CHIEF COMPLAINT: Palpitations

PRESENT ILLNESS: 50 year old man with prior MI and Cx stenting in [**2145**], HTN, +
chol, GERD, admitted to Sturdy ER with complaints of
palpitations since thursday. The palpitations are associated
with pain in his throat and neck, and worsen with even mild
exertion. He also describes worsening dyspnea on exertion over
the past 2 weeks. He felt lightheaded while walking today. Today
the palpitations seemed to be more frequent, occuring for
minutes at a time. He had similar palpitations 6 months after
his MI/Cath in [**2146**], that resolved spontaneously. He was seen by
Dr. [**Last Name (STitle) 3100**] recently and had an outpatient stress test that was
notable for inferolateral ischemia by pt report. In the OSH ER
on telemetry, the patient was found to have multiple PVCs,
including periods concerning for non-sustained V-Tach. Upon
admission, he denies chest or throat pain. He does feel
intermittant fluttering. He does not feel short of breath at
rest.

MEDICAL HISTORY: 1. Coronary Artery Disease - history of myocardial infarction
and s/p PCI/stening to circumflex in [**2145**].
2. Hypertension
3. Hyperlipidemia
4. Bifasicular block
5. GERD
6. Cholecystectomy

MEDICATION ON ADMISSION: Atenolol 12.5 QD
Zestril 2.5 QD
Lipitor 20 QD
Prilosec 20 QD
B6-B12-folic acid
Ecotrin 325mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, no JVD
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.

FAMILY HISTORY: His father had a heart attack at age 50

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. HI father had a heart
attack at age 50
Subendocardial infarction, initial episode of care,Paroxysmal supraventricular tachycardia,Other bilateral bundle branch block,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Ostium secundum type atrial septal defect,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Percutaneous transluminal coronary angioplasty status
Subendo infarct, initial,Parox atrial tachycardia,Bilat bb block NEC,Crnry athrscl natve vssl,Hyperlipidemia NEC/NOS,Hypertension NOS,Secundum atrial sept def,Esophageal reflux,Obstructive sleep apnea,Old myocardial infarct,Status-post ptca
Admission Date:  [**2151-8-6**]              Discharge Date:   [**2151-8-14**]

Date of Birth:  [**2094-11-16**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1267**]
Chief Complaint:
Palpitations

Major Surgical or Invasive Procedure:
[**2151-8-7**] Cardiac catheterization
[**2151-8-10**] 1. Four Vessel Coronary Artery Bypass Grafting(left
internal mammary to left anterior descending artery, vein grafts
to obtuse marginal, PLV branch and right coronary artery) 2.
Cryoablation of posterior lateral wall for VT focus


History of Present Illness:
50 year old man with prior MI and Cx stenting in [**2145**], HTN, +
chol, GERD, admitted to Sturdy ER with complaints of
palpitations since thursday. The palpitations are associated
with pain in his throat and neck, and worsen with even mild
exertion. He also describes worsening dyspnea on exertion over
the past 2 weeks. He felt lightheaded while walking today. Today
the palpitations seemed to be more frequent, occuring for
minutes at a time. He had similar palpitations 6 months after
his MI/Cath in [**2146**], that resolved spontaneously. He was seen by
Dr. [**Last Name (STitle) 3100**] recently and had an outpatient stress test that was
notable for inferolateral ischemia by pt report. In the OSH ER
on telemetry, the patient was found to have multiple PVCs,
including periods concerning for non-sustained V-Tach. Upon
admission, he denies chest or throat pain. He does feel
intermittant fluttering. He does not feel short of breath at
rest.


Past Medical History:
1. Coronary Artery Disease - history of myocardial infarction
and s/p PCI/stening to circumflex in [**2145**].
2. Hypertension
3. Hyperlipidemia
4. Bifasicular block
5. GERD
6. Cholecystectomy

Social History:
Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. HI father had a heart
attack at age 50

Family History:
His father had a heart attack at age 50

Physical Exam:
Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, no JVD
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.

Chest: No chest wall deformities, scoliosis or kyphosis.
Non-tender. Resp were unlabored, no accessory muscle use. CTAB,
no crackles, wheezes or rhonchi.
Abd: Soft, NTND. No HSM or tenderness.
Ext: No c/c/e.


Pertinent Results:
[**2151-8-7**] 06:50AM BLOOD WBC-5.5 RBC-4.58* Hgb-15.2 Hct-42.6
MCV-93 MCH-33.2* MCHC-35.7* RDW-14.3 Plt Ct-187
[**2151-8-7**] 06:50AM BLOOD PT-11.5 PTT-24.3 INR(PT)-1.0
[**2151-8-7**] 06:50AM BLOOD Glucose-109* UreaN-16 Creat-1.2 Na-140
K-4.6 Cl-105 HCO3-28 AnGap-12
[**2151-8-6**] 09:51PM BLOOD CK-MB-1 cTropnT-<0.01
[**2151-8-7**] 06:50AM BLOOD CK-MB-1 cTropnT-<0.01
[**2151-8-9**] 12:35PM BLOOD %HbA1c-5.4

[**2151-8-9**] TTE: The left atrium is mildly dilated. The interatrial
septum is aneurysmal. A color Doppler signal of near-continuous
left-to-right shunt is seen across the interatrial septum c/w a
secundum type atrial septal defect. Left ventricular wall
thickness, cavity size, and systolic function are normal
(LVEF>55%). Regional left ventricular wall motion is normal.
Tissue Doppler imaging  suggests a normal left ventricular
filling pressure (PCWP<12mmHg). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
are mildly thickened but aortic stenosis is not present. No
aortic regurgitation is seen. The mitral valve leaflets are
structurally normal. There is no mitral valve prolapse. Mild
(1+) mitral regurgitation is seen. The estimated pulmonary
artery systolic pressure is normal. There is no pericardial
effusion.


Brief Hospital Course:
Mr. [**Known lastname 35389**] was admitted under cardiology. Prior to cardiac
catheterization, he was loaded with Plavix. He remained pain
free on medical therapy but continued to experience symptomatic
runs of non-sustained ventricular tachycardia. Cardiac
catheterization on [**8-7**] revealed severe three vessel
coronary artery disease for which cardiac surgery was consulted.
Routine preoperative evaluation was performed including an EP
consult given his ventricular ectopy. It was felt that the
ventricular tachycardia was ischemia related and agreed with
plans for surgical revascularization. Cryoablation was also
recommended at time of surgical revascularization. A
preoperative echocardiogram was obtained which showed normal
left ventricular wall thickness, cavity size, and systolic
function. There was [**2-16**]+ mitral regurgitation and no aortic
valve disease. It was also notable for a left-to-right shunt
across the interatrial septum at rest, consistent with secundum
atrial septal defect.  His preoperative course was otherwise
uneventful and he was eventually cleared for surgery.

On [**8-10**], Dr. [**Last Name (STitle) **] performed coronary artery bypass
grafting along with cryoablation. For surgical details, please
see seperate dictated operative note. Following the operation,
he was brought to the CSRU for invasive monitoring. Within 24
hours, he awoke neurologically intact and was extubated without
incident. He maintained stable hemodynamics and weaned from
inotropic support without difficulty. Low dose beta blockade was
resumed and he transferred to the SDU on postoperative day two.
He remained in a normal sinus rhythm.

[**8-11**], pt was transfered to the regular cardiax
floor. Here he remained stable. Chest tubes were DC'd in the
usual fashiom. Pacing wires were zDC'd in the usual fashion.
There was no sequele. Pt progressed with PT to a state that he
could go home with VNA services

To note pt did have post operative Afib on the 28th. His Bp was
borderline. We stopped his ace inhibitor and increased his BB.
Pt converted back to NSR. EP was consulted. They confered with
the aforementioned plan.


Medications on Admission:
Atenolol 12.5 QD
Zestril 2.5 QD
Lipitor 20 QD
Prilosec 20 QD
B6-B12-folic acid
Ecotrin 325mg


Discharge Medications:
1. Vitamin C 500 mg Tablet Sig: One (1) Tablet PO once a day for
30 days.
Disp:*30 Tablet(s)* Refills:*0*
2. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
once a day for 4 weeks.
Disp:*28 Tablet(s)* Refills:*0*
3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
4. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed.
5. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO twice a day.
7. Zestril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
8. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
9. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 3
days.
Disp:*3 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
Community VNA

Discharge Diagnosis:
Coronary Artery Disease - s/p CABG
Ventricular Tachycardia - s/p Cryoablation
Atrial Septal Defect
Mild Mitral Regurgitation
Ventricular Tachycardia
History of MI [**2145**]
History of PCI/stenting to circumflex system [**2145**]
Hypertension
Hyperlipidemia
Bifasicular Block

Discharge Condition:
Good

Discharge Instructions:
Patient should shower daily, no baths. No creams, lotions or
ointments to incisions. No driving for at least one month. No
lifting more than 10 lbs for at least 10 weeks from the date of
surgery. Monitor wounds for signs of infection. Please call
cardiac surgeon if start to experience fevers, sternal drainage
and/or wound erythema.


Followup Instructions:
Cardiac surgeon, Dr. [**Last Name (STitle) **] in [**5-20**] weeks.
Local PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in [**3-20**] weeks.
Local cardiologist, Dr. [**Last Name (STitle) 6203**] in [**3-20**] weeks.


Completed by:[**2151-8-14**]
{'Subendocardial infarction, initial episode of care,Paroxysmal supraventricular tachycardia,Other bilateral bundle branch block,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Ostium secundum type atrial septal defect,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}


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: Palpitations

PRESENT ILLNESS: 50 year old man with prior MI and Cx stenting in [**2145**], HTN, +
chol, GERD, admitted to Sturdy ER with complaints of
palpitations since thursday. The palpitations are associated
with pain in his throat and neck, and worsen with even mild
exertion. He also describes worsening dyspnea on exertion over
the past 2 weeks. He felt lightheaded while walking today. Today
the palpitations seemed to be more frequent, occuring for
minutes at a time. He had similar palpitations 6 months after
his MI/Cath in [**2146**], that resolved spontaneously. He was seen by
Dr. [**Last Name (STitle) 3100**] recently and had an outpatient stress test that was
notable for inferolateral ischemia by pt report. In the OSH ER
on telemetry, the patient was found to have multiple PVCs,
including periods concerning for non-sustained V-Tach. Upon
admission, he denies chest or throat pain. He does feel
intermittant fluttering. He does not feel short of breath at
rest.

MEDICAL HISTORY: 1. Coronary Artery Disease - history of myocardial infarction
and s/p PCI/stening to circumflex in [**2145**].
2. Hypertension
3. Hyperlipidemia
4. Bifasicular block
5. GERD
6. Cholecystectomy

MEDICATION ON ADMISSION: Atenolol 12.5 QD
Zestril 2.5 QD
Lipitor 20 QD
Prilosec 20 QD
B6-B12-folic acid
Ecotrin 325mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Gen: WDWN middle aged male in NAD. Oriented x3. Mood, affect
appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa.
Neck: Supple, no JVD
CV: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4.

FAMILY HISTORY: His father had a heart attack at age 50

SOCIAL HISTORY: Social history is significant for the absence of current tobacco
use. There is no history of alcohol abuse. HI father had a heart
attack at age 50 

### Response:
{'Subendocardial infarction, initial episode of care,Paroxysmal supraventricular tachycardia,Other bilateral bundle branch block,Coronary atherosclerosis of native coronary artery,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Ostium secundum type atrial septal defect,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric),Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}
