CHIEF COMPLAINT: Type A aortic dissection

PRESENT ILLNESS: This 78 year old male presented to [**Hospital3 **] ED with the acute
onset of severe tearing pain in the upper back and left arm  In
the ED the arm was cold, obviously ischemic and his sysytolic BP
was greater than 200. A CTA demonstated a Type A dissection.  He
was intubated and Labetolol and Nicardipine infusions were
begun.  He was air transported to [**Hospital1 18**] for surgical treatment.

MEDICAL HISTORY: Hypertension
hyperlipidemia

MEDICATION ON ADMISSION: allopurinol, flomax

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone
non smoker/drinker
Dissection of aorta, thoracic,Acute kidney failure, unspecified,Aortic valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atherosclerosis of aorta,Anemia, unspecified,Atrial fibrillation
Dsct of thoracic aorta,Acute kidney failure NOS,Aortic valve disorder,Hypertension NOS,Hyperlipidemia NEC/NOS,Aortic atherosclerosis,Anemia NOS,Atrial fibrillation
Name:  [**Known lastname 13614**],[**Known firstname **]                    Unit No:   [**Numeric Identifier 13615**]

Admission Date:  [**2104-2-2**]              Discharge Date:   [**2104-2-8**]

Date of Birth:  [**2025-2-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 741**]
Addendum:
Additional physical exam findings included a heel ulcer-
According to wound care nurse assessment on date of discharge:
Pt has an intact 6.5 x 7.5 left heel blister- stage 2 pressure
ulcer. There is no erythema and the fluid is beginning to
reabsorb.

The wound care service was consulted and recommendations were
made for off loading as well as dressings.

Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] Nursing Care - [**Location (un) 5850**]

                             [**Name6 (MD) **] [**Name8 (MD) 747**] MD [**MD Number(2) 748**]

Completed by:[**2104-2-12**]

Admission Date:  [**2104-2-2**]              Discharge Date:   [**2104-2-8**]

Date of Birth:  [**2025-2-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Type A aortic dissection

Major Surgical or Invasive Procedure:
Graft replacement Ascending Aorta & resuspension of Aortic valve
[**2104-2-3**]


History of Present Illness:
This 78 year old male presented to [**Hospital3 **] ED with the acute
onset of severe tearing pain in the upper back and left arm  In
the ED the arm was cold, obviously ischemic and his sysytolic BP
was greater than 200. A CTA demonstated a Type A dissection.  He
was intubated and Labetolol and Nicardipine infusions were
begun.  He was air transported to [**Hospital1 18**] for surgical treatment.

Past Medical History:
Hypertension
hyperlipidemia

Social History:
lives alone
non smoker/drinker

Family History:
non-contributory

Physical Exam:
Admission:

Pulse: 60s in SR    Resp:  CMV 100% 550 x 16   O2 sat: 96%
B/P  Right:    Left:
Height:     Weight:

General:
Skin: Dry [] intact []
HEENT: PERRLA [] EOMI []
Neck:  Supple [] Full ROM []
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur IV/VI HSM at base
Abdomen: Soft [x] non-distended [] non-tender []  bowel sounds
Extremities: Warm [x], well-perfused [x]  LUE cold, mottled
Neuro: GCS 3T
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: absent

Carotid Bruit        Right: (-)   Left: (-)


Pertinent Results:
[**2104-2-7**] 05:10AM BLOOD WBC-9.0 RBC-3.20* Hgb-9.0* Hct-27.5*
MCV-86 MCH-28.2 MCHC-32.8 RDW-13.5 Plt Ct-224
[**2104-2-6**] 01:28AM BLOOD WBC-11.6* RBC-3.50* Hgb-10.1* Hct-30.6*
MCV-88 MCH-28.9 MCHC-33.1 RDW-14.0 Plt Ct-168
[**2104-2-8**] 05:20AM BLOOD PT-12.9 INR(PT)-1.1
[**2104-2-7**] 05:10AM BLOOD PT-12.4 PTT-21.9* INR(PT)-1.0
[**2104-2-8**] 05:20AM BLOOD UreaN-37* Creat-1.0 K-3.9
[**2104-2-7**] 05:10AM BLOOD Glucose-105* UreaN-35* Creat-1.2 Na-143
K-3.9 Cl-109* HCO3-27 AnGap-11
[**2104-2-6**] 01:28AM BLOOD Glucose-92 UreaN-40* Creat-1.3* Na-145
K-3.7 Cl-110* HCO3-26 AnGap-13

[**2104-2-3**] 04:19AM BLOOD WBC-5.5 RBC-3.21* Hgb-9.1* Hct-26.8*
MCV-84 MCH-28.3 MCHC-33.8 RDW-13.9 Plt Ct-181
[**2104-2-7**] 05:10AM BLOOD WBC-9.0 RBC-3.20* Hgb-9.0* Hct-27.5*
MCV-86 MCH-28.2 MCHC-32.8 RDW-13.5 Plt Ct-224
[**2104-2-3**] 04:18AM BLOOD PT-14.5* PTT-34.0 INR(PT)-1.3*
[**2104-2-7**] 05:10AM BLOOD PT-12.4 PTT-21.9* INR(PT)-1.0
[**2104-2-4**] 05:05AM BLOOD Glucose-121* UreaN-29* Creat-1.3* Na-144
K-4.4 Cl-112* HCO3-24 AnGap-12
[**2104-2-7**] 05:10AM BLOOD Glucose-105* UreaN-35* Creat-1.2 Na-143
K-3.9 Cl-109* HCO3-27 AnGap-11


[**Hospital1 18**] ECHOCARDIOGRAPHY REPORT

EU CRITICAL, [**Doctor Last Name **]       [**Hospital1 18**] [**Numeric Identifier 85815**]
(Complete) Done [**2104-2-3**] at 1:53:51 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **] R.
[**Hospital1 18**], Division of Cardiothorac
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2025-12-12**]
Age (years): 78 M  Hgt (in):
BP (mm Hg): /  Wgt (lb):
HR (bpm):  BSA (m2):
Indication: Type A dissection. Note: Patient's name is [**Name (NI) **]
[**Name (NI) 85816**].
ICD-9 Codes: 786.51, 441.00, 424.1, 424.0
Test Information
Date/Time: [**2104-2-3**] at 01:53    Interpret MD: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD

Test Type: TEE (Complete) Son[**Name (NI) 930**]: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3318**], MD
Doppler: Full Doppler and color Doppler Test Location:
Anesthesia West OR cardiac
Contrast: None Tech Quality: Adequate
Tape #: 2010AW1-: Machine: [**Doctor Last Name **]
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  50% to 55%  >= 55%
Aorta - Ascending:  *5.2 cm  <= 3.4 cm

Findings
LEFT ATRIUM: No spontaneous echo contrast is seen in the LAA.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum.

LEFT VENTRICLE: Low normal LVEF.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Ascending aortic intimal flap/dissection.. Aortic arch
intimal flap/dissection. Descending aorta intimal flap/aortic
dissection.

AORTIC VALVE: Mildly thickened aortic valve leaflets (3).
Moderate to severe (3+) AR.

MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+)
MR.

TRICUSPID VALVE: Physiologic TR.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was under general anesthesia throughout
the procedure. The TEE probe was passed with assistance from the
anesthesioology staff using a laryngoscope. No TEE related
complications.
Conclusions
Pre-CPB:
This is a directed study in an emergency case with a Type A
dissection.

No spontaneous echo contrast is seen in the left atrial
appendage.
Overall left ventricular systolic function is low normal (LVEF
50-55%).
Right ventricular chamber size and free wall motion are normal.
A mobile density is seen in the ascending aorta, the aortic arch
and the descending aorta consistent with an intimal flap/aortic
dissection.
The aortic valve leaflets (3) are mildly thickened. Moderate to
severe (3+) aortic regurgitation is seen. There is an intact
STJ.
The mitral valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen.
There is no pericardial effusion.

Post-CPB:
The patient is on a phenylephrine drip and is AV-Paced.
There is a prosthetic ascending aorta. There is trace - 1+ AI.
Trace MR.
[**First Name (Titles) **] [**Last Name (Titles) 50255**] systolic fxn. Other parameters as pre-bypass.

  I certify that I was present for this procedure in compliance
with HCFA regulations.

Electronically signed by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 3318**], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2104-2-3**] 04:23


?????? [**2096**] CareGroup IS. All rights reserved.


Brief Hospital Course:
Following transfer Mr.[**Known lastname 2137**] was taken emergently to the
Operating Room where the dissection was repaired with a #28mm
Gelweave tube graft and the valve resuspended (see operative
note for details). He tolerated the procedure well and weaned
from bypass on Neo Synephrine, Propofol and Insulin infusions.

He remained stable and was kept intubated the day after surgery.
Pressors were weaned off, he awoke intact and was extubated on
POD 2.  He was diuresed and after some initial confusion was
neurologically intact by POD 3.  CTs were removed according to
protocol and beta blockade and ACE inhibitors begun for blood
pressure control. His rhythm went into rate controlled atrial
fibrillation on [**3-5**] and he was treated with Amiodarone and
beta-blocker.

He was transferred to the floor on POD 3, pacing wires were
discontinued per protocol and Physical Therapy worked with him
for mobilization and strength. POD#4 anticoagulation with
Coumadin was initiated for atrial fibrillation. He continued to
progress and was cleared for discharge to rehab on POD# 5.  All
follow up appointments were advised.

Medications on Admission:
allopurinol, flomax

Discharge Medications:
1. Allopurinol 300 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
2. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
3. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
4. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain.
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
9. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12
hours).
11. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO Q12H (every
12 hours) for 10 days.
Disp:*40 Tablet(s)* Refills:*0*
12. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day): 400mg [**Hospital1 **] x 2 weeks, then 200mg [**Hospital1 **] x 2 weeks, then
200mg daily until further instructed. Tablet(s)
13. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for wheezes.
15. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for wheezing.
16. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

17. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
18. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: dose
to change daily for goal INR 2-2.5. Tablet(s)
19. Outpatient Lab Work
serial PT/INR
dx: atrial fibrillation
goal INR 2-2.5
20. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
TBA

Discharge Diagnosis:
Type A Aortic Dissection
Hyperlipidemia
hypertension


Discharge Condition:
Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating, gait steady
Sternal pain managed with tylenol prn


Discharge Instructions:
Discharge Instructions:	Please shower daily including washing
incisions gently with mild soap, no baths or swimming, and look
at your incisions
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 until follow up with
surgeon
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]

	


Followup Instructions:
Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) 170**] appointment arranged for [**3-13**], at
1pm
Dr. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 83262**] in [**12-15**] weeks ([**Telephone/Fax (1) 9674**])
Dr. [**Last Name (STitle) 83262**] to follow coumadin on discharge from rehab
Dr. [**First Name (STitle) **] (cardiolotist, [**Hospital6 48601**])
[**Telephone/Fax (1) 9674**] [**2104-3-3**] 3pm
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will schedule
Provider: [**Name10 (NameIs) **] [**Name8 (MD) 6144**], MD Phone:[**Telephone/Fax (1) 170**]
Date/Time:[**2104-3-13**] 1:00



Completed by:[**2104-2-8**]
{'Dissection of aorta, thoracic,Acute kidney failure, unspecified,Aortic valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atherosclerosis of aorta,Anemia, unspecified,Atrial fibrillation'}


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: Type A aortic dissection

PRESENT ILLNESS: This 78 year old male presented to [**Hospital3 **] ED with the acute
onset of severe tearing pain in the upper back and left arm  In
the ED the arm was cold, obviously ischemic and his sysytolic BP
was greater than 200. A CTA demonstated a Type A dissection.  He
was intubated and Labetolol and Nicardipine infusions were
begun.  He was air transported to [**Hospital1 18**] for surgical treatment.

MEDICAL HISTORY: Hypertension
hyperlipidemia

MEDICATION ON ADMISSION: allopurinol, flomax

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission:

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives alone
non smoker/drinker 

### Response:
{'Dissection of aorta, thoracic,Acute kidney failure, unspecified,Aortic valve disorders,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Atherosclerosis of aorta,Anemia, unspecified,Atrial fibrillation'}
