up for a complaint of
worsening cough.  She underwent a pre-operative work-up.  She
was brought to the Operating Room on [**2130-10-6**] and underwent an
ascending aortic aneurysm replacement.  Overall the patient
tolerated the procedure well and post-operatively was
transferred to the CVICU in stable condition for recovery and
invasive monitoring.  On waking she did not follow commands and
did not move her right upper extremity.  She was re-sedated
overnight.  The following day she was again woken while
witholding narcotics and she presented with a simlilar exam.  A
head CT was performed which was negative for an acute
intracranial process.  A neurology consult was obtained.  She
was weaned from vasopressor support.  Chest tubes and pacing
wires were discontinued without complication.  She was treated
with amiodarone for post-operative atrial fibrillation and
converted to a sinus rhythm.   Beta blocker was initiated and
the patient was gently diuresed toward the preoperative weight.
She was able to be extubated with the aid of precedex on
post-operative day 5.  Zosyn was started to treat possible
pneumonia.  The patient was evaluated by the physical therapy
service for assistance with strength and mobility.  On
post-operative day seven her neurological deficits persisted so
an MRI was performed.  This study revealed likely global
cortical hypoxia.  By the time of discharge on POD 11 the
patient remained abulic with a flaccid right upper extremity and
vision loss.  Her sternal wound was healing and pain was
controlled with oral analgesics.  The patient was discharged to
[**Hospital1 **], [**Location (un) 86**] with appropriate follow up instructions.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Metoprolol Succinate XL 50 mg PO DAILY
2. Simvastatin 40 mg PO DAILY
3. Pantoprazole 40 mg PO Q24H
4. Levothyroxine Sodium 125 mcg PO DAILY
5. Gabapentin Dose is Unknown  PO Frequency is Unknown
6. Pioglitazone 45 mg PO DAILY
7. GlipiZIDE XL 10 mg PO DAILY
8. Aspirin 81 mg PO DAILY
9. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]


Discharge Medications:
1. Levothyroxine Sodium 125 mcg PO DAILY
2. Simvastatin 40 mg PO DAILY
3. Aspirin 81 mg PO DAILY
4. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
5. Acetaminophen 325-650 mg PO Q4H:PRN pain/temp
6. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing
7. Albuterol-Ipratropium [**3-4**] PUFF IH Q6H:PRN wheezing
8. Amiodarone 400 mg PO BID
400mg [**Hospital1 **] x 1 week, then 400mg daily x 1 week, then 200mg daily

9. Furosemide 80 mg PO BID Duration: 7 Days
10. Guaifenesin-Dextromethorphan 5 mL PO Q6H:PRN cough
11. Heparin 5000 UNIT SC TID
12. Glargine 24 Units Breakfast
Insulin SC Sliding Scale using REG Insulin
13. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheezing
14. Latanoprost 0.005% Ophth. Soln. 1 DROP LEFT EYE HS
15. Metoprolol Tartrate 50 mg PO TID
Hold for HR < 55 or SBP < 90 and call medical provider.
16. Miconazole Powder 2% 1 Appl TP QID:PRN rash
17. Neutra-Phos 2 PKT PO TID
18. Potassium Chloride 40 mEq PO Q12H Duration: 7 Doses
Hold for K+ > 4.5
19. Sodium Chloride Nasal [**1-30**] SPRY NU TID:PRN dry nose
20. Pantoprazole 40 mg PO Q24H


Discharge Disposition:
Extended Care

Facility:
tbd

Discharge Diagnosis:
ascending aortic aneurysm
global cortical hypoxia
- Hypertension
- Type II Diabetes
- Dyslipidemia
- Hypothyroidism
- Asthma
- Polymyalgia Rheumatica
- GERD
- History of SVT s/p ablation
- Post Herpetic Neuralgia
- History of PNA
Past Surgical History:
- Appendectomy
- Thyroid surgery


Discharge Condition:
RUE flaccid, LUE intermittently moves to verbal command,
possibly visual deficits. Abulic.
Sternal pain managed with oral analgesics
Sternal Incision - healing well, no erythema or drainage
Edema: 1+


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming, and look at your incisions
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart
No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge

Followup Instructions:
You are scheduled for the following appointments:
Surgeon Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] Date/Time:[**2130-11-15**] 3:30

Cardiologist Dr. [**Last Name (STitle) 14522**] [**2130-11-2**] 11:15

Please call to schedule the following:
Neurology: Dr. [**Last Name (STitle) 1693**] [**Telephone/Fax (1) 1694**]

Primary Care Dr. [**Last Name (STitle) **] ([**Telephone/Fax (1) 41759**] in [**5-4**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2130-10-17**]
{'Thoracic aneurysm without mention of rupture,Cerebral artery occlusion, unspecified with cerebral infarction,Central nervous system complication,Anoxic brain damage,Atrial fibrillation,Unspecified visual loss,Other ill-defined conditions,Other acquired deformities of forearm, excluding fingers,Unspecified disorder of muscle, ligament, and fascia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Esophageal reflux,Rheumatoid arthritis'}


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: cough

PRESENT ILLNESS: This is a seventy-eight year old female with multiple cardiac
risk factors who presents to clinic today following an
incidental finding of an aortic root/ascending aortic aneurysm.
She recently underwent chest CT scan in [**2130-7-30**] for a
persistent cough which is now much improved following a course
of Prednisone and Advair inhaler. Aneurysm now measures
approximately 5.8 centimeters. Currently she feels well. She
admits to mild dyspnea on exertion,
otherwise denies chest/back pain, orthopnea, PND, syncope,
hoarseness and pedal edema.

MEDICAL HISTORY: Ascending Aortic Aneurysm, Hypertension, Type II Diabetes,
Dyslipidemia, Hypothyroidism, Asthma, Polymyalgia Rheumatica,
GERD,  History of SVT s/p ablation, Post Herpetic Neuralgia,
History of PNA, Appendectomy, Thyroid surgery

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from webOMR.
1. Metoprolol Succinate XL 50 mg PO DAILY
2. Simvastatin 40 mg PO DAILY
3. Pantoprazole 40 mg PO Q24H
4. Levothyroxine Sodium 125 mcg PO DAILY
5. Gabapentin Dose is Unknown  PO Frequency is Unknown
6. Pioglitazone 45 mg PO DAILY
7. GlipiZIDE XL 10 mg PO DAILY
8. Aspirin 81 mg PO DAILY
9. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]

ALLERGIES: Erythromycin Base

PHYSICAL EXAM: Pulse: 74  Resp: 16  O2 sat: 97%
B/P  Right: 150/91   Left: 160/90
Height: 63 inches    Weight: 156 lbs

FAMILY HISTORY: Denies premature coronary artery disease

SOCIAL HISTORY: Ms. [**Known lastname 41757**] lives alone.  she denies cigarette, alcohol, or
illicit drug use. 

### Response:
{'Thoracic aneurysm without mention of rupture,Cerebral artery occlusion, unspecified with cerebral infarction,Central nervous system complication,Anoxic brain damage,Atrial fibrillation,Unspecified visual loss,Other ill-defined conditions,Other acquired deformities of forearm, excluding fingers,Unspecified disorder of muscle, ligament, and fascia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Asthma, unspecified type, unspecified,Esophageal reflux,Rheumatoid arthritis'}
