CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an
86-year-old female who was recently in an outside hospital
one month prior for transient ischemic attack.  The patient
presented again to the local emergency room with nonspecific
mental status change and chest pain.  The patient was worked
up at the outside hospital on CT scan, which showed type A
aortic dissection and a pericardial effusion.  The patient
was then transferred to [**Hospital1 69**]
for further workup and definitive care.   Pain had been of
right shoulder pain and right upper chest pain.  She noted
shortness of breath.  Previously, the patient had been seen
at [**Hospital **] Hospital on [**2172-1-17**] after paresthesia and
weakness.  At that time there were no focal abnormalities
found on the examination or the head CT and the patient was
discharged home.

MEDICAL HISTORY: 1.  Hypothyroidism.
2.  Depression.
3.  Hypertension.

MEDICATION ON ADMISSION: 1.  Levoxyl 125 mcg p.o.q.d.
2.  Depakote 250 mg p.o.q.a.m. and 500 mg q.p.m.
3.  Zyprexa 10 mg p.o.q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with daughters, does not
use alcohol or tobacco.
Dissection of aorta, thoracic,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified disease of pericardium,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Dsct of thoracic aorta,Surg compl-heart,Atrial fibrillation,Pericardial disease NOS,Hypothyroidism NOS,Hypertension NOS,Depressive disorder NEC,Abn react-anastom/graft
Admission Date:  [**2172-3-17**]       Discharge Date:  [**2172-3-24**]

Date of Birth:                    Sex:  F

Service:  CARDIOTHOR

HISTORY OF THE PRESENT ILLNESS:  The patient is an
86-year-old female who was recently in an outside hospital
one month prior for transient ischemic attack.  The patient
presented again to the local emergency room with nonspecific
mental status change and chest pain.  The patient was worked
up at the outside hospital on CT scan, which showed type A
aortic dissection and a pericardial effusion.  The patient
was then transferred to [**Hospital1 69**]
for further workup and definitive care.   Pain had been of
right shoulder pain and right upper chest pain.  She noted
shortness of breath.  Previously, the patient had been seen
at [**Hospital **] Hospital on [**2172-1-17**] after paresthesia and
weakness.  At that time there were no focal abnormalities
found on the examination or the head CT and the patient was
discharged home.

PAST MEDICAL HISTORY:
1.  Hypothyroidism.
2.  Depression.
3.  Hypertension.

PAST SURGICAL HISTORY:  History is significant for status
post total abdominal hysterectomy and status post right hip
repair.

MEDICATIONS ON ADMISSION:
1.  Levoxyl 125 mcg p.o.q.d.
2.  Depakote 250 mg p.o.q.a.m. and 500 mg q.p.m.
3.  Zyprexa 10 mg p.o.q.d.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  The patient lives with daughters, does not
use alcohol or tobacco.

PHYSICAL EXAMINATION:  Examination revealed the following:
The patient was alert and oriented times two.  HEENT:  Within
normal limits.  LUNGS:  Lungs were clear.  HEART:  Distant
sounds, but regular rate and rhythm.  ABDOMEN:  Obese, soft,
nontender.  EXTREMITIES:  Edematous, 1+ with palpable distal
pulses.

LABORATORY DATA:  Laboratory studies revealed the following:
White count 9.0; hematocrit 33.8; platelet count 95, PT 14,
PTT 42.7, INR 1.4, 1.4, sodium 139, potassium 5.2, chloride
109, bicarbonate 22, glucose 119, CPK 71.

EKG:  EKG was significant for sinus bradycardia with left
shift, no evidence of active ischemia, Q waves in V1 and
widened QRS.

CT scan was from an outside hospital, which was significant
for a type A aortic dissection, pericardial effusion.

HOSPITAL COURSE:  The patient, on the day of admission, was
taken to the operating room, where she underwent replacement
of ascending aorta and re-suspension of aortic valve.  She
tolerated the procedure well.  She was transferred to the
PACU with nitroglycerin and propofol drip.  Postoperatively,
she was A paced.  She was placed on nitroglycerin and Nipride
drip to keep the systolic blood pressure 100 to 110.  She was
transfused one unit of packed red blood cells for the
hematocrit of 26.  Two units FFP were infused.

In the unit, the patient was reversed, although she remained
unresponsive.  All sedation was withheld.  She did have some
reflexive motor function intact.  She was not following any
verbal commands and the family stated that the patient is
hard of hearing.

The patient remained hemodynamically stable on postoperative
day #1.  Neurologically, she continued to remain somnolent,
withdrawing extremities to pain only.  The patient's blood
pressure did go above goal rate.  She was started on
Hydralazine p.r.n. for better rate and blood pressure
control.

On postoperative day #2, the patient developed rapid atrial
fibrillation with episodes of hypotension.  She was started
on Neo-Synephrine to be continued to maintain blood pressure
between 100 to 110 systolic.  She was bolused with
Amiodarone.  She converted to normal sinus rhythm only to
revert back to rapid atrial fibrillation that same day.  She
was continued on the Amiodarone.  She maintained her blood
pressure.  She reconverted back to sinus and Amiodarone was
continued.

On postoperative day #3, the patient was much more awake,
following commands.  She was alert and oriented to person,
but not place or time.  She was able to stand, but was very
weak and deconditioned.  There was no evidence of any
laterality regarding to weakness.

On postoperative day #5, the patient continued to remain
stable both neurologically and hemodynamically.  She was
transferred to the floor for the remain of her recovery.  The
patient remained awake, alert, and oriented.  Occasionally,
the patient had mild confusion.  Blood pressure has been well
controlled.

On postoperative day #6, the patient did have an episode of
atrial fibrillation.  She was given 5 mg of Lopressor IV,
which reconverted her to sinus rhythm.  She remained afebrile
and hemodynamically stable.

On postoperative day #7, the wires were discontinued,
catheter was discontinued.  She was seen by the Department of
Physical Therapy who agreed with rehabilitation for the
patient.  She remained stable and not ready for discharge.

DISCHARGE DIAGNOSIS:
1.  Ascending aorta dissection type A, status post aortic
arch replacement and re-suspension of aortic valve.
2.  Postoperative atrial fibrillation.
3.  Hypothyroidism.
4.  Depression.
5.  Hypertension.

MEDICATIONS ON DISCHARGE:
1.  Lopressor 12.5 mg p.o.b.i.d.
2.  Lasix 40 mg p.o.t.i.d.
3.  Potassium chloride 20 mEq p.o.b.i.d.
4.  Colace 100 mg p.o.b.i.d.
5.  EC ASA 325 mg p.o.q.d.
6.  Protonix 40 mg p.o.q.d.
7.  Zyprexa 10 mg p.o.q.d.
8.  Amiodarone 400 mg p.o.t.i.d. until [**2172-3-26**]; then
Amiodarone 400 mg p.o.b.i.d. from [**2172-3-27**] to [**2172-4-2**];
then Amiodarone 400 mg p.o.q.d. from [**2172-4-3**] onward.
9.  Captopril 6.25 mg p.o.q.8h.
10. Levoxyl 125 mcg p.o.q.d.
11. Depakote 250 mg p.o.q.a.m.; Depakote 500 p.o.q.p.m.
12. Miconazole powder applied p.r.n.
13. Heparin 5000 units p.o. subcutaneously b.i.d.
14. Tylenol 650 mg p.o.q.4h.p.r.n.
15. Advil 400 mg p.o.q.6h.p.r.n.

CONDITION ON DISCHARGE:  Stable.













FOLLOW-UP CARE:  The patient will followup with Dr. [**Last Name (STitle) 70**]
in six weeks.  The patient will followup with the primary
care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 40439**] in approximately two weeks.  The
patient's ready for rehabilitation at this time.




                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 40440**]

Dictated By:  [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], M.D.
MEDQUIST36
D:  [**2172-3-24**]  15:08
T:  [**2172-3-24**]  15:32
JOB#:  [**Job Number 40441**]
{'Dissection of aorta, thoracic,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified disease of pericardium,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: The patient is an
86-year-old female who was recently in an outside hospital
one month prior for transient ischemic attack.  The patient
presented again to the local emergency room with nonspecific
mental status change and chest pain.  The patient was worked
up at the outside hospital on CT scan, which showed type A
aortic dissection and a pericardial effusion.  The patient
was then transferred to [**Hospital1 69**]
for further workup and definitive care.   Pain had been of
right shoulder pain and right upper chest pain.  She noted
shortness of breath.  Previously, the patient had been seen
at [**Hospital **] Hospital on [**2172-1-17**] after paresthesia and
weakness.  At that time there were no focal abnormalities
found on the examination or the head CT and the patient was
discharged home.

MEDICAL HISTORY: 1.  Hypothyroidism.
2.  Depression.
3.  Hypertension.

MEDICATION ON ADMISSION: 1.  Levoxyl 125 mcg p.o.q.d.
2.  Depakote 250 mg p.o.q.a.m. and 500 mg q.p.m.
3.  Zyprexa 10 mg p.o.q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient lives with daughters, does not
use alcohol or tobacco. 

### Response:
{'Dissection of aorta, thoracic,Cardiac complications, not elsewhere classified,Atrial fibrillation,Unspecified disease of pericardium,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Depressive disorder, not elsewhere classified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
