CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 53 year old gentleman
who presented to outside hospital with complaints of headache
and malaise.  The patient reported feeling nauseous, having
headache, and having substernal chest pressure.  His wife
checked his blood pressure which was low but noted that he
was tachycardic.  He was taken by ambulance to an outside
hospital where he was found to be in atrial flutter.  The
patient was given Digoxin and Cardizem and multiple fluid
boluses where he converted to sinus rhythm.  The patient was
also given Lovenox.  Echocardiogram was performed in the
Emergency Department that showed intimal flap on the
ascending aorta with aortic insufficiency.  The CAT scan
revealed a type A aortic dissection.  The patient was
transferred to [**Hospital1 69**] for
further management.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Dissection of aorta, thoracic,Aortic valve disorders,Hemorrhage complicating a procedure,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified essential hypertension
Dsct of thoracic aorta,Aortic valve disorder,Hemorrhage complic proc,Atrial fibrillation,Urin tract infection NOS,Hypertension NOS
Admission Date:  [**2114-5-12**]       Discharge Date:  [**2114-5-21**]

Date of Birth:   [**2061-2-13**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This is a 53 year old gentleman
who presented to outside hospital with complaints of headache
and malaise.  The patient reported feeling nauseous, having
headache, and having substernal chest pressure.  His wife
checked his blood pressure which was low but noted that he
was tachycardic.  He was taken by ambulance to an outside
hospital where he was found to be in atrial flutter.  The
patient was given Digoxin and Cardizem and multiple fluid
boluses where he converted to sinus rhythm.  The patient was
also given Lovenox.  Echocardiogram was performed in the
Emergency Department that showed intimal flap on the
ascending aorta with aortic insufficiency.  The CAT scan
revealed a type A aortic dissection.  The patient was
transferred to [**Hospital1 69**] for
further management.

PAST MEDICAL HISTORY:  Hypertension.

PAST SURGICAL HISTORY:
1.  Status post omental resection.
2.  Status post right inguinal hernia repair.

PREOPERATIVE MEDICATIONS:
1.  Atenolol 25 mg p.o. once daily.
2.  Aspirin.

ALLERGIES:  No known drug allergies.

REVIEW OF SYSTEMS:  Upon admission to [**Hospital1 190**], the patient complained of shortness of breath
and substernal chest pain, denied blurred vision, slurred
speech, dysarthria or difficulty swallowing.  The patient
denied arm or leg weakness, no abdominal pain.

PHYSICAL EXAMINATION:  Vital signs revealed temperature 98.9,
pulse 78, blood pressure left arm 121/27 and in the right arm
72/63, respiratory rate 14, oxygen saturation 95% in room
air.  In general, the patient is awake and alert in no
apparent distress.  The neck was supple without bruits.  The
heart was regular rate and rhythm, positive murmur.
Respiratory - The lungs are clear to auscultation
bilaterally.  The abdomen is soft, nontender, nondistended,
no masses.  Extremities are warm without edema.  Pulses -
carotids 2+ bilaterally, radial 1+ right and 2+ left, femoral
pulses 2+ bilaterally, popliteal pulses 2+ bilaterally,
dorsalis pedis pulses 2+ bilaterally, and posterior tibial
pulses 1+ bilaterally.  Neurologically, cranial nerves II
through XII are grossly intact.  Strength is [**3-26**] bilateral
upper and lower extremities.  Fine motor sensation is intact.

LABORATORY DATA:  White blood cell count was 10.1, hematocrit
40.7, platelet count 138,000.  Prothrombin time 14.6, INR
1.4, partial thromboplastin time 36.2.  Sodium 134, potassium
4.4, chloride 104, bicarbonate 19, blood urea nitrogen 12,
creatinine 0.9, glucose 99.

CT scan from the outside hospital revealed aortic dissection
from the aortic root proximal to the iliac bifurcation.

HOSPITAL COURSE:  The patient was taken emergently to the
operating room by Dr. [**Last Name (STitle) **] on [**2114-5-12**], for repair of the
ascending aortic dissection.  The patient underwent an aortic
valve replacement with a 25 millimeter St Jude valve as well
as placement of a 28 millimeter gelweave graft supracoronary.
Please see operative note for further details.  The
transesophageal echocardiogram in the operating room showed
preserved left ventricular systolic function, moderate right
ventricular systolic dysfunction.  In the operating room, the
patient had several episodes of atrial fibrillation. Post
cardiopulmonary bypass, the patient was placed on Amiodarone
drip.  Upon admission to the Intensive Care Unit, it was
noted that the patient had a large amount of chest tube
output.  The patient was resuscitated with blood products and
coagulopathy was attempted to be treated.  However, the large
amount of chest tube output continued and the patient was
taken back to the operating room for reexploration after one
and one half hours in the Intensive Care Unit.  In the
operating room during reoperation, it was found that the
patient was bleeding from the aortic suture line.  This was
repaired and the patient was transported back to the
Intensive Care Unit in stable condition.  The patient
required low dose Dobutamine to maintain adequate cardiac
output and low dose Neo-Synephrine to maintain blood pressure
as well as requiring multiple blood products for
resuscitation.  Immediately postoperatively, the patient was
allowed to awake.  The patient responded to commands and
moved all extremities equally.  The patient was resedated as
hemodynamics were labile.  The patient remained intubated on
mechanical ventilation and was not extubated until the
afternoon of postoperative day number one.  The patient
continued to have adequate cardiac indices on the Dobutamine
and it was weaned to off on postoperative day number two.
The patient continued on Amiodarone remaining in sinus
rhythm.  The patient's chest tubes remained dry and they were
removed on postoperative day number two.  The patient
continued to progress well, was out of bed and was
transferred from the Intensive Care Unit to the floor on
postoperative day number three.  The patient was again
working with physical therapy, ambulating and tolerating it
well.  On postoperative day number four, the patient spiked a
low grade fever.  The patient was pancultured.  Cultures
subsequently did not show anything, however, urinalysis on
postoperative day number five was positive for nitrites.  The
patient was placed on a five day course of Ciprofloxacin and
subsequent urine culture remained sterile.  The patient had
been started on Coumadin postoperatively for his mechanical
aortic valve replacement and the patient's INR on
postoperative day number five rose to 3.4.  Coumadin was
held.  On postoperative day number seven, the patient had a
CT angiogram done to study the dimension of the true and
false lumen of his aorta for future reference.  CT scan
showed a normal appearing ascending aorta, dissection
beginning in the aortic arch involving the left subclavian
and left common carotid and the left brachiocephalic
arteries.  It also shows flow through both true and false
lumens with the right renal artery originating from the true
lumen and the left renal artery originating from the false
lumen.  The dissection extends down into the iliac arteries.
The patient continued to progress well and on postoperative
day number nine, the patient was cleared for discharge.

CONDITION ON DISCHARGE:  Temperature maximum 100.4,
temperature current 98.0, pulse 78 and sinus rhythm, blood
pressure in his left arm 124/70, blood pressure in the right
arm 140/72, respiratory rate 18, room air oxygen saturation
97%.  Weight on [**2114-5-21**], is 82.5 kilograms, preoperatively
the patient was 88 kilograms.

Laboratory data revealed a white blood cell count of 11.2,
hematocrit 33.4, platelet count 439,000.  Sodium 135,
potassium 4.3, chloride 100, bicarbonate 24, blood urea
nitrogen 15, creatinine 0.8, glucose 91.  Prothrombin time
19.6, INR 2.5.

Neurologically, the patient is awake, alert and oriented
times three, nonfocal strength, equal bilaterally upper
extremity and lower extremity.  The heart is regular rate and
rhythm, no rub and no murmur, sharp valve click.  Respiratory
breath sounds are clear bilaterally with scattered rhonchi.
Gastrointestinal revealed positive bowel sounds, soft,
nontender, nondistended, tolerating a regular diet.  Sternal
incision staples are intact.  There is no erythema and no
drainage.  Sternum is stable.  Right groin staples are
intact.  There is a minimal amount of erythema but no
drainage.  Extremities have trace edema.

MEDICATIONS ON DISCHARGE:
1.  Lasix 20 mg p.o. twice a day times four days.
2.  Potassium Chloride 20 meq p.o. twice a day times four
days.
3.  Zantac 150 mg p.o. twice a day.
4.  Amiodarone 200 mg p.o. once daily.
5.  Losartan 25 mg p.o. once daily.
6.  Lopressor 100 mg p.o. twice a day.
7.  Ciprofloxacin 500 mg p.o. twice a day times one day to
complete a five day course.
8.  Dilaudid 2 to 4 mg p.o. q4-6hours p.r.n.
9.  Coumadin 2.5 mg p.o. on [**2114-5-21**], [**2114-5-22**], and [**2114-5-23**].
Blood is to be drawn by Dr.[**Name (NI) 48074**] office on [**2114-5-24**], and
dose to be determined by Dr. [**Last Name (STitle) **].

DISCHARGE DIAGNOSES:
1.  Hypertension.
2.  Type A aortic dissection.
3.  Repair of type A aortic dissection with [**First Name8 (NamePattern2) 48075**]
[**Male First Name (un) 923**] aortic valve replacement and 28 millimeter gelweave
ascending aortic supracoronary graft.
4.  Perioperative atrial fibrillation.
5.  Postoperative bleeding/reexploration for bleeding.

FO[**Last Name (STitle) **]P:  The patient is to follow-up with Dr. [**Last Name (STitle) **] in
one month.  The patient is to follow-up with Dr. [**Last Name (STitle) **] by
telephone on [**2114-5-24**]. and is to follow-up with Dr. [**Last Name (STitle) **] in
the office in one to two weeks.  The patient is to return to
[**Hospital Ward Name 121**] Two in one week for staple removal.  The patient is to
follow-up with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], in
one to two weeks.  The patient is to follow-up with Dr. [**Last Name (Prefixes) 411**] in one month.




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 1541**]
MEDQUIST36

D:  [**2114-5-21**]  15:21
T:  [**2114-5-21**]  19:09
JOB#:  [**Job Number 48076**]
{'Dissection of aorta, thoracic,Aortic valve disorders,Hemorrhage complicating a procedure,Atrial fibrillation,Urinary tract infection, site not specified,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: 

PRESENT ILLNESS: This is a 53 year old gentleman
who presented to outside hospital with complaints of headache
and malaise.  The patient reported feeling nauseous, having
headache, and having substernal chest pressure.  His wife
checked his blood pressure which was low but noted that he
was tachycardic.  He was taken by ambulance to an outside
hospital where he was found to be in atrial flutter.  The
patient was given Digoxin and Cardizem and multiple fluid
boluses where he converted to sinus rhythm.  The patient was
also given Lovenox.  Echocardiogram was performed in the
Emergency Department that showed intimal flap on the
ascending aorta with aortic insufficiency.  The CAT scan
revealed a type A aortic dissection.  The patient was
transferred to [**Hospital1 69**] for
further management.

MEDICAL HISTORY: Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Dissection of aorta, thoracic,Aortic valve disorders,Hemorrhage complicating a procedure,Atrial fibrillation,Urinary tract infection, site not specified,Unspecified essential hypertension'}
