CHIEF COMPLAINT: [**9-18**] substernal chest pain.

PRESENT ILLNESS: The patient is a 74-year-old
female with history of hypertension, deep vein thrombosis,
IVC clot, status post Coumadin therapy with no known coronary
artery disease, was in her usual state of good health this
a.m. when patient experienced sudden onset of [**9-18**]
substernal chest pain radiating to her back between her
shoulder blades.  Patient experienced shortness of breath,
diaphoresis and nausea with pain persisting.  She called 911
and was taken to [**Hospital **] Hospital with systolic blood
pressures in the 120s.  Patient was given morphine with
resolution of chest pain and Vitamin K 10 mg intravenously
for an INR of 7.0.  Patient was taken for emergent CTA and
was found to have Type B aortic dissection from her left
subclavian down to the bifurcation >..........<arteries.
Patient transferred to [**Hospital6 256**]
for further care after the initiation of Nipride drip.

MEDICAL HISTORY: 1.  Hypertension since age of 50.
2.  Rheumatoid arthritis on Bextra.
3.  Deep vein thrombosis, left saphenous vein and most
recently left femoral vein [**5-12**].  Recent ultrasound [**10-9**] negative for persistence of clot.  IVC clot [**7-12**].  Hepatic
ultrasound, of note, recently negative for IVC clot.
4.  Prior work-up for hepatocellular liver disease, status
post biopsy, negative hepatitis serologies revealed chronic
active liver disease Grade 3 Stage 4, unclear etiology.
5.  Status post total abdominal hysterectomy bilateral
salpingo-oophorectomy.

MEDICATION ON ADMISSION: 1.  Atenolol 50 po q.d.
2.  Lasix 40 po q.d.
3.  KCL 10 mEq po q.d.
4.  Coumadin 3.5 mg po q.d.
5.  Bextra prn.

ALLERGIES: Penicillin, Mavik.

PHYSICAL EXAM: 

FAMILY HISTORY: No early coronary artery disease, no blood
dyscrasias.  Positive prior history of tobacco use.
Currently does not smoke.

SOCIAL HISTORY: The patient is married with five children.
Dissection of aorta, thoracic,Unspecified chronic liver disease without mention of alcohol,Rheumatoid arthritis,Acute upper respiratory infections of unspecified site,Long-term (current) use of anticoagulants
Dsct of thoracic aorta,Chronic liver dis NOS,Rheumatoid arthritis,Acute uri NOS,Long-term use anticoagul
Admission Date:  [**2144-10-17**]     Discharge Date:  [**2144-10-23**]

Date of Birth:   [**2070-2-5**]     Sex:  F

Service:  CARDIOLOGY

CHIEF COMPLAINT:  [**9-18**] substernal chest pain.

HISTORY OF PRESENT ILLNESS:  The patient is a 74-year-old
female with history of hypertension, deep vein thrombosis,
IVC clot, status post Coumadin therapy with no known coronary
artery disease, was in her usual state of good health this
a.m. when patient experienced sudden onset of [**9-18**]
substernal chest pain radiating to her back between her
shoulder blades.  Patient experienced shortness of breath,
diaphoresis and nausea with pain persisting.  She called 911
and was taken to [**Hospital **] Hospital with systolic blood
pressures in the 120s.  Patient was given morphine with
resolution of chest pain and Vitamin K 10 mg intravenously
for an INR of 7.0.  Patient was taken for emergent CTA and
was found to have Type B aortic dissection from her left
subclavian down to the bifurcation >..........<arteries.
Patient transferred to [**Hospital6 256**]
for further care after the initiation of Nipride drip.

On arrival, patient was afebrile with blood pressures of
130/160, chest pain free, on Nipride of 65 mg per minute.
Patient was seen by CT surgery who revealed that the CT scans
confirmed type B dissection without thoracic surgical
intervention.  She had a surgery Consult as well who felt it
would be best managed medically.  Fresh frozen plasma ordered
for correction of coagulopathy.  Patient was transferred to
Coronary Care Unit for continual care.

Patient denies lightheadedness, change in mental status,
visual changes, shortness of breath, chest pain, abdominal
pain.  No history of paroxysmal nocturnal dyspnea, orthopnea,
leg swelling or bleeding gums, recent changes in blood
pressure regimen.

PAST MEDICAL HISTORY:
1.  Hypertension since age of 50.
2.  Rheumatoid arthritis on Bextra.
3.  Deep vein thrombosis, left saphenous vein and most
recently left femoral vein [**5-12**].  Recent ultrasound [**10-9**] negative for persistence of clot.  IVC clot [**7-12**].  Hepatic
ultrasound, of note, recently negative for IVC clot.
4.  Prior work-up for hepatocellular liver disease, status
post biopsy, negative hepatitis serologies revealed chronic
active liver disease Grade 3 Stage 4, unclear etiology.
5.  Status post total abdominal hysterectomy bilateral
salpingo-oophorectomy.

SOCIAL HISTORY:  The patient is married with five children.

ALLERGIES:  Penicillin, Mavik.

MEDICATIONS ON ADMISSION:
1.  Atenolol 50 po q.d.
2.  Lasix 40 po q.d.
3.  KCL 10 mEq po q.d.
4.  Coumadin 3.5 mg po q.d.
5.  Bextra prn.

FAMILY HISTORY:  No early coronary artery disease, no blood
dyscrasias.  Positive prior history of tobacco use.
Currently does not smoke.

SOCIAL HISTORY:  Cashier at Shaw's.  Is physically active.
No tobacco, ethanol or intravenous drug use.

PHYSICAL EXAMINATION:  Vital signs on admission:  Temperature
97.4.  Heart rate 54.  Blood pressure 150/84.  Retaken:
140/62.  Respiratory rate 12.  Oxygen saturation 99% on room
air.  Head, eyes, ears, nose and throat:  In general, no
acute distress, pleasant female.  Pupils are equal, round,
and reactive to light and accommodation.  Extraocular
movements intact.  Mucous membranes moist.  Oropharynx clear.
Dentures in place.  Neck:  Jugular venous pressure 9 cm, no
carotid bruits.  Pulmonary:  Clear to auscultation
bilaterally.  Cardiovascular:  Bradycardic, regular rhythm,
S1, S2 normal, high pitch 2/6 systolic ejection murmur heard
best along the sternal border in apex, no AI murmur.
Abdomen:  Soft, nontender, nondistended, positive bowel
sounds, no liver pulsation, no hepatosplenomegaly.
Extremities:  No edema, no cyanosis, no clubbing, palpable
dorsalis pedis and posterior tibial pulses and femoral pulses
bilaterally.  Neurological:  Alert and oriented times three,
5/5 strength and sensation, 2+ deep tendon reflexes in all
extremities.  Skin:  No splinter hemorrhages, no palmar
erythema.

OUTSIDE HOSPITAL LABORATORIES:  White blood cell count 10.3,
hematocrit 41.9, platelet count 349,000, INR 9.0.  Chem-7:
Sodium 140, potassium 3.2, chloride 104, bicarbonate 27, BUN
19, creatinine 0.9, glucose 110, magnesium 1.6.

RADIOLOGIC STUDIES:  Most recent ultrasounds of the lower
extremities and abdomen negative for clot.
Electrocardiogram:  Normal sinus rhythm at 60 beats per
minute, left anterior descending, poor R wave progression, no
ST or ischemic changes.

Patient admitted for medical management of aortic dissection.

HOSPITAL COURSE:

1.  Patient transitioned from Nipride GTTS to initially
Metoprolol then switched to labetalol 150 po b.i.d. increased
to 200 mg po b.i.d.  Patient was weaned off Nipride on
hospital day two with the initiation of Lasix 20 mg po q.d.,
Amlodipine 10 mg po q.d. and Valsartan 160 mg po q.d. with
goal systolic blood pressure of 100-120.  Patient continued
to be monitored on telemetry without events.  Patient's
reverse coagulation with two units of fresh frozen plasma,
status post 10 mg of intravenous Vitamin K.  Follow-up chest
x-rays revealed no mediastinal enlargement.  Patient was
chest pain free throughout hospital stay.  She will follow-up
with Dr. [**Last Name (STitle) **] for repeat CT scan evaluation and also
outpatient echocardiogram.

2.  Coagulopathy:  Patient on Coumadin for prior deep vein
thrombosis.  In light of Type B dissection Coumadin held, and
patient reversed with fresh frozen plasma and Vitamin K.
Patient to hold on anticoagulation until dissection is
healed. Attempts to contact primary care physician to assess
full work-up of prior hypercoagulability studies revealed
normal blood clotting factors with normal liver biopsy.
Patient will follow up with primary care physician for
[**Name9 (PRE) 48258**] once cleared from Cardiology to assess need for
re-introduction of Coumadin, inform patient to monitor for
lower extremity swelling or pain and to call primary care
physician if this occurs.  Patient informed to avoid long
duration of immobility, encouraged to elevate feet, and
remain active.

3.  Renal:  In light of extent of Type B dissection, concern
for renal artery involvement was monitored.  Creatinine
continued to remain at baseline with serial urinalyses
negative for blood or evidence of compromise.  Will follow-up
if serial exams per Dr. [**Last Name (STitle) **].

4.  Infectious Disease:  Hospital day two, patient developed
low grade temperatures with rhinorrhea, feeling cold-like
symptoms.  Patient given Rhinocort to be as per nostril, as
well as saline spray with resolution in nasal discomfort.
Chest x-ray PA and lateral was clear for evidence of
pneumonia or congestion.  Patient to follow-up with primary
care physician if symptoms persist.  No antibiotics were
administered.  Blood cultures and urine cultures were
negative to the date of this dictation.

DISPOSITION:  Patient discharged home on [**2144-10-23**]
chest pain free with VNA Services to help monitor her blood
pressure.  Patient to record blood pressures and bring to
appointment with Dr. [**Last Name (STitle) **].  Also, VNA nursing to assist in
appropriate dietary management, low sodium diet, cardiac
healthy diet.  Patient informed to call if she develops
similar pain or hematuria.

MEDICATIONS ON DISCHARGE:
1.  Aspirin 325 mg po q.d.
2.  Lasix 20 mg po q.d.
3.  Valsartan 160 mg po q.d.
4.  Amlodipine 10 mg po q.d.
5.  Labetalol 200 mg po b.i.d.

FOLLOW-UP APPOINTMENTS:  Dr. [**Last Name (STitle) **] in one week on Wednesday,
[**2144-10-28**], and to follow-up with primary care
physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 27706**], in one week as well.

DISCHARGE STATUS:  Patient discharged to home with VNA
Services.

DISCHARGE CONDITION:  Stable condition, chest pain free.




                          [**Name6 (MD) **] [**Name8 (MD) **], MD  [**MD Number(1) 21980**]

Dictated By:[**Last Name (NamePattern1) 972**]

MEDQUIST36

D:  [**2144-10-23**]  02:48
T:  [**2144-10-24**]  22:36
JOB#:  [**Job Number 105119**]
{'Dissection of aorta, thoracic,Unspecified chronic liver disease without mention of alcohol,Rheumatoid arthritis,Acute upper respiratory infections of unspecified site,Long-term (current) use of anticoagulants'}


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: [**9-18**] substernal chest pain.

PRESENT ILLNESS: The patient is a 74-year-old
female with history of hypertension, deep vein thrombosis,
IVC clot, status post Coumadin therapy with no known coronary
artery disease, was in her usual state of good health this
a.m. when patient experienced sudden onset of [**9-18**]
substernal chest pain radiating to her back between her
shoulder blades.  Patient experienced shortness of breath,
diaphoresis and nausea with pain persisting.  She called 911
and was taken to [**Hospital **] Hospital with systolic blood
pressures in the 120s.  Patient was given morphine with
resolution of chest pain and Vitamin K 10 mg intravenously
for an INR of 7.0.  Patient was taken for emergent CTA and
was found to have Type B aortic dissection from her left
subclavian down to the bifurcation >..........<arteries.
Patient transferred to [**Hospital6 256**]
for further care after the initiation of Nipride drip.

MEDICAL HISTORY: 1.  Hypertension since age of 50.
2.  Rheumatoid arthritis on Bextra.
3.  Deep vein thrombosis, left saphenous vein and most
recently left femoral vein [**5-12**].  Recent ultrasound [**10-9**] negative for persistence of clot.  IVC clot [**7-12**].  Hepatic
ultrasound, of note, recently negative for IVC clot.
4.  Prior work-up for hepatocellular liver disease, status
post biopsy, negative hepatitis serologies revealed chronic
active liver disease Grade 3 Stage 4, unclear etiology.
5.  Status post total abdominal hysterectomy bilateral
salpingo-oophorectomy.

MEDICATION ON ADMISSION: 1.  Atenolol 50 po q.d.
2.  Lasix 40 po q.d.
3.  KCL 10 mEq po q.d.
4.  Coumadin 3.5 mg po q.d.
5.  Bextra prn.

ALLERGIES: Penicillin, Mavik.

PHYSICAL EXAM: 

FAMILY HISTORY: No early coronary artery disease, no blood
dyscrasias.  Positive prior history of tobacco use.
Currently does not smoke.

SOCIAL HISTORY: The patient is married with five children. 

### Response:
{'Dissection of aorta, thoracic,Unspecified chronic liver disease without mention of alcohol,Rheumatoid arthritis,Acute upper respiratory infections of unspecified site,Long-term (current) use of anticoagulants'}
