CHIEF COMPLAINT: The patient was admitted as a postoperative
admission.  He was scheduled for admission for Bentall
procedure with a question of an MVR.  His chief complaint was
left chest discomfort with exertion and occasional
palpitations.

PRESENT ILLNESS: The patient is with known aortic
aneurysm followed by echocardiogram for many years.  Positive
ETT on [**2198-12-10**] showed an ejection fraction of 62% with
no defects.  MRI in [**2198-8-10**] showed a 5.2 cm thoracic
ascending aortic aneurysm and aortic insufficiency.  Cardiac
catheterization performed on [**2199-7-17**], showed dilated
ascending aorta, normal mitral valve, normal left ventricular
function with normal wall motion, no coronary artery disease.
Cardiac echocardiogram from [**2199-5-25**], showed an ejection
fraction of 62% with hypokinesis in the apex, aortic
insufficiency, 3+ mitral regurgitation, 1+ tricuspid
regurgitation, and dilated aorta to 5.6 cm.

MEDICAL HISTORY: Significant for hypertension,
hypercholesterolemia, gout, anxiety, depression, hemorrhoids,
tonsillectomy as a child, and a left inguinal hernia repair.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: Vitals signs:  Temperature 98.3??????,
heart rate 55 in sinus rhythm, blood pressure 97/59,
respirations 20, oxygen saturation 93% on room air, weight
preoperatively 75.8 kg, discharge weight 82.7 kg.  General:
The patient was alert and oriented times three.  He moved all
extremities.  He followed commands.  Chest:  Breath sounds
clear to auscultation bilaterally.  Heart:  Regular, rate and
rhythm.  S1 and S2 with a click.  Sternum was stable.
Incision was open to air, clean and dry.  Abdomen:  Soft,
nontender, nondistended.  Positive bowel sounds.
Extremities:  Warm and well perfused with no clubbing,
cyanosis or edema.  Right groin incision with mattress
sutures to be removed in [**6-18**] days.

FAMILY HISTORY: Both parents had aortic aneurysms repaired.
Father also had coronary artery disease, both remain alive to
this date.

SOCIAL HISTORY: The patient's occupation is a material
inventory specialist.  He lives alone.  He has a remote
tobacco history.  He quite in [**2198-9-9**].  Prior to that,
he smoked for 32 years.  He quit the use ETOH in [**2198-9-9**].  No other related drug use.
Thoracic aneurysm without mention of rupture,Mitral valve insufficiency and aortic valve insufficiency,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia
Thoracic aortic aneurysm,Mitral/aortic val insuff,Surg compl-heart,Atrial fibrillation,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2199-7-19**]       Discharge Date:  [**2199-7-23**]

Date of Birth:   [**2145-9-5**]       Sex:  M

Service:  CARDIOTHORACIC SERVICE

CHIEF COMPLAINT:  The patient was admitted as a postoperative
admission.  He was scheduled for admission for Bentall
procedure with a question of an MVR.  His chief complaint was
left chest discomfort with exertion and occasional
palpitations.

HISTORY OF PRESENT ILLNESS:  The patient is with known aortic
aneurysm followed by echocardiogram for many years.  Positive
ETT on [**2198-12-10**] showed an ejection fraction of 62% with
no defects.  MRI in [**2198-8-10**] showed a 5.2 cm thoracic
ascending aortic aneurysm and aortic insufficiency.  Cardiac
catheterization performed on [**2199-7-17**], showed dilated
ascending aorta, normal mitral valve, normal left ventricular
function with normal wall motion, no coronary artery disease.
Cardiac echocardiogram from [**2199-5-25**], showed an ejection
fraction of 62% with hypokinesis in the apex, aortic
insufficiency, 3+ mitral regurgitation, 1+ tricuspid
regurgitation, and dilated aorta to 5.6 cm.

PAST MEDICAL HISTORY:  Significant for hypertension,
hypercholesterolemia, gout, anxiety, depression, hemorrhoids,
tonsillectomy as a child, and a left inguinal hernia repair.

PREOPERATIVE MEDICATIONS:  Atenolol 50 mg q.d., Procardia 30
mg q.d., Paxil 10 mg q.d., Allopurinol 300 mg q.d.

ALLERGIES:  PENICILLIN.

FAMILY HISTORY:  Both parents had aortic aneurysms repaired.
Father also had coronary artery disease, both remain alive to
this date.

SOCIAL HISTORY:  The patient's occupation is a material
inventory specialist.  He lives alone.  He has a remote
tobacco history.  He quite in [**2198-9-9**].  Prior to that,
he smoked for 32 years.  He quit the use ETOH in [**2198-9-9**].  No other related drug use.

PHYSICAL EXAMINATION:  Vital signs:  Heart rate 66, blood
pressure 115/62, respirations 12, height 6 feet even, weight
180 pounds.  General:  The patient was a tall,
well-nourished, anxious gentleman.  Skin:  Anterior right
tibia with faint rash, otherwise clear.  HEENT:  No
thyromegaly.  He wears [**Location (un) 1131**] glasses.  Right ear deformity.
Neck:  Supple.  No jugular venous distention.  No carotid
bruits.  Heart:  Regular, rate and rhythm.  S1 and S2.  There
was a 2/6 systolic ejection murmur and a faint diastolic
murmur.  Chest:  Clear to auscultation bilaterally.  Abdomen:
Soft, nontender, nondistended.  Positive bowel sounds.  No
hepatosplenomegaly.  Extremities:  Warm and well perfused.
Left lower extremity with varicosities.  No venous stasis.
Neurological:  Grossly intact.  Cranial nerves III-XII
grossly intact.  Excellent strength in all four extremities.
Pulses:  Femoral 2+ bilaterally.  Dorsalis pedis 2+
bilaterally.  Posterior tibial 2+ bilaterally.  Radial 2+
bilaterally.

LABORATORY DATA:  Hematocrit 43, white blood cell count 6.5,
platelet count 203,000; PT 12.1, INR 1.0; sodium 140,
potassium 4.2, chloride 105, CO2 21, BUN 18, creatinine 0.7,
glucose 81, LDH 172.

HOSPITAL COURSE:  On [**7-19**], the patient was admitted to
the [**Hospital6 256**] at which time he
underwent an ascending aortic aneurysm repair via Bentall
procedure with #28 gel weave and #25 St. [**Male First Name (un) 923**] aortic valve
replacement.  He tolerated the operation well and was
transferred from the Operating Room to the Cardiothoracic
Intensive Care Unit.

The patient did well in the immediate postoperative period.
Shortly after arrival in the Cardiothoracic Intensive Care
Unit, he was weaned from the ventilator and extubated.  He
remained hemodynamically stable overnight with no events and
required no cardioactive intravenous medications.  On the
morning of postoperative day #1, the patient remained
hemodynamically stable.  His chest tubes were removed, and he
was transferred from the Cardiothoracic Intensive Care Unit
to ......... for continuing postoperative care and cardiac
rehabilitation.

On postoperative day #2, the patient experienced one episode
of atrial fibrillation for which he was treated with
Lopressor 20 mg IV in 5 mg increments, 40 mEq Potassium, 2 g
of Magnesium Sulfate, and at which time he remained in atrial
fibrillation.  At that time, he was started on Amiodarone
drip.  After a loading dose of Amiodarone, he converted to
normal sinus rhythm.  Over the next several days, the patient
remained hemodynamically stable.  His activity level was
gradually increased to the point that on postoperative day
#4, he was ambulating at a level 3 which was equivalent to
walking 100 feet with minimal assistance.  He was also begun
on anticoagulation for protection of his aortic valve
replacement on postoperative day #2.  The patient received 5
mg of Coumadin on postoperative day #2 and #3, and 10 mg on
postoperative day #4.


At that point, the patient was deemed stable and ready for
transfer to rehabilitation for continuing postoperative care
and cardiac rehabilitation.

At the time of transfer, the patient's condition was stable.

DISCHARGE PHYSICAL EXAM:  Vitals signs:  Temperature 98.3??????,
heart rate 55 in sinus rhythm, blood pressure 97/59,
respirations 20, oxygen saturation 93% on room air, weight
preoperatively 75.8 kg, discharge weight 82.7 kg.  General:
The patient was alert and oriented times three.  He moved all
extremities.  He followed commands.  Chest:  Breath sounds
clear to auscultation bilaterally.  Heart:  Regular, rate and
rhythm.  S1 and S2 with a click.  Sternum was stable.
Incision was open to air, clean and dry.  Abdomen:  Soft,
nontender, nondistended.  Positive bowel sounds.
Extremities:  Warm and well perfused with no clubbing,
cyanosis or edema.  Right groin incision with mattress
sutures to be removed in [**6-18**] days.

DISCHARGE LAB DATA:  Sodium 134, potassium 4.5, chloride 99,
CO2 24, BUN 24, creatinine 0.8, glucose 115; white blood cell
count 10, hematocrit 31, platelet count 132,000; PT 19.9, INR
2.6.

DISCHARGE MEDICATIONS:  Coumadin 4 mg q.d. x the next 3 days
with INR to be drawn on Thursday, [**7-25**], Allopurinol 300
mg q.d., Paxil 10 mg q.d., Lasix 20 mg q.d. x 7 days,
Potassium Chloride 20 mEq q.d. x 7 days, Amiodarone 400 mg
t.i.d. through [**7-30**], then b.i.d. x 7 days, then 400 mg
q.d. x 7 days, then 200 mg q.d. thereafter, Tylenol #3 [**12-11**]
tab q.4 hours p.r.n.

DISPOSITION:  The patient is to be discharged to
rehabilitation.

FO[**Last Name (STitle) **]P: Appointment with Dr. [**Last Name (Prefixes) **] to be made by the
patient in [**2-10**] weeks.  Primary care physician to follow PT
and INR once the patient is transferred to rehabilitation.
Goal INR is to be 2.5-3.0.

DISCHARGE DIAGNOSIS:
1.  Hypertension.
2.  Hypercholesterolemia.
3.  Gout.
4.  Anxiety.
5.  Depression.
6.  Status post Bentall procedure with aortic valve
replacement #25 St. [**Male First Name (un) 1525**] mechanical valve.





                            [**Doctor Last Name 412**] [**Last Name (Prefixes) 413**], M.D.  [**MD Number(1) 414**]

Dictated By:[**Name8 (MD) 415**]
MEDQUIST36

D:  [**2199-7-23**]  12:40
T:  [**2199-7-23**]  13:38
JOB#:  [**Job Number 19014**]
{'Thoracic aneurysm without mention of rupture,Mitral valve insufficiency and aortic valve insufficiency,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: The patient was admitted as a postoperative
admission.  He was scheduled for admission for Bentall
procedure with a question of an MVR.  His chief complaint was
left chest discomfort with exertion and occasional
palpitations.

PRESENT ILLNESS: The patient is with known aortic
aneurysm followed by echocardiogram for many years.  Positive
ETT on [**2198-12-10**] showed an ejection fraction of 62% with
no defects.  MRI in [**2198-8-10**] showed a 5.2 cm thoracic
ascending aortic aneurysm and aortic insufficiency.  Cardiac
catheterization performed on [**2199-7-17**], showed dilated
ascending aorta, normal mitral valve, normal left ventricular
function with normal wall motion, no coronary artery disease.
Cardiac echocardiogram from [**2199-5-25**], showed an ejection
fraction of 62% with hypokinesis in the apex, aortic
insufficiency, 3+ mitral regurgitation, 1+ tricuspid
regurgitation, and dilated aorta to 5.6 cm.

MEDICAL HISTORY: Significant for hypertension,
hypercholesterolemia, gout, anxiety, depression, hemorrhoids,
tonsillectomy as a child, and a left inguinal hernia repair.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN.

PHYSICAL EXAM: Vitals signs:  Temperature 98.3??????,
heart rate 55 in sinus rhythm, blood pressure 97/59,
respirations 20, oxygen saturation 93% on room air, weight
preoperatively 75.8 kg, discharge weight 82.7 kg.  General:
The patient was alert and oriented times three.  He moved all
extremities.  He followed commands.  Chest:  Breath sounds
clear to auscultation bilaterally.  Heart:  Regular, rate and
rhythm.  S1 and S2 with a click.  Sternum was stable.
Incision was open to air, clean and dry.  Abdomen:  Soft,
nontender, nondistended.  Positive bowel sounds.
Extremities:  Warm and well perfused with no clubbing,
cyanosis or edema.  Right groin incision with mattress
sutures to be removed in [**6-18**] days.

FAMILY HISTORY: Both parents had aortic aneurysms repaired.
Father also had coronary artery disease, both remain alive to
this date.

SOCIAL HISTORY: The patient's occupation is a material
inventory specialist.  He lives alone.  He has a remote
tobacco history.  He quite in [**2198-9-9**].  Prior to that,
he smoked for 32 years.  He quit the use ETOH in [**2198-9-9**].  No other related drug use. 

### Response:
{'Thoracic aneurysm without mention of rupture,Mitral valve insufficiency and aortic valve insufficiency,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified essential hypertension,Pure hypercholesterolemia'}
