CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: Mr. [**Known lastname 25758**] is a 72 y/o M with h/o hyperlipidemia and HTN who was
recently admitted for two syncopal episodes and syncope work-up.
 On [**2165-7-17**], the patient had his first syncopal episode after
PT session after R knee arthroscopy.  About two hours after the
PT session, the patient was sitting at the edge of his bed when
he suddenly got very fatigued and fainted, described it as a
"wave of drowsiness".  +LOC, the next thing he remembers was
waking up on his floor and hearing the telephone ring.  He
denies any lightheadedness or feeling funny after awaking, and
reports standing up and feeling fine. The patient had another PT
session two days later that was uneventful.  However, about [**4-16**]
hours after his next session, he had another syncopal event--he
was standing up and felt a wave of nausea and then fell to the
floor.  +LOC again, and his wife reported that he was down for
less than a minute before he woke up.

MEDICAL HISTORY: Past Medical History:
- treated in his 30's for ? multiple sclerosis, transient loss
of
function of right arm/leg after months
- hypertension
- hyperlipidemia
- Lyme disease- early [**2154**]
- syncope [**2152**], [**2147**] and 2 episodes in [**7-/2165**]
- Peridontal disease

MEDICATION ON ADMISSION: 1Medications at home:
AMLODIPINE - 2.5 mg Tablet - one Tablet(s) by mouth daily
ATORVASTATIN [LIPITOR] - 10 mg Tablet - 1 Tablet(s) by mouth
once
a day - No Substitution
CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth daily to start [**7-30**]

ALLERGIES: Penicillins / Zocor / Ciprofloxacin

PHYSICAL EXAM: Pulse:72 Resp:12  O2 sat:97/RA
B/P  Right:138/68    Left:146/72
Height:5'6"     Weight:165 lbs

FAMILY HISTORY: No early CAD, sudden cardiac death. Aunts with [**Name2 (NI) **] in 60s.
Father passed of PE.

SOCIAL HISTORY: Lives with wife, formerly worked as a financial analyst, now
retired. Quit smoking 40 years ago, drinks 1 glass of wine/beer
nightly, no illicits.
Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Syncope and collapse,Sinoatrial node dysfunction
Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Syncope and collapse,Sinoatrial node dysfunct
Admission Date:  [**2165-7-30**]              Discharge Date:   [**2165-8-9**]

Date of Birth:  [**2092-9-9**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Zocor / Ciprofloxacin

Attending:[**First Name3 (LF) 1505**]
Chief Complaint:
Syncope


Major Surgical or Invasive Procedure:
s/p CABGx3
S/P PPM


History of Present Illness:
Mr. [**Known lastname 25758**] is a 72 y/o M with h/o hyperlipidemia and HTN who was
recently admitted for two syncopal episodes and syncope work-up.
 On [**2165-7-17**], the patient had his first syncopal episode after
PT session after R knee arthroscopy.  About two hours after the
PT session, the patient was sitting at the edge of his bed when
he suddenly got very fatigued and fainted, described it as a
"wave of drowsiness".  +LOC, the next thing he remembers was
waking up on his floor and hearing the telephone ring.  He
denies any lightheadedness or feeling funny after awaking, and
reports standing up and feeling fine. The patient had another PT
session two days later that was uneventful.  However, about [**4-16**]
hours after his next session, he had another syncopal event--he
was standing up and felt a wave of nausea and then fell to the
floor.  +LOC again, and his wife reported that he was down for
less than a minute before he woke up.

The patient denies any associated diaphoresis, chest pain,
shortness of breath, change in vision, feeling of being flushed,
headaches.  The patient had a negative head CT and negative MI
w/u.  He was d/c'd with a holter monitor and followed up with
his PCP.  [**Name Initial (NameIs) **] stress ECHO was done on [**2165-7-29**] by Dr. [**Last Name (STitle) **] and
there were notable EKG changes (ST depressions).  The Echo
showed normal LV function with appropriate augmentation of all
LV segments post exercise and EF 65%. He denies any history of
chest pain or dypsnea. He was loaded with 300mg of Plavix by Dr.
[**Last Name (STitle) **] and was referred for cardiac catheterization.

On catheterization today, the pt was found to have LMCA 50%
stenosis into LAD which by pressure wire had an FFR of 0.71, LCX
had mild disease, and RCA had mild disease, with 80% small PDA.


On [**2165-8-5**] Mr. [**Name13 (STitle) 7493**] was taken to the operating room after
completing a plavix washout where he underwent Coronary artery
bypass grafting x3 with a free left internal mammary artery
graft to left anterior descending and reverse saphenous vein
graft to the ramus intermedius and the first obtuse marginal
branch. Immediately post-operatively he was admitted to the ICU
intubated and sedated for ongoing hemodynamic monitoring and
care. He awoke neurologically intact and was weaned and
extubated from the ventilator. On POD#1 he was started on
betablockers and lasix. He was transferred to the stepdown unit
for ongoing postoperative care. CT were removed per protocol.
pre and post-operatively he was evaluated by electrophysiology
and




Past Medical History:
Past Medical History:
- treated in his 30's for ? multiple sclerosis, transient loss
of
function of right arm/leg after months
- hypertension
- hyperlipidemia
- Lyme disease- early [**2154**]
- syncope [**2152**], [**2147**] and 2 episodes in [**7-/2165**]
- Peridontal disease

Past Surgical History:
s/p Left knee arthroscopy


Social History:
Lives with wife, formerly worked as a financial analyst, now
retired. Quit smoking 40 years ago, drinks 1 glass of wine/beer
nightly, no illicits.


Family History:
No early CAD, sudden cardiac death. Aunts with [**Name2 (NI) **] in 60s.
Father passed of PE.


Physical Exam:
Pulse:72 Resp:12  O2 sat:97/RA
B/P  Right:138/68    Left:146/72
Height:5'6"     Weight:165 lbs

General:
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur [] grade ______
Abdomen: Soft [x] non-distended [x] non-tender [x]  bowel sounds
+ [x]
Extremities: Warm [x], well-perfused [x]  Edema [x] _____
Varicosities: +1
Neuro: Grossly intact [x]
Pulses:
Femoral      Right:  +2 Left: +2
DP           Right:  +2 Left: +2
PT           [**Name (NI) 167**]:  +2 Left: +2
Radial       Right:  cath site Left: +2

Carotid Bruit        Right:  0  Left: 0


Pertinent Results:
Cardiac Cath: [**2165-7-30**]
1. Significant left main coronary artery and left anterior
descending
coronary artery disease based on fractional flow reserve
measurement.

Carotid series: [**2165-7-31**]
Impression: Right ICA <40% stenosis.
Left ICA <40% stenosis.

LE venous duplex: [**2165-7-31**]
IMPRESSION: Patent greater saphenous veins with small diameters
on the left and marginal to small diameters on the right.

ECHO: [**2165-7-31**]
The left atrium is mildly dilated. The left atrium is elongated.
No atrial septal defect is seen by 2D or color Doppler. The
estimated right atrial pressure is 0-5 mmHg. There is mild
symmetric left ventricular hypertrophy with normal cavity size.
Overall left ventricular systolic function is normal (LVEF>55%).
Tissue Doppler imaging suggests a normal left ventricular
filling pressure (PCWP<12mmHg). Doppler parameters are most
consistent with Grade I (mild) left ventricular diastolic
dysfunction. Right ventricular chamber size and free wall motion
are normal. The aortic root is mildly dilated at the sinus
level. The ascending aorta is mildly dilated. The aortic valve
leaflets (3) appear structurally normal with good leaflet
excursion and no aortic stenosis or aortic regurgitation. The
mitral valve appears structurally normal with trivial mitral
regurgitation. The estimated pulmonary artery systolic pressure
is normal. There is no pericardial effusion.
PCXR [**8-8**]
IMPRESSION: Preserved biventricular regional and global systolic
function. Mild dilatation of the aortic root and ascending
aorta. No significant valvular abnormalities.
FINDINGS: As compared to the previous radiograph, the chest
tubes and all
monitoring and support devices have been removed. There is
interposition of
colon between the liver and the chest wall. No detectable
pneumothorax is
present. Mild basal areas of atelectasis but no evidence of
pneumonia or
pulmonary edema. Unchanged size of the cardiac silhouette.

[**2165-8-9**] 06:30AM BLOOD WBC-7.9 RBC-3.83* Hgb-12.5* Hct-35.7*
MCV-93 MCH-32.5* MCHC-34.9 RDW-13.3 Plt Ct-233
[**2165-8-9**] 06:30AM BLOOD Plt Ct-233

Brief Hospital Course:
Pt underwent CABGx3(free LIMA, Y to SVG-RI, SVG-OM)on [**8-5**] he
had a stable intra-op course see OR note for further details.
He arrived from OR hemodynamcially stable and intubated.  He
weaned and extubated well but was somewhat sleepy therefore
narcotics were discontinued and he was switched to Ultram with
good effect. He transferred to floor on POD #1 and continued to
progress well.  He had a PPM placed successfully on POD#3 for
pre-op vasovagal symptoms (see operative note).  The pacer  was
interrogated on POD 4 and his epicardial were removed that same
day without incident. His chest tubes remained in for drainage
but they were eventually discontinued without incident.  His CXR
on discharge revaled bilateral effusions left greater than right
and pacing leads in good placement.  He was gently diuresed over
his post-op course and is being discharged home on low dose
diuretic therapy for one week.  He was cleared for discharge to
home with VNA services on POD#4.

Medications on Admission:
1Medications at home:
AMLODIPINE - 2.5 mg Tablet - one Tablet(s) by mouth daily
ATORVASTATIN [LIPITOR] - 10 mg Tablet - 1 Tablet(s) by mouth
once
a day - No Substitution
CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth daily to start [**7-30**]

Medications - OTC
ASPIRIN [BABY ASPIRIN] -  (Prescribed by Other Provider; OTC) -
81 mg Tablet, Chewable - 1 Tablet(s) by mouth daily
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D] -  (Prescribed by Other
Provider) - Dosage uncertain
Antifungal topical ointment for toe nail daily
--------------- --------------- ---------------

Discharge Medications:
1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*2*
2. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig:
One (1) Tablet, ER Particles/Crystals PO every twenty-four(24)
hours.
Disp:*7 Tablet, ER Particles/Crystals(s)* Refills:*0*
7. clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO four
times a day for 2 days.
Disp:*8 Capsule(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary diagnosis:
- Coronary artery disease with left main disease

Secondary diagnoses:
-hypertension
-hyperlipidemia


Discharge Condition:
Alert and oriented x3 nonfocal
Ambulating with steady gait
Incisional pain managed with Ultram
Incisions:
Sternal - healing well, no erythema or drainage,
PPM site Clean and dry
Leg Right/Left - healing well, no erythema or drainage.
Edema None


Discharge Instructions:
No showering for 1 week after one week please shower daily
including washing incisions gently with mild soap, no baths or
swimming until cleared by surgeon. Look at your incisions daily
for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Wound check with cardiac surgery on [**2165-8-14**] at 10:30am [**Last Name (un) **]
Office building [**Location (un) **] [**Hospital Unit Name **]
Surgeon: Dr [**Last Name (STitle) **] on [**7-28**] at 1:15pm [**Hospital **] medical office
building [**Doctor First Name **] [**Location (un) **] [**Hospital Unit Name **]
Cardiologist:Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] on [**9-6**] at 11:00
Device clinic [**Telephone/Fax (1) 2272**] on Thursday [**8-15**] at 11:30
[**Hospital Ward Name 23**] building [**Location (un) 436**]

Please call to schedule appointments with your
Primary Care Dr [**Last Name (STitle) 2204**] in [**1-13**] weeks

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**




Completed by:[**2165-8-9**]
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Syncope and collapse,Sinoatrial node dysfunction'}


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: Syncope

PRESENT ILLNESS: Mr. [**Known lastname 25758**] is a 72 y/o M with h/o hyperlipidemia and HTN who was
recently admitted for two syncopal episodes and syncope work-up.
 On [**2165-7-17**], the patient had his first syncopal episode after
PT session after R knee arthroscopy.  About two hours after the
PT session, the patient was sitting at the edge of his bed when
he suddenly got very fatigued and fainted, described it as a
"wave of drowsiness".  +LOC, the next thing he remembers was
waking up on his floor and hearing the telephone ring.  He
denies any lightheadedness or feeling funny after awaking, and
reports standing up and feeling fine. The patient had another PT
session two days later that was uneventful.  However, about [**4-16**]
hours after his next session, he had another syncopal event--he
was standing up and felt a wave of nausea and then fell to the
floor.  +LOC again, and his wife reported that he was down for
less than a minute before he woke up.

MEDICAL HISTORY: Past Medical History:
- treated in his 30's for ? multiple sclerosis, transient loss
of
function of right arm/leg after months
- hypertension
- hyperlipidemia
- Lyme disease- early [**2154**]
- syncope [**2152**], [**2147**] and 2 episodes in [**7-/2165**]
- Peridontal disease

MEDICATION ON ADMISSION: 1Medications at home:
AMLODIPINE - 2.5 mg Tablet - one Tablet(s) by mouth daily
ATORVASTATIN [LIPITOR] - 10 mg Tablet - 1 Tablet(s) by mouth
once
a day - No Substitution
CLOPIDOGREL [PLAVIX] -  (Prescribed by Other Provider) - 75 mg
Tablet - 1 Tablet(s) by mouth daily to start [**7-30**]

ALLERGIES: Penicillins / Zocor / Ciprofloxacin

PHYSICAL EXAM: Pulse:72 Resp:12  O2 sat:97/RA
B/P  Right:138/68    Left:146/72
Height:5'6"     Weight:165 lbs

FAMILY HISTORY: No early CAD, sudden cardiac death. Aunts with [**Name2 (NI) **] in 60s.
Father passed of PE.

SOCIAL HISTORY: Lives with wife, formerly worked as a financial analyst, now
retired. Quit smoking 40 years ago, drinks 1 glass of wine/beer
nightly, no illicits. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Syncope and collapse,Sinoatrial node dysfunction'}
