CHIEF COMPLAINT: Episodes of recurrent Ventricular tachycardia

PRESENT ILLNESS: 75 y.o. male transferred from [**Hospital6 **] with V-Tach,
BiV ICD firing several times per day. Loaded with amiodarone in
the ED. Recently admitted in [**Month (only) 956**] for Left lead revision.
.
He reports a history of recurrent ICD firing since it was placed
approximately 3 years ago but has not had an incident since
[**Month (only) 956**] when his leads were revised. ~4am on [**4-12**] his ICD fired
while he was sleeping. He was scheduled to have a colonoscopy
today so went through a bowel prep throughout the day but did
take his medications. His ICD fired again early this morning. He
was instructed not to take his medications and remain NPO for
his colonoscopy, but when his gastroenterologist found out that
his ICD had fired again, he cancelled the procedure. The patient
then took his usual morning medications at ~1pm. His ICD fired 2
more times, and as he was close to his cardiologist's office, he
stopped in. His ICD was interrogated, verified that it did fire,
and he was sent by ambulance to [**Hospital6 33**] ED. There,
he was loaded with IV amio (15 mg/min for 150mg, then 1mg/min)
and transferred to [**Hospital1 18**] for further care. The patient reports a
fluttering-type of sensation and "funny feeling" before his ICD
fired each time, similar to the past, but he never syncopized,
had chest pain, or had shortness of breath. Currently he feels
at his baseline with no complaints.
.
ROS: No orthopnea, PND, chest discomfort, lower-extremity
swelling, N/V/D/C/abdominal pain, fevers, chills.

MEDICAL HISTORY: -Ischemic cardiomyopathy, EF documented as low as 15%
-CHF
-Prior MI
-[**2102**] CABG at [**Hospital6 **]
--Cath report from [**Hospital1 112**] [**2121-3-28**]:
---Right-dominant system
---50% LMCA ostial lesion
---50% tubular stenosis at bifurcation of LAD and LCx
---proximal LAD-> D1 stent placed on [**2-/2121**] patent
---LIMA->LAD patent, known occlusion of RCA.
--- Pressures, Aortic - 127/65, RA 16-17, RV 64/8, PA 61/26,
PCWP 27
-Ventricular tachycardia, s/p ablation
-Prior ICD implant with upgrade to BiV ICD in [**6-22**]
-Atrial flutter, s/p ablation
-Chronic renal insufficiency (baseline creatinine 2.0)
-Peripheral vascular disease
-Facial melanoma
-Bladder cancer

MEDICATION ON ADMISSION: Aspirin 81 mg daily
Digoxin .125 mg daily
Lasix 120 qAM, 80 mg qPM
Mexiletine 200 mg [**Hospital1 **]
Hydralazine 10 mg three times a day
Protonix 40 mg [**Hospital1 **]
Lisinopril 2.5 mg qd
Metoprolol 100 mg q AM, 50 mg qPM
Folic acid 1 mg qd
Niferex 150 mg daily
colace 100 mg [**Hospital1 **]
Plavix 75 mg daily
Flomax 0.4 mg daily
MVI 1 qd
Lipitor 80 mg daily
Amiodarone 200 mg daily
Imdur 60 mg qd
Advair 250/1 puff [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Blood pressure was 117/56 while supine. Pulse was 63 beats/min
and regular, respiratory rate was 14 breaths/min.
GEN: well developed, well nourished and well groomed. Oriented
to person, place and time. Mood and affect appropriate.
HEENT: no xanthalesma, no conjunctiva pallor, mucous membranes
moist
NECK: supple with JVP of 10cm with +HJR. carotid pulses +1.
There was no thyromegaly. left-sided carotid bruit
PULM: No chest wall deformities, scoliosis or kyphosis.
Respirations unlabored, no accessory muscle use. lungs CTAB, no
W/R/R
COR: PMI diffuse, laterally displaced to anterior axillary line.
There were no thrills, lifts or palpable S3 or S4. Normal S1,
loud P2. [**1-23**] early systolic murmur at LLSB radiating to apex.
ABD: No pulsatile masses, no hepatosplenomegaly or tenderness,
NT, ND, +BS. No abdominal or femoral bruits.
EXT: No pallor, cyanosis, clubbing or edema.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+
Left: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+

FAMILY HISTORY: No family history of premature CAD or SCD.

SOCIAL HISTORY: No EtOH or tobacco use.
Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified angina pectoris,Chronic kidney disease, unspecified,Other specified forms of chronic ischemic heart disease,Iron deficiency anemia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Automatic implantable cardiac defibrillator in situ,Personal history of malignant neoplasm of bladder,Peripheral vascular disease, unspecified,Aortocoronary bypass status
Parox ventric tachycard,CHF NOS,Chr airway obstruct NEC,Angina pectoris NEC/NOS,Chronic kidney dis NOS,Chr ischemic hrt dis NEC,Iron defic anemia NOS,Hy kid NOS w cr kid I-IV,Status autm crd dfbrltr,Hx of bladder malignancy,Periph vascular dis NOS,Aortocoronary bypass
Admission Date:  [**2123-4-13**]              Discharge Date:   [**2123-4-22**]

Date of Birth:  [**2047-10-30**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Episodes of recurrent Ventricular tachycardia

Major Surgical or Invasive Procedure:
Electrophysiologic study and Ventricular tachycardia ablation.


History of Present Illness:
75 y.o. male transferred from [**Hospital6 **] with V-Tach,
BiV ICD firing several times per day. Loaded with amiodarone in
the ED. Recently admitted in [**Month (only) 956**] for Left lead revision.
.
He reports a history of recurrent ICD firing since it was placed
approximately 3 years ago but has not had an incident since
[**Month (only) 956**] when his leads were revised. ~4am on [**4-12**] his ICD fired
while he was sleeping. He was scheduled to have a colonoscopy
today so went through a bowel prep throughout the day but did
take his medications. His ICD fired again early this morning. He
was instructed not to take his medications and remain NPO for
his colonoscopy, but when his gastroenterologist found out that
his ICD had fired again, he cancelled the procedure. The patient
then took his usual morning medications at ~1pm. His ICD fired 2
more times, and as he was close to his cardiologist's office, he
stopped in. His ICD was interrogated, verified that it did fire,
and he was sent by ambulance to [**Hospital6 33**] ED. There,
he was loaded with IV amio (15 mg/min for 150mg, then 1mg/min)
and transferred to [**Hospital1 18**] for further care. The patient reports a
fluttering-type of sensation and "funny feeling" before his ICD
fired each time, similar to the past, but he never syncopized,
had chest pain, or had shortness of breath. Currently he feels
at his baseline with no complaints.
.
ROS: No orthopnea, PND, chest discomfort, lower-extremity
swelling, N/V/D/C/abdominal pain, fevers, chills.


Past Medical History:
-Ischemic cardiomyopathy, EF documented as low as 15%
-CHF
-Prior MI
-[**2102**] CABG at [**Hospital6 **]
--Cath report from [**Hospital1 112**] [**2121-3-28**]:
---Right-dominant system
---50% LMCA ostial lesion
---50% tubular stenosis at bifurcation of LAD and LCx
---proximal LAD-> D1 stent placed on [**2-/2121**] patent
---LIMA->LAD patent, known occlusion of RCA.
--- Pressures, Aortic - 127/65, RA 16-17, RV 64/8, PA 61/26,
PCWP 27
-Ventricular tachycardia, s/p ablation
-Prior ICD implant with upgrade to BiV ICD in [**6-22**]
-Atrial flutter, s/p ablation
-Chronic renal insufficiency (baseline creatinine 2.0)
-Peripheral vascular disease
-Facial melanoma
-Bladder cancer

Pacemaker/ICD, BiV ICD in [**6-22**], revised in [**2-24**].

Cardiac Risk Factors: Dyslipidemia, Hypertension. No diabetes.

Social History:
No EtOH or tobacco use.

Family History:
No family history of premature CAD or SCD.

Physical Exam:
Blood pressure was 117/56 while supine. Pulse was 63 beats/min
and regular, respiratory rate was 14 breaths/min.
GEN: well developed, well nourished and well groomed. Oriented
to person, place and time. Mood and affect appropriate.
HEENT: no xanthalesma, no conjunctiva pallor, mucous membranes
moist
NECK: supple with JVP of 10cm with +HJR. carotid pulses +1.
There was no thyromegaly. left-sided carotid bruit
PULM: No chest wall deformities, scoliosis or kyphosis.
Respirations unlabored, no accessory muscle use. lungs CTAB, no
W/R/R
COR: PMI diffuse, laterally displaced to anterior axillary line.
There were no thrills, lifts or palpable S3 or S4. Normal S1,
loud P2. [**1-23**] early systolic murmur at LLSB radiating to apex.
ABD: No pulsatile masses, no hepatosplenomegaly or tenderness,
NT, ND, +BS. No abdominal or femoral bruits.
EXT: No pallor, cyanosis, clubbing or edema.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+
Left: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+


Pertinent Results:
[**2123-4-22**] 06:55AM BLOOD WBC-9.7 RBC-4.09* Hgb-10.0* Hct-31.1*
MCV-76* MCH-24.5* MCHC-32.2 RDW-18.6* Plt Ct-316
[**2123-4-22**] 09:45AM BLOOD PT-22.6* PTT-37.7* INR(PT)-2.2*
[**2123-4-22**] 06:55AM BLOOD Glucose-95 UreaN-42* Creat-2.4* Na-137
K-3.8 Cl-101 HCO3-25 AnGap-15
[**2123-4-20**] 06:59PM BLOOD CK(CPK)-65
[**2123-4-22**] 06:55AM BLOOD Calcium-9.1 Phos-3.9 Mg-2.6

Chest X-ray on [**2123-4-19**]:
AP UPRIGHT VIEW OF THE CHEST:
The mildly enlarged heart is unchanged.  The mediastinal and
hilar contours are normal.  The lungs are clear.  The ICD and
pacemaker leads are in proper positions projecting over the
right atrium, right ventricle, and left ventricle. Patient is
status post CABG.
IMPRESSION:
1.  No acute cardiopulmonary process is noted.
2.  Mildly enlarged heart is unchanged.



Brief Hospital Course:
#) CV - Rhythm: Patient on Mexiletine 200mg [**Hospital1 **] and amiodarone
200mg qday as outpatient but was started on amiodarone
continuous infusion at OSH. Pacer interrogation demonstrated
firing x4 as above. Given previous history of ischemic disease,
this may be V-tach with permanent re-entrant substrate secondary
to ischemia/infarction. Recent increasing frequency of events
may be secondary to recent bowel preparations from colonoscopy,
and decreased absorption of anti-arrhythmic agents secondary to
this. Had recurrent episodes of V-tach with ICD firing on [**4-14**].
Now status-post VT ablation on [**2123-4-16**].  Per Electrophysiology
service recommendations, restarted mexiletine and continued oral
amiodarone 200mg qdaily. Started on anticoagulation with
warfarin and heparin gtt after VT ablation procedure, which will
need to continue for 2 months.
.
#) Ischemia - History of CABG in [**2102**]. Experienced few episodes
of angina associated with V-tach during this admission, that
resolved with sublingual nitroglycerin without and significant
ECG changes.  Continued with aspirin, clopidogrel, metoprolol,
statin, but held lisinopril.
.
#) Pump - Per records, patient has EF ranging 15-25%. Although
JVP is elevated, appears to be euvolemic otherwise, given
absence of crackles on pulmonary exam and absence of peripheral
oedema. Continued with furosemide 120mg qAM, 80mg qPM ,
Isosorbide mononitrate, and hydralazine, metoprolol. Held
lisinopril, can consider discontinuing if already on
Imdur/hydralazine.  Discontinued digoxin due to
arrhythmogenicity
.
#) Valves - no known issues. [**Month (only) 116**] have mitral regurgitation
secondary to dilated cardiomyopathy. No symptoms.
.
#) Hypertension - Continued metoprolol, imdur/hydralazine,
furosemide.
.
#) Chronic renal failure - Creatinine was slightly elevated from
baseline of 2.0. Likely secondary to recent bowel
preparation/dehydration. Electrolytes and volume status stable.
Held Lisinopril.
.
#) COPD - Continued advair.
.
#) Iron deficiency anemia - Patient was undergoing colonoscopy
for work-up of this.
Continued with iron supplements.  Guaiaced stools and monitor
hematocrit.

Medications on Admission:
Aspirin 81 mg daily
Digoxin .125 mg daily
Lasix 120 qAM, 80 mg qPM
Mexiletine 200 mg [**Hospital1 **]
Hydralazine 10 mg three times a day
Protonix 40 mg [**Hospital1 **]
Lisinopril 2.5 mg qd
Metoprolol 100 mg q AM, 50 mg qPM
Folic acid 1 mg qd
Niferex 150 mg daily
colace 100 mg [**Hospital1 **]
Plavix 75 mg daily
Flomax 0.4 mg daily
MVI 1 qd
Lipitor 80 mg daily
Amiodarone 200 mg daily
Imdur 60 mg qd
Advair 250/1 puff [**Hospital1 **]


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Furosemide 80 mg Tablet Sig: 1.5 Tablets PO QAM (once a day
(in the morning)).
3. Furosemide 80 mg Tablet Sig: One (1) Tablet PO QDay at 3:00
PM.
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
5. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO QAM
(once a day (in the morning)).
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO QPM
(once a day (in the evening)).
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO DAILY (Daily).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
11. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
12. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
13. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
15. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day.

16. Mexiletine 200 mg Capsule Sig: One (1) Capsule PO Q12H
(every 12 hours).
17. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
18. Warfarin 1 mg Tablet Sig: Two (2) Tablet PO at bedtime:
Adjust dose as directed by primary care physician.
[**Name Initial (NameIs) **]:*60 Tablet(s)* Refills:*2*
19. Bactrim DS 160-800 mg Tablet Sig: One (1) Tablet PO twice a
day for 6 days: To complete 7-day course on [**2123-4-27**].
[**Date Range **]:*12 Tablet(s)* Refills:*0*
20. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
21. INR check  Sig: PT and INR   2 times per week.: Please have
INR checked 2 times per week in lab in Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
office building and forward results to Dr. [**Last Name (STitle) 36589**].
[**Last Name (STitle) **]:*qs * Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Ventricular tachycardia
Urinary tract infection

Secondary diagnoses:
Ischemic cardiomyopathy
Chronic renal insufficiency
Coronary artery disease


Discharge Condition:
Vital signs stable.


Discharge Instructions:
You were admitted for evaluation of abnormal heart rhythm.  You
were evaluated by heart rhythm specialist and had an ablation
procedure to help improve problems with heart rhythm.  Your
rhythm medications were adjusted.  Also, you were started on
blood thinners (Coumadin) which you should continue for at least
1 month.  You were also started on antibiotic for urinary tract
infection.  Please complete the full course of antibiotic even
if you no longer have any symptoms.  Please call your physician
or report to the emergency room if you notice worsening chest
pain, shortness of breath, severe palpitations, receive a shock
from your ICD device, or any other concerning symptoms.

Followup Instructions:
You should follow up for your blood-thinning levels (INR) in the
laboratory at your primary care physician's office building.
(Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 36589**]).  You should have your next level checked
on Friday [**2123-4-23**].  You have been given a prescription for this
and the results will be automatically sent to your primary care
physician.  [**Name10 (NameIs) **] taking 2mg of Coumading until adjustment
made by primary care.
.
You have been scheduled for follow-up in Dr.[**Name (NI) 66351**] office
on Mondary [**4-26**] at noon.  Please call [**0-0-**] for any
questions or to change your appointment.



Completed by:[**2123-4-25**]
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified angina pectoris,Chronic kidney disease, unspecified,Other specified forms of chronic ischemic heart disease,Iron deficiency anemia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Automatic implantable cardiac defibrillator in situ,Personal history of malignant neoplasm of bladder,Peripheral vascular disease, unspecified,Aortocoronary bypass 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: Episodes of recurrent Ventricular tachycardia

PRESENT ILLNESS: 75 y.o. male transferred from [**Hospital6 **] with V-Tach,
BiV ICD firing several times per day. Loaded with amiodarone in
the ED. Recently admitted in [**Month (only) 956**] for Left lead revision.
.
He reports a history of recurrent ICD firing since it was placed
approximately 3 years ago but has not had an incident since
[**Month (only) 956**] when his leads were revised. ~4am on [**4-12**] his ICD fired
while he was sleeping. He was scheduled to have a colonoscopy
today so went through a bowel prep throughout the day but did
take his medications. His ICD fired again early this morning. He
was instructed not to take his medications and remain NPO for
his colonoscopy, but when his gastroenterologist found out that
his ICD had fired again, he cancelled the procedure. The patient
then took his usual morning medications at ~1pm. His ICD fired 2
more times, and as he was close to his cardiologist's office, he
stopped in. His ICD was interrogated, verified that it did fire,
and he was sent by ambulance to [**Hospital6 33**] ED. There,
he was loaded with IV amio (15 mg/min for 150mg, then 1mg/min)
and transferred to [**Hospital1 18**] for further care. The patient reports a
fluttering-type of sensation and "funny feeling" before his ICD
fired each time, similar to the past, but he never syncopized,
had chest pain, or had shortness of breath. Currently he feels
at his baseline with no complaints.
.
ROS: No orthopnea, PND, chest discomfort, lower-extremity
swelling, N/V/D/C/abdominal pain, fevers, chills.

MEDICAL HISTORY: -Ischemic cardiomyopathy, EF documented as low as 15%
-CHF
-Prior MI
-[**2102**] CABG at [**Hospital6 **]
--Cath report from [**Hospital1 112**] [**2121-3-28**]:
---Right-dominant system
---50% LMCA ostial lesion
---50% tubular stenosis at bifurcation of LAD and LCx
---proximal LAD-> D1 stent placed on [**2-/2121**] patent
---LIMA->LAD patent, known occlusion of RCA.
--- Pressures, Aortic - 127/65, RA 16-17, RV 64/8, PA 61/26,
PCWP 27
-Ventricular tachycardia, s/p ablation
-Prior ICD implant with upgrade to BiV ICD in [**6-22**]
-Atrial flutter, s/p ablation
-Chronic renal insufficiency (baseline creatinine 2.0)
-Peripheral vascular disease
-Facial melanoma
-Bladder cancer

MEDICATION ON ADMISSION: Aspirin 81 mg daily
Digoxin .125 mg daily
Lasix 120 qAM, 80 mg qPM
Mexiletine 200 mg [**Hospital1 **]
Hydralazine 10 mg three times a day
Protonix 40 mg [**Hospital1 **]
Lisinopril 2.5 mg qd
Metoprolol 100 mg q AM, 50 mg qPM
Folic acid 1 mg qd
Niferex 150 mg daily
colace 100 mg [**Hospital1 **]
Plavix 75 mg daily
Flomax 0.4 mg daily
MVI 1 qd
Lipitor 80 mg daily
Amiodarone 200 mg daily
Imdur 60 mg qd
Advair 250/1 puff [**Hospital1 **]

ALLERGIES: Penicillins

PHYSICAL EXAM: Blood pressure was 117/56 while supine. Pulse was 63 beats/min
and regular, respiratory rate was 14 breaths/min.
GEN: well developed, well nourished and well groomed. Oriented
to person, place and time. Mood and affect appropriate.
HEENT: no xanthalesma, no conjunctiva pallor, mucous membranes
moist
NECK: supple with JVP of 10cm with +HJR. carotid pulses +1.
There was no thyromegaly. left-sided carotid bruit
PULM: No chest wall deformities, scoliosis or kyphosis.
Respirations unlabored, no accessory muscle use. lungs CTAB, no
W/R/R
COR: PMI diffuse, laterally displaced to anterior axillary line.
There were no thrills, lifts or palpable S3 or S4. Normal S1,
loud P2. [**1-23**] early systolic murmur at LLSB radiating to apex.
ABD: No pulsatile masses, no hepatosplenomegaly or tenderness,
NT, ND, +BS. No abdominal or femoral bruits.
EXT: No pallor, cyanosis, clubbing or edema.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
.
Pulses:
Right: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+
Left: Carotid 1+ Femoral 2+ Popliteal 1+ DP 1+ PT 1+

FAMILY HISTORY: No family history of premature CAD or SCD.

SOCIAL HISTORY: No EtOH or tobacco use. 

### Response:
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Chronic airway obstruction, not elsewhere classified,Other and unspecified angina pectoris,Chronic kidney disease, unspecified,Other specified forms of chronic ischemic heart disease,Iron deficiency anemia, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Automatic implantable cardiac defibrillator in situ,Personal history of malignant neoplasm of bladder,Peripheral vascular disease, unspecified,Aortocoronary bypass status'}
