CHIEF COMPLAINT: ICD firing.

PRESENT ILLNESS: This is a 65-year-old gentleman,
with a history of CD, status post a VT arrest, and PTCA of
the LAD in [**2186**], who presents with ICD firing several times
over last night.  The patient had instances of the ICD firing
about 2 weeks ago without any preceding symptoms.  He was
seen at [**Hospital3 68**] where he was observed for about four
days and then released.

MEDICAL HISTORY: 1. CAD, status post anterior MI.
2. Prostate cancer, on chemotherapy, last dose 3 weeks ago.
3. Type 2 diabetes x 4 years with the complication of
neuropathy.
4. ?History of atrial fibrillation.
5. Hypertension.
6. Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: NKDA.

PHYSICAL EXAM: Vitals on arrival were temperature 98.7,
blood pressure 100/60, heart rate 68, respiratory rate 18,
100% on 3 liters.  This was an obese gentleman, sitting at
60%, in no apparent distress.  He was alert and oriented x 3.
He had dry mucous membranes.  Pupils were equal and reactive
with anicteric sclerae.  Neck was supple.  It was difficult
to assess JVP secondary to habitus.  He had very distant
heart sounds, but usually regular rate with occasional
premature beats.  Lungs had decreased breath sounds in the
right lower lobe and crackles noted in the left lower lobe.
Abdomen was soft, nontender, nondistended, with positive
bowel sounds.  He had 1+ pitting edema bilaterally to the
knees with stasis dermatitis noted.

FAMILY HISTORY: 

SOCIAL HISTORY: Has smoked about 1-1/2 packs a day for the
past 60 years.  Denies alcohol or IVDU.  Lives with his wife.
Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Old myocardial infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes
Parox ventric tachycard,Crnry athrscl natve vssl,Status-post ptca,Hyperlipidemia NEC/NOS,Hypertension NOS,Old myocardial infarct,DMII neuro nt st uncntrl,Neuropathy in diabetes
Admission Date:  [**2195-4-12**]       Discharge Date:  [**2195-4-17**]

Date of Birth:   [**2129-11-25**]       Sex:  M

Service:  CARDIAC MEDICINE

CHIEF COMPLAINT:  ICD firing.

HISTORY OF PRESENT ILLNESS:  This is a 65-year-old gentleman,
with a history of CD, status post a VT arrest, and PTCA of
the LAD in [**2186**], who presents with ICD firing several times
over last night.  The patient had instances of the ICD firing
about 2 weeks ago without any preceding symptoms.  He was
seen at [**Hospital3 68**] where he was observed for about four
days and then released.

He had been feeling well until the night before admission
when, at about 2:00 am, he began to feel nauseous and then
the ICD fired.  He did not have preceding chest pain,
shortness of breath, palpitations, lightheadedness, or
diaphoresis.  The ICD fired a second time, and he was seen
again at [**Hospital3 68**].  He was observed overnight and
then discharged.  When the ICD fired again that next day, he
called 911 and was brought to [**Hospital1 18**].  He was noted to be in
recurrent V-tach and was shocked multiple times by the ICD.

RECENT REVIEW OF SYSTEMS:  Notable only for diarrhea for the
last several days.

PAST MEDICAL HISTORY:
1. CAD, status post anterior MI.
2. Prostate cancer, on chemotherapy, last dose 3 weeks ago.
3. Type 2 diabetes x 4 years with the complication of
neuropathy.
4. ?History of atrial fibrillation.
5. Hypertension.
6. Hyperlipidemia.

MEDICATIONS:
1. Hydralazine 25 mg.
2. Isosorbide 10 mg tid.
3. Metoprolol 50 [**Hospital1 **].
4. Gemfibrozil 600 [**Hospital1 **].
5. Warfarin alternating doses of 2 and 4 mg qd.
6. Furosemide.
7. Aspirin 325 qd
8. Glipizide 5 [**Hospital1 **].
9. Potassium 20 qd.
10.Neurontin 100 tid.
11.Amiodarone 200 qd.

ALLERGIES:  NKDA.

SOCIAL HISTORY:  Has smoked about 1-1/2 packs a day for the
past 60 years.  Denies alcohol or IVDU.  Lives with his wife.

PHYSICAL EXAM:  Vitals on arrival were temperature 98.7,
blood pressure 100/60, heart rate 68, respiratory rate 18,
100% on 3 liters.  This was an obese gentleman, sitting at
60%, in no apparent distress.  He was alert and oriented x 3.
He had dry mucous membranes.  Pupils were equal and reactive
with anicteric sclerae.  Neck was supple.  It was difficult
to assess JVP secondary to habitus.  He had very distant
heart sounds, but usually regular rate with occasional
premature beats.  Lungs had decreased breath sounds in the
right lower lobe and crackles noted in the left lower lobe.
Abdomen was soft, nontender, nondistended, with positive
bowel sounds.  He had 1+ pitting edema bilaterally to the
knees with stasis dermatitis noted.

LABS AND STUDIES:  EKG showed sinus with AV delay,
questionable right bundle branch pattern with left anterior
fascicular block.  Left axis deviation.  Inverted T waves
were noted in AVL.  Q waves in V1, V2, with poor R wave
progression.  On rhythm strips taken during events, he was
noted to have a wide complex regular tachycardia at a rate of
approximately 250, that after shock responded by changing
into an irregular more narrow complex tachycardia (AF).  Initial
CBC showed a white count of 8.1, hematocrit 34.4, platelet
count 180.  He had a PT of 16.6, PTT 22, INR 1.8.  Chem-7
showed a sodium of 140, potassium 3.8, chloride 104, CO2 24,
BUN 15, creatinine 0.8, glucose 170.  He had a calcium of
9.2, mag 2.0, phos 3.4.  Initial set of enzymes showed a CK
of 26, troponin-T less than 0.01.  Previous cath performed in
[**2186-4-12**] showed a 100% RCA lesion, LAD of 100% that was
PTCA'd, EF 25%, with apical and anterolateral akinesis.

HOSPITAL COURSE:  The patient was admitted to cardiac
medicine on telemetry.  He was scheduled for an ICD pacer
interrogation by EP.  His enzymes were followed to rule out
MI.

On the evening of admission, [**4-12**], the patient
experienced multiple runs of V-tach with the rate in the
200s.  He was shocked by his ICD multiple times.  His vital
signs were initially stable, other than the rhythm of VT.  He
was given 150 mg IV amiodarone, 5 mg IV metoprolol x 2, 2 gm
of magnesium, 40 mEq of KCL, and 0.5 mg of versed.  After
receiving these medications, the patient's blood pressure
decreased to the 70s/40s.  He was given a bolus of fluids,
after which he increased to 90/60.  The EKG showed no
ischemic changes.  However, he was transferred to the ICU for
further monitoring and continuation of the amiodarone GTT.
He had a femoral line placement at that time.

He was monitored in the ICU until [**4-13**].  At this point, he
was determined stable enough to return to the floor.  He
underwent a VT ablation procedure by electrophysiology on
[**4-14**].  Overnight, on the [**4-15**], the patient developed
intermittent AFIB with rates into the 120s-130s, and a blood
pressure, systolic, in the 90s/70s.  He received IV beta
blocker and converted back into normal sinus rhythm with a
rate in the 80s.  He had no chest pain or shortness of breath
during this episode.  In the early morning hours of [**4-16**],
he developed rapid AFIB again with rates into the 140s.  He
was given IV diltiazem which decreased his systolic pressure
from the 90s to 60s.  At that point, he was given multiple
small normal saline boluses to increase his pressure.  He
also received some IV Lopressor, as well as PO Lopressor.
Given his recurrent episodes of AFIB with rapid ventricular
response, he was taken to the EP Lab for a synchronous
cardioversion on the morning of the 4.  He received 1 shock
of 200 joules and converted to normal sinus rhythm with a
rate in the mid-80s.  He was changed to an amiodarone rate of
400 [**Hospital1 **], his beta blocker was increased to tid dosing of 37.5
metoprolol, a low dose ACE inhibitor was added at 6.25 tid,
and digoxin qd of 0.125 was added as well.

The patient remained stable status post cardioversion, and by
the [**4-17**], on hospital day #6, he was feeling well with
stable heart rate and blood pressure.  His INR was noted to
be therapeutic between 2 and 3.  The patient was evaluated by
physical therapy and determined that he did not need home
services.  It was decided that he was prepared for discharge
with a 4-week follow-up with Device Clinic and [**Doctor Last Name 1911**] in
cardiology.

DISCHARGE CONDITION:  Good.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:
1. Coronary artery disease.
2. Ventricular tachycardia.
3. Atrial fibrillation with rapid ventricular response.

DISCHARGE MEDICATIONS:
1. Aspirin 325 mg qd.
2. Gabapentin 100 mg q 8 h.
3. Gemfibrozil 600 mg [**Hospital1 **].
4. Lasix 20 mg qd.
5. Glipizide 5 mg [**Hospital1 **].
6. Metoprolol 37.5 mg tid.
7. Amiodarone 400 mg [**Hospital1 **] for the first 2 weeks post
discharge, with instructions to the patient to decrease to
400 mg qd thereafter until seen in [**Hospital **] Clinic.
8. Digoxin 0.125 qd.
9. Captopril 6.25 tid.
10.Warfarin 2.5 qd.

FOLLOW-UP:  The patient is scheduled to be seen in Device
Clinic and by Dr. [**Last Name (STitle) 1911**] on [**5-11**].  He was instructed
to continue his Coumadin blood draws as he had been prior to
his admission to the hospital.




                            [**First Name4 (NamePattern1) 610**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3812**]

Dictated By:[**Last Name (NamePattern1) 10454**]
MEDQUIST36

D:  [**2195-4-17**]  12:21
T:  [**2195-4-17**]  12:25
JOB#:  [**Job Number 10455**]
{'Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Old myocardial infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes'}


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: ICD firing.

PRESENT ILLNESS: This is a 65-year-old gentleman,
with a history of CD, status post a VT arrest, and PTCA of
the LAD in [**2186**], who presents with ICD firing several times
over last night.  The patient had instances of the ICD firing
about 2 weeks ago without any preceding symptoms.  He was
seen at [**Hospital3 68**] where he was observed for about four
days and then released.

MEDICAL HISTORY: 1. CAD, status post anterior MI.
2. Prostate cancer, on chemotherapy, last dose 3 weeks ago.
3. Type 2 diabetes x 4 years with the complication of
neuropathy.
4. ?History of atrial fibrillation.
5. Hypertension.
6. Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: NKDA.

PHYSICAL EXAM: Vitals on arrival were temperature 98.7,
blood pressure 100/60, heart rate 68, respiratory rate 18,
100% on 3 liters.  This was an obese gentleman, sitting at
60%, in no apparent distress.  He was alert and oriented x 3.
He had dry mucous membranes.  Pupils were equal and reactive
with anicteric sclerae.  Neck was supple.  It was difficult
to assess JVP secondary to habitus.  He had very distant
heart sounds, but usually regular rate with occasional
premature beats.  Lungs had decreased breath sounds in the
right lower lobe and crackles noted in the left lower lobe.
Abdomen was soft, nontender, nondistended, with positive
bowel sounds.  He had 1+ pitting edema bilaterally to the
knees with stasis dermatitis noted.

FAMILY HISTORY: 

SOCIAL HISTORY: Has smoked about 1-1/2 packs a day for the
past 60 years.  Denies alcohol or IVDU.  Lives with his wife. 

### Response:
{'Paroxysmal ventricular tachycardia,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Old myocardial infarction,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes'}
