CHIEF COMPLAINT: chest and back pain

PRESENT ILLNESS: Ms. [**Known lastname 90713**] is an 84 year old female with a history of congestive
heart failure, aortic stenosis, atrial fibrillation and
hypertension who presented to an outside hospital complaining of
chest pain.  She had no palpable pulses and she was hypotensive.
A subsequent CT scan showed a Type A dissection with pericardial
effusion. She transferred to [**Hospital1 18**] for further evaluation and
treatment.

MEDICAL HISTORY: congestive heart failure, aortic stenosis, atrial fibrillation
and hypertension

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: PE:  BP - 111/90  HR 112 (ST)
General - intubated, cachectic, patient moving RUE
HEENT - PERRLA, ETT in place
Neck - supple
Lungs - few scattered rhonch
Cardio - heart sounds distant, cannot appreciate murmur
Abdomen - +BS, soft, nontender
Extremities - +2 pitting edema, pulses are not palpable in UE or
LE but present by doppler
Neuro - intubated, opens eyes occassionally spontaneously, has
moved RUE, no purposeful movement

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown
Dissection of aorta, thoracic,Hemopericardium,Shock, unspecified,Acidosis,Congestive heart failure, unspecified,Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Encounter for palliative care,Surgical or other procedure not carried out because of contraindication
Dsct of thoracic aorta,Hemopericardium,Shock NOS,Acidosis,CHF NOS,Aortic valve disorder,Atrial fibrillation,Hypertension NOS,Encountr palliative care,No proc/contraindication
Admission Date:  [**2174-9-3**]              Discharge Date:   [**2174-9-3**]

Date of Birth:  [**2089-10-28**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Allergies/ADRs on File

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

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname 90713**] is an 84 year old female with a history of congestive
heart failure, aortic stenosis, atrial fibrillation and
hypertension who presented to an outside hospital complaining of
chest pain.  She had no palpable pulses and she was hypotensive.
A subsequent CT scan showed a Type A dissection with pericardial
effusion. She transferred to [**Hospital1 18**] for further evaluation and
treatment.

Past Medical History:
congestive heart failure, aortic stenosis, atrial fibrillation
and hypertension

Social History:
unknown

Family History:
unknown

Physical Exam:
PE:  BP - 111/90  HR 112 (ST)
General - intubated, cachectic, patient moving RUE
HEENT - PERRLA, ETT in place
Neck - supple
Lungs - few scattered rhonch
Cardio - heart sounds distant, cannot appreciate murmur
Abdomen - +BS, soft, nontender
Extremities - +2 pitting edema, pulses are not palpable in UE or
LE but present by doppler
Neuro - intubated, opens eyes occassionally spontaneously, has
moved RUE, no purposeful movement


Brief Hospital Course:
Ms. [**Known lastname 90713**] was admitted to cardiac surgery for surgical evaluation
of her type A aortic dissection.  As she recently had a
prolonged admission for a congestive heart failure and is a
frail 82 year-old, it was felt that she would not tolerate what
would likely become a prolonged post-operative course.  She
progressively became hypotensive despite high doses of
neosynepherine.  A bedside echocardiogram revealed an increasing
pericardial effusion.  After multiple discussions with her
health care proxy and multiple family members, comfort measures
only were instituted.  She was given fentanyl and extubated.
She expired at 14:23 on [**2174-9-3**].

Medications on Admission:
unknown

Discharge Medications:
not applicable

Discharge Disposition:
Expired

Discharge Diagnosis:
type a dissection

Discharge Condition:
expired

Discharge Instructions:
not applicable

Followup Instructions:
not applicable


Completed by:[**2174-9-3**]
{'Dissection of aorta, thoracic,Hemopericardium,Shock, unspecified,Acidosis,Congestive heart failure, unspecified,Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Encounter for palliative care,Surgical or other procedure not carried out because of contraindication'}


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 and back pain

PRESENT ILLNESS: Ms. [**Known lastname 90713**] is an 84 year old female with a history of congestive
heart failure, aortic stenosis, atrial fibrillation and
hypertension who presented to an outside hospital complaining of
chest pain.  She had no palpable pulses and she was hypotensive.
A subsequent CT scan showed a Type A dissection with pericardial
effusion. She transferred to [**Hospital1 18**] for further evaluation and
treatment.

MEDICAL HISTORY: congestive heart failure, aortic stenosis, atrial fibrillation
and hypertension

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: PE:  BP - 111/90  HR 112 (ST)
General - intubated, cachectic, patient moving RUE
HEENT - PERRLA, ETT in place
Neck - supple
Lungs - few scattered rhonch
Cardio - heart sounds distant, cannot appreciate murmur
Abdomen - +BS, soft, nontender
Extremities - +2 pitting edema, pulses are not palpable in UE or
LE but present by doppler
Neuro - intubated, opens eyes occassionally spontaneously, has
moved RUE, no purposeful movement

FAMILY HISTORY: unknown

SOCIAL HISTORY: unknown 

### Response:
{'Dissection of aorta, thoracic,Hemopericardium,Shock, unspecified,Acidosis,Congestive heart failure, unspecified,Aortic valve disorders,Atrial fibrillation,Unspecified essential hypertension,Encounter for palliative care,Surgical or other procedure not carried out because of contraindication'}
