CHIEF COMPLAINT: new onset back pain

PRESENT ILLNESS: 45 yo female s/p mechanical MVR in [**2153**] by Dr. [**Last Name (STitle) 14714**]. New
onset back pain on [**4-2**] at OSH. echo showed type A aortic
dissection. Transferred to [**Hospital1 18**] for further eval. and
treatment.

MEDICAL HISTORY: mechanical MVR [**2153**] (29mm Carbomedics)
HTN
DJD with chronic LBP
spontaneous PTX [**2138**]
C section [**2151**]

MEDICATION ON ADMISSION: coumadin 5 mg daily
cardizem 240 mg daily
folic acid daily
zantac
vitamins
calcium
tylenol
abx prophylaxis for dental procs.

ALLERGIES: Penicillins

PHYSICAL EXAM: NAD
neuro grossly intact
CTAB, well-healed sternal incision
RRR   3/6 SEM
soft, flat abd, +BS
warm extrems, no edema, + distal pulses
BP equal in both arms

FAMILY HISTORY: 

SOCIAL HISTORY: married, lives with husband
non-[**Name2 (NI) 1818**], no ETOH
Dissection of aorta, thoracic,Aortic valve disorders,Hemorrhage complicating a procedure,Atrial fibrillation,Acute pericarditis, unspecified,Hemopericardium,Other and unspecified coagulation defects,Heart valve replaced by other means,Unspecified essential hypertension,Degeneration of lumbar or lumbosacral intervertebral disc,Long-term (current) use of anticoagulants
Dsct of thoracic aorta,Aortic valve disorder,Hemorrhage complic proc,Atrial fibrillation,Acute pericarditis NOS,Hemopericardium,Coagulat defect NEC/NOS,Heart valve replac NEC,Hypertension NOS,Lumb/lumbosac disc degen,Long-term use anticoagul
Admission Date:  [**2164-4-2**]              Discharge Date:   [**2164-4-14**]

Date of Birth:  [**2118-11-10**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
new onset back pain

Major Surgical or Invasive Procedure:
Repair of type A dissection/reexploration for hematoma [**2164-4-2**]


History of Present Illness:
45 yo female s/p mechanical MVR in [**2153**] by Dr. [**Last Name (STitle) 14714**]. New
onset back pain on [**4-2**] at OSH. echo showed type A aortic
dissection. Transferred to [**Hospital1 18**] for further eval. and
treatment.

Past Medical History:
mechanical MVR [**2153**] (29mm Carbomedics)
HTN
DJD with chronic LBP
spontaneous PTX [**2138**]
C section [**2151**]

Social History:
married, lives with husband
non-[**Name2 (NI) 1818**], no ETOH

Physical Exam:
NAD
neuro grossly intact
CTAB, well-healed sternal incision
RRR   3/6 SEM
soft, flat abd, +BS
warm extrems, no edema, + distal pulses
BP equal in both arms

Pertinent Results:
[**2164-4-14**] 06:12AM BLOOD WBC-19.0* Plt Ct-828*
[**2164-4-13**] 07:00AM BLOOD WBC-17.2* RBC-3.56* Hgb-10.6* Hct-30.8*
MCV-87 MCH-29.9 MCHC-34.6 RDW-14.9 Plt Ct-700*
[**2164-4-14**] 06:12AM BLOOD Plt Ct-828*
[**2164-4-14**] 06:12AM BLOOD PT-39.8* INR(PT)-4.5*
[**2164-4-10**] 01:50AM BLOOD Glucose-119* UreaN-16 Creat-0.7 Na-139
K-3.3 Cl-106 HCO3-25 AnGap-11
[**2164-4-9**] 10:40AM BLOOD ALT-24 AST-23 LD(LDH)-379* AlkPhos-76
Amylase-130* TotBili-1.5
[**2164-4-9**] 10:40AM BLOOD Lipase-127*
[**2164-4-9**] 10:40AM BLOOD Albumin-3.5

Brief Hospital Course:
Admitted on [**4-2**] and CTA done to evaluate aorta. Type A
confirmed and taken to OR emergently with Dr. [**Last Name (STitle) 914**] for repair
of ascending aorta via redo sternotomy. Transferred to the CSRU
in stable condition on neosynephrine and propofol drips.
Returned to the OR for mediastinal exploration for bleeding
early the next morning. Clot was evacuated and chest dressed
open with esmarck bandage. Kept sedated and paralyzed while
chest open. Went back to OR for sternal washout and closure on
POD #2. Coumadin started on POD #3 and pacing wires were
removed. On amiodarone drip for A fib and extubated on [**4-5**]. On
heparin drip initially while INR was increasing. Evaluated by
swallowing consult. Chest tubes removed on POD #4. Dobhoff tube
placed. Foley removed on POD #5 and transferred to the floor to
begin increasing her activity level.

Beta blocade titrated. Abdominal labs sent for poor appetite.
Swallowing evaluation repeated on [**4-9**] and much improved.
Heparin DCed on [**4-10**] and lovenox started. Baseline postop CTA
done on [**4-11**] and had improving PO intake. Levofloxacin started
for small amount serous sternal drainage on [**4-13**].WBC increased
to 19 on [**4-14**], but cultures were negative. Cleared for discharge
by Dr. [**Last Name (STitle) 914**] on POD #[**11-25**]. Target INR is 3.0-3.5. INR on day
of discharge 4.5. Coumadin held for evening of discharge.
Coumadin dosing and INR to be followed by Dr. [**Last Name (STitle) 14715**] in
[**Location (un) 8117**] NH [**Telephone/Fax (1) 14716**]. Next blood draw scheduled for [**4-16**].

Medications on Admission:
coumadin 5 mg daily
cardizem 240 mg daily
folic acid daily
zantac
vitamins
calcium
tylenol
abx prophylaxis for dental procs.

Discharge Medications:
1. Furosemide 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours) for 7 days.
Disp:*14 Tablet(s)* Refills:*0*
2. Potassium Chloride 10 mEq Capsule, Sustained Release Sig: Two
(2) Capsule, Sustained Release PO Q12H (every 12 hours) for 7
days.
Disp:*28 Capsule, Sustained Release(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) for 7 days: Then decrease dose to 200 mg PO daily.
Disp:*35 Tablet(s)* Refills:*0*
8. Acetaminophen-Codeine 300-30 mg Tablet Sig: 1-2 Tablets PO
every 4-6 hours as needed.
Disp:*50 Tablet(s)* Refills:*0*
9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
10. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
11. Coumadin 1 mg Tablet Sig: Zero (0) Tablet PO tonight: Take 1
mg on [**4-15**] PM, then take as directed by Dr. [**Last Name (STitle) 14715**] for INR
goal of [**2-17**].5.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
Home Health & Hospice Care of [**Location (un) 8117**], NH

Discharge Diagnosis:
Acute type A aortic dissection.
s/p Mechanical MVR
chronic LB pain
HTN


Discharge Condition:
Good.


Discharge Instructions:
Follow medications on discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 lbs. for 3 months.
Shower daily, let water flow over wounds, pat dry with a towel.
Call our office for sternal drainage, temp>101.5.

Followup Instructions:
Make an appointment with Dr. [**Last Name (STitle) 14717**] for 1-2 weeks.
Make an appointment with Dr. [**Last Name (STitle) 914**] for 4 weeks.
INR/coumadin dosing to be followed by Dr. [**Last Name (STitle) 14715**] in [**Location (un) 8117**]
[**Numeric Identifier 14718**]- target INR 3.0-3.5


Completed by:[**2164-4-16**]
{'Dissection of aorta, thoracic,Aortic valve disorders,Hemorrhage complicating a procedure,Atrial fibrillation,Acute pericarditis, unspecified,Hemopericardium,Other and unspecified coagulation defects,Heart valve replaced by other means,Unspecified essential hypertension,Degeneration of lumbar or lumbosacral intervertebral disc,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: new onset back pain

PRESENT ILLNESS: 45 yo female s/p mechanical MVR in [**2153**] by Dr. [**Last Name (STitle) 14714**]. New
onset back pain on [**4-2**] at OSH. echo showed type A aortic
dissection. Transferred to [**Hospital1 18**] for further eval. and
treatment.

MEDICAL HISTORY: mechanical MVR [**2153**] (29mm Carbomedics)
HTN
DJD with chronic LBP
spontaneous PTX [**2138**]
C section [**2151**]

MEDICATION ON ADMISSION: coumadin 5 mg daily
cardizem 240 mg daily
folic acid daily
zantac
vitamins
calcium
tylenol
abx prophylaxis for dental procs.

ALLERGIES: Penicillins

PHYSICAL EXAM: NAD
neuro grossly intact
CTAB, well-healed sternal incision
RRR   3/6 SEM
soft, flat abd, +BS
warm extrems, no edema, + distal pulses
BP equal in both arms

FAMILY HISTORY: 

SOCIAL HISTORY: married, lives with husband
non-[**Name2 (NI) 1818**], no ETOH 

### Response:
{'Dissection of aorta, thoracic,Aortic valve disorders,Hemorrhage complicating a procedure,Atrial fibrillation,Acute pericarditis, unspecified,Hemopericardium,Other and unspecified coagulation defects,Heart valve replaced by other means,Unspecified essential hypertension,Degeneration of lumbar or lumbosacral intervertebral disc,Long-term (current) use of anticoagulants'}
