CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 62 yo [**Male First Name (un) 4746**] with h/o Type B aortic dissection, who has been
medically managed by Dr.[**Last Name (STitle) **] for the a few years. Pt. ran
out of meds last week and noted to have a SBP today of 200. Was
alos c/o chest discomfort. Went to [**Hospital **] where a CT
chest revealed an Type A aortic dissection.

MEDICAL HISTORY: Vasectomy in the past

MEDICATION ON ADMISSION: Norvasc 10 daily, HCTZ 25 daily, Lisinopril 40 [**Hospital1 **], Propranolol
80 [**Hospital1 **], MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: There is family history of coronary artery disease of a brother
who died at 62 with a history of Myocardial Infarction.

SOCIAL HISTORY: Patient stated he drinks 2 glasses of wine on the weekends. Upon
further discussion with the girlfriend, he had been drinking on
average 6 beers a night for a few months and possibly more. He
occasionally smokes cigars. He is employed at a law office in
the area.
Dissection of aorta, thoracic,Other and unspecified coagulation defects,Marfan syndrome,Acute posthemorrhagic anemia,Unspecified essential hypertension,Aortic valve disorders,Other and unspecified angina pectoris,Other fluid overload,Family history of other cardiovascular diseases
Dsct of thoracic aorta,Coagulat defect NEC/NOS,Marfan syndrome,Ac posthemorrhag anemia,Hypertension NOS,Aortic valve disorder,Angina pectoris NEC/NOS,Fluid overload NEC,Fam hx-cardiovas dis NEC
Admission Date:  [**2149-9-7**]              Discharge Date:   [**2149-9-12**]

Date of Birth:  [**2087-4-11**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 922**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
1. Bentall procedure with a 27-mm [**Company 1543**] Freestyle
    bioprosthesis. The valve data is the following:  Serial
    #[**Serial Number 74637**].
2. Replacement of ascending aorta and at least half of the
    aortic arch with a Vaskutek Dacron tube graft using deep
    hypothermic circulatory arrest.  Valve data is the
    following:  Vaskutek Gelweave graft catalog #[**Numeric Identifier 42229**],
    lot #[**Serial Number 74638**], serial #[**Serial Number 74639**]


History of Present Illness:
62 yo [**Male First Name (un) 4746**] with h/o Type B aortic dissection, who has been
medically managed by Dr.[**Last Name (STitle) **] for the a few years. Pt. ran
out of meds last week and noted to have a SBP today of 200. Was
alos c/o chest discomfort. Went to [**Hospital **] where a CT
chest revealed an Type A aortic dissection.


Past Medical History:
Vasectomy in the past

Social History:
Patient stated he drinks 2 glasses of wine on the weekends. Upon
further discussion with the girlfriend, he had been drinking on
average 6 beers a night for a few months and possibly more. He
occasionally smokes cigars. He is employed at a law office in
the area.


Family History:
There is family history of coronary artery disease of a brother
who died at 62 with a history of Myocardial Infarction.

Physical Exam:
Admission Physical Exam

Pulse: 74 Resp: 18  O2 sat: 97%
B/P  Right: 116/65    Left:
Height:     Weight:

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema Varicosities:
None [x]
Neuro: Grossly intact, no deficits
Pulses:
Femoral      Right:  +2 Left: +2
DP           Right:  +2 Left: +2
PT           [**Name (NI) 167**]:  +2 Left: +2
Radial       Right:  +2 Left: +2

Carotid Bruit        Right:  0  Left: 0


Pertinent Results:
[**2149-9-8**]
Pre CPB:
No spontaneous echo contrast or thrombus is seen in the body of
the left atrium or left atrial appendage.
No atrial septal defect is seen by 2D or color Doppler.
Left ventricular wall thicknesses are normal. The left
ventricular cavity size is normal. Overall left ventricular
systolic function is normal (LVEF>55%).
Right ventricular chamber size and free wall motion are normal.
The aortic root is mildly dilated at the sinus level. The
ascending aorta is moderately dilated. The aortic arch is
moderately dilated. The descending thoracic aorta is markedly
dilated. An aortic disection flap is seen in all visible
portions of the aorta, extending proximally to the right
coronary sinus and non coronary sinus.
There is no aortic valve stenosis. Moderate (2+) aortic
regurgitation is seen. The aortic regurgitation jet is
eccentric, directed toward the anterior mitral leaflet, and may
be underestimated.
There is no mitral valve prolapse. Trivial mitral regurgitation
is seen.
Moderate [2+] tricuspid regurgitation is seen.
Post CPB:
The patient is being AV paced.
The cardiac output is 7L/min.
There is a bioprosthetic valve in the aortic position, there is
no insufficiency, and the mean gradient is 16mmHg.
There is trivial mitral regurgitation.
There is mild/moderate tricuspid regurgitation.
There is a disection flap present in the descending aorta.
The ascending aorta has been replaced with a tube graft.
The biventricular systolic function is preserved.

[**2149-9-11**] 04:35AM [**Month/Day/Year 3143**] WBC-7.2 RBC-3.53* Hgb-11.1* Hct-32.2*
MCV-91 MCH-31.3 MCHC-34.4 RDW-14.9 Plt Ct-174
[**2149-9-11**] 04:35AM [**Month/Day/Year 3143**] Glucose-101* UreaN-13 Creat-1.0 Na-136
K-3.7 Cl-100 HCO3-30 AnGap-10
[**2149-9-11**] 04:35AM [**Month/Day/Year 3143**] WBC-7.2 RBC-3.53* Hgb-11.1* Hct-32.2*
MCV-91 MCH-31.3 MCHC-34.4 RDW-14.9 Plt Ct-174
[**2149-9-12**] 04:45AM [**Month/Day/Year 3143**] Na-135 K-3.9 Cl-102

Brief Hospital Course:
62 yo male who presented with acute chest pain. The patient had
a history of a type B aortic dissection, but the CT scan which
was done in the emergency room at an outside facility showed new
type A aortic dissection. Evidently the patient had run out of
his antihypertensive medications for the last week and was
severely hypertensive upon arrival to the emergency room with a
SBP up to 200 mm Hg. The
patient was emergently transferred to [**Hospital1 827**].  After reviewing the CT scan, he was taken
emergently to the operating room for repair of acute type A
aortic dissection. He underwent a Bentall procedure with a 27-mm
[**Company 1543**] Freestyle bioprosthesis with coronary button
reimplantation, replacement of ascending aorta and at least half
of the aortic arch with a Vaskutek Dacron tube graft using deep
hypothermic circulatory arrest.  See operative note for full
details.  Postoperatively he had a high chest tube output and
received multiple [**Company **] products.  He remained intubated on post
operative night due to bleeding and was extubated post operative
day 2 after receiving Precedex. He was weaned off all vasoactive
medications.  He was started on Lopressor and Losartan for good
[**Company **] pressure control and these were titrated up as [**Company **]
pressure tolerated.  He had some impulsive behavior and was kept
in the ICU an extra day for that reason.  He was transferred to
the step down unit on post operative day 3. Chest tubes and
pacing wires were removed per caridac surgery protocol. He was
evaluated by physical therapy for strength and mobility. On post
operative day 5 he was tolerating a full oral diet, his
incisions were healing well and he was ambulating with
assistance.  It was felt that he was safe for discharge home at
this time.  He is to follow up with a CT of the torso and an
echo on [**9-23**] 1 week before follow up visit with Dr [**Last Name (STitle) 914**].  It
was also recommended that he be seen by Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at
[**Hospital3 1810**] for evaluation for possible Marfan's
syndrome.

Medications on Admission:
Norvasc 10 daily, HCTZ 25 daily, Lisinopril 40 [**Hospital1 **], Propranolol
80 [**Hospital1 **], MVI

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
Disp:*180 Tablet(s)* Refills:*2*
2. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
4. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
5. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
Disp:*30 Tablet(s)* Refills:*2*
6. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
9. losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
10. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
[**11-30**]  Inhalation every four (4) hours as needed for shortness of
breath or wheezing.
Disp:*qs * Refills:*1*


Discharge Disposition:
Home With Service

Facility:
VNA of Southeastern Mass.

Discharge Diagnosis:
1. An acute type A aortic dissection.
2. Acute aortic insufficiency secondary to #1.
3. Chronic type B aortic dissection.
4. Questionable Marfan's syndrome with a highly arch
palate.


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


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 are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) 914**] [**9-30**] at 2:30PM
Cardiologist: Dr. [**Last Name (STitle) **] [**10-6**] at 11AM

Following tests are scheduled:
[**2149-9-23**]
Echo @ 1pm - [**Hospital Ward Name 2104**] Building [**Location (un) **]
CTA TORSO 2pm < ---- Nothing to eat 3hrs prior - [**Hospital Ward Name 23**]
Building [**Location (un) **]

Please call to schedule appointments with your
Primary Care Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1391**] in [**11-30**] weeks [**Telephone/Fax (1) 48572**]
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Hospital3 1810**] in [**11-30**] weeks
[**Telephone/Fax (1) 41241**]

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



Completed by:[**2149-9-12**]
{'Dissection of aorta, thoracic,Other and unspecified coagulation defects,Marfan syndrome,Acute posthemorrhagic anemia,Unspecified essential hypertension,Aortic valve disorders,Other and unspecified angina pectoris,Other fluid overload,Family history of other cardiovascular diseases'}


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: 62 yo [**Male First Name (un) 4746**] with h/o Type B aortic dissection, who has been
medically managed by Dr.[**Last Name (STitle) **] for the a few years. Pt. ran
out of meds last week and noted to have a SBP today of 200. Was
alos c/o chest discomfort. Went to [**Hospital **] where a CT
chest revealed an Type A aortic dissection.

MEDICAL HISTORY: Vasectomy in the past

MEDICATION ON ADMISSION: Norvasc 10 daily, HCTZ 25 daily, Lisinopril 40 [**Hospital1 **], Propranolol
80 [**Hospital1 **], MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission Physical Exam

FAMILY HISTORY: There is family history of coronary artery disease of a brother
who died at 62 with a history of Myocardial Infarction.

SOCIAL HISTORY: Patient stated he drinks 2 glasses of wine on the weekends. Upon
further discussion with the girlfriend, he had been drinking on
average 6 beers a night for a few months and possibly more. He
occasionally smokes cigars. He is employed at a law office in
the area. 

### Response:
{'Dissection of aorta, thoracic,Other and unspecified coagulation defects,Marfan syndrome,Acute posthemorrhagic anemia,Unspecified essential hypertension,Aortic valve disorders,Other and unspecified angina pectoris,Other fluid overload,Family history of other cardiovascular diseases'}
