CHIEF COMPLAINT: Shortness of breath on exertion, Second degree Type II
atrioventricular block.

PRESENT ILLNESS: Mr. [**Known lastname **] is 71 year old male with diabetes, hyperlipidemia,
hypertension, and family history of CAD, who presents with
Second Degree Type II AV Block. Patient reports being in his
normal state of health up until one month ago when routine
stress testing at his cardiologist office showed occasional
second degree Type II AV Block. At that time he was told that
this could be further evaluated in approximately one month and
he may need a pacemaker down the road.  In addition, his
metoprolol was decreased from 50mg to 25mg daily.  For the last
week the patient notes increased shortness of breath with
activity, noting fatigue/shortness of breath when walking [**Age over 90 **]
yards to the mail box. He also endorses occasional dizziness
over the past week with exertion, but no syncope. Patient notes
no other abdominal pain, heart palpitations, or diaphoresis.
Throughout this time patient thought these symptoms were
releated to his COPD. At PCP today patient's ECG showed type II
Second Degree AV block. Was sent to ED. In ED at OSH Dr. [**Last Name (STitle) 11493**]
sent patient to [**Hospital1 18**] for pacmaker placement.

MEDICAL HISTORY: 1. Diabetes Mellitus
2. Dyslipidemia
3. Hypertension
4. Cardiac History: Cath 10 years ago that showed two 30%
lesions. RBBB, Pt notes this has been stable since
childhood/teens
5. Asthma/COPD- 12 years
6. Osteoarthritis
7. Obesity

MEDICATION ON ADMISSION: FLUTICASONE-SALMETEROL [ADVAIR DISKUS]:250 mcg-50 mcg/Dose, 1
puff [**Hospital1 **]
LISINOPRIL: 20mg Daily
METFORMIN: 750mg [**Hospital1 **]
METOPROLOL SUCCINATE [TOPROL XL]: 25mg Daily
SIMVASTATIN [ZOCOR]: 40mg Daily
ASPIRIN: 325 mg Tablet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T= 98.1 BP=144/51 HR= 42 RR=20 O2 sat= 97% room air
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: Sclera anicteric. PERRL, EOMI.
NECK: Supple, JVP difficult to evaluate given body habitus
CARDIAC: Distant heart sounds. Normal S1, S2. No m/r/g.
LUNGS: Resp were unlabored, no accessory muscle use. Rales
bilateral bases. No wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Radial 2+ DP 2+ PT 2+
Left: Radial 2+ DP 2+ PT 2+

FAMILY HISTORY: Father died of MI at age 75.

SOCIAL HISTORY: - Tobacco history: Quit 15 years ago, 3 ppd for 30 years prior
- ETOH: Once yearly on Super Bowl Sunday
- Illicit drugs:  None
Other second degree atrioventricular block,Chronic obstructive asthma, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Av block-2nd degree NEC,Chronic obst asthma NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2188-8-19**]              Discharge Date:   [**2188-8-21**]

Date of Birth:  [**2116-10-7**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Doctor First Name 1402**]
Chief Complaint:
Shortness of breath on exertion, Second degree Type II
atrioventricular block.

Major Surgical or Invasive Procedure:
Placement of dual chamber [**Company 1543**] pacemaker

History of Present Illness:
Mr. [**Known lastname **] is 71 year old male with diabetes, hyperlipidemia,
hypertension, and family history of CAD, who presents with
Second Degree Type II AV Block. Patient reports being in his
normal state of health up until one month ago when routine
stress testing at his cardiologist office showed occasional
second degree Type II AV Block. At that time he was told that
this could be further evaluated in approximately one month and
he may need a pacemaker down the road.  In addition, his
metoprolol was decreased from 50mg to 25mg daily.  For the last
week the patient notes increased shortness of breath with
activity, noting fatigue/shortness of breath when walking [**Age over 90 **]
yards to the mail box. He also endorses occasional dizziness
over the past week with exertion, but no syncope. Patient notes
no other abdominal pain, heart palpitations, or diaphoresis.
Throughout this time patient thought these symptoms were
releated to his COPD. At PCP today patient's ECG showed type II
Second Degree AV block. Was sent to ED. In ED at OSH Dr. [**Last Name (STitle) 11493**]
sent patient to [**Hospital1 18**] for pacmaker placement.

In the CCU, pt asymptomatic in bed with a heart rate of 33 and
blood pressure of 134/64. Patient denies any current shortness
of breath, dizziness, chest pain, or palpitations.  On
evaluation by the EP service on admission, carotid massage was
noted to resolve AV block resulting in 1:1 conduction.

On review of systems, He denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. S/he denies recent fevers, chills or
rigors. He denies exertional buttock or calf pain. All of the
other review of systems were negative.

Cardiac review of systems is notable for absence of chest pain,
paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, or syncope.

Past Medical History:
1. Diabetes Mellitus
2. Dyslipidemia
3. Hypertension
4. Cardiac History: Cath 10 years ago that showed two 30%
lesions. RBBB, Pt notes this has been stable since
childhood/teens
5. Asthma/COPD- 12 years
6. Osteoarthritis
7. Obesity

Social History:
- Tobacco history: Quit 15 years ago, 3 ppd for 30 years prior
- ETOH: Once yearly on Super Bowl Sunday
- Illicit drugs:  None

Family History:
Father died of MI at age 75.

Physical Exam:
VS: T= 98.1 BP=144/51 HR= 42 RR=20 O2 sat= 97% room air
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: Sclera anicteric. PERRL, EOMI.
NECK: Supple, JVP difficult to evaluate given body habitus
CARDIAC: Distant heart sounds. Normal S1, S2. No m/r/g.
LUNGS: Resp were unlabored, no accessory muscle use. Rales
bilateral bases. No wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Radial 2+ DP 2+ PT 2+
Left: Radial 2+ DP 2+ PT 2+

Pertinent Results:
Admission Labs:
[**2188-8-19**] WBC-10.9 RBC-4.48* Hgb-13.6* Hct-39.6* MCV-88 MCH-30.3
MCHC-34.3 RDW-13.4 Plt Ct-250
[**2188-8-19**] Glucose-216* UreaN-17 Creat-1.2 Na-140 K-4.7 Cl-106
HCO3-22 AnGap-17
[**2188-8-19**] Calcium-9.7 Phos-3.6 Mg-1.9
[**2188-8-19**] PT-12.2 PTT-26.9 INR(PT)-1.0

Discharge Labs:

[**2188-8-21**] 05:15AM BLOOD WBC-10.2 RBC-4.75 Hgb-13.7* Hct-42.5
MCV-89 MCH-28.9 MCHC-32.3 RDW-13.0 Plt Ct-227
[**2188-8-21**] 05:15AM BLOOD Glucose-165* UreaN-17 Creat-1.1 Na-138
K-4.8 Cl-105 HCO3-24 AnGap-14
[**2188-8-21**] 05:15AM BLOOD Calcium-9.4 Phos-3.6 Mg-2.2

EKG: #1
Sinus bradycardia. Prolonged P-R interval. Left atrial
abnormality.
Right bundle-branch block. Blocked atrial premature beat. No
previous tracing available for comparison.

EKG: #2
Sinus bradycardia. Left atrial abnormality. Right bundle-branch
block.
Compared to the previous tracing atrial ectopy is no longer
present.


Brief Hospital Course:
Mr. [**Known lastname **] is 71 year old male with diabetes, hyperlipidemia,
hypertension, COPD and family history of CAD, who complains of
dyspnea on exertion for the past week and was found to have
Second Degree Type II AV Block at a PCP [**Name Initial (PRE) **].

# RHYTHM: He was admitted with Mobitz Type II heart block on
ECG. The block was infranodal and conduction improved with
carotid massage.  He remained stable overnight after admission
with heart rate in the 30's.  He then had a dual chamber
[**Company 1543**] pacemaker placed without complications with HV time of
85msec. Afterword, he remained in a ventricular paced rhythm. He
was maintained on metoprolol 25mg [**Hospital1 **]. CXR after pacemaker
placement showed appropriate lead placement.

# CORONARIES/PUMP: Patient has not recently had a cardiac
catheterization or echo.  He reports a cardiac cath 10 years ago
which showed two 30% lesions.  Continued aspirin 325mg po daily
and his home dose of simvastatin 40mg po daily.  He was also
continued on metoprolol as above.

# HYPERTENSION: Continued home lisinopril 20mg daily and
metoprolol as above.

# DIABETES: The patient was maintained on an insulin sliding
scale during admission.  Metformin was restarted at discharge.

# COPD: He had no issues during this admission and was continued
home Advair 250 mcg/50 mcg [**Hospital1 **], and albuterol as needed.

# HYPERLIPIDEMIA: Continued home simvastatin 40mg po daily.

Patient was FULL CODE during this admission.

Medications on Admission:
FLUTICASONE-SALMETEROL [ADVAIR DISKUS]:250 mcg-50 mcg/Dose, 1
puff [**Hospital1 **]
LISINOPRIL: 20mg Daily
METFORMIN: 750mg [**Hospital1 **]
METOPROLOL SUCCINATE [TOPROL XL]: 25mg Daily
SIMVASTATIN [ZOCOR]: 40mg Daily
ASPIRIN: 325 mg Tablet

Discharge Medications:
1. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 2 days: Please take this medication for 2 days
after your procedure.
Disp:*8 Capsule(s)* Refills:*0*
5. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1)  Inhalation twice a day.
6. Metformin 500 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
7. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO once a day.
Tablet Sustained Release 24 hr(s)


Discharge Disposition:
Home

Discharge Diagnosis:
Second Degree Type II Heart Block
Coronary Heart disease
Diabetes Mellitus Type 2
Hyperlipidemia


Discharge Condition:
Stable. afebrile.


Discharge Instructions:
You were admitted to the hospital due to a slow heart rate.  You
had a slow heart rate because there was a block in the
conduction system in your heart.  To fix this problem, you
received a pacemaker ([**Name (NI) 1543**] dual chamber pacemaker).  You
will need to keep the dressing over the pacemaker clean and dry
for one week until your appointment with the device clinic. You
cannot shower but may take a bath as long as the dressing stays
dry. You will take antibiotics for 2 days to prevent an
infection at the site. You cannot lift your left arm over your
head for 6 weeks, including no activities such as swimming or
tennis. No carrying more than 5 pounds for 6 weeks with your
left arm. Please see the discharge instructions regarding
pacemakers that was given to you at discharge.

Medication changes:
1. Cephalexin: to take for 48 hours to prevent an infection at
the pacer site.

Please call Dr. [**Last Name (STitle) 11493**] or Dr. [**Last Name (STitle) 1911**] if you notice any
increasing swelling, bruising, bleeding or increasing pain at
the pacer site. If the pacer site is sore, you can take Tylenol.
Also call Dr. [**Last Name (STitle) 11493**] or Dr. [**Last Name (STitle) 1911**] for fevers, chills,
dizziness, chest pain or trouble breathing.

Followup Instructions:
DEVICE CLINIC Phone:[**Telephone/Fax (1) 62**] Date/Time: [**2188-8-26**] 2:00.
[**Hospital Ward Name 23**] clinical Center, [**Hospital Ward Name 516**]. [**Location (un) **] [**Location (un) 86**]

Follow up with Dr. [**Last Name (STitle) 11493**] or Dr. [**Last Name (STitle) 1911**] in 2 months phone:
[**Telephone/Fax (1) **] or ([**Telephone/Fax (1) 76272**]

Follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 20585**] within the next Month.
([**Telephone/Fax (1) 76673**] can talk to Dr. [**Last Name (STitle) 1911**] about another
PCP.
{'Other second degree atrioventricular block,Chronic obstructive asthma, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,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: Shortness of breath on exertion, Second degree Type II
atrioventricular block.

PRESENT ILLNESS: Mr. [**Known lastname **] is 71 year old male with diabetes, hyperlipidemia,
hypertension, and family history of CAD, who presents with
Second Degree Type II AV Block. Patient reports being in his
normal state of health up until one month ago when routine
stress testing at his cardiologist office showed occasional
second degree Type II AV Block. At that time he was told that
this could be further evaluated in approximately one month and
he may need a pacemaker down the road.  In addition, his
metoprolol was decreased from 50mg to 25mg daily.  For the last
week the patient notes increased shortness of breath with
activity, noting fatigue/shortness of breath when walking [**Age over 90 **]
yards to the mail box. He also endorses occasional dizziness
over the past week with exertion, but no syncope. Patient notes
no other abdominal pain, heart palpitations, or diaphoresis.
Throughout this time patient thought these symptoms were
releated to his COPD. At PCP today patient's ECG showed type II
Second Degree AV block. Was sent to ED. In ED at OSH Dr. [**Last Name (STitle) 11493**]
sent patient to [**Hospital1 18**] for pacmaker placement.

MEDICAL HISTORY: 1. Diabetes Mellitus
2. Dyslipidemia
3. Hypertension
4. Cardiac History: Cath 10 years ago that showed two 30%
lesions. RBBB, Pt notes this has been stable since
childhood/teens
5. Asthma/COPD- 12 years
6. Osteoarthritis
7. Obesity

MEDICATION ON ADMISSION: FLUTICASONE-SALMETEROL [ADVAIR DISKUS]:250 mcg-50 mcg/Dose, 1
puff [**Hospital1 **]
LISINOPRIL: 20mg Daily
METFORMIN: 750mg [**Hospital1 **]
METOPROLOL SUCCINATE [TOPROL XL]: 25mg Daily
SIMVASTATIN [ZOCOR]: 40mg Daily
ASPIRIN: 325 mg Tablet

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T= 98.1 BP=144/51 HR= 42 RR=20 O2 sat= 97% room air
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: Sclera anicteric. PERRL, EOMI.
NECK: Supple, JVP difficult to evaluate given body habitus
CARDIAC: Distant heart sounds. Normal S1, S2. No m/r/g.
LUNGS: Resp were unlabored, no accessory muscle use. Rales
bilateral bases. No wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness.
EXTREMITIES: No c/c/e.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Radial 2+ DP 2+ PT 2+
Left: Radial 2+ DP 2+ PT 2+

FAMILY HISTORY: Father died of MI at age 75.

SOCIAL HISTORY: - Tobacco history: Quit 15 years ago, 3 ppd for 30 years prior
- ETOH: Once yearly on Super Bowl Sunday
- Illicit drugs:  None 

### Response:
{'Other second degree atrioventricular block,Chronic obstructive asthma, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
