CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 42-year-old man
with known aortic coarctation. He is post surgical repair of
the coarctation with a descending thoracic aneurysm. He has a
bicuspid aortic valve, systemic hypertension and left
ventricular systolic dysfunction. Additionally, the patient
has some left ventricular dysfunction. He has a history of
nonsustained ventricular tachycardia. An ICD was implanted in
[**2128-4-23**]. Post implantation of his
ICD, a chest x-ray suggested an abnormality of the aorta and
a chest CT was performed. The chest CT showed aortic
coarctation with a descending thoracic aorta of 5 cm.
Additionally, the patient had bilateral inguinal hernia
repairs and a vasectomy.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: He has a cousin with a congenital defect and
a grandfather who had coronary artery bypass grafting. He is
employed as a construction worker.

SOCIAL HISTORY: The patient lives with his wife and 2
children. He drinks alcohol only socially. He quit tobacco
use approximately 2 months prior to admission. Prior to that,
he had a 20-30 year pack history.
Coarctation of aorta (preductal) (postductal),Congenital insufficiency of aortic valve,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Fitting and adjustment of automatic implantable cardiac defibrillator
Coarctation of aorta,Cong aorta valv insuffic,Thoracic aortic aneurysm,Hypertension NOS,Ftng autmtc dfibrillator
Unit No:  [**Numeric Identifier 63096**]
Admission Date: [**2128-12-1**]
Discharge Date: [**2128-12-7**]
Date of Birth:  [**2086-6-3**]
Sex:  M
Service:  CSU


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 42-year-old man
with known aortic coarctation. He is post surgical repair of
the coarctation with a descending thoracic aneurysm. He has a
bicuspid aortic valve, systemic hypertension and left
ventricular systolic dysfunction. Additionally, the patient
has some left ventricular dysfunction. He has a history of
nonsustained ventricular tachycardia. An ICD was implanted in
[**2128-4-23**]. Post implantation of his
ICD, a chest x-ray suggested an abnormality of the aorta and
a chest CT was performed. The chest CT showed aortic
coarctation with a descending thoracic aorta of 5 cm.
Additionally, the patient had bilateral inguinal hernia
repairs and a vasectomy.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS:  His medications preoperatively include Coreg
6.25 mg b.i.d., Lasix 20 mg daily, digoxin 0.25 mg daily,
lisinopril 5 mg daily.

SOCIAL HISTORY:  The patient lives with his wife and 2
children. He drinks alcohol only socially. He quit tobacco
use approximately 2 months prior to admission. Prior to that,
he had a 20-30 year pack history.

FAMILY HISTORY:  He has a cousin with a congenital defect and
a grandfather who had coronary artery bypass grafting. He is
employed as a construction worker.

PREOPERATIVE PHYSICAL EXAMINATION:  Height is 177 cm, weight
92.5 kg. Vital signs - heart rate 66, blood pressure in the
right arm of 157/78. In the left leg, it is 94/65. JVP is 4-6
cm. Lungs are clear to auscultation bilaterally. Cardiac exam
- regular rate and rhythm, 2-3/6 systolic ejection murmur in
the right upper sternal border. Abdomen is soft, nontender
and nondistended with normoactive bowel sounds, no
hepatosplenomegaly. Extremities are warm and well-perfused
with 2+ pulses in the upper extremities and diminished pulses
in his lower extremities. There is significant radial-to-
femoral delay. No clubbing, cyanosis or edema.

EKG shows sinus rhythm with 66 beats per minute with a normal
QRS, LVF with ST-T wave changes, nonspecific in the lateral
and inferior leads. PR interval is 0.18. The echo done shows
trivial mitral and tricuspid regurgitation with moderate left
ventricular systolic dysfunction and an estimated EF of 36%,
trivial AS with no aortic regurgitation and trivial pulmonary
regurgitation, severe coarctation of the aorta with a
tortuous, unobstructed transverse arch, no aortic root
dilatation, mild ascending aortic dilatation with the root
measuring 3.4 cm and the ascending aorta measuring 3.4 cm.
Chest CT done at [**Hospital3 5097**] in [**2128-4-23**] showed elongated
bilateral axillary lymph nodes, ICD generator in the left
chest, coarctation of the aorta with luminal diameter of 13-
14 mm, dilated infundibulum or aneurysm of cameral at the
left subclavian artery origin and 10-11 mm left periaortic
soft tissue nodule at the celiac origin. Cath done in [**2128-4-23**] showed dilated descending aorta distal to the site of
the coarctation, minimal luminal diameter at the coarctation
site measuring 6 mm, ascending aorta measuring 29 mm, arch
measuring 25 mm. Coronary angiography revealed left dominant
system with no significant coronary artery disease.

LABORATORY DATA:  PT 12, PTT 34, INR 1, white count 8.8,
hematocrit 46.9. UA is negative, sodium 142, potassium 4.2,
chloride 103, CO2 of 27, BUN 14, creatinine 0.8, glucose 81.
ALT is 42, AST 27, alkaline phosphatase 46, total bilirubin
0.4, total protein 7.5, albumin 4.8.

HOSPITAL COURSE:  On the [**5-1**], the patient was a
direct admission to the operating room where he underwent
distal arch replacement with a descending thoracic aorta
replacement and an aorta to subclavian bypass. Please see the
OR report for full details. In summary, the patient had a
distal arch replacement with a #22 mm graft with a 8 mm
sidearm via a left thoracotomy. The bypass time was 40
minutes. He tolerated the operation well and was transferred
from the operating room to the cardiothoracic intensive care
unit. At the time of transfer, his mean arterial pressure was
68 with a CVP of 17. The patient did well in the immediate
postoperative period. He remained hemodynamically stable. His
ICD was turned back on. His anesthesia was reversed. His
sedation was weaned to the point where the patient was able
to awaken and follow commands and then he was re-sedated and
fully ventilated throughout the day of his surgery. On
postoperative day 1, the patient continued to do well,
remaining hemodynamically stable. His sedation was again
lightened and he was placed on Precedex. From that point, his
ventilation was weaned to pressor support ventilation.
Diuresis was begun and the patient remained intubated
throughout postoperative day 1 to give him a full day of
diuretic therapy prior to extubation. On postoperative day 2,
his pressor support and ventilation was weaned. He continued
to be vigorously diuresed and he was successfully extubated.
On postoperative day 3, the patient remained hemodynamically
stable. All his intravenous medications were converted to
oral medications. His intrathecal catheter was removed. His
chest tubes were removed and he was transferred from the
cardiothoracic intensive care unit to the floor for
continuing postoperative care and cardiac rehabilitation.
Over the next several days, the patient's activity level was
advanced with the assistance of the nursing staff as well as
the physical therapy staff. He remained hemodynamically
stable and on postoperative day 6, it was decided that the
patient was stable and ready to be discharged to home.

At the time of this dictation, the patient's physical
examination is as follows: Vital signs - temperature 98.4,
heart rate 97, sinus rhythm, blood pressure 100/60,
respiratory rate 20, O2 saturation 97% on room air. Lab data
- white count 11, hematocrit 29.2, platelets 175, sodium 139,
potassium 4.3, chloride 98, CO2 of 32, BUN 17, creatinine
0.8, glucose 101. Neurologic - alert and oriented x3. He
moves all extremities, follows commands, nonfocal exam.
Pulmonary - clear to auscultation bilaterally. Cardiac -
regular rate and rhythm. Incision - left thoracoabdominal
with staples clean and dry with a small amount of serous
drainage from the chest tube sites. Abdomen is soft,
nontender and nondistended with normoactive bowel sounds.
Extremities are warm and well-perfused with no edema.

DISCHARGE MEDICATIONS:  Discharge medications include
potassium chloride 20 mEq daily, Colace 100 mg b.i.d.,
aspirin 81 mg daily, Percocet 5/325 one to two tablets q.4-
6h. as needed for pain, metoprolol 50 mg b.i.d., ibuprofen
800 mg q.8h. x2 weeks, then p.r.n., Lasix 20 mg daily.

DI[**Last Name (STitle) 408**]E INSTRUCTIONS:  The patient is to be discharged to
home with VNA. He is to follow up in the wound clinic in 2
weeks, follow up with the BACH program at [**Hospital3 1810**]
in [**2-26**] weeks and follow up with Dr. [**Last Name (Prefixes) **] in 4 weeks.

DISCHARGE DIAGNOSES:
1.  Status post distal arch and descending aorta replacement
    with an aorto-subclavian bypass via left thoracotomy.
2.  Hypertension.
3.  Bicuspid aortic valve.
4.  Myocarditis.
5.  History of ventricular tachycardia status post ICD
    placement.
6.  Status post bilateral inguinal hernia repairs.
7.  Status post vasectomy.

CONDITION AT TIME OF DISCHARGE:  Good.



                        [**Doctor Last Name **] [**Last Name (Prefixes) **], M.D. [**MD Number(1) 1288**]

Dictated By:[**Last Name (NamePattern4) 1718**]
MEDQUIST36
D:  [**2128-12-7**] 13:30:58
T:  [**2128-12-7**] 14:49:32
Job#:  [**Job Number 63097**]
{'Coarctation of aorta (preductal) (postductal),Congenital insufficiency of aortic valve,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Fitting and adjustment of automatic implantable cardiac defibrillator'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 42-year-old man
with known aortic coarctation. He is post surgical repair of
the coarctation with a descending thoracic aneurysm. He has a
bicuspid aortic valve, systemic hypertension and left
ventricular systolic dysfunction. Additionally, the patient
has some left ventricular dysfunction. He has a history of
nonsustained ventricular tachycardia. An ICD was implanted in
[**2128-4-23**]. Post implantation of his
ICD, a chest x-ray suggested an abnormality of the aorta and
a chest CT was performed. The chest CT showed aortic
coarctation with a descending thoracic aorta of 5 cm.
Additionally, the patient had bilateral inguinal hernia
repairs and a vasectomy.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: He has a cousin with a congenital defect and
a grandfather who had coronary artery bypass grafting. He is
employed as a construction worker.

SOCIAL HISTORY: The patient lives with his wife and 2
children. He drinks alcohol only socially. He quit tobacco
use approximately 2 months prior to admission. Prior to that,
he had a 20-30 year pack history. 

### Response:
{'Coarctation of aorta (preductal) (postductal),Congenital insufficiency of aortic valve,Thoracic aneurysm without mention of rupture,Unspecified essential hypertension,Fitting and adjustment of automatic implantable cardiac defibrillator'}
