CHIEF COMPLAINT: 

PRESENT ILLNESS: Seventy-seven-year-old male with
a history of coronary artery disease, CHF with an EF of 15%,
hyperlipidemia, smoker, type 2 diabetic, and known history of
sustained VT in [**2190-4-16**] after an
inferior-posterolateral MI in which she received a [**Company 1543**]
pacer and a cardiac catheterization in [**Location (un) 47**] showing an
EF of 15%, 90% circ/80% disease.  Treated medically for
ischemia.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Bee stings.

PHYSICAL EXAM: 97.0, 66, 157/48, 12.  No apparent distress,
alert and oriented times three.  Right pupil 4 mm, left pupil
2 mm.  No wheezes or crackles.  Regular rate, normal S1, S2,
no S3, S4, 1/6 systolic ejection murmur at the left upper
sternal border, question of radiating to the right carotid.
The patient also has bilateral carotid bruits.  Patient also
has diminished pulses in his feet.

FAMILY HISTORY: Were not recorded on any
notes on admission.  Social history that is known is that
patient lives with his wife.  Does not smoke or drink any
alcohol at this time.

SOCIAL HISTORY: 
Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Automatic implantable cardiac defibrillator in situ
Parox ventric tachycard,CHF NOS,Thrombocytopenia NOS,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Ocl crtd art wo infrct,Status autm crd dfbrltr
Admission Date:  [**2192-4-13**]     Discharge Date:  [**2192-4-18**]

Date of Birth:   [**2115-3-20**]     Sex:  M

Service:  Cardiac Care Unit

HISTORY OF PRESENT ILLNESS:  Seventy-seven-year-old male with
a history of coronary artery disease, CHF with an EF of 15%,
hyperlipidemia, smoker, type 2 diabetic, and known history of
sustained VT in [**2190-4-16**] after an
inferior-posterolateral MI in which she received a [**Company 1543**]
pacer and a cardiac catheterization in [**Location (un) 47**] showing an
EF of 15%, 90% circ/80% disease.  Treated medically for
ischemia.

Patient had felt weak for the last two weeks with two
mechanical falls, no syncope.  Last night in bed, patient
felt fell.  Felt ICD fire and irregular pulse afterwards.
The patient went to the [**Location (un) 47**] ED and noted sustained VT.
The ICD fired again.  IV amiodarone infusion started.
Patient denied any chest pain, shortness of breath, or
dyspnea on exertion or edema.  Of note, p.o. amiodarone dose
decreased from 800 to 400 to 200 over two weeks due to
questionable increased LH.  Patient converted to sinus rhythm
post 100 mg of amiodarone and is planned for a left carotid
evaluation by Dr. [**First Name (STitle) **] next week.

Transferred for question of evaluation of ischemia and V-tach
from outside hospital.

ALLERGIES:  Bee stings.

OUTPATIENT MEDICATIONS:
1. Aspirin 81 mg.
2. Coreg 12.5 mg b.i.d.
3. Lisinopril 20 mg q.d.
4. Digoxin 0.125 mg q.d.
5. Protonix 40 mg q.d.
6. Colace.
7. Heparin drip on transfer.
8. Amiodarone 0.5 mg/minute IV.
9. At home also with Lasix 80 mg q.a.m., 40 mg q.p.m.
10. Lipitor 20 mg.
11. Glucotrol 5 mg.
12. Plavix 75 mg, but not taking per the patient for one
month.

SOCIAL HISTORY AND FAMILY HISTORY:  Were not recorded on any
notes on admission.  Social history that is known is that
patient lives with his wife.  Does not smoke or drink any
alcohol at this time.

PHYSICAL EXAM:  97.0, 66, 157/48, 12.  No apparent distress,
alert and oriented times three.  Right pupil 4 mm, left pupil
2 mm.  No wheezes or crackles.  Regular rate, normal S1, S2,
no S3, S4, 1/6 systolic ejection murmur at the left upper
sternal border, question of radiating to the right carotid.
The patient also has bilateral carotid bruits.  Patient also
has diminished pulses in his feet.

EKG:  Sinus bradycardia at 53, left bundle branch pattern,
left axis, [**Street Address(2) 4793**] depressions in I, aVL, V4 through V6, P-R
prolongation.

Echocardiogram in [**2185-7-17**] showed an EF of 45%,
inferior-posterior akinesis.

Catheterization on [**2190-5-11**] at [**Location (un) 47**]:  Left
ventricular EF of 13%, LAD left minimal, left main normal.
Diagonal-2 80%.  Left circ 90%, ramus totally occluded.
Collaterals and RCA normal.

LABORATORIES:  Troponins 0.85, 0.13 on transfer.  CPK 60s and
56.  BNP of 461.  Sodium 140, potassium 4.1, chloride 103,
bicarb 29, BUN 49, creatinine 1.7, baseline 1.3-1.1.  CBC:
white blood cell count 10.6, 31.7 hematocrit, 93 platelets.
TSH 5.3.  Digoxin level 2.0.

HOSPITAL COURSE:
1. Ischemia:  The patient ruled out for any cardiac enzyme
abnormalities except for a small troponin leak.  CKs never
elevated.  The patient did not go under any other coronary
artery evaluation.

2. Neurologic:  The patient underwent a carotid
echocardiogram, which showed 70-79% stenosis in his right
carotid which has already undergone a carotid endarterectomy
and the left carotid had a 90% stenosis.  Patient also
underwent a CTA to examine his carotids further and the
results of this test is pending.

Patient was scheduled with Dr. [**First Name (STitle) **] for next Wednesday,
[**4-25**] to undergo a stent to the left carotid prior to EP
study.

3. V-tach:  The patient had one further run of [**6-23**] beats of
V-tach while in the hospital and one of 20 beats, but the AID
did not fire.  The patient converted spontaneously.  His only
symptoms were that the patient felt lightheaded.  The patient
did not lose consciousness.  The patient will undergo a
carotid stent on the left side because of concerns that
during the EP study that he will become underperfused, his
cerebral vasculature with this much stenosis.  The patient is
to have a stent placed next Wednesday by Dr. [**First Name (STitle) **], and then
six weeks later endothelialization of the stent, EP study
will be performed to try to find the focuses of V-tach and to
ablate them.

4. CHF:  The patient was stable.  No diuresis was performed.

5. Diabetes mellitus:  Regular insulin-sliding scale.

6. Thrombocytopenia:  Patient discontinued his Heparin after
had no elevation of CKs and no further chest pain.

DISCHARGE STATUS:  Patient is able to ambulate with a walker
and able to feed himself and do activities of daily living.

DISCHARGED TO:  Home with VNA services.

DISCHARGE MEDICATIONS:
1. Glucotrol 5 mg q.d.
2. Aspirin 81 mg q.d.
3. Protonix 40 mg q.d.
4. Docusate sodium 100 mg b.i.d.
5. Atorvastatin 20 mg q.d.
6. Percocet 5/325 q.4-6h. as needed for pain.
7. Captopril 25 mg t.i.d.  It will be discussed at his
outpatient appointment whether to increase this dose.
8. Amiodarone 400 mg q.d.
9. Carvedilol 3.125 mg b.i.d.
10. Plavix 75 mg q.d.

FOLLOWUP:  The patient is to followup with Dr. [**First Name (STitle) **] next
Wednesday for a carotid stent.  This appointment has been
scheduled and the Cardiology Department will be contacting
him for the appointment time.  The patient will then follow
up six weeks after the stent is placed, endothelialization
for an EP study to consider V-fib ablation.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 15176**], M.D.  [**MD Number(1) 15177**]

Dictated By:[**Name8 (MD) 26705**]

MEDQUIST36

D:  [**2192-4-18**]  13:32
T:  [**2192-4-20**]  07:48
JOB#:  [**Job Number 52382**]

 (cclist)
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Automatic implantable cardiac defibrillator in situ'}


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: 

PRESENT ILLNESS: Seventy-seven-year-old male with
a history of coronary artery disease, CHF with an EF of 15%,
hyperlipidemia, smoker, type 2 diabetic, and known history of
sustained VT in [**2190-4-16**] after an
inferior-posterolateral MI in which she received a [**Company 1543**]
pacer and a cardiac catheterization in [**Location (un) 47**] showing an
EF of 15%, 90% circ/80% disease.  Treated medically for
ischemia.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: Bee stings.

PHYSICAL EXAM: 97.0, 66, 157/48, 12.  No apparent distress,
alert and oriented times three.  Right pupil 4 mm, left pupil
2 mm.  No wheezes or crackles.  Regular rate, normal S1, S2,
no S3, S4, 1/6 systolic ejection murmur at the left upper
sternal border, question of radiating to the right carotid.
The patient also has bilateral carotid bruits.  Patient also
has diminished pulses in his feet.

FAMILY HISTORY: Were not recorded on any
notes on admission.  Social history that is known is that
patient lives with his wife.  Does not smoke or drink any
alcohol at this time.

SOCIAL HISTORY:  

### Response:
{'Paroxysmal ventricular tachycardia,Congestive heart failure, unspecified,Thrombocytopenia, unspecified,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Automatic implantable cardiac defibrillator in situ'}
