CHIEF COMPLAINT: AAA / claudication

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 75562**] is a 76-year-old woman who presents for
prehydration for an elective thoracic aortic stent graft.
Thoracic aneurysm was an incidental finding on CT for chest cold

MEDICAL HISTORY: Past medical history:
1. 7-8 cm right renal mass with possible invasion into the
collecting system and perinephric fat
2. 7 cm left adrenal mass appears separate from the surrounding
organs and from the left kidney.
3. Constipation
4. Hypertension
5. Type 2 diabetes x3 years.
6. Hip replacement [**2105**]
7. Cardiac stent [**2096**]

MEDICATION ON ADMISSION: Meds: HCTZ 25', amlodipine 5', Atenolol 100', Glyburide 2.5',
ASA 81,
Vytorin 10/40', Senekot 1 tab'

ALLERGIES: Epinephrine

PHYSICAL EXAM: a/o
nad
supple / farom
neg lymphandopathy
neg supraclavicular nodes
cta
rrr
abd benign
sugical inc c/d/i
Pulses: dopplerable DP/PT b/l

FAMILY HISTORY: Family History:  Mother lived to be 87.  Father died at 52 of
stroke.  No history of kidney problems or cancer.

SOCIAL HISTORY: Social History:  The patient is a retired receptionist, is
currently active, working around the house, and no change in
daily activities.  She has a 90-pack-year history of smoking.
She quit 10 years ago.  No significant alcohol or drug use
Thoracic aneurysm without mention of rupture,Dissection of iliac artery,Malignant neoplasm of kidney, except pelvis,Secondary malignant neoplasm of adrenal gland,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified
Thoracic aortic aneurysm,Dissection iliac artery,Malig neopl kidney,Second malig neo adrenal,Athscl extrm ntv art NOS,Hypertension NOS,DMII wo cmp nt st uncntr,Anemia NOS
Admission Date:  [**2108-1-2**]              Discharge Date:   [**2108-1-8**]

Date of Birth:  [**2031-2-24**]             Sex:   F

Service: SURGERY

Allergies:
Epinephrine

Attending:[**First Name3 (LF) 2777**]
Chief Complaint:
AAA / claudication

Major Surgical or Invasive Procedure:
thoracic aortic stent graft
left common iliac to femoral bpass graft,
femoral endarterectomy


History of Present Illness:
[**Known firstname **] [**Known lastname 75562**] is a 76-year-old woman who presents for
prehydration for an elective thoracic aortic stent graft.
Thoracic aneurysm was an incidental finding on CT for chest cold

Past Medical History:
Past medical history:
1. 7-8 cm right renal mass with possible invasion into the
collecting system and perinephric fat
2. 7 cm left adrenal mass appears separate from the surrounding
organs and from the left kidney.
3. Constipation
4. Hypertension
5. Type 2 diabetes x3 years.
6. Hip replacement [**2105**]
7. Cardiac stent [**2096**]


Social History:
Social History:  The patient is a retired receptionist, is
currently active, working around the house, and no change in
daily activities.  She has a 90-pack-year history of smoking.
She quit 10 years ago.  No significant alcohol or drug use

Family History:
Family History:  Mother lived to be 87.  Father died at 52 of
stroke.  No history of kidney problems or cancer.


Physical Exam:
a/o
nad
supple / farom
neg lymphandopathy
neg supraclavicular nodes
cta
rrr
abd benign
sugical inc c/d/i
Pulses: dopplerable DP/PT b/l


Pertinent Results:
[**2108-1-7**] 05:53AM BLOOD

WBC-12.9* RBC-3.39*# Hgb-10.2*# Hct-29.5* MCV-87 MCH-30.0
MCHC-34.6 RDW-15.0 Plt Ct-187#

[**2108-1-3**] 07:26PM BLOOD

PT-14.4* PTT-38.6* INR(PT)-1.3*

[**2108-1-7**] 09:47PM BLOOD

Glucose-116* UreaN-13 Creat-0.9 Na-140 K-3.6 Cl-103 HCO3-30
AnGap-11

[**2108-1-7**] 09:47PM BLOOD

Calcium-9.1 Phos-2.8 Mg-1.7

[**2108-1-6**] 9:17 PM

CHEST (PA & LAT)

Right internal jugular catheter tip continues to terminate in
the proximal right atrium. Cardiomediastinal contours are stable
in appearance following placement of aortic stent graft. Small
bilateral pleural effusions and adjacent bibasilar atelectasis
are not substantially changed allowing for technical differences
between the examinations.

IMPRESSION: Small bilateral pleural effusions and bibasilar
atelectasis.

ECHO

[**Known lastname **], [**Known firstname 3996**]       [**Hospital1 18**] [**Numeric Identifier 75563**]
(Complete) Done [**2108-1-3**] at 2:55:16 PM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**]
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2031-2-24**]
Age (years): 76 F  Hgt (in): 62
BP (mm Hg): 145/67  Wgt (lb): 171
HR (bpm): 67  BSA (m2): 1.79 m2
Indication: Intraoperative TEE for thoracic aortic stent
placement
ICD-9 Codes: 440.0, 441.2, 424.1, 424.0
Test Information
Date/Time: [**2108-1-3**] at 14:55    Interpret MD: [**Name6 (MD) 1509**] [**Name8 (MD) 1510**],
MD
Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1510**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2007AW1-: Machine: [**Pager number **]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55%  >= 55%

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler.

LEFT VENTRICLE: Normal regional LV systolic function. Overall
normal LVEF (>55%).

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal aortic diameter at the sinus level. Normal
ascending aorta diameter.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3). Trace
AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. No TEE related complications. The patient appears
to be in sinus rhythm. Results were personally reviewed with the
MD caring for the patient.
Conclusions
Limited focussed examination

1.No atrial septal defect is seen by 2D or color Doppler.

2.Regional left ventricular wall motion is normal. Overall left
ventricular systolic function is normal (LVEF>55%).

3.Right ventricular chamber size and free wall motion are
normal.

4.The aortic valve leaflets (3) are mildly thickened. Trace
aortic regurgitation is seen.

5. The mitral valve leaflets are mildly thickened. Mild (1+)
mitral regurgitation is seen.

6. Small aneurysm in the descending aorta distal to the left
subclavian is seen. Unable to visualize it very clearly.

7. Post stent deployment unable to rule out endovascular leak
due to poor imaging conditions. Dr [**Last Name (STitle) 914**] aware and is
comfortable that there is no leak.

[**2108-1-4**] 10:38 AM

CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST

CHEST: The endotracheal tube terminates above the carina. A
nasogastric tube terminates in the distal stomach. A right
internal jugular central venous catheter terminates in the main
pulmonary artery, at its junction with the right pulmonary
artery. The patient is status post aortic stent graft placement
into the descending thoracic aorta. There is minimal high
attenuation where the saccular aneurysm was previously seen.
However, there is no evidence of frank contrast extravasation.
Calcification lining the aorta is mild. An enlarged right
infrahilar lymph node remains.

There is no pericardial effusion. There are new small bilateral
pleural effusions with adjacent atelectasis, which appear
simple. There are two faint right middle lobe nodules measuring
3 mm (2, 24; 2, 25). Extensive coronary artery calcifications
are again noted.

ABDOMEN: A subcentimeter low attenuation lesion at the junctions
of segments VIII and VII in the liver (2, 39) is too small to
characterize but believed to represent a cyst. A second
subcentimeter vague focus in segment VI (2, 50) is also too
small to characterize. The main portal vein is patent. There is
vicarious excretion of contrast into the gallbladder. The spleen
is unremarkable. The pancreas is within normal limits. There has
been no interval change in the appearance of heterogeneous left
adrenal and right renal masses. The right adrenal gland appears
unremarkable. A simple 4.4 cm left interpolar renal cortical
cyst persists.

There is a moderate amount of high-attenuation fluid in the
anterior and posterior pararenal spaces, compatible with
hemorrhage. The psoas muscles appear symmetric. The aorta,
celiac, superior mesenteric and inferior mesenteric arteries are
patent, although there is moderate calcified plaque along the
course of the aorta.

There is no bowel dilatation. The colon is decompressed. There
is trace free fluid in the pericolic gutters. There is an
anterior abdominal scar in the midline with scattered
subcutaneous air locules. At least one locule of air abuts the
posterior aspect of the left rectus musculature (2, 99).
Additional air is seen along the left pelvic side wall, in an
extraperitoneal location.

PELVIS: A Foley catheter decompresses the bladder. The rectum
and sigmoid colon are decompressed. The uterus is present. Trace
ascites is low in attenuation. A 16 mm right adnexal cyst is
again identified. The pelvis is obscured by the left hip
arthroplasty. There is moderate soft tissue stranding in both
groins, without evidence of discrete collection to suggest groin
hematoma.

OSSEOUS STRUCTURES: There are no suspicious lytic or blastic
lesions. Moderate endplate osteophytes are seen at multiple
levels.

IMPRESSION:
1. Patient status post descending thoracic aortic stent graft
placement with new small bilateral and pleural effusions, a new
small-to-moderate amount of retroperitoneal hemorrhage and new
simple ascites.
2. The bowel is decompressed but unremarkable and the mesenteric
vessels are patent.
3. Redemonstration of suspicious right renal and left adrenal
masses.
4. Stable right adnexal cystic lesion.
5. The pulmonary artery catheter is at the junction of the main
and right pulmonary arteries and should be advanced.



Brief Hospital Course:
Mrs. [**Known lastname **],[**Known firstname 3996**] F was admitted on [**1-2**] with thoracic AAA.
She agreed to have an elective surgery. Pre-operatively, she was
consented. A CXR, EKG, UA, CBC, Electrolytes, T/S - were
obtained,  all other preperations were made.

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

She was prepped, and brought down to the operating room for
surgery. Intra-operatively, she was closely monitored, she did
drop her pressures and became hemodynamicaaly unstable. The
complication was identified, thought to be likely dissected with
the overdistention by the 22-French sheath. She then underwent a
left common iliac artery conduit and iliofemoral bypass, left
common femoral endarterectomy.

The patient was transfused and given fluid for resuscitation.
She did remain bradycardic with a heart rate in the low 40s
despite atropine. Her blood pressure was
stable without pressors at the completion of the procedure. She
was taken to the ICU.
further care.

Because of the drop in pressur, a cardiac consult was obatined.
The pt did r/o for MI

She did recieve blood products for anemia secondary to to the OR
procedure.

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

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


Medications on Admission:
Meds: HCTZ 25', amlodipine 5', Atenolol 100', Glyburide 2.5',
ASA 81,
Vytorin 10/40', Senekot 1 tab'


Discharge Medications:
1. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
4. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
12. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed.
Disp:*25 Tablet(s)* Refills:*0*
13. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 5 days.
Disp:*20 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
partners home care

Discharge Diagnosis:
s/p thoracic aortic stent graft


Discharge Condition:
good


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 [**2-19**]
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 [**4-22**] 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:
please call Dr[**Name (NI) 7446**] office for an appointment in 2
weeks



Completed by:[**2108-1-13**]
{'Thoracic aneurysm without mention of rupture,Dissection of iliac artery,Malignant neoplasm of kidney, except pelvis,Secondary malignant neoplasm of adrenal gland,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified'}


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: AAA / claudication

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 75562**] is a 76-year-old woman who presents for
prehydration for an elective thoracic aortic stent graft.
Thoracic aneurysm was an incidental finding on CT for chest cold

MEDICAL HISTORY: Past medical history:
1. 7-8 cm right renal mass with possible invasion into the
collecting system and perinephric fat
2. 7 cm left adrenal mass appears separate from the surrounding
organs and from the left kidney.
3. Constipation
4. Hypertension
5. Type 2 diabetes x3 years.
6. Hip replacement [**2105**]
7. Cardiac stent [**2096**]

MEDICATION ON ADMISSION: Meds: HCTZ 25', amlodipine 5', Atenolol 100', Glyburide 2.5',
ASA 81,
Vytorin 10/40', Senekot 1 tab'

ALLERGIES: Epinephrine

PHYSICAL EXAM: a/o
nad
supple / farom
neg lymphandopathy
neg supraclavicular nodes
cta
rrr
abd benign
sugical inc c/d/i
Pulses: dopplerable DP/PT b/l

FAMILY HISTORY: Family History:  Mother lived to be 87.  Father died at 52 of
stroke.  No history of kidney problems or cancer.

SOCIAL HISTORY: Social History:  The patient is a retired receptionist, is
currently active, working around the house, and no change in
daily activities.  She has a 90-pack-year history of smoking.
She quit 10 years ago.  No significant alcohol or drug use 

### Response:
{'Thoracic aneurysm without mention of rupture,Dissection of iliac artery,Malignant neoplasm of kidney, except pelvis,Secondary malignant neoplasm of adrenal gland,Atherosclerosis of native arteries of the extremities, unspecified,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified'}
