CHIEF COMPLAINT: syncope

PRESENT ILLNESS: [**Known firstname 2411**] [**Known lastname 6160**] is a 69 year old woman who was recently found
to have aortic insufficiency and an ascending aortic aneurysm
during a work-up for syncope

MEDICAL HISTORY: ascending aortic aneurysm
aortic insufficiency
recurrent syncope
right lower lobe nodule
right upper lobe subpleural plaques
mild hypercholesterolemia
s/p partial oophorectomy
s/p ligal ligation
s/p removal of sebaceous cyst on neck

MEDICATION ON ADMISSION: aspirin 81 mg daily
fish oil daily
multivitamin daily
CoQ10

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Bee Pollens /
Codeine / Epinephrine / Tetanus

PHYSICAL EXAM: At the time of admission, Ms. [**Known lastname 6160**] was noted to be in no
acute distress, but was somewhat anxious.  Her skin was
unremarkable.  No jugular venous distension was found.  Her
lungs were clear to ausculatation bilaterally.  Her heart was of
regular rate and rhythm with a IV/VI diastolic murmur.  His
abdomen was soft, non-tender, and non-distended.  Her
extremities were warm and well perfused with no edema.  No
varicosities were noted.

FAMILY HISTORY: Her family history is non-contributory.

SOCIAL HISTORY: Ms. [**Known lastname 6160**] is a retired human resources manager.
Abdominal aneurysm without mention of rupture,Unspecified pleural effusion,Aortic valve disorders,Pure hypercholesterolemia
Abdom aortic aneurysm,Pleural effusion NOS,Aortic valve disorder,Pure hypercholesterolem
Admission Date:  [**2129-5-18**]              Discharge Date:   [**2129-5-23**]

Date of Birth:  [**2059-10-28**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins / Sulfa (Sulfonamide Antibiotics) / Bee Pollens /
Codeine / Epinephrine / Tetanus

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
syncope

Major Surgical or Invasive Procedure:
aortic valve replacement (25mm [**Company 1543**] Mosaic), ascending
aorta-arch replacement (elephant trunk) [**2129-5-18**]


History of Present Illness:
[**Known firstname 2411**] [**Known lastname 6160**] is a 69 year old woman who was recently found
to have aortic insufficiency and an ascending aortic aneurysm
during a work-up for syncope

Past Medical History:
ascending aortic aneurysm
aortic insufficiency
recurrent syncope
right lower lobe nodule
right upper lobe subpleural plaques
mild hypercholesterolemia
s/p partial oophorectomy
s/p ligal ligation
s/p removal of sebaceous cyst on neck

Social History:
Ms. [**Known lastname 6160**] is a retired human resources manager.

Family History:
Her family history is non-contributory.

Physical Exam:
At the time of admission, Ms. [**Known lastname 6160**] was noted to be in no
acute distress, but was somewhat anxious.  Her skin was
unremarkable.  No jugular venous distension was found.  Her
lungs were clear to ausculatation bilaterally.  Her heart was of
regular rate and rhythm with a IV/VI diastolic murmur.  His
abdomen was soft, non-tender, and non-distended.  Her
extremities were warm and well perfused with no edema.  No
varicosities were noted.

Pertinent Results:
[**2129-5-20**] 02:44AM BLOOD WBC-12.8* RBC-3.73* Hgb-11.3* Hct-32.0*
MCV-86 MCH-30.4 MCHC-35.4* RDW-14.8 Plt Ct-186
[**2129-5-20**] 02:44AM BLOOD Plt Ct-186
[**2129-5-19**] 03:00AM BLOOD PT-15.2* PTT-34.0 INR(PT)-1.3*
[**2129-5-20**] 02:44AM BLOOD Glucose-71 UreaN-18 Creat-0.7 Na-135
K-3.8 Cl-100 HCO3-28 AnGap-11
[**2129-5-19**] 03:00AM BLOOD ALT-23 AST-47* CK(CPK)-329* AlkPhos-42
TotBili-2.1*
[**2129-5-21**] 07:00AM BLOOD WBC-12.1* RBC-4.03* Hgb-12.3 Hct-35.3*
MCV-88 MCH-30.5 MCHC-34.7 RDW-14.3 Plt Ct-161
[**2129-5-22**] 01:17PM BLOOD UreaN-17 Creat-0.8 K-4.8



[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

[**Known lastname **], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 81287**]
(Complete) Done [**2129-5-18**] at 11:18:36 AM      PRELIMINARY
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) 177**] C.
[**Hospital Unit Name 927**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2059-10-28**]
Age (years): 69 F  Hgt (in): 63
BP (mm Hg): 110/52  Wgt (lb): 124
HR (bpm): 62  BSA (m2): 1.58 m2
Indication: aortic aneurysm, intraoperative management
ICD-9 Codes: 780.2
Test Information
Date/Time: [**2129-5-18**] at 11:18    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2009AW2-: Machine: 2
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Septal Wall Thickness:  0.7 cm  0.6 - 1.1 cm
Left Ventricle - Inferolateral Thickness:  0.7 cm  0.6 - 1.1 cm

Left Ventricle - Diastolic Dimension:  3.3 cm  <= 5.6 cm
Left Ventricle - Systolic Dimension:  5.1 cm
Left Ventricle - Fractional Shortening:  *-0.55  >= 0.29
Left Ventricle - Ejection Fraction:  65%  >= 55%
Aorta - Annulus:  2.0 cm  <= 3.0 cm
Aorta - Sinus Level:  3.1 cm  <= 3.6 cm
Aorta - Sinotubular Ridge:  *3.1 cm  <= 3.0 cm
Aorta - Ascending:  *5.5 cm  <= 3.4 cm
Aorta - Arch:  *5.2 cm  <= 3.0 cm
Aorta - Descending Thoracic:  *3.5 cm  <= 2.5 cm

Findings
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA and extending into the RV. No ASD by 2D or color
Doppler.

LEFT VENTRICLE: Normal LV wall thickness and cavity size.
Overall normal LVEF (>55%).

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

AORTA: Normal aortic diameter at the sinus level. Markedly
dilated ascending aorta. Markedly dilated aortic arch.
Moderately dilated descending aorta

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. Moderate
(2+) AR.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR.

TRICUSPID VALVE: Normal tricuspid valve leaflets. No TR.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets.
No PR.

PERICARDIUM: No pericardial effusion.

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. Results were
Conclusions
PRE-BYPASS:

1. No atrial septal defect or PFO is seen by 2D or color Doppler
although difficult to find IAS due to rotation of the heart from
the aortic aneurysm.

2. Left ventricular wall thicknesses and cavity size are normal.
Overall left ventricular systolic function is normal (LVEF>55%).


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

4. The ascending aorta is markedly dilated The aortic arch is
markedly dilated. The descending thoracic aorta is moderately
dilated.

5. The aortic valve leaflets (3) appear structurally normal with
good leaflet excursion and no aortic stenosis. Moderate (2+)
aortic regurgitation is seen.

6. The mitral valve appears structurally normal with trivial
mitral regurgitation.

7. There is no pericardial effusion.

8. Dr. [**Last Name (STitle) 914**] was notified in person of the results during the
surgery on [**2129-5-18**] at 1005.

POSTBYPASS

1. Patient is on nitroglycerin infusions

2. LV EF appears underfilled initially. After blood products the
LV EF looks similar to prebypass

3. A tissue valve is noted in the aortic position. It is well
seated and well functioning. No perivalvular leaks noted. Peak
gradient of 6 mmHg and mean gradient 2 mmHg.

4. Graft material is noted in the ascending aorta and tube graft
is seen in the descending aorta
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Interpretation assigned to [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician


?????? [**2123**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Ms. [**Known lastname 6160**] was brought to the operating room on [**2129-5-18**] and
underwent a thoracic aortic aneurysm repair.  This procedure was
performed by Dr. [**Last Name (STitle) 914**].  She tolerated the procedure well and
was transferred in critical but stable condition to the surgical
intensive care unit.  She was extubated and weaned from her
pressors by the following day.  Her chest tubes were removed.
She was transferred to the surgical step down floor.  Beta
blockade was increased as tolerated and she was gently diuresed.
Ace inhibitor was started for optimal control of blood pressure.
 The patient made excellent progress with physical therapy.  By
the time of discharge on POD 5 the patient was ambulating
freely, the wound was healing and pain was controlled with oral
analgesics.  She was discharged home with VNA and appropriate
follow up instructions.

Medications on Admission:
aspirin 81 mg daily
fish oil daily
multivitamin daily
CoQ10

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
3. Captopril 25 mg Tablet Sig: Three (3) Tablet PO TID (3 times
a day).
Disp:*270 Tablet(s)* Refills:*2*
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 1 weeks.
Disp:*7 Tablet(s)* Refills:*0*
6. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for 1
weeks.
Disp:*7 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
7. Menthol-Cetylpyridinium 3 mg Lozenge Sig: One (1) Lozenge
Mucous membrane PRN (as needed). Lozenge(s)
8. Phenol 1.4 % Aerosol, Spray Sig: One (1) Spray Mucous
membrane Q4H (every 4 hours) as needed.


Discharge Disposition:
Home With Service

Facility:
[**Hospital3 3765**] Home Care

Discharge Diagnosis:
ascending aortic arch aneurysm, aortic insufficiency


Discharge Condition:
good


Discharge Instructions:
Please shower daily including washing incisions, no baths or
swimming
Monitor wounds for infection - redness, drainage, or increased
pain
Report any fever greater than 101
Report any weight gain of greater than 2 pounds in 24 hours or 5
pounds in a week
No creams, lotions, powders, or ointments to incisions
No driving for approximately one month
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]


Followup Instructions:
Dr [**Last Name (STitle) 914**] (cardiac surgery) in 4 weeks ([**Telephone/Fax (1) 170**]) please
call for appointment, have CT scan prior to this visit
Dr. [**Last Name (STitle) **] (vascular surgeon)
Dr [**Last Name (STitle) 81288**] (PCP) in [**3-8**] weeks ([**Telephone/Fax (1) 81289**]) please call for
appointment
Dr [**Last Name (STitle) **] (cardiologist) in [**3-8**] weeks please call for
appointment
Wound check appointment [**Hospital Ward Name 121**] 2 as instructed by nurse
([**Telephone/Fax (1) 3071**])



Completed by:[**2129-5-23**]
{'Abdominal aneurysm without mention of rupture,Unspecified pleural effusion,Aortic valve disorders,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: syncope

PRESENT ILLNESS: [**Known firstname 2411**] [**Known lastname 6160**] is a 69 year old woman who was recently found
to have aortic insufficiency and an ascending aortic aneurysm
during a work-up for syncope

MEDICAL HISTORY: ascending aortic aneurysm
aortic insufficiency
recurrent syncope
right lower lobe nodule
right upper lobe subpleural plaques
mild hypercholesterolemia
s/p partial oophorectomy
s/p ligal ligation
s/p removal of sebaceous cyst on neck

MEDICATION ON ADMISSION: aspirin 81 mg daily
fish oil daily
multivitamin daily
CoQ10

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Bee Pollens /
Codeine / Epinephrine / Tetanus

PHYSICAL EXAM: At the time of admission, Ms. [**Known lastname 6160**] was noted to be in no
acute distress, but was somewhat anxious.  Her skin was
unremarkable.  No jugular venous distension was found.  Her
lungs were clear to ausculatation bilaterally.  Her heart was of
regular rate and rhythm with a IV/VI diastolic murmur.  His
abdomen was soft, non-tender, and non-distended.  Her
extremities were warm and well perfused with no edema.  No
varicosities were noted.

FAMILY HISTORY: Her family history is non-contributory.

SOCIAL HISTORY: Ms. [**Known lastname 6160**] is a retired human resources manager. 

### Response:
{'Abdominal aneurysm without mention of rupture,Unspecified pleural effusion,Aortic valve disorders,Pure hypercholesterolemia'}
