CHIEF COMPLAINT: Presyncope

PRESENT ILLNESS: 82M with hx of CAD s/p DES to RCA [**2-18**], hx of symptomatic MR,
s/p MR repair with [**Company 1543**] ring placement with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**]
ligation with subsequent hx of NSVT s/p briefly on sotalol and
metoprolol, later placed on Amiodarone, recently down titrated
from 200mg to 100mg daily, that is presenting with presyncopal
like episode. The pt is followed by Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**Name (STitle) 2025**] and his
amiodarone has been titrated down over due to pt concerns for
toxicity. The pt was was due to be placed on a Holter monitor
this coming Monday but this has not been performed yet.

MEDICAL HISTORY: mitral regurgitation
coronary artery disease s/p RCA stenting [**3-21**]
premature vent. contractions with ventricular tachycardia
hypertension
chronic diastolic heart failure
prostate cancer
obstructive sleep apnea
glaucoma
arthritis
chronic back pain
? Parkinson's disease

MEDICATION ON ADMISSION: Amiodarone 100mg Daily
ASA 81mg Daily
Pravastatin 40mg Daily
Lisinopril 10mg Daily
Metoprolol Succinate 50mg Daily
Lumigan 0.01% one drop per left eye QHS
Fluticasone Propionate 50mcg [**Hospital1 **]
Saline Nasal Spray
Colace PRN
Senna
Co Enzyme Q
Hyaluronic Acid 140mg
Fatty Acids
MVI
Melatonin 3mg QHS
Tylenol 650mg

ALLERGIES: IV Dye, Iodine Containing

PHYSICAL EXAM: Admission Exam
VS: Afebrile BP 126/77 HR 63 NSR with occasional PVCs RR 16
96O2%
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: no premature CAD

SOCIAL HISTORY: lives alone, widowed
occasional ETOH use
remote cigar use
works as a part-time headhunter
Paroxysmal ventricular tachycardia,Chronic diastolic heart failure,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified glaucoma,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Arthropathy, unspecified, site unspecified
Parox ventric tachycard,Chr diastolic hrt fail,Crnry athrscl natve vssl,Status-post ptca,Glaucoma NOS,Obstructive sleep apnea,Hypertension NOS,Arthropathy NOS-unspec
Admission Date:  [**2181-7-22**]              Discharge Date:   [**2181-7-25**]

Date of Birth:  [**2099-2-23**]             Sex:   M

Service: MEDICINE

Allergies:
IV Dye, Iodine Containing

Attending:[**First Name3 (LF) 106**]
Chief Complaint:
Presyncope

Major Surgical or Invasive Procedure:
RVOT VT ablation ([**2181-7-23**])


History of Present Illness:
82M with hx of CAD s/p DES to RCA [**2-18**], hx of symptomatic MR,
s/p MR repair with [**Company 1543**] ring placement with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**]
ligation with subsequent hx of NSVT s/p briefly on sotalol and
metoprolol, later placed on Amiodarone, recently down titrated
from 200mg to 100mg daily, that is presenting with presyncopal
like episode. The pt is followed by Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**Name (STitle) 2025**] and his
amiodarone has been titrated down over due to pt concerns for
toxicity. The pt was was due to be placed on a Holter monitor
this coming Monday but this has not been performed yet.

Pt reports that for the last three days he has decreased energy.
He denied chest pain, sob, nausesa or emesis. He states that
today, while sitting as his computer, he had visual changes and
felt as though he was going to pass-out. He denies LOC. He
subsequently called EMS and was brought into the [**Hospital1 18**] ED.

In the ED, initial vitals were 97.2 86 152/62 16 99%. Cardiac
exam notable for tachycardia. Labs notable for trop 0.02, Cr
1.6. Telemetry was notable for sustained VT. The pt was
amiodarone loaded with 150mg then started on 1mg/min gtt. The
sustained VT resolved prior to transfer to the CCU. Vitals prior
to transfer 97.1 86-140 99/64 18 99RA.

On arrival to the CCU the pt states he is tired but feels
otherwise fine.

On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock or calf pain. All of the other
review of systems were negative.

Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations, syncope or presyncope.

Past Medical History:
mitral regurgitation
coronary artery disease s/p RCA stenting [**3-21**]
premature vent. contractions with ventricular tachycardia
hypertension
chronic diastolic heart failure
prostate cancer
obstructive sleep apnea
glaucoma
arthritis
chronic back pain
? Parkinson's disease

Social History:
lives alone, widowed
occasional ETOH use
remote cigar use
works as a part-time headhunter


Family History:
no premature CAD

Physical Exam:
Admission Exam
VS: Afebrile BP 126/77 HR 63 NSR with occasional PVCs RR 16
96O2%
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 5cm.
CARDIAC: Regular with occasional PVCs. PMI located in 5th
intercostal space, midclavicular line. RR, normal S1, S2. No
m/r/g. No thrills, lifts. No S3 or S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominal bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+


Pertinent Results:
Labs:
[**2181-7-22**] 02:30AM BLOOD WBC-5.0 RBC-4.31* Hgb-14.4 Hct-42.7
MCV-99* MCH-33.4* MCHC-33.7 RDW-13.6 Plt Ct-177
[**2181-7-22**] 08:21AM BLOOD WBC-4.9 RBC-4.30* Hgb-14.2 Hct-42.3
MCV-98 MCH-33.0* MCHC-33.5 RDW-13.7 Plt Ct-172

[**2181-7-22**] 02:30AM BLOOD Glucose-145* UreaN-30* Creat-1.6* Na-140
K-3.8 Cl-105 HCO3-22 AnGap-17
[**2181-7-22**] 08:21AM BLOOD Glucose-100 UreaN-26* Creat-1.3* Na-139
K-4.0 Cl-105 HCO3-23 AnGap-15

[**2181-7-22**] 02:30AM BLOOD cTropnT-0.02*
[**2181-7-22**] 08:21AM BLOOD cTropnT-0.01

[**2181-7-22**] 08:21AM BLOOD TSH-3.9

[**2181-7-22**] 02:30AM BLOOD Calcium-8.9 Phos-3.9 Mg-2.4
.
Studies:
CXR ([**2181-7-22**])
There is stable mild cardiomegaly. Retrocardiac opacification
likely represents atelectasis, however underlying infectious
process cannot be completely excluded. No evidence of focal
consolidation, pleural effusion or pneumothorax. Partially
visualized sternotomy wires appear midline and intact.


Brief Hospital Course:
82M with coronary artery disease s/p DES to RCA in [**2179**] and
mitral regurgitation s/p [**Company 1543**] ring placement with course
complicated by NSVT post surgery.  He has been on sotalol in the
past and amiodarone most recently for suppression of his NSVT.
He was admitted with monomorphic VT of same morphology as his
NSVT in setting of decreasing his amiadorone dose.

1. RHYTHM: Stable inferior axis monomorphic ventricular
tachycardia likely from right ventricular outflow tract.  It
could also be due scar from his mitral valve ring placement.
With long half life of amiodarone unlikely related to decreasing
amiodarone dose.  He was started on amiodarone drip on admission
without any effect on NSVT.  Amiodarone drip was discontinued
and uptitrated metoprolol to 50 mg po BID which helped suppress
NSVT.  No evidence of ischemia as precipitant for his
ventricular tachycardia.  TSH within normal range. He underwent
EP Study on [**2181-7-24**] with ablation of RVOT.  He tolerated the
procedure well without any complications.

2. CORONARIES: Single vessel disease RCA disease per last cath.
s/p DES to RCA in [**2179**].  ECG without new ST-T changes. Troponin
negative. He was continued on aspirin, statin, B-Blocker and
ACE-I.

3. PUMP: Last known EF 55%. Pt appears clinically euvolemic.

4. Glaucoma: Stable.  Continued on home eye drops.

Medications on Admission:
Amiodarone 100mg Daily
ASA 81mg Daily
Pravastatin 40mg Daily
Lisinopril 10mg Daily
Metoprolol Succinate 50mg Daily
Lumigan 0.01% one drop per left eye QHS
Fluticasone Propionate 50mcg [**Hospital1 **]
Saline Nasal Spray
Colace PRN
Senna
Co Enzyme Q
Hyaluronic Acid 140mg
Fatty Acids
MVI
Melatonin 3mg QHS
Tylenol 650mg

Discharge Medications:
1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. pravastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
3. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day.
4. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
5. Lumigan 0.01 % Drops Sig: One (1) drop to left eye Ophthalmic
once a day.
6. fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal [**Hospital1 **] (2 times a day).
7. Saline Nasal 0.65 % Aerosol, Spray Sig: One (1)  Nasal twice
a day.
8. docusate sodium 100 mg Capsule Sig: [**2-11**] Capsules PO BID (2
times a day) as needed for constipation.
9. senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
10. coenzyme Q10  Oral
11. Hyaluronic Acid  Oral
12. Fatty Acid Base  Miscellaneous
13. multivitamin     Tablet Sig: One (1) Tablet PO once a day.
14. melatonin 3 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis
1. Right ventricular outflow tract ventricular tachycardia

Secondary Diagnsois
1. Coronary artery disease


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted with abnormal rhythm called monomorphic
ventricular tachycardia which was causing you chest discomfort.
Electrophysiology study showed a focus in your heart that
started your abnormal rhythm which was ablated.  You tolerated
the procedure well without any complications.

FOLLOWING MEDICATION CHANGES WERE MADE TO YOUR MEDICAL REGIMEN
STOP AMIODARONE 100 mg by mouth daily

Followup Instructions:
Department: GERONTOLOGY
When: THURSDAY [**2181-8-2**] at 12:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2847**], MD [**Telephone/Fax (1) 719**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: CARDIAC SERVICES
When: FRIDAY [**2181-8-31**] at 1 PM
With: [**Name6 (MD) 251**] [**Last Name (NamePattern4) 677**], M.D. [**Telephone/Fax (1) 62**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: MEDICAL SPECIALTIES
When: TUESDAY [**2181-10-23**] at 2:15 PM
With: [**Doctor First Name **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 612**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Paroxysmal ventricular tachycardia,Chronic diastolic heart failure,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified glaucoma,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Arthropathy, unspecified, site unspecified'}


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: Presyncope

PRESENT ILLNESS: 82M with hx of CAD s/p DES to RCA [**2-18**], hx of symptomatic MR,
s/p MR repair with [**Company 1543**] ring placement with [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) 1916**]
ligation with subsequent hx of NSVT s/p briefly on sotalol and
metoprolol, later placed on Amiodarone, recently down titrated
from 200mg to 100mg daily, that is presenting with presyncopal
like episode. The pt is followed by Dr. [**Last Name (STitle) **] [**Last Name (STitle) **] [**Name (STitle) 2025**] and his
amiodarone has been titrated down over due to pt concerns for
toxicity. The pt was was due to be placed on a Holter monitor
this coming Monday but this has not been performed yet.

MEDICAL HISTORY: mitral regurgitation
coronary artery disease s/p RCA stenting [**3-21**]
premature vent. contractions with ventricular tachycardia
hypertension
chronic diastolic heart failure
prostate cancer
obstructive sleep apnea
glaucoma
arthritis
chronic back pain
? Parkinson's disease

MEDICATION ON ADMISSION: Amiodarone 100mg Daily
ASA 81mg Daily
Pravastatin 40mg Daily
Lisinopril 10mg Daily
Metoprolol Succinate 50mg Daily
Lumigan 0.01% one drop per left eye QHS
Fluticasone Propionate 50mcg [**Hospital1 **]
Saline Nasal Spray
Colace PRN
Senna
Co Enzyme Q
Hyaluronic Acid 140mg
Fatty Acids
MVI
Melatonin 3mg QHS
Tylenol 650mg

ALLERGIES: IV Dye, Iodine Containing

PHYSICAL EXAM: Admission Exam
VS: Afebrile BP 126/77 HR 63 NSR with occasional PVCs RR 16
96O2%
GENERAL: NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: no premature CAD

SOCIAL HISTORY: lives alone, widowed
occasional ETOH use
remote cigar use
works as a part-time headhunter 

### Response:
{'Paroxysmal ventricular tachycardia,Chronic diastolic heart failure,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Unspecified glaucoma,Obstructive sleep apnea (adult)(pediatric),Unspecified essential hypertension,Arthropathy, unspecified, site unspecified'}
