CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 78 year old retired urologist
presented to OSH complaining of 40 minutes of chest pain that
radiated to his back and throat. Per report from OSH, ECG
notable for inferior and lateral ST changes concerning for
ischemia and pt not currently in AFib. CTA done at OSH revealed
type A Aortic dissection. He was medflighted into [**Hospital1 18**]. Dr.[**Last Name (STitle) **]
reviewed the CTA and Mr.[**Known lastname **] was taken emergently to the
operating room.

MEDICAL HISTORY: Chronic AFib->on Pradaxa, HTN,
? hx of
cardiac dz per OSH HPI, prostate cancer.

MEDICATION ON ADMISSION: Nexium 40(1),lipitor 40 mg 3x/weekly.,
Propafenone HCL 150mg (4), Pradaxa 150 (2), Levitra prn

ALLERGIES: morphine

PHYSICAL EXAM: pt was seen emergently-VS noted

FAMILY HISTORY: 

SOCIAL HISTORY: has family in vicinity
? girlfriend
Dissection of aorta, thoracic,Acute kidney failure with lesion of tubular necrosis,Other and unspecified coagulation defects,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Other fluid overload,Unspecified psychosis,Anticoagulants causing adverse effects in therapeutic use,Thrombocytopenia, unspecified,Disorders of phosphorus metabolism,Other and unspecified special symptoms or syndromes, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of prostate
Dsct of thoracic aorta,Ac kidny fail, tubr necr,Coagulat defect NEC/NOS,Hemorrhage complic proc,Ac posthemorrhag anemia,Aortic valve disorder,Atrial fibrillation,Hypertension NOS,Fluid overload NEC,Psychosis NOS,Adv eff anticoagulants,Thrombocytopenia NOS,Dis phosphorus metabol,Special symptom NEC/NOS,Abn react-anastom/graft,Hx-prostatic malignancy
Name:  [**Known lastname 14407**],[**Known firstname **] J                   Unit No:   [**Numeric Identifier 14408**]

Admission Date:  [**2106-9-25**]              Discharge Date:   [**2106-10-11**]

Date of Birth:  [**2028-9-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
morphine

Attending:[**First Name3 (LF) 135**]
Addendum:
Dr. [**Known lastname **] remained inpatient for an additional twenty-four hours
to  monitor his response to beta blockade.  He tolerated this
well, and was discharged to [**Hospital1 **] of [**Location (un) 776**] and Islands on
POD 16.  At the time of discharge he was alert and oriented x 3
without confusion.  The wounds were healing and pain was
controlled with Tylenol.

Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
[**2106-9-25**] emergency repl. ascending and arch aorta
[**2106-9-27**] chest closure


Past Medical History:
Chronic AFib->on Pradaxa, HTN,
? hx of
cardiac dz per OSH HPI, prostate cancer.


Pertinent Results:
[**2106-10-11**] 06:47AM BLOOD PT-18.1* INR(PT)-1.6*
[**2106-10-10**] 04:40AM BLOOD PT-15.8* INR(PT)-1.4*
[**2106-10-9**] 07:17AM BLOOD PT-16.1* INR(PT)-1.4*
[**2106-10-8**] 06:05AM BLOOD PT-19.1* INR(PT)-1.7*
[**2106-10-7**] 02:49AM BLOOD PT-27.3* PTT-38.6* INR(PT)-2.6*
[**2106-10-6**] 01:59AM BLOOD PT-28.8* PTT-40.6* INR(PT)-2.8*
[**2106-10-5**] 03:20AM BLOOD PT-29.0* PTT-42.6* INR(PT)-2.8*
[**2106-10-4**] 02:00AM BLOOD PT-27.2* PTT-40.6* INR(PT)-2.6*
[**2106-10-3**] 02:22AM BLOOD PT-28.4* PTT-38.4* INR(PT)-2.7*
[**2106-10-2**] 04:24AM BLOOD PT-21.8* INR(PT)-2.0*
[**2106-10-1**] 04:40AM BLOOD PT-17.2* PTT-31.6 INR(PT)-1.5*
[**2106-9-30**] 03:13AM BLOOD PT-12.0 PTT-29.9 INR(PT)-1.0
[**2106-9-29**] 02:53AM BLOOD PT-11.5 PTT-30.9 INR(PT)-1.0
[**2106-9-27**] 09:47AM BLOOD PT-12.0 PTT-36.2* INR(PT)-1.0
[**2106-9-27**] 02:13AM BLOOD PT-12.1 PTT-34.6 INR(PT)-1.0

Discharge Medications:
1. propafenone 150 mg Tablet [**Month/Day/Year 1649**]: One (1) Tablet PO QID (4 times
a day).
2. aspirin 81 mg Tablet, Chewable [**Month/Day/Year 1649**]: One (1) Tablet, Chewable
PO DAILY (Daily).
3. docusate sodium 100 mg Capsule [**Month/Day/Year 1649**]: One (1) Capsule PO BID (2
times a day) for 2 weeks.
4. atorvastatin 20 mg Tablet [**Month/Day/Year 1649**]: One (1) Tablet PO DAILY
(Daily).
5. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) 1649**]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
6. warfarin 1 mg Tablet [**Last Name (STitle) 1649**]: MD to order daily dose  Tablet PO
DAILY (Daily).
7. acetaminophen 325 mg Tablet [**Last Name (STitle) 1649**]: Two (2) Tablet PO Q4H (every
4 hours) as needed for temperature >38.0.
8. bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Last Name (STitle) 1649**]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
9. lactulose 10 gram/15 mL Syrup [**Last Name (STitle) 1649**]: Thirty (30) ML PO Q8H
(every 8 hours) as needed for constipation.
10. diltiazem HCl 180 mg Capsule, Extended Release [**Last Name (STitle) 1649**]: Three
(3) Capsule, Extended Release PO DAILY (Daily).
11. hydralazine 25 mg Tablet [**Last Name (STitle) 1649**]: Two (2) Tablet PO Q6H (every 6
hours).
12. carvedilol 12.5 mg Tablet [**Last Name (STitle) 1649**]: One (1) Tablet PO BID (2
times a day).
13. furosemide 40 mg Tablet [**Last Name (STitle) 1649**]: One (1) Tablet PO once a day
for 1 weeks.
14. potassium chloride 20 mEq Tablet, ER Particles/Crystals [**Last Name (STitle) 1649**]:
One (1) Tablet, ER Particles/Crystals PO once a day for 1 weeks.

15. Outpatient Lab Work
Labs: PT/INR for Coumadin ?????? indication A Fib
Goal INR 2.0-2.5
First draw [**2106-10-12**]


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 41**] - [**Hospital3 709**] ([**Hospital **]
Hospital of [**Location (un) 776**] and Islands)

Discharge Diagnosis:
acute Type A aortic dissection s/p repl. ascending and arch
aorta
acute renal failure
Chronic AFib->was on Pradaxa s/p ablation
hypertension
hx of cardiac dz per OSH HPI
prostate cancer


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with assistance
Incisional pain managed with oral analgesics
Incisions:
Sternal and R axillary - healing well, no erythema or drainage
 Edema 1+


Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 1477**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 1477**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You have been scheduled for the following appts:
Surgeon Dr. [**Last Name (STitle) **] Thursday [**11-11**] @ 1:15 pm  [**Hospital Ward Name **] [**Hospital Unit Name **]
Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (cardiologist) [**Telephone/Fax (1) 14409**]  [**10-25**] @ 11:00 AM

Please call to schedule appointments with your
Primary Care Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 12223**] in 4 weeks
Recommended Renal follow up, please call to make an appointment
#[**Telephone/Fax (1) 13670**]

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 1477**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication A Fib
Goal INR 2.0-2.5
First draw [**2106-10-12**]
*** please arrange for coumadin/INR f/u with PCP or cardiologist
prior to discharge from rehab***


                             [**First Name11 (Name Pattern1) 77**] [**Last Name (NamePattern4) 137**] MD [**MD Number(2) 138**]

Completed by:[**2106-10-11**]

Admission Date:  [**2106-9-25**]              Discharge Date:   [**2106-10-11**]

Date of Birth:  [**2028-9-17**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
morphine

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
[**2106-9-25**] emergency repl. ascending and arch aorta
[**2106-9-27**] chest closure


History of Present Illness:
78 year old retired urologist
presented to OSH complaining of 40 minutes of chest pain that
radiated to his back and throat. Per report from OSH, ECG
notable for inferior and lateral ST changes concerning for
ischemia and pt not currently in AFib. CTA done at OSH revealed
type A Aortic dissection. He was medflighted into [**Hospital1 18**]. Dr.[**Last Name (STitle) **]
reviewed the CTA and Mr.[**Known lastname **] was taken emergently to the
operating room.


Past Medical History:
Chronic AFib->on Pradaxa, HTN,
? hx of
cardiac dz per OSH HPI, prostate cancer.


Social History:
has family in vicinity
? girlfriend

Physical Exam:
pt was seen emergently-VS noted

Pulse: 64 Resp:  O2 sat:
B/P  104/65
Height: 74"    Weight: ? 90 kg

Five Meter Walk Test #1_______ #2 _________  #3_________

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI []
Neck:  Supple [x] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [] non-distended [] non-tender []  bowel sounds +
[]
Extremities: Warm [x], well-perfused []  Edema [] _____
Varicosities: None []
Neuro: Grossly intact [x]
Pulses:
Femoral      Right:   Left:
DP           Right:2+ Left:2+ bounding DP pulses(B)

PT           [**Name (NI) 167**]:   Left:
Radial       Right:   Left:

Carotid Bruit        Right:    Left:


Pertinent Results:
Pe-Bypass:

No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is low normal (LVEF
50-55%).
Right ventricular chamber size and free wall motion are normal.

The ascending aorta is severely dilated. The descending thoracic
aorta is mildly dilated. A mobile density is seen in the
ascending and descending aorta, and across the arch, consistent
with an intimal flap/aortic dissection. The aortic valve
leaflets (3) are mildly thickened. There is no aortic valve
stenosis. Mild aortic regurgitation is seen. The flap overlies
the aortic valve enough that the short axis window is poor, and
coronary flow cannot be determined. The STJ looks intact.

Trivial mitral regurgitation is seen.
There is no pericardial effusion.

Post-CPB:

The patient is paced, on no inotropes.
Preserved biventricular systolic fxn.
There is a tube graft in the ascending aorta. 1+ AI.
Descending aorta unchanged. Other parameters as pre-bypass.
  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2106-10-7**] 13:18


Brief Hospital Course:
Mr.[**Known lastname **] was Medflighted in from [**Hospital3 **] and taken emergently
to OR for Type A dissection repair with Dr. [**Last Name (STitle) **]. He underwent
Resection of ascending aortic dissection with hemi-arch
replacement under circulatory arrest. Cross clamp time:  99
minutes.Pump time:170 minutes.Circulatory arrest time:26
minutes.  He had been on Pradaxa at home and had significant
coagulopathy postoperatively requiring his chest to be left
open. On [**2106-9-27**] his bleeding has stopped, and he was brought
back to the operating room for closure of the sternum. Please
refer to operative reports for further surgical details.

Mr.[**Known lastname **] [**Last Name (Titles) 8337**] the operations well and was transferred back
to the CVICU intubated and sedated in  stable condition on
titrated phenylephrine and propofol drips. Postoperatively, he
developed renal failure with creatinine peaking at 5.8. Renal
service was consulted. His creatnine trended down during
admission. Chest tubes and pacing wires removed per protocol. He
was gently diuresed toward his preop weight. He awoke
neurologically intact and was extubated on POD #4. He had
intermittent confusion over the next few days. His mental status
cleared and he was transferred to the step down unit on POD # 12
to begin increasing his activity level. Physical Therapy was
consulted for evaluation of strength and mobility. His chronic
atrial fibrillation was not well rate controlled on maximum dose
of Diltiazem and Rhythmol alone. Beta-blocker was added to his
regimen, as previously the patient deferred beta-blocker due to
his feeling lethargic after taking it. A Non-selective
beta-adrenoreceptor was initiated in lieu of Lopressor. His
anticoagulation was resumed with Coumadin. The remainder of his
postoperative course was essentially uneventful. His Creatnine
continued to trend down and he was cleared to [**Hospital1 **] [**Hospital3 **]
rehab on POD#15. All follow up appointments were advised.

(stopped [**10-10**])


Medications on Admission:
Nexium 40(1),lipitor 40 mg 3x/weekly.,
Propafenone HCL 150mg (4), Pradaxa 150 (2), Levitra prn


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Hospital3 **] ([**Hospital **]
Hospital of [**Location (un) **] and Islands)

Discharge Diagnosis:
acute Type A aortic dissection s/p repl. ascending and arch
aorta
acute renal failure
Chronic AFib->was on Pradaxa s/p ablation
hypertension
hx of cardiac dz per OSH HPI
prostate cancer


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with oral analgesics
Incisions:
Sternal and R axillary - healing well, no erythema or drainage
 Edema ................



Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You have been scheduled for the following appts:
Surgeon Dr. [**Last Name (STitle) **] Thursday [**11-11**] @ 1:15 pm  [**Hospital Ward Name **] [**Hospital Unit Name **]
Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (cardiologist) [**Telephone/Fax (1) 19666**]  [**10-25**] @ 11:00 AM

Please call to schedule appointments with your
Primary Care Dr.[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 4 weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**

Labs: PT/INR for Coumadin ?????? indication A Fib
Goal INR 2.0-2.5
First draw day after discharge
*** please arrange for coumadin/INR f/u with PCP or cardiologist
prior to discharge from rehab***



Completed by:[**2106-10-10**]
{'Dissection of aorta, thoracic,Acute kidney failure with lesion of tubular necrosis,Other and unspecified coagulation defects,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Other fluid overload,Unspecified psychosis,Anticoagulants causing adverse effects in therapeutic use,Thrombocytopenia, unspecified,Disorders of phosphorus metabolism,Other and unspecified special symptoms or syndromes, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,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: chest pain

PRESENT ILLNESS: 78 year old retired urologist
presented to OSH complaining of 40 minutes of chest pain that
radiated to his back and throat. Per report from OSH, ECG
notable for inferior and lateral ST changes concerning for
ischemia and pt not currently in AFib. CTA done at OSH revealed
type A Aortic dissection. He was medflighted into [**Hospital1 18**]. Dr.[**Last Name (STitle) **]
reviewed the CTA and Mr.[**Known lastname **] was taken emergently to the
operating room.

MEDICAL HISTORY: Chronic AFib->on Pradaxa, HTN,
? hx of
cardiac dz per OSH HPI, prostate cancer.

MEDICATION ON ADMISSION: Nexium 40(1),lipitor 40 mg 3x/weekly.,
Propafenone HCL 150mg (4), Pradaxa 150 (2), Levitra prn

ALLERGIES: morphine

PHYSICAL EXAM: pt was seen emergently-VS noted

FAMILY HISTORY: 

SOCIAL HISTORY: has family in vicinity
? girlfriend 

### Response:
{'Dissection of aorta, thoracic,Acute kidney failure with lesion of tubular necrosis,Other and unspecified coagulation defects,Hemorrhage complicating a procedure,Acute posthemorrhagic anemia,Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Other fluid overload,Unspecified psychosis,Anticoagulants causing adverse effects in therapeutic use,Thrombocytopenia, unspecified,Disorders of phosphorus metabolism,Other and unspecified special symptoms or syndromes, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Personal history of malignant neoplasm of prostate'}
