CHIEF COMPLAINT: Status post fall and syncope.

PRESENT ILLNESS: This is a 77-year-old male with
a history of coronary artery disease status post coronary
artery bypass grafting with a history of atrial flutter
status post ablation on Coumadin, status post CEA, who was
admitted to the MICU for management of a subarachnoid
hemorrhage.  The patient was in his usual state of health
until 8:30 AM on the morning of admission when he fell while
doing his usual morning exercises on his deck.  He struck the
occiput of his head and lost consciousness.  He did not know
why he fell.  He denies chest pain, shortness of breath,
nausea, vomiting, lightheadedness, dizziness, vertigo.  The
patient denies tripping or falling, no loss of balance.  He
was found by his son and brought to [**Name (NI) **] Hospital.

MEDICAL HISTORY: 1. Left carotid endarterectomy in
[**2176**], asymptomatic.  In 02/99 a carotid ultrasound showed
right internal carotid artery 40-59% stenosis and left
internal carotid artery patent.  2. Coronary artery disease
status post coronary artery bypass grafting in [**2176**] with
negative stress thallium one year ago.  3. History of atrial
fibrillation, atrial flutter, status post radiofrequency
ablation in [**2189-6-9**].  Holter monitor showed sinus rhythm
with VPBs on [**2189-6-11**].  4. Hyperlipidemia.  5. Gout.  6.
Congestive heart failure.  7. Arthritis.  8. Status post
cataract surgery.  9. Status post cyst removal on his thigh
in [**2185**].  10. Hyperhomocysteinemia.  11. Hypertension.  12.
Lumbar disc herniations.

MEDICATION ON ADMISSION: 1. Ismo 20 mg p.o. b.i.d.  2.
Zestril 30 mg p.o. q. day.  3. Ziac 25\6.25 mg p.o. q. day.
4. Aspirin.  5. Allopurinol 300 mg p.o. q.p.m.  6. Colchicine
0.6 mg p.o. q.p.m.  7. Baycol 0.4 mg p.o. q.p.m.  8. Coumadin
q.h.s.  9. Vitamin C, vitamin E.  10. Zocor.  11. Glucosamine
chondroitin.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Two brothers with coronary artery disease.
No sudden cardiac death.

SOCIAL HISTORY: No tobacco, no alcohol use.  He is retired
from the Army and lives with his wife.
Atrial fibrillation,Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Unspecified hypertensive heart disease with heart failure,Mitral valve insufficiency and aortic valve stenosis,Other and unspecified coagulation defects,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Gout, unspecified,Disturbances of sulphur-bearing amino-acid metabolism
Atrial fibrillation,Subarach hem-brief coma,Hyp ht dis NOS w ht fail,Mitral insuf/aort stenos,Coagulat defect NEC/NOS,Ocl mlt bi art wo infrct,Gout NOS,Sulph amino-acid met dis
Admission Date:  [**2189-7-26**]     Discharge Date:  [**2189-7-31**]


Service:  Medicine

CHIEF COMPLAINT:  Status post fall and syncope.

HISTORY OF PRESENT ILLNESS:  This is a 77-year-old male with
a history of coronary artery disease status post coronary
artery bypass grafting with a history of atrial flutter
status post ablation on Coumadin, status post CEA, who was
admitted to the MICU for management of a subarachnoid
hemorrhage.  The patient was in his usual state of health
until 8:30 AM on the morning of admission when he fell while
doing his usual morning exercises on his deck.  He struck the
occiput of his head and lost consciousness.  He did not know
why he fell.  He denies chest pain, shortness of breath,
nausea, vomiting, lightheadedness, dizziness, vertigo.  The
patient denies tripping or falling, no loss of balance.  He
was found by his son and brought to [**Name (NI) **] Hospital.

At [**Location (un) **] he had a head CT that showed a small subarachnoid
hemorrhage of his interhemispheric falx which was thought to
be post-traumatic.  He then had an MRI/MRA of his head which
showed interhemispheric subarachnoid hemorrhage with no
aneurysm.  He was noted to have an INR of 2.3 on Coumadin.
He was transferred to [**Hospital6 256**]
for a neurosurgical evaluation.

At [**Hospital6 256**] in the Emergency Room
he was comfortable except for posterior headache.
Neurosurgery was consulted and it was felt that the patient's
subarachnoid hemorrhage was secondary to trauma and no the
reason for his fall.  It was recommended that he be admitted
to the MICU for monitoring.  Vitamin K 10 mg subcutaneous was
given in the Emergency Room x1.

PAST MEDICAL HISTORY:  1. Left carotid endarterectomy in
[**2176**], asymptomatic.  In 02/99 a carotid ultrasound showed
right internal carotid artery 40-59% stenosis and left
internal carotid artery patent.  2. Coronary artery disease
status post coronary artery bypass grafting in [**2176**] with
negative stress thallium one year ago.  3. History of atrial
fibrillation, atrial flutter, status post radiofrequency
ablation in [**2189-6-9**].  Holter monitor showed sinus rhythm
with VPBs on [**2189-6-11**].  4. Hyperlipidemia.  5. Gout.  6.
Congestive heart failure.  7. Arthritis.  8. Status post
cataract surgery.  9. Status post cyst removal on his thigh
in [**2185**].  10. Hyperhomocysteinemia.  11. Hypertension.  12.
Lumbar disc herniations.

MEDICATIONS ON ADMISSION:  1. Ismo 20 mg p.o. b.i.d.  2.
Zestril 30 mg p.o. q. day.  3. Ziac 25\6.25 mg p.o. q. day.
4. Aspirin.  5. Allopurinol 300 mg p.o. q.p.m.  6. Colchicine
0.6 mg p.o. q.p.m.  7. Baycol 0.4 mg p.o. q.p.m.  8. Coumadin
q.h.s.  9. Vitamin C, vitamin E.  10. Zocor.  11. Glucosamine
chondroitin.

SOCIAL HISTORY:  No tobacco, no alcohol use.  He is retired
from the Army and lives with his wife.

FAMILY HISTORY:  Two brothers with coronary artery disease.
No sudden cardiac death.

PHYSICAL EXAMINATION:  VITAL SIGNS:  On admission temperature
was 98.8, heart rate irregular at 79 beats per minute.  Blood
pressure 192/65, O2 saturation 96% on room air.  GENERAL:  No
acute distress.  HEENT:  Mucous membranes moist.  Tongue
midline.  Pupils reactive.  Extraocular movements intact.
NECK:  Supple, no lymphadenopathy.  Bilateral carotid bruits
were noted right greater than left.  CARDIOVASCULAR:
Irregularly irregular.  Normal S1, S2, with a II/VI systolic
murmur at the left upper sternal border radiating to the
carotids into the apex.  LUNGS:  Clear to auscultation
bilaterally.  ABDOMEN:  Soft, nontender, nondistended,
positive bowel sounds.  EXTREMITIES:  Warm, no edema.
NEUROLOGIC:  Alert and appropriate.  Mental status:  Alert
and oriented x3 with fluent speech.  Cranial nerves two
through 12 intact.  Motor - normal tone.  Strength - [**6-13**]
bilateral upper and lower extremities throughout.  Sensation
intact to light touch and pinprick.  Reflexes 1+ symmetrical;
no pronator drift.

LABORATORY DATA:  On admission the white count was 4.1,
hematocrit 39.7, platelet count 119, INR 2.3, sodium 139,
potassium 4.3, chloride 100, bicarbonate 29, BUN 19,
creatinine 1.2, glucose 115, calcium 9.1.

EKG:  Atrial flutter at 69 beats per minute with variable
block.  PVCs showed no acute ST-T wave changes.

HOSPITAL COURSE:  The patient was admitted initially to the
MICU where he was monitored overnight and was stable.  He was
called out to the [**Hospital1 **] the following day.

1. CARDIOVASCULAR:  The patient remained on telemetry
overnight and was first noted to have sinus pauses of greater
than three seconds at a time and sinus bradycardia.  The
patient was ruled out for an acute myocardial infarction by
cardiac enzymes and was evaluated by the EP service for
question of sinus bradycardia and pauses causing syncope.  An
EP study was performed on [**2189-7-28**] and the patient was noted
to have inducible ventricular tachycardia and was scheduled
for an ICD the following morning.  On [**2189-7-29**] the patient
had an ICD with pacer capabilities placed without
complications.  Afterward the patient was noted to have a run
of ventricular tachycardia of 27 beats which was
asymptomatic.  He had no further episodes of pauses or
bradycardia once his beta blocker was discontinued.  The
patient was loaded on amiodarone and will be discharged on
amiodarone.  He will follow up with the EP service after
discharge.

The patient also underwent a repeat echocardiogram to rule
out valvular abnormalities as the cause for his syncope.  His
echocardiogram showed left ventricular ejection fraction of
40%, mild AF, moderate AR, moderate to severe pulmonary
hypertension, moderate mitral regurgitation, moderate
tricuspid regurgitation, and some focal wall motion
abnormalities.

The patient also underwent repeat carotid ultrasound which
showed right side with 40-59% stenosis which was unchanged
from his prior study, and less than 40% stenosis.

Hypertension - the patient had elevated blood pressures
during his hospitalization.  He was started on hydralazine 20
mg p.o. q.i.d., hydrochlorothiazide 25 mg p.o. q. day, and
continued on his lisinopril at 40 mg p.o. q. day.  Blood
pressure was better controlled at that point.  He will have
his blood pressure checked as an outpatient.  A home visiting
nurse will help teach the patient how to check his blood
pressure at home.

2. NEUROLOGIC:  The patient was taken off Coumadin and
reversed with vitamin K.  He had no further episodes of
bleeding and was felt stable by neurosurgery.  The plan was
to keep his INR less than 3 for at least seven days and then
have his Coumadin restarted.  This will be restarted as an
outpatient.  His neurologic examination remained completely
normal.

DISPOSITION:  The patient was discharged home in stable
condition.  Physical Therapy will evaluate him for home
safety prior to discharge.

FOLLOW UP:  He will follow up in [**Hospital **] clinic on [**2189-8-6**] at
2:30 PM and he will also have pulmonary function tests
performed on [**8-6**] at 1:30 PM for baseline for amiodarone.

The patient will also have a Holter monitor placed for
evaluation after discharge to be followed up by Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) **], his primary cardiologist.

DISCHARGE MEDICATIONS:
1. Lisinopril 40 mg p.o. q. day.
2. Ismo 20 mg p.o. b.i.d.
3. Allopurinol 300 mg p.o. q. day.
4. Hydrochlorothiazide 25 mg p.o. q. day.
5. Potassium chloride 10 mEq p.o. q. day.
6. Baycol 0.4 mg p.o. q.p.m.
7. Amiodarone 200 mg p.o. b.i.d.
8. Colchicine 0.6 mg p.o. q. day.
9. Hydralazine 20 mg p.o. q.i.d. prn. for systolic blood
pressure greater than 160.
10. The patient will not be taking aspirin, Coumadin, or Ziac
until further instructed.

DISCHARGE DIAGNOSES:
1. Syncope secondary to cardiac arrhythmia.  Patient with
inducible ventricular tachycardia and history of atrial
fibrillation/atrial flutter status post radiofrequency
ablation with ICD placement/pacer placement on [**2189-7-29**].
2. Subarachnoid hemorrhage secondary to trauma.
3. Coronary artery disease status post coronary artery bypass
grafting in [**2176**].
4. Bilateral carotid stenoses.
5. Hyperlipidemia.
6. Gout.
7. Congestive heart failure.
8. Arthritis.
9. Status post cataract surgery.
10. Hyperhomocysteinemia.
11. Hypertension.
12. Lumbar disc herniations.
13. Status post cyst removal from his thigh in the past.






                          [**Name6 (MD) **] [**Last Name (NamePattern4) 5467**], M.D.  [**MD Number(1) 5468**]

Dictated By:[**Last Name (NamePattern1) 9422**]

MEDQUIST36

D:  [**2189-7-31**]  14:41
T:  [**2189-8-2**]  09:45
JOB#:  [**Job Number 9423**]
{'Atrial fibrillation,Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Unspecified hypertensive heart disease with heart failure,Mitral valve insufficiency and aortic valve stenosis,Other and unspecified coagulation defects,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Gout, unspecified,Disturbances of sulphur-bearing amino-acid metabolism'}


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: Status post fall and syncope.

PRESENT ILLNESS: This is a 77-year-old male with
a history of coronary artery disease status post coronary
artery bypass grafting with a history of atrial flutter
status post ablation on Coumadin, status post CEA, who was
admitted to the MICU for management of a subarachnoid
hemorrhage.  The patient was in his usual state of health
until 8:30 AM on the morning of admission when he fell while
doing his usual morning exercises on his deck.  He struck the
occiput of his head and lost consciousness.  He did not know
why he fell.  He denies chest pain, shortness of breath,
nausea, vomiting, lightheadedness, dizziness, vertigo.  The
patient denies tripping or falling, no loss of balance.  He
was found by his son and brought to [**Name (NI) **] Hospital.

MEDICAL HISTORY: 1. Left carotid endarterectomy in
[**2176**], asymptomatic.  In 02/99 a carotid ultrasound showed
right internal carotid artery 40-59% stenosis and left
internal carotid artery patent.  2. Coronary artery disease
status post coronary artery bypass grafting in [**2176**] with
negative stress thallium one year ago.  3. History of atrial
fibrillation, atrial flutter, status post radiofrequency
ablation in [**2189-6-9**].  Holter monitor showed sinus rhythm
with VPBs on [**2189-6-11**].  4. Hyperlipidemia.  5. Gout.  6.
Congestive heart failure.  7. Arthritis.  8. Status post
cataract surgery.  9. Status post cyst removal on his thigh
in [**2185**].  10. Hyperhomocysteinemia.  11. Hypertension.  12.
Lumbar disc herniations.

MEDICATION ON ADMISSION: 1. Ismo 20 mg p.o. b.i.d.  2.
Zestril 30 mg p.o. q. day.  3. Ziac 25\6.25 mg p.o. q. day.
4. Aspirin.  5. Allopurinol 300 mg p.o. q.p.m.  6. Colchicine
0.6 mg p.o. q.p.m.  7. Baycol 0.4 mg p.o. q.p.m.  8. Coumadin
q.h.s.  9. Vitamin C, vitamin E.  10. Zocor.  11. Glucosamine
chondroitin.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Two brothers with coronary artery disease.
No sudden cardiac death.

SOCIAL HISTORY: No tobacco, no alcohol use.  He is retired
from the Army and lives with his wife. 

### Response:
{'Atrial fibrillation,Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness,Unspecified hypertensive heart disease with heart failure,Mitral valve insufficiency and aortic valve stenosis,Other and unspecified coagulation defects,Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction,Gout, unspecified,Disturbances of sulphur-bearing amino-acid metabolism'}
