CHIEF COMPLAINT: Dyspnea on exertion.

PRESENT ILLNESS: Ms. [**Known lastname **] is a 78 year-old
woman with a dilated aorta to 7 cm found on routine chest
x-ray.  A CT scan also showed a dilated aorta.  The patient
was admitted for presumed ascending aortic aneurysm repair.

MEDICAL HISTORY: 1.  Peptic ulcer disease.
2.  Hypertension.
3.  Bilateral cataracts.
4.  Renal calculi.
5.  Obesity.

MEDICATION ON ADMISSION: 

ALLERGIES: Non-steroidal anti-inflammatory drugs and
aspirins both of which cause gastric upset and gastritis.
Also intravenous contrast, which causes chills and shaking.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Positive tobacco use, three to five
cigarettes per day.  No alcohol use.
Thoracic aneurysm without mention of rupture,Hemorrhage complicating a procedure,Hematemesis,Surgical or other procedure not carried out because of contraindication,Atherosclerosis of aorta,Unspecified essential hypertension
Thoracic aortic aneurysm,Hemorrhage complic proc,Hematemesis,No proc/contraindication,Aortic atherosclerosis,Hypertension NOS
Admission Date:  [**2185-4-5**]       Discharge Date:  [**2185-4-14**]

Date of Birth:   [**2106-10-23**]       Sex:  F

Service:  CARDIOTHORACIC

CHIEF COMPLAINT:  Dyspnea on exertion.

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname **] is a 78 year-old
woman with a dilated aorta to 7 cm found on routine chest
x-ray.  A CT scan also showed a dilated aorta.  The patient
was admitted for presumed ascending aortic aneurysm repair.

PAST MEDICAL HISTORY:
1.  Peptic ulcer disease.
2.  Hypertension.
3.  Bilateral cataracts.
4.  Renal calculi.
5.  Obesity.

MEDICATIONS PRIOR TO ADMISSION:
1.  Hydrochlorothiazide 25 mg q.d.
2.  Protonix 40 mg q.d.
3.  Multivitamin.
4.  Atenolol 25 mg q.d.

ALLERGIES:  Non-steroidal anti-inflammatory drugs and
aspirins both of which cause gastric upset and gastritis.
Also intravenous contrast, which causes chills and shaking.

SOCIAL HISTORY:  Positive tobacco use, three to five
cigarettes per day.  No alcohol use.

Carotid ultra sounds done in [**Month (only) 956**] of this year showed no
significant disease and a Myoview done also in [**Month (only) 956**]
showed decreased uptake at the apex without wall motion
abnormalities and an EF of 70%.

PHYSICAL EXAMINATION:  Heart rate of 80 sinus, blood pressure
132/88 on the right and 122/88 on the left.  Height is 5'3".
Weight is 160 pounds.  General, no acute distress.  Skin no
obvious lesions.  HEENT pupils are equal, round and reactive
to light.  Extraocular movements intact.  Neck si supple with
no JVD or bruits.  Chest is clear to auscultation
bilaterally.  Cardiac is regular rate and rhythm.  S1 and S2
with no murmur.  Abdomen is soft, nontender, nondistended.
No hepatosplenomegaly.  No costovertebral angle tenderness.
Extremities are warm and well perfuse with no clubbing,
cyanosis or edema.  No varicosities noted.  Neurological
cranial nerves II through XII intact.  Nonfocal examination.
Excellent strength in all four extremities.  Pulses femoral
2+ bilaterally.  Dorsalis pedis pulse 2+ bilaterally.
Posterior tibial pulse 1+ bilaterally.  Radial 2+
bilaterally.

LABORATORY DATA:  White blood cell count 10.3, hematocrit 42,
platelets 314, PT 13, PTT 26, INR 1.1.  Sodium 135, potassium
3.1, chloride 101, CO2 25, BUN 27, creatinine 1.2.  Glucose
195, ALT 8, AST 12, alkaline phosphatase 94, albumin 3.7,
amylase 27.  Urinalysis is negative.  Chest x-ray shows
ascending aortic aneurysm at the mid arch.

HOSPITAL COURSE:  The patient was a direct admission to the
Operating Room for presumed ________.  However, a
transesophageal echocardiogram done prior to preinitiation of
the surgery revealed that the distal ascending arch was only
4 cm with no aortic insufficiency and an intraluminal
hematoma in the distal ascending aorta with a descending
aorta that had severe atheromatous disease and calcifications
throughout.  The decision was made at that time to cancel the
surgical procedure.  Following which the patient was
transferred to the Cardiothoracic Intensive Care Unit for
recovery from anesthesia.  Once in the Cardiothoracic
Intensive Care Unit the patient's anesthesia was reversed.
She was successfully weaned from the ventilator and
extubated.  Following extubation the patient complained of
nausea and had several episodes of hematemesis with clots.
An nasogastric tube was placed with a return of frank blood
that we were unable to lavage to clear.  Gastrointestinal was
called at that time following which they did an endoscopy,
which showed no varices and no bleeding sites with blood in
the fundus and stomach body, but no areas of active bleeding
seen.  Following that General Surgery was also consulted and
the patient underwent celiac angiography, which showed no
evidence of active extravasation.  It did, however, show an
abnormal collection of air present adjacent to the left
curvature of the stomach.  CT of the abdomen was done also,
which showed extraluminal air medial to the esophagus at the
gastroesophageal junction as well as near the lesser
curvature of the stomach.

The patient was brought back to the Intensive Care Unit and
followed over the next several days with serial hematocrits.
She had no further episodes of hematemesis.  On the following
day she had a gastrograph and swallow, which was also
negative and therefore a decision was made to treat the
patient conservatively keeping her NPO and treating her with
triple antibiotics while maintaining her in the hospital for
one week on total parenteral nutrition.  The patient did well
during that period of time and had no further episodes of
hematemesis and no melena.  Her hematocrit remained stable.
Her diet was advanced slowly, starting on post TEE day four
from clear liquids to full liquids to soft solids to a
regular diet and on hospital day ten it was decided that the
patient was stable and ready to be discharged to home.

At the time the patient's physical examination is as follows,
temperature 98, heart rate 76 sinus rhythm, blood pressure
138/80, respiratory rate 14, O2 sat 97% on room air.  Weight
prehospital was 86 kilograms, at discharge is 74 kilograms.
Laboratory data on the day of discharge white blood cell
count 10, hematocrit 31, platelets 354, sodium 140, potassium
4.4, chloride 100, CO2 24, BUN 25, creatinine 0.9, glucose
120.  Physical examination neurological alert and oriented
times three, moves all extremities, follows commands.
Respiratory clear to auscultation bilaterally.  Cardiac
regular rate and rhythm.  S1 and S2.  No murmur.  Abdomen
soft, nontender, nondistended with normoactive bowel sounds.
Extremities are warm and well perfuse with no clubbing,
cyanosis or edema.

DISCHARGE MEDICATIONS:
1.  Atenolol 25 mg q.d.
2.  Prilosec 40 mg q.d.
3.  Levofloxacin 250 mg q.d. times seven days.
4.  Flagyl 500 mg t.i.d. times seven days.

CONDITION ON DISCHARGE:  Good.

DISCHARGE DIAGNOSES:
1.  Hypertension.
2.  Peptic ulcer disease.
3.  Bilateral cataract.
4.  Renal calculi.
5.  Ascending abdominal aortic by MRI.

Sh[**Last Name (STitle) 14388**]o be discharged to home.  She is to have follow up
with Dr. [**First Name (STitle) **] her primary care physician in three to four
weeks and follow up with Dr. [**Last Name (Prefixes) **] in his office also
in three to four weeks.






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

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

D:  [**2185-4-14**]  12:12
T:  [**2185-4-14**]  12:20
JOB#:  [**Job Number 14389**]
{'Thoracic aneurysm without mention of rupture,Hemorrhage complicating a procedure,Hematemesis,Surgical or other procedure not carried out because of contraindication,Atherosclerosis of aorta,Unspecified essential hypertension'}


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: Dyspnea on exertion.

PRESENT ILLNESS: Ms. [**Known lastname **] is a 78 year-old
woman with a dilated aorta to 7 cm found on routine chest
x-ray.  A CT scan also showed a dilated aorta.  The patient
was admitted for presumed ascending aortic aneurysm repair.

MEDICAL HISTORY: 1.  Peptic ulcer disease.
2.  Hypertension.
3.  Bilateral cataracts.
4.  Renal calculi.
5.  Obesity.

MEDICATION ON ADMISSION: 

ALLERGIES: Non-steroidal anti-inflammatory drugs and
aspirins both of which cause gastric upset and gastritis.
Also intravenous contrast, which causes chills and shaking.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Positive tobacco use, three to five
cigarettes per day.  No alcohol use. 

### Response:
{'Thoracic aneurysm without mention of rupture,Hemorrhage complicating a procedure,Hematemesis,Surgical or other procedure not carried out because of contraindication,Atherosclerosis of aorta,Unspecified essential hypertension'}
