CHIEF COMPLAINT: transfer from [**Hospital6 33**] with known aortic Type A
dissection. Awake and c/o throat pain at time of transfer
Cheif complaint at [**Hospital1 34**]: throat pain and chest heaviness

PRESENT ILLNESS: 37 yo man without significant past medical history awoke morning
of admission with sudden onset of cough followed by pain in his
throat.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: MVI

ALLERGIES: Vancomycin / Zosyn

PHYSICAL EXAM: deferred due to emergent nature of case

FAMILY HISTORY: Uncle passed away after dissection

SOCIAL HISTORY: works as telecommunication technitian
tob quit 1.5 years ago, 10 pack year history
ETOH denies
drug use denies
Dissection of aorta, thoracic,Dissection of other artery,Rhabdomyolysis,Other respiratory complications,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Aortic valve disorders,Arterial embolism and thrombosis of upper extremity,Hyperosmolality and/or hypernatremia,Marfan syndrome,Subclavian steal syndrome,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Obesity, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Exotropia, unspecified,Visual field defect, unspecified
Dsct of thoracic aorta,Dissection artery NEC,Rhabdomyolysis,Respiratory comp NEC,Pneumonia, organism NOS,Ac kidny fail, tubr necr,Aortic valve disorder,Upper extremity embolism,Hyperosmolality,Marfan syndrome,Subclavian steal syndrom,Drug dermatitis NOS,Adv eff antibiotics NEC,Cardiac dysrhythmias NEC,Obesity NOS,Abn react-artif implant,Exotropia NOS,Visual field defect NOS
Admission Date:  [**2106-3-31**]              Discharge Date:   [**2106-4-22**]

Date of Birth:  [**2068-11-26**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Vancomycin / Zosyn

Attending:[**First Name3 (LF) 165**]
Chief Complaint:
transfer from [**Hospital6 33**] with known aortic Type A
dissection. Awake and c/o throat pain at time of transfer
Cheif complaint at [**Hospital1 34**]: throat pain and chest heaviness

Major Surgical or Invasive Procedure:
[**2106-3-31**] 1. Emergent repair of type A aortic dissection with
Aortic Root Replacement, Bentall procedure with size 29 St. [**Male First Name (un) 923**]
mechanical Valsalva composite graft. 2. Hemiarch replacement
with a size 30 Gelweave graft. 3. Right axillary artery
cannulation.
[**2106-4-1**] 1. Exploration of left subclavian artery followed by
brachial embolectomy after cutdown. 2. Stent of axillary and
subclavian arteries. 3. Arteriography.
[**2106-4-2**] 1. Prophylactic left forearm fasciotomy. 2. Prophylactic
left hand fasciotomy. 3. Left open carpal tunnel release. 4.
Layered closure, medial arm wound.


History of Present Illness:
37 yo man without significant past medical history awoke morning
of admission with sudden onset of cough followed by pain in his
throat.

Past Medical History:
none

Social History:
works as telecommunication technitian
tob quit 1.5 years ago, 10 pack year history
ETOH denies
drug use denies

Family History:
Uncle passed away after dissection

Physical Exam:
deferred due to emergent nature of case

Pertinent Results:
[**2106-3-31**] 03:40PM   PT-13.2 PTT-26.1 INR(PT)-1.1
[**2106-3-31**] 03:40PM   PLT COUNT-346
[**2106-3-31**] 03:40PM   WBC-16.7* RBC-5.18 HGB-16.9 HCT-47.2 MCV-91
MCH-32.6* MCHC-35.7* RDW-13.3
[**2106-3-31**] 03:40PM   CK-MB-4
[**2106-3-31**] 03:40PM   cTropnT-<0.01
[**2106-3-31**] 03:40PM   ALT(SGPT)-31 AST(SGOT)-23 CK(CPK)-177* ALK
PHOS-66 TOT BILI-1.1
[**2106-3-31**] 03:40PM   GLUCOSE-157* UREA N-26* CREAT-1.3* SODIUM-138
POTASSIUM-5.4* CHLORIDE-106 TOTAL CO2-22 ANION GAP-15
[**2106-3-31**] 03:44PM   GLUCOSE-149* LACTATE-3.1* NA+-144 K+-5.4*
CL--104 TCO2-22
[**2106-4-22**] 04:15AM BLOOD WBC-6.3 RBC-2.89* Hgb-8.8* Hct-26.8*
MCV-93 MCH-30.5 MCHC-32.9 RDW-17.3* Plt Ct-514*
[**2106-4-22**] 04:15AM BLOOD Plt Ct-514*
[**2106-4-22**] 04:15AM BLOOD PT-31.2* PTT-40.2* INR(PT)-3.2*
[**2106-4-21**] 05:46AM BLOOD Glucose-100 UreaN-24* Creat-1.0 Na-139
K-4.5 Cl-101 HCO3-29 AnGap-14
[**2106-4-18**] 03:12AM BLOOD ALT-1 AST-19 LD(LDH)-303* AlkPhos-61
Amylase-31 TotBili-0.4
========================================
    [**Known lastname 13613**],[**Known firstname **] [**Medical Record Number 82107**] M  37  [**2068-11-26**]
Radiology Report MR HEAD W/O CONTRAST Study Date of [**2106-4-18**]
7:30 PM
Reason: visual changes in right eye r/o stroke no focal deificts

[**Hospital 93**] MEDICAL CONDITION:
37 year old man with s/p asc aorta replacement with mechanical
AVR
REASON FOR THIS EXAMINATION:visual changes in right eye r/o
stroke no focal deificts
Final Report
MRI OF THE BRAIN WITHOUT GADOLINIUM. MRA OF THE BRAIN USING 3D
TIME-OF-FLIGHT TECHNIQUE.
HISTORY: Status post aortic surgery with visual changes, rule
out stroke.
There are no comparison studies.
FINDINGS:
There is no evidence for acute transcortical ischemia. There is
a
questionable focus of increased DWI signal within the left
cerebellum with no associated mass effect or edema. This could
represent a tiny focus of acute ischemia. This is too small to
characterize on the ADC maps.
No supratentorial evidence for acute ischemia is seen. There is
no mass
effect or midline shift. Intracranial flow voids are maintained.

Bilateral mastoid opacification and under-pneumatization is
seen.
There is mucosal thickening in the left sphenoid sinus.
MRA of the circle of [**Location (un) 431**] is motion-degraded. There is
apparent prominence of the left ophthalmic artery origin which
may be artifactual. Recommend correlation with CTA for further
evaluation.
IMPRESSION:
Questionable tiny focus of possible acute ischemia in the left
inferior
cerebellum, without associated mass effect or edema.
Markedly degraded MRA. Questionable prominence at the origin of
the left
ophthalmic artery. Recommend correlation with CTA.
 DR. [**First Name (STitle) **] [**Name (STitle) 12563**]
===========================================
[**Known lastname 13613**],[**Known firstname **] [**Medical Record Number 82107**] M  37  [**2068-11-26**]
Radiology Report CHEST (PORTABLE AP) Study Date of [**2106-4-18**] 4:39
PM
[**Hospital 93**] MEDICAL CONDITION:  37 year old man with s/p asc
aorta replacement and avr
REASON FOR THIS EXAMINATION: evaluate left lower lobe ? effusion

Final Report
REASON FOR EXAM: SP ascending aorta replacement and AVR.
Followup left lower lobe opacity.
Comparison is made with prior study [**2106-4-13**].
Left lower lobe opacity has improved, but not completely
resolved. The right lung is grossly clear. There are no large
pleural effusions or pneumothorax.
Mild-to-moderate cardiomegaly is stable. Mediastinal widening
has improved.
Mild interstitial edema has improved. Left displacement of the
distal
external wire is unchanged from prior study, new from [**4-10**].
IMPRESSION: Improved, but not complete resolution of left lower
lobe
atelectasis.
Left central venous catheter tip is in the SVC.
DR. [**First Name (STitle) 3901**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3902**]
==============================================
 [**Hospital1 18**] ECHOCARDIOGRAPHY REPORT
[**Known lastname 13613**], [**Known firstname **]       [**Hospital1 18**] [**Numeric Identifier 82108**]Portable
TEE (Complete) Done [**2106-4-2**] at 11:34:03 AM      FINAL
Referring Physician     [**Name9 (PRE) **] Information
[**Name9 (PRE) **], [**First Name3 (LF) **]
Division of Cardiothoracic [**Doctor First Name **]
[**First Name (Titles) **] [**Last Name (Titles) **]
[**Hospital Unit Name 4081**]
[**Location (un) 86**], [**Numeric Identifier 718**]  Status: Inpatient DOB: [**2068-11-26**]
Age (years): 37 M  Hgt (in): 70
BP (mm Hg): 115/65  Wgt (lb): 300
HR (bpm): 113  BSA (m2): 2.48 m2
Indication: Aortic dissection. H/O cardiac surgery. Left
ventricular function. Prosthetic valve function
ICD-9 Codes: 441.00, V43.3
Test Information
Date/Time: [**2106-4-2**] at 11:34    Interpret MD: [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **], MD

Test Type: Portable TEE (Complete) Son[**Name (NI) 930**]: Cardiology
Fellow
Doppler: Full Doppler and color Doppler Test Location: West
SICU/CTIC/VICU
Contrast: None Tech Quality: Adequate
Tape #: 2009W000-0:00 Machine: Vivid i-3
    Sedation: Patient was monitored by a nurse throughout the
procedure
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  55%  >= 55%
Findings
LEFT ATRIUM: No thrombus in the LAA.
RIGHT ATRIUM/INTERATRIAL SEPTUM: A catheter or pacing wire is
seen in the RA. Normal interatrial septum. No ASD by 2D or color
Doppler.
LEFT VENTRICLE: Overall normal LVEF (>55%).
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
AORTA: Aortic arch intimal flap/dissection. Descending aorta
intimal flap/aortic dissection. Flow in false lumen.
AORTIC VALVE: Mechanical aortic valve prosthesis (AVR). Normal
AVR leaflets. Trace AR.
MITRAL VALVE: Normal mitral valve leaflets with trivial MR.
TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR.
PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not well seen.
PERICARDIUM: No pericardial effusion.
GENERAL COMMENTS: A TEE was performed in the location listed
above. I certify I was present in compliance with HCFA
regulations. The patient was monitored by a nurse [**First Name (Titles) **] [**Last Name (Titles) 9833**]
throughout the procedure. The patient was monitored by a nurse
in [**Last Name (Titles) 9833**] throughout the procedure. The patient was under
general anesthesia throughout the procedure. The patient appears
to be in sinus rhythm.
Conclusions
No thrombus is seen in the left atrial appendage. 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. A
mobile density is seen in the aortic arch and descending aorta
consistent with an intimal flap/aortic dissection. There is flow
in the false lumen. A mechanical aortic valve prosthesis is
present. The prosthetic aortic valve leaflets appear normal.
Trace aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no pericardial effusion.
IMPRESSION: Normal biventricular contractile function and normal
appearance of the prosthetic mechanical aortic valve were
visualized. There was no pericardial effusion. The the
dissection in the aortic arch and descending aorta was
visualized.
  I certify that I was present for this procedure in compliance
with HCFA regulations.
Electronically signed by [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **], MD, Interpreting
physician [**Last Name (NamePattern4) **] [**2106-4-2**] 12:02
================================================


Brief Hospital Course:
37 year old male med flighted in from outside hospital, went
directly to operating room for type A dissection repair.  See
operative report for further details.  [**Year (4 digits) **] surgery was
consulted for left arm due to left subclavian dissection.  He
was hemodynamically stable with nitroglycerin and fluid
resuscitation.  He returned to the operating room for
exploration of left subclavian artery and angioplasty by
[**Year (4 digits) 1106**] surgery on postoperative day one.  See operative report
for further details.  Due to prolonged ischemia he underwent
fasciotomy of left arm.  See operative report for further
details.  Over the first few days postoperative days he remained
intubated requiring increased PEEP for hypoxia and supportive
care.  On postoperative day three he had decreased urine output
however myoglobin was decreasing from admission and CK
decreasing from peak of  55,950 and receiving fluid.  He
continued with oliguria and was treated with diuretics but no
response.  Renal was consulted and he was started on
ultrafiltrate for volume removal on [**2106-4-4**].  He remained
intubated and sedated due to volume overload however
hemodynamically stable on heparin for mechanical aortic valve
with resolving rhabdomylosis.  He continued with ultrafiltrate
for fluid removal, and intubated.  On [**4-6**] due to increased
white blood cell count he was started on antibiotics to cover
sputum that had gram negative and gram positive, and lines were
changed.  He developed a rash on vancomycin and zosyn, the
vancomycin was stopped and the zosyn was changed to meropenum.
The rash progressively resolved, and the meropenum was
discontinued after course completed.  He continued on
ultrafiltrate with aggressive fluid removal until [**2106-4-8**], and
he was monitored for the next few days but restarted
ultrafiltrate due to increased ventilatory requirements.  After
volume was removed he was weaned from the ventilator and
extubated on [**4-12**], however due respiratory difficulty and
hypoxia he was reintubated.
He was aggressively diuresed for several additional days. On
[**4-15**] he was again extubated, he remained in the ICU for several
additional days for pulmonary toilet and hemodynamic monitoring.
On [**4-20**] he was transferred from the ICU to the step down floor
where he continued to progress. He was noted to have two
episodes of bradycardia while off oxygen, resolving when oxygen
was replaced.  Therefore, he may benefit from an outpatient
sleep study.  On [**4-22**] he was transferred to rehabilitation at
[**Hospital 38**] Rehabilitation Center.


Medications on Admission:
MVI

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Carvedilol 12.5 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
6. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Warfarin 1 mg Tablet Sig: adjust dose to target INR 2.5-3.0
Tablets PO DAILY (Daily): Target INR 2.5-3.0.
8. Insulin Glargine 100 unit/mL Solution Sig: Thirty (30) units
Subcutaneous once a day.
9. Insulin Lispro 100 unit/mL Solution Sig: sliding scale
Subcutaneous Q AC&HS.
10. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for fever/pain.
11. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO HS (at bedtime) as needed for constipation.
12. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily) as needed for constipation.
13. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl
Topical QID (4 times a day).
14. Clonazepam 0.25 mg Tablet, Rapid Dissolve Sig: One (1)
Tablet, Rapid Dissolve PO three times a day as needed for
anxiety.
15. Valsartan 40 mg Tablet Sig: One (1) Tablet PO once a day.
16. Tramadol 50 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6
hours) as needed for pain.
17. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
18. Ipratropium-Albuterol 18-103 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
19. Fentanyl 50 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr
Transdermal Q72H (every 72 hours).
20. Hydromorphone 2 mg Tablet Sig: 4-6 mg PO Q4H (every 4 hours)
as needed for pain.
21. Oxymetazoline 0.05 % Aerosol, Spray Sig: One (1) Spray Nasal
[**Hospital1 **] (2 times a day) as needed for congestion.
22. Potassium Chloride 20 mEq Packet Sig: One (1) packet PO Q12H
(every 12 hours).
23. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day): hold SBP<110.
24. Lasix 40 mg Tablet Sig: One (1) Tablet PO twice a day.
25. Warfarin 7.5 mg Tablet Sig: One (1) Tablet PO once for 1
days: [**4-22**] dose.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Type A Aortic Dissection, s/p repair
Marfans Syndrome
Obesity
Postop Ischemic Left Arm, s/p repair
Acute Renal Failure secondary to Rhabdomylosis
Postop Pneumonia
Postop Right Eye Visual Deficits


Discharge Condition:
Good

Discharge Instructions:
Take medications as directed in discharge instructions.
Do not drive for 4 weeks.
Do not lift more than 10 pounds for 10 weeks.
Shower daily, let water flow over wounds, pat dry with a towel.
Do not use lotions, powders, or creams on wounds.
Call our office for sternal drainage, redness, temperature
>101.5.

Followup Instructions:
- Dr. [**Last Name (STitle) **](Cardiac Surgery) in one month, call for appt
- Dr. [**Last Name (STitle) 23606**](Plastic Surgery Resident Clinic) on [**2106-4-30**] -
please call [**Telephone/Fax (1) 4652**] for an appointment time
- Dr. [**Last Name (STitle) **](PCP), call for appt
Provider: [**Name10 (NameIs) **] [**Apartment Address(1) 871**] ([**Doctor First Name **]) [**Doctor First Name **] LMOB (NHB)
Phone:[**Telephone/Fax (1) 1237**] Date/Time:[**2106-6-3**] 3:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3469**], MD Phone:[**Telephone/Fax (1) 1237**]
Date/Time:[**2106-6-3**] 3:45
Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Hospital3 1810**] for Genetic Counseling
[**Telephone/Fax (1) 54211**]
Sleep study for sleep apnea as outpatient is recommended


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 173**]

Completed by:[**2106-4-22**]
{'Dissection of aorta, thoracic,Dissection of other artery,Rhabdomyolysis,Other respiratory complications,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Aortic valve disorders,Arterial embolism and thrombosis of upper extremity,Hyperosmolality and/or hypernatremia,Marfan syndrome,Subclavian steal syndrome,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Obesity, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Exotropia, unspecified,Visual field defect, unspecified'}


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: transfer from [**Hospital6 33**] with known aortic Type A
dissection. Awake and c/o throat pain at time of transfer
Cheif complaint at [**Hospital1 34**]: throat pain and chest heaviness

PRESENT ILLNESS: 37 yo man without significant past medical history awoke morning
of admission with sudden onset of cough followed by pain in his
throat.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: MVI

ALLERGIES: Vancomycin / Zosyn

PHYSICAL EXAM: deferred due to emergent nature of case

FAMILY HISTORY: Uncle passed away after dissection

SOCIAL HISTORY: works as telecommunication technitian
tob quit 1.5 years ago, 10 pack year history
ETOH denies
drug use denies 

### Response:
{'Dissection of aorta, thoracic,Dissection of other artery,Rhabdomyolysis,Other respiratory complications,Pneumonia, organism unspecified,Acute kidney failure with lesion of tubular necrosis,Aortic valve disorders,Arterial embolism and thrombosis of upper extremity,Hyperosmolality and/or hypernatremia,Marfan syndrome,Subclavian steal syndrome,Dermatitis due to drugs and medicines taken internally,Other specified antibiotics causing adverse effects in therapeutic use,Other specified cardiac dysrhythmias,Obesity, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Exotropia, unspecified,Visual field defect, unspecified'}
