CHIEF COMPLAINT: Greater than 6-cm aneurysm of the descending thoracic aorta

PRESENT ILLNESS: History of Present Illness:
Mr. [**Known lastname 28221**] is a 72 year old male with known thoracic aortic
aneurysm who recently underwent endovascular repair of his
abdominal aortic aneurysm in [**2190-2-28**]. His past medical history
is also notable for coronary artery disease and he is status
post
coronary artery bypass grafting surgery. His postoperative
course
since [**2190-2-28**] has been unremarkable and he has made excellent
recovery. Given his thoracic aortic aneurysm has now slightly
increased in size since previous study, he presents for
endovascular repair of his descending thoracic aortic aneurysm.

MEDICAL HISTORY: -MIx3, status-post stent [**98**] years ago, and CABG and [**Hospital3 **] 5 years ago.
-Diabetes Mellitus II, not on medication.
-s/p Cholecystectomy
-s/p Colon CA, status-post resection x2 (no radiation)
-Manic depression
-History of pneumothorax (at age 35) s/p thoracotomy
-OSA

MEDICATION ON ADMISSION: Zetia 10mg daily
Gemfibrozil 600mg twice daily
Lithium 600mg daily
Toprol 50mg daily
Omeprazole 20mg daily
Simvastatin 80mg daily
Aspirin 81mg daily

ALLERGIES: Morphine

PHYSICAL EXAM: Physical Exam:

FAMILY HISTORY: FAMILY HISTORY: Dad had 2 aortas (?) and cerebral aneurysms,
Diabetes, manic depression and colon cancer in dad

SOCIAL HISTORY: SOCIAL HISTORY: Quit smoking 5 years ago, social EtOH, lives in
[**Location (un) **] alone; performs all activities of daily living.
Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
Thoracic aortic aneurysm,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Old myocardial infarct,DMII wo cmp nt st uncntr,Obstructive sleep apnea,Esophageal reflux,BPH w/o urinary obs/LUTS
Admission Date:  [**2190-10-11**]              Discharge Date:   [**2190-10-13**]

Date of Birth:  [**2118-3-22**]             Sex:   M

Service: SURGERY

Allergies:
Morphine

Attending:[**First Name3 (LF) 2777**]
Chief Complaint:
Greater than 6-cm aneurysm of the descending thoracic aorta

Major Surgical or Invasive Procedure:
PROCEDURES:
1. Stent graft repair of descending thoracic aortic
    aneurysm with the [**Doctor Last Name 4726**] tag endoprosthesis x2. The first
    endoprosthesis is the following:  Catalog number [**Serial Number 65878**],
    lot number [**Serial Number 65879**]; second one is catalog number
    [**Serial Number 65880**], lot number [**Serial Number 65881**].
2. Thoracic aortography.


History of Present Illness:
History of Present Illness:
Mr. [**Known lastname 28221**] is a 72 year old male with known thoracic aortic
aneurysm who recently underwent endovascular repair of his
abdominal aortic aneurysm in [**2190-2-28**]. His past medical history
is also notable for coronary artery disease and he is status
post
coronary artery bypass grafting surgery. His postoperative
course
since [**2190-2-28**] has been unremarkable and he has made excellent
recovery. Given his thoracic aortic aneurysm has now slightly
increased in size since previous study, he presents for
endovascular repair of his descending thoracic aortic aneurysm.


Past Medical History:
-MIx3, status-post stent [**98**] years ago, and CABG and [**Hospital3 **] 5 years ago.
-Diabetes Mellitus II, not on medication.
-s/p Cholecystectomy
-s/p Colon CA, status-post resection x2 (no radiation)
-Manic depression
-History of pneumothorax (at age 35) s/p thoracotomy
-OSA

Social History:
SOCIAL HISTORY: Quit smoking 5 years ago, social EtOH, lives in
[**Location (un) **] alone; performs all activities of daily living.


Family History:
FAMILY HISTORY: Dad had 2 aortas (?) and cerebral aneurysms,
Diabetes, manic depression and colon cancer in dad

Physical Exam:
Physical Exam:

Pulse: 74 Resp:  16
B/P  Right: 132/60    Left: 128/62
Height: 71"    Weight: 209

General: WDWN in NAD
Skin: Dry [X] intact [X]
HEENT: PERRLA [X] EOMI [X] OP benign
Neck:  Supple [X] Full ROM [X]
Chest: Lungs clear bilaterally [X]
Heart: RRR [X] I/VI systolic murmur
Abdomen: Soft [X] non-distended [X] non-tender [X]  bowel sounds
+ [X] Well healed laparotomy and cholecystectomy incisions.
Extremities: Warm [X], well-perfused [X]  No Edema. Right groin
incision well healed
Varicosities: Left GSV surgicall absent above knee
Neuro: Grossly intact
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: None appreciated  Left: None
appreciated


Pertinent Results:
[**2190-10-12**] 04:00AM BLOOD

WBC-7.0 RBC-4.02* Hgb-11.7* Hct-34.3* MCV-85 MCH-29.0 MCHC-34.0
RDW-13.0 Plt Ct-194

[**2190-10-12**] 07:13AM BLOOD

PT-12.7 PTT-24.9 INR(PT)-1.1

[**2190-10-12**] 04:00AM BLOOD

Glucose-127* UreaN-17 Creat-0.9 Na-140 K-4.1 Cl-107 HCO3-27
AnGap-10

[**2190-10-12**] 04:00AM BLOOD

ALT-37 AST-41* AlkPhos-63 TotBili-0.4

[**2190-10-11**] 12:05PM BLOOD

Glucose-141* Lactate-1.2 Na-139 K-4.4 Cl-106

[**2190-10-11**] 08:30AM

URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.016
[**2190-10-11**] 08:30AM
URINE Blood-NEG Nitrite-NEG Protein-NEG Glucose-NEG Ketone-NEG
Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG

ECHO:

The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
and cavity size are normal. Right ventricular chamber size and
free wall motion are normal. The ascending aorta is mildly
dilated. There are simple atheroma in the ascending aorta. The
descending thoracic aorta is markedly dilated. There are complex
(>4mm) atheroma in the descending thoracic aorta. The aortic
wall is thickened consistent with an intramural hematoma. There
are three aortic valve leaflets. The aortic valve leaflets are
moderately thickened. There is no aortic valve stenosis. Trace
aortic regurgitation is seen. The mitral valve leaflets are
moderately thickened. Torn mitral chordae are present. There is
no systolic anterior motion of the mitral valve leaflets. No
mitral regurgitation is seen. There is no pericardial effusion.


Brief Hospital Course:
Mr. [**Known lastname **],[**Known firstname **] was admitted on [**10-11**] with Thoracic aortic
aneurysm. He agreed to have an elective surgery.
Pre-operatively, he was consented. A CXR, EKG, UA, CBC,
Electrolytes, T/S - were obtained,  all other preperations were
made.

Pre hydrated with bicarb and mucomyst.

It was decided that she would undergo a Endovascular repair of
thoracic aortic aneurysm.

He was prepped, and brought down to the operating room for
surgery. Intra-operatively, he was closely monitored and
remained hemodynamically stable. He tolerated the procedure well
without any difficulty or complication.

Post-operatively, he was extubated and transferred to the CVICU
for further stabilization and monitoring.

Perioperative AB given.

He was then transferred to the VICU for further recovery. While
in the VICU he recieved monitered care. When stable he was
delined. His diet was advanced. A PT consult was obtained. When
he was stabalized from the acute setting of post operative care,
he was transfered to floor status

On the floor, he remained hemodynamically stable with his pain
controlled. He progressed with physical therapy to improve her
strength and mobility. He continues to make steady progress
without any incidents. He was discharged home in stable
condition.


Medications on Admission:
Zetia 10mg daily
Gemfibrozil 600mg twice daily
Lithium 600mg daily
Toprol 50mg daily
Omeprazole 20mg daily
Simvastatin 80mg daily
Aspirin 81mg daily


Discharge Medications:
1. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
3. Lithium Carbonate 300 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
4. Toprol XL 50 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
6. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
7. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO once a day for
10 days.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Thoracic aortic aneurysm.


Discharge Condition:
Stable


Discharge Instructions:
Division of Vascular and Endovascular Surgery

Endovascular Aortic Aneurysm Discharge Instructions

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 [**3-2**]
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 [**5-3**] 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: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**MD Number(3) 1240**]:[**Telephone/Fax (1) 7477**]
Date/Time:[**2190-11-17**] 8:00

Provider: [**Name10 (NameIs) **] SCAN Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2190-11-18**] 10:30

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 2625**]
Date/Time:[**2190-11-18**] 11:15



Completed by:[**2190-10-13**]
{'Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}


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: Greater than 6-cm aneurysm of the descending thoracic aorta

PRESENT ILLNESS: History of Present Illness:
Mr. [**Known lastname 28221**] is a 72 year old male with known thoracic aortic
aneurysm who recently underwent endovascular repair of his
abdominal aortic aneurysm in [**2190-2-28**]. His past medical history
is also notable for coronary artery disease and he is status
post
coronary artery bypass grafting surgery. His postoperative
course
since [**2190-2-28**] has been unremarkable and he has made excellent
recovery. Given his thoracic aortic aneurysm has now slightly
increased in size since previous study, he presents for
endovascular repair of his descending thoracic aortic aneurysm.

MEDICAL HISTORY: -MIx3, status-post stent [**98**] years ago, and CABG and [**Hospital3 **] 5 years ago.
-Diabetes Mellitus II, not on medication.
-s/p Cholecystectomy
-s/p Colon CA, status-post resection x2 (no radiation)
-Manic depression
-History of pneumothorax (at age 35) s/p thoracotomy
-OSA

MEDICATION ON ADMISSION: Zetia 10mg daily
Gemfibrozil 600mg twice daily
Lithium 600mg daily
Toprol 50mg daily
Omeprazole 20mg daily
Simvastatin 80mg daily
Aspirin 81mg daily

ALLERGIES: Morphine

PHYSICAL EXAM: Physical Exam:

FAMILY HISTORY: FAMILY HISTORY: Dad had 2 aortas (?) and cerebral aneurysms,
Diabetes, manic depression and colon cancer in dad

SOCIAL HISTORY: SOCIAL HISTORY: Quit smoking 5 years ago, social EtOH, lives in
[**Location (un) **] alone; performs all activities of daily living. 

### Response:
{'Thoracic aneurysm without mention of rupture,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}
