CHIEF COMPLAINT: Chest and back pain

PRESENT ILLNESS: This  62 year old white male with a history of coronary artery
disease went to the ED and was admitted to [**Hospital6 16464**] for chest pain.

MEDICAL HISTORY: hypertension
hypercholesterolemia
depression
[**Last Name (un) 309**] body disease-(followed Dr. [**Last Name (STitle) **]
old brain hemorrhage on MRI, L arm tremor
sleep apnea on home CPAP
prostate cancer
s/p radical prostatectomy
s/p lumbar laminectomy x2
s/p tonsilectomy

MEDICATION ON ADMISSION: lisinopril, lopressor, lipitor, hydrochlorothiazide, prozac,
norvasc, potassium

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Deferred

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: exercise -walking
no tobacco
social EtOH
married
insurance sales
Dissection of aorta, thoracic,Dissection of other artery,Dissection of coronary artery,Paralytic ileus,Other postoperative infection,Cellulitis and abscess of leg, except foot,Pulmonary collapse,Unspecified pleural effusion,Aortic valve disorders,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,Chronic kidney disease, unspecified,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate,Retention of urine, unspecified,Atrial fibrillation
Dsct of thoracic aorta,Dissection artery NEC,Dissection cor artery,Paralytic ileus,Other postop infection,Cellulitis of leg,Pulmonary collapse,Pleural effusion NOS,Aortic valve disorder,Abn react-anastom/graft,Chronic kidney dis NOS,Dementia w Lewy bodies,Dementia w/o behav dist,Depressive disorder NEC,Hy kid NOS w cr kid I-IV,Pure hypercholesterolem,Hx-prostatic malignancy,Retention urine NOS,Atrial fibrillation
Admission Date:  [**2111-4-14**]              Discharge Date:   [**2111-4-26**]

Date of Birth:  [**2048-7-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
Chest and back pain

Major Surgical or Invasive Procedure:
[**2111-4-14**] - Emergent repair of Type A Aortic Dissection
left heart catheterization, coronary angiogram


History of Present Illness:
This  62 year old white male with a history of coronary artery
disease went to the ED and was admitted to [**Hospital6 16464**] for chest pain.

Troponins were negative  and there were no EKG changes. He was
then transferred for cardiac catheterization. In the lab no
significant coronary disease was found, however, he was then
found to have an acute type A aortic dissection. Surgical
referrral was then made.

Past Medical History:
hypertension
hypercholesterolemia
depression
[**Last Name (un) 309**] body disease-(followed Dr. [**Last Name (STitle) **]
old brain hemorrhage on MRI, L arm tremor
sleep apnea on home CPAP
prostate cancer
s/p radical prostatectomy
s/p lumbar laminectomy x2
s/p tonsilectomy

Social History:
exercise -walking
no tobacco
social EtOH
married
insurance sales


Family History:
Noncontributory

Physical Exam:
Deferred

Pertinent Results:
[**2111-4-14**] ECHO
PREBYPASS
No atrial septal defect is seen by 2D or color Doppler. Overall
left ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
ascending aorta is moderately/severely dilated. The descending
thoracic aorta is mildly dilated. A mobile density is seen in
the ascending aorta consistent with an intimal flap/aortic
dissection. The flap originates just proximal to the
sino-tubular junction and extends through the arch and into the
descending aorta. The aortic valve leaflets (3) are mildly
thickened. Severe (4+) aortic regurgitation is seen and is
secondary to the disection flap prolapsing into/through the AV
during diastole. The mitral valve leaflets are mildly thickened.
Mild (1+) mitral regurgitation is seen.

POSTBYPASS
The patient is receiving an infusion of epinephrine at 0.03
ucg/kg/min
LV systolic function remains preserved in the setiing of
inotropes. RV systolic function is borderline normal. The AI is
now trace. The disection flap is no longer seen in the ascending
aorta but remains in the arch and descending aorta. There is a
tube graft visualized in the ascending aorta. The remaining
study is unchanged compared to prebypass.
[**2111-4-22**] 05:54AM BLOOD WBC-12.5* RBC-3.24* Hgb-9.7* Hct-30.1*
MCV-93 MCH-29.9 MCHC-32.2 RDW-16.0* Plt Ct-160
[**2111-4-16**] 03:01AM BLOOD WBC-11.2* RBC-2.93* Hgb-9.1* Hct-26.5*
MCV-90 MCH-31.2 MCHC-34.5 RDW-16.2* Plt Ct-114*
[**2111-4-22**] 05:54AM BLOOD Glucose-131* UreaN-22* Creat-1.2 Na-143
K-2.6* Cl-102 HCO3-35* AnGap-9
[**2111-4-22**] 07:07AM BLOOD K-2.8*
[**2111-4-15**] 03:59AM BLOOD Glucose-127* UreaN-18 Creat-1.2 Na-139
K-4.0 Cl-112* HCO3-22 AnGap-9

Brief Hospital Course:
Following detection of the Type A dissection at cardiac
catheterization he was taken  for emergent repair. He was taken
immediately to the Operating Room where he underwent surgical
repair of his aortic dissection with resuspension of the aortic
valve. Please see operative note for details.

He weaned from bypass on Neo Synephrine, Epinephrine and
Propofol infusions in stable condition. Postoperatively he was
taken to the intensive care unit for monitoring. He awoke
intact, was weaned from the ventilator and extubated.  Pressors
were weaned to off and he remained stable.  Chest tubes were
discontinued without complication.  The patient was disoriented,
and narcotics were minimized.

His mental status improved and he became alert and oriented.  He
had a postoperative ileus, treated conservatively.  He regained
bowel sounds, had normal bowel movements and the NG tube was
removed and liquidws started.  His diet was gradually advanced
to a regular heart healthy diet.

Physical Therapy worked with him for mobility and strengthening.
beta blockade was instituted and he was diuresed towards his
preoperative weight.  Blood pressure was controlled
pharmacologically.  He required reinsertion of the Foley
catheter for retention and Tamsulosin was started. Foley was
subsequently removed and he was able to spontaneously void.

ON POD#10 His right lower extremity SVG harvest site was noted
to erythematous, warma dn tender to touch. He was treated with
IV Vanco and po levaquin with improvement. He was sent to rehab
on POD#12 on a 7day course of oral bactrim and levaquin after
being cleared by DR. [**Last Name (STitle) **].

He was referred to a rehabilitation facility for further
recovery prior to return home.


Medications on Admission:
lisinopril, lopressor, lipitor, hydrochlorothiazide, prozac,
norvasc, potassium

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
4. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
5. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
7. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
9. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for PAIN.
11. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO HS (at bedtime).
12. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for fever/pain.
13. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal
Sig: One (1) Tab Sust.Rel. Particle/Crystal PO DAILY (Daily) for
10 days: while on lasix.
14. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 7 days: for right lower extremity
cellulitis.
15. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day for 10
days: until edema has resolved and at pre-op weight.
17. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO twice a
day for 7 days: for RLE cellulitis.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 745**] Health Care Center

Discharge Diagnosis:
Type A Aortic dissection
hypertension
hyperlipidemia
depression
prostate cancer
Early [**Last Name (un) 309**] Body dementia
post operative ileus
saphenous vein graft cellulitis right thigh


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

Alert and oriented x3, nonfocal
Ambulating, gait steady
Sternal pain managed with Ultram prn


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:
Surgeon Dr. [**Last Name (STitle) **] [**2111-5-20**] at 1pm ([**Telephone/Fax (1) 170**])
Please call to schedule appointments
Primary Care Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 131**] in [**2-14**] weeks ([**Telephone/Fax (1) 133**])
Cardiologist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**2-14**] weeks ([**Telephone/Fax (1) 5768**])
Wound check appointment - [**Hospital Ward Name 121**] 6 ([**Telephone/Fax (1) 3071**]) - your nurse
will schedule



Completed by:[**2111-4-26**]
{'Dissection of aorta, thoracic,Dissection of other artery,Dissection of coronary artery,Paralytic ileus,Other postoperative infection,Cellulitis and abscess of leg, except foot,Pulmonary collapse,Unspecified pleural effusion,Aortic valve disorders,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,Chronic kidney disease, unspecified,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate,Retention of urine, 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: Chest and back pain

PRESENT ILLNESS: This  62 year old white male with a history of coronary artery
disease went to the ED and was admitted to [**Hospital6 16464**] for chest pain.

MEDICAL HISTORY: hypertension
hypercholesterolemia
depression
[**Last Name (un) 309**] body disease-(followed Dr. [**Last Name (STitle) **]
old brain hemorrhage on MRI, L arm tremor
sleep apnea on home CPAP
prostate cancer
s/p radical prostatectomy
s/p lumbar laminectomy x2
s/p tonsilectomy

MEDICATION ON ADMISSION: lisinopril, lopressor, lipitor, hydrochlorothiazide, prozac,
norvasc, potassium

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Deferred

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: exercise -walking
no tobacco
social EtOH
married
insurance sales 

### Response:
{'Dissection of aorta, thoracic,Dissection of other artery,Dissection of coronary artery,Paralytic ileus,Other postoperative infection,Cellulitis and abscess of leg, except foot,Pulmonary collapse,Unspecified pleural effusion,Aortic valve disorders,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,Chronic kidney disease, unspecified,Dementia with lewy bodies,Dementia in conditions classified elsewhere without behavioral disturbance,Depressive disorder, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate,Retention of urine, unspecified,Atrial fibrillation'}
