CHIEF COMPLAINT: Asymptomatic Ascending Aortic Aneurysm

PRESENT ILLNESS: Mr. [**Known lastname **] is a 72-year-old male who in [**2146**] underwent an aortic
valve replacement with a mechanical Bjork-Shiley valve. He has
been followed for an enlarging ascending aorta and his most
recent echo showed it to be now at 6 cm. He is now presenting
for repair of the ascending aortic aneurysm

MEDICAL HISTORY: s/p AVR (Bjork-Shiley) [**2146**]
s/p ICD [**2161**]
MI at age 46
Cardiomyopathy
CHF
AAA
Colorectal Cancer
UTI
Colostomy [**2144**]
Hyperlipidemia
HTN

MEDICATION ON ADMISSION: Aldactone 25mg QD
Captopril 25mg TID
Coreg 12.5mg [**Hospital1 **]
Coumadin
Lasix 80mg QD
Lovastatin 40mg QD
Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN: NAD
NECK: Supple, FROM
LUNGS: Clear
HEART: RRR, Crisp valve click, Nl S1-S2
ABD: Soft, NT/ND/NABS
EXT: Warm, well perfused, 1+ edema.
NEURO: Nonfocal. No carotid bruits.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Retired lift truck operator. 60 pack year history of smoking. He
quit over 10 years ago. Lives with his wife. [**Name (NI) **] does not drink
alcohol. He is edentulous.
Thoracic aneurysm without mention of rupture,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other primary cardiomyopathies,Congestive heart failure, unspecified,Unspecified essential hypertension,Anemia, unspecified,Automatic implantable cardiac defibrillator in situ,Heart valve replaced by other means,Personal history of malignant neoplasm of large intestine
Thoracic aortic aneurysm,Surg compl-heart,Atrial fibrillation,Prim cardiomyopathy NEC,CHF NOS,Hypertension NOS,Anemia NOS,Status autm crd dfbrltr,Heart valve replac NEC,Hx of colonic malignancy
Admission Date:  [**2167-7-21**]              Discharge Date:   [**2167-7-31**]

Date of Birth:  [**2094-9-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Asymptomatic Ascending Aortic Aneurysm

Major Surgical or Invasive Procedure:
[**2167-7-23**] - Redo Sternotomy, Replacement of Ascending Aorta (32mm
gelweave tube graft)


History of Present Illness:
Mr. [**Known lastname **] is a 72-year-old male who in [**2146**] underwent an aortic
valve replacement with a mechanical Bjork-Shiley valve. He has
been followed for an enlarging ascending aorta and his most
recent echo showed it to be now at 6 cm. He is now presenting
for repair of the ascending aortic aneurysm

Past Medical History:
s/p AVR (Bjork-Shiley) [**2146**]
s/p ICD [**2161**]
MI at age 46
Cardiomyopathy
CHF
AAA
Colorectal Cancer
UTI
Colostomy [**2144**]
Hyperlipidemia
HTN

Social History:
Retired lift truck operator. 60 pack year history of smoking. He
quit over 10 years ago. Lives with his wife. [**Name (NI) **] does not drink
alcohol. He is edentulous.

Family History:
Noncontributory

Physical Exam:
GEN: NAD
NECK: Supple, FROM
LUNGS: Clear
HEART: RRR, Crisp valve click, Nl S1-S2
ABD: Soft, NT/ND/NABS
EXT: Warm, well perfused, 1+ edema.
NEURO: Nonfocal. No carotid bruits.

Pertinent Results:
[**2167-7-23**] ECHO
PRE CPB The left atrium is elongated. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thicknesses
are normal. The left ventricular cavity size is normal. Due to
suboptimal technical quality, a focal wall motion abnormality
cannot be fully excluded. There is moderate to severe global
left ventricular hypokinesis (LVEF = 30 %). There is moderate
global right ventricular free wall hypokinesis. The ascending
aorta is markedly dilated. This dilation appears to taper down
near the arch but limited views prevent full assessment. There
are simple atheroma in the aortic arch. There are focal
calcifications in the aortic arch. The descending thoracic aorta
is mildly dilated. There are complex (>4mm) atheroma in the
descending thoracic aorta. A single tilting disk type aortic
valve prosthesis is present. The aortic valve prosthesis appears
to be well seated. The disk is poorly seen but appears to be
moving appropriately. Some fibrinous echodensities are seen on
the LVOT side of the valve and are likely evidence of some
degeneration. There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve leaflets are moderately
thickened. Mild (1+) mitral regurgitation is seen. [Due to
acoustic shadowing, the severity of tricuspid regurgitation may
be significantly UNDERestimated.] There is a trivial/physiologic
pericardial effusion.

POST CPB The patient is receiving epinephrine by infusion. The
left ventricle continues to display moderate to severe global
dysfunction, but now with slightly more hypokinesis of the
inferior wall. The EF is about 30%. The right ventricle displays
somewhat improved function from pre-bypass study - now mildly
globally hypokinetic. The ascending aortic graft is only poorly
seen. The thoracic aorta appers intact distal to the graft.
Mitral regurgitation is now trace. No other changes from pre-cpb
study.

[**2167-7-30**] 07:00AM BLOOD WBC-7.1 RBC-3.02* Hgb-9.9* Hct-28.8*
MCV-95 MCH-32.8* MCHC-34.5 RDW-13.9 Plt Ct-288
[**2167-7-31**] 06:45AM BLOOD PT-25.8* PTT-46.2* INR(PT)-2.6*
[**2167-7-30**] 07:00AM BLOOD Glucose-118* UreaN-21* Creat-1.7* Na-137
K-3.8 Cl-100 HCO3-28 AnGap-13
[**2167-7-21**] 08:55PM BLOOD ALT-17 AST-23 LD(LDH)-153 AlkPhos-61
Amylase-47 TotBili-1.3
RADIOLOGY  Final Report

CHEST (PA & LAT)  [**2167-7-28**] 2:36 PM

CHEST (PA & LAT)

Reason: evaluate for effusion

[**Hospital 93**] MEDICAL CONDITION:
72 year old man with s/p asc aorta replac
REASON FOR THIS EXAMINATION:
evaluate for effusion
CHEST X-RAY

HISTORY: Status post ascending aorta repair, evaluate for
effusion.

Two views. Comparison with [**2167-7-24**]. The patient is status post
median sternotomy and MVR, as before. Mediastinal structures are
unchanged. An ICD remains in place. A right internal jugular
catheter has been withdrawn. Allowing for differences in
technique, there is no other significant change.

IMPRESSION: No significant interval change.

DR. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4392**]





Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the [**Hospital1 18**] on [**2167-7-21**] for surgical
management of his dilated ascending aorta. Heparin was started
as he had been off his coumadin for 5 days in aticipation of
surgery. On [**2167-7-23**], Mr. [**Known lastname **] was taken to the operating room
where he underwent a redo sternotomy with replacement of his
ascending aorta. An intraopertaive vascular surgery consult was
obtained as it was decided to use his right axillary artery for
arterial cannulation. Please see operative note for details.
Postoperatively he was taken to the intensive care unit for
monitoring. By postoperative day one, Mr. [**Known lastname **] had awoke
neurologically intact and was extubated. Aspirin, beta blockade
and a statin were resumed. The electrophysiology service was
consulted for interrogation of his pacemaker and it was
reprogrammed to function appropriately. Haldol was used for some
mild postoperative aggitation. Coumadin was resumed for his
mechanical valve. Mr. [**Known lastname **] developed atrial fibrillation for
which amiodarone was started. Mr. [**Known lastname **] remained in the
intensive care unit for a few extra days due to agitation and
confusion however this slowly cleared. On postoperative day
three, he was transferred to the step down unit for further
recovery. He was gently diuresed towards his preoperative
weight. The physical therapy service was consulted for
assistance with his postoperative strength and mobility. His
mental status cleared and on POD 7 he was discharged to rehab in
stable condition.

Medications on Admission:
Aldactone 25mg QD
Captopril 25mg TID
Coreg 12.5mg [**Hospital1 **]
Coumadin
Lasix 80mg QD
Lovastatin 40mg QD
Multivitamin

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
2. Potassium Chloride 20 mEq Packet Sig: One (1) Packet PO Q12H
(every 12 hours) for 7 days.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Lovastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
7. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO ONCE (Once): Dose
for INR goal of 2.5-3.0.
9. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) as needed for UTI for 3 days.
10. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
11. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Albuterol Sulfate 0.083 % (0.83 mg/mL) Solution Sig: One (1)
 Inhalation Q6H (every 6 hours) as needed.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 12564**] Health Network

Discharge Diagnosis:
Mild AI/Dilated ascending aorta s/p Replacement
s/p AVR [**2146**]
s/p ICD
s/p Colostomy
AF
MI at age 46
Cardiomyopathy
CHF
UTI
Colorectal Cancer
AAA


Discharge Condition:
Stable


Discharge Instructions:
1)  Monitor wounds for signs of infection. These include
redness, drainage or increased pain. In the event that you have
drainage from your sternal wound, please contact the [**Name2 (NI) 5059**] at
([**Telephone/Fax (1) 1504**].
2)  Report any fever greater then 100.5.
3)  Report any weight gain of 2 pounds in 24 hours or 5 pounds
in 1 week.
4)  No lotions, creams or powders to incision until it has
healed. You may shower and wash incision. Please shower daily.
No bathing or swimming for 1 month. Use sunscreen on incision if
exposed to sun.
5) No lifting greater then 10 pounds for 10 weeks.
6) No driving for 1 month.
7) Call with any questions or concerns.


Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 1 month. ([**Telephone/Fax (1) 1504**]
Follow-up with cardiologist Dr. [**Last Name (STitle) 5017**] in 2 weeks.
Follow-up with pcp [**Last Name (NamePattern4) **]. [**First Name (STitle) 745**] in [**1-31**] weeks. [**Telephone/Fax (1) 68885**]
Call all providers for appointments.



Completed by:[**2167-7-31**]
{'Thoracic aneurysm without mention of rupture,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other primary cardiomyopathies,Congestive heart failure, unspecified,Unspecified essential hypertension,Anemia, unspecified,Automatic implantable cardiac defibrillator in situ,Heart valve replaced by other means,Personal history of malignant neoplasm of large intestine'}


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: Asymptomatic Ascending Aortic Aneurysm

PRESENT ILLNESS: Mr. [**Known lastname **] is a 72-year-old male who in [**2146**] underwent an aortic
valve replacement with a mechanical Bjork-Shiley valve. He has
been followed for an enlarging ascending aorta and his most
recent echo showed it to be now at 6 cm. He is now presenting
for repair of the ascending aortic aneurysm

MEDICAL HISTORY: s/p AVR (Bjork-Shiley) [**2146**]
s/p ICD [**2161**]
MI at age 46
Cardiomyopathy
CHF
AAA
Colorectal Cancer
UTI
Colostomy [**2144**]
Hyperlipidemia
HTN

MEDICATION ON ADMISSION: Aldactone 25mg QD
Captopril 25mg TID
Coreg 12.5mg [**Hospital1 **]
Coumadin
Lasix 80mg QD
Lovastatin 40mg QD
Multivitamin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN: NAD
NECK: Supple, FROM
LUNGS: Clear
HEART: RRR, Crisp valve click, Nl S1-S2
ABD: Soft, NT/ND/NABS
EXT: Warm, well perfused, 1+ edema.
NEURO: Nonfocal. No carotid bruits.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Retired lift truck operator. 60 pack year history of smoking. He
quit over 10 years ago. Lives with his wife. [**Name (NI) **] does not drink
alcohol. He is edentulous. 

### Response:
{'Thoracic aneurysm without mention of rupture,Cardiac complications, not elsewhere classified,Atrial fibrillation,Other primary cardiomyopathies,Congestive heart failure, unspecified,Unspecified essential hypertension,Anemia, unspecified,Automatic implantable cardiac defibrillator in situ,Heart valve replaced by other means,Personal history of malignant neoplasm of large intestine'}
