CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 75-year-old
male with the acute onset of back pain and mild dyspnea on
exertion at 9:30 a.m. with mild chest pain.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Dissection of aorta, abdominal,Aortic valve disorders,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate
Dsct of abdominal aorta,Aortic valve disorder,Hypertension NOS,Hx-prostatic malignancy
Admission Date:  [**2107-12-6**]     Discharge Date:  [**2107-12-12**]

Date of Birth:   [**2034-8-16**]     Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 75-year-old
male with the acute onset of back pain and mild dyspnea on
exertion at 9:30 a.m. with mild chest pain.

No neurologic symptoms, speech slurring, or weakness.  No
history of cerebrovascular accident, myocardial infarction,
or diabetes mellitus.  Positive well controlled hypertension.
Recent exercise treadmill test revealed no ischemic changes.
He walks three miles per day.  A very remote history of
smoking greater than 40 years ago.  No history of trauma.  He
came to the Emergency Department this afternoon.

PHYSICAL EXAMINATION ON PRESENTATION:  The patient was
afebrile, heart rate was 78, blood pressure was 120/70,
respiratory rate was 18, oxygen saturation was 100% on 2
liters.  Head, eyes, ears, nose, and throat examination
revealed normocephalic and atraumatic.  No lymphadenopathy.
No TM.  Pupils were equal, round, and reactive to light and
accommodation.  The neck was supple.  Positive bruits
bilaterally.  Cardiovascular examination revealed a regular
rate and rhythm.  A 2/6 systolic ejection murmur.  Positive
diastolic murmur.  The lungs were clear to auscultation
bilaterally.  The abdomen was soft and moderately distended.
An old well-healed scar.  No guarding or rebound.  No
thrombotic thrombocytopenic purpura.  Extremities revealed no
clubbing, cyanosis, or edema.  Pulse examination revealed 2+
bilaterally throughout.  Carotids had a positive bruit
bilaterally versus transmitted aortic valve murmur.

PERTINENT LABORATORY DATA ON PRESENTATION:   Pertinent
laboratories revealed hematocrit was 37.9.  Creatine kinase
was 108.  CK/MB was 3.  Troponin I was less than 0.3.

HOSPITAL COURSE:   The patient came to the Emergency
Department on [**2107-12-6**] with complaints of severe
acute onset of severe back pain and mild dyspnea on exertion.

The patient was brought to the computed tomography scanner
and was read as type A aortic dissection to the proximal
extent to the iliacs bilaterally.  The patient was
subsequently diagnosed with acute type A dissection with
probably aortic valve involvement.  The patient was placed on
an esmolol drip, and labetalol, and nitroglycerin as needed
to prevent hypertension that could worsen the dissection.

The patient was taken to the operating room emergently for an
aortic dissection repair.  In the operating room, the
pericardium was opened without any evidence of
intrapericardial blood.  An obvious ascending dissection was
visualized and repaired.  Total cardiopulmonary bypass time
was 163 minutes.  Cross-clamp time was 54 minutes.
Circulatory arrest time was 27 minutes at 15 degrees
Centigrade.

The patient tolerated the procedure well, and there were no
complications encountered throughout the course of the
operative procedure.  The patient was subsequently
transferred to the Cardiothoracic Intensive Care Unit where
he remained intubated overnight.

The patient was given 2 units of fresh frozen plasma, and 2
units of packed red blood cells, as well as cryodes, and
platelets for a hematocrit of 20.  Postoperatively, the
patient received another 2 units of packed red blood cells,
and a subsequent hematocrit was 26.6.  The patient was given
a nitroglycerin drip and nitroprusside to keep his systolic
blood pressure in the 90s to 110s and heart rate at 70s to
80s.  The patient remained in a normal sinus rhythm without
ectopy.

On postoperative day two, the patient was extubated without
event.  Then, his arterial blood gas was found to be within
normal limits.  The patient's urine output was found to be
excellent, and blood urea nitrogen and creatinine were 27 and
1.1; respectively.

On postoperative day four, the patient was transferred to the
floor, and his pacer wires were discontinued, and his
labetalol dose was decreased.  Before the patient was
transferred to the floor, the patient's chest tube was
discontinued.

On postoperative day six, the patient was found to be feeling
quite well and vital signs were stable.  The patient was
subsequently discharged home with visiting nurse care.

MEDICATIONS ON DISCHARGE:
1.  Labetalol 200 mg p.o. b.i.d.
2.  Atorvastatin 10 mg p.o. q.d.
3.  Percocet one to two tablets p.o. q.4-6h. as needed (for
pain).
4.  Tylenol.
5.  Aspirin 325 mg p.o. q.d.
6.  Colace 100 mg p.o. b.i.d.
7.  Ranitidine 150 mg p.o. b.i.d.
8.  Lasix 20 mg p.o. b.i.d. (for seven days).
9.  K-Dur 20 mEq p.o. b.i.d. (for seven days).

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE DISPOSITION:   The patient was discharged to home
with [**Hospital6 407**] services.





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

Dictated By:[**Last Name (NamePattern1) 14176**]

MEDQUIST36

D:  [**2107-12-12**]  17:27
T:  [**2107-12-15**]  08:24
JOB#:  [**Job Number 28554**]
{'Dissection of aorta, abdominal,Aortic valve disorders,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}


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: The patient is a 75-year-old
male with the acute onset of back pain and mild dyspnea on
exertion at 9:30 a.m. with mild chest pain.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Dissection of aorta, abdominal,Aortic valve disorders,Unspecified essential hypertension,Personal history of malignant neoplasm of prostate'}
