CHIEF COMPLAINT: Shortness of breath with known Aneurysm

PRESENT ILLNESS: 86 y/o male with known asc. aortic aneurysm x 3yrs. He has
developed increased shortness of breath and fatigue. Aneurysm
has slightly increased in size. Recent cardiac cath revealed
coronary artery disease along with moderate mitral
regurgitation. He is being admitted for elective surgery.

MEDICAL HISTORY: Coronary Artery Disease, Ascending Aortic Aneurysm, Mitral
Regurgitation, Diabetes Mellitus, Hypertension, Benign Prostatic
Hypertrophy, Obesity, Hiatal hernia, s/p pacemaker in [**2129**], s/p
left knee surgery

MEDICATION ON ADMISSION: Zocor 40mg qd, Felodipine 10mg qd, Terazosin 5mg qd, Atenolol
50mg qd, Aspirin 325mg qd, Proscar 5mg qd, Novolog 70/30 5qAM,
8qPM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
VS: 60 14 112/60 5'8" 210#
Gen: WD/WN male in NAD
Skin: W/D -lesions
HEENT: NC/AT EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: CTAB -w/r/r
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies tobacco use. Admits to rare ETOH use.
Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Pulmonary collapse,Congestive heart failure, unspecified,Thoracic aneurysm without mention of rupture,Mitral valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified anemias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Diaphragmatic hernia without mention of obstruction or gangrene,Obesity, unspecified,Cardiac pacemaker in situ,Long-term (current) use of insulin
Crnry athrscl natve vssl,Pneumonia, organism NOS,Pulmonary collapse,CHF NOS,Thoracic aortic aneurysm,Mitral valve disorder,Hypertension NOS,DMII wo cmp nt st uncntr,Anemia NEC,BPH w/o urinary obs/LUTS,Diaphragmatic hernia,Obesity NOS,Status cardiac pacemaker,Long-term use of insulin
Admission Date:  [**2134-5-17**]              Discharge Date:   [**2134-5-30**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
Shortness of breath with known Aneurysm

Major Surgical or Invasive Procedure:
[**2134-5-17**] Coronary Artery Bypass Graft x 2 (LIMA to LAD, SVG to
PDA), Asc. Aorta Replacement (26mm gelweave graft), Mitral Valve
Replacement (31mm CE mosaic tissue valve)
[**2134-5-21**] Flexible bronchoscopy
[**2134-5-28**] PICC line placement

History of Present Illness:
86 y/o male with known asc. aortic aneurysm x 3yrs. He has
developed increased shortness of breath and fatigue. Aneurysm
has slightly increased in size. Recent cardiac cath revealed
coronary artery disease along with moderate mitral
regurgitation. He is being admitted for elective surgery.

Past Medical History:
Coronary Artery Disease, Ascending Aortic Aneurysm, Mitral
Regurgitation, Diabetes Mellitus, Hypertension, Benign Prostatic
Hypertrophy, Obesity, Hiatal hernia, s/p pacemaker in [**2129**], s/p
left knee surgery

Social History:
Denies tobacco use. Admits to rare ETOH use.

Family History:
Non-contributory

Physical Exam:
On admission:
VS: 60 14 112/60 5'8" 210#
Gen: WD/WN male in NAD
Skin: W/D -lesions
HEENT: NC/AT EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: CTAB -w/r/r
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: A&O x 3, MAE, non-focal

Pertinent Results:
Echo [**2134-5-17**]: PRE-BYPASS: The probe could not be advanced beyond
the mid-esophagus. Even at that level, windows and views were
very limited. Therefore it was not possible to assess
ventricular fxn or the tricuspid valve. No atrial septal defect
is seen by 2D or color Doppler. The aortic root is mildly
dilated at the sinus level. The ascending aorta is markedly
dilated The aortic arch is mildly dilated. The descending
thoracic aorta is mildly dilated. There are three aortic valve
leaflets. The aortic valve leaflets are mildly thickened. There
is no aortic valve stenosis. Trace aortic regurgitation is seen.
The mitral valve leaflets are moderately thickened. There is
mild mitral valve prolapse. There is severe mitral annular
calcification. There is mild mitral stenosis (area 1.5-2.0cm2).
The mitral regurgitation jet is eccentric. There is no
pericardial effusion. POST-BYPASS: Limited views of the
prosthetic mitral valve were seen. From what was visible, the
valve seemed well-seated without perivalvular leak or MR. Could
not assess LV or RV fxn. Aortic valve appeared unchanged. Dr.
[**First Name (STitle) 6507**] assisted on exam. We recommended esophagoscopy and
transthoracic echo on this patient.
Echo [**5-24**]: 1. No atrial septal defect is seen by 2D or color
Doppler. 2. Left ventricular wall thicknesses and cavity size
are normal. Due to suboptimal technical quality, a focal wall
motion abnormality cannot be fully excluded. Overall left
ventricular systolic function is mildly depressed. 3. Right
ventricular chamber size is normal. Right ventricular systolic
function is borderline normal. 4. There are three aortic valve
leaflets. The aortic valve leaflets are mildly thickened. There
is no aortic valve stenosis. Trace aortic regurgitation is seen.
5. A bioprosthetic mitral valve prosthesis is present. The
motion of the mitral valve prosthetic leaflets appears normal.
The transmitral gradient is normal for this prosthesis. A small
perivalvular mitral prosthesis leak is seen in the anteromedial
aspect of the valve. 6. There is no pericardial effusion.
UE U/S [**5-26**]:Ultrasound evaluation of the left upper extremity
deep venous system using grayscale, color, pulse wave Doppler
reveals the left internal jugular, subclavian, axillary,
brachial, basilic veins to be fully compressible with normal
Doppler waveforms, augmentation, and respiratory variation in
flow. The left cephalic vein is not compressible with
hyperechogenic within the lumen consistent with thrombosis.
CXR [**5-27**]: The right internal jugular catheter was withdrawn in
meantime interval. The pacemaker leads terminate in right atrium
and right ventricle, unchanged. The heart size is markedly
enlarged but stable. There is worsening of the left lower lobe
and right lower lobe atelectasis. Right pleural effusion is
small to moderate. Left pleural effusion cannot be assessed due
to the fact that the left costophrenic angle was not included in
the field of view. There is slight worsening of the perihilar
haziness and upper zone pulmonary vasculature redistribution
suggesting mild pulmonary edema. The distended azygos vein
contributes to the diagnosis suggesting for overload.
[**2134-5-17**] 02:40PM BLOOD WBC-12.0*# RBC-3.26*# Hgb-10.4*#
Hct-29.2*# MCV-90 MCH-31.8 MCHC-35.5* RDW-15.0 Plt Ct-69*#
[**2134-5-21**] 03:01PM BLOOD WBC-8.6 RBC-3.17* Hgb-9.9* Hct-29.4*
MCV-93 MCH-31.2 MCHC-33.7 RDW-15.5 Plt Ct-103*
[**2134-5-28**] 06:35AM BLOOD WBC-8.1 RBC-3.97* Hgb-12.1* Hct-36.8*
MCV-93 MCH-30.4 MCHC-32.8 RDW-15.1 Plt Ct-310
[**2134-5-17**] 02:40PM BLOOD PT-19.2* PTT-65.9* INR(PT)-1.8*
[**2134-5-25**] 03:34AM BLOOD PT-14.3* PTT-30.6 INR(PT)-1.3*
[**2134-5-17**] 04:33PM BLOOD UreaN-14 Creat-0.8 Cl-120* HCO3-22
[**2134-5-28**] 06:35AM BLOOD Glucose-147* UreaN-25* Creat-1.4* Na-137
K-4.1 Cl-99 HCO3-32 AnGap-10
[**2134-5-27**] 06:00AM BLOOD Calcium-8.5 Mg-2.5
[**2134-5-28**] 06:35AM BLOOD Mg-2.6

Brief Hospital Course:
Mr. [**Known lastname 14410**] was a same day admit after undergoing all
pre-operative work-up as an outpatient. On day of admission he
was brought to the operating room where he underwent Coronary
Artery Bypass Graft x 2, Asc. Aorta Replacement, and Mitral
Valve Replacement. Please see operative report for details.
Following surgery he was transferred to the CSRU for invasive
monitoring in stable condition. Over the next two days he
remained intubated secondary to hemodynamic instability
requiring multiple Inotropes. on post-op day two he was weaned
from sedation, awoke neurologically intact and extubated. He
required aggressive pulmonary toilet via multiple inhalers and
diuresis. He was gently diuresed towards his pre-op weight. On
post-op day four he underwent a bronchoscopy for left lung
atelectasis and a mucous plug was removed. Gram stain from
bronchoscopy revealed gram negative rods and antibiotics were
started. On post-op day five he was transfused one unit pRBC.
Chest tubes and epicardial pacing wires were removed per
protocol. Despite aggressive pulmonary toilet, diuresis for CHF
and antibiotics for pneumonia, patient was having worsening
shortness of breath on post-op day six and eventually had
respiratory decompensation that required re-intubation. He was
eventually weaned from sedation on post-op day eight and
extubated without incident. On post-op day nine he underwent an
upper ext. U/S which revealed a thrombosis of the left cephalic
vein. He began ambulating well with PT and on post-op day ten he
was transferred to the telemetry floor for further care. Over
the next two days there were no further complications. On
post-op day eleven he required a PICC line placement d/t poor
venous access. He continued to work with physical therapy for
strength and mobility. He appeared stable on post-op day twelve,
but still required additional physical therapy. He was therefore
discharged to rehab facility with the appropriate follow-up
appointments and medications.Prior to d/c a UA was sent after
UOP cloudy. Results were negative for UTI.

Medications on Admission:
Zocor 40mg qd, Felodipine 10mg qd, Terazosin 5mg qd, Atenolol
50mg qd, Aspirin 325mg qd, Proscar 5mg qd, Novolog 70/30 5qAM,
8qPM

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Metoprolol Succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Terazosin 5 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
7. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 2 weeks.
9. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 2
weeks.
10. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
11. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
12. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily). Tablet(s)
13. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 5 days.
14. Insulin NPH-Regular Human Rec 100 unit/mL (70-30) Suspension
Sig: Five (5) units Subcutaneous qAM: Please also have Insulin
Sliding Scale (see attached).
15. Insulin NPH-Regular Human Rec 100 unit/mL (70-30) Suspension
Sig: 8 (eight) units Subcutaneous qPM: Please also have Insulin
Sliding Scale (see attached).

Discharge Disposition:
Extended Care

Facility:
[**Doctor Last Name **] Nursing & Rehabilitation Center - [**Location (un) **]

Discharge Diagnosis:
Coronary Artery Disease/Ascending Aortic Aneurysm/Mitral
Regurgitation s/p Coronary Artery Bypass Graft x 2, Asc. Aorta
Replacement, Mitral Valve Replacement
Pneumonia
Congestive Heart Failure
Deep Vein Thrombosis
PMH: Diabetes Mellitus, Hypertension, Benign Prostatic
Hypertrophy, Obesity, Hiatal hernia, s/p pacemaker in [**2129**], s/p
left knee surgery

Discharge Condition:
Good

Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Please shower daily.
No bathing or swimming for 1 month. Use sunscreen on incision if
exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7)  Call with any questions or concerns.

[**Last Name (NamePattern4) 2138**]p Instructions:
Dr. [**Last Name (Prefixes) **] in 4 weeks
Dr. [**Last Name (STitle) **] in [**2-6**] weeks
Dr. [**Last Name (STitle) 2204**] in [**1-5**] weeks


Completed by:[**2134-5-30**]
{'Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Pulmonary collapse,Congestive heart failure, unspecified,Thoracic aneurysm without mention of rupture,Mitral valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified anemias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Diaphragmatic hernia without mention of obstruction or gangrene,Obesity, unspecified,Cardiac pacemaker in situ,Long-term (current) use of insulin'}


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: Shortness of breath with known Aneurysm

PRESENT ILLNESS: 86 y/o male with known asc. aortic aneurysm x 3yrs. He has
developed increased shortness of breath and fatigue. Aneurysm
has slightly increased in size. Recent cardiac cath revealed
coronary artery disease along with moderate mitral
regurgitation. He is being admitted for elective surgery.

MEDICAL HISTORY: Coronary Artery Disease, Ascending Aortic Aneurysm, Mitral
Regurgitation, Diabetes Mellitus, Hypertension, Benign Prostatic
Hypertrophy, Obesity, Hiatal hernia, s/p pacemaker in [**2129**], s/p
left knee surgery

MEDICATION ON ADMISSION: Zocor 40mg qd, Felodipine 10mg qd, Terazosin 5mg qd, Atenolol
50mg qd, Aspirin 325mg qd, Proscar 5mg qd, Novolog 70/30 5qAM,
8qPM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
VS: 60 14 112/60 5'8" 210#
Gen: WD/WN male in NAD
Skin: W/D -lesions
HEENT: NC/AT EOMI, PERRL, OP benign
Neck: Supple, FROM, -JVD, -carotid bruits
Chest: CTAB -w/r/r
Heart: CTAB -w/r/r
Abd: Soft, NT/ND, +BS
Ext: Warm, well-perfused, -edema, -varicosities, 2+ pulses
throughout
Neuro: A&O x 3, MAE, non-focal

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies tobacco use. Admits to rare ETOH use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Pulmonary collapse,Congestive heart failure, unspecified,Thoracic aneurysm without mention of rupture,Mitral valve disorders,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other specified anemias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Diaphragmatic hernia without mention of obstruction or gangrene,Obesity, unspecified,Cardiac pacemaker in situ,Long-term (current) use of insulin'}
