CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 78-year-old female,
with known ascending aortic aneurysm.  The patient complains
of recently shortness of breath with exertion and minimal
epigastric indigestion with activity which resolves with
rest.  Cardiac catheterization done [**2185-3-22**] showed an
ejection fraction of 54 percent, with a mid-LAD lesion of 30-
40 percent.  Chest MRA in [**2185-7-14**] showed a 6.4 cm ascending
aortic aneurysm.  The patient had been originally scheduled
for surgery in [**2185-4-14**]; however, at that time her surgery
was canceled due to an esophageal tear.  As an outpatient,
the patient had a repeat upper endoscopy which showed a well-
healed tear.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: Aspirin which causes GI upset.  IV dye which
causes shaking chills.  Shellfish which causes nausea and
vomiting.

PHYSICAL EXAM: Neurologically, the patient was awake, alert,
oriented x 3.  No apparent deficit.  Her grip strength and
her plantar flexion were equal bilaterally.  Heart was
regular rate and rhythm without rub or murmur.  Respiratory -
breath sounds were coarse with scattered rhonchi throughout.
The patient had a moderately productive cough, but was not
expectorating any sputum.  GI - positive bowel sounds, soft,
nontender, nondistended.  The patient was tolerating a
regular diet and having normal bowel movements.  Extremities
- pulses were 2 plus bilateral radials and 2 plus bilateral
DP and PT.  Extremities were warm and well-perfused without
any evidence of edema.  Sternal incision was clean, dry and
intact.  The sternum was stable without any erythema or
drainage.  The right subclavian incision had mild tenderness
to palpation in the area of the incision with a small amount
of separation at the lateral portion of the incision which
was scabbed over.  There was no erythema, and there was no
drainage.

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smokes approximately a half pack
per day with approximately 35-pack year.  The patient denies
ETOH.  She lives alone in Rosalindale next door to her
sister.
Thoracic aneurysm without mention of rupture,Congestive heart failure, unspecified,Atrial fibrillation,Methicillin susceptible pneumonia due to Staphylococcus aureus,Other and unspecified coagulation defects,Accidental puncture or laceration during a procedure, not elsewhere classified,Urinary tract infection, site not specified,Anomalies of aortic arch
Thoracic aortic aneurysm,CHF NOS,Atrial fibrillation,Meth sus pneum d/t Staph,Coagulat defect NEC/NOS,Accidental op laceration,Urin tract infection NOS,Anomalies of aortic arch
Admission Date: [**2185-9-12**]        Discharge Date: [**2185-9-30**]

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

Service:  CSU


HISTORY OF PRESENT ILLNESS:  This is a 78-year-old female,
with known ascending aortic aneurysm.  The patient complains
of recently shortness of breath with exertion and minimal
epigastric indigestion with activity which resolves with
rest.  Cardiac catheterization done [**2185-3-22**] showed an
ejection fraction of 54 percent, with a mid-LAD lesion of 30-
40 percent.  Chest MRA in [**2185-7-14**] showed a 6.4 cm ascending
aortic aneurysm.  The patient had been originally scheduled
for surgery in [**2185-4-14**]; however, at that time her surgery
was canceled due to an esophageal tear.  As an outpatient,
the patient had a repeat upper endoscopy which showed a well-
healed tear.

PAST MEDICAL HISTORY:  Hypertension.

GERD.

Cataract.

Nephrolithiasis.

Ascending aortic aneurysm.

Status post cesarean section x 3.

ALLERGIES:  Aspirin which causes GI upset.  IV dye which
causes shaking chills.  Shellfish which causes nausea and
vomiting.

PREOPERATIVE MEDICATIONS:
1. Hydrochlorothiazide 25 mg po qd.
2. Atenolol 50 mg po qd.
3. Milk of Magnesia prn.


SOCIAL HISTORY:  The patient smokes approximately a half pack
per day with approximately 35-pack year.  The patient denies
ETOH.  She lives alone in Rosalindale next door to her
sister.

HO[**Last Name (STitle) **] COURSE:  The patient was taken to the operating room
with Dr. [**Last Name (Prefixes) **] on [**9-13**] for replacement of her
aortic arch and her proximal descending aorta with an aorto-
subclavian bypass and a vertebro-subclavian bypass.  Total
cardiopulmonary bypass time was 214 minutes.  Crossclamp time
43 minutes.  Total circulatory arrest time was 50 minutes
divided up into 3 intervals.  Postoperatively, the patient
was transferred to the Intensive Care Unit in stable
condition on Nitroglycerin and epinephrine drips.

Upon admission to the Intensive Care Unit, the patient was
noted to have a small amount of blood draining from bilateral
ears.  ENT consult was obtained, and upon examination by the
ENT staff, it was noted that the patient had blood behind her
eardrums but no perforation, unclear etiology.  Recommended
antibiotic ear drops for 7 days and continued reassessment.
The situation resolved, and the patient had no further
issues.  The patient had some labile hemodynamics immediately
postop requiring correction of coagulopathy and transfusion
of packed red blood cells, without significant chest tube
output.  The patient initially required increased PEEP for
poor oxygenation.

On postop day 1, the patient began to awaken, and it was felt
that perhaps the patient had some mild right-sided weakness.
At that time, the patient's goal blood pressure was
increased, and the patient remained very sleepy for the next
few days.  Eventually, fully awoke and was found to be
neurologically intact.  The patient was started on Lasix with
good diuresis.  The patient was intermittently hypertensive
due to stimulation.  The patient was started on Lopressor.
Continued to be on Nitroglycerin.  The patient intermittently
had been on sodium nitroprusside which caused hypoxia, and
this was discontinued.  The patient was started on Combivent
inhalers with moderate improvement in her expiratory wheezes.

On postoperative day 3, the patient had been placed on CPAP
which had tolerated well.  Towards the end of the day, the
patient acutely became anxious, agitated and hypertensive,
complaining that she was having trouble breathing.  Chest x-
ray was obtained at that time which was unremarkable.  The
patient was placed back on with resolution of the incident.

On postoperative day 3, cardiology consult was obtained for
assistance in managing hypertension.  It was recommended to
continue aggressive diuresis and continue current medical
therapy.  The patient was weaned on mechanical ventilation
and extubated initially with hemodynamic instability,
hypertension and tachycardia which resolved.  The patient
remained extubated approximately 2-1/2 hours, at which time
she became acutely agitated, short of breath and tachypneic,
and quickly progressed to respiratory failure.  The patient
was emergently reintubated.  It was felt that her failure was
due to volume overload.  The patient was continued to be
aggressively diuresed.  The patient was started on Natrecor,
as well as her Lasix to aid in diuresis and help with
hypertension.  The patient's creatinine had slowly begun to
rise and peaked at approximately 2.1.  The patient's sputum
from [**9-18**] grew MRSA.  The patient was started on IV
vancomycin for treatment.  The patient was started on tube
feeds.  The patient had several episodes of rapid atrial
fibrillation for which she was started on amiodarone.  All
episodes were nonsustained.

The patient underwent bronchoscopy which showed moderate
secretions bilaterally which were aspirated, and moderate to
severe malacia of the distal trachea.  The patient continued
to be aggressively diuresed and was extubated on [**9-22**],
and due to the presence of tracheomalacia, the patient was
extubated and placed on intermittent CPAP which was gradually
weaned off, as the patient continued diuresis.  The patient
underwent a swallowing evaluation on [**9-23**] which
showed no evidence of aspiration.  The patient continued on
her amiodarone for her atrial fibrillation.  The patient was
intermittently pleasantly confused which subsequently
resolved.  The patient developed an elevated white blood cell
count on [**9-24**].  The patient was pancultured.  The patient's
UA was positive, and urine culture was subsequently negative.
The patient had been started on levofloxacin.  Repeat urine
culture was sent on [**9-30**] with results still pending.  The
patient's Lasix was discontinued on [**9-26**] due to rise
in creatine and patient being below preop weight.

On [**9-27**], the patient was transferred from the Intensive Care
Unit to the regular part of the hospital and began being
screened for rehab.  On [**9-30**], the patient was cleared for
discharge to rehab.

CONDITION AT DISCHARGE:  T-max 97.6, pulse 75 in sinus
rhythm, blood pressure 129/80, respiratory rate 18, room air
oxygen saturation 93 percent.  The patient's weight on [**9-30**]
was 68.5 kg, which was decreased from 69.3 on [**9-29**].

LABORATORY DATA:  White blood cell count 16.1, hematocrit
36.6, platelet count 687, sodium 144, potassium 4.1, chloride
106, bicarb 22, BUN 51, creatinine 1.9, glucose 81.

PHYSICAL EXAM:  Neurologically, the patient was awake, alert,
oriented x 3.  No apparent deficit.  Her grip strength and
her plantar flexion were equal bilaterally.  Heart was
regular rate and rhythm without rub or murmur.  Respiratory -
breath sounds were coarse with scattered rhonchi throughout.
The patient had a moderately productive cough, but was not
expectorating any sputum.  GI - positive bowel sounds, soft,
nontender, nondistended.  The patient was tolerating a
regular diet and having normal bowel movements.  Extremities
- pulses were 2 plus bilateral radials and 2 plus bilateral
DP and PT.  Extremities were warm and well-perfused without
any evidence of edema.  Sternal incision was clean, dry and
intact.  The sternum was stable without any erythema or
drainage.  The right subclavian incision had mild tenderness
to palpation in the area of the incision with a small amount
of separation at the lateral portion of the incision which
was scabbed over.  There was no erythema, and there was no
drainage.

DISCHARGE MEDICATIONS:
1. Amiodarone 200 mg po qd x 1 month.
2. Combivent MDI 1-2 puffs q 6 h prn.
3. Flovent 110 mcg MDI 2 puffs inhaled [**Hospital1 **].
4. Nicotine 14 mg patch 1 transdermally qd x 3 weeks.
5. Protonix 40 mg po qd.
6. Lopressor 25 mg po bid.
7. Levofloxacin 250 mg po q 48 h x 6 days.


DISCHARGE DIAGNOSES:  Ascending aortic aneurysm.

Status post replacement of total aortic arch and proximal
descending aorta with aorto-subclavian and vertebro-
subclavian bypass on [**9-13**].

Postoperative hemotympanum of unknown etiology, which is
resolved.

Prolonged intubation due to volume overload.

Postoperative Methicillin resistant Staphylococcus aureus
pneumonia.

Postoperative renal insufficiency.

Postoperative urinary tract infection.

Hypertension.

Peripheral vascular disease.

FO[**Last Name (STitle) 996**]P:  The patient is to follow-up with her primary care
physician [**Last Name (NamePattern4) **] [**2-15**] weeks.  She is to follow-up with her
cardiologist in [**2-15**] weeks.  She is to follow-up with Dr. [**Last Name (Prefixes) 2545**] in 4 weeks.

The patient is to be discharged to [**Location (un) 582**] of [**Hospital 620**] Rehab
facility in stable condition.



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

Dictated By:[**Last Name (NamePattern4) 8524**]
MEDQUIST36
D:  [**2185-9-30**] 10:31:00
T:  [**2185-9-30**] 11:36:24
Job#:  [**Job Number 14390**]
{'Thoracic aneurysm without mention of rupture,Congestive heart failure, unspecified,Atrial fibrillation,Methicillin susceptible pneumonia due to Staphylococcus aureus,Other and unspecified coagulation defects,Accidental puncture or laceration during a procedure, not elsewhere classified,Urinary tract infection, site not specified,Anomalies of aortic arch'}


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: This is a 78-year-old female,
with known ascending aortic aneurysm.  The patient complains
of recently shortness of breath with exertion and minimal
epigastric indigestion with activity which resolves with
rest.  Cardiac catheterization done [**2185-3-22**] showed an
ejection fraction of 54 percent, with a mid-LAD lesion of 30-
40 percent.  Chest MRA in [**2185-7-14**] showed a 6.4 cm ascending
aortic aneurysm.  The patient had been originally scheduled
for surgery in [**2185-4-14**]; however, at that time her surgery
was canceled due to an esophageal tear.  As an outpatient,
the patient had a repeat upper endoscopy which showed a well-
healed tear.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: Aspirin which causes GI upset.  IV dye which
causes shaking chills.  Shellfish which causes nausea and
vomiting.

PHYSICAL EXAM: Neurologically, the patient was awake, alert,
oriented x 3.  No apparent deficit.  Her grip strength and
her plantar flexion were equal bilaterally.  Heart was
regular rate and rhythm without rub or murmur.  Respiratory -
breath sounds were coarse with scattered rhonchi throughout.
The patient had a moderately productive cough, but was not
expectorating any sputum.  GI - positive bowel sounds, soft,
nontender, nondistended.  The patient was tolerating a
regular diet and having normal bowel movements.  Extremities
- pulses were 2 plus bilateral radials and 2 plus bilateral
DP and PT.  Extremities were warm and well-perfused without
any evidence of edema.  Sternal incision was clean, dry and
intact.  The sternum was stable without any erythema or
drainage.  The right subclavian incision had mild tenderness
to palpation in the area of the incision with a small amount
of separation at the lateral portion of the incision which
was scabbed over.  There was no erythema, and there was no
drainage.

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smokes approximately a half pack
per day with approximately 35-pack year.  The patient denies
ETOH.  She lives alone in Rosalindale next door to her
sister. 

### Response:
{'Thoracic aneurysm without mention of rupture,Congestive heart failure, unspecified,Atrial fibrillation,Methicillin susceptible pneumonia due to Staphylococcus aureus,Other and unspecified coagulation defects,Accidental puncture or laceration during a procedure, not elsewhere classified,Urinary tract infection, site not specified,Anomalies of aortic arch'}
