CHIEF COMPLAINT: ascending aortic aneurysm

PRESENT ILLNESS: 81yo F for whom a routine CXR in [**10-30**] showed an aneurysm of the
ascending aorta that had increased in size from prior CXRs.
This was confirmed on CT in [**12-2**].  TTE showed the ascending
aneurysm measuring 5.1cm with proximal arch involvement
measuring 4.2cm, mild AI, and preserved LVEF 55%.  Cardiac cath
showed no atherosclerotic lesions.  Accordingly, she presented
for elective aneurysmal repair

MEDICAL HISTORY: HTN
hypercholesterolemia
R fem AV fistula
anxiety/depression
osteoporosis
varicose veins
h/o R ankle fx
hard-of-hearing

MEDICATION ON ADMISSION: Lipitor 20
Diovan/HCTZ 25'
Darvocet PRN
Xanax 0.25
ASA 81'
Ca+

ALLERGIES: Iodine Containing Agents Classifier / Heparin Agents

PHYSICAL EXAM: elderly female in NAD, appears stated age
Afebrile, P 86, BP R 147/65, L 162/77, RR 16
5'1", 150 lbs
PERRL, EOMi, non-icteric, sl B ptosis
neck supple, no JVD. + carotid bruit
CTAB
RRR, 2/6 SEM
soft, non-tender, non-distended, present bowel sounds. no
hepatosplenomegaly, no CVA tenderness
WWP, no C/C/E. BL varicosities
CN II-XII non-focal. MAE, 4/5 strength
Pulses: radial, femoral, PT 2+ BL, DP 1+ BL

FAMILY HISTORY: Sister with aortic aneurysm.

SOCIAL HISTORY: 3 sons. non-[**Name2 (NI) 1818**]
Thoracic aneurysm without mention of rupture,Aortic valve disorders,Iatrogenic cerebrovascular infarction or hemorrhage,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure,Anticoagulants causing adverse effects in therapeutic use,Pneumonia due to Hemophilus influenzae [H. influenzae],Urinary tract infection, site not specified,Other convulsions,Tricuspid atresia and stenosis, congenital,Acute posthemorrhagic anemia,Hypovolemia,Ventricular fibrillation,Unspecified pleural effusion,Arteritis, unspecified,Hemiplegia, unspecified, affecting unspecified side,Hypotension, unspecified,Unspecified essential hypertension,Precipitous drop in hematocrit
Thoracic aortic aneurysm,Aortic valve disorder,Iatrogen CV infarc/hmrhg,Acute necrosis of liver,Ac kidny fail, tubr necr,Hemorrhage complic proc,Adv eff anticoagulants,H.influenzae pneumonia,Urin tract infection NOS,Convulsions NEC,Cong tricusp atres/sten,Ac posthemorrhag anemia,Hypovolemia,Ventricular fibrillation,Pleural effusion NOS,Arteritis NOS,Unsp hemiplga unspf side,Hypotension NOS,Hypertension NOS,Drop, hematocrit, precip
Admission Date:  [**2192-4-24**]              Discharge Date:   [**2192-5-17**]


Service: CARDIOTHORACIC

Allergies:
Iodine Containing Agents Classifier / Heparin Agents

Attending:[**First Name3 (LF) 1283**]
Chief Complaint:
ascending aortic aneurysm

Major Surgical or Invasive Procedure:
Ascending aortic aneurysm repair with #30 Gelweave graft on
[**2192-4-24**]
PEG, Trach on [**2192-5-10**]
PICC placement [**2192-4-24**]


History of Present Illness:
81yo F for whom a routine CXR in [**10-30**] showed an aneurysm of the
ascending aorta that had increased in size from prior CXRs.
This was confirmed on CT in [**12-2**].  TTE showed the ascending
aneurysm measuring 5.1cm with proximal arch involvement
measuring 4.2cm, mild AI, and preserved LVEF 55%.  Cardiac cath
showed no atherosclerotic lesions.  Accordingly, she presented
for elective aneurysmal repair

Past Medical History:
HTN
hypercholesterolemia
R fem AV fistula
anxiety/depression
osteoporosis
varicose veins
h/o R ankle fx
hard-of-hearing

Social History:
3 sons. non-[**Name2 (NI) 1818**]

Family History:
Sister with aortic aneurysm.

Physical Exam:
elderly female in NAD, appears stated age
Afebrile, P 86, BP R 147/65, L 162/77, RR 16
5'1", 150 lbs
PERRL, EOMi, non-icteric, sl B ptosis
neck supple, no JVD. + carotid bruit
CTAB
RRR, 2/6 SEM
soft, non-tender, non-distended, present bowel sounds. no
hepatosplenomegaly, no CVA tenderness
WWP, no C/C/E. BL varicosities
CN II-XII non-focal. MAE, 4/5 strength
Pulses: radial, femoral, PT 2+ BL, DP 1+ BL

Pertinent Results:
[**2192-4-24**] 04:05PM BLOOD WBC-3.0*# RBC-1.68*# Hgb-4.7*# Hct-14.8*#
MCV-88 MCH-27.9 MCHC-31.7 RDW-13.7 Plt Ct-61*#
[**2192-4-24**] 05:12PM BLOOD WBC-6.1# RBC-2.97*# Hgb-8.8*# Hct-25.1*#
MCV-84 MCH-29.7 MCHC-35.2*# RDW-13.9 Plt Ct-155#
[**2192-5-3**] 03:27AM BLOOD WBC-13.0*# RBC-3.39* Hgb-9.6* Hct-29.7*
MCV-88 MCH-28.2 MCHC-32.2 RDW-13.9 Plt Ct-298
[**2192-5-4**] 01:51AM BLOOD WBC-14.8* RBC-2.30*# Hgb-6.4*# Hct-20.6*#
MCV-90 MCH-27.9 MCHC-31.1 RDW-13.9 Plt Ct-363
[**2192-5-4**] 02:33AM BLOOD Hgb-6.5* Hct-20.1*
[**2192-5-4**] 05:08AM BLOOD Hct-19.1*
[**2192-5-4**] 09:09PM BLOOD Hct-23.9*
[**2192-5-5**] 12:57AM BLOOD Hct-29.1*
[**2192-5-6**] 04:12AM BLOOD WBC-19.7* RBC-3.48* Hgb-10.5* Hct-29.4*
MCV-85 MCH-30.2 MCHC-35.7* RDW-15.3 Plt Ct-145*
[**2192-5-15**] 04:50AM BLOOD WBC-10.7 RBC-3.68* Hgb-10.8* Hct-32.5*
MCV-88 MCH-29.3 MCHC-33.2 RDW-15.0 Plt Ct-239
[**2192-4-25**] 01:00AM BLOOD PT-13.3* PTT-27.2 INR(PT)-1.2*
[**2192-4-30**] 12:08PM BLOOD PT-12.6 PTT-28.1 INR(PT)-1.1
[**2192-5-1**] 05:04AM BLOOD PT-12.9 PTT-51.7* INR(PT)-1.1
[**2192-5-1**] 03:30PM BLOOD PTT-36.3*
[**2192-5-2**] 02:45AM BLOOD PT-12.2 PTT-42.3* INR(PT)-1.0
[**2192-5-3**] 03:27AM BLOOD PT-16.9* PTT-150* INR(PT)-1.6*
[**2192-5-3**] 05:37AM BLOOD PTT-57.5*
[**2192-5-3**] 07:56PM BLOOD PT-15.1* PTT-78.8* INR(PT)-1.4*
[**2192-5-4**] 01:51AM BLOOD PT-21.1* PTT-150* INR(PT)-2.0*
[**2192-5-4**] 05:08AM BLOOD PT-23.8* PTT-73.0* INR(PT)-2.4*
[**2192-5-4**] 09:09PM BLOOD PT-17.7* INR(PT)-1.7*
[**2192-5-7**] 03:32AM BLOOD PT-13.7* PTT-23.6 INR(PT)-1.2*
[**2192-5-13**] 03:44AM BLOOD PT-13.1 PTT-21.6* INR(PT)-1.1
[**2192-4-24**] 05:12PM BLOOD Plt Ct-155#
[**2192-4-27**] 03:07AM BLOOD Plt Ct-107*
[**2192-4-30**] 02:33AM BLOOD Plt Ct-165
[**2192-5-3**] 03:27AM BLOOD Plt Ct-298
[**2192-5-5**] 02:16AM BLOOD Plt Ct-158#
[**2192-5-7**] 03:32AM BLOOD Plt Ct-106*
[**2192-5-8**] 04:30AM BLOOD Plt Smr-LOW Plt Ct-97*
[**2192-5-10**] 02:09AM BLOOD Plt Ct-88*
[**2192-5-12**] 03:34AM BLOOD Plt Ct-155
[**2192-5-15**] 04:50AM BLOOD Plt Ct-239
[**2192-4-26**] 02:41AM BLOOD Glucose-93 UreaN-19 Creat-1.0 Na-139
K-4.1 Cl-106 HCO3-22 AnGap-15
[**2192-5-1**] 03:00AM BLOOD Glucose-147* UreaN-33* Creat-1.0 Na-139
K-4.3 Cl-101 HCO3-31 AnGap-11
[**2192-5-6**] 04:12AM BLOOD Glucose-115* UreaN-64* Creat-2.8* Na-138
K-3.3 Cl-99 HCO3-24 AnGap-18
[**2192-5-7**] 03:32AM BLOOD Glucose-117* UreaN-61* Creat-2.3* Na-140
K-3.9 Cl-104 HCO3-23 AnGap-17
[**2192-5-8**] 04:30AM BLOOD UreaN-54* Creat-1.7* Na-139 Cl-106
HCO3-23
[**2192-5-15**] 04:50AM BLOOD Glucose-90 UreaN-33* Creat-0.8 Na-144
K-4.4 Cl-109* HCO3-28 AnGap-11
[**2192-4-25**] 03:56PM BLOOD ALT-12 AST-38 LD(LDH)-328* AlkPhos-45
Amylase-68 TotBili-0.4
[**2192-5-4**] 01:51AM BLOOD ALT-107* AST-134* AlkPhos-90 Amylase-9
TotBili-0.4
[**2192-5-5**] 01:57AM BLOOD ALT-1265* AST-2968* LD(LDH)-1425*
AlkPhos-86 TotBili-0.8
[**2192-5-5**] 05:27AM BLOOD ALT-1010* AST-2115* AlkPhos-82
[**2192-5-6**] 04:12AM BLOOD ALT-798* AST-1149* LD(LDH)-661*
AlkPhos-88 TotBili-0.9
[**2192-5-7**] 09:20AM BLOOD ALT-623* AST-613* LD(LDH)-652*
AlkPhos-107 TotBili-1.1
[**2192-5-9**] 02:27AM BLOOD ALT-332* AST-143* LD(LDH)-700*
AlkPhos-106 Amylase-140* TotBili-1.4
[**2192-5-7**] 09:20AM BLOOD Albumin-2.4*
[**2192-4-26**] 02:41AM BLOOD Phenyto-9.4*
[**2192-5-1**] 03:00AM BLOOD Phenyto-10.6
[**2192-5-2**] 02:45AM BLOOD Phenyto-8.5*
[**2192-5-11**] 03:15AM BLOOD Phenyto-2.8*
[**2192-5-13**] 03:44AM BLOOD Phenyto-2.7*
[**2192-5-13**] 01:02PM BLOOD Type-ART pO2-103 pCO2-39 pH-7.43
calHCO3-27 Base XS-1
[**2192-5-5**] 05:22AM BLOOD HEPARIN DEPENDENT ANTIBODIES- Positive
[**2192-5-3**] 06:30PM URINE RBC-[**5-5**]* WBC->50 Bacteri-MANY Yeast-NONE
Epi-0
[**2192-5-3**] 06:30PM URINE Blood-LG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-MOD
[**2192-5-13**] 04:40PM URINE RBC-0-2 WBC-0-2 Bacteri-MANY Yeast-MANY
Epi-0
[**2192-5-13**] 04:40PM URINE Blood-SM Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG

Brief Hospital Course:
     81yo F underwent ascending aortic and proximal arch repair
with Gelweave graft on [**2192-4-24**]; see operative report for
details. Pt was brought post-operatively to the cardiac surgery
intensive care unit, intubated, with chest tubes, pacing wires,
and Foley catheter in place. She had moderate pressor
requirements overnight. On POD 1, she experienced a witnessed
grand mal seizure that self-terminated after 2 minutes. Dilantin
and Ativan were provided thereafter; a CT Head showed old
infarct but no new infarct, and no further seizure activity was
witnessed. Repeat Head CT 2 days later was limited by motion
artifact, and MRI showed subacute infarcts. EEG was negative for
seizure and Carotid duplex was negative for stenotic plaque.
     The hemodynamics improved over the next several days and
the pressor agents of epinephrine and neosynephrine were weaned
off.  Attempts to extubation were withheld due to patient's
inability to follow commands or orient to surroundings, precedex
was tried as well.  She also had residual LUE motor deficit.
Sedating meds were ceased.
     On POD 4, swelling of the L arm was evaluated with
Ultrasound Doppler which showed occlusive thrombus of the L
internal jugular vein and L basilic vein, but the subclavian and
cephalic veins were patent and anticoagulation was not given.
Around this time, the heart rate intermittently went into AFib
and AFlutter, controlled on lopressor and amiodarone, but the
combination of AFib and DVT prompted the decision to
anticoagulate with heparin drip (without bolus) on POD 6.  Upon
achieving therapeutic levels (which subsequently overshot), the
hematocrit dropped 9 points from 30 to 21, hemodynamics remained
stable, abdominal exam was soft, and stools were only trace
guaiac positive.  Heparin was held, CT torso showed a large left
retroperitoneal hematoma measuring 20x10x8cm.  Coagulopathy was
reversed with platelet transfusion (1unit), and ultimately she
consumed 7u PRBCs, 6u FFP. CT also showed mediastinal widening;
a Swan-Ganz catheter was re-placed, a TTE showed no significant
effusion or decreased ejection fraction, and renal ultrasound
showed no hydronephrosis.  In the context of this work-up, a HIT
was sent and resulted positive; but given the prior bleed the
decision was made not to actively anticoagulate to treat the
HIT+.  From this event, she did experience a bump in BUN/Cr and
LFTs from shock liver and pre-renal ATN, both of which resolved
over the next few days.
     She did vent wean to minimal support but remained
neurologically non-interactive.  An extubation attempt on POD 14
was unsuccessful and she was re-intubated within an hour.
Accordingly, she underwent a PEG/Trach on [**2192-5-10**] (POD 16), see
operative report for details; she had previously been fed with
nasogastric Dobhoff tube.  She subsequently performed well on
trach collar trials for several hours each day, with improving
mental status that allowed her to follow commands and move all
extremities.
     The remainder of the hospital course was notable for a UTI
of pan-sensitive proteus on POD 9, an HFlu PNA on POD 9, which
were treated with 10day courses of Levaquin and Ampicillin
respectively.  Subsequent urinalysis was negative.
Additionally, a PICC line had been placed by IR on POD 8.  She
remained afebrile with normalizing WBC.

Medications on Admission:
Lipitor 20
Diovan/HCTZ 25'
Darvocet PRN
Xanax 0.25
ASA 81'
Ca+

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  QID
(4 times a day) as needed.
5. Phenytoin 100 mg/4 mL Suspension Sig: Four (4) ml PO Q8H
(every 8 hours).
6. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

9. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty
(30) mg PO DAILY (Daily).
10. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).

1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  QID
(4 times a day) as needed.
5. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
6. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

8. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: Thirty
(30) mg PO DAILY (Daily).
9. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
11. Phenytoin 100 mg/4 mL Suspension Sig: Six (6) mL PO Q8H
(every 8 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
ascending aortic aneurysm s/p graft repair
CVA with seizure
deep venous thrombosis of L IJ, L basilic
HIT+
retroperitoneal bleed
HTN
hypercholesterolemia
depression/anxiety


Discharge Condition:
stable


Discharge Instructions:
[**Name8 (MD) **] MD [**First Name (Titles) **] [**Last Name (Titles) **] or chills, chest pain, shortness of breath,
nausea/vomiting or intolerance of tube feeds.

[**Month (only) 116**] shower. No baths or swimming. No creams, lotions, or
ointments to any incisions.

No heavy lifting (>10lbs) for 10 weeks from sternotomy.  Can
participate in physical therapy.

[**Last Name (NamePattern4) 2138**]p Instructions:
Please follow-up with Dr. [**Last Name (STitle) 141**] upon discharge from rehab.
Please follow-up with Dr. [**Last Name (Prefixes) **] (cardiac surgeon) in [**12-30**]
weeks from hospital discharge, or upon discharge from rehab.
Call [**Telephone/Fax (1) 170**] for an appointment.
{'Thoracic aneurysm without mention of rupture,Aortic valve disorders,Iatrogenic cerebrovascular infarction or hemorrhage,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure,Anticoagulants causing adverse effects in therapeutic use,Pneumonia due to Hemophilus influenzae [H. influenzae],Urinary tract infection, site not specified,Other convulsions,Tricuspid atresia and stenosis, congenital,Acute posthemorrhagic anemia,Hypovolemia,Ventricular fibrillation,Unspecified pleural effusion,Arteritis, unspecified,Hemiplegia, unspecified, affecting unspecified side,Hypotension, unspecified,Unspecified essential hypertension,Precipitous drop in hematocrit'}


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: ascending aortic aneurysm

PRESENT ILLNESS: 81yo F for whom a routine CXR in [**10-30**] showed an aneurysm of the
ascending aorta that had increased in size from prior CXRs.
This was confirmed on CT in [**12-2**].  TTE showed the ascending
aneurysm measuring 5.1cm with proximal arch involvement
measuring 4.2cm, mild AI, and preserved LVEF 55%.  Cardiac cath
showed no atherosclerotic lesions.  Accordingly, she presented
for elective aneurysmal repair

MEDICAL HISTORY: HTN
hypercholesterolemia
R fem AV fistula
anxiety/depression
osteoporosis
varicose veins
h/o R ankle fx
hard-of-hearing

MEDICATION ON ADMISSION: Lipitor 20
Diovan/HCTZ 25'
Darvocet PRN
Xanax 0.25
ASA 81'
Ca+

ALLERGIES: Iodine Containing Agents Classifier / Heparin Agents

PHYSICAL EXAM: elderly female in NAD, appears stated age
Afebrile, P 86, BP R 147/65, L 162/77, RR 16
5'1", 150 lbs
PERRL, EOMi, non-icteric, sl B ptosis
neck supple, no JVD. + carotid bruit
CTAB
RRR, 2/6 SEM
soft, non-tender, non-distended, present bowel sounds. no
hepatosplenomegaly, no CVA tenderness
WWP, no C/C/E. BL varicosities
CN II-XII non-focal. MAE, 4/5 strength
Pulses: radial, femoral, PT 2+ BL, DP 1+ BL

FAMILY HISTORY: Sister with aortic aneurysm.

SOCIAL HISTORY: 3 sons. non-[**Name2 (NI) 1818**] 

### Response:
{'Thoracic aneurysm without mention of rupture,Aortic valve disorders,Iatrogenic cerebrovascular infarction or hemorrhage,Acute and subacute necrosis of liver,Acute kidney failure with lesion of tubular necrosis,Hemorrhage complicating a procedure,Anticoagulants causing adverse effects in therapeutic use,Pneumonia due to Hemophilus influenzae [H. influenzae],Urinary tract infection, site not specified,Other convulsions,Tricuspid atresia and stenosis, congenital,Acute posthemorrhagic anemia,Hypovolemia,Ventricular fibrillation,Unspecified pleural effusion,Arteritis, unspecified,Hemiplegia, unspecified, affecting unspecified side,Hypotension, unspecified,Unspecified essential hypertension,Precipitous drop in hematocrit'}
