CHIEF COMPLAINT: Intubated status post ventricular
fibrillation arrest.

PRESENT ILLNESS: This is a 50-year-old male with
known coronary artery disease who collapsed suddenly in the
park while standing with his wife by their car.  His wife
started CPR immediately.  EMS was called at 8:56 and arrived
at 9:02.  The patient was found to be unconscious without
pulses or spontaneous breathing.  He was shocked immediately
at 200 joules and 300 joules for ventricular fibrillation and
went into to asystole.  CPR was restarted and patient was
intubated.  He was shocked again at 360 joules for
ventricular fibrillation at 9:08 and went in to
idioventricular rate which then converted to sinus rate.  He
received Amiodarone, heparin and Nitroglycerin drip.

MEDICAL HISTORY: Coronary artery disease status post
silent myocardial infarction.  Last cath [**2190-6-9**] at
outside hospital in [**State **].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father had his first MI at age 54.

SOCIAL HISTORY: Former smoker with 30 pack year history,
stopped [**2188-6-9**].  Alcohol, one beer per night.
Ventricular fibrillation,Anoxic brain damage,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Pure hypercholesterolemia
Ventricular fibrillation,Anoxic brain damage,Pneumonia, organism NOS,Crnry athrscl natve vssl,Old myocardial infarct,Pure hypercholesterolem
Admission Date:  [**2190-11-22**]     Discharge Date:  [**2190-11-26**]

Date of Birth:   [**2131-8-22**]     Sex:  M

Service:  CCU

CHIEF COMPLAINT:  Intubated status post ventricular
fibrillation arrest.

HISTORY OF PRESENT ILLNESS:  This is a 50-year-old male with
known coronary artery disease who collapsed suddenly in the
park while standing with his wife by their car.  His wife
started CPR immediately.  EMS was called at 8:56 and arrived
at 9:02.  The patient was found to be unconscious without
pulses or spontaneous breathing.  He was shocked immediately
at 200 joules and 300 joules for ventricular fibrillation and
went into to asystole.  CPR was restarted and patient was
intubated.  He was shocked again at 360 joules for
ventricular fibrillation at 9:08 and went in to
idioventricular rate which then converted to sinus rate.  He
received Amiodarone, heparin and Nitroglycerin drip.

During his ambulance ride to the [**Hospital6 33**], he
went back into ventricular tachycardia again and lost pulses.
He was again shocked at 360 joules for two times and went
back into sinus and stayed in sinus since 9:32.  On his
arrival to the [**Hospital3 **] Emergency Room his heart rate was
80, blood pressure 157/70.  He received 2 mg Versed, 100 mcg
Fentanyl and an 8 mg Pavulon.  His blood pressure dropped to
60/30 for which he was given IV fluids and Dopamine.  His EKG
showed ST elevation in leads III, aVF and ST depression in I,
aVL and V1 through V5 which was suggested of inferior MI.

He was given aspirin, Lopressor and started on a heparin
drip.  He was transferred to [**Hospital1 188**] for PTCA.  On his arrival to the Cath lab, he was on
Amiodarone and Dopamine drip.  In the Cath lab no acute
changes were identified compared to his last cath done in [**2190-6-9**], therefore no intervention has been performed.  He
tolerated the procedure well and was weaned off Dopamine.  He
remained on Amiodarone drip upon his arrival to the CCU.

PAST MEDICAL HISTORY:  Coronary artery disease status post
silent myocardial infarction.  Last cath [**2190-6-9**] at
outside hospital in [**State **].

MEDICATIONS:
1.  Lisinopril 20 mg q.d.
2.  Aspirin 160 q.d.
3.  Lovastatin 40 mg q.d.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  Father had his first MI at age 54.

SOCIAL HISTORY:  Former smoker with 30 pack year history,
stopped [**2188-6-9**].  Alcohol, one beer per night.

PHYSICAL EXAMINATION:  On arrival to CCU temperature 92.6
F-O, heart rate 50, blood pressure 106/63, O2 sat 100% on
vent, FIO2 0.6.  In general intubated, awake following simple
commands.  Cardiovascular:  Normal S1, S2.  Lungs:  Bilateral
equal breath sounds.  Abdomen:  Soft, nondistended,
nontender.  Extremities:  No edema.  Neuro:  Nonfocal exam.

LABORATORY:  At [**Hospital6 33**], white count 16.1,
hematocrit 45.6, platelets 261,000.  Chem-7 with a sodium of
140, potassium 3.7, chloride 98, bicarbonate 17, BUN 21,
creatinine 1.3, glucose 348, calcium 10.  PT 15.3, PTT 30.8,
INR 1.1.  Total bilirubin 0.4, ALT 198, AST 257, troponin
0.2.

Chest x-ray with cardiomegaly, no infiltrates. Endotracheal
tube tip at level of aortic arch.

EKG with ST elevation in II, aVF, ST depression in I, aVL, V1
to V5.

Cath report [**2190-6-9**] at outside hospital in [**State **].
Occlusion of mid RCA and OM1, large normal LAD, large
diagonal 1 with 50 to 60% of narrowing, akinetic posterior
basal segment with ejection fraction of 35%.

Labs on arrival to CCU with a white count of 13.7, hematocrit
of 43.5, platelets 217, sodium 138, potassium 3.6, chloride
104, bicarbonate 20, BUN 22, creatinine 1.0, glucose 213,
calcium 7.7, phosphorus 4.3, magnesium 2.3.  CK 307.

ABG 7.22, 45, 157 at vent setting of total volume of 700,
rate of 12, PEEP of 5 and FIO2 of 1.

Cath report at [**Hospital1 69**] showed
left [**Known lastname **] coronary artery 30% of diffuse disease;  LAD, twin
LAD with large diagonal branch with 70% of mid stenosis, mild
LAD disease, left circumflex, occlusion OM1, patent OM2,
occlusion of distal left circumflex with collateral RCA
occlusion with left to right collaterals.   RA pressure with
mean of 15, PA pressure of 46/26 with a mean of 35, wedge of
20.

Chest x-ray shows endotracheal tube and NG tube in
appropriate place, pulmonary edema, left lower lobe collapse
versus consolidation.

EKG post cath with a sinus rate; improved ST depression in V1
to V6.

HOSPITAL COURSE:  He regained his consciousness quickly off
sedation and was extubated without any difficulty on hospital
day #2.  Since he collapsed suddenly while standing, a head
CT Scan was also obtained to rule out any head trauma.  He
had no focal neurological deficit except for some mild
cognitive impairment.  He was evaluated by PT and OT before
discharge and outpatient cognitive therapy was recommended.

Given the test results on admission, the ventricular
fibrillation arrest was likely scar mediated instead of
primary ischemia.  It was evaluated by Electrophysiology
Service and an AICD was placed on hospital day #3 without any
complications.  He had no events on Telemetry while in the
hospital, but decision was made to continue Amiodarone for
arrhythmia prevention.  He had been treated with a seven day
course of Levaquin for possible pneumonia given initial chest
x-ray finding and his low grade temperature of 100.0 F.  He
also received a course of prophylactic Vancomycin and Keflex
for AICD placement.

He complained of chest pain with deep breathing which was
likely due to the CPR and multiple shocks he received prior
to admission.  He was given Tylenol and Tylenol #3 for pain
control since Percocet makes him hallucinate.  He had never
complained of shortness of breath while in the hospital and
maintained O2 saturation in the 90s on room air.  However he
was found to desaturate to 86 with ambulating and two liters
of nasal cannula made his O2 saturation go back to 90,
although he had no complaints of dyspnea during the
desaturation.  He was sent home with temporary O2 supplement.

Since he appeared to improve his O2 saturation with deep
breathing, the desaturation may be due to his inability to
take deep breaths secondary to pain; however given the
toxicity profile of Amiodarone, the patient was advised to
have outpatient pulmonary function tests, thyroid function
tests and liver function test monitoring.

Most recent labs on discharge showed a white count of 9.5,
hematocrit 34.2 and stable, platelets 167, sodium 139,
potassium 4.1, chloride 102, bicarbonate 28, BUN 14,
creatinine 0.9, glucose 99, calcium 8.7, magnesium 1.9, phos
3.0.  PT 12.9, PTT 25, INR 1.2.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  Home.

DISCHARGE MEDICATIONS:
1.  Aspirin 325 q.d.
2.  Metoprolol 25 b.i.d.
3.  Lisinopril 10 q.d.
4.  Amiodarone 400 b.i.d. for two weeks, 400 q.d. for one
month, 200 q.d. for maintenance.
5.  Lasix 20 mg q.d.
6.  Potassium 20 mEq q.d.
7.  Lovastatin 40 mg q.d.
8.  Sublingual Nitroglycerin p.r.n.
9.  Keflex 500 q.i.d. for four days.
10. Levaquin 500 q.d. for seven days.
11. Tylenol #3.

DISCHARGE FOLLOW UP:
1.  Device Clinic in one week on [**2190-12-2**] at 1:30 PM.
2.  Outpatient follow up with PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 7474**] [**Name (STitle) 44683**],
cardiologist in [**State **].

ADDENDUM:  Patient also had a transthoracic echocardiogram
performed on admission.  The TTE showed left ventricle cavity
is dilated, overall left ventricular systolic function
severely depressed, ejection fraction less than 15%.  The LV
cavity is also dilated. There is severe global right
ventricle free wall hypokinesis.  The aortic valve appears
grossly normal.  The mitral valve leaflets are structurally
normal.  There is moderate thickening of the mitral valve
chordae.  Trivial mitral valve regurgitation is also seen.
There is no pericardial effusion.  This suggests severely
depressed ejection fraction of less than 15%, may be due to
stunned myocardium secondary to the shocks.  A copy of the
echocardiogram and cath report was given to the patient's
wife.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D.  [**MD Number(1) 1009**]

Dictated By:[**Last Name (NamePattern1) 225**]

MEDQUIST36

D:  [**2190-11-27**]  17:31
T:  [**2190-11-30**]  16:37
JOB#:  [**Job Number 44684**]

cc:[**Telephone/Fax (1) 44685**]
{'Ventricular fibrillation,Anoxic brain damage,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Pure hypercholesterolemia'}


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: Intubated status post ventricular
fibrillation arrest.

PRESENT ILLNESS: This is a 50-year-old male with
known coronary artery disease who collapsed suddenly in the
park while standing with his wife by their car.  His wife
started CPR immediately.  EMS was called at 8:56 and arrived
at 9:02.  The patient was found to be unconscious without
pulses or spontaneous breathing.  He was shocked immediately
at 200 joules and 300 joules for ventricular fibrillation and
went into to asystole.  CPR was restarted and patient was
intubated.  He was shocked again at 360 joules for
ventricular fibrillation at 9:08 and went in to
idioventricular rate which then converted to sinus rate.  He
received Amiodarone, heparin and Nitroglycerin drip.

MEDICAL HISTORY: Coronary artery disease status post
silent myocardial infarction.  Last cath [**2190-6-9**] at
outside hospital in [**State **].

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father had his first MI at age 54.

SOCIAL HISTORY: Former smoker with 30 pack year history,
stopped [**2188-6-9**].  Alcohol, one beer per night. 

### Response:
{'Ventricular fibrillation,Anoxic brain damage,Pneumonia, organism unspecified,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Pure hypercholesterolemia'}
