CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a healthy 70-year-old
female with a past medical history of prolonged hypertension,
hypercholesterolemia, and pacemaker who presented from the
outside hospital after developed a severe [**8-31**] substernal
tearing chest pain while playing golf that was radiating to
her back and was unrelieved with nitroglycerin and morphine.
Patient was transferred from [**Hospital3 **], where her blood
pressure was found to be systolic 200s.  The patient was
started on a labetalol drip, 20 mg intravenously, but still
did not control her blood pressure optimally.

MEDICAL HISTORY: The patient's past medical history was
significant for hypertension, diet controlled
hypercholesterolemia, PMR.  Patient, of note, stopped
prednisone about a year ago.  Pancreatitis of unknown
etiology.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: 1.  Hypertension in patient's brother and father.
2.  Stroke.  [**Name (NI) **] father died of stroke at the age of
70.
3.  Leukemia in brother.
4.  History of [**Doctor Last Name **] aneurysm in a distant relative.

SOCIAL HISTORY: The patient lives with her husband.  She is
retired.  Very active.  Plays golf every day.  Has a history
of smoking, but quit at the age of 40.  Alcohol:  One glass
of red wine a day.
Dissection of aorta, thoracoabdominal,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Polymyalgia rheumatica
Dsct of thoracoabd aorta,Hyperlipidemia NEC/NOS,Hypertension NOS,Polymyalgia rheumatica
Admission Date:  [**2159-5-20**]     Discharge Date:  [**2159-5-23**]

Date of Birth:   [**2088-8-29**]     Sex:  F

Service:  CCU

HISTORY OF PRESENT ILLNESS:  Patient is a healthy 70-year-old
female with a past medical history of prolonged hypertension,
hypercholesterolemia, and pacemaker who presented from the
outside hospital after developed a severe [**8-31**] substernal
tearing chest pain while playing golf that was radiating to
her back and was unrelieved with nitroglycerin and morphine.
Patient was transferred from [**Hospital3 **], where her blood
pressure was found to be systolic 200s.  The patient was
started on a labetalol drip, 20 mg intravenously, but still
did not control her blood pressure optimally.

The patient had a chest CT with and without contrast that
showed an aortic dissection with an origin just distal to the
takeoff of the left subclavian artery at the beginning of the
aortic arch to the diaphragm.  The patient was sent to [**Hospital6 1760**] for further management.

Upon arrival to the [**Hospital6 256**]
Emergency Department, the patient was nauseated and
diaphoretic.  Blood pressure intermittently dropped to mid
70s and then came back up to 170s-180s.  The patient was
started on Nipride drip and osmolal and labetalol was
stopped.  The patient did not complain of any headache,
visual changes, lightheadedness, loss of consciousness,
weakness, abdominal pain, lower extremity swelling or
dizziness.

PAST MEDICAL HISTORY:  The patient's past medical history was
significant for hypertension, diet controlled
hypercholesterolemia, PMR.  Patient, of note, stopped
prednisone about a year ago.  Pancreatitis of unknown
etiology.

PAST SURGICAL HISTORY:  Status post cholecystectomy, status
post left total knee replacement, status post right rotator
cuff repair, bilateral cataract surgery.

OUTPATIENT MEDICATIONS:
1.  Atenolol.
2.  Prinivil.
3.  Vioxx.
4.  Patient is not currently taking lovastatin.

ALLERGIES:  Codeine.

FAMILY HISTORY:
1.  Hypertension in patient's brother and father.
2.  Stroke.  [**Name (NI) **] father died of stroke at the age of
70.
3.  Leukemia in brother.
4.  History of [**Doctor Last Name **] aneurysm in a distant relative.

SOCIAL HISTORY:  The patient lives with her husband.  She is
retired.  Very active.  Plays golf every day.  Has a history
of smoking, but quit at the age of 40.  Alcohol:  One glass
of red wine a day.

PHYSICAL EXAMINATION:  The patient's temperature was 96.8.
Patient's blood pressure was 118/54 in the right arm and
123/60 in the left arm.  Patient's pulse was 70 and equal
bilaterally.  Respiratory rate was 11.  Oxygen saturation 96%
on two liters of nasal cannula.  Generally, the patient was
lying in bed, was extremely diaphoretic.  Head, eyes, ears,
nose and throat:  Pupils are equal, round, and reactive to
light and accommodation.  Extraocular muscles were intact.
Oropharyngeal mucosa was normal and moist.  Neck:  2+ equal
carotid pulses, no bruits, no jugular venous distention.
Pulmonary:  Mild kyphosis.  Chest was clear to auscultation
bilaterally.  Cardiovascular system:  Regular rate and
rhythm, normal S1, S2, 2/6 systolic ejection murmur that was
holosystolic and heard best at the left sternal border with
faint radiation to both carotids.  No diastolic murmurs.
Faint S4.  Abdomen:  Positive bowel sounds, soft, nontender,
nondistended, no hepatosplenomegaly.  Extremities:  Pulses
were equal bilaterally in the upper and lower extremities.
There was no cyanosis, clubbing or edema.  Neurological:
Cranial nerves II through XII are intact.  Patient had normal
sensory and motor exam.

LABORATORIES:  Patient had a white blood cell count of 11.1.
Patient's hematocrit was 35.4, INR 1.2.  Patient's chemistry
panel:  Sodium 138, potassium 4.3, chloride 106, bicarbonate
22, BUN 20, creatinine 0.6, glucose 166.  Patient's CK was
71.  Patient's electrocardiogram showed normal sinus rhythm
at the rate of 60, normal axis, normal intervals, T wave
inversion in lead III and patient met criteria for left
ventricular hypertrophy.  Repeat CT scan of abdomen and chest
was done to better characterize the exact takeoff of the
dissection and showed aortic dissection origin just distal to
the takeoff of the left subclavian artery.  There was no
false lumen distal to the esophageal hiatus.

HOSPITAL COURSE:

1.  Aortic dissection:  As confirmed by CT scan at [**Hospital6 1760**], patient presented with Type
B or Type 3 aortic dissection.  As above, this is not a
surgical emergency and was managed medically by tight control
of blood pressure and heart rate.  The goal parameters were
set at heart rate of less than 60, systolic blood pressure
less than 120.  This was in agreement with CT Surgery consult
which continued to follow the patient with us.  In order to
achieve optimal hemodynamics, the patient was started on
labetalol drip without a bolus and osmolal was titrated off.
Patient was also started on Nipride to cover the range of
systolic blood pressure more than 120.  Arterial lines were
placed in the right radial artery for closer blood pressure
monitoring.
The patient was watched closely in the Intensive Care Unit
for the potential complications of acute aortic dissection
such as extension of dissection, manifesting by a mesenteric
ischemia, renal artery involvement, extension into the
proximal and coronary arteries, carotids and pericardium.
Patient was followed with neurological checks q. 2-4 hours.
Overnight, patient has done very well, blood pressure was at
goal.  Another set of cardiac enzymes was checked and was
negative.  In order to evaluate her holosystolic murmur heard
on the physical examination, patient got an echocardiogram
which showed ejection fraction of 70%, mildly dilated left
atrium, 5.6 x 5.2, ascending aorta dimension of 3.8 cm, arch
of 3.8 cm, and minimal aortic stenosis with minimal gradient.
There was no effusion and there was no aortic regurgitation.

The following day, the patient was weaned off of Nipride and
labetalol to oral beta-blockers.  The patient was started
Metoprolol 50 t.i.d.  The dose was subsequently changed to 50
b.i.d. due to a transient episode of hypotension with
systolic blood pressures of 80s.  Patient was completely
asymptomatic with this episode and a physical examination
revealed no new findings.  The patient was subsequently
transferred to the general nursing floor and has done
extremely well and has tolerated the above doses of
beta-blocker.  The patient's systolic blood pressures were in
the range of 106 to 140s and patient's pulse was ranging from
60 to 70s.

It was decided to send the patient home on Lopressor 75 mg
t.i.d.  Patient was instructed to have a very close follow-up
with her primary care physician for close blood pressure
checks.  Patient has been given a lot of education about her
diagnosis including things to watch out for in terms of
complications of aortic dissection and the need for
aggressive blood pressure control.

2.  Infectious Disease:  The patient's urine culture was
positive in the outside hospital and she was transferred on
levofloxacin, however, after her sensitivities were
available, it was found that the offending organism was E.
Coli and levofloxacin was changed to Bactrim.  Patient is to
complete a seven day course of Bactrim as an outpatient.

3.  Gastrointestinal:  The patient was watched closely
clinically for any signs of potential mesenteric ischemia.
Serial guaiacs were negative.  Patient's nausea during the
first few hours upon transfer resolved with tight blood
pressure control and Zofran.

4.  Renal:  Patient received a big dye load due to subsequent
CT of abdomen and pelvis.  Mucomyst was given in the
Emergency Department prior to the second CT.  Patient did
receive post study hydration and patient's creatinine was
stable at discharge at 0.8.

CONDITION ON DISCHARGE:  Good.

DISCHARGE STATUS:  The patient is to be discharged home.
Patient received a consultation from Physical Therapy while
in patient and is to follow their recommendation as far as
advancing activity slowly.  Patient is to follow-up with her
primary care physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Name (STitle) 5395**], within a few days
after discharge.  It was suggested to the patient to
follow-up with a cardiologist at [**Hospital6 649**], but patient inquired to be referred to a
cardiology group in her area by her primary care physician.

DISCHARGE DIAGNOSIS:  Type B acute aortic dissection.

DISCHARGE MEDICATIONS:
1.  Lopressor 75 mg po b.i.d.
2.  Bactrim.  Patient is to finish up a seven day course.

FOLLOW-UP PLANS:  Patient is to follow-up with her primary
care physician, [**Last Name (NamePattern4) **]. [**First Name (STitle) **] [**Name (STitle) 5395**], within the next few days
after discharge.  Dr. [**First Name (STitle) **] [**Name (STitle) 5395**] is to recommend a close
cardiology follow-up for the patient in her area of
residence.


                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Name8 (MD) 20654**]

MEDQUIST36

D:  [**2159-5-30**]  10:26
T:  [**2159-6-3**]  16:26
JOB#:  [**Job Number 20655**]

cc:[**Name (STitle) 20656**]
{'Dissection of aorta, thoracoabdominal,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Polymyalgia rheumatica'}


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: Patient is a healthy 70-year-old
female with a past medical history of prolonged hypertension,
hypercholesterolemia, and pacemaker who presented from the
outside hospital after developed a severe [**8-31**] substernal
tearing chest pain while playing golf that was radiating to
her back and was unrelieved with nitroglycerin and morphine.
Patient was transferred from [**Hospital3 **], where her blood
pressure was found to be systolic 200s.  The patient was
started on a labetalol drip, 20 mg intravenously, but still
did not control her blood pressure optimally.

MEDICAL HISTORY: The patient's past medical history was
significant for hypertension, diet controlled
hypercholesterolemia, PMR.  Patient, of note, stopped
prednisone about a year ago.  Pancreatitis of unknown
etiology.

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: 1.  Hypertension in patient's brother and father.
2.  Stroke.  [**Name (NI) **] father died of stroke at the age of
70.
3.  Leukemia in brother.
4.  History of [**Doctor Last Name **] aneurysm in a distant relative.

SOCIAL HISTORY: The patient lives with her husband.  She is
retired.  Very active.  Plays golf every day.  Has a history
of smoking, but quit at the age of 40.  Alcohol:  One glass
of red wine a day. 

### Response:
{'Dissection of aorta, thoracoabdominal,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Polymyalgia rheumatica'}
