CHIEF COMPLAINT: 2:1 CHB s/p temp pacer wire placement, here for pacemaker and
ICD

PRESENT ILLNESS: 79 yo M w/ hx with CAD, CM w/ EF 15-20%, and an OSH admission
two weeks ago for syncope with 2:1 heart block that subsequently
reverted to 1:1 conduction who went to see his cardiologist [**6-14**]
for fatigue and recent syncope ([**6-13**]). He was found to be in 2:1
heart block with a ventricular rate in the 30s and an SBP in the
70s; he was admitted to an OSH. His furosemide dose had been
increased prior to his admission and his hypotension was
partially attributed to overdiuresis.  Pt. received a normal
saline bolus with an increase in his SBP to the 90s. He was
stable overnight and was then transferred to [**Hospital1 18**] for EP
consult and biventricular pacemaker w/ ICD implantation.
.
Pt was taken for temp wire placement, as pacer/ICD placement was
deferred given his INR 2.7.
.

MEDICAL HISTORY: Cardiomayopathy (EF of 15-20%), MI, PAF on anticoagulation,
prostate ca s/p prostatectomy, DMII, CRI, anteroseptal apical
scar + small apical aneurysm w/ thrombus formation -- **on
Coumadin

MEDICATION ON ADMISSION: Outpt medications:
KCL 20mg po q24h
warfarin 2mg po qhs
NTG SL prn
flonase
ativan 1mg po bid prn,
lipitor 20 mg q24h
imdur 120mg po q24h
valsartan 320mg po q24h
lasix 40mg po q24h (recently increased from 20 mg QD)
amiodarone 200mg po q24h (recnetly discontinued)
.
Meds on transfer:
lipitor 80mg po q24h, flonase, imdur 120mg po q24h, KCl 20mg po
24h, detrol 4mg po qhs, valsartan 320mg po q24h
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.0 70 V paced, 108/57 92%RA -> 96% 3L NC RR 15
Gen: cauc obese M lying in bed in NAD
Heart: RRR, S1, S2, no m/r/g
Lungs: CTBLA, no rales or wheezing
Abd: obese, NABS/S/NT/ND, no masses, no HSM
R Groin: no hematoma, femoral sheath in place, no bruit
Ext: DP 1+ b/l LE, PT 1+ b/l

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with wife.
Atrioventricular block, complete,Hematoma complicating a procedure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other specified forms of chronic ischemic heart disease,Atrial fibrillation,Long-term (current) use of anticoagulants,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of prostate,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure
Atriovent block complete,Hematoma complic proc,CHF NOS,Acute kidney failure NOS,Chr ischemic hrt dis NEC,Atrial fibrillation,Long-term use anticoagul,Old myocardial infarct,DMII wo cmp nt st uncntr,Hx-prostatic malignancy,Abn react-procedure NEC
Admission Date:  [**2168-6-15**]              Discharge Date:   [**2168-6-20**]

Date of Birth:  [**2089-5-7**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Location (un) 1279**]
Chief Complaint:
2:1 CHB s/p temp pacer wire placement, here for pacemaker and
ICD


Major Surgical or Invasive Procedure:
S/P biV pacemaker and ICD placement


History of Present Illness:
79 yo M w/ hx with CAD, CM w/ EF 15-20%, and an OSH admission
two weeks ago for syncope with 2:1 heart block that subsequently
reverted to 1:1 conduction who went to see his cardiologist [**6-14**]
for fatigue and recent syncope ([**6-13**]). He was found to be in 2:1
heart block with a ventricular rate in the 30s and an SBP in the
70s; he was admitted to an OSH. His furosemide dose had been
increased prior to his admission and his hypotension was
partially attributed to overdiuresis.  Pt. received a normal
saline bolus with an increase in his SBP to the 90s. He was
stable overnight and was then transferred to [**Hospital1 18**] for EP
consult and biventricular pacemaker w/ ICD implantation.
.
Pt was taken for temp wire placement, as pacer/ICD placement was
deferred given his INR 2.7.
.


Past Medical History:
Cardiomayopathy (EF of 15-20%), MI, PAF on anticoagulation,
prostate ca s/p prostatectomy, DMII, CRI, anteroseptal apical
scar + small apical aneurysm w/ thrombus formation -- **on
Coumadin

Social History:
Lives with wife.

Physical Exam:
96.0 70 V paced, 108/57 92%RA -> 96% 3L NC RR 15
Gen: cauc obese M lying in bed in NAD
Heart: RRR, S1, S2, no m/r/g
Lungs: CTBLA, no rales or wheezing
Abd: obese, NABS/S/NT/ND, no masses, no HSM
R Groin: no hematoma, femoral sheath in place, no bruit
Ext: DP 1+ b/l LE, PT 1+ b/l


Pertinent Results:
EKG:
[**5-19**] CHB Vent R 30's
[**2168-6-15**] sinus w/ 2:1 AV block w/ VR 35 AV delay 250msec, RBBB w/
LAD likely LAFB, q in V1-V4, LAE, QTc 500msec, QRS 150msec;
post-procedure EKG: V paced @ 75bpm QRS 200msec
.
Rad:
[**7-15**] stress MIBI for CAD - EF 55%
3/04 myoview EF 21%, lg anterolat infarct extending around apex
to inf wall
.
Echo: pending at time of discharge
.
[**2168-6-17**] 06:25AM BLOOD WBC-10.7 RBC-4.21* Hgb-13.0* Hct-40.3
MCV-96 MCH-31.0 MCHC-32.4 RDW-13.8 Plt Ct-169
[**2168-6-17**] 06:25AM BLOOD Plt Ct-169
[**2168-6-17**] 06:25AM BLOOD PT-13.9* PTT-26.4 INR(PT)-1.3
[**2168-6-16**] 05:26AM BLOOD PT-15.2* PTT-30.1 INR(PT)-1.5
[**2168-6-15**] 07:29PM BLOOD PT-16.6* PTT-25.3 INR(PT)-1.8
[**2168-6-17**] 06:25AM BLOOD Glucose-110* UreaN-32* Creat-1.7* Na-143
K-4.2 Cl-108 HCO3-25 AnGap-14
[**2168-6-16**] 05:26AM BLOOD Glucose-138* UreaN-37* Creat-1.6* Na-142
K-4.6 Cl-110* HCO3-23 AnGap-14
[**2168-6-17**] 06:25AM BLOOD Mg-2.1
[**2168-6-16**] 05:26AM BLOOD Calcium-8.7 Phos-2.4* Mg-2.2
[**2168-6-16**] 05:26AM BLOOD TSH-1.6

Brief Hospital Course:
79 yo male with  history of CAD, EF 20% w/ new Complete heart
block, currently in 2:1 block, s/p temporary wire placement,
transferred here for permanent pacemaker.
.
# Heart block- He was given vitamin K SQ at the outside hospital
and his INR was 1.5 so ICD and [**Hospital1 **]-V pacer placed on [**2168-6-16**]. The
pacer/ICD was placed without complications. He was V paced. He
reported feeling much better after the pacemaker was placed. He
developed a hematoma at the site of pacemaker implantation which
was monitored by EP: pressure bandage applied with resolution.
EP interogated the pacemaked prior to discharge on [**6-20**]. Pt is to
complete 7 day course of abx as prescribed.

#CAD: We initially held his carvedilol given the heart block. We
continued amiodarone and ASA and statin. We lowered his dose of
carvedilol given persistent hypotension after the procedure,
likely [**2-17**] decrease volume. Patients SBP in 80-90s range,
however he remained asymtpomatic.  Although initially
discontinued, he was started on low dose of valsartan (40mg
daily) prior to discharge. He should follow up with his
cardiologist/PCP and have blood pressure meds adjusted as
tolerated.
.
#CHF: Currently euvolemic. Given ARF and hypotension, patients
lasix and diurel were held, and ultimately not restarted on
discharge per EP recs. He should have these restarted in follow
up with his cardiologist/PCP.
.
# ARF - Likely in setting of overdiuresis given recent increase
in lasix and poor perfusion from heart block . His creatinine on
admission was 2.5 up from baseline, and went down to 1.7 and
then back up to 2.1 with re-starting of lasix and diovan. His
creatinine was trending back down upon discharge, to 1.4 after
d/cing lasix and diovan. His urinalysis and urine eos were
negative.
.


Medications on Admission:
Outpt medications:
KCL 20mg po q24h
warfarin 2mg po qhs
NTG SL prn
flonase
ativan 1mg po bid prn,
lipitor 20 mg q24h
imdur 120mg po q24h
valsartan 320mg po q24h
lasix 40mg po q24h (recently increased from 20 mg QD)
amiodarone 200mg po q24h (recnetly discontinued)
.
Meds on transfer:
lipitor 80mg po q24h, flonase, imdur 120mg po q24h, KCl 20mg po
24h, detrol 4mg po qhs, valsartan 320mg po q24h
.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 30191**] - [**Location (un) 22287**]

Discharge Diagnosis:
Heart block 2:1
S/P biV pacemaker and ICD placement


Discharge Condition:
Good

Discharge Instructions:
Take all medications as prescribed
Call you doctor if you feel lightheaded, dizzy, palpitations.
You need to have your INR checked on Monday, [**2168-6-20**].

Followup Instructions:
{'Atrioventricular block, complete,Hematoma complicating a procedure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other specified forms of chronic ischemic heart disease,Atrial fibrillation,Long-term (current) use of anticoagulants,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of prostate,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}


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: 2:1 CHB s/p temp pacer wire placement, here for pacemaker and
ICD

PRESENT ILLNESS: 79 yo M w/ hx with CAD, CM w/ EF 15-20%, and an OSH admission
two weeks ago for syncope with 2:1 heart block that subsequently
reverted to 1:1 conduction who went to see his cardiologist [**6-14**]
for fatigue and recent syncope ([**6-13**]). He was found to be in 2:1
heart block with a ventricular rate in the 30s and an SBP in the
70s; he was admitted to an OSH. His furosemide dose had been
increased prior to his admission and his hypotension was
partially attributed to overdiuresis.  Pt. received a normal
saline bolus with an increase in his SBP to the 90s. He was
stable overnight and was then transferred to [**Hospital1 18**] for EP
consult and biventricular pacemaker w/ ICD implantation.
.
Pt was taken for temp wire placement, as pacer/ICD placement was
deferred given his INR 2.7.
.

MEDICAL HISTORY: Cardiomayopathy (EF of 15-20%), MI, PAF on anticoagulation,
prostate ca s/p prostatectomy, DMII, CRI, anteroseptal apical
scar + small apical aneurysm w/ thrombus formation -- **on
Coumadin

MEDICATION ON ADMISSION: Outpt medications:
KCL 20mg po q24h
warfarin 2mg po qhs
NTG SL prn
flonase
ativan 1mg po bid prn,
lipitor 20 mg q24h
imdur 120mg po q24h
valsartan 320mg po q24h
lasix 40mg po q24h (recently increased from 20 mg QD)
amiodarone 200mg po q24h (recnetly discontinued)
.
Meds on transfer:
lipitor 80mg po q24h, flonase, imdur 120mg po q24h, KCl 20mg po
24h, detrol 4mg po qhs, valsartan 320mg po q24h
.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 96.0 70 V paced, 108/57 92%RA -> 96% 3L NC RR 15
Gen: cauc obese M lying in bed in NAD
Heart: RRR, S1, S2, no m/r/g
Lungs: CTBLA, no rales or wheezing
Abd: obese, NABS/S/NT/ND, no masses, no HSM
R Groin: no hematoma, femoral sheath in place, no bruit
Ext: DP 1+ b/l LE, PT 1+ b/l

FAMILY HISTORY: 

SOCIAL HISTORY: Lives with wife. 

### Response:
{'Atrioventricular block, complete,Hematoma complicating a procedure,Congestive heart failure, unspecified,Acute kidney failure, unspecified,Other specified forms of chronic ischemic heart disease,Atrial fibrillation,Long-term (current) use of anticoagulants,Old myocardial infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of prostate,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}
