CHIEF COMPLAINT: Chest pain.

PRESENT ILLNESS: The patient is a 74-year-old
gentleman admitted on [**9-27**] from an outside hospital
for evaluation of type B aortic dissection and concern for
pulmonary embolus.

MEDICAL HISTORY: 1.  Hypertension.
2.  Gastroesophageal reflux disease.
3.  Pancreatitis.
4.  A remote history of thyroglossal cyst resection in [**2146**].
5.  He is status post a preserving Whipple procedure for
periampullary pancreatic carcinoma/
6.  History of upper gastrointestinal bleed in [**2186-9-4**].  Esophagogastroduodenoscopy in [**2186-8-4**] with
ulceration.
7.  Hernia repair in [**2179**].
8.  History of collapsed lung in [**2151**].

MEDICATION ON ADMISSION: (Home medications included)
1.  Protonix 40 mg by mouth once per day.
2.  Metoprolol 25 mg by mouth twice per day.
3.  Lisinopril 5 mg by mouth once per day.
4.  Flomax by mouth as needed.
5.  Ambien by mouth as needed.

ALLERGIES: DEMEROL.

PHYSICAL EXAM: 

FAMILY HISTORY: No family history of coronary artery
disease, hypertension, or diabetes.

SOCIAL HISTORY: He quit smoking 35 years ago, but he was
smoking one pack per day times 20 years up to then.
Occasional alcohol use.
Dissection of aorta, thoracic,Unspecified pleural effusion,Pulmonary collapse,Retention of urine, unspecified,Esophageal reflux,Unspecified essential hypertension
Dsct of thoracic aorta,Pleural effusion NOS,Pulmonary collapse,Retention urine NOS,Esophageal reflux,Hypertension NOS
Admission Date:  [**2186-9-27**]       Discharge Date:  [**2186-10-6**]

Date of Birth:   [**2112-5-20**]       Sex:  M

Service:  CCU

CHIEF COMPLAINT:  Chest pain.

HISTORY OF PRESENT ILLNESS:  The patient is a 74-year-old
gentleman admitted on [**9-27**] from an outside hospital
for evaluation of type B aortic dissection and concern for
pulmonary embolus.

He presented four days ago with chest pain located in the
middle of the chest with radiation to his back and also down
to his arm.  No nausea.  No vomiting.  The patient was
discharged home after a workup for myocardial infarction on
[**9-25**].

The patient presented again with increased chest pain and had
a computed tomography which was notable for type B aortic
dissection.  His denies any recent fevers or chills.  He has
had an increased weight loss over the last several months.
Besides that, no other complaints.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Gastroesophageal reflux disease.
3.  Pancreatitis.
4.  A remote history of thyroglossal cyst resection in [**2146**].
5.  He is status post a preserving Whipple procedure for
periampullary pancreatic carcinoma/
6.  History of upper gastrointestinal bleed in [**2186-9-4**].  Esophagogastroduodenoscopy in [**2186-8-4**] with
ulceration.
7.  Hernia repair in [**2179**].
8.  History of collapsed lung in [**2151**].

FAMILY HISTORY:   No family history of coronary artery
disease, hypertension, or diabetes.

SOCIAL HISTORY:  He quit smoking 35 years ago, but he was
smoking one pack per day times 20 years up to then.
Occasional alcohol use.

ALLERGIES:  DEMEROL.

MEDICATIONS ON ADMISSION:  (Home medications included)
1.  Protonix 40 mg by mouth once per day.
2.  Metoprolol 25 mg by mouth twice per day.
3.  Lisinopril 5 mg by mouth once per day.
4.  Flomax by mouth as needed.
5.  Ambien by mouth as needed.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs on
examination revealed his temperature was 98.7 degrees
Fahrenheit, his heart rate was 74, his blood pressure was
116/51 in the left arm, blood pressure in his right arm was
120/58, his oxygen saturation was 95% on room air, and his
respiratory rate was 18.  In general, in no acute distress
and comfortable.  Head, eyes, ears, nose, and throat
examination revealed normocephalic and atraumatic.  The neck
was supple.  Pupils were equal, round, and reactive to light
and accommodation.  Cardiovascular examination revealed a
regular rate and rhythm.  No murmurs, gallops, or rubs.
Respiratory examination revealed the lungs were clear
bilaterally with very mild left lower lobe decreased breath
sounds.  No crackles or wheezes were noted.  The abdomen was
soft, nontender, and nondistended.  Bowel sounds were
present.  Extremity examination revealed the extremities were
warm.  No clubbing, cyanosis, or edema.

PERTINENT LABORATORY VALUES ON PRESENTATION:   Laboratories
on admission revealed white blood cell count was 11.3, his
hematocrit was 32.3, and his platelets were 193.  INR was
1.3.  Partial thromboplastin time was 32.2.  Sodium was 132,
potassium was 3.6, chloride was 104, bicarbonate was 23,
blood urea nitrogen was 20, creatinine was 0.7, and blood
glucose was 95.  Creatine kinase was 15.  Troponin was 0.05.
Magnesium was 1.7, phosphorous was 3.7, and calcium was 8.8.

PERTINENT RADIOLOGY/IMAGING:  A chest x-ray revealed left
lower lobe collapse/consolidation with associated layered
pleural effusion.  Also with right-sided atelectasis.
Cardiomegaly without evidence of overt heart failure.

A computed tomography angiogram showed no pulmonary edema.  A
left-sided pleural effusion and a dissection which was
unchanged when compared  to an earlier study.

Computed tomography showed a type B dissection from the left
subclavian to the diaphragm.

CONCISE SUMMARY OF HOSPITAL COURSE BY ISSUE/SYSTEM:  The
patient was admitted to the Coronary Care Unit for evaluation
of type B dissection.  Cardiology Surgery and Vascular
Surgery were involved and evaluated the patient and felt that
due to repeat x-ray and decreased symptoms, because the
patient had remained asymptomatic, there was no need to
intervene surgically and to manage the patient medically.

The patient was managed medically well with blood pressure
control.  His blood pressure goal was to keep his blood
pressures at 70s which was initially achieved through drips.
He was put on an esmolol drip and nitroprusside drip, and he
was eventually weaned off the nitroprusside and esmolol drip
and put on by mouth medications.

On the day prior to discharge, he continued to have some
light dizziness, and some of his blood pressure medications
were held because his blood pressures were going down to the
high 80s.  Since the day prior to discharge, his blood
pressure medications were readjusted and the frequency was
changed from 500 mg by mouth twice per day to 300 mg by mouth
three times per day to achieve better blood pressure control
and without any more evidence of hypotensive episodes.  Since
the patient's tolerated the current regimen change well, also
on the day of discharge his lisinopril was withheld the day
prior.  This was changed from lisinopril twice per day to
lisinopril once per day.

In terms of his pulmonary status, the patient pleural
effusion was most likely secondary to his dissection.  Per
Surgery recommendation, no tap was necessary at this time and
that it would be reabsorbed over time.  He received a
magnetic resonance imaging on the day prior to discharge
which showed no change from the previous magnetic resonance
imaging when he was first admitted in terms of the dissection
or the pleural effusion.  The patient was to follow up with
his primary care physician to actually see the progression of
the pleural effusion and the dissection.  So far, no change.

In terms of renal, no issues on admission.  Followed
regularly throughout the hospital course.  The patient's
creatinine tolerated the dye doses well without a bump in his
creatinine.

In terms of gastrointestinal, the patient was maintained on
proton pump inhibitor given his history of upper
gastrointestinal bleed.

In terms of Infectious Disease, the patient had a one-time
temperature increase to 101 on admission; however, he has
been afebrile since, and no acute Infectious Disease issues
since admission.

In terms of prophylaxis, he was treated with subcutaneous
heparin, and Protonix, and a bowel regimen.  On the day prior
to discharge, the patient had multiple bowel movements which
he noted to have relieved the mild abdominal pain that he was
experiencing.  Since then, he had no other complaints except
mild dizziness which was most likely secondary to his
decreased blood pressures.  He originally came in blood
pressures over 130s to 140s, and now he was in the 110s and
100s to 110s.  He was tolerating his by mouth blood pressure
medications well.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was stable.

DISCHARGE STATUS:  The patient was discharged to home with
[**Hospital6 407**] services.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was instructed to call of follow up if he
experienced chest pain, shortness of breath, or abdominal
pain.
2.  The patient was instructed to buy a blood pressure
machine for frequent blood pressure checks.  The patient was
instructed to check his blood pressure about every four hours
by himself and by his wife.
3.  The patient was instructed to use caution when getting
out of bed or if dizzy when getting out of bed.
4.  The patient had a follow-up appointment with Dr. [**Last Name (STitle) **]
who is covering for his primary care physician on [**Name9 (PRE) 766**],
[**10-9**], at 2:30.
6.  The patient was instructed that it was important to
follow up with blood pressure checks and to follow up with
Dr. [**Last Name (STitle) **].  Dr. [**Last Name (STitle) **] can set up an appointment with
Cardiology at this time.  Vascular Surgery was [**Name (NI) 653**], and
they noted that there was no reason for them to follow and
for him to follow up with his primary care physician.
7.  Followup with Cardiology is important secondary to his
dissection.
8.  The patient was also scheduled for a magnetic resonance
imaging in four weeks to evaluate the progression of
dissection.

FINAL DISCHARGE DIAGNOSES:
1.  Aortic dissection (type B).
2.  Hypertension.
3.  Gastroesophageal reflux disease.
4.  History of pancreatitis.
5.  History of upper gastrointestinal bleed with ulceration
in [**2186-8-4**].
6.  History of thyroglossal cyst resection in [**2146**].
7.  Status post Whipple procedure for pancreatic cancer in
[**2186-8-4**].

MAJOR SURGICAL/INVASIVE PROCEDURES:  The patient had a
computed tomography in [**2186-9-4**] with complex type B
dissection.  No pulmonary embolus was noted.  In [**2186-9-4**] a magnetic resonance imaging was done which showed
thoracic aortic aneurysm with large mural hematoma and
separate focal dissection in descending thoracic aorta.  A
repeat magnetic resonance imaging on [**10-5**] to compare
versus prior showed no changes.

MEDICATIONS ON DISCHARGE:
1.  Pantoprazole 40 mg by mouth q.12h.
2.  Docusate 100 mg by mouth twice per day.
3.  Hydrochlorothiazide 25 mg by mouth once per day.
4.  Lisinopril 20 mg by mouth once per day.
5.  Amlodipine 10 mg by mouth once per day.
6.  Labetalol 300 mg by mouth three times per day
7.  Vicodin by mouth as needed (not to exceed three tablets
per day and also to hold if sedated or has respiratory
distress).

DISCHARGE DISPOSITION:  The patient has [**Hospital6 1587**] set up to teach the patient and his wife about
medications and also about proper blood pressure measuring
and the frequency (which should be about every four hours).

DISCHARGE ACTIVITIES:  Out of bed with assistance.

DISCHARGE DIET:  Cardiac heart-healthy diet taken as
tolerated.





                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15176**], M.D.  [**MD Number(1) 15177**]

Dictated By:[**Dictator Info 47734**]
MEDQUIST36

D:  [**2186-10-6**]  12:54
T:  [**2186-10-6**]  13:12
JOB#:  [**Job Number 47735**]
{'Dissection of aorta, thoracic,Unspecified pleural effusion,Pulmonary collapse,Retention of urine, unspecified,Esophageal reflux,Unspecified essential hypertension'}


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: The patient is a 74-year-old
gentleman admitted on [**9-27**] from an outside hospital
for evaluation of type B aortic dissection and concern for
pulmonary embolus.

MEDICAL HISTORY: 1.  Hypertension.
2.  Gastroesophageal reflux disease.
3.  Pancreatitis.
4.  A remote history of thyroglossal cyst resection in [**2146**].
5.  He is status post a preserving Whipple procedure for
periampullary pancreatic carcinoma/
6.  History of upper gastrointestinal bleed in [**2186-9-4**].  Esophagogastroduodenoscopy in [**2186-8-4**] with
ulceration.
7.  Hernia repair in [**2179**].
8.  History of collapsed lung in [**2151**].

MEDICATION ON ADMISSION: (Home medications included)
1.  Protonix 40 mg by mouth once per day.
2.  Metoprolol 25 mg by mouth twice per day.
3.  Lisinopril 5 mg by mouth once per day.
4.  Flomax by mouth as needed.
5.  Ambien by mouth as needed.

ALLERGIES: DEMEROL.

PHYSICAL EXAM: 

FAMILY HISTORY: No family history of coronary artery
disease, hypertension, or diabetes.

SOCIAL HISTORY: He quit smoking 35 years ago, but he was
smoking one pack per day times 20 years up to then.
Occasional alcohol use. 

### Response:
{'Dissection of aorta, thoracic,Unspecified pleural effusion,Pulmonary collapse,Retention of urine, unspecified,Esophageal reflux,Unspecified essential hypertension'}
