CHIEF COMPLAINT: Syncope and lsot of consciousness

PRESENT ILLNESS: 84 y/o M (hard of hearing) with h/o HTN, ?CAD p/w syncope. He is
a school monitor who was at the school. He says that he was
watching kids play and he passed out. The next thing he
remembers was that he was in the SICU at [**Hospital1 18**].
Per EMS, a child intiated rescue breathing at the school.
Patient had a laceration to the back of the head and was
unresponsive. He was then intubated by EMS for airway protection
and flown to [**Hospital1 18**]. Eventually extubated in the SICU and doing
well.
.
ROS: Pt has h/o of DOE; he says that he can climb one flight of
stairs. He had an episode of dizziness last year when he stood
up from sitting position. He also has some swelling of feet for
the past 2 years which has been waxing and [**Doctor Last Name 688**]. No h/o of
chest pain, palpitations, n/v/diaphoresis. No h/o of any
transient loss of vision/blurriness. His bowel and bladder
habits are normal.

MEDICAL HISTORY: PMHx:
HTN
CAD: EF 40-45% w/ hypokinesis of post/lat walls w/ moderate
decrease in overall systolic fn of left ventricle
Squamous cell carcinoma s/p PPN, intravesicular mitomycin '[**05**]
Diverticulosis causing rectal bleeding
Sigmoid polyps
Hemorhoids
Shingles
Melanoma
.
PSHx:
Hernia repair x2
Ear surgeries for Melanoma resection
Anal fissure

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals: 98.6, 124/71, 89, 16, 95%/RA
Gen: confortable, alert awake, oriented x3
HEENT: PERRLA, EOMI, Anicteric, Carotid Bruit on left
Heart: S1/S2, Trigeminy, no m/r/g
Lungs: CTAB
Abd: soft, obese, NT
Ext: 2+ bilateral edema
Skin: Occipital lac
Neuro: hard of hearing, no focal deficits

FAMILY HISTORY: Mother Died of Kidney disease
[**Name (NI) 62283**] a violent death

SOCIAL HISTORY: Lives at home in [**Location (un) **]; has a 15 pack smoking history;
occasional drinking. He used to work in Navy as a transporter.
Syncope and collapse,Atrial fibrillation,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Other primary cardiomyopathies,Open wound of scalp, without mention of complication,Other fall,Open wound of auricle, ear, without mention of complication,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other conjunctivitis
Syncope and collapse,Atrial fibrillation,Acute kidney failure NOS,Urin tract infection NOS,CHF NOS,Prim cardiomyopathy NEC,Open wound of scalp,Fall NEC,Open wound of auricle,Ocl mlt bi art wo infrct,Hypertension NOS,Crnry athrscl natve vssl,Conjunctivitis NEC
Admission Date:  [**2116-12-10**]              Discharge Date:   [**2116-12-20**]


Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Syncope and lsot of consciousness

Major Surgical or Invasive Procedure:
Dual Chamber Pace Maker Placement
Intubation


History of Present Illness:
84 y/o M (hard of hearing) with h/o HTN, ?CAD p/w syncope. He is
a school monitor who was at the school. He says that he was
watching kids play and he passed out. The next thing he
remembers was that he was in the SICU at [**Hospital1 18**].
Per EMS, a child intiated rescue breathing at the school.
Patient had a laceration to the back of the head and was
unresponsive. He was then intubated by EMS for airway protection
and flown to [**Hospital1 18**]. Eventually extubated in the SICU and doing
well.
.
ROS: Pt has h/o of DOE; he says that he can climb one flight of
stairs. He had an episode of dizziness last year when he stood
up from sitting position. He also has some swelling of feet for
the past 2 years which has been waxing and [**Doctor Last Name 688**]. No h/o of
chest pain, palpitations, n/v/diaphoresis. No h/o of any
transient loss of vision/blurriness. His bowel and bladder
habits are normal.


Past Medical History:
PMHx:
HTN
CAD: EF 40-45% w/ hypokinesis of post/lat walls w/ moderate
decrease in overall systolic fn of left ventricle
Squamous cell carcinoma s/p PPN, intravesicular mitomycin '[**05**]
Diverticulosis causing rectal bleeding
Sigmoid polyps
Hemorhoids
Shingles
Melanoma
.
PSHx:
Hernia repair x2
Ear surgeries for Melanoma resection
Anal fissure


Social History:
Lives at home in [**Location (un) **]; has a 15 pack smoking history;
occasional drinking. He used to work in Navy as a transporter.

Family History:
Mother Died of Kidney disease
[**Name (NI) 62283**] a violent death


Physical Exam:
Vitals: 98.6, 124/71, 89, 16, 95%/RA
Gen: confortable, alert awake, oriented x3
HEENT: PERRLA, EOMI, Anicteric, Carotid Bruit on left
Heart: S1/S2, Trigeminy, no m/r/g
Lungs: CTAB
Abd: soft, obese, NT
Ext: 2+ bilateral edema
Skin: Occipital lac
Neuro: hard of hearing, no focal deficits


Pertinent Results:
ECHO Study Date of [**2116-12-15**]
The left atrium is dilated. The left ventricular cavity size is
normal. LV
systolic function appears depressed with inferolateral
hypokinesis and mild hypokinesis elsewhere (estimated ejection
fraction ?40%). The aortic valve  leaflets are mildly thickened.
There is no aortic valve stenosis. No aortic regurgitation is
seen. The mitral valve leaflets are mildly thickened. Mild  (1+)
mitral regurgitation is seen. The tricuspid valve leaflets are
mildly  thickened. There is mild pulmonary artery systolic
hypertension. There is an  anterior space which most likely
represents a fat pad, though a loculated  anterior pericardial
effusion cannot be excluded.
*
EEG Study Date of [**2116-12-12**]
Mildly abnormal EEG with some focal slowing noted over the
right temporal region intermittently, and further anatomic
correlation
is recommended.
*
CT CHEST/ABDOMEN/PELVIS W/CONTRAST [**2116-12-10**]
1. Numerous ovoid high-attenuation foci in the stomach which
could represent swallowed pills.
2. Orogastric tube tip in the distal esophagus.
3. Bilateral renal cysts.
*
CT CERVIAL SPINE
No evidence of fracture or subluxation.
*
CT HEAD
Left scalp hematoma. No evidence of an acute intracranial
hemorrhage.
*
CAROTID SERIES COMPLETE  [**2116-12-14**]
Moderate plaque with a left 40-59% and a right less than 40%
carotid stenosis.

Brief Hospital Course:
# Syncope: Unclear if pt tripped or had syncopal episode. He was
not orthostatic on examination. Initially he had bigemies and
trigeminies. However eventually he developed Afib a few days
after admission. ECHO showed LV sys function depressed with
inferolateral hypokinesis with EF of around 40%. EF unchanged
from prior ECHO done few year back at OSH.  Carotid USG shows
moderated stenosis in both Carotids. The EMS EKG tracings showed
evidence of pauses. This could have potentially caused him to
have a syncope. Read below for further management of
dysrhythmia.
.
# Afib: Per his PCP, [**Name10 (NameIs) **] had rhythm disturbances in the past but
never had Afib. During this admission, he developed Afib. He was
started on Metoprolol which was increased to 75 TID. This did
not rate control him. He was then given IV bolus of 25 mg Dilt
for rate control and then started on Dilt drip. He was later put
on 90 mg Dilt PO QID and transitioned to long acting Dilt 360 mg
QD. EP evaluated him and decided to place Dual Chamber Pacer
which was placed on [**2116-12-18**]. He was also started on Coumadin
during this admission. He will follow up with the Device clinic
at [**Hospital1 18**].
.
# UTI: Initially after admission, he developed UIT. He also had
a foley placed on admission which was D/C'ed. He was started on
Ciprofloxacin and completed a 7 day course of it. He was not
sent home on Ciprofloxacin.
.
# Rising Creatinine: on admission, his creatinine was 1.3 which
increased to 1.5 as he was on lasix intially. Lasix was then
discontinued. His creatinine remained stable at 1.5 during the
course of this admission.
.
#DOE: had DOE at baseline. ECHo was done which showed EF of 40%
with inferolateral hypokinesis. He could also have an element of
COPD. We recommended outpatient PFT's.
.
# HTN: He was continued on Atenolol, Lisinopril.
.
# Laceration: He had laceration/abrasions on his scalp from his
initial syncopal fall. He received wound care for that.

Discharge Medications:
1. Keflex 500 mg Capsule Sig: One (1) Capsule PO twice a day for
4 doses.
Disp:*4 Capsule(s)* Refills:*0*
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Warfarin 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
Disp:*30 Tablet(s)* Refills:*2*
5. Diltiazem HCl 360 mg Capsule, Sustained Release Sig: One (1)
Capsule, Sustained Release PO DAILY (Daily).
Disp:*30 Capsule, Sustained Release(s)* Refills:*2*
6. Erythromycin 5 mg/g Ointment Sig: One (1) application
Ophthalmic  QID (4 times a day) for 1 weeks.
Disp:*28 application* Refills:*0*
7. Outpatient Lab Work
Please get your INR, Creatinine checked and report it to your
primary care physician.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Syncope
Atrial Fibrillation


Discharge Condition:
All vitals are stable.


Discharge Instructions:
Please take all your medications and follow up with all your
appointments. Please report to the ED or to your physician if
you have any chest pain/discomfort, palpitations, dizziness or
any concerns at all.
.
Please get your INR checked on Monday [**12-21**] in your Primary care
Physician's clinic. Please discuss this with your primary care
physician and adjust the dose of Coumadin. Please also get your
Creatinine checked at the same time.
.
Please take oral antibiotics for 2 days after discharge.
.
Please follow up with the Device clinic at [**Hospital1 18**] for your
Pacemaker check.

Followup Instructions:
You have a follow up appointment in the Device Clinic at [**Hospital1 18**].
Provider:  [**Name10 (NameIs) 676**] CLINIC Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2116-12-28**]
3:00
.
Please Call to schedule with your Primary Care Physician.
[**Name Initial (NameIs) 2169**]: [**Name10 (NameIs) **],[**Name11 (NameIs) 1955**] [**Name Initial (NameIs) **]  [**Telephone/Fax (1) 62284**]  appointment
.
Other appointments that you can make:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 9472**]  Call to schedule
appointment



Completed by:[**2116-12-23**]
{'Syncope and collapse,Atrial fibrillation,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Other primary cardiomyopathies,Open wound of scalp, without mention of complication,Other fall,Open wound of auricle, ear, without mention of complication,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other conjunctivitis'}


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: Syncope and lsot of consciousness

PRESENT ILLNESS: 84 y/o M (hard of hearing) with h/o HTN, ?CAD p/w syncope. He is
a school monitor who was at the school. He says that he was
watching kids play and he passed out. The next thing he
remembers was that he was in the SICU at [**Hospital1 18**].
Per EMS, a child intiated rescue breathing at the school.
Patient had a laceration to the back of the head and was
unresponsive. He was then intubated by EMS for airway protection
and flown to [**Hospital1 18**]. Eventually extubated in the SICU and doing
well.
.
ROS: Pt has h/o of DOE; he says that he can climb one flight of
stairs. He had an episode of dizziness last year when he stood
up from sitting position. He also has some swelling of feet for
the past 2 years which has been waxing and [**Doctor Last Name 688**]. No h/o of
chest pain, palpitations, n/v/diaphoresis. No h/o of any
transient loss of vision/blurriness. His bowel and bladder
habits are normal.

MEDICAL HISTORY: PMHx:
HTN
CAD: EF 40-45% w/ hypokinesis of post/lat walls w/ moderate
decrease in overall systolic fn of left ventricle
Squamous cell carcinoma s/p PPN, intravesicular mitomycin '[**05**]
Diverticulosis causing rectal bleeding
Sigmoid polyps
Hemorhoids
Shingles
Melanoma
.
PSHx:
Hernia repair x2
Ear surgeries for Melanoma resection
Anal fissure

MEDICATION ON ADMISSION: 

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals: 98.6, 124/71, 89, 16, 95%/RA
Gen: confortable, alert awake, oriented x3
HEENT: PERRLA, EOMI, Anicteric, Carotid Bruit on left
Heart: S1/S2, Trigeminy, no m/r/g
Lungs: CTAB
Abd: soft, obese, NT
Ext: 2+ bilateral edema
Skin: Occipital lac
Neuro: hard of hearing, no focal deficits

FAMILY HISTORY: Mother Died of Kidney disease
[**Name (NI) 62283**] a violent death

SOCIAL HISTORY: Lives at home in [**Location (un) **]; has a 15 pack smoking history;
occasional drinking. He used to work in Navy as a transporter. 

### Response:
{'Syncope and collapse,Atrial fibrillation,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Other primary cardiomyopathies,Open wound of scalp, without mention of complication,Other fall,Open wound of auricle, ear, without mention of complication,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Other conjunctivitis'}
