CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: This is a 75 year old female who presented to [**Hospital3 3765**]
on [**2-3**] with pain between her shoulder blades. CT angio
at that time was reported as Type A aortic dissection and she
was transferred to [**Hospital1 2025**] for further evaluation and treatment.
This diagnosis could not be confirmed on repeat CT scan because
of poor quality. She was concomitantly noted to have an
expanding opacity in the right apex. Because [**Hospital1 2025**] could not
accept emergent cardiac surgical patients at that time, she was
eventually transferred to the [**Hospital1 18**] for further evaluation and
treatment. Of note, patient had developed facial swelling
thought to be related to IV contrast allergy. She required
pretreatment with Solumedrol, Benadryl, and H2 blockers.

MEDICAL HISTORY: Hypertension
Elevated Cholesterol
Temporal Arteritis
Prior Cesarean Sections

MEDICATION ON ADMISSION: IV Esmolol, IV Nipride, Aspirin 81 qd, Simvastatin 40 qd,
Prednisone 9 qd, Calcium, MVI, Fosamax 70 qweek, Xalantan eye
gtts

ALLERGIES: Prochlorperazine / Ciprofloxacin / Iodine

PHYSICAL EXAM: PREOP EXAM
Vitals: 108/49, 83, 18
General: Elderly female in no acute distress, somewhat
apprehensive
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Denies premature coronary disease.

SOCIAL HISTORY: Denied tobacco and ETOH. Married, lives with husband.
Dissection of aorta, thoracoabdominal,Hemorrhage complicating a procedure,Cyst and pseudocyst of pancreas,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Pulmonary collapse,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Other dysphagia,Giant cell arteritis
Dsct of thoracoabd aorta,Hemorrhage complic proc,Pancreat cyst/pseudocyst,Ac DVT/embl low ext NOS,Pulmonary collapse,Urin tract infection NOS,Abn react-procedure NEC,Accid in resident instit,Hypertension NOS,Cardiac dysrhythmias NEC,Dysphagia NEC,Giant cell arteritis
Admission Date:  [**2186-2-4**]              Discharge Date:   [**2186-2-15**]

Date of Birth:  [**2110-5-12**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Prochlorperazine / Ciprofloxacin / Iodine

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
[**2186-2-4**] Endovascular Stent of Descending Thoracic Aorta
[**2186-2-6**] Right VATS, Decortication, Evacuation of Hematoma


History of Present Illness:
This is a 75 year old female who presented to [**Hospital3 3765**]
on [**2-3**] with pain between her shoulder blades. CT angio
at that time was reported as Type A aortic dissection and she
was transferred to [**Hospital1 2025**] for further evaluation and treatment.
This diagnosis could not be confirmed on repeat CT scan because
of poor quality. She was concomitantly noted to have an
expanding opacity in the right apex. Because [**Hospital1 2025**] could not
accept emergent cardiac surgical patients at that time, she was
eventually transferred to the [**Hospital1 18**] for further evaluation and
treatment. Of note, patient had developed facial swelling
thought to be related to IV contrast allergy. She required
pretreatment with Solumedrol, Benadryl, and H2 blockers.

Past Medical History:
Hypertension
Elevated Cholesterol
Temporal Arteritis
Prior Cesarean Sections

Social History:
Denied tobacco and ETOH. Married, lives with husband.

Family History:
Denies premature coronary disease.

Physical Exam:
PREOP EXAM
Vitals: 108/49, 83, 18
General: Elderly female in no acute distress, somewhat
apprehensive
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

Pertinent Results:
[**2186-2-4**] 10:52AM BLOOD WBC-12.3* RBC-3.55* Hgb-11.1* Hct-31.7*
MCV-89 MCH-31.2 MCHC-35.0 RDW-15.2 Plt Ct-275
[**2186-2-4**] 10:52AM BLOOD PT-11.6 PTT-21.3* INR(PT)-1.0
[**2186-2-4**] 10:52AM BLOOD Glucose-164* UreaN-26* Creat-0.8 Na-139
K-4.6 Cl-106 HCO3-21* AnGap-17
[**2186-2-4**] 10:52AM BLOOD ALT-16 AST-21 CK(CPK)-46 AlkPhos-48
Amylase-56 TotBili-1.0
[**2186-2-4**] 10:52AM BLOOD Albumin-3.6 Calcium-7.8* Phos-3.1 Mg-1.8
[**2186-2-4**] 10:52AM BLOOD %HbA1c-5.6
[**2186-2-4**] Chest/Abd CTA:
1. Extensive mediastinal and right pleural hematoma, new since
the outside hospital CT of six hours prior, and thought most
likely to reflect rupture of the false lumen of the known aortic
dissection.
2. Probable type B aortic dissection with indistinctness of the
true origin of the false lumen due to extensive hematoma. The
dissection flap likely originates just proximal to the left
subclavian artery. There is a common origin of the right
brachiocephalic and left common carotid arteries. There is no
apparent ascending aorta involvement.
3. Cystic pancreatic body mass, which can be evaluated on a
non-emergent basis with MRCP.
[**2186-2-4**] Intraop TEE:
The dissection was localized to distal arch and descending
thoracic aorta. Visualized portion of Ascending aorta was free
of dissection and there was a trace aortic regurgitation. There
was no pericardial effusion. There was a large bilateral pleural
effusion.  After the stent was placed it was difficult to
visualize the distal arch and the descending thoracic aorta.
There was no dissection in the ascending aorta seen. There was
no pericardial effusion at the end of procedure. No stent leaks
could be visualized because of poor TEE windows. Biventricular
systolic function was well preserved.
[**2186-2-6**] Chest/Abd CTA:
1. Extensive mediastinal and right pleural hematoma with
interval increase in the right pleural hematoma and atelectasis
of the right lower lobe. There also is a small left basal
effusion present.
2. Patent stent in the thoracic aorta as described above.
[**2186-2-9**] Upper Extremity Ultrasound: Right upper extremity DVT
confined to the brachial vein.
[**2186-2-10**] Renal Ultrasound: 1. No hydronephrosis and no stones or
solid masses identified in either kidney. 2. Appropriate renal
symmetrical blood flow is seen bilaterally.
[**2186-2-10**] Chest x-ray: In comparison with study of [**2186-2-8**], the
right chest tube has been removed. There may be a tiny residual
pneumothorax. Increased opacification persists at the left base,
though the right base is now quite clear.

[**2186-2-14**] 05:55AM BLOOD WBC-13.4* RBC-3.27* Hgb-9.9* Hct-29.5*
MCV-90 MCH-30.4 MCHC-33.7 RDW-14.3 Plt Ct-321
[**2186-2-12**] 07:20AM BLOOD PT-11.9 PTT-25.6 INR(PT)-1.0
[**2186-2-14**] 05:55AM BLOOD Glucose-101 UreaN-17 Creat-0.5 Na-139
K-4.1 Cl-105 HCO3-25 AnGap-13

Brief Hospital Course:
Mrs. [**Known lastname 77561**] was admitted and underwent emergent CT scan
which showed no type A aortic dissection but did reveal probable
type B aortic dissection with indistinctness of the true origin
of the false lumen due to extensive hematoma. The dissection
flap likely originated just proximal to the left subclavian
artery. The CT scan was also notable for extensive mediastinal
and right pleural hematoma. Given the above findings, the
endovascular team was mobilized and emergent endovascular stent
grafting was performed. For surgical details, please see
seperate dictated operative note. Following the operation, she
was brought to the CVICU for invasive monitoring. Despite
several right sided chest tubes, chest x-rays continued to
demonstrate right pleural opacity. The Thoracic service was
therefore consulted and she returned to the operating room on
[**2-6**] for VATS procedure along with decortication and clot
evacuation. Subsequent chest x-rays showed signficant
improvement and she was extubated on [**2-7**] without incident.
She remained hypertensive and required multiple
anti-hypertensive agents with goal SBP 120-140 mmHg. On [**2-9**], she was noted to have right upper extremity swelling and
underwent ultrasound which revealed a deep vein thrombosis
confined to the brachial vein. She was subsequently started on
SQ Heparin. Chest tubes were eventually removed without
complication. Over the remainder of her hospital stay, her
anti-hypertensive regimen was titrated accordingly. Beta
blockade was eventually decreased prior to discharge for
bradycardia (rate 40-50's). She otherwise maintained stable
hemodynamics and remained in a normal sinus rhythm.
Of note, on [**2-8**], she was noted to have difficulty
swallowing which prompted bedside swallow evaluation which
initially showed soft sign and symptoms of aspiration. She was
initially kept NPO and underwent video swallow study which
revealed moderate oropharyngeal dysphagia with consistent deep
penetration and silent aspiration of thin liquids. Her diet was
therefore advanced to thin liquids and ground solid
consistencies. She was placed on strict aspiration precautions
and her pills were crushed in puree.
In addition, she received stress dose steroids for her history
of temporal arteritis. By discharge, she was back at her
preoperative dose of prednisone.
She was medically cleared for discharge to rehab on
postoperative day 11.

Medications on Admission:
IV Esmolol, IV Nipride, Aspirin 81 qd, Simvastatin 40 qd,
Prednisone 9 qd, Calcium, MVI, Fosamax 70 qweek, Xalantan eye
gtts

Discharge Medications:
1. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
2. Clonidine 0.1 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
6. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
10. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO every 6-8 hours as needed for pain.
11. Prednisone 1 mg Tablet Sig: Nine (9) Tablet PO once a day:
Patient should take 9mg per day.
12. Captopril 25 mg Tablet Sig: Four (4) Tablet PO TID (3 times
a day).


Discharge Disposition:
Extended Care

Facility:
[**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **]

Discharge Diagnosis:
Ruptured Type B Aortic Dissection - s/p Endovascular Stent Graft
Postoperative Hemothorax - s/p Right VATS
Upper Extremity Deep Vein Thrombosis
Postop Oropharyngeal Dysphagia
Postop Bradycardia
Hypertension
Elevated Cholesterol
Temporal Arteritis
Pancreatic Cyst/Mass


Discharge Condition:
Improved


Discharge Instructions:
1)Please shower daily. No baths. Pat dry incisions, do not rub.
2)Avoid creams and lotions to surgical incisions.
3)Call surgeon if there is concern for wound infection.
4)Staples may be removed in one week if clinically indicated
5)Aspiration precautions.


Followup Instructions:
Dr. [**Last Name (STitle) **] in one month, call for appt
Dr. [**Last Name (STitle) **] in one month, call for appt
Dr. [**Last Name (STitle) 22799**] in [**1-8**] weeks, call for appt



Completed by:[**2186-2-15**]
{'Dissection of aorta, thoracoabdominal,Hemorrhage complicating a procedure,Cyst and pseudocyst of pancreas,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Pulmonary collapse,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Other dysphagia,Giant cell arteritis'}


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: This is a 75 year old female who presented to [**Hospital3 3765**]
on [**2-3**] with pain between her shoulder blades. CT angio
at that time was reported as Type A aortic dissection and she
was transferred to [**Hospital1 2025**] for further evaluation and treatment.
This diagnosis could not be confirmed on repeat CT scan because
of poor quality. She was concomitantly noted to have an
expanding opacity in the right apex. Because [**Hospital1 2025**] could not
accept emergent cardiac surgical patients at that time, she was
eventually transferred to the [**Hospital1 18**] for further evaluation and
treatment. Of note, patient had developed facial swelling
thought to be related to IV contrast allergy. She required
pretreatment with Solumedrol, Benadryl, and H2 blockers.

MEDICAL HISTORY: Hypertension
Elevated Cholesterol
Temporal Arteritis
Prior Cesarean Sections

MEDICATION ON ADMISSION: IV Esmolol, IV Nipride, Aspirin 81 qd, Simvastatin 40 qd,
Prednisone 9 qd, Calcium, MVI, Fosamax 70 qweek, Xalantan eye
gtts

ALLERGIES: Prochlorperazine / Ciprofloxacin / Iodine

PHYSICAL EXAM: PREOP EXAM
Vitals: 108/49, 83, 18
General: Elderly female in no acute distress, somewhat
apprehensive
HEENT: Oropharynx benign, EOMI
Neck: Supple, no JVD
Lungs: CTA bilaterally
Heart: Regular rate and rhythm
Abdomen: Soft, nontender with normoactive bowel sounds
Ext: Warm, no edema
Pulses: 2+ distally
Neuro: Alert and oriented, CN 2- 12 grossly intact, no focal
deficits noted

FAMILY HISTORY: Denies premature coronary disease.

SOCIAL HISTORY: Denied tobacco and ETOH. Married, lives with husband. 

### Response:
{'Dissection of aorta, thoracoabdominal,Hemorrhage complicating a procedure,Cyst and pseudocyst of pancreas,Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity,Pulmonary collapse,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Other dysphagia,Giant cell arteritis'}
